NATIONAL MEDICAL ENTERPRISES INC /NV/
S-3/A, 1995-02-13
GENERAL MEDICAL & SURGICAL HOSPITALS, NEC
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<PAGE>
 
    
 AS FILED WITH THE SECURITIES AND EXCHANGE COMMISSION ON FEBRUARY 13, 1995     
 
                                                       REGISTRATION NO. 33-57057

================================================================================
                       SECURITIES AND EXCHANGE COMMISSION
                             WASHINGTON, D.C. 20549
 
                               ----------------
                                 
                              AMENDMENT NO. 2     
                                       TO
                                    FORM S-3
                             REGISTRATION STATEMENT
                                     Under
                           The Securities Act of 1933
 
                               ----------------
                       NATIONAL MEDICAL ENTERPRISES, INC.
             (EXACT NAME OF REGISTRANT AS SPECIFIED IN ITS CHARTER)
 
                               ----------------
                 NEVADA                                95-2557091
    (State or other jurisdiction of                (I.R.S. Employer           
     incorporation or organization)                Identification No.)
                              2700 Colorado Avenue
                         Santa Monica, California 90404
                                 (310) 998-8000
  (Address, including zip code, and telephone number, including area code, of
                   registrant's principal executive offices)
 
                               ----------------
                              SCOTT M. BROWN, ESQ.
              Senior Vice President, Secretary and General Counsel
                       National Medical Enterprises, Inc.
                              2700 Colorado Avenue
                         Santa Monica, California 90404
                                 (310) 998-8000
 (Name, address, including zip code, and telephone number, including area code,
                             of agent for service)
 
                               ----------------
                        Copies of all communications to:
         THOMAS C. JANSON, JR.                  KIRK A. DAVENPORT, ESQ.
  SKADDEN, ARPS, SLATE, MEAGHER & FLOM              LATHAM & WATKINS
   300 SOUTH GRAND AVENUE, SUITE 3400         885 THIRD AVENUE, SUITE 1000
     LOS ANGELES, CALIFORNIA 90071              NEW YORK, NEW YORK 10022
             (213) 687-5000                          (212) 906-1200
 
  APPROXIMATE DATE OF COMMENCEMENT OF PROPOSED SALE TO THE PUBLIC: As soon as
practicable after this Registration Statement becomes effective.
 
  If the only securities being registered on this Form are being offered
pursuant to dividend or interest reinvestment plans, please check the following
box. [_]
 
  If any of the securities being registered on this Form are to be offered on a
delayed or continuous basis pursuant to Rule 415 under the Securities Act of
1933, other than securities offered only in connection with dividend or
interest reinvestment plans, please check the following box. [_]
       
                               ----------------
 
  THE REGISTRANT HEREBY AMENDS THIS REGISTRATION STATEMENT ON SUCH DATE OR
DATES AS MAY BE NECESSARY TO DELAY ITS EFFECTIVE DATE UNTIL THE REGISTRANT
SHALL FILE A FURTHER AMENDMENT WHICH SPECIFICALLY STATES THAT THIS REGISTRATION
STATEMENT SHALL THEREAFTER BECOME EFFECTIVE IN ACCORDANCE WITH SECTION 8(A) OF
THE SECURITIES ACT OF 1933 OR UNTIL THE REGISTRATION STATEMENT SHALL BECOME
EFFECTIVE ON SUCH DATE AS THE COMMISSION, ACTING PURSUANT TO SAID SECTION 8(A),
MAY DETERMINE.
 
================================================================================
<PAGE>
 
                                    PART II
 
                     INFORMATION NOT REQUIRED IN PROSPECTUS
 
ITEM 14. OTHER EXPENSES OF ISSUANCE AND DISTRIBUTION.
 
  The following table sets forth the various expenses in connection with the
sale and distribution of the securities being registered, other than
underwriting discounts and commissions. All of the amounts shown are estimated
except the SEC registration fee and the NASD filing fee. The Company will bear
all of such expenses.
 
<TABLE>
      <S>                                                            <C>
      SEC registration fee.......................................... $  344,830
      NASD filing fee...............................................     30,500
      Rating Agency Fee.............................................    100,000
      Blue sky fees and expenses....................................     25,000
      Printing and engraving expenses...............................    330,000
      Legal fees and expenses.......................................  1,250,000
      Accounting fees and expenses..................................    150,000
      Trustee fees..................................................     10,000
      Miscellaneous.................................................     50,000
                                                                     ----------
          Total..................................................... $2,290,330
                                                                     ==========
</TABLE>
 
ITEM 15. INDEMNIFICATION OF DIRECTORS AND OFFICERS.
 
  Section 78.751 of the Nevada General Corporation Law ("Nevada Law") provides
generally and in pertinent part that a Nevada corporation may indemnify its
directors and officers against expenses, judgments, fines, and settlements
actually and reasonably incurred by them in connection with any civil suit or
action, except actions by or in the right of the corporation, or any
administrative or investigative proceeding if, in connection with the matters
in issue, they acted in good faith and in a manner they reasonably believed to
be in, or not opposed to, the best interests of the corporation, and in
connection with any criminal suit or proceeding, if in connection with the
matters in issue, they had no reasonable cause to believe their conduct was
unlawful. Section 78.751 further provides that, in connection with the defense
or settlement of any action by or in the right of the corporation, a Nevada
corporation may indemnify its directors and officers against expenses actually
and reasonably incurred by them if, in connection with the matters in issue,
they acted in good faith, in a manner they reasonably believed to be in, or not
opposed to, the best interest of the corporation. Section 78.751 further
permits a Nevada corporation to grant its directors and officers additional
rights of indemnification through by-law provisions and otherwise.
 
  Article X of the Restated Articles of Incorporation, as amended, of the
Registrant and Article X of the Restated By-Laws, as amended, of the Registrant
provide that the Registrant shall indemnify its directors and officers to the
fullest extent permitted by Nevada Law. The Registrant has entered into
indemnification agreements with each of its directors and executive officers.
Such indemnification agreements are intended to provide a contractual right to
indemnification, to the maximum extent permitted by law, for expenses
(including attorneys' fees), judgments, penalties, fines, and amounts paid in
settlement actually and reasonably incurred by the person to be indemnified in
connection with any proceeding (including, to the extent permitted by
applicable law, any derivative action) to which they are, or are threatened to
be made, a party by reason of their status in such positions. Such
indemnification agreements do not change the basic legal standards for
indemnification set forth under Nevada Law or the Restated Articles of
Incorporation, as amended, of the Registrant. Such agreements are intended to
be in furtherance, and not in limitation of, the general right to
indemnification provided in the Registrant's Restated Articles of
Incorporation, as amended.
 
                                      II-1
<PAGE>
 
  Section 78.037 of the Nevada Law provides that the articles of incorporation
may contain a provision eliminating or limiting the personal liability of a
director or officer to the corporation or its shareholders for monetary damages
for breach of fiduciary duty as a director provided that such provision shall
not eliminate or limit the liability of a director or officer (i) for acts or
omissions which involve intentional misconduct or a knowing violation of law,
or (ii) under Section 78.300 of the Nevada Law (relating to liability for
unauthorized acquisitions or redemptions of, or dividends on, capital stock).
 
  Insofar as indemnification for liabilities arising under the Securities Act
may be permitted to directors, officers or persons controlling the Registrant
pursuant to the foregoing provisions, the Registrant has been informed that in
the opinion of the Securities and Exchange Commission such indemnification is
against public policy as expressed in the Securities Act and is therefore
unenforceable.
 
ITEM 16. EXHIBITS
 
  (a) Exhibits
 
<TABLE>
     <C>    <S>
       1.1  Form of Underwriting Agreement between NME and the Underwriters
       2.1* Agreement and Plan of Merger, dated as of October 10, 1994, by and
             among NME, AMH Acquisition Co. and American Medical Holdings,
             Inc. (incorporated by reference to Exhibit 2(A) to NME's
             Quarterly Report on Form 10-Q for the fiscal quarter ended August
             31, 1994)
       3.1* Restated By-Laws of NME, as amended September 28, 1994
       4.1  Form of Indenture between NME and Bank of New York, as Trustee,
             relating to the Senior Notes (including the form of certificate
             representing the Senior Notes)
       4.2  Form of Indenture between NME and Bank of New York, as Trustee,
             relating to the Senior Subordinated Notes (including the form of
             certificate representing the Senior Subordinated Notes)
       5.1  Opinion of Scott M. Brown, Esq.
      11.1* Statement of Computation of Per Share Earnings for the three
             fiscal years ended May 31, 1994 (incorporated by reference to
             Exhibit 11 to NME's Annual Report on Form 10-K for the fiscal
             year ended May 31, 1994)
      11.2* Statement of Computation of Per Share Earnings for the three
             months ended November 30, 1993 and 1994 (incorporated by
             reference to Exhibit 11 to NME's Quarterly Report on Form 10-Q
             for the fiscal quarter ended November 30, 1994).
      11.3* Statement of Computation of Pro Forma Per Share Earnings for the
             fiscal year ended May 31, 1994 and the six months ended November
             30, 1993 and 1994.
      12.1* Statement of Computation of Ratios of Earnings to Fixed Charges
      12.2* Statement of Computation of Pro Forma Ratios of Earnings to Fixed
             Charges
      23.1  Consent of Scott M. Brown, Esq. (to be included in the opinion
             filed as Exhibit 5.1)
      23.2* Consent of KPMG Peat Marwick LLP
      23.3* Consent of Price Waterhouse LLP
      23.4  Consent of Robert W. O'Leary
      23.5* Consent of John T. Casey
      23.6* Consent of Thomas J. Pritzker
      24.1* Power of Attorney
      25.1  Statement of Eligibility of Bank of New York, as Trustee with
             respect to the Senior Notes
      25.2  Statement of Eligibility of Bank of New York, as Trustee with
             respect to the Senior Subordinated Notes
      27.1* Financial Data Schedule (incorporated by reference to Exhibit 27.1
             to NME's Quarterly Report on Form 10-Q for the fiscal quarter
             ended November 30, 1994)
</TABLE>
- --------
       
    
*  Previously filed.     
 
                                      II-2
<PAGE>
 
ITEM 17. UNDERTAKINGS.
 
  (a) The undersigned Registrant hereby undertakes that, for purposes of
determining any liability under the Securities Act of 1933, each filing of the
Registrant's annual report pursuant to Section 13(a) or 15(d) of the Securities
Exchange Act of 1934 (and, where applicable, each filing of an employee benefit
plan's annual report pursuant to Section 15(d) of the Securities Exchange Act
of 1934) that is incorporated by reference in the registration statement shall
be deemed to be a new registration statement relating to the securities offered
herein, and the offering of such securities at that time shall be deemed to be
the initial bona fide offering thereof.
 
  (b) The undersigned Registrant hereby undertakes to deliver or cause to be
delivered with the Prospectus, to each person to whom the Prospectus is sent or
given, the latest annual report to security holders that is incorporated by
reference in the Prospectus and furnished pursuant to and meeting the
requirements of Rule 14a-3 or Rule 14c-3 under the Securities Exchange Act of
1934; and, where interim financial information required to be presented by
Article 3 of Regulation S-X is not set forth in the Prospectus, to deliver, or
cause to be delivered to each person to whom the Prospectus is sent or given,
the latest quarterly report that is specifically incorporated by reference in
the Prospectus to provide such interim financial information.
 
  (c) Insofar as indemnification for liabilities arising under the Securities
Act of 1933 may be permitted to directors, officers and controlling persons of
the Registrant pursuant to the foregoing provisions, the Nevada Law, the
Restated Articles of Incorporation, and the Restated Bylaws, as amended, or
otherwise, the Registrant has been advised that in the opinion of the
Securities and Exchange Commission such indemnification is against public
policy as expressed in the Act and is, therefore, unenforceable. In the event
that a claim for indemnification against such liabilities (other than the
payment by the Registrant of expenses incurred or paid by a director, officer
or controlling person of the Registrant in the successful defense of any
action, suit or proceeding) is asserted by such director, officer or
controlling person in connection with the securities being registered, the
Registrant will, unless in the opinion of its counsel the matter has been
settled by controlling precedent, submit to a court of appropriate jurisdiction
the question whether such indemnification by it is against public policy as
expressed in the Act and will be governed by the final adjudication of such
issue.
 
  (d) The Registrant hereby undertakes that:
 
    (1) For purposes of determining any liability under the Securities Act of
  1933, the information omitted from the form of Prospectus filed as part of
  this Registration Statement in reliance upon Rule 430A and contained in the
  form of Prospectus filed by the Registrant pursuant to Rule 424(b)(1) or
  (4) or 497(h) under the Securities Act shall be deemed to be part of this
  Registration Statement as of the time it was declared effective.
 
    (2) For the purpose of determining any liability under the Securities Act
  of 1933, each post-effective amendment that contains a form of prospectus
  shall be deemed to be a new registration statement relating to the
  securities offered therein, and the offering of such securities at that
  time shall be deemed to be the initial bona fide offering thereof.
 
                                      II-3
<PAGE>
 
                                   SIGNATURES
   
  Pursuant to the requirements of the Securities Act of 1933, the Registrant
certifies that it has reasonable grounds to believe that it meets all of the
requirements for filing on Form S-3 and has duly caused this Amendment No. 2 to
this Registration Statement to be signed on its behalf by the undersigned,
thereunto duly authorized, in the City of Santa Monica, State of California on
February 13, 1995.     
 
                                          NATIONAL MEDICAL ENTERPRISES, INC.
 
                                          By:     /s/ Scott M. Brown
                                            -----------------------------------
                                                      Scott M. Brown
                                             Senior Vice President, Secretary
                                                    and General Counsel
   
  Pursuant to the requirements of the Securities Act of 1933, this Amendment
No. 2 to this Registration Statement has been signed by the following persons
in the capacities and on the dates indicated:     
 
<TABLE>
<CAPTION>
              SIGNATURE                              TITLE                 DATE
              ---------                              -----                 ----
 <C>                                  <S>                                  <C>
                  *                   Chairman of the Board of Directors
 ------------------------------------  and Chief Executive Officer
         Jeffrey C. Barbakow           (Principal Executive Officer)
                                     
                                     
                  *                   President, Chief Operating Officer
 ------------------------------------  and Director
        Michael H. Focht, Sr.        
                                     
                  *                   Senior Vice President and Chief
 ------------------------------------  Financial Officer
         Raymond L. Mathiasen          (Principal Financial and
                                       Accounting Officer)
                                     
                                     
                  *                   Director
 ------------------------------------
          Bernice B. Bratter         

                  *                   Director
 ------------------------------------
          Maurice J. DeWald          

                  *                   Director
 ------------------------------------
           Peter de Wetter           

                  *                   Director
 ------------------------------------
         Edward Egbert, M.D.         

                  *                   Director
 ------------------------------------
            Raymond A. Hay           

</TABLE> 
                                      II-4
<PAGE>
 
<TABLE>
<CAPTION>
              SIGNATURE                 TITLE            DATE
              ---------                 -----            ----
 <C>                                  <S>                <C> 
                                     
                  *                   Director
 ------------------------------------
            Lester B. Korn           

                  *                   Director
 ------------------------------------
         James P. Livingston         

                  *                   Director
 ------------------------------------
         Richard S. Schweiker        
</TABLE>
                                                             
*By: /s/ Scott M. Brown                                  February 13, 1995      
    --------------------------                                           
         Scott M. Brown
        Attorney-in-fact
 
                                      II-5
<PAGE>
 
                                 EXHIBIT INDEX
<TABLE>
<CAPTION>
                                                                          SEQUENTIALLY
 EXHIBIT                                                                    NUMBERED
 NUMBER                            DESCRIPTION                                PAGE
 -------                           -----------                            ------------
 <C>     <S>                                                              <C>
    1.1  Form of Underwriting Agreement between NME and the
          Underwriters
    2.1* Agreement and Plan of Merger, dated as of October 10, 1994, by
          and among NME, AMH Acquisition Co. and American Medical
          Holdings, Inc. (incorporated by reference to Exhibit 2(A) to
          NME's Quarterly Report on Form 10-Q for the fiscal quarter
          ended August 31, 1994)
    3.1* Restated By-Laws of NME, as amended September 28, 1994
    4.1  Form of Indenture between NME and Bank of New York, as
          Trustee, relating to the Senior Notes (including the form of
          certificate representing the Senior Notes)
    4.2  Form of Indenture between NME and Bank of New York, as
          Trustee, relating to the Senior Subordinated Notes (including
          the form of certificate representing the Senior Subordinated
          Notes)
    5.1  Opinion of Scott M. Brown, Esq.
   11.1* Statement of Computation of Per Share Earnings for the three
          fiscal years ended May 31, 1994 (incorporated by reference to
          Exhibit 11 to NME's Annual Report on Form 10-K for the fiscal
          year ended May 31, 1994)
   11.2* Statement of Computation of Per Share Earnings for the three
          months ended November 30, 1993 and 1994 (incorporated by
          reference to Exhibit 11 to NME's Quarterly Report on Form 10-
          Q for the fiscal quarter ended November 30, 1994).
   11.3* Statement of Computation of Pro Forma Per Share Earnings for
          the fiscal year ended May 31, 1994 and the six months ended
          November 30, 1993 and 1994.
   12.1* Statement of Computation of Ratios of Earnings to Fixed
          Charges
   12.2* Statement of Computation of Pro Forma Ratios of Earnings to
          Fixed Charges
   23.1  Consent of Scott M. Brown, Esq. (to be included in the opinion
          filed as Exhibit 5.1)
   23.2* Consent of KPMG Peat Marwick LLP
   23.3* Consent of Price Waterhouse LLP
   23.4  Consent of Robert W. O'Leary
   23.5* Consent of John T. Casey
   23.6* Consent of Thomas J. Pritzker
   24.1* Power of Attorney
   25.1  Statement of Eligibility of Bank of New York, as Trustee with
          respect to the Senior Notes
   25.2  Statement of Eligibility of Bank of New York, as Trustee with
          respect to the Senior Subordinated Notes
   27.1* Financial Data Schedule (incorporated by reference to Exhibit
          27.1 to NME's Quarterly Report on Form 10-Q for the fiscal
          quarter ended November 30, 1994)
</TABLE>
- --------
       
       
   
*  Previously filed.     

<PAGE>
 
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
 
                       NATIONAL MEDICAL ENTERPRISES, INC.
 
                                      AND
 
                          DONALDSON, LUFKIN & JENRETTE
                             SECURITIES CORPORATION
 
                     MERRILL LYNCH, PIERCE, FENNER & SMITH
                                  INCORPORATED
 
                       MORGAN STANLEY & CO. INCORPORATED
 
                              SALOMON BROTHERS INC
 
                          J.P. MORGAN SECURITIES INC.
 
                           BT SECURITIES CORPORATION
 
                               SMITH BARNEY INC.
 
                              BA SECURITIES, INC.
 
                     -------------------------------------
 
                             UNDERWRITING AGREEMENT
 
                     -------------------------------------
 
                         Dated as of February    , 1995
 
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
<PAGE>
 
                       NATIONAL MEDICAL ENTERPRISES, INC.
 
                            % SENIOR NOTES DUE 2002
                      % SENIOR SUBORDINATED NOTES DUE 2005
 
                             UNDERWRITING AGREEMENT
 
                                                                February  , 1995
 
DONALDSON, LUFKIN & JENRETTE
  SECURITIES CORPORATION
MERRILL LYNCH, PIERCE, FENNER & SMITH
              INCORPORATED
MORGAN STANLEY & CO. INCORPORATED
SALOMON BROTHERS INC
J.P. MORGAN SECURITIES INC.
BT SECURITIES CORPORATION
SMITH BARNEY INC.
BA SECURITIES, INC.
c/o Donaldson, Lufkin & Jenrette
  Securities Corporation
  140 Broadway
  New York, New York 10005
 
Ladies and Gentlemen:
 
  Subject to the terms and conditions herein contained, National Medical
Enterprises, Inc., a Nevada corporation (the "Company"), proposes to issue and
sell to Donaldson, Lufkin & Jenrette Securities Corporation ("DLJ"), Merrill
Lynch, Pierce, Fenner & Smith Incorporated, Morgan Stanley & Co. Incorporated,
Salomon Brothers Inc, J.P.Morgan Securities Inc., BT Securities Corporation,
Smith Barney Inc. and BA Securities, Inc. (collectively with DLJ, the
"Underwriters") an aggregate of $300 million principal amount of its    %
Senior Notes due 2002 (the "Senior Notes") and $700 million principal amount of
its    % Senior Subordinated Notes due 2005 (the "Senior Subordinated Notes"
and, together with the Senior Notes, the "Securities"). The Senior Notes are to
be issued pursuant to the provisions of an Indenture (the "Senior Note
Indenture") to be dated as of        , 1995, by and between the Company and The
Bank of New York, as Trustee (the "Senior Note Trustee"). The Senior
Subordinated Notes are to be issued pursuant to the provisions of an Indenture
(the "Senior Subordinated Note Indenture" and, together with the Senior Note
Indenture, the "Indentures") to be dated as of        , 1995, by and between
the Company and The Bank of New York, as Trustee (the "Senior Subordinated Note
Trustee" and, together with the Senior Note Trustee, the "Trustees").
 
  The Securities are being issued and sold in connection with the acquisition
(the "Acquisition") of American Medical Holdings, Inc., a Delaware corporation
("AMH"), by the Company. The Acquisition is being effected pursuant to an
Agreement and Plan of Merger, dated as of October 10, 1994 (the "Merger
Agreement"), by and among the Company, AMH Acquisition Co., a Delaware
corporation and a wholly owned subsidiary of the Company (the "Merger Sub"),
and AMH. Pursuant to the Merger Agreement, the Company will acquire all of the
issued and outstanding capital stock of AMH (the "Merger"). At the time the
Merger is consummated (the "Effective Time of the Merger") and pursuant to the
Merger Agreement, Merger Sub will be merged with and into AMH with AMH as the
surviving corporation. Prior to or concurrently with the issuance and sale of
the Securities, the Company will enter into a new bank credit facility
(together with the documents and agreements contemplated thereby, the "New
Credit Facility") with Morgan Guaranty Trust Company of New York, as
administrative agent, and certain lenders named therein. The Merger Agreement,
the New Credit Facility, this Agreement, the Securities and the Indentures are
collectively referred to herein as the "Transaction Documents."
<PAGE>
 
  1. Registration Statement and Prospectus. The Company has prepared and filed
with the Securities and Exchange Commission (the "Commission") in accordance
with the provisions of the Securities Act of 1933, as amended, and the rules
and regulations of the Commission promulgated pursuant thereto (collectively,
the "Act"), a registration statement on Form S-3 (No. 33-57057), with respect
to the Securities, including a preliminary prospectus, subject to completion,
relating to the Securities. The registration statement, as amended at the time
it becomes effective or, if a post-effective amendment is filed with respect
thereto, as amended by such post-effective amendment at the time of its
effectiveness (including in each case all documents incorporated or deemed to
be incorporated by reference therein, if any, all financial statements and
exhibits, and the information, if any, contained in a prospectus subsequently
filed with the Commission pursuant to Rule 424(b) under the Act and deemed to
be a part of the registration statement at the time of its effectiveness
pursuant to Rule 430A of the Act) is hereinafter referred to as the
"Registration Statement"; and the prospectus constituting a part of the
Registration Statement at the time it became effective, or such revised
prospectus as shall be provided to the Underwriters for use in connection with
the offering of the Securities that differs from the prospectus on file with
the Commission at the time the Registration Statement became effective
(including, in each case, all documents incorporated or deemed to be
incorporated by reference therein, if any), whether or not filed with the
Commission pursuant to Rule 424(b) under the Act, is hereinafter referred to as
the "Prospectus." Any reference herein to the Registration Statement, the
Prospectus, any amendment or supplement thereto or any preliminary prospectus
shall be deemed to refer to and include the documents incorporated by reference
therein, and any reference herein to the terms "amend," "amendment" or
"supplement" with respect to the Registration Statement or Prospectus shall be
deemed to refer to and include the filing after the execution hereof of any
document with the Commission deemed to be incorporated by reference therein.
 
  2. Agreements to Sell and Purchase. On the basis of the representations and
warranties contained in this Agreement, and subject to its terms and
conditions, the Company agrees to issue and sell to the Underwriters, and the
Underwriters agree, severally and not jointly, to purchase from the Company,
(i) the Senior Notes in the respective principal amounts set forth opposite
their names on Schedule I hereto, plus such amount as they may individually
become obligated to purchase pursuant to Section 8 hereof, at a purchase price
equal to     % of the principal amount of the Senior Notes (the "Senior Note
Purchase Price") and (ii) the Senior Subordinated Notes in the respective
principal amounts set forth opposite their names on Schedule II hereto, plus
such amount as they may individually become obligated to purchase pursuant to
Section 8 hereof, at a purchase price equal to    % of the principal amount of
the Senior Subordinated Notes (the "Senior Subordinated Note Purchase Price"
and, together with the Senior Note Purchase Price, the "Purchase Price").
 
  3. Delivery and Payment. Delivery to you of and payment for the Securities
shall be made at 10:00 A.M., New York City time, on                 , 1995
(such time and date being referred to as the "Closing Date"), at the offices of
DLJ at 140 Broadway, New York, New York 10005 (Cashier's Window, Main Level),
or such other place as you shall reasonably designate.
 
  The Securities in definitive form shall be registered in such names and
issued in such denominations as you shall request in writing not later than two
full business days prior to the Closing Date, and shall be made available to
you at the offices of DLJ (or at such other place as shall be acceptable to
you) for inspection not later than 10:00 A.M., New York City time, on the
business day next preceding the Closing Date. The Securities shall be delivered
to you on the Closing Date with any transfer taxes payable upon initial
issuance thereof duly paid by the Company, for your respective accounts against
payment of the appropriate Purchase Price by certified or official bank check
or checks payable in New York Clearing House or similar next-day funds to the
order of the Company. The Closing Date and the location of delivery of, and the
form of payment for, the Securities may be varied by agreement between DLJ and
the Company.
 
  4. Agreements of the Company. The Company agrees with each of you that:
 
    (a) It will, if the Registration Statement has not heretofore become
  effective under the Act, and if otherwise necessary or required by law,
  file an amendment to the Registration Statement or, if necessary
 
                                       2
<PAGE>
 
  pursuant to Rule 430A of the Act, a post-effective amendment to the
  Registration Statement, in each case as soon as practicable after the
  execution and delivery of this Agreement, and it will use its best efforts
  to cause the Registration Statement or such post-effective amendment to
  become effective at the earliest possible time. If the Registration
  Statement has become effective and the Company, omitting from the
  Prospectus certain information in reliance upon Rule 430A of the Act,
  elects not to file a post-effective amendment pursuant to Rule 430A of the
  Act, it will file the form of Prospectus required by Rule 424(b) of the Act
  within the time period specified by Rule 430A and Rule 424(b) of the Act.
  The Company will otherwise comply in a timely manner with all applicable
  provisions of Rule 424 and Rule 430A of the Act.
 
    (b) It will advise DLJ promptly and, if requested by DLJ, confirm such
  advice in writing, (i) when the Registration Statement has become
  effective, if and when the Prospectus is sent for filing pursuant to Rule
  424 of the Act and when any post-effective amendment to the Registration
  Statement becomes effective, (ii) of the receipt of any comments from the
  Commission or any state securities commission or any other regulatory
  authority that relate to the Registration Statement or requests by the
  Commission or any state securities commission or any other regulatory
  authority for any amendment or supplement to the Registration Statement or
  any amendment or supplements to the Prospectus or for additional
  information, (iii) of the issuance by the Commission of any stop order
  suspending the effectiveness of the Registration Statement, or of the
  suspension of qualification of the Securities for offering or sale in any
  jurisdiction, or the initiation of any proceeding for such purpose by the
  Commission or any state securities commission or any other regulatory
  authority and (iv) of the happening of any event during the period referred
  to in paragraph (d), below, which makes any statement of a material fact
  made in the Registration Statement untrue or which requires the making of
  any additions to or changes in the Registration Statement in order to make
  the statements therein not misleading or that makes any statement of a
  material fact made in the Prospectus untrue or which requires the making of
  any addition to or change in the Prospectus in order to make the statements
  therein, in light of the circumstances under which they were made, not
  misleading. The Company shall use its best efforts to prevent the issuance
  of any stop order or order suspending the qualification or exemption of the
  Securities under any Federal or state securities or Blue Sky laws, and, if
  at any time the Commission shall issue any stop order suspending the
  effectiveness of the Registration Statement, or any state securities
  commission or any other regulatory authority shall issue an order
  suspending the qualification or exemption of the Securities under any state
  securities or Blue Sky laws, the Company shall use every reasonable effort
  to obtain the withdrawal or lifting of such order at the earliest possible
  time.
 
    (c) Promptly after the Registration Statement becomes effective, and from
  time to time thereafter for such period in your reasonable judgment as a
  prospectus is required to be delivered in connection with sales of the
  Securities by an Underwriter or a dealer, it will furnish to each
  Underwriter and each dealer, without charge, as many copies of the
  Prospectus, including all documents incorporated by reference therein, (and
  of any amendment or supplement to the Prospectus) as you may reasonably
  request.
 
    (d) If during the period specified in paragraph (c) of this Section 4 any
  event shall occur as a result of which it becomes necessary to amend or
  supplement the Prospectus in order to make the statements therein, in the
  light of the circumstances existing as of the date the Prospectus is
  delivered to an offeree or a purchaser, not misleading, or if it is
  necessary to amend or supplement the Prospectus to comply with any law, it
  will promptly prepare and file with the Commission an appropriate amendment
  or supplement to the Prospectus so that the statements in the Prospectus,
  as so amended or supplemented, will not, in the light of the circumstances
  existing as of the date the Prospectus is so delivered, be misleading, and
  will comply with applicable law, and will promptly notify you of such event
  and amendment or supplement and furnish to you without charge such number
  of copies thereof as you may reasonably request.
 
    (e) It will make generally available to its security holders, as soon as
  practicable and for the time period specified by Rule 158 under the Act, a
  consolidated earnings statement which shall satisfy the provisions of
  Section 11(a) and Rule 158 of the Act.
 
                                       3
<PAGE>
 
    (f) Whether or not the transactions contemplated hereby are consummated
  or this Agreement is terminated, it will pay and be responsible for all
  costs, charges, expenses, fees and taxes incurred in connection with or
  incident to (i) the preparation, printing, filing, distribution and
  delivery under the Act of the Registration Statement (including financial
  statements and exhibits), each preliminary prospectus, the Prospectus and
  all amendments and supplements thereto, (ii) the registration with the
  Commission and the issuance and delivery of the Securities, (iii) the
  printing and delivery of this Agreement, the Indentures, any memoranda
  describing state securities or Blue Sky Laws and all other agreements,
  memoranda, reports, correspondence and other documents printed, distributed
  and delivered in connection with the offering of the Securities, (iv) the
  registration or qualification of the Securities for offer and sale under
  the securities or Blue Sky laws of the jurisdictions referred to in
  paragraph (i), below (including, in each case, the fees and disbursements
  of counsel relating to such registration or qualification and memoranda
  relating thereto and any filing fees in connection therewith), (v)
  furnishing such copies of the Registration Statement (including exhibits),
  Prospectus and preliminary prospectuses, and all amendments and supplements
  to any of them, including any document incorporated by reference therein,
  as may be reasonably requested by the Underwriters or by dealers to whom
  Securities may be sold, (vi) the filing, registration and clearance with
  the National Association of Securities Dealers, Inc. (the "NASD") of the
  Underwriters' compensation in connection with the offering of the
  Securities (including, without limitation, any filing fees in connection
  therewith but excluding the fees of Latham & Watkins, legal counsel to the
  Underwriters ("Underwriters' Counsel")), (vii) the listing of the
  Securities on the New York Stock Exchange (the "NYSE"), (viii) the rating
  of the Securities by investment rating agencies, (ix) any "qualified
  independent underwriter" as required by Schedule E of the Bylaws of the
  NASD (including fees and disbursements of counsel for such qualified
  independent underwriter) and (x) the performance by the Company of its
  other obligations under this Agreement, including (without limitation) the
  fees of the Trustees, the cost of its personnel and other internal costs,
  the cost of printing and engraving the certificates representing the
  Securities, and all expenses and taxes incident to the sale and delivery of
  the Securities to the Underwriters.
 
    (g) It will furnish to DLJ, without charge, two (2) signed copies (plus
  one additional signed copy to Underwriters' Counsel of the Registration
  Statement as first filed with the Commission and of each amendment or
  supplement to it, including each post-effective amendment, all exhibits
  filed therewith and all documents incorporated by reference therein, and
  such number of conformed copies of the Registration Statement as so filed
  and of each amendment to it, including each post-effective amendment, but
  without exhibits, as you may reasonably request.
 
    (h) It will not file any amendment or supplement to the Registration
  Statement, whether before or after the time when it becomes effective, or
  make any amendment or supplement to the Prospectus (other than any document
  required to be filed under the Securities Exchange Act of 1934, as amended,
  including the rules and regulations thereunder (collectively, the "Exchange
  Act") that upon filing is deemed to be incorporated by reference therein)
  of which you shall not previously have been advised and provided a copy
  prior to the filing thereof or to which you shall reasonably object; it
  will furnish to you at or prior to the filing thereof a copy of any
  document that upon filing is deemed to be incorporated by reference in the
  Registration Statement or Prospectus; and it will prepare and file with the
  Commission, promptly upon your reasonable request, any amendment or
  supplement to the Registration Statement or amendment or supplement to the
  Prospectus which may be necessary or advisable in connection with the
  distribution of the Securities by you, and will use its best efforts to
  cause the same to become effective as promptly as possible.
 
    (i) Prior to any public offering of the Securities, it will cooperate
  with you and Underwriters' Counsel in connection with the registration or
  qualification of the Securities for offer and sale by the Underwriters
  under the state securities or Blue Sky laws of such United States
  jurisdictions as you may request [and the securities laws of the United
  Kingdom, Switzerland and Japan]. The Company will continue such
  qualification in effect so long as required by law for distribution of the
  Securities and will file such consents to service of process or other
  documents as may be necessary in order to effect such
 
                                       4
<PAGE>
 
  registration or qualification (provided, that the Company shall not be
  obligated to qualify as a foreign corporation in any jurisdiction in which
  it is not so qualified nor to take any action that would subject it to
  general consent to service of process in any jurisdiction in which it is
  not now so subject).
 
    (j) It timely will complete all required filings and otherwise comply
  fully in a timely manner with all provisions of the Exchange Act to effect
  the registration of the Securities pursuant thereto, and will file timely
  all reports and any definitive proxy or information statements required to
  be filed by the Company with the Commission pursuant to Sections 13(a),
  13(c), 14 or 15(d) of the Exchange Act subsequent to the date of the
  Prospectus and it will use its best efforts to cause the Securities to be
  listed on the NYSE and to maintain such listing while any of the Securities
  are outstanding.
 
    (k) So long as any of the Securities are outstanding, it will mail to
  each of the Underwriters, without charge, a copy of each report or other
  publicly available information furnished to holders of the Securities, or
  filed with the Commission, whether or not required by law or pursuant to
  the applicable Indenture, and such other publicly available information
  concerning the Company and its subsidiaries as you may reasonably request,
  at the same time as such reports or other information are furnished to such
  holders.
 
    (l) It will not voluntarily claim, and will actively resist any attempts
  to claim, the benefit of any usury laws against the holders of the
  Securities.
 
    (m) It will use the proceeds from the sale of the Securities in the
  manner described in the Prospectus under the caption "Use of Proceeds."
 
    (n) During the period beginning on the date of this Agreement and
  continuing to and including the Closing Date, it will not offer, sell,
  contract to sell or otherwise dispose of any debt securities of the Company
  or warrants, rights, or options to purchase debt securities of the Company
  (other than (i) the Securities and (ii) commercial paper issued in the
  ordinary course of business), without your prior written consent.
 
    (o) It will use its best efforts to do and perform all things required to
  be done and performed under this Agreement by it prior to or after the
  Closing Date and to satisfy all conditions precedent on its part to be
  satisfied prior to the delivery of the Securities.
 
  5. Representations and Warranties. The Company represents and warrants to
each Underwriter that:
 
    (a) When the Registration Statement becomes effective, including on the
  date of effectiveness of any post-effective amendment, at the date of the
  Prospectus (if different) and at the Closing Date, the Registration
  Statement will comply in all material respects with the provisions of the
  Act, and will not contain any untrue statement of a material fact or omit
  to state any material fact required to be stated therein or necessary to
  make the statements therein not misleading; the Prospectus and each
  supplement or amendment thereto will not at the date of the Prospectus, at
  the date of any such supplement or amendment and at the Closing Date,
  contain any untrue statement of a material fact or omit to state any
  material fact necessary in order to make the statements therein, in the
  light of the circumstances under which they were made, not misleading,
  except that the representations and warranties contained in this paragraph
  (a) shall not apply to statements in or omissions from the Registration
  Statement or the Prospectus (or any supplement or amendment to them) made
  in reliance upon and in conformity with information relating to any
  Underwriter furnished to the Company in writing by or on behalf of any
  Underwriter through DLJ expressly for use therein. The Company acknowledges
  for all purposes under this Agreement (including this paragraph and Section
  6 hereof) that the statements set forth in the last paragraph on the cover
  page and the third paragraph under the caption "Underwriting" in the
  Prospectus constitute the only written information furnished to the Company
  by or on behalf of any Underwriter through DLJ expressly for use in the
  Registration Statement, the preliminary prospectus, or the Prospectus (or
  any amendment or supplement to any of them) and that the Underwriters shall
  not be deemed to have provided any information (and therefore are not
  responsible for any statements or omissions) pertaining to any arrangement
  or agreement with respect to any party other than the Underwriters. When
  the Registration Statement becomes effective, including at the date of any
  post-
 
                                       5
<PAGE>
 
  effective amendment, at the date of the Prospectus and any amendment or
  supplement thereto (if different) and at the Closing Date, the Indentures
  will have been qualified under and will conform in all material respects to
  the requirements of the Trust Indenture Act of 1939, as amended, and the
  rules and regulations promulgated pursuant thereto (collectively, the
  "TIA"). No contract or document of a character required to be described in
  the Registration Statement, the Prospectus or any of the documents
  incorporated by reference therein or to be filed as an exhibit to the
  Registration Statement or to any of the documents incorporated by reference
  therein has not been described and filed as required.
 
    (b) Each preliminary prospectus and the Prospectus, filed as part of the
  Registration Statement as originally filed or as part of any amendment or
  supplement thereto, or filed pursuant to Rule 424 or 430A under the Act,
  complied when so filed in all material respects with the Act.
 
    (c) The documents incorporated by reference in the Registration
  Statement, the Prospectus, any amendment or supplement thereto or any
  preliminary prospectus, when they became or become effective under the Act
  or were or are filed with the Commission under the Exchange Act, as the
  case may be, conformed or will conform in all material respects with the
  requirements of the Act or the Exchange Act, as applicable.
 
    (d) No action has been taken and no statute, rule, regulation or order
  has been enacted, adopted or issued by any United States Federal or state
  [or United Kingdom, Swiss or Japanese] governmental body, agency or
  official which prevents the issuance of the Securities, suspends the
  effectiveness of the Registration Statement, prevents or suspends the use
  of any preliminary prospectus or suspends the sale of the Securities in any
  jurisdiction referred to in Section 4(i) hereof; no injunction, restraining
  order, or order of any nature by any Federal or state court has been issued
  with respect to the Company or any of its subsidiaries which would prevent
  or suspend the issuance or sale of the Securities, the effectiveness of the
  Registration Statement, or the use of any preliminary prospectus or
  Prospectus in any jurisdiction referred to in Section 4(i) hereof; and the
  Company has complied in all material respects with every request of the
  Commission or any securities authority or agency of any jurisdiction for
  additional information (to be included in the Registration Statement or the
  Prospectus or otherwise).
 
    (e) The capitalization table set forth in the Prospectus under the
  caption "Historical and Pro Forma Capitalization" identifies in reasonable
  detail all outstanding short-term and long-term indebtedness of the Company
  and its subsidiaries, prior to and after giving effect to the Merger and
  the related transactions on the terms described in the Prospectus.
 
    (f) The Senior Notes rank and will rank on a parity with all unsecured
  indebtedness (other than subordinated indebtedness) of the Company that is
  outstanding on the date hereof or that may be incurred hereafter, and
  senior to all subordinated indebtedness of the Company that is outstanding
  on the date hereof or that may be incurred hereafter. All indebtedness
  represented by the Senior Subordinated Notes shall be subordinated in right
  of payment only to the Senior Indebtedness identified on Schedule
  attached hereto, and only to the extent and in the manner set forth in the
  Senior Subordinated Note Indenture and in the Senior Subordinated Notes.
 
    (g) The Indentures have been duly authorized by the Company and, when
  duly executed and delivered in accordance with their terms, will be valid
  and legally binding agreements of the Company, enforceable against the
  Company in accordance with their terms, subject to applicable bankruptcy,
  insolvency, reorganization, moratorium, fraudulent transfer and similar
  laws affecting creditors' rights and remedies generally and to general
  principles of equity (regardless of whether enforcement is sought in a
  proceeding at law or in equity) and except to the extent that a waiver of
  rights under any usury laws may be unenforceable.
 
    (h) The Securities have been duly authorized by the Company and, when
  executed and delivered by the Company and authenticated by the applicable
  Trustee in accordance with the applicable Indenture and paid for in
  accordance with the terms of this Agreement, will constitute legal, valid
  and binding obligations of the Company, enforceable against the Company
  according to their terms, subject to
 
                                       6
<PAGE>
 
  applicable bankruptcy, insolvency, reorganization, moratorium, fraudulent
  transfer and similar laws affecting creditors' rights and remedies
  generally and to general principles of equity (regardless of whether
  enforcement is sought in a proceeding at law or in equity) and except to
  the extent that a waiver of rights under any usury laws may be
  unenforceable, will be entitled to the benefits of the applicable Indenture
  and will conform in all material respects to the description thereof in the
  Prospectus.
 
    (i) This Agreement has been duly authorized and validly executed and
  delivered by the Company and constitutes a valid and legally binding
  agreement of the Company, enforceable against the Company in accordance
  with its terms, subject to applicable bankruptcy, insolvency,
  reorganization, moratorium, fraudulent transfer and similar laws affecting
  creditors' rights and remedies generally and to general principles of
  equity (regardless of whether enforcement is sought in a proceeding at law
  or in equity) and except to the extent that rights to indemnification and
  contribution with respect to liability in connection with Federal or state
  securities laws may be unenforceable under such laws or the policies
  underlying such laws.
 
    (j) The execution and delivery of this Agreement by the Company, the
  execution and delivery of the Indentures and the Securities by the Company,
  the execution and delivery of each of the Transaction Documents by each of
  the Company, Merger Sub and AMH (each a "Merger Party" and collectively,
  the "Merger Parties"), to the extent each is a party thereto, the issuance
  and sale of the Securities, the performance of this Agreement, the
  Indentures and the Transaction Documents and the consummation of the
  transactions contemplated by this Agreement and the other Transaction
  Documents will not conflict with or result in a breach or violation of any
  of the respective charters or bylaws of the Company, AMH or any of their
  respective subsidiaries (each, a "Subsidiary" and collectively, the
  "Subsidiaries") or any of the terms or provisions of, or constitute a
  default or cause an acceleration of any obligation under or result in the
  imposition or creation of (or the obligation to create or impose) any
  security interest, mortgage, pledge, claim, lien, encumbrance or adverse
  interest of any nature (each, a "Lien") with respect to, any of the
  Transaction Documents or any other obligation, bond, agreement, note,
  debenture, or other evidence of indebtedness, or any indenture, mortgage,
  deed of trust or other agreement, lease or instrument to which the Company,
  AMH or any of the Subsidiaries is a party or by which it or any of them is
  bound, or to which any properties of the Company, AMH or any of the
  Subsidiaries is or may be subject, or any order of any court or
  governmental agency, body or official having jurisdiction over the Company,
  AMH or any of the Subsidiaries or any of their properties, or violate or
  conflict with any statute, rule or regulation or administrative regulation
  or decree or court decree applicable to the Company, AMH or any of the
  Subsidiaries, or any of their respective assets or properties where, in any
  such instance, such conflict, breach, violation, default, acceleration of
  indebtedness or Lien would have, singly or in the aggregate, a material
  adverse effect or a prospective material adverse effect on the assets,
  liabilities, results of operations or financial condition of the Company,
  AMH and the Subsidiaries, taken as a whole ( a "Material Adverse Effect").
 
    (k) No authorization, approval or consent or order of, or filing with,
  any court or governmental body, agency or official is necessary in
  connection with the transactions contemplated by this Agreement, except
  such as may be required by the NASD or have been obtained and made under
  the Act, the TIA or state securities or Blue Sky laws or regulations.
  Neither the Company nor, to the best of the Company's knowledge, any of its
  affiliates is presently doing business with the government of Cuba or with
  any person or affiliate located in Cuba.
 
    (l) The Securities have been approved for listing on the NYSE, subject to
  official notice of issuance.
 
    (m) The Company has been duly organized, is validly existing as a
  corporation in good standing under the laws of the State of Nevada and has
  the requisite power and authority to carry on its business as it is
  currently being conducted, to own, lease and operate its properties and to
  authorize the offering of the Securities, to execute, deliver and perform
  this Agreement and to issue, sell and deliver the Securities, and is duly
  qualified and is in good standing as a foreign corporation authorized to do
  business in each jurisdiction where the operation, ownership or leasing of
  property or the conduct of its business
 
                                       7
<PAGE>
 
  requires such qualification. AMH and each of the Subsidiaries of the
  Company or of AMH that (i) directly or indirectly own or lease any interest
  in any hospitals, healthcare facilities or medical office buildings, (ii)
  directly or indirectly conduct any insurance activities or (iii) are
  otherwise material to the Company or AMH, as the case may be (collectively,
  the "Significant Subsidiaries") has been duly organized, is validly
  existing as a corporation in good standing under the laws of its
  jurisdiction of incorporation and has the requisite power and authority to
  carry on its business as it is currently being conducted and to own, lease
  and operate its properties and each is duly qualified and is in good
  standing as a foreign corporation authorized to do business in each
  jurisdiction where the operation, ownership or leasing of property or the
  conduct of its business requires such qualifications.
 
    (n) All of the issued and outstanding shares of capital stock of, or
  other ownership interests in, each of the Significant Subsidiaries have
  been duly authorized and validly issued, and all of the shares of capital
  stock of, or other ownership interests in, each of the Significant
  Subsidiaries are owned, directly or through subsidiaries, by the Company or
  AMH, as the case may be. All such shares of capital stock are fully paid
  and nonassessable, and are owned free and clear of any Lien, except Liens
  securing indebtedness under the New Credit Facility, and there are no
  outstanding subscriptions, rights, warrants, options, calls, convertible or
  exchangeable securities, commitments of sale, or Liens related to or
  entitling any person to purchase or otherwise to acquire any shares of the
  capital stock of, or other ownership interest in, any of the Subsidiaries,
  except that shareholders of Australian Medical Enterprises, Ltd. ("AME")
  have certain preemptive rights with respect to rights offerings by AME.
 
    (o) None of the Company, AMH or the Subsidiaries is in violation of its
  respective charter or bylaws or in default in the performance of any
  obligation, bond, agreement, debenture, note or any other evidence of
  indebtedness, or any indenture, mortgage, deed of trust or other contract,
  lease or other instrument to which the Company, AMH or any of the
  Subsidiaries is a party or by which any of them is bound, or to which any
  of the property or assets of the Company, AMH or any of the Subsidiaries is
  subject, except as would not have, singly or in the aggregate, a Material
  Adverse Effect.
 
    (p) There is no action, suit, proceeding or investigation before or by
  any court, governmental agency or body, arbitration board or tribunal, or
  governmental or private accrediting body, domestic or foreign, pending
  against or affecting the Company, AMH, or any of the Subsidiaries, or any
  of their respective assets or properties, which is required to be disclosed
  in the Registration Statement or the Prospectus, or which could have,
  singly or in the aggregate, a Material Adverse Effect, or which might
  materially and adversely affect the Company's or any of its Subsidiaries'
  performance of its obligations, as applicable, pursuant to this Agreement
  (including, without limitation, the issuance of the Securities), the other
  Transaction Documents or the transactions contemplated hereby and thereby,
  and to the best of the Company's knowledge, after due inquiry, no such
  action, suit, or proceeding is contemplated or threatened.
 
    None of the Company, AMH or the Subsidiaries is subject to any judgment,
  order, decree, rule or regulation of any court, governmental authority or
  arbitration board or tribunal which has had or which can reasonably be
  expected to have, a Material Adverse Effect.
 
    (q) Except as could not reasonably be expected to have, singly or in the
  aggregate, a Material Adverse Effect, none of the Company, AMH or the
  Subsidiaries is in violation of any Federal, state or local laws or
  regulations relating to pollution or protection of human health or the
  environment (including, without limitation, ambient air, surface water,
  ground water, land surface or subsurface strata), including, without
  limitation, laws and regulations relating to emissions, discharges,
  releases or threatened releases of toxic or hazardous substances, materials
  or wastes, or petroleum and petroleum products ("Materials of Environmental
  Concern"), or otherwise relating to the protection of human health and
  safety, or the storage, disposal, transport or handling of Materials of
  Environmental Concern (collectively, "Environmental Laws"), which violation
  includes, but is not limited to, noncompliance with any permits or other
  governmental authorizations; none of the Company, AMH or the Subsidiaries
  has received any communication (written or oral), whether from a
  governmental authority or otherwise,
 
                                       8
<PAGE>
 
  alleging any such violation or noncompliance, and there are no
  circumstances, either past, present or that are reasonably foreseeable,
  that may lead to such violation in the future; there is no pending or
  threatened claim, action, investigation or notice (written or oral) by any
  person or entity alleging potential liability for investigatory, cleanup,
  or governmental responses costs, or natural resources or property damages,
  or personal injuries, attorney's fees or penalties relating to (x) the
  presence, or release into the environment, of any Material of Environmental
  Concern at any location owned or operated by the Company, AMH or any of the
  Subsidiaries, now or in the past, or (y) circumstances forming the basis of
  any violation, or alleged violation, of any Environmental Law
  (collectively, "Environmental Claims"); and there are no past or present
  actions, activities, circumstances, conditions, events or incidents, that
  could form the basis of any Environmental Claim against the Company, AMH or
  any of the Subsidiaries or against any person or entity whose liability for
  any Environmental Claim the Company, AMH or any of the Subsidiaries has
  retained or assumed either contractually or by operation of law. In the
  ordinary course of its business, the Company conducts a periodic review of
  the effect of Environmental Laws on the business, operations and properties
  of the Company and its Subsidiaries, in the course of which it identifies
  and evaluates associated costs and liabilities (including, without
  limitation, any capital or operating expenditures required for clean-up,
  closure of properties or compliance with Environmental Laws or any permit,
  license or approval, any related constraints on operating activities and
  any potential liabilities to third parties); on the basis of such review,
  the Company has reasonably concluded that such associated costs and
  liabilities could not, singly or in the aggregate, have a Material Adverse
  Effect.
 
    (r) None of the Company, AMH or the Subsidiaries is in violation of any
  Federal, state or local law relating to discrimination in the hiring,
  promotion or pay of employees nor any applicable wage or hour laws that,
  singly or in the aggregate, could have a Material Adverse Effect. There is
  (A) no significant unfair labor practice complaint pending against the
  Company, AMH or any of the Subsidiaries or, to the best knowledge of the
  Company, threatened against any of them, before the National Labor
  Relations Board or any state or local labor relations board, and no
  significant grievance or significant arbitration proceeding arising out of
  or under any collective bargaining agreement is so pending against the
  Company, AMH or any of the Subsidiaries or, to the best knowledge of the
  Company threatened against any of them, and (B) no labor dispute in which
  the Company, AMH or any of the Subsidiaries is involved nor, to the best
  knowledge of the Company, is any labor dispute imminent, other than routine
  disciplinary and grievance matters. The Company, AMH and the Subsidiaries
  are in compliance in all material respects with all presently applicable
  provisions of the Employee Retirement Income Security Act of 1974, as
  amended ("ERISA"), and the regulations and published interpretations
  thereunder; no "reportable event" (as defined in ERISA and the regulations
  and published interpretations thereunder) has occurred or is reasonably
  expected to occur with respect to any "pension plan" (as defined in ERISA
  and the regulations and published interpretations thereunder) established
  or maintained by the Company, AMH or any of the Subsidiaries; the amount of
  "unfunded benefit liabilities" (as defined in ERISA and the regulations and
  published interpretations thereunder) under all "pension plans" does not
  exceed $                   ; none of the Company, AMH or the Subsidiaries
  has incurred or expects to incur liability under (i) Title IV of ERISA with
  respect to termination of, or withdrawal from, any "pension plan" [in
  excess of $          ] or (ii) Sections 4971, 4975, or 4980B of the
  Internal Revenue Code of 1986, as amended (the "Code"); and each "pension
  plan" established or maintained by the Company, AMH or any of the
  Subsidiaries that is intended to be qualified under Section 401(a) of the
  Code is so qualified in all material respects and nothing has occurred,
  whether by action or by failure to act, which would cause the loss of such
  qualification.
 
    (s) Except as could not have, singly or in the aggregate, a Material
  Adverse Effect, the Company, AMH and each of the Subsidiaries has good and
  marketable title, free and clear of all Liens, to all property and assets
  of the described in the Registration Statement as being owned by it and
  such properties and assets are in good repair and suitable for use as so
  described. All leases to which the Company, AMH or each of the Subsidiaries
  is a party are valid and binding and no default has occurred or is
  continuing thereunder which could result, singly or in the aggregate, in a
  Material Adverse Effect,
 
                                       9
<PAGE>
 
  and the Company, AMH and each of the Subsidiaries enjoy peaceful and
  undisturbed possession under all such leases to which any of them is a
  party as lessee with such exceptions as do not interfere with the use made
  by the Company, AMH or such Subsidiary.
 
    (t) The Company, AMH, and each of the Subsidiaries maintain insurance at
  least in such amounts and covering at least such risks as is adequate for
  the conduct of their respective businesses and the value of their
  respective properties and as is customary for companies engaged in similar
  businesses in similar industries.
 
    (u) The firms of accountants that have certified or shall certify the
  applicable consolidated financial statements and supporting schedules and
  the notes thereto of the Company and AMH filed or to be filed with the
  Commission as part of the Registration Statement and the Prospectus are
  independent public accountants with respect to the Company and its
  Subsidiaries, and AMH and its Subsidiaries, respectively, as required by
  the Act. The consolidated financial statements, together with related
  schedules and notes, set forth or incorporated by reference in the
  Prospectus and the Registration Statement, comply as to form in all
  material respects with the requirements of the Act and fairly present the
  consolidated financial position of the Company and its Subsidiaries and AMH
  and its Subsidiaries, as the case may be, at the respective dates indicated
  and the results of their operations and their cash flows for the respective
  periods indicated, in accordance with generally accepted accounting
  principles in the United States of America ("GAAP") consistently applied
  throughout such periods and in accordance with Regulation S-X. The pro
  forma financial statements contained in the Registration Statement have
  been prepared in conformity with the standards set forth in Rule 11-02 of
  Regulation S-X and on a basis consistent with such historical statements
  and give effect to assumptions made on a reasonable basis and present
  fairly the historical and proposed transactions contemplated by the
  Prospectus and this Agreement. The Company's and AMH's ratios of earnings
  to fixed charges (actual and pro forma) included in the Prospectus under
  the captions "Prospectus Summary--Summary Unaudited Pro Forma Condensed
  Combined Financial Data," "Pro Forma Financial Information," "Selected
  Historical Financial Information of NME," "Selected Historical Financial
  Information of AMH" and in Exhibit 12 to the Registration Statement have
  been calculated in compliance with Item 503(d) of the Commission's
  Regulation S-K. The other financial and statistical information and data
  included or incorporated by reference in the Prospectus and in the
  Registration Statement, historical and pro forma, are accurately presented
  and prepared on a basis consistent with such financial statements and the
  books and records of the Company.
 
    (v) The projected amount of operating synergies and other cost reductions
  resulting from the Merger included in the Registration Statement (i) is
  within the coverage of Rule 175(b) under the Act, (ii) was determined by
  the Company with a reasonable basis and in good faith and (iii) was
  determined in accordance with Item 10 of the Commission's Regulation S-K.
  The assumptions used in the determination of the amount of such projected
  operating synergies and other cost reductions are all those the Company
  believes are significant in projecting the amount of such synergies and
  other cost reductions. The projected amount included in the Registration
  Statement reflects a reasonable estimate of the amount of operating
  synergies and other cost reductions resulting from the Merger.
  Notwithstanding the foregoing, no assurance can be made as to the amount of
  cost savings, if any, that actually will be realized.
 
    (w) Except as contemplated by the Registration Statement and the
  Prospectus, subsequent to the respective dates as of which information is
  presented in the Registration Statement and the Prospectus and up to the
  Closing Date (i) none of the Company, AMH or the Subsidiaries has incurred
  any liabilities or obligations, direct or contingent, which are material to
  the Company, AMH and the Subsidiaries, taken as a whole, or entered into
  any transaction not in the ordinary course of business, (ii) there has been
  no decision or judgment in the nature of litigation or arbitration that
  could reasonably be expected to have a Material Adverse Effect, (iii) there
  has been no dividend or distribution of any kind declared, paid or made by
  the Company on any class of its capital stock and (iv) there has not been
  any material adverse change, or any development which could involve a
  material adverse change, in the results of
 
                                       10
<PAGE>
 
  operations, assets, liabilities or financial condition of the Company or
  its Subsidiaries, taken as a whole, or AMH and its Subsidiaries, taken as a
  whole (any of the items set forth in clauses (i), (ii), or (iii), above, a
  "Material Adverse Change").
 
    (x) All tax returns required to be filed by the Company, AMH or any of
  the Subsidiaries in any jurisdiction have been filed and all taxes,
  including withholding taxes, penalties and interest, assessments, fees and
  other charges due or claimed to be due from such entities have been paid,
  other than those being contested in good faith and for which adequate
  reserves have been provided or those currently payable without penalty or
  interest. All Tax Returns (as hereinafter defined) filed by the Company,
  AMH and the Subsidiaries prior to the date hereof were complete and
  accurate in all material respects. No material claim for assessment or
  collection of Taxes is presently being asserted against the Company, AMH or
  the Subsidiaries. Furthermore, none of the Company, AMH or the Subsidiaries
  is a party to any pending action, proceeding or investigation by any
  governmental authority for the assessment or collection of Taxes, nor does
  the Company have knowledge of any such threatened action, proceeding or
  investigation. No waivers of statutes of limitation in respect of any Tax
  Returns have been given by or requested of the Company, AMH or any of the
  Subsidiaries, nor has the Company, AMH or any of the Subsidiaries agreed to
  any extension of time with respect to a Tax assessment or deficiency. No
  material claim by any authority in a jurisdiction where the Company, AMH or
  any of the Subsidiaries does not currently file a Tax Return is pending to
  the effect that the Company, AMH or any of the Subsidiaries is or may be
  subject to taxation by that jurisdiction. No Liens are presently imposed
  upon or asserted against any of the Company's, AMH's or any of the
  Subsidiaries' assets as a result of or in connection with any failure, or
  alleged failure, to pay any Tax. As of the Closing Date, none of the
  Company, AMH or the Subsidiaries will have any agreement, whether or not
  written, providing for the payment of Tax liabilities or entitlement to
  refunds with any other party. The Company, AMH and the Subsidiaries have
  withheld and paid all Taxes required to be withheld in connection with any
  amounts paid or owing to any employee, creditor, independent contractor or
  other third party with respect to the business of the Company, AMH or the
  Subsidiaries, as the case may be. The unpaid Taxes of the Company and its
  Subsidiaries and AMH and its Subsidiaries do not exceed the reserve for Tax
  liability (as opposed to any reserve for deferred Taxes established to
  reflect timing differences between work and tax income) set forth on the
  most recent balance sheet of the Company or AMH, respectively, as adjusted
  for the passage of time through the date hereof in accordance with the past
  custom and practice of the Company and AMH, respectively, in filing its Tax
  Returns. For purposes of this Agreement, the terms "Tax" and "Taxes" shall
  mean all federal, state, local or foreign income, payroll, employee
  withholding, unemployment insurance, social security, sales, use, service
  use, leasing use, excise, franchise, gross receipts, value added,
  alternative or add-on minimum, estimated, occupation, real and personal
  property, stamp, transfer, workers' compensation, severance, windfall
  profits, environmental (including taxes under Section 59A of the Internal
  Revenue Code of 1986, as amended), or other tax of the same or of a similar
  nature, including any interest, penalty, or addition thereto, whether
  disputed or not. The term "Tax Return" means any return, declaration,
  report, form, claim for refund, or information return or statement relating
  to Taxes or income subject to taxation, or any amendment thereto, and
  including any schedule or attachment thereto.
 
    (y) (i) Except as described in the Registration Statement or Prospectus
  or as could not reasonably be expected to have a Material Adverse Effect,
  each of the Company, AMH and the Subsidiaries has all certificates,
  consents, exemptions, orders, permits, licenses, authorizations,
  accreditations or other approvals or rights (each, an "Authorization") of
  and from, and has made all declarations and filings with, all Federal,
  state, local and other governmental authorities, all self-regulatory
  organizations, all governmental and private accrediting bodies and all
  courts and other tribunals, necessary or required to own, lease, license
  and use its properties and assets and to conduct its business in the manner
  described in the Prospectus, (ii) all such Authorizations are valid and in
  full force and effect, except as could not have, singly or in the
  aggregate, a Material Adverse Effect, (iii) the Company, AMH and the
  Subsidiaries are in compliance in all material respects with the terms and
  conditions of all such Authorizations and with the rules and regulations of
  the regulatory authorities and governing bodies having jurisdiction with
 
                                       11
<PAGE>
 
  respect thereto and (iv) none of the Company, AMH or the Subsidiaries has
  received any notice of proceedings relating to the revocation or
  modification of any such Authorization.
 
    (z) The Company, AMH and each of the Subsidiaries maintain a system of
  internal accounting controls sufficient to provide reasonable assurance
  that (i) transactions are executed in accordance with management's general
  or specific authorizations; (ii) transactions are recorded as necessary to
  permit preparation of financial statements in conformity with GAAP and to
  maintain asset accountability; (iii) access to assets is permitted only in
  accordance with management's general or specific authorization; and (iv)
  the recorded accountability for assets is compared with the existing assets
  at reasonable intervals and appropriate action is taken with respect to any
  differences.
 
    (aa) None of the Company, AMH, Merger Sub or any agent acting on their
  respective behalf has taken or will take any action that is reasonably
  likely to cause the issuance or sale of the Securities or the incurrence of
  the indebtedness under the New Credit Facility to violate Regulation G, T,
  U, or X of the Board of Governors of the Federal Reserve System, in each
  case as in effect, on the date hereof.
 
    (bb) None of the Company, AMH or the Significant Subsidiaries is (i) an
  "investment company" or a company "controlled" by an investment company
  within the meaning of the Investment Company Act of 1940, as amended, or
  (ii) a "holding company" or a "subsidiary company" of a holding company, or
  an "affiliate" thereof within the meaning of the Public Utility Holding
  Company Act of 1935, as amended.
 
    (cc) Except as described in the Registration Statement or Prospectus,
  none of the Company, AMH or the Subsidiaries, nor any director, officer,
  agent, employee or other person associated with or acting on behalf of the
  Company, AMH or any of the Subsidiaries, has used any corporate funds for
  any unlawful contribution, gift, entertainment or other unlawful expense
  relating to political activity; made any direct or indirect unlawful
  payment to any foreign or domestic government official or employee from
  corporate funds; violated or is in violation of any provision of the
  Foreign Corrupt Practices Act of 1977; or made any bribe, rebate, payoff,
  influence payment, kickback or other unlawful payment.
 
    (dd) Each certificate signed by any officer of the Company and delivered
  to the Underwriters or the Underwriters' Counsel shall be deemed to be a
  representation and warranty by the Company to each Underwriter as to the
  matters covered thereby.
 
    (ee) The Company, Merger Sub and AMH (each, a "Merger Party" and,
  collectively the "Merger Parties") have, to the extent each is or will be a
  party thereto, all requisite corporate power and authority to execute,
  deliver and perform their respective obligations under each of the
  Transaction Documents; each of the Transaction Documents has been (or, with
  respect to the New Credit Facility, at or prior to the Effective Time of
  the Merger, will be) duly and validly authorized, executed and delivered by
  the Merger Parties, to the extent each is a party thereto, and each
  constitutes a valid and legally binding agreement of the Merger Party
  enforceable against each Merger Party in accordance with its terms
  (assuming due authorization, execution and delivery of each Transaction
  Document by any other party thereto) except that enforcement thereof may be
  subject to (i) bankruptcy, insolvency, reorganization, moratorium or other
  similar laws now or hereafter in effect relating to creditors' rights
  generally and (ii) general principles of equity (regardless of whether
  enforceability is considered in a proceeding at law or in equity); except
  as set forth in the Prospectus, no consent, approval, authorization or
  order of any court or governmental agency or body is required for the
  performance of any of the Transaction Documents by each of the Merger
  Parties, to the extent each is a party thereto, or the consummation by each
  of the Merger Parties of any of the transactions contemplated thereby,
  except such as may be required and have been obtained, or upon
  effectiveness of the Registration Statement, will have been obtained, under
  the Act, the TIA or state securities or "Blue Sky" laws in connection with
  the purchase and distribution of the Securities by the Underwriters; and
  none of the Merger Parties is in default in the performance or observance
  of any obligation, agreement, covenant or condition contained in any of the
  Transaction Documents, which default would have a Material Adverse Effect.
 
                                       12
<PAGE>
 
    (ff) The Merger has been duly authorized by the Merger Parties and the
  Merger has been approved by stockholders of AMH holding the requisite
  number of shares required to approve the Merger; approval of the Merger by
  the shareholders of the Company is not required; insofar as the Prospectus
  contains summaries of the Merger Agreement and the Merger, such summaries
  are in all material respects accurate.
 
    (gg) Immediately after the consummation of the Merger and the
  transactions contemplated by the Transaction Documents, the fair value and
  present fair saleable value of the assets of the Company will exceed the
  sum of its stated liabilities and identified contingent liabilities;
  neither the Company nor AMH will be, after giving effect to the execution,
  delivery and performance of the Transaction Documents, to the extent each
  is a party thereto, and the consummation of the transactions contemplated
  thereby, (i) left with unreasonably small capital with which to carry on
  its business as it is proposed to be conducted, (ii) unable to pay its
  debts (contingent or otherwise) as they mature or (iii) otherwise
  insolvent.
 
    (hh) The Company has delivered to the Underwriters a true and correct
  copy of each of the Transaction Documents that have been executed and
  delivered prior to the date of this Agreement and each other Transaction
  Document in the form substantially as it will be executed and delivered on
  or prior to the Closing Date, together with all related agreements and all
  schedules and exhibits thereto, and there have been no amendments,
  alterations, modifications or waivers of any of the provisions of any of
  the Transaction Documents since their date of execution or from the form in
  which it has been delivered to the Underwriters; there exists as of the
  date hereof (after giving effect to the transactions contemplated by the
  Transaction Documents) no event or condition which would constitute a
  default or an event of default (in each case as defined in the New Credit
  Facility) under the New Credit Facility and no event or condition which
  would constitute a default or an event of default (in each case as defined
  in each of the Transaction Documents) under any of the Transaction
  Documents other than the New Credit Facility which would reasonably be
  expected to result in a Material Adverse Effect or materially adversely
  effect the ability of each of the Merger Parties to consummate the Merger
  and the transactions contemplated by the Merger Agreement.
 
  6. Indemnification.
 
    (a) The Company agrees to indemnify and hold harmless (i) each of the
  Underwriters and their respective affiliates, (ii) each person, if any, who
  controls (within the meaning of Section 15 of the Act or Section 20 of the
  Exchange Act) any of the Underwriters or any of their respective affiliates
  (any of the persons referred to in this clause (ii) being hereinafter
  referred to as a "Controlling Person"), and (iii) each of the respective
  officers, directors, partners, employees, representatives and agents of any
  of the Underwriters or any Controlling Person, and each of their respective
  officers, directors, partners, employees, representatives and agents (any
  person referred to in clause (i), (ii) or (iii) of this Section 6(a) may
  hereinafter be referred to as an "Indemnified Person") to the fullest
  extent lawful, from and against any and all losses, claims, damages,
  judgments, actions, costs, assessments, expenses and other liabilities
  (collectively, "Liabilities"), including without limitation and as
  incurred, reimbursement of all reasonable costs of investigating,
  preparing, pursuing or defending any claim or action, or any investigation
  or proceeding by any federal, state or local authority, regulatory body,
  administrative agency, court or other governmental or quasi-governmental
  body, commenced or threatened, including the reasonable fees and expenses
  of counsel to any Indemnified Person, to the extent such Liabilities are
  directly or indirectly caused by, related to, based upon or arising out of,
  or in connection with, (A) any untrue statement or alleged untrue statement
  of a material fact contained in the Registration Statement (or any
  supplement or amendment thereto), or the Prospectus (including any
  amendment or supplement thereto) or any preliminary prospectus, or any
  omission or alleged omission to state therein a material fact required to
  be stated therein or necessary to make the statements therein (in the case
  of the Prospectus, in light of the circumstances under which they were
  made) not misleading, except insofar as such Liabilities are caused by an
  untrue statement or omission or alleged untrue statement or omission that
  is (x) made in reliance upon and in conformity with information relating to
  any of the Underwriters furnished in writing to the Company by or on behalf
  of the Underwriter through DLJ expressly for use
 
                                       13
<PAGE>
 
  in the Registration Statement (or any amendment or supplement thereto) or
  the Prospectus (or any amendment or supplement thereto) or any preliminary
  prospectus or (y) with respect to the Underwriter from whom the person
  asserting the Liabilities purchased Securities, made in any preliminary
  prospectus if a copy of the Prospectus (as amended or supplemented, if the
  Company shall have furnished the Underwriters with such amendments or
  supplements thereto on a timely basis) was not delivered by or on behalf of
  such Underwriter to the person asserting the Liabilities, if required by
  law to have been so delivered by the Underwriter seeking indemnification,
  at or prior to the written confirmation of the sale of the Securities, and
  it shall be finally determined by a court of competent jurisdiction, in a
  judgment not subject to appeal or review, that the Prospectus (as so
  amended or supplemented) would have completely corrected such untrue
  statement or omission; or (B) any breach by the Company of any
  representation or warranty or failure to comply with any of its agreements
  contained herein. The foregoing indemnity shall be in addition to any
  liability that the Company might otherwise have to any of the Underwriters
  and such other Indemnified Persons. The Company shall notify you promptly
  of the institution, threat or assertion of any claim, proceeding (including
  any governmental investigation) or litigation in connection with the
  matters addressed by this Agreement which involves the Company or an
  Indemnified Person.
 
    (b) In case any action or proceeding (for all purposes of this Section 6,
  including any governmental or quasi-governmental investigation) shall be
  brought or asserted against any of the Indemnified Persons with respect to
  which indemnity under this Section 6 may be sought against the Company,
  such Underwriter (or the Underwriter controlled by such Controlling Person)
  promptly shall notify the Company in writing and the Company shall assume
  the defense thereof, including the employment of counsel reasonably
  satisfactory to such Underwriter and payment of all fees and expenses;
  provided, that the delay or failure to give such notice shall not relieve
  the Company from any liability that it may have on account of the indemnity
  under this Section 6, unless and only to the extent that such delay or
  omission materially adversely affects the ability of the Company to defend
  or assume the defense of such action or proceeding. Upon receiving such
  notice, the Company shall be entitled to participate in any such action or
  proceeding and to assume, at its sole expense, the defense thereof, with
  counsel reasonably satisfactory to such Indemnified Person (who shall not,
  except with the consent of the Indemnified Person to be represented, be
  counsel to the Company or any of the Subsidiaries) and, after written
  notice from the Company to such Indemnified Person of its election so to
  assume the defense thereof within five business days after receipt of the
  notice from the Indemnified Person of such action or proceeding, the
  Company shall not be liable to such Indemnified Person hereunder for legal
  expenses of other counsel subsequently incurred by such Indemnified Person
  in connection with the defense thereof, other than reasonable costs of
  investigation, unless (i) the Company agrees in writing to pay such fees
  and expenses, or (ii) the Company fails promptly to assume such defense or
  fails to employ counsel reasonably satisfactory to such Indemnified Person,
  or (iii) the named parties to any such action or proceeding (including any
  impleaded parties) include both such Indemnified Person and the Company or
  an affiliate of the Company, and that Indemnified Person shall have been
  advised by counsel that either (x) there may be one or more legal defenses
  available to such Indemnified Person that are different from or additional
  to those available to the Company or such affiliate or (y) a conflict may
  exist between such Indemnified Person and the Company or such affiliate. In
  the event of any of clause (i), (ii) and (iii) of the immediately preceding
  sentence, the Company shall not have the right to assume the defense
  thereof on behalf of the Indemnified Person and such Indemnified Person
  shall have the right to employ its own counsel in any such action and the
  fees and expenses of such counsel shall be paid, as incurred, by the
  Company, subject to repayment to the Company if it is ultimately determined
  that an Indemnified Party is not entitled to indemnification hereunder, it
  being understood, however, that the Company shall not, in connection with
  any one such action or proceeding or separate but substantially similar or
  related actions in the same jurisdiction arising out of the same general
  allegations or circumstances, be liable for the fees and expenses of more
  than one separate firm of attorneys (in addition to any local counsel) for
  all of the Indemnified Persons which firm shall be designated in writing by
  DLJ. The Company shall be not be liable for any settlement of any such
  action or proceeding effected without the Company's written
 
                                       14
<PAGE>
 
  consent, which consent may not be unreasonably withheld, but if settled
  with the written consent of the Company, the Company agrees to indemnify
  and hold harmless any Indemnified Person from and against any loss or
  liability by reason of such settlement. The Company shall not, without the
  prior written consent of each Indemnified Person, settle or compromise or
  consent to the entry of any judgment in or otherwise seek to terminate any
  pending or threatened action, claim, suit, investigation or other
  proceeding in respect of which any Indemnified Person is or could have been
  a party and indemnification or contribution could have been sought
  hereunder by such Indemnified Person, unless such settlement, compromise,
  consent or termination includes an unconditional release of each
  Indemnified Person from all liability on claims that are the subject matter
  of such proceeding.
 
    (c) Each of the Underwriters agrees, severally and not jointly, to
  indemnify and hold harmless the Company, its directors, its officers who
  sign the Registration Statement, and any person controlling (within the
  meaning of Section 15 of the Act or Section 20 of the Exchange Act) the
  Company, to the same extent as the foregoing indemnity from the Company to
  each of the Indemnified Persons, but only with respect to claims and
  actions based on information relating to such Underwriter furnished in
  writing by or on behalf of such Underwriter through DLJ expressly for use
  in the Registration Statement, Prospectus or preliminary prospectus, as
  applicable. In case any action shall be brought against the Company, any of
  its directors, any such officer, or any such controlling person based on
  the Registration Statement, the Prospectus or any preliminary prospectus in
  respect of which indemnity is sought against any Underwriter pursuant to
  the foregoing sentence, the Underwriter shall have the rights and duties
  given to the Company (except that if the Company shall have assumed the
  defense thereof, such Underwriter shall not be required to do so, but may
  employ separate counsel therein and participate in the defense thereof, but
  the fees and expenses of such counsel shall be at the expense of such
  Underwriter), and the Company, its directors, any such officers, and each
  such controlling person shall have the rights and duties given to the
  Indemnified Person by Section 6(b) above.
 
    (d) If the indemnification provided for in this Section 6 is finally
  determined by a court of competent jurisdiction to be unavailable to an
  Indemnified Person in respect of any Liabilities referred to herein, then
  the Company, in lieu of indemnifying such Indemnified Person, shall
  contribute to the amount paid or payable by such Indemnified Person as a
  result of such Liabilities: (i) in such proportion as is appropriate to
  reflect the relative benefits received by the Company on the one hand and
  the Indemnified Person on the other hand from the offering of the
  Securities, or (ii) if the allocation provided by clause (i), above, is not
  permitted by applicable law, in such proportion as is appropriate to
  reflect not only the relative benefits referred to in clause (i), above,
  but also the relative fault of the Company and the Indemnified Person in
  connection with the actions, statements or omissions that resulted in such
  Liabilities, as well as any other relevant equitable considerations. The
  relative benefits received by the Company, on the one hand, and any of the
  Underwriters (and its related Indemnified Persons), on the other hand,
  shall be deemed to be in the same proportion as the total proceeds from the
  offering (net of underwriting discounts and commissions but before
  deducting expenses) received by the Company bear to the total underwriting
  discounts and commissions received by such Underwriter, in each case as set
  forth in the Prospectus. The relative fault of the Company and the
  Underwriter shall be determined by reference to, among other things,
  whether the untrue or alleged untrue statement of a material fact or the
  omission or alleged omission to state a material fact related to
  information supplied by the Company or the Underwriter and the parties'
  relative intent, knowledge, access to information and opportunity to
  correct or prevent such statement or omission. The indemnity and
  contribution obligations of the Company set forth herein shall be in
  addition to any liability or obligation the Company may otherwise have to
  any Indemnified Person.
 
  The Company and the Underwriters agree that it would not be just and
equitable if contribution pursuant to this Section 6(d) were determined by pro
rata allocation (even if the Underwriters were treated as one entity for such
purpose) or by any other method of allocation that does not take account of the
equitable considerations referred to in the immediately preceding paragraph.
The amount paid or payable by an indemnified party as a result of the losses,
claims, damages, judgments, liabilities or expenses referred to in the
immediately preceding paragraph shall be deemed to include, subject to the
limitations set forth above,
 
                                       15
<PAGE>
 
any legal or other expenses reasonably incurred by such indemnified party in
connection with investigating or defending any such action or claim.
Notwithstanding the provisions of this Section 6, none of the Underwriters (and
its related Indemnified Persons referred to in Section 6 above) shall be
required to contribute, in the aggregate, any amount in excess of the amount by
which the total underwriting discount applicable to the Securities purchased by
such Underwriter exceeds the amount of any damages or liabilities which such
Underwriter (and its related Indemnified Persons referred to in Section 6
above) has otherwise been required to pay or incur by reason of such untrue or
alleged untrue statement or omission or alleged omission or other indemnified
action or proceeding. Notwithstanding anything to the contrary contained
herein, no person guilty of fraudulent misrepresentation (within the meaning of
Section 11(f) of the Act) shall be entitled to contribution from any person who
was not guilty of such fraudulent misrepresentation. The Underwriters'
obligations to contribute pursuant to this Section 6(d) are several in
proportion to the respective aggregate principal amount of Securities purchased
by each of the Underwriters hereunder and not joint.
 
  7. Conditions of Underwriters' Obligations. The respective obligations of the
several Underwriters to purchase any Securities under this Agreement are
subject to the satisfaction or waiver by the several Underwriters of each of
the following conditions on the Closing Date:
 
    (a) All the representations and warranties of the Company contained in
  this Agreement shall be true and correct on the Closing Date and as of the
  Effective Time of the Merger after giving effect to the transactions
  contemplated by the Transaction Documents, with the same force and effect
  as if made on and as of the Closing Date and as of the Effective Time of
  the Merger, respectively. The Company and its Subsidiaries shall have
  performed or complied with all of their obligations and agreements herein
  contained and required to be performed or complied with by it at or prior
  to the Closing Date.
 
    (b) (i) The Registration Statement shall have become effective (or, if a
  post-effective amendment is required to be filed pursuant to Rule 430A of
  the Act, such post-effective amendment shall have become effective (or, if
  any Securities are sold in reliance upon Rule 430A of the Act and no post-
  effective amendment is so required to be filed, the Prospectus shall have
  been timely filed with the Commission in accordance with Section 4(a)
  hereof)) on the date of this Agreement or at such later date and time as
  you may approve in writing, (ii) at the Closing Date, no stop order
  suspending the effectiveness of the Registration Statement shall have been
  issued and no proceedings for that purpose shall have been commenced or
  shall be pending before or contemplated by the Commission and every request
  for additional information on the part of the Commission shall have been
  complied with in all respects, (iii) no stop order suspending the sale of
  the Securities in any jurisdiction referred to in Section 4(i) shall have
  been issued and no proceeding for that purpose shall have been commenced or
  shall be pending or threatened, and (iv) since the effective date of the
  Registration Statement, there shall not have occurred any event required to
  be set forth in an amendment or supplement to the Registration Statement or
  Prospectus that has not been set forth, and there shall not have been any
  document required to be filed under the Exchange Act that upon such filing
  would be deemed to be incorporated by reference in the Prospectus that has
  not been so filed.
 
    (c) No action shall have been taken and no statute, rule, regulation or
  order shall have been enacted, adopted or issued by any governmental
  agency, body or official which would, as of the Closing Date, prevent the
  issuance of the Securities; and no injunction, restraining order or order
  of any nature by any Federal or state court shall have been issued as of
  the Closing Date which would prevent the issuance of the Securities.
  Subsequent to the execution and delivery of this Agreement and prior to the
  Closing Date, there shall not have been any downgrading, nor shall any
  notice have been given of any intended or potential downgrading or of any
  review for a possible change that does not indicate the direction of the
  possible change, in the rating accorded any of the Company's securities by
  any "nationally recognized statistical rating organization," as such term
  is defined for purposes of Rule 436(g)(2) of the Act.
 
    (d) (i) Since the earlier of the date hereof or the dates as of which
  information is given in the Registration Statement and the Prospectus,
  there shall not have been any Material Adverse Change, (ii) since the date
  of the latest balance sheet included in the Registration Statement and the
  Prospectus,
 
                                       16
<PAGE>
 
  there shall not have been any material adverse change, or development
  involving a prospective material adverse change, in the capital stock or
  debt, of the Company, AMH and the Subsidiaries, taken as a whole, and (iii)
  the Company, AMH and the Subsidiaries shall have no liability or
  obligation, direct or contingent, that is material to the Company, AMH and
  the Subsidiaries, taken as a whole, and which is not disclosed in the
  Registration Statement and the Prospectus.
 
    (e) You shall have received a certificate of the Company, dated the
  Closing Date, executed on behalf of the Company, by an executive officer
  and a financial officer of the Company satisfactory to you confirming, as
  of the Closing Date, the matters set forth in paragraphs (a), (b), (c) and
  (d) of this Section 7.
 
    (f) On the Closing Date, you shall have received:
 
      (1) an opinion (satisfactory to you and your counsel), dated the
    Closing Date, of Skadden, Arps, Slate, Meagher & Flom, counsel for the
    Company ("Skadden, Arps"), to the effect that:
 
        (i) the Registration Statement was declared effective in
      compliance with the Act; any required filing of the Prospectus, and
      any amendments or supplements thereto, pursuant to Rule 424(b) has
      been sent for filing in the manner and within the time period
      required by Rule 424(b); and, to the best of such counsel's
      knowledge, no stop order suspending the effectiveness of the
      Registration Statement or any part thereof has been issued and no
      proceedings therefor have been instituted or are pending or
      contemplated under the Act; and the Indentures have been qualified
      under the TIA;
 
        (ii) at the time it became effective and on the Closing Date, the
      Registration Statement, including all documents incorporated by
      reference therein (except for financial statements, the notes
      thereto and related schedules and other financial and statistical
      data included therein and the Statements of Eligibility and
      Qualification of the Trustees on Forms T-l (the "Forms T-1"), as to
      which no opinion need be expressed), complied as to form in all
      material respects with the Act, the Exchange Act and the TIA;
 
        (iii) each document filed pursuant to the Exchange Act and
      incorporated by reference in the Prospectus, at the time it was
      filed or last amended (except for financial statements, the notes
      thereto and related schedules and other financial, numerical,
      statistical or accounting data included or incorporated by reference
      therein or omitted therefrom, as to which such counsel need express
      no opinion), complied as to form in all material respects to the
      applicable requirements of the Exchange Act;
 
        (iv) the Company has full power and authority to execute, deliver
      and perform this Agreement and the Company has full power and
      authority to authorize, issue and sell the Securities as
      contemplated by this Agreement; this Agreement has been duly
      authorized, executed and delivered by the Company, and the
      Securities and the Indentures have been duly authorized, executed
      and delivered by the Company;
 
        (v) when authenticated in accordance with the terms of the
      Indentures and delivered and paid for by the Underwriters in
      accordance with the terms of this Agreement, the Securities will
      constitute valid and legally binding obligations of the Company,
      enforceable against the Company in accordance with their respective
      terms and entitled to the benefits of their respective Indenture,
      subject to applicable bankruptcy, insolvency, fraudulent conveyance,
      reorganization, moratorium and similar laws affecting creditors'
      rights and remedies generally and to general principles of equity
      (regardless of whether enforcement is sought in a proceeding at law
      or in equity) and except to the extent that a waiver of rights under
      any usury laws may be unenforceable;
 
        (vi) the Indentures, assuming due authorization, execution and
      delivery thereof by the applicable Trustee, each constitute a valid
      and legally binding agreement of the Company, enforceable against
      the Company in accordance with their terms, subject to applicable
 
                                       17
<PAGE>
 
      bankruptcy, insolvency, fraudulent conveyance, reorganization,
      moratorium and similar laws affecting creditors' rights and remedies
      generally and to general principles of equity (regardless of whether
      enforcement is sought in a proceeding at law or in equity) and
      except to the extent that a waiver of rights under any usury laws
      may be unenforceable;
 
        (vii) the Securities and the Indentures conform in all material
      respects to the descriptions thereof contained in the Prospectus;
 
        (viii) the Company and each of its Significant Subsidiaries (as
      defined under the Commission's Regulation S-X) is a duly organized
      and validly existing corporation in good standing under the laws of
      its jurisdiction of organization, has the requisite corporate power
      and authority to own, lease and operate its properties and to
      conduct its business as described in the Registration Statement and
      the Prospectus, and, to the extent each is a party thereto, to
      execute, deliver and perform its obligations pursuant to the
      Indentures and this Agreement, and is duly qualified as a foreign
      corporation and in good standing in each jurisdiction where the
      ownership, leasing or operation of property or the conduct of its
      business requires such qualification, except where the failure so to
      be qualified could not have, singly or in the aggregate, a Material
      Adverse Effect;
 
        (ix) neither the Company nor any of its Significant Subsidiaries
      is (a) an "investment company" or a company "controlled" by an
      investment company within the meaning of the Investment Company Act
      of 1940, as amended, or (b) a "holding company" or a "subsidiary
      company" of a holding company, or an "affiliate" thereof within the
      meaning of the Public Utility Holding Company Act of 1935, as
      amended;
 
        (x) the descriptions in the Registration Statement and the
      Prospectus of statutes, legal and governmental proceedings,
      contracts and other documents, other than the descriptions of such
      matters in the Registration Statement and the Prospectus under the
      captions set forth in subsection (f)(3)(i) of this Section 7, are
      accurate in all material respects as of the dates thereof and such
      counsel does not know of any legal or governmental proceedings
      required to be described in the Registration Statement or Prospectus
      which are not described as required or of any contracts or documents
      of a character required to be described in the Registration
      Statement or Prospectus (or required to be filed under the Exchange
      Act if upon such filing they would be incorporated by reference
      therein) or to be filed as exhibits to the Registration Statement
      which are not described and filed as required; it being understood
      that such counsel need express no opinion as to the financial
      statements, notes or schedules or other financial data included
      therein or those parts of the Registration Statement that constitute
      the Forms T-1);
 
        (xi) no consent, approval, authorization or order of any United
      States governmental agency or body is required for the consummation
      by the Company of the transactions contemplated by this Agreement
      and the Indentures in connection with the sale of the Securities,
      except such as may be required under the Act, the TIA or state
      securities or "blue sky" laws, provided, that the opinion set forth
      in this paragraph may be limited to those statutes, laws and
      regulations currently in effect which, in the experience of such
      counsel, are ordinarily applicable to transactions of the type
      contemplated by this Agreement and the Indentures;
 
        (xii) the execution and delivery by the Company of this Agreement
      and the Indentures and the issuance and sale of the Securities to
      you as contemplated thereby and the performance of its obligations
      pursuant to this Agreement and the Indentures will not conflict with
      or result in a breach or violation of any of the terms or provisions
      of, or constitute a default under, (a) any of the respective
      charters or bylaws of the Company or any of its Significant
      Subsidiaries, (b) assuming compliance with all applicable securities
      laws and "blue sky" laws of those jurisdictions in which the
      Securities may be offered or sold, any existing applicable statute,
      rule
 
                                       18
<PAGE>
 
      or regulation or any order of any court or governmental agency or
      body having jurisdiction over the Company or any of its Significant
      Subsidiaries or any of their properties or (c) any agreement or
      instrument to which the Company or any of its Subsidiaries is a
      party and that has been specifically identified to us by the Company
      as being material to the Company and its Subsidiaries taken as a
      whole and set forth on Schedule     hereto; provided that the
      opinion expressed in clause (b) is limited to those statutes, rules
      or regulations which, in the experience of such counsel, are
      normally applicable to transactions of the type contemplated by this
      Agreement in connection with the sale of the Securities;
 
        (xiii) to the best of such counsel's knowledge, there is no
      current, pending or threatened action, suit or proceeding before any
      court or governmental agency, authority or body or any arbitrator
      involving the Company or any of its Subsidiaries or to which any of
      their respective property is subject of a character required to be
      disclosed in the Registration Statement which is not adequately
      disclosed in the Prospectus;
 
        (xiv) all of the issued and outstanding shares of capital stock
      of, or other ownership interests in, each Significant Subsidiary of
      the Company have been duly and validly authorized and issued, and
      the shares of capital stock of, or other ownership interests in,
      each such subsidiary are owned of record, directly or through
      subsidiaries, by the Company, are fully paid and nonassessable, and
      to the best knowledge of such counsel are owned free and clear of
      any Lien;
 
        (xv) the Company and its Subsidiaries, to the extent each is a
      party thereto, have full power and authority to execute, deliver and
      perform the Merger Agreement;
 
        (xvi) the Merger Agreement and the New Credit Facility conform in
      all material respects to the descriptions thereof contained in the
      Prospectus and are valid, duly authorized and enforceable agreements
      against the Merger Parties, to the extent each is a party thereto;
      and
 
        (xvii) the approval of the Merger by the shareholders of the
      Company is not required.
 
      (2) In giving their opinion required by subsection (f)(l) of this
    Section 7, such counsel (i) may state that such opinions are limited to
    matters governed by the Federal laws of the United States of America,
    the laws of the State of New York, the laws of the State of Delaware
    and the laws of the State of Nevada, and (ii) shall state that (a) such
    counsel has acted as counsel to the Company in connection with the
    preparation of the Registration Statement and (b) such counsel has
    participated in conferences with officers and other representatives of
    the Company and AMH, representatives of the independent public
    accountants for the Company and AMH, your representatives and your
    counsel at which the contents of the Registration Statement and the
    Prospectus and related matters were discussed and, although such
    counsel is not passing upon and does not assume any responsibility for,
    the accuracy, completeness or fairness of the statements contained in
    the Registration Statement or the Prospectus on the basis of the
    foregoing, no fact has come to the attention of such counsel that leads
    it to believe that the Registration Statement, at the time it became
    effective, contained an untrue statement of a material fact or omitted
    to state a material fact required to be stated therein or necessary to
    make the statements therein not misleading or that the Prospectus, as
    of its date and as of the Closing Date, contained an untrue statement
    of a material fact or omitted to state a material fact required to be
    stated therein or necessary to make the statements therein, in light of
    the circumstances under which they were made, not misleading, it being
    understood that such counsel is not expressing any opinion or belief as
    to the financial statements, schedules and other financial or
    statistical data included in or excluded from the Registration
    Statement or the Prospectus, or the Statements of Eligibility and
    Qualifications of the Trustees on Form T-1.
 
                                       19
<PAGE>
 
      In rendering the foregoing opinions, Skadden, Arps may rely as to
    matters of Nevada law on the opinion of Woodburn & Wedge, Nevada
    counsel to the Company, or such other counsel as is reasonably
    satisfactory to the Underwriters' Counsel.
 
      (3) an opinion (satisfactory to you and Underwriters' Counsel), dated
    the Closing Date, of             , regulatory counsel for the Company,
    to the effect that:
 
        (i) the descriptions in the Registration Statement and the
      Prospectus of statutes, legal and governmental proceedings,
      contracts and other documents and regulatory matters described in
      the Prospectus under the captions "Risk Factors--Limits on
      Reimbursement," "-- Extensive Regulation," "--Healthcare Reform
      Legislation," "Healthcare Industry Overview," "Business--Medicare,
      Medicaid and other Revenues," and "--Healthcare Regulation and
      Licensing," and in the Company's Annual Report on Form 10-K for the
      fiscal year ended May 31, 1994 under the captions "Medicare,
      Medicaid and Other Revenues" and "Health Care Reform, Regulation,
      Licensing and Insurance" insofar as such statements constitute
      summaries of legal matters, documents or proceedings referred to
      therein are accurate in all material respects and fairly present the
      information shown as of the dates thereof; and
 
        (ii) each of the Company and its Subsidiaries has such
      Authorizations from all regulatory or governmental officials, bodies
      and tribunals as are necessary to own, lease and operate its
      respective properties and to conduct its business in the manner
      described in the Prospectus.
 
      (4) In giving their opinion required by subsection f(3) of this
    Section 7, such counsel shall state that no fact has come to the
    attention of such counsel that leads it to believe that the
    descriptions of statutes, legal and governmental proceedings, contracts
    and other documents and regulatory matters described in the
    Registration Statement and the Prospectus under the captions set forth
    in subsection (f)(3)(i) of this Section 7 contained an untrue statement
    of a material fact or omitted to state a material fact required to be
    stated therein or necessary to make the statements therein, in light of
    the circumstances under which they were made, not misleading.
 
    (g) You shall have received an opinion, dated the Closing Date, of Latham
  & Watkins, counsel for the Underwriters, in form and substance reasonably
  satisfactory to you.
 
    (h) You shall have received each of the opinions required to be delivered
  under any of the other Transaction Documents, together with appropriate
  reliance letters addressed to the Underwriters.
 
    (i) You shall have received letters on and as of the date hereof as well
  as on and as of the Closing Date, in the latter case constituting an
  affirmation of the statements set forth in the earlier letters, in form and
  substance satisfactory to you, from KPMG Peat Marwick LLP and Price
  Waterhouse LLP, independent public accountants to the Company and AMH,
  respectively, with respect to the financial statements and certain
  financial information contained in the Registration Statement and the
  Prospectus as you shall reasonably require.
 
    (j) All corporate proceedings and other legal matters incident to the
  authorization, form and validity of this Agreement, the Securities, the
  Registration Statement and the Prospectus, and all other legal matters
  relating to this Agreement and the transactions contemplated hereby shall
  be reasonably satisfactory in all respects to Latham & Watkins, and such
  counsel shall have been furnished with such documents and opinions, in
  addition to those set forth above, as they may reasonably require for the
  purpose of enabling them to review or pass upon the matters referred to in
  this Section 7, in order to evidence the accuracy, completeness and
  satisfaction in all material respects of any of the representations,
  warranties or conditions herein contained and to render the opinion
  referred to in Section 7(g).
 
    (k) The Company shall not have failed at or prior to the Closing Date to
  perform or comply with any of the agreements herein contained and required
  to be performed or complied with by the Company at or prior to the Closing
  Date.
 
 
                                       20
<PAGE>
 
    (l) There shall have been no amendments, alterations, modifications, or
  waivers of any provisions of the Transaction Documents since the date of
  the execution and delivery thereof by the parties thereto other than those
  which are disclosed in the Registration Statement or the Prospectus or any
  supplement thereto or which under the Act are not required to be disclosed
  in the Prospectus or any supplement thereto and which have been disclosed
  to the Underwriters prior to the date hereof.
 
    (m) Each of the Merger Parties shall, to the extent each is a party
  thereto, have complied in all respects with all agreements and covenants in
  the Transaction Documents and performed all conditions specified therein
  that the terms thereof require to be complied with or performed at or prior
  to the Effective Time of the Merger, except to the extent that such
  compliance or performance has been waived by the other parties to the
  applicable Transaction Documents.
 
    (n) The certificate of merger with respect to the Merger shall have been
  filed with the Secretary of State of the State of Delaware and shall have
  become effective, the Merger shall have occurred and all other transactions
  contemplated by the Transaction Documents (other than the closing of the
  offering and sale of the Securities under this Agreement) to be consummated
  at or prior to the Effective Time of the Merger shall have been consummated
  prior to or simultaneously with the consummation of the purchase and sale
  of the Securities hereunder.
 
    (o) Prior to or concurrently with the purchase and sale of the Securities
  hereunder, the Company shall have entered into the New Credit Facility and
  satisfied all conditions to borrowing thereunder and you shall have
  received counterparts, conformed as executed, thereof. The Lenders under
  the New Credit Facility shall have indicated to you that all such
  conditions have been satisfied and that they are prepared to fund term
  loans in the amount of $          and revolving loans in the amount of
  $              .
 
    (p) Except as is disclosed to the Underwriters in writing, the
  representations and warranties of the Company set forth in the Transaction
  Documents shall be true, accurate and complete in all respects.
 
    (q) On or before the Closing Date, the Underwriters and Latham & Watkins,
  counsel for the Underwriters, shall have received such further documents,
  opinions, certificates and schedules or instruments relating to the
  business, corporate, legal and financial affairs of each of the Merger
  Parties as they shall have heretofore reasonably requested.
 
    (r) Prior to the purchase and sale of the Securities hereunder, the
  Company's tender offers to purchase for cash any and all of the Company's
  outstanding Medium Term Notes, with maturities ranging through 1997 and 7 %
  unsecured Notes due 1997 (the "NME Tender Offers") and the Company's tender
  offers to purchase for cash any and all of the 11% Senior Notes due 2000,
  9% Senior Subordinated Notes due 2006, 13% Senior Subordinated Notes due
  2001 and 15% Junior Subordinated Debentures due 2005 of American Medical
  International, Inc. ("AMI") (collectively, the "AMI Post 1991 Debt
  Securities") and the related consent solicitations (collectively, the "AMI
  Post 1991 Debt Securities Tender Offers") and the Company's tender offers
  (the "AMI Swiss Bonds Tender Offers" and, together with the AMI Post 1991
  Debt Securities Tender Offers, the "AMI Tender Offers") to purchase for
  cash any and all of the 6% Dual Currency Bonds due 1997 and the 5% Swiss
  Franc Bonds due 1996 of AMI (collectively, the "AMI Swiss Bonds") shall
  have expired, the Company shall have accepted for payment all such
  securities validly tendered pursuant to such tender offers and each of the
  indentures governing the AMI Post 1991 Debt Securities shall have been
  amended as contemplated by the applicable offer to purchase and consent
  solicitation; immediately after the Effective Time of the Merger, the
  Company shall have assigned its rights and obligations to purchase the AMI
  Post 1991 Debt Securities and the AMI Swiss Bonds under the AMI Tender
  Offers to AMI and transferred to AMI, from borrowings under the New Credit
  Facility, the amount of funds necessary to consummate such AMI Tender
  Offers and the Company and AMI shall have made provisions satisfactory to
  the Underwriters so that the NME Tender Offers and the AMI Tender Offers,
  respectively, are consummated as soon as practicable following the Closing
  Date. You shall have received evidence satisfactory to you that the Company
  has accepted for payment all securities validly tendered pursuant to the
  NME Tender Offers and the AMI Tender Offers, the indentures governing the
  AMI Post 1991
 
                                       21
<PAGE>
 
  Debt Securities have been amended pursuant to the applicable offer to
  purchase and consent solicitation, the Company has assigned to AMI its
  rights and obligations to purchase the AMI Post 1991 Debt Securities and
  the AMI Swiss Bonds under the AMI Tender Offers, and the Company and AMI
  will consummate the NME Tender Offers and the AMI Tender Offers,
  respectively, as soon as practicable following the Closing Date.
 
    (s) Prior to or concurrently with the purchase and sale of the Securities
  hereunder, AMI shall have mailed redemption notices with respect to all of
  its outstanding 11% Senior Notes due 2015 and 9% Convertible Debentures due
  2001 and you shall have received evidence satisfactory to you that such
  redemption notices have been so mailed by AMI.
 
  8. Effective Date of Agreement, Default and Termination. This Agreement shall
become effective upon the later of (i) the execution and delivery of this
Agreement by the parties hereto, (ii) unless the Company intends to rely on
Rule 430A of the Act, the effectiveness of the Registration Statement, and
(iii) if the Company intends to rely on Rule 430A of the Act, the earlier of
the effectiveness of a post-effective amendment filed in compliance with Rule
430A of the Act or the filing of a final prospectus pursuant to Rule 424(b).
 
  This Agreement may be terminated at any time on or prior to the Closing Date
by you by notice to the Company if any of the following has occurred: (i)
subsequent to the date the Registration Statement is declared effective or the
date of this Agreement, any Material Adverse Change which, in your judgment,
impairs the investment quality of the Securities, (ii) any outbreak or
escalation of hostilities or other national or international calamity or crisis
or material adverse change in the financial markets of the United States or
elsewhere, or any other substantial national or international calamity or
emergency if the effect of such outbreak, escalation, calamity, crisis or
emergency would, in your judgment make it impracticable or inadvisable to
market the Securities or to enforce contracts for the sale of the Securities,
(iii) any suspension or limitation of trading generally in securities on the
New York, American or Pacific Stock Exchanges, the National Association of
Securities Dealers Automated Quotation National Market, or the over-the-counter
markets or any setting of minimum prices for trading on such exchanges or
markets, (iv) any declaration of a general banking moratorium by either Federal
or New York authorities, (v) the taking of any action by any Federal, state or
local government or agency in respect of its monetary or fiscal affairs that in
your judgment has a material adverse effect on the financial markets in the
United States, and would, in your judgment, make it impracticable or
inadvisable to market the Securities or to enforce contracts for the sale of
the Securities, (vi) any securities of the Company or any of its Subsidiaries
shall have been downgraded or placed on any "watch list" for possible
downgrading or reviewed for a possible change that does not indicate the
direction of the possible change by any "nationally recognized statistical
rating organization," as such term is defined for purposes of Rule 436(g)(2) of
the Act, or (vii) the enactment, publication, decree or other promulgation of
any Federal or state statute, regulation, or rule or order of any court or
other governmental authority which in your judgment could have a Material
Adverse Effect.
 
  If this Agreement shall be terminated by you pursuant to clause (i), (vi) or
(vii) of the second paragraph of this Section 8 or because of the failure or
refusal on the part of the Company to comply with the terms or to fulfill any
of the conditions of this Agreement, the Company agrees to reimburse you for
all reasonable out-of-pocket expenses (including the reasonable fees and
disbursements of counsel) incurred by you. Notwithstanding any termination of
this Agreement, the Company shall be liable for all expenses which it has
agreed to pay pursuant to Section 4(f) hereof. If this Agreement is terminated
pursuant to this Section 8, such termination shall be without liability of any
Underwriter to the Company or any of its Subsidiaries.
 
  If on the Closing Date any of the Underwriters shall fail or refuse to
purchase the Securities which it has agreed to purchase hereunder on such date,
and the aggregate principal amount of such Securities that such defaulting
Underwriter or Underwriters, as the case may be, agreed but failed or refused
to purchase does not exceed 10% of the total principal amount of such
Securities to be purchased on such date by all Underwriters, each non-
defaulting Underwriter shall be obligated severally, in the proportion which
the
 
                                       22
<PAGE>
 
amount of Securities set forth opposite its name in Schedule I and Schedule II,
respectively, hereto bears to the aggregate principal amount of Securities
which all the non-defaulting Underwriters, as the case may be, have agreed to
purchase, or in such other proportion as you (at your option) may specify, to
purchase the Securities that such defaulting Underwriter or Underwriters, as
the case may be, agreed but failed or refused to purchase on such date;
provided that in no event shall the aggregate principal amount of Securities
that any Underwriter has agreed to purchase pursuant to Section 2 hereof be
increased pursuant to this Section 8 by an amount in excess of one-ninth of
such principal amount of Securities without the written consent of such
Underwriter. If, on the Closing Date any of the Underwriters shall fail or
refuse to purchase the Securities, as the case may be, and the total principal
amount of Securities with respect to which such default occurs exceeds 10% of
the total amount of Securities to be purchased on such date by all Underwriters
and arrangements satisfactory to you and the Company for the purchase of such
Securities are not made within 48 hours after such default, this Agreement
shall terminate without liability on the part of the non-defaulting
Underwriters and the Company, except as otherwise provided in this Section 8.
In any such case that does not result in termination of this Agreement, either
you or the Company may postpone the Closing Date for not longer than seven (7)
days, in order that the required changes, if any, in the Registration Statement
and the Prospectus or any other documents or arrangements may be effected. Any
action taken under this paragraph shall not relieve a defaulting Underwriter
from liability in respect of any default of any such Underwriter under this
Agreement.
 
  9. Notices. Notices given pursuant to any provision of this Agreement shall
be addressed as follows: (a) if to the Company, to it at 2700 Colorado Avenue,
Santa Monica, California 90404, Attention: Treasurer, with copies to Attention:
General Counsel and to Skadden, Arps, Slate, Meagher & Flom, 300 South Grand
Avenue, Suite 3400, Los Angeles, California 90071, Attention: Thomas C. Janson,
Jr. and (b) if to any Underwriter, to Donaldson, Lufkin & Jenrette Securities
Corporation, 140 Broadway, New York, New York 10005, Attention: Syndicate
Department, and, in each case, with a copy to Latham & Watkins, 855 Third
Avenue, Suite 1000, New York, New York 10022, Attention: Kirk A. Davenport,
Esq., or in any case to such other address as the person to be notified may
have requested in writing.
 
  10. Governing Law. THIS AGREEMENT SHALL BE GOVERNED BY AND CONSTRUED IN
ACCORDANCE WITH THE INTERNAL LAWS OF THE STATE OF NEW YORK AS APPLIED TO
CONTRACTS MADE AND PERFORMED ENTIRELY WITHIN THE STATE OF NEW YORK, WITHOUT
REGARD TO PRINCIPLES OF CONFLICTS OF LAW. THE COMPANY HEREBY IRREVOCABLY
SUBMITS TO THE EXCLUSIVE JURISDICTION OF THE FEDERAL AND NEW YORK STATE COURTS
LOCATED IN THE CITY OF NEW YORK IN CONNECTION WITH ANY SUIT, ACTION OR
PROCEEDING RELATED TO THIS AGREEMENT OR ANY OF THE MATTERS CONTEMPLATED HEREBY,
IRREVOCABLY WAIVES ANY DEFENSE OF LACK OF PERSONAL JURISDICTION AND IRREVOCABLY
AGREES THAT ALL CLAIMS IN RESPECT OF ANY SUIT, ACTION OR PROCEEDING MAY BE
HEARD AND DETERMINED IN ANY SUCH COURT. THE COMPANY IRREVOCABLY WAIVES, TO THE
FULLEST EXTENT IT MAY EFFECTIVELY DO SO UNDER APPLICABLE LAW, ANY OBJECTION
WHICH IT MAY NOW OR HEREAFTER HAVE TO THE LAYING OF VENUE OF ANY SUCH SUIT,
ACTION OR PROCEEDING BROUGHT IN ANY SUCH COURT AND ANY CLAIM THAT ANY SUCH
SUIT, ACTION OR PROCEEDING BROUGHT IN ANY SUCH COURT HAS BEEN BROUGHT IN AN
INCONVENIENT FORUM.
 
  11. Severability. Any determination that any provision of this Agreement may
be, or is, unenforceable shall not affect the enforceability of the remainder
of this Agreement.
 
  12. Successors. Except as otherwise provided, this Agreement has been and is
made solely for the benefit of and shall be binding upon the Company, the
Underwriters, any Indemnified Person referred to herein and their respective
successors and assigns, all as and to the extent provided in this Agreement,
and no other person shall acquire or have any right under or by virtue of this
Agreement. The terms "successors and assigns" shall not include a purchaser of
any of the Securities from any of the Underwriters merely because of such
purchase.
 
                                       23
<PAGE>
 
  13. Certain Definitions. For purposes of this Agreement, (a) "business day"
means any day on which the NYSE, Inc. is open for trading and (b) "subsidiary"
has the meaning set forth in Rule 405 of the Act.
 
  14. Counterparts. This Agreement may be executed in one or more counterparts
and, if executed in one or more counterparts, the executed counterparts shall
each be deemed to be an original, not all such counterparts shall together
constitute one and the same instrument.
 
  15. Headings. The headings herein are inserted for convenience of reference
only and are not intended to be part of, or to effect the meaning or
interpretation of, this Agreement.
 
  16. Survival. The indemnities and contribution provisions and the other
agreements, representations and warranties of the Company, its officers and
directors and of the Underwriters set forth in or made pursuant to this
Agreement shall remain operative and in full force and effect, and will survive
delivery of and payment for the Securities, regardless of (i) any
investigation, or statement as to the results thereof, made by or on behalf of
any of the Underwriters or by or on behalf of the Company, the officers or
directors of the Company or any controlling person of the Company, (ii)
acceptance of the Securities and payment for them hereunder and (iii)
termination of this Agreement.
 
  This Agreement may be signed in various counterparts which together shall
constitute one and the same instrument. Please confirm that the foregoing
correctly sets forth the agreement among the Company and you.
 
                                          Very truly yours,
 
                                          NATIONAL MEDICAL ENTERPRISES, INC.
 
                                          By:
                                            -----------------------------------
                                             Name:
                                             Title:
 
The foregoing Underwriting Agreement
is hereby confirmed and accepted as
of the date first above written.
 
DONALDSON, LUFKIN & JENRETTE
  SECURITIES CORPORATION
 
MERRILL LYNCH, PIERCE, FENNER & SMITH
            INCORPORATED
MORGAN STANLEY & CO. INCORPORATED
SALOMON BROTHERS INC
J.P. MORGAN SECURITIES INC.
BT SECURITIES CORPORATION
SMITH BARNEY INC.
BA SECURITIES, INC.
 
Acting on behalf of themselves
 
By Donaldson, Lufkin & Jenrette
   Securities Corporation
 
By:
  ----------------------------------------
  Name:
  Title:
 
                                       24
<PAGE>
 
                                   SCHEDULE I
 
                                  SENIOR NOTES
 
<TABLE>
<CAPTION>
                                                            PRINCIPAL PERCENTAGE
UNDERWRITER                                                  AMOUNT    OF TOTAL
- -----------                                                 --------- ----------
<S>                                                         <C>       <C>
Donaldson, Lufkin & Jenrette Securities Corporation........ $          $
Merrill Lynch, Pierce, Fenner & Smith
         Incorporated......................................
Morgan Stanley & Co. Incorporated..........................
Salomon Brothers Inc.......................................
J.P. Morgan Securities Inc.................................
BT Securities Corporation..................................
Smith Barney Inc...........................................
BA Securities, Inc.........................................
                                                            --------   --------
  Total.................................................... $          $
                                                            ========   ========
</TABLE>
 
                                       25
<PAGE>
 
                                  SCHEDULE II
 
                           SENIOR SUBORDINATED NOTES
 
<TABLE>
<CAPTION>
                                                            PRINCIPAL PERCENTAGE
UNDERWRITER                                                  AMOUNT    OF TOTAL
- -----------                                                 --------- ----------
<S>                                                         <C>       <C>
Donaldson, Lufkin & Jenrette Securities Corporation........ $          $
Merrill Lynch, Pierce, Fenner & Smith
         Incorporated......................................
Morgan Stanley & Co. Incorporated..........................
Salomon Brothers Inc.......................................
J.P. Morgan Securities Inc.................................
BT Securities Corporation..................................
Smith Barney Inc...........................................
BA Securities, Inc.........................................
                                                            --------   --------
  Total.................................................... $          $
                                                            ========   ========
</TABLE>
 
                                       26

<PAGE>

                                                                     EXHIBIT 4.1
================================================================================


                      NATIONAL MEDICAL ENTERPRISES, INC.


                         ----------------------------

                                 $300,000,000

                           ___ SENIOR NOTES due 2002

                         ----------------------------

                                   INDENTURE

                          Dated as of March ___, 1995

                         ----------------------------



                         ----------------------------

                              THE BANK OF NEW YORK

                         ----------------------------


                                   as Trustee

================================================================================
<PAGE>
 
                               TABLE OF CONTENTS
<TABLE>
<CAPTION>
                                                                            Page

<S>                                                                         <C>
ARTICLE 1 - DEFINITIONS AND INCORPORATION
            BY REFERENCE
 
    Section 1.01.  Definitions............................................    1
    Section 1.02.  Other Definitions......................................   13
    Section 1.03.  Incorporation by Reference of TIA......................   14
    Section 1.04.  Rules of Construction..................................   14
 
ARTICLE 2 - THE SECURITIES
 
    Section 2.01.  Form and Dating........................................   15
    Section 2.02.  Execution and Authentication...........................   15
    Section 2.03.  Registrar and Paying Agent.............................   16
    Section 2.04.  Paying Agent to Hold Money in Trust....................   16
    Section 2.05.  Holder Lists...........................................   17
    Section 2.06.  Transfer and Exchange..................................   17
    Section 2.07.  Replacement Securities.................................   17
    Section 2.08.  Outstanding Securities.................................   18
    Section 2.09.  Treasury Securities....................................   18
    Section 2.10.  Temporary Securities...................................   18
    Section 2.11.  Cancellation...........................................   19
    Section 2.12.  Defaulted Interest.....................................   19
    Section 2.13.  Record Date............................................   19
    Section 2.14.  CUSIP Number...........................................   19
    Section 2.15.  Offer to Purchase By Application of
                   Excess Proceeds........................................   20
 
ARTICLE 3 - COVENANTS
 
    Section 3.01.  Payment of Securities..................................   22
    Section 3.02.  Maintenance of Office or Agency........................   22
    Section 3.03.  Commission Reports.....................................   23
    Section 3.04.  Compliance Certificate.................................   24
    Section 3.05   Taxes..................................................   25
    Section 3.06.  Stay, Extension and Usury Laws.........................   25
    Section 3.07.  Limitations on Restricted Payments.....................   25
    Section 3.08.  Limitations on Dividends and Other Payment
                   Restrictions Affecting Subsidiaries....................   28
    Section 3.09.  Limitations on Incurrence of Indebtedness and
                   Issuance of Preferred Stock............................   29
    Section 3.10.  Asset Sales............................................   31
    Section 3.11.  Limitations on Transactions with Affiliates............   32
 
</TABLE>

                                       i
<PAGE>
 
<TABLE>
<CAPTION> 
                                                                            Page
                           
<S>                                                                         <C>
    Section 3.12.  Limitations on Liens...................................   33
    Section 3.13.  Change of Control......................................   33
    Section 3.14.  Corporate Existence....................................   35
    Section 3.15.  Line of Business.......................................   35
    Section 3.16.  Limitations on Issuances of Guarantees of
                   Indebtedness by Subsidiaries...........................   35
    Section 3.17.  No Amendment to Subordination Provisions of
                   Senior Subordinated Note Indenture.....................   36
 
ARTICLE 4 - SUCCESSORS
 
    Section 4.01.  Limitations On Mergers, Consolidations or
                   Sales of Assets........................................   36
    Section 4.02.  Successor Corporation Substituted......................   37
 
ARTICLE 5 - DEFAULTS AND REMEDIES
 
    Section 5.01.  Events of Default......................................   37
    Section 5.02.  Acceleration...........................................   40
    Section 5.03.  Other Remedies.........................................   40
    Section 5.04.  Waiver of Past Defaults................................   40
    Section 5.05.  Control by Majority....................................   40
    Section 5.06.  Limitation on Suits....................................   41
    Section 5.07.  Rights of Holders to Receive Payment...................   41
    Section 5.08.  Collection Suit by Trustee.............................   41
    Section 5.09.  Trustee May File Proofs of Claim.......................   42
    Section 5.10.  Priorities.............................................   42
    Section 5.11.  Undertaking for Costs..................................   43
 
ARTICLE 6 - TRUSTEE
 
    Section 6.01.  Duties of Trustee......................................   43
    Section 6.02.  Rights of Trustee......................................   44
    Section 6.03.  Individual Rights of Trustee...........................   45
    Section 6.04.  Trustee's Disclaimer...................................   45
    Section 6.05.  Notice of Defaults.....................................   45
    Section 6.06.  Reports by Trustee to Holders..........................   45
    Section 6.07.  Compensation and Indemnity.............................   46
    Section 6.08.  Replacement of Trustee.................................   46
    Section 6.09.  Successor Trustee or Agent by Merger, etc..............   47
    Section 6.10.  Eligibility; Disqualification..........................   48
    Section 6.11.  Preferential Collection of Claims Against
                   Company................................................   48
</TABLE>

                                      ii
<PAGE>
 
<TABLE>
<CAPTION> 
                                                                            Page

<S>                                                                         <C>
ARTICLE 7 - DISCHARGE OF INDENTURE
 
    Section 7.01.  Defeasance and Discharge of this
                   Indenture and the Securities...........................   48
    Section 7.02.  Legal Defeasance and Discharge.........................   48
    Section 7.03.  Covenant Defeasance....................................   49
    Section 7.04.  Conditions to Legal or Covenant Defeasance.............   49
    Section 7.05.  Deposited Money and Government Securities to
                   be Held in Trust; Other Miscellaneous
                   Provisions.............................................   51
    Section 7.06.  Repayment to Company...................................   51
    Section 7.07.  Reinstatement..........................................   52
 
ARTICLE 8 - AMENDMENT, SUPPLEMENT AND WAIVER
 
    Section 8.01.  Without Consent of Holders.............................   52
    Section 8.02.  With Consent of Holders................................   53
    Section 8.03.  Compliance with TIA....................................   54
    Section 8.04.  Revocation and Effect of Consents......................   54
    Section 8.05.  Notation on or Exchange of Securities..................   54
    Section 8.06.  Trustee to Sign Amendments, etc........................   55
 
ARTICLE 9 - MISCELLANEOUS
 
    Section 9.01.  TIA Controls...........................................   55
    Section 9.02.  Notices................................................   55
    Section 9.03.  Communication by Holders with Other Holders............   56
    Section 9.04.  Certificate and Opinion as to
                   Conditions Precedent...................................   56
    Section 9.05.  Statements Required in Certificate or Opinion..........   57
    Section 9.06.  Rules by Trustee and Agents............................   57
    Section 9.07.  Legal Holidays.........................................   57
    Section 9.08.  No Personal Liability of Directors, Officers,
                   Employees and Stockholders.............................   58
    Section 9.09.  Duplicate Originals....................................   58
    Section 9.10.  Governing Law..........................................   58
    Section 9.11.  No Adverse Interpretation of Other Agreements..........   58
    Section 9.12.  Successors.............................................   58
    Section 9.13.  Severability...........................................   58
    Section 9.14.  Counterpart Originals..................................   58
    Section 9.15.  Table of Contents, Headings, etc.......................   59
 
EXHIBITS
 
    Exhibit A      FORM OF SECURITY.......................................    A
    Exhibit B      FORM OF GUARANTEE......................................    B
</TABLE>

                                      iii
<PAGE>
 
                            CROSS-REFERENCE TABLE*
<TABLE> 
<CAPTION> 

TRUST INDENTURE
  ACT SECTION                                                  INDENTURE SECTION
- ---------------                                                -----------------
<S>                                                            <C>
    310(a)(1)................................................               6.10
       (a)(2)................................................               6.10
       (a)(3)................................................               N.A.
       (a)(4)................................................               N.A.
       (a)(5)................................................               6.10
       (b)...................................................         6.08; 6.10
       (c)...................................................               N.A.
    311(a)...................................................               6.11
       (b)...................................................               6.11
       (c)...................................................               N.A.
    312(a)...................................................               2.05
       (b)...................................................               9.03
       (c)...................................................               9.03
    313(a)...................................................               6.06
       (b)(1)................................................               N.A.
       (b)(2)................................................               6.06
       (c)...................................................         6.06; 9.02
       (d)...................................................               6.06
    314(a)...................................................         3.03; 9.02
       (b)...................................................               N.A.
       (c)(1)................................................               9.04
       (c)(2)................................................               9.04
       (c)(3)................................................               N.A.
       (d)...................................................               N.A.
       (e)...................................................               9.05
       (f)...................................................               N.A.
    315(a)...................................................            6.01(iii)(b)
       (b)...................................................         6.05; 9.02
       (c)...................................................            6.01(i)
       (d)...................................................            6.01(iii)
       (e)...................................................               5.11
    316(a)(last sentence)....................................               2.09
       (a)(1)(A).............................................               5.05
       (a)(1)(B).............................................               5.04
       (a)(2)................................................               N.A.
       (b)...................................................               5.07
       (c)...................................................         2.13; 8.04
 
</TABLE>

                                       
<PAGE>
 
<TABLE> 

<S>                                                                       <C>
    317(a)(1)................................................               5.08
       (a)(2)................................................               5.09
       (b)...................................................               2.04
    318(a)...................................................               9.01
       (b)...................................................               N.A.
       (c)...................................................               9.01
</TABLE>

N.A. means not applicable.


- ----------------------------
*THIS CROSS-REFERENCE TABLE IS NOT PART OF THE INDENTURE.

                                        
<PAGE>
 
     INDENTURE dated as of March ___, 1995 between National Medical Enterprises,
Inc., a Nevada corporation (the "Company"), and The Bank of New York, as trustee
(the "Trustee").

     The Company and the Trustee agree as follows for the benefit of each other
and for the equal and ratable benefit of the Holders of the ____% Senior Notes
due 2002 (the "Securities"):


                                   ARTICLE 1
                         DEFINITIONS AND INCORPORATION
                                  BY REFERENCE

Section 1.01.  Definitions.

     "Acquired Debt" means, with respect to any specified Person, (i)
Indebtedness of any other Person existing at the time such other Person is
merged with or into or became a Subsidiary of such specified Person, including,
without limitation, Indebtedness incurred in connection with, or in
contemplation of, such other Person merging with or into or becoming a
Subsidiary of such specified Person, and (ii) Indebtedness secured by a Lien
encumbering any asset acquired by such specified Person.

     "Affiliate" of any specified Person means any other Person directly or
indirectly controlling or controlled by or under direct or indirect common
control with such specified Person.  For purposes of this definition, "control"
(including, with correlative meanings, the terms "controlling," "controlled by"
and "under common control with"), as used with respect to any Person, shall mean
the possession, directly or indirectly, of the power to direct or cause the
direction of the management or policies of such Person, whether through the
ownership of voting securities, by agreement or otherwise; provided, however,
that beneficial ownership of 10% or more of the voting securities of a Person
shall be deemed to be control.

     "Agent" means any Registrar, Paying Agent or co-registrar.

     "Asset Sale" means (i) the sale, lease, conveyance or other disposition of
any assets (including, without limitation, by way of a sale and leaseback
transaction) other than in the ordinary course of business consistent with past
practice (provided that the sale, lease, conveyance or other disposition of all
or substantially all of the assets of the Company and its Subsidiaries taken as
a whole shall be governed by Section 3.13 and/or Article 4 hereof and not by
Section 3.10 hereof) and (ii) the issuance or sale by the Company or any of its
Subsidiaries of Equity Interests of any of the Company's Subsidiaries, in the
case of either clause (i) or (ii), whether in a single transaction or a series
of related transactions (a) that have a fair market value in excess of $25.0
million or (b) for net proceeds in excess of $25.0 million.  Notwithstanding the
foregoing:  (a) a transfer of assets by the Company to a

<PAGE>
 
Subsidiary or by a Subsidiary to the Company or to another Subsidiary, (b) an
issuance of Equity Interests by a Subsidiary to the Company or to another
Subsidiary, (c) a Restricted Payment that is permitted by Section 3.07 hereof
and (d) a Hospital Swap will not be deemed to be an Asset Sale.

     "Board of Directors" means the Board of Directors of the Company or any
authorized committee thereof.

     "Business Day" means any day other than a Legal Holiday.

     "Capital Lease" means, at the time any determination thereof is to be made,
any lease of property, real or personal, in respect of which the present value
of the minimum rental commitment would be capitalized on a balance sheet of the
lessee in accordance with GAAP.

     "Capital Lease Obligation" means, at the time any determination thereof is
to be made, the amount of the liability in respect of a Capital Lease that would
at such time be so required to be capitalized on a balance sheet in accordance
with GAAP.

     "Capital Stock" means (i) in the case of a corporation, corporate stock,
(ii) in the case of an association or business entity, any and all shares,
interests, participations, rights or other equivalents (however designated) of
corporate stock, (iii) in the case of a partnership, partnership interests
(whether general or limited) and (iv) any other interest or participation that
confers on a Person the right to receive a share of the profits and losses of,
or distributions of assets of, the issuing Person.

     "Change of Control" means the occurrence of any of the following:  (i) the
sale, lease, transfer, conveyance or other disposition, in one or a series of
related transactions, of all or substantially all of the assets of the Company
and its Subsidiaries taken as a whole to any Person or group (as such term is
used in Sections 13(d)(3) and 14(d)(2) of the Exchange Act), other than to (a) a
Person or group who, prior to such transaction, held a majority of the voting
power of the voting stock of the Company, (ii) the acquisition by any Person or
group, as defined above, of a direct or indirect interest in more than 50% of
the voting power of the voting stock of the Company by way of merger,
consolidation or otherwise, or (iii) the first day on which a majority of the
members of the Board of Directors of the Company are not Continuing Directors.

     "Change of Control Triggering Event" means the occurrence of both a Change
of Control and a Rating Decline.

     "Commission" means the Securities and Exchange Commission.

     "Company" means National Medical Enterprises, Inc., as obligor under the
Securities, unless and until a successor replaces National Medical Enterprises,
Inc., in accordance with Article 4 hereof and thereafter includes such
successor.

                                       2
<PAGE>
 
     "Consolidated Cash Flow" means, with respect to any Person for any period,
the Consolidated Net Income of such Person for such period plus (i) an amount
equal to any extraordinary loss of such Person plus any net loss realized in
connection with an Asset Sale (to the extent such losses were deducted in
computing such Consolidated Net Income), plus (ii) provision for taxes based on
income or profits of such Person and its Subsidiaries, for such period, to the
extent such provision for taxes was included in computing such Consolidated Net
Income, plus (iii) the Fixed Charges of such Person and its Subsidiaries for
such period, to the extent such Fixed Charges were deducted in computing such
Consolidated Net Income, plus (iv) depreciation and amortization (including
amortization of goodwill and other intangibles but excluding amortization of
prepaid cash expenses that were paid in a prior period) of such Person and its
Subsidiaries for such period to the extent such depreciation and amortization
were deducted in computing such Consolidated Net Income, in each case, on a
consolidated basis and determined in accordance with GAAP.  Notwithstanding the
foregoing, the provision for taxes on the income or profits of, and the
depreciation and amortization of, a Subsidiary of the referent Person shall be
added to Consolidated Net Income to compute Consolidated Cash Flow only to the
extent (and in same proportion) that the Net Income of such Subsidiary was
included in calculating the Consolidated Net Income of such Person and only if a
corresponding amount would be permitted at the date of determination to be
dividended to the Company by such Subsidiary without prior approval (that has
not been obtained), pursuant to the terms of its charter and all agreements,
instruments, judgments, decrees, orders, statutes, rules and governmental
regulations applicable to that Subsidiary or its stockholders.

     "Consolidated Net Income" means, with respect to any Person for any period,
the aggregate of the Net Income of such Person and its Subsidiaries for such
period, on a consolidated basis, determined in accordance with GAAP but
excluding any one-time charge or expense incurred in order to consummate the
Refinancing; provided, that (i) the Net Income of any Person that is not a
Subsidiary or that is accounted for by the equity method of accounting shall be
included only to the extent of the amount of dividends or distributions paid in
cash to the referent Person or a Wholly Owned Subsidiary thereof, (ii) the Net
Income of any Subsidiary shall be excluded to the extent that the declaration or
payment of dividends or similar distributions by that Subsidiary of that Net
Income is not at the date of determination permitted without any prior
governmental approval (that has not been obtained) or, directly or indirectly,
by operation of the terms of its charter or any agreement, instrument, judgment,
decree, order, statute, rule or governmental regulation applicable to that
Subsidiary or its stockholders, (iii) the Net Income of any Person acquired in a
pooling of interests transaction for any period prior to the date of such
acquisition shall be excluded, and (iv) the cumulative effect of a change in
accounting principles shall be excluded.

     "Consolidated Net Worth" means, with respect to any Person as of any date,
the sum of (i) the consolidated equity of the common stockholders of such Person
and its consolidated Subsidiaries as of such date plus (ii) the respective
amounts reported on such Person's balance sheet as of such date with respect to
any series of preferred stock (other than Disqualified Stock), less all write-
ups (other than write-ups resulting from foreign currency translations and
write-ups of tangible assets of a going concern business made in accordance with
GAAP as a result of the acquisition of such business) subsequent to the date

                                       3
<PAGE>
 
hereof in the book value of any asset owned by such Person or a consolidated
Subsidiary of such Person, and excluding the cumulative effect of a change in
accounting principles, all as determined in accordance with GAAP.

     "Continuing Directors" means, as of any date of determination, any member
of the Board of Directors of the Company who (i) was a member of such Board of
Directors on the date hereof or (ii) was nominated for election or elected to
such Board of Directors with the affirmative vote of a majority of the
Continuing Directors who were members of such Board at the time of such
nomination or election.

     "Corporate Trust Office of the Trustee" shall be at the address of the
Trustee specified in Section 9.02 or such other address as to which the Trustee
may give notice to the Company.

     "Default" means any event that is or with the passage of time or the giving
of notice or both would be an Event of Default.

     "Disqualified Stock" means any Capital Stock that, by its terms (or by the
terms of any security into which it is convertible or for which it is
exchangeable), or upon the happening of any event, matures or is mandatorily
redeemable, pursuant to a sinking fund obligation or otherwise, or is redeemable
at the option of the Holder thereof, in whole or in part, on or prior to
September __, 2002.

     "Equity Interests" means Capital Stock and all warrants, options or other
rights to acquire Capital Stock (but excluding any debt security that is
convertible into, or exchangeable for, Capital Stock).

     "Exchange Act" means the Securities Exchange Act of 1934, as amended.

     "Existing Indebtedness" means Indebtedness of the Company and its
Subsidiaries (other than Indebtedness under the New Credit Facility) in
existence on the date hereof, until such amounts are repaid, including all
reimbursement obligations with respect to letters of credit outstanding as of
the date hereof (other than letters of credit issued pursuant to the New Credit
Facility).

     "Fixed Charge Coverage Ratio" means with respect to any Person for any
period, the ratio of the Consolidated Cash Flow of such Person for such period
to the Fixed Charges of such Person for such period; provided, however, that in
the event that the Company or any of its Subsidiaries incurs, assumes,
Guarantees or redeems any Indebtedness (other than revolving credit borrowings)
or issues preferred stock subsequent to the commencement of the period for which
the Fixed Charge Coverage Ratio is being calculated but prior to the date on
which the event for which the calculation of the Fixed Charge Coverage Ratio is
made (the "Calculation Date"), then the Fixed Charge Coverage Ratio shall be
calculated giving pro forma effect to such incurrence, assumption, Guarantee or
redemption of Indebtedness, or such issuance or redemption of preferred stock,
as if the same had occurred at the beginning of the applicable four-quarter
reference period; and

                                       4
<PAGE>
 
provided further that for purposes of making the computation referred to above,
(i) acquisitions that have been made by the Company or any of its Subsidiaries,
including through mergers or consolidations and including any related financing
transactions, during the four-quarter reference period or subsequent to such
reference period and on or prior to the Calculation Date shall be deemed to have
occurred on the first day of the four-quarter reference period, and (ii) the
Consolidated Cash Flow and Fixed Charges attributable to discontinued
operations, as determined in accordance with GAAP, and operations or businesses
disposed of prior to the Calculation Date, shall be excluded.

     "Fixed Charges" means, with respect to any Person for any period, the sum
of (i) the consolidated interest expense of such Person and its Subsidiaries for
such period, whether paid or accrued, (including, without limitation,
amortization of original issue discount, non-cash interest payments, the
interest component of any deferred payment obligations, the interest component
of all payments associated with Capital Lease Obligations, commissions,
discounts and other fees and charges incurred in respect of letters of credit or
bankers' acceptance financings, and net payments (if any) pursuant to Hedging
Obligations) and (ii) the consolidated interest expense of such Person and its
Subsidiaries that was capitalized during such period, and (iii) any interest
expense on Indebtedness of another Person that is Guaranteed by such Person or
one of its Subsidiaries or secured by a Lien on assets of such Person or one of
its Subsidiaries (whether or not such Guarantee or Lien is called upon) and (iv)
the product of (a) all cash dividend payments (and non-cash dividend payments in
the case of a Person that is a Subsidiary) on any series of preferred stock of
such Person, times (b) a fraction, the numerator of which is one and the
denominator of which is one minus the then current combined federal, state and
local statutory tax rate of such Person, expressed as a decimal, in each case,
on a consolidated basis and in accordance with GAAP.

     "GAAP" means generally accepted accounting principles set forth in the
opinions and pronouncements of the Accounting Principles Board of the American
Institute of Certified Public Accountants and statements and pronouncements of
the Financial Accounting Standards Board or in such other statements by such
other entity as have been approved by a significant segment of the accounting
profession, as in effect from time to time.

     "Government Securities" means direct obligations of, or obligations
guaranteed by, the United States of America for the payment of which guarantee
or obligations the full faith and credit of the United States is pledged.

     "Guarantee" means a guarantee (other than by endorsement of negotiable
instruments for collection in the ordinary course of business), direct or
indirect, in any manner (including, without limitation, letters of credit and
reimbursement agreements in respect thereof), of all or any part of any
Indebtedness.

     "Hedging Obligations" means, with respect to any Person, the obligations of
such Person under (i) interest rate swap agreements, interest rate cap
agreements and interest rate collar agreements, (ii) foreign exchange contracts
or currency swap agreements and

                                       5
<PAGE>
 
(iii) other agreements or arrangements designed to protect such Person against
fluctuations in interest rates or currency values.

     "Holder" means a Person in whose name a Security is registered.

     "Hospital" means a hospital, outpatient clinic, long-term care facility or
other facility that is used or useful in the provision of healthcare services.

     "Hospital Swap" means an exchange of assets by the Company or a Subsidiary
of the Company for one or more Hospitals and/or one or more Related Businesses
or for the Capital Stock of any Person owning one or more Hospitals and/or one
or more Related Businesses.

     "Indebtedness" means with respect to any Person any indebtedness of such
Person, whether or not contingent, in respect of borrowed money or evidenced by
bonds, notes, debentures or similar instruments or letters of credit (or
reimbursement agreements in respect thereof) or banker's acceptances or
representing Capital Lease Obligations or the balance deferred and unpaid of the
purchase price of any property or representing any Hedging Obligations, except
any such balance that constitutes an accrued expense or trade payable, if and to
the extent any of the foregoing indebtedness (other than letter of credit and
Hedging Obligations) would appear as a liability upon a balance sheet of such
Person prepared in accordance with GAAP, as well as all indebtedness of others
secured by a Lien on any asset of such Person (whether or not such indebtedness
is assumed by such Person) and, to the extent not otherwise included, the
Guarantee by such Person of any indebtedness of any other Person.

     "Indenture" means this Indenture, as amended or supplemented from time to
time.

     "International Subsidiaries" means International-NME, Inc., NME (Australia)
Pty. Limited, and National Medical Enterprises Corp., and each of such Person's
respective Subsidiaries.

     "Investment Grade" means a rating of BBB- or higher by S&P or Baa3 or
higher by Moody's or the equivalent of such ratings by S&P or Moody's.  In the
event that the Company shall select any other Rating Agency, the equivalent of
such ratings by such Rating Agency shall be used.

     "Investments" means, with respect to any Person, all investments by such
Person in other Persons (including Affiliates) in the form of direct or indirect
loans (including Guarantees of Indebtedness or other obligations), advances or
capital contributions, purchases or other acquisitions for consideration of
Indebtedness, Equity Interests or other securities and all other items that are
or would be classified as investments on a balance sheet prepared in accordance
with GAAP; provided that an acquisition of assets, Equity Interests or other
securities by the Company for consideration consisting of common equity
securities for the Company shall not be deemed to be an Investment.

                                       6
<PAGE>
 
     "Lien" means, with respect to any asset, any mortgage, lien, pledge,
charge, security interest or encumbrance of any kind in respect of such asset
given to secure Indebtedness, whether or not filed, recorded or otherwise
perfected under applicable law (including any conditional sale or other title
retention agreement, any lease in the nature thereof, any option or other
agreement to sell or give a security interest in and any filing of or agreement
to give any financing statement under the Uniform Commercial Code (or equivalent
statutes) of any jurisdiction with respect to any such lien, pledge, charge or
security interest).

     "Moody's" means Moody's Investors Services, Inc. and its successors.

     "Net Income" means, with respect to any Person, the net income (loss) of
such Person, determined in accordance with GAAP and before any reduction in
respect of preferred stock dividends, excluding, however, (i) any gain (but not
loss), together with any related provision for taxes on such gain (but not
loss), realized in connection with (a) any Asset Sale (including, without
limitation, dispositions pursuant to sale and leaseback transactions) or (b) the
disposition of any securities by such Person or any of its Subsidiaries or the
extinguishment of any Indebtedness of such Person or any of its Subsidiaries,
and (ii) any extraordinary or nonrecurring gain (but not loss), together with
any related provision for taxes on such extraordinary or nonrecurring gain (but
not loss).

     "Net Proceeds" means the aggregate cash proceeds received by the Company or
any of its Subsidiaries in respect of any Asset Sale (including, without
limitation, any cash received upon the sale or other disposition of any
Permitted Non-Cash Consideration received in any Asset Sale), net of the direct
costs relating to such Asset Sale (including, without limitation, legal,
accounting and investment banking fees, and sales commissions) and any other
expenses incurred or to be incurred by the Company or a Subsidiary as a direct
result of the sale of such assets (including, without limitation, severance,
relocation, lease termination and other similar expenses), taxes actually paid
or payable as a result thereof, amounts required to be applied to the repayment
of Indebtedness (other than Senior Term Debt or Senior Revolving Debt) secured
by a Lien permitted hereunder on the asset or assets that were the subject of
such Asset Sale and any reserve for adjustment in respect of the sale price of
such asset or assets established in accordance with GAAP.

     "New Credit Facility" means that certain Credit Agreement, dated as of
February __, 1995, by and among the Company and Morgan Guaranty Trust Company of
New York and the other banks that are party thereto, providing for $2.0 billion
in aggregate principal amount of Senior Term Debt and up to $500.0 million in
aggregate principal amount of Senior Revolving Debt, including any related
notes, collateral documents, instruments and agreements executed in connection
therewith, and in each case as amended, modified, extended, renewed, refunded,
replaced or refinanced, in whole or in part, from time to time.

     "Non-Cash Consideration" means any non-cash consideration received by the
Company or a Subsidiary of the Company in connection with an Asset Sale and any
non-cash consideration received by the Company or any of its Subsidiaries upon
disposition thereof.

                                       7
<PAGE>
 
     "Non-Recourse Debt" means Indebtedness of an International Subsidiary (i)
as to which neither the Company nor any of its Subsidiaries (other than the
International Subsidiaries) (a) provides credit support of any kind (including
any undertaking, agreement or instrument that would constitute Indebtedness of
the Company or any of its Subsidiaries), or (b) is directly or indirectly liable
(as a guarantor or otherwise) and (ii) no default with respect to which
(including any rights that the holders thereof may have to take enforcement
action against an International Subsidiary) would permit (upon notice, lapse of
time or both) any holder of any other Indebtedness of the Company or any of its
Subsidiaries (other than the International Subsidiaries) to declare a default on
such other Indebtedness or cause the payment thereof to be accelerated or
payable prior to its stated maturity (except any provisions set forth in
Existing Indebtedness until the same is repaid or refinanced).

     "Obligations" means any principal, interest, penalties, fees,
indemnifications, reimbursements, damages and other liabilities payable under
the documentation governing any Indebtedness.

     "Officers" means the Chairman of the Board, the Chief Executive Officer,
the President, the Chief Operating Officer, the Chief Financial Officer, the
Treasurer, any Assistant Treasurer, the Controller, the Secretary and any Vice
President of the Company or any Subsidiary, as the case may be.

     "Officers' Certificate" means a certificate signed by two Officers, one of
whom must be the principal executive officer, principal financial officer or
principal accounting officer of the Company.

     "Opinion of Counsel" means an opinion from legal counsel who is reasonably
acceptable to the Trustee.  The counsel may be an employee of or counsel to the
Company, any Subsidiary or the Trustee.

     "Payment Default" means any failure to pay any scheduled installment of
interest or principal on any Indebtedness within the grace period provided for
such payment in the documentation governing such Indebtedness.

     "Performance Investment Plan" means the 1989 Performance Investment Plan 
adopted by the Company's Board of Directors on March 10, 1989.

     "Permitted Collateral" means, collectively, (i) all Capital Stock and other
Equity Interests of the Company's present and future direct Subsidiaries, (ii)
all intercompany Indebtedness owed to the Company and (iii) all Capital Stock
and other Equity Interests in Westminster Health Care Holdings PLC and The
Hillhaven Corporation owned by the Company.

     "Permitted Liens" means (i) Liens on Permitted Collateral securing Senior
Term Debt of the Company under the New Credit Facility in an aggregate principal
amount at any time outstanding not to exceed an amount equal to $2.0 billion
less the aggregate amount of all repayments, optional or mandatory, of the
principal of any Senior Term Debt (other than repayments that are immediately
reborrowed) that have been made since the date

                                       8
<PAGE>
 
hereof; (ii) Liens on Permitted Collateral securing Senior Revolving Debt and
letters of credit of the Company incurred pursuant to the New Credit Facility in
an aggregate principal amount at any time outstanding (with letters of credit
being deemed to have a principal amount equal to the maximum potential
reimbursement obligation of the Company with respect thereto) not to exceed an
amount equal to $500.0 million less the aggregate amount of all Net Proceeds of
Asset Sales applied to permanently reduce commitments with respect to such
Indebtedness pursuant to Section 3.10 hereof; (iii) Liens in favor of the
Company; (iv) Liens on property of a Person existing at the time such Person is
merged into or consolidated with the Company or any Subsidiary of the Company;
provided, that such Liens were in existence prior to the contemplation of such
merger or consolidation and do not extend to any assets other than those of the
Person merged into or consolidated with the Company; (v) Liens on property
existing at the time of acquisition thereof by the Company or any Subsidiary of
the Company; provided that such Liens were in existence prior to the
contemplation of such acquisition; (vi) Liens to secure the performance of
statutory obligations, surety or appeal bonds, performance bonds or other
obligations of a like nature incurred in the ordinary course of business; (vii)
Liens existing or created on the date hereof; (viii) Liens for taxes,
assessments or governmental charges or claims that are not yet delinquent or
that are being contested in good faith by appropriate proceedings promptly
instituted and diligently concluded; provided that any reserve or other
appropriate provision as shall be required in conformity with GAAP shall have
been made therefor, (ix) other Liens on assets of the Company or any Subsidiary
of the Company securing Indebtedness that is permitted by the terms hereof to be
outstanding having an aggregate principal amount at any one time outstanding not
to exceed 10% of the Stockholders' Equity of the Company; and (x) Liens to
secure Permitted Refinancing Indebtedness incurred to refinance Indebtedness
that was secured by a Lien permitted hereunder and that was incurred in
accordance with the provisions hereof; provided, that such Liens do not extend
to or cover any property or assets of the Company or any Subsidiary other than
assets or property securing the Indebtedness so refinanced.

     "Permitted Refinancing Indebtedness" means any Indebtedness of the Company
or any of its Subsidiaries issued in exchange for, or the net proceeds of which
are used solely to extend, refinance, renew, replace, defease or refund, other
Indebtedness of the Company or any of its Subsidiaries; provided that, except in
the case of Indebtedness of the Company issued in exchange for, or the net
proceeds of which are used solely to extend, refinance, renew, replace, defease
or refund Indebtedness of a Subsidiary of the Company:  (i) the principal amount
of such Permitted Refinancing Indebtedness does not exceed the principal amount
of the Indebtedness so extended, refinanced, renewed, replaced, defeased or
refunded (plus the amount of any premiums paid and reasonable expenses incurred
in connection therewith); (ii) such Permitted Refinancing Indebtedness has a
final maturity date later than the final maturity date of, and has a Weighted
Average Life to Maturity equal to or greater than the Weighted Average Life to
Maturity of, the Indebtedness being extended, refinanced, renewed, replaced,
defeased or refunded; (iii) if the Indebtedness being extended, refinanced,
renewed, replaced, defeased or refunded is subordinated in right of payment to
the Securities, such Permitted Refinancing Indebtedness has a final maturity
date later than the final maturity date of, and is subordinated in right of
payment to, the Securities on terms at least as favorable to the Holders of
Securities as those contained in the documentation

                                       9
<PAGE>
 
governing the Indebtedness being extended, refinanced, renewed, replaced,
defeased or refunded; and (iv) such Indebtedness is incurred either by the
Company or by the Subsidiary who is the obligor on the Indebtedness being
extended, renewed, replaced, defeased or refunded.

     "Person" means any individual, corporation, partnership, joint venture,
association, joint-stock company, trust, unincorporated organization (including
any subdivision or ongoing business of any such entity or substantially all of
the assets of any such entity, subdivision or business).

     "Physician Joint Venture Distributions" means distributions made by the
Company or any of its Subsidiaries to any physician, pharmacist or other allied
healthcare professional in connection with the unwinding, liquidation or other
termination of any joint venture or similar arrangement between any such Person
and the Company or any of its Subsidiaries.

     "Physician Support Obligations" means any obligation or Guarantee incurred
in the ordinary course of business by the Company or a Subsidiary of the Company
in connection with any advance, loan or payment to, or on behalf of or for the
benefit of any physician, pharmacist or other allied healthcare professional for
the purpose of recruiting, redirecting or retaining the physician, pharmacist or
other allied healthcare professional to provide service to patients in the
service area of any Hospital or Related Business owned or operated by the
Company or any of its Subsidiaries; excluding, however, compensation for
services provided by physicians, pharmacists or other allied healthcare
professionals to any Hospital or Related Business owned or operated by the
Company or any of its Subsidiaries.

     "Qualified Equity Interests" shall mean all Equity Interests of the Company
other than Disqualified Stock of the Company.

     "Rating Agencies" means (i) S&P and (ii) Moody's or (iii) if S&P or Moody's
or both shall not make a rating of the Securities publicly available, a
nationally recognized securities rating agency or agencies, as the case may be,
selected by the Company, shall be substituted for S&P or Moody's or both, as the
case may be.

     "Rating Category" means (i) with respect to S&P, any of the following
categories:  BB, B, CCC, CC, C and D (or equivalent successor categories); (ii)
with respect to Moody's, any of the following categories:  Ba, B, Caa, Ca, C and
D (or equivalent successor categories); and (iii) the equivalent of any such
category of S&P or Moody's used by another Rating Agency.  In determining
whether the rating of the Securities has decreased by one or more gradations,
gradations within Rating Categories (+ and - for S&P, 1, 2 and 3 for Moody's; or
the equivalent gradations for another Rating Agency) shall be taken into account
(e.g., with respect to S&P, a decline in a rating from BB+ to BB, as well as
from BB- to B+, will constitute a decrease of one gradation).

                                       10
<PAGE>
 
     "Rating Date" means the date which is 90 days prior to the earlier of (i) a
Change of Control and (ii) the first public notice of the occurrence of a Change
of Control or of the intention by the Company to effect a Change of Control.

     "Rating Decline" means the occurrence on or within 90 days after the date
of the first public notice of the occurrence of a Change of Control or of the
intention by the Company to effect a Change of Control (which period shall be
extended so long as the rating of the Securities is under publicly announced
consideration for possible downgrade by any of the Rating Agencies) of:  (a) in
the event the Securities are rated by either Moody's or S&P on the Rating Date
as Investment Grade, a decrease in the rating of the Securities by both Rating
Agencies to a rating that is below Investment Grade, or (b) in the event the
Securities are rated below Investment Grade by both Rating Agencies on the
Rating Date, a decrease in the rating of the Securities by either Rating Agency
by one or more gradations (including gradations within Rating Categories as well
as between Rating Categories).

     "Refinancing" has the meaning ascribed to it in the prospectus dated
January 31, 1995 relating to the Securities.

     "Related Business" means a healthcare business affiliated or associated
with a Hospital or any business related or ancillary to the provision of
healthcare services or the operation of a Hospital.

     "Responsible Officer" when used with respect to the Trustee, means any
officer within the corporate trust department of the Trustee (or any successor
group of the Trustee) or any other officer of the Trustee customarily performing
functions similar to those performed by any of the above designated officers and
also means, with respect to a particular corporate trust matter, any other
officer to whom such matter is referred because of his knowledge of and
familiarity with the particular subject.

     "Restricted Investment" means an Investment in any of the International
Subsidiaries.

     "Securities" means the securities described above, issued under this
Indenture.

     "Securities Act" means the Securities Act of 1933, as amended.

     "Senior Revolving Debt" means revolving credit loans outstanding from time
to time under the New Credit Facility.

     "Senior Subordinated Asset Sale Offer" means the offer to purchase Senior
Subordinated Notes made by the Company to holders of Senior Subordinated Notes
under Section 4.10 of the Senior Subordinated Note Indenture.

     "Senior Subordinated Notes" means the ____% Senior Subordinated Notes due
2005 of the Company limited in aggregate principal amount of $700.0 million,
issued pursuant to the Senior Subordinated Note Indenture.

                                       11
<PAGE>
 
     "Senior Subordinated Note Indenture" means the Indenture dated as of March
__, 1995 between the Company and The Bank of New York, as trustee, under which
the Senior Subordinated Notes were issued.

     "Senior Term Debt" means term loans outstanding from time to time under the
New Credit Facility.

     "Significant Subsidiary" means any Subsidiary that would be a "significant
subsidiary" as defined in Article 1, Rule 1-02 of Regulation S-X, promulgated
pursuant to the Act, as such Regulation is in effect on the date hereof.

     "S&P" means Standard & Poor's Corporation and its successors.

     "Specified Assets" means the Company's and its Subsidiaries' interest in
The Hillhaven Corporation and Westminster Healthcare Holdings PLC owned as of
the date hereof and the Capital Stock and assets of the International
Subsidiaries.

     "Stockholders' Equity" means, with respect to any Person as of any date,
the stockholders' equity of such Person determined in accordance with GAAP as of
the date of the most recent available internal financial statements of such
Person, and calculated on a pro forma basis to give effect to any acquisition or
disposition by such Person consummated or to be consummated since the date of
such financial statements and on or prior to the date of such calculation.

     "Subsidiary" means, with respect to any Person, (i) any corporation,
association or other business entity of which more than 50% of the total voting
power of shares of Capital Stock entitled (without regard to the occurrence of
any contingency) to vote in the election of directors, managers or trustees
thereof is at the time owned or controlled, directly or indirectly, by such
Person or one or more of the other Subsidiaries of that Person (or a combination
thereof) and (ii) any partnership (a) the sole general partner or the managing
general partner of which is such Person or a Subsidiary of such Person or (b)
the only general partners of which are such Person or of one or more
Subsidiaries of such Person (or any combination thereof), provided that no
International Subsidiary shall be deemed to be a "Subsidiary" for any purpose
hereunder for so long as such International Subsidiary:  (a) has no Indebtedness
other than Existing Indebtedness and Non-Recourse Debt; (b) is not a party to
any agreement, contract, arrangement or understanding with the Company or any of
its other Subsidiaries (other than International Subsidiaries) except any such
agreement, contract, arrangement or understanding that (i) was in effect on the
date hereof, or (ii) meets the requirements of Section 3.11 hereof; (c) is a
Person with respect to which neither the Company nor any of its Subsidiaries
(other than International Subsidiaries) has any direct or indirect obligation
(x) to subscribe for additional Equity Interests or (y) to maintain or preserve
such Person's financial condition or to cause such Person to achieve any
specified level of operating results except, in each case, any such obligation
in existence on the date hereof or created pursuant to the terms of any
Investment permitted by Section 3.07; and (d) has not Guaranteed or otherwise
directly or indirectly provided credit support for any Indebtedness of the
Company or any of its Subsidiaries (other than International

                                       12
<PAGE>
 
Subsidiaries).  If, at any time, any International Subsidiary would fail to meet
the foregoing requirements, it shall thereafter be deemed to be a Subsidiary for
all purposes of this Indenture and any Indebtedness of such International
Subsidiary shall be deemed to be incurred by a Subsidiary of the Company as of
such date (and, if such Indebtedness is not permitted to be incurred as of such
date under Section 3.09 hereof the Company shall be in default of such
covenant).

     "TIA" means the Trust Indenture Act of 1939, as amended (15 U.S.C. (S)
77aaa-77bbbb) as in effect on the date on which this Indenture is qualified
under the TIA, except as provided in Section 8.03 hereof.

     "Transfer Restriction" means, with respect to the Company's Subsidiaries,
any encumbrance or restriction on the ability of any Subsidiary to (i) pay
dividends or make any other distributions to the Company or any of its
Subsidiaries (a) on its Capital Stock or (b) with respect to any other interest
or participation in, or measured by, its profits, (ii) pay any Indebtedness owed
to the Company or any of its Subsidiaries, (iii) make loans or advances to the
Company or any of its Subsidiaries, or (iv) transfer any of its properties or
assets to the Company or any of its Subsidiaries.

     "Trustee" means the party named as such above until a successor replaces it
in accordance with the applicable provisions of this Indenture and thereafter
means the successor serving hereunder.

     "Weighted Average Life to Maturity" means, when applied to any Indebtedness
at any date, the number of years obtained by dividing (i) the sum of the
products obtained by multiplying (a) the amount of each then remaining
installment, sinking fund, serial maturity or other required payments of
principal, including payment at final maturity, in respect thereof, by (b) the
number of years (calculated to the nearest one-twelfth) that will elapse between
such date and the making of such payment, by (ii) the then outstanding principal
amount of such Indebtedness.

     "Wholly Owned Subsidiary" of any Person means any Subsidiary of such Person
all of the outstanding Capital Stock or other ownership interests of which
(other than directors' qualifying shares) shall at the time be owned by such
Person or by one or more Wholly Owned Subsidiaries of such Person and one or
more Wholly Owned Subsidiaries of such Person.
<TABLE>
<CAPTION>
 
Section 1.02.   Other Definitions.

                                         Defined in
     Term                                 Section
     ----                                ---------- 
     <S>                                   <C> 
     "Affiliate Transaction"............   3.11
     "Bankruptcy Law"...................   5.01
     "Change of Control Offer"..........   3.13
     "Change of Control Payment"........   3.13
     "Change of Control Payment Date"...   3.13
     "Commencement Date"................   2.15
 
</TABLE>

                                       13
<PAGE>
 
<TABLE>
     <S>                                   <C>
     "Covenant Defeasance"..............   7.03
     "Custodian"........................   5.01
     "Event of Default".................   5.01
     "Excess Proceeds"..................   3.10
     "incur"............................   3.09
     "Legal Defeasance".................   7.02
     "Legal Holiday"....................   9.07
     "Notice of Default"................   5.01
     "Offer Amount".....................   2.15
     "Offer Period".....................   2.15
     "Paying Agent".....................   2.03
     "Purchase Date"....................   2.15
     "Purchase Price"...................   3.10
     "Registrar"........................   2.03
     "Restricted Payments"..............   3.07
     "Senior Asset Sale Offer"..........   3.10
 
</TABLE>

Section 1.03.  Incorporation by Reference of TIA.

          Whenever this Indenture refers to a provision of the TIA, the
provision is incorporated by reference in and made a part of this Indenture.

          The following TIA terms used in this Indenture have the following
meanings:

          "indenture securities" means the Securities;

          "indenture security holder" means a Holder;

          "indenture to be qualified" means this Indenture;

          "indenture trustee" or "institutional trustee" means the Trustee;

          "obligor" on the Securities means the Company and any successor
obligor upon the Securities.

          All other terms used in this Indenture that are defined by the TIA,
defined by TIA reference to another statute or defined by the Commission rule
under the TIA have the meanings so assigned to them.

Section 1.04.  Rules of Construction.

          Unless the context otherwise requires:

          (1) a term has the meaning assigned to it;

                                       14
<PAGE>
 
          (2) an accounting term not otherwise defined has the meaning assigned
     to it in accordance with GAAP;

          (3)  "or" is not exclusive;

          (4) words in the singular include the plural, and in the plural
     include the singular; and

          (5) provisions apply to successive events and transactions.


                                   ARTICLE 2
                                 THE SECURITIES

Section 2.01.  Form and Dating.

          The Securities and the Trustee's certificate of authentication shall
be substantially in the form of Exhibit A hereto, the terms of which are
incorporated in and made a part of this Indenture. The Securities may have
notations, legends or endorsements approved as to form by the Company and
required by law, stock exchange rule, agreements to which the Company is subject
or usage. Each Security shall be dated the date of its authentication. The
Securities shall be issuable only in registered form, without coupons, in
denominations of $1,000 and integral multiples thereof.

Section 2.02.  Execution and Authentication.

          An Officer of the Company shall sign the Securities for the Company by
manual or facsimile signature. The Company's seal shall be reproduced on the
Securities and may be in facsimile form.

          If an Officer whose signature is on a Security no longer holds that
office at the time the Security is authenticated, the Security shall
nevertheless be valid.

          A Security shall not be valid until authenticated by the manual
signature of the Trustee. The signature of the Trustee shall be conclusive
evidence that the Security has been authenticated under this Indenture. The form
of Trustee's certificate of authentication to be borne by the Securities shall
be substantially as set forth in Exhibit A hereto.

          The Trustee shall, upon a written order of the Company signed by two
Officers of the Company, authenticate Securities for original issue up to an
aggregate principal amount stated in paragraph 4 of the Securities. The
aggregate principal amount of Securities outstanding at any time shall not
exceed the amount set forth herein except as provided in Section 2.07.

          The Trustee may appoint an authenticating agent acceptable to the
Company to authenticate Securities. Unless limited by the terms of such
appointment, an authenticating

                                       15
<PAGE>
 
agent may authenticate Securities whenever the Trustee may do so. Each reference
in this Indenture to authentication by the Trustee includes authentication by
such agent. An authenticating agent has the same rights as an Agent to deal with
the Company or an Affiliate of the Company.

Section 2.03.  Registrar and Paying Agent.

          The Company shall maintain (i) an office or agency where Securities
may be presented for registration of transfer or for exchange (including any co-
registrar, the "Registrar") and (ii) an office or agency where Securities may be
presented for payment (the "Paying Agent"). The Registrar shall keep a register
of the Securities and of their transfer and exchange. The Company may appoint
one or more co-registrars and one or more additional paying agents. The term
"Paying Agent" includes any additional paying agent. The Company may change any
Paying Agent, Registrar or co-registrar without prior notice to any Holder. The
Company shall notify the Trustee and the Trustee shall notify the Holders of the
name and address of any Agent not a party to this Indenture. If the Company
fails to appoint or maintain another entity as Registrar or Paying Agent, the
Trustee shall act as such. The Company or any of its Subsidiaries may act as
Paying Agent, Registrar or co-registrar. The Company shall enter into an
appropriate agency agreement with any Agent not a party to this Indenture, which
shall incorporate the provisions of the TIA. The agreement shall implement the
provisions of this Indenture that relate to such Agent. The Company shall notify
the Trustee of the name and address of any such Agent. If the Company fails to
maintain a Registrar or Paying Agent, or fails to give the foregoing notice, the
Trustee shall act as such, and shall be entitled to appropriate compensation in
accordance with Section 6.07 hereof.

          The Company initially appoints the Trustee as Registrar, Paying Agent
and agent for service of notices and demands in connection with the Securities.

Section 2.04.  Paying Agent to Hold Money in Trust.

          On or prior to the due date of principal of, premium, if any, and
interest on any Securities, the Company shall deposit with the Trustee or the
Paying Agent money sufficient to pay such principal, premium, if any, and
interest becoming due. The Company shall require each Paying Agent other than
the Trustee to agree in writing that the Paying Agent shall hold in trust for
the benefit of the Holders or the Trustee all money held by the Paying Agent for
the payment of principal of, premium, if any, and interest on the Securities,
and shall notify the Trustee of any Default by the Company in making any such
payment. While any such Default continues, the Trustee may require a Paying
Agent to pay all money held by it to the Trustee. The Company at any time may
require a Paying Agent to pay all money held by it to the Trustee. Upon payment
over to the Trustee, the Paying Agent (if other than the Company) shall have no
further liability for the money delivered to the Trustee. If the Company acts as
Paying Agent, it shall segregate and hold in a separate trust fund for the
benefit of the Holders all money held by it as Paying Agent.

                                       16
<PAGE>
 
Section 2.05.  Holder Lists.

          The Trustee shall preserve in as current a form as is reasonably
practicable the most recent list available to it of the names and addresses of
Holders and shall otherwise comply with TIA (S) 312(a). If the Trustee is not
the Registrar, the Company shall furnish to the Trustee at least seven Business
Days before each interest payment date and at such other times as the Trustee
may request in writing a list in such form and as of such date as the Trustee
may reasonably require of the names and addresses of Holders, including the
aggregate principal amount of the Securities held by each thereof, and the
Company shall otherwise comply with TIA (S) 312(a).

Section 2.06.  Transfer and Exchange.

          When Securities are presented to the Registrar with a request to
register the transfer or to exchange them for an equal principal amount of
Securities of other denominations, the Registrar shall register the transfer or
make the exchange if its requirements for such transactions are met; provided,
however, that any Security presented or surrendered for registration of transfer
or exchange shall be duly endorsed or accompanied by a written instruction of
transfer in form satisfactory to the Registrar and the Trustee duly executed by
the Holder thereof or by his attorney duly authorized in writing. To permit
registrations of transfer and exchanges, the Company shall issue and the Trustee
shall authenticate Securities at the Registrar's request, subject to such rules
as the Trustee may reasonably require.

          Neither the Company nor the Registrar shall be required to register
the transfer or exchange of a Security between the record date and the next
succeeding interest payment date.

          No service charge shall be made to any Holder for any registration of
transfer or exchange (except as otherwise expressly permitted herein), but the
Company may require payment of a sum sufficient to cover any transfer tax or
similar governmental charge payable in connection therewith (other than such
transfer tax or similar governmental charge payable upon exchanges pursuant to
Sections 2.10 or 8.05 hereof, which shall be paid by the Company).

          Prior to due presentment for registration of transfer of any Security,
the Trustee, any Agent and the Company may deem and treat the Person in whose
name any Security is registered as the absolute owner of such Security for the
purpose of receiving payment of principal of, premium, if any, and interest on
such Security and for all other purposes whatsoever, whether or not such
Security is overdue, and neither the Trustee, any Agent nor the Company shall be
affected by notice to the contrary.

Section 2.07.  Replacement Securities.

          If any mutilated Security is surrendered to the Trustee or the
Company, or the Trustee receives evidence to its satisfaction of the
destruction, loss or theft of any Security,

                                       17
<PAGE>
 
the Company shall issue and the Trustee, upon written order of the Company
signed by two Officers of the Company, shall authenticate a replacement Security
if the Trustee's requirements for replacements of Securities are met. If
required by the Trustee or the Company, an indemnity bond must be supplied by
the Holder that is sufficient in the judgment of the Trustee and the Company to
protect the Company, the Trustee, any Agent and any authenticating agent from
any loss which any of them may suffer if a Security is replaced. Each of the
Company and the Trustee may charge for its expenses in replacing a Security.

          Every replacement Security is an additional obligation of the
Company.

Section 2.08.  Outstanding Securities.

          The Securities outstanding at any time are all the Securities
authenticated by the Trustee except for those cancelled by it, those delivered
to it for cancellation and those described in this Section as not outstanding.

          If a Security is replaced pursuant to Section 2.07 hereof, it ceases
to be outstanding unless the Trustee receives proof satisfactory to it that the
replaced Security is held by a bona fide purchaser.

          If the principal amount of any Security is considered paid under
Section 3.01 hereof, it ceases to be outstanding and interest on it ceases to
accrue.

          Subject to Section 2.09 hereof, a Security does not cease to be
outstanding because the Company or an Affiliate of the Company holds the
Security.

Section 2.09.  Treasury Securities.

          In determining whether the Holders of the required principal amount of
Securities then outstanding, have concurred in any demand, direction, waiver or
consent, Securities owned by the Company or any Affiliate of the Company shall
be considered as though not outstanding, except that for purposes of determining
whether the Trustee shall be protected in relying on any such demand, direction,
waiver or consent, only Securities which a Responsible Officer actually knows to
be so owned shall be so considered. Notwithstanding the foregoing, Securities
that are to be acquired by the Company or an Affiliate of the Company pursuant
to an exchange offer, tender offer or other agreement shall not be deemed to be
owned by the Company or an Affiliate of the Company until legal title to such
Securities passes to the Company or Affiliate, as the case may be.

Section 2.10.  Temporary Securities.

          Until definitive Securities are ready for delivery, the Company may
prepare and the Trustee, upon receipt of the written order of the Company signed
by two Officers of the Company, shall authenticate temporary Securities.
Temporary Securities shall be substantially in the form of definitive Securities
but may have variations that the Company and the Trustee consider appropriate
for temporary Securities. Without unreasonable delay,

                                       18
<PAGE>
 
the Company shall prepare and the Trustee, upon receipt of the written order of
the Company signed by two Officers of the Company, shall authenticate definitive
Securities in exchange for temporary Securities. Until such exchange, temporary
Securities shall be entitled to the same rights, benefits and privileges as
definitive Securities.

Section 2.11.  Cancellation.

          The Company at any time may deliver Securities to the Trustee for
cancellation. The Registrar and Paying Agent shall forward to the Trustee any
Securities surrendered to them for registration of transfer, exchange or
payment. The Trustee shall cancel all Securities surrendered for registration of
transfer, exchange, payment, replacement or cancellation and shall return such
cancelled Securities to the Company. The Company may not issue new Securities to
replace Securities that it has paid or that have been delivered to the Trustee
for cancellation.

Section 2.12.  Defaulted Interest.

          If the Company defaults in a payment of interest on the Securities, it
shall pay the defaulted interest in any lawful manner plus, to the extent
lawful, interest payable on the defaulted interest, to the Persons who are
Holders on a subsequent special record date, which date shall be at the earliest
practicable date but in all events at least five Business Days prior to the
payment date, in each case at the rate provided in the Securities and in Section
3.01 hereof. The Company shall, with the consent of the Trustee, fix or cause to
be fixed each such special record date and payment date. At least 15 days before
the special record date, the Company (or the Trustee, in the name of and at the
expense of the Company) shall mail to Holders a notice that states the special
record date, the related payment date and the amount of such interest to be
paid.

Section 2.13.  Record Date.

          The record date for purposes of determining the identity of Holders
entitled to vote or consent to any action by vote or consent authorized or
permitted under this Indenture shall be determined as provided for in TIA (S)
316(c).

Section 2.14.  CUSIP Number.

          The Company in issuing the Securities may use a "CUSIP" number, and if
it does so, the Trustee shall use the CUSIP number in notices to Holders;
provided that any such notice may state that no representation is made as to the
correctness or accuracy of the CUSIP number printed in the notice or on the
Securities, and that reliance may be placed only on the other identification
numbers printed on the Securities. The Company will promptly notify the Trustee
of any change in the CUSIP number.

                                       19
<PAGE>
 
Section 2.15.  Offer to Purchase By Application of Excess Proceeds.

          In the event that the Company shall commence a Senior Asset Sale Offer
pursuant to Section 3.10 hereof, it shall follow the procedures specified below:

          No later than the date on which the aggregate amount of Excess
Proceeds exceeds $25.0 million, the Company shall notify the Trustee of such
Senior Asset Sale Offer and provide the Trustee with an Officers' Certificate
setting forth, in addition to the information to be included therein pursuant to
Section 3.10 the calculations used in determining the amount of Net Proceeds to
be applied to the purchase of Securities. The Company shall commence or cause to
be commenced the Senior Asset Sale Offer on a date no later than 10 Business
Days after such notice (the "Commencement Date").

          The Senior Asset Sale Offer shall remain open for at least 20 Business
Days after the Commencement Date relating to such Senior Asset Sale Offer and
shall remain open for no more than such 20 Business Days, except to the extent
required by applicable law (as so extended, the "Offer Period"). No later than
one Business Day after the termination of the Offer Period (the "Purchase
Date"), the Company shall purchase the principal amount (the "Offer Amount") of
Securities required to be purchased in such Senior Asset Sale Offer pursuant to
Sections 2.15 and 3.10 hereof or, if less than the Offer Amount has been
tendered, all Securities tendered in response to the Senior Asset Sale Offer.

          If the Purchase Date is on or after an interest payment record date
and on or before the related interest payment date, any accrued interest shall
be paid to the Person in whose name a Security is registered at the close of
business on such record date, and no additional interest shall be payable to
Holders who tender Securities pursuant to the Senior Asset Sale Offer.

          On the Commencement Date of any Senior Asset Sale Offer, the Company
shall send, by first class mail, a notice to each of the Holders at their last
registered address, with a copy to the Trustee. Such notice, which shall govern
the terms of the Senior Asset Sale Offer, shall contain all instructions and
materials necessary to enable the Holders to tender Securities pursuant to the
Senior Asset Sale Offer and shall state:

               (1)  that the Senior Asset Sale Offer is being made pursuant to
                    this Section 2.15 and Section 3.10 hereof and the length of
                    time the Senior Asset Sale Offer shall remain open; 

               (2)  the Offer Amount, the Purchase Price and the Purchase Date; 

               (3)  that any Security not tendered or accepted for payment shall
                    continue to accrue interest; 

               (4)  that, unless the Company defaults in the payment of the
                    Purchase Price, any Security accepted for payment pursuant
                    to

                                       20
<PAGE>
 
                    the Senior Asset Sale Offer shall cease to accrue interest
                    after the Purchase Date;

               (5)  that Holders electing to have a Security purchased pursuant
                    to any Senior Asset Sale Offer shall be required to
                    surrender the Security, with the form entitled "Option of
                    Holder to Elect Purchase" on the reverse of the Security
                    completed, to the Company, a depositary, if appointed by the
                    Company, or a Paying Agent at the address specified in the
                    notice prior to the close of business on the Business Day
                    preceding the Purchase Date;

               (6)  that Holders shall be entitled to withdraw their election if
                    the Company, depositary or Paying Agent, as the case may be,
                    receives, not later than the close of business on the
                    Business Day preceding the termination of the Offer Period,
                    a facsimile transmission or letter setting forth the name of
                    the Holder, the principal amount of the Security the Holder
                    delivered for purchase and a statement that such Holder is
                    withdrawing his election to have the Security purchased;

               (7)  that, if the aggregate principal amount of Securities
                    surrendered by Holders exceeds the Offer Amount, the Trustee
                    shall select the Securities to be purchased on a pro rata
                    basis (with such adjustments as may be deemed appropriate by
                    the Trustee so that only Securities in denominations of
                    $1,000, or integral multiples thereof, shall be purchased);
                    and

               (8)  that Holders whose Securities were purchased only in part
                    shall be issued new Securities equal in principal amount to
                    the unpurchased portion of the Securities surrendered.

          On or before the Purchase Date, the Company shall irrevocably deposit
with the Trustee or Paying Agent in immediately available funds the aggregate
Purchase Price with respect to a principal amount of Securities equal to the
Offer Amount, together with accrued interest thereon, to be held for payment in
accordance with the terms of this Section.  On the Purchase Date, the Company
shall, to the extent lawful, (i) accept for payment, on a pro rata basis to the
extent necessary, an aggregate principal amount equal to the Offer Amount of
Securities tendered pursuant to the Senior Asset Sale Offer, or if less than the
Offer Amount has been tendered, all Securities or portion thereof tendered, (ii)
deliver or cause the Paying Agent or depositary, as the case may be, to deliver
to the Trustee Securities so accepted and (iii) deliver to the Trustee an
Officers' Certificate stating that such Securities or portions thereof were
accepted for payment by the Company in accordance with the terms of this Section
2.15.  The Company, depositary or Paying Agent, as the case may be, shall
promptly (but in any case not later than two Business Days after the Purchase
Date) mail or deliver to each tendering Holder an amount equal to the Purchase
Price plus accrued and

                                       21
<PAGE>
 
unpaid interest with respect to the Securities tendered by such Holder and
accepted by the Company for purchase, and the Company shall promptly issue a new
Security, and the Trustee shall authenticate and mail or deliver such new
Security, to such Holder, equal in principal amount to any unpurchased portion
of such Holder's Securities surrendered.  Any Security not accepted in the
Senior Asset Sale Offer shall be promptly mailed or delivered by the Company to
the Holder thereof.  The Company shall publicly announce in a newspaper of
general circulation the results of the Senior Asset Sale Offer on the Purchase
Date.

          The Senior Asset Sale Offer shall be made by the Company in compliance
with all applicable laws, including, without limitation, Regulation 14E of the
Exchange Act and the rules thereunder and all other applicable federal and state
securities laws.

                                   ARTICLE 3
                                   COVENANTS

Section 3.01.  Payment of Securities.

          The Company shall pay or cause to be paid the principal of, premium,
if any, and interest on the Securities on the dates and in the manner provided
in this Indenture and the Securities.  Principal, premium, if any, and interest
shall be considered paid on the date due if the Paying Agent, if other than the
Company or a Subsidiary of the Company, holds as of 10:00 a.m. Eastern Time on
the due date money deposited by the Company in immediately available funds and
designated for and sufficient to pay all principal, premium, if any, and
interest then due.  Such Paying Agent shall return to the Company, no later than
five days following the date of payment, any money (including accrued interest)
that exceeds such amount of principal, premium, if any, and interest to be paid
on the Securities.

          The Company shall pay interest (including post-petition interest in
any proceeding under any Bankruptcy Law) on overdue principal at the rate equal
to 1% per annum in excess of the interest rate then applicable to the Securities
to the extent lawful.  In addition, it shall pay interest (including post-
petition interest in any proceeding under any Bankruptcy Law) on overdue
installments of interest (without regard to any applicable grace period) at the
same rate to the extent lawful.

Section 3.02.  Maintenance of Office or Agency.

          The Company shall maintain in the Borough of Manhattan, the City of
New York, an office or agency (which may be an office of the Trustee or an
affiliate of the Trustee, Registrar or co-registrar) where Securities may be
surrendered for registration of transfer or exchange and where notices and
demands to or upon the Company in respect of the Securities and this Indenture
may be served.  The Company shall give prompt written notice to the Trustee of
the location, and any change in the location, of such office or agency.  If at
any time the Company shall fail to maintain any such required office or agency
or shall fail to furnish the Trustee with the address thereof, such
presentations, surrenders, notices and demands may be made or served at the
Corporate Trust Office of the Trustee.

                                       22
<PAGE>
 
          The Company may also from time to time designate one or more other
offices or agencies where the Securities may be presented or surrendered for any
or all such purposes and may from time to time rescind such designations;
provided, however, that no such designation or rescission shall in any manner
relieve the Company of its obligation to maintain an office or agency in the
Borough of Manhattan, the City of New York for such purposes.  The Company shall
give prompt written notice to the Trustee of any such designation or rescission
and of any change in the location of any such other office or agency.

          The Company hereby designates The Bank of New York, 101 Barclay
Street, 21 West, New York, New York 10286 as one such office or agency of the
Company in accordance with Section 2.03.

Section 3.03.  Commission Reports.

          (i) So long as any of the Securities remain outstanding, the Company
shall file with the Trustee within 15 days after the filing thereof with the
Commission copies of the annual reports and of the information, documents and
other reports (or copies of such portions of any of the foregoing as the
Commission may by rule and regulations prescribe) which the Company is required
to file with the Commission pursuant to Section 13 or 15(d) of the Exchange Act.
All obligors on the Securities shall comply with the provisions of TIA (S)
314(a).  Notwithstanding that the Company may not be required to be subject to
the reporting requirements of Section 13 or 15(d) of the Exchange Act or
otherwise report on an annual and quarterly basis on forms provided for such
annual and quarterly reporting pursuant to rules and regulations promulgated by
the Commission, the Company will file with the Commission and provide the
Trustee (a) within 90 days after the end of each fiscal year, annual reports on
Form 10-K (or any successor or comparable form) containing the information
required to be contained therein (or required in such successor or comparable
form), including a "Management's Discussion and Analysis of Financial Condition
and Results of Operations" and a report thereon by the Company's certified
public accountants; (b) within 45 days after the end of each of the first three
fiscal quarters of each fiscal year, reports on Form 10-Q (or any successor or
comparable form) containing the information required to be contained therein (or
required in any successor or comparable form) including a "Management's
Discussion and Analysis of Financial Condition and Results of Operations"; and
(c) promptly from time to time after the occurrence of an event required to be
therein reported, such other reports on Form 8-K (or any successor or comparable
form) containing the information required to be contained therein (or required
in any successor or comparable form); provided, however, that the Company shall
not be in default of the provisions of this Section 3.03(i) for any failure to
file reports with the Commission solely by the refusal by the Commission to
accept the same for filing.  Each of such reports will be prepared in accordance
with generally accepted accounting principles.  The Company will in all cases,
without cost to each recipient, provide copies of such information to the
Holders.

          (ii) The Trustee, at the Company's expense, will promptly mail copies
of such annual reports, information, documents and other reports filed with the
Trustee pursuant

                                       23
<PAGE>
 
to Section 3.03 to the Holders at their addresses appearing in the register of
Securities maintained by the Registrar.

          (iii)  If filing such annual reports, information, documents and other
reports with the Commission is not permitted under the Exchange Act or the rules
and regulations of the Commission, the Company shall, after the dates for filing
set forth above, promptly upon written request make copies of such annual
reports, information, documents and other reports available to prospective
purchasers of the Securities, and to securities analysts and broker-dealers upon
their request.

          (iv) The Company shall provide the Trustee with a sufficient number of
copies of all reports and other documents and information that the Trustee may
be required to deliver to the Holders under this Section 3.03.

          (v)  Delivery of such reports, information and documents to the
Trustee is for informational purposes only and the Trustee's receipt of such
shall not constitute constructive notice of any information contained therein or
determinable from information contained therein, including the Company's
compliance with any of its covenants hereunder (as to which the Trustee is
entitled to rely exclusively on Officers' Certificates).

Section 3.04.  Compliance Certificate.

          (i)  The Company shall deliver to the Trustee, within 120 days after
the end of each fiscal year, an Officers' Certificate stating that a review of
the activities of the Company and its Subsidiaries during the preceding fiscal
year has been made under the supervision of the signing Officers with a view to
determining whether each has kept, observed, performed and fulfilled its
obligations under this Indenture, and further stating, as to each such Officer
signing such certificate, that to the best of his or her knowledge each entity
has kept, observed, performed and fulfilled each and every covenant contained in
this Indenture and is not in default in the performance or observance of any of
the terms, provisions and conditions of this Indenture (or, if a Default or
Event of Default shall have occurred, describing all such Defaults or Events of
Default of which he or she may have knowledge and what action each is taking or
proposes to take with respect thereto), all without regard to periods of grace
or notice requirements, and that to the best of his or her knowledge no event
has occurred and remains in existence by reason of which payments on account of
the principal of or interest, if any, on the Securities is prohibited or if such
event has occurred, a description of the event and what action each is taking or
proposes to take with respect thereto.

          (ii)  So long as not contrary to the then current recommendations of
the American Institute of Certified Public Accountants, the year-end financial
statements delivered pursuant to Section 3.03 above shall be accompanied by a
written statement of the Company's certified independent public accountants (who
shall be a firm of established national reputation) that in making the
examination necessary for certification of such financial statements nothing has
come to their attention which would lead them to believe that the Company or any
Subsidiary of the Company has violated any provisions of Article 3 or

                                       24
<PAGE>
 
of Article 4 of this Indenture or, if any such violation has occurred,
specifying the nature and period of existence thereof, it being understood that
such accountants shall not be liable directly or indirectly to any Person for
any failure to obtain knowledge of any such violation.

          (iii)  The Company shall, so long as any of the Securities are
outstanding, deliver to the Trustee, forthwith upon any Officer becoming aware
of (a) any Default or Event of Default or (b) any event of default under any
other mortgage, indenture or instrument, an Officers' Certificate specifying
such Default, Event of Default or event of default and what action the Company
is taking or proposes to take with respect thereto.

Section 3.05.  Taxes.

          The Company shall pay, and shall cause each of its Subsidiaries to
pay, prior to delinquency, all material taxes, assessments, and governmental
levies except (i) as contested in good faith by appropriate proceedings and with
respect to which appropriate reserves have been taken in accordance with GAAP or
(ii) where the failure to effect such payment is not adverse in any material
respect to the Holders.

Section 3.06.  Stay, Extension and Usury Laws.

          The Company covenants (to the extent that it may lawfully do so) that
it shall not at any time insist upon, plead, or in any manner whatsoever claim
or take the benefit or advantage of, any stay, extension or usury law wherever
enacted, now or at any time hereafter in force, that may affect the covenants or
the performance of this Indenture; and the Company (to the extent that it may
lawfully do so) hereby expressly waives all benefit or advantage of any such
law, and covenants that it shall not, by resort to any such law, hinder, delay
or impede the execution of any power herein granted to the Trustee, but shall
suffer and permit the execution of every such power as though no such law has
been enacted.

Section 3.07.  Limitations on Restricted Payments.

          The Company shall not, and shall not permit any of its Subsidiaries
to, directly or indirectly:  (i) declare or pay any dividend or make any
distribution on account of the Company's or any of its Subsidiaries' Equity
Interests (other than (w) Physician Joint Venture Distributions, (x) dividends
or distributions payable in Qualified Equity Interests of the Company, (y)
dividends or distributions payable to the Company or any Subsidiary of the
Company and (z) dividends or distributions by any Subsidiary of the Company
payable to all holders of a class of Equity Interests of such Subsidiary on a
pro rata basis); (ii) purchase, redeem or otherwise acquire or retire for value
any class of Equity Interests of the Company; (iii) make any principal payment
on, or purchase, redeem, defease or otherwise acquire or retire for value any
Indebtedness that is subordinated to the Securities issued hereunder, except at
the original final maturity date thereof or pursuant to the Refinancing; or (iv)
make any Restricted Investment (all such payments and other actions set forth in
clauses (i) through (iv) above being collectively referred to as "Restricted
Payments"), unless at the time of and after giving effect to such Restricted
Payment (the amount of any such Restricted Payment, if other than cash, shall be
the fair market value (as conclusively evidenced by a resolution of

                                       25
<PAGE>
 
the Board of Directors set forth in an Officers' Certificate delivered to the
Trustee within 60 days prior to the date of such Restricted Payment) of the
asset(s) proposed to be transferred by the Company or such Subsidiary, as the
case may be, pursuant to such Restricted Payment):

          (a)  no Default or Event of Default shall have occurred and be
               continuing at the time of such Restricted Payment or would occur
               as a consequence thereof; and

          (b)  the Company would, at the time of such Restricted Payment and
               after giving pro forma effect thereto as if such Restricted
               Payment had been made at the beginning of the most recently ended
               four full fiscal quarter period for which internal financial
               statements are available immediately preceding the date of such
               Restricted Payment, have been permitted to incur at least $1.00
               of additional Indebtedness pursuant to the Fixed Charge Coverage
               Ratio test set forth in the first paragraph of Section 3.09; and

          (c)  such Restricted Payment, together with the aggregate of all other
               Restricted Payments (other than Restricted Payments made pursuant
               to clauses (ii), (iii), (iv) and (v) of the following paragraph)
               made by the Company and its Subsidiaries after the date hereof,
               is less than the sum of (1) 50% of the Consolidated Net Income of
               the Company for the period (taken as one accounting period) from
               the first day of the first full fiscal quarter commencing after
               the date hereof to the end of the Company's most recently ended
               full fiscal quarter for which internal financial statements are
               available at the time of such Restricted Payment (or, if such
               Consolidated Net Income for such period is a deficit, less 100%
               of such deficit), plus (2) 100% of the aggregate net cash
               proceeds received by the Company from the issue or sale (other
               than to a Subsidiary of the Company) since the date hereof of (A)
               Qualified Equity Interests of the Company or (B) debt securities
               of the Company or any of its Subsidiaries that have been
               converted into or exchanged for such Qualified Equity Interests
               of the Company, plus (3) $20.0 million.

          If no Default or Event of Default has occurred and is continuing, the
foregoing provisions will not prohibit:

          (i)  the payment of any dividend within 60 days after the date of
               declaration thereof, if at said date of declaration such payment
               would have complied with the provisions hereof;

          (ii) the payment of cash dividends on any series of Disqualified Stock
               issued after the date hereof in an aggregate amount not to exceed
               the

                                       26
<PAGE>
 
               cash received by the Company since the date hereof upon issuance
               of such Disqualified Stock;

        (iii)  the repurchase of the Performance Investment Plan investment
               options from the holders thereof;

         (iv)  the redemption, repurchase, retirement or other acquisition of
               any Equity Interests of the Company or any Subsidiary in exchange
               for, or out of the net cash proceeds of, the substantially
               concurrent sale (other than to a Subsidiary of the Company) of
               Qualified Equity Interests of the Company); provided that the
               amount of any such net cash proceeds that are utilized for any
               such redemption, repurchase, retirement or other acquisition
               shall be excluded from clause (c)(2) of the preceding paragraph;

          (v)  the defeasance, redemption or repurchase of subordinated
               Indebtedness with the net cash proceeds from an incurrence of
               Permitted Refinancing Indebtedness or in exchange for or out of
               the net cash proceeds from the substantially concurrent sale
               (other than to a Subsidiary of the Company) of Qualified Equity
               Interests of the Company; provided, that the amount of any such
               net cash proceeds that are utilized for any such redemption,
               repurchase, retirement or other acquisition shall be excluded
               from clause (c)(2) of the preceding paragraph;

         (vi)  the repurchase, redemption or other acquisition or retirement for
               value of any Equity Interests of the Company or any Subsidiary of
               the Company held by any member of the Company's (or any of its
               Subsidiaries') management pursuant to any management equity
               subscription agreement or stock option agreement in effect as of
               the date hereof or entered into thereafter; provided, however,
               that the aggregate price paid for all such repurchased, redeemed,
               acquired or retired Equity Interests in any twelve-month period
               shall not exceed $5.0 million and no Default or Event of Default
               shall have occurred and be continuing immediately after such
               transaction; and

        (vii)  the making and consummation of (A) a Senior Subordinated Asset
               Sale Offer in accordance with the provisions of the Senior
               Subordinated Note Indenture with any Excess Proceeds that remain
               after consummation of a Senior Asset Sale Offer, within 120 days
               of the consummation of such Senior Asset Sale Offer, or (B) a
               Change of Control Offer with respect to the Senior Subordinated
               Notes in accordance with the provisions of the Senior
               Subordinated Note Indenture.

          Not later than the date of making any Restricted Payment, the Company
shall deliver to the Trustee an Officers' Certificate stating that such
Restricted Payment is

                                       27
<PAGE>
 
permitted and setting forth the basis upon which the calculations required by
this covenant were computed, which calculations may be based upon the Company's
latest available financial statements.

Section 3.08.  Limitations on Dividends and Other Payment Restrictions Affecting
               Subsidiaries.

          The Company shall not, and shall not permit any of its Subsidiaries
to, directly or indirectly, create or otherwise cause or suffer to exist or
become effective any consensual Transfer Restriction, except for such Transfer
Restrictions existing under or by reason of:

          (a)  Existing Indebtedness as in effect on the date hereof,

          (b)  the Indenture and the Securities,

          (c)  applicable law,

          (d)  any instrument governing Indebtedness or Capital Stock of a
               Person acquired by the Company or any of its Subsidiaries as in
               effect at the time of such acquisition (except to the extent such
               Indebtedness was incurred in connection with or in contemplation
               of such acquisition or in violation of Section 3.09 hereof),
               which encumbrance or restriction is not applicable to any Person,
               or the properties or assets of any Person, other than the Person,
               or the property or assets of the Person, so acquired, provided
               that the Consolidated Cash Flow of such Person shall not be taken
               into account in determining whether such acquisition was
               permitted by the terms hereof except to the extent that such
               Consolidated Cash Flow would be permitted to be dividends to the
               Company without the prior consent or approval of any third party,

          (e)  customary non-assignment provisions in leases entered into in the
               ordinary course of business and consistent with past practice,

          (f)  purchase money obligations for property acquired in the ordinary
               course of business that impose restrictions on the ability of any
               of the Company's Subsidiaries to transfer the property so
               acquired to the Company or any of its Subsidiaries,

          (g)  Permitted Refinancing Indebtedness, provided that the
               restrictions contained in the agreements governing such Permitted
               Refinancing Indebtedness are no more restrictive than those
               contained in the agreements governing the Indebtedness being
               refinanced, or

          (h)  the New Credit Facility and related documentation as the same is
               in effect on the date hereof and as amended or replaced from time
               to time, provided that no such amendment or replacement is more
               restrictive as

                                       28
<PAGE>
 
               to the matters enumerated above than the New Credit Facility and
               related documentation as in effect on the date hereof.

Section 3.09.  Limitations on Incurrence of Indebtedness and Issuance of
               Preferred Stock

          The Company shall not, and shall not permit any of its Subsidiaries
to, directly or indirectly, create, incur, issue, assume, Guarantee or otherwise
become directly or indirectly liable, contingently or otherwise, with respect to
(collectively, "incur") after the date hereof any Indebtedness (including
Acquired Debt) and the Company shall not issue any Disqualified Stock, and shall
not permit any of its Subsidiaries to issue any shares of preferred stock;
provided, however, that the Company may incur Indebtedness (including Acquired
Debt) and the Company may issue shares of Disqualified Stock, if the Fixed
Charge Coverage Ratio for the Company's most recently ended four full fiscal
quarters for which internal financial statements are available immediately
preceding the date on which such additional Indebtedness is incurred or such
Disqualified Stock is issued would have been at least (x) 2.25 to 1 if such
incurrence or issuance occurs on or before March 31, 1996, or (y) 2.5 to 1 if
such incurrence or issuance occurs at any time thereafter, in each case
determined on a pro forma basis (including a pro forma application of the net
proceeds therefrom), as if the additional Indebtedness had been incurred or the
Disqualified Stock had been issued, as the case may be, at the beginning of such
four-quarter period.  Indebtedness consisting of reimbursement obligations in
respect of a letter of credit will be deemed to be incurred when the letter of
credit is first issued.  The Company will not permit any of the International
Subsidiaries to incur any Indebtedness other than Non-Recourse Debt.

          The foregoing provisions will not apply to:

          (a)  the incurrence by the Company of Senior Term Debt pursuant to the
               New Credit Facility in an aggregate principal amount at any time
               outstanding not to exceed an amount equal to $2.0 billion less
               the aggregate amount of all repayments, optional or mandatory, of
               the principal of any Senior Term Debt (other than repayments that
               are immediately reborrowed) that have been made since the date
               hereof;

          (b)  the incurrence by the Company of Senior Revolving Debt and
               letters of credit pursuant to the New Credit Facility in an
               aggregate principal amount at any time outstanding (with letters
               of credit being deemed to have a principal amount equal to the
               maximum potential reimbursement obligation of the Company with
               respect thereto) not to exceed an amount equal to $500.0 million
               less the aggregate amount of all Net Proceeds of Asset Sales
               applied to permanently reduce the commitments with respect to
               such Indebtedness pursuant to Section 3.10 hereof;

          (c)  the incurrence by the Company of Indebtedness represented by the
               Securities;

                                       29
<PAGE>
 
          (d)  the incurrence by the Company and its Subsidiaries of the 
               Existing Indebtedness;

          (e)  the incurrence by the Company or any of its Subsidiaries of
               Permitted Refinancing Indebtedness in exchange for, or the
               proceeds of which are used to extend, refinance, renew, replace,
               defease, or refund, Indebtedness that was permitted by this
               Indenture to be incurred (including, without limitation, Existing
               Indebtedness);

          (f)  the incurrence by the Company of Hedging Obligations that are
               incurred for the purpose of fixing or hedging interest rate or
               currency risk with respect to any fixed or floating rate
               Indebtedness that is permitted by the terms hereof to be
               outstanding or any receivable or liability the payments of which
               is determined by reference to a foreign currency; provided, that
               the notional principal amount of any such Hedging Obligation does
               not exceed the principal amount of the Indebtedness to which such
               Hedging Obligation relates;

          (g)  the incurrence by the Company or any of its Subsidiaries of
               Physician Support Obligations;

          (h)  the incurrence by the Company or any of its Subsidiaries of
               intercompany Indebtedness between or among the Company and any of
               its Subsidiaries;

          (i)  the incurrence by the Company or any of its Subsidiaries of
               Indebtedness represented by performance bonds, standby letters of
               credit or appeal bonds, in each case to the extent incurred in
               the ordinary course of business of the Company or such
               Subsidiary;

          (j)  the incurrence by any Subsidiary of the Company of Indebtedness,
               the aggregate principal amount of which, together with all other
               Indebtedness of the Company's Subsidiaries at the time
               outstanding (excluding the Existing Indebtedness until repaid or
               refinanced and excluding Physician Support Obligations), does not
               exceed the greater of (1) 10% of the Company's Stockholders'
               Equity or (2) $10.0 million; provided that, in case of clause (1)
               only, the Fixed Charge Coverage Ratio for the Company's most
               recently ended four full fiscal quarters for which internal
               financial statements are available immediately preceding the date
               on which such Indebtedness is incurred would have been at least
               (x) 2.25 to 1 if such incurrence occurs on or before March 31,
               1996, or (y) 2.5 to 1 if such incurrence occurs at any time
               thereafter, in each case determined on a pro forma basis
               (including a pro forma application of the net proceeds
               therefrom), as if such Indebtedness has been incurred at the
               beginning of such four-quarter period; and

                                       30
<PAGE>
 
          (k) the incurrence by the Company of Indebtedness (in addition to
Indebtedness permitted by any other clause of this paragraph) in an aggregate
principal amount not exceeding $250.0 million at any one time outstanding.

Section 3.10.  Asset Sales.

          The Company shall not, and shall not permit any of its Subsidiaries to
consummate an Asset Sale, unless (i) the Company (or the Subsidiary as the case
may be) receives consideration at the time of such Asset Sale at least equal to
the fair market value (as conclusively determined by a resolution of the Board
of Directors set forth in an Officers' Certificate delivered to the Trustee) of
the assets or Equity Interests issued or sold or otherwise disposed of and (ii)
except in the case of a sale of Specified Assets, at least 80% of the
consideration therefor received by the Company or such Subsidiary is in the form
of cash; provided, however, that for purposes of this provision, (x) the amount
of (A) any liabilities (as shown on the Company's or such Subsidiary's most
recent balance sheet or in the notes thereto), of the Company or any Subsidiary
(other than, in the case of an Asset Sale by the Company, liabilities that are
by their terms subordinated to the Securities that are assumed by the transferee
of any such assets and (B) any securities or other obligations received by the
Company or any such Subsidiary from such transferee that are immediately
converted by the Company or such Subsidiary into cash (or as to which the
Company or such Subsidiary has received at or prior to the consummation of the
Asset Sale a commitment (which may be subject to customary conditions) from a
nationally recognized investment, merchant or commercial bank to convert into
cash within 90 days of the consummation of such Asset Sale and which are
thereafter actually converted into cash within such 90-day period) will be
deemed to be cash (but shall not be deemed to be Net Proceeds for purposes of
the following provisions until reduced to cash); and (y) the fair market value
of any Non-Cash Consideration received by the Company or a Subsidiary in any
Asset Sale shall be deemed to be cash (but shall not be deemed to be Net
Proceeds for purposes of the following provisions until reduced to cash) to the
extent that the aggregate fair market value (as conclusively determined by a
resolution of the Board of Directors set forth in an Officers' Certificate
delivered to the Trustee) of all Non-Cash Consideration (measured at the time
received and without giving effect to any subsequent changes in value) held by
the Company immediately after consummation of such Asset Sale does not exceed
10% of the Company's Stockholders' Equity.

          Within 365 days after the receipt of any Net Proceeds from an Asset
Sale, the Company may apply the Net Proceeds from such Asset Sale (i) to
purchase one or more Hospitals or Related Businesses and/or a controlling
interest in the Capital Stock of a Person owning one or more Hospitals and/or
one or more Related Businesses, (ii) to make a capital expenditure or to acquire
other tangible assets, in each case, that are used or useful in any business in
which the Company is permitted to be engaged pursuant to Section 3.15 hereof,
(iii) to permanently reduce Senior Term Debt or Existing Indebtedness of a
Subsidiary or (iv) to permanently reduce Senior Revolving Debt (and to
correspondingly reduce commitments with respect thereto), except that up to an
aggregate of $200.0 million of Net Proceeds from Asset Sales may be applied
after the date hereof to reduce Senior Revolving

                                       31
<PAGE>
 
Debt without a corresponding reduction in commitments with respect thereto.
Pending the final application of any such Net Proceeds, the Company may
temporarily reduce Senior Revolving Debt or otherwise invest such Net Proceeds
in any manner that is not prohibited by the terms hereof.  Any Net Proceeds from
Asset Sales that are not so invested or applied will be deemed to constitute
"Excess Proceeds."  When the aggregate amount of Excess Proceeds exceeds $25.0
million, the Company shall make an offer to all holders of Securities and any
other Indebtedness of the Company ranking on a parity with the Securities from
time to time outstanding with similar provisions requiring the Company to make
an offer to purchase or to redeem such Indebtedness with the proceeds from any
assets, pro rata in proportion to the respective principal amounts of the
Securities and such other Indebtedness then outstanding (a "Senior Asset Sale
Offer") to purchase the maximum principal amount of Securities and such other
Indebtedness that may be purchased out of the Excess Proceeds, at an offer price
in cash equal to 100% of the principal amount thereof (the "Purchase Price")
plus accrued and unpaid interest thereon, if any, to the date of purchase, in
accordance with the procedures set forth in Section 2.15 hereof.  To the extent
that aggregate amount of Securities and such other Indebtedness tendered
pursuant to a Senior Asset Sale Offer is less than the Excess Proceeds, the
Company may use any remaining Excess Proceeds for general corporate purposes
including an offer to purchase Senior Subordinated Notes pursuant to Section
4.10 of the Senior Subordinated Note Indenture.  If the aggregate principal
amount of Securities and such other Indebtedness surrendered by holders pursuant
to a Senior Asset Sale Offer exceeds the amount of Excess Proceeds, the Trustee
shall select the Securities and such other Indebtedness to be purchased on a pro
rata basis.  Upon completion of a Senior Asset Sale Offer, the amount of Excess
Proceeds shall be reset at zero.

Section 3.11.  Limitations on Transactions with Affiliates.

          The Company shall not, and shall not permit any of its Subsidiaries
to, sell, lease, transfer or otherwise dispose of any of its properties or
assets to, or purchase any property or assets from, or enter into or make any
contract, agreement, understanding, loan, advance or Guarantee with, or for the
benefit of, any Affiliate (each of the foregoing, an "Affiliate Transaction")
unless (i) such Affiliate Transaction is on terms that are no less favorable to
the Company or the relevant Subsidiary than those that could have been obtained
in a comparable transaction by the Company or such Subsidiary with an unrelated
Person and (ii) the Company delivers to the Trustee (a) with respect to any
Affiliate Transaction involving aggregate consideration in excess of $5.0
million, a resolution of the Board of Directors set forth in an Officers'
Certificate certifying that such Affiliate Transaction complies with clause (i)
above and that such Affiliate Transaction was approved by a majority of the
disinterested members of the Board of Directors and (b) with respect to any
Affiliate Transaction involving aggregate consideration in excess of $15.0
million, an opinion as to the fairness of such Affiliate Transaction to the
Company or such Subsidiary from a financial point of view issued by an
unaffiliated investment banking firm of national standing; provided, however,
that (x) transactions or payments pursuant to any employment arrangements or
employee or director benefit plans entered into by the Company or any of its
Subsidiaries in the ordinary course of business and consistent with the past
practice of the Company or such Subsidiary, (y) transactions between or among
the Company and/or its

                                       32
<PAGE>
 
Subsidiaries and (z) Restricted Payments permitted under Section 3.07, in each
case, shall not be deemed Affiliate Transactions.

Section 3.12.  Limitations on Liens.

          The Company shall not, and shall not permit any of its Subsidiaries
to, directly or indirectly create, incur, assume or suffer to exist any Lien
(except Permitted Liens) on any asset now owned or hereafter acquired, or on any
income or profits therefrom, or assign or convey any right to receive income
therefrom, unless all payments due hereunder and under the Securities are
secured on an equal and ratable basis with the Obligations so secured until such
time as such Obligations are no longer secured by a Lien.

Section 3.13.  Change of Control.

          Upon the occurrence of a Change of Control Triggering Event, each
Holder of Securities shall have the right to require the Company to repurchase
all or any part (equal to $1,000 or an integral multiple thereof) of such
Holder's Securities pursuant to an offer described below (the "Change of Control
Offer") at an offer price in cash equal to 101% of the aggregate principal
amount thereof, plus accrued and unpaid interest, if any, thereon to the date of
repurchase (the "Change of Control Payment") on a date that is not more than 90
days after the occurrence of such Change of Control Triggering Event (the
"Change of Control Payment Date").  The Company shall comply with the
requirements of Regulation 14e-1 under the Exchange Act and any other securities
laws and regulations thereunder to the extent such laws and regulations are
applicable in connection with the repurchase of the Securities as a result of a
Change of Control.

          Within 30 days following any Change of Control Triggering Event, the
Company shall mail, or at the Company's request the Trustee shall mail, a notice
of a Change of Control to each Holder (at its last registered address with a
copy to the Trustee and the Paying Agent) offering to repurchase the Securities
held by such Holder pursuant to the procedure specified in such notice.  The
Change of Control Offer shall remain open from the time of mailing until the
close of business on the Business Day preceding the Change of Control Payment
Date.  The notice, which shall govern the terms of the Change of Control Offer,
shall state:

          (1)  that the Change of Control Offer is being made pursuant to this
               Section 3.13 and that all Securities tendered will be accepted
               for payment;

          (2)  the Change of Control Payment and the Change of Control Payment
               Date, which date shall be no earlier than 30 days nor later than
               60 days from the date such notice is mailed;

          (3)  that any Securities not tendered will continue to accrue interest
               in accordance with the terms of the Indenture;

                                       33
<PAGE>
 
          (4)  that, unless the Company defaults in the payment of the Change of
               Control Payment, all Securities accepted for payment pursuant to
               the Change of Control Offer shall cease to accrue interest after
               the Change of Control Payment Date;

          (5)  that Holders electing to have Securities purchased pursuant to
               the Change of Control Offer will be required to surrender their
               Securities, with the form entitled "Option of Holder to Elect
               Purchase" on the reverse of the Security completed, to the Paying
               Agent at the address specified in the notice prior to the close
               of business on the Business Day preceding the Change of Control
               Payment Date;

          (6)  that Holders will be entitled to withdraw their election if the
               Paying Agent receives, not later than the close of business on
               the Business Day preceding the Change of Control Payment Date, a
               facsimile transmission or letter setting forth the name of the
               Holder, the principal amount of Securities the Holder delivered
               for purchase, and a statement that such Holder is withdrawing his
               election to have such Securities purchased;

          (7)  that Holders whose Securities are being purchased only in part
               will be issued new Securities equal in principal amount to the
               unpurchased portion of the Securities surrendered, which
               unpurchased portion must be equal to $1,000 in principal amount
               or an integral multiple thereof; and

          (8)  the circumstances and relevant facts regarding such Change of
               Control (including, but not limited to, information with respect
               to pro forma historical and, if available, projected financial
               information after giving effect to such Change of Control,
               information regarding the Person or Persons acquiring control and
               such Person's or Persons' business plans going forward).

          On the Change of Control Payment Date, the Company shall, to the
extent lawful, (i) accept for payment Securities or portions thereof properly
tendered and not withdrawn pursuant to the Change of Control Offer, (ii) deposit
with the Paying Agent an amount equal to the Change of Control Payment in
respect of all Securities or portions thereof so tendered and (iii) deliver or
cause to be delivered to the Trustee the Securities so accepted together with an
Officers' Certificate stating the aggregate principal amount of Securities or
portions thereof being purchased by the Company.  The Paying Agent shall
promptly mail to each Holder of Securities so tendered payment in an amount
equal to the Change of Control Payment for such Securities, and the Trustee
shall promptly authenticate and mail or deliver (or cause to be transferred by
book entry) a new Security to such Holder equal in principal amount to any
unpurchased portion of the Securities surrendered, if any; provided, that each
such new Security shall be in a principal amount of $1,000 or an integral

                                       34
<PAGE>
 
multiple thereof.  The Company shall publicly announce the results of the Change
of Control Offer on or as soon as practicable after the Change of Control
Payment Date.

Section 3.14.  Corporate Existence.

          Subject to Section 3.13 and Article 4 hereof, the Company shall do or
cause to be done all things necessary to preserve and keep in full force and
effect (i) its corporate existence, and the corporate, partnership or other
existence of each of its Subsidiaries, in accordance with the respective
organizational documents (as the same may be amended from time to time) of each
Subsidiary and (ii) the rights (charter and statutory), licenses and franchises
of the Company and its Subsidiaries; provided, however, that the Company shall
not be required to preserve any such right, license or franchise, or the
corporate, partnership or other existence of any of its Subsidiaries, if the
Board of Directors shall determine that the preservation thereof is no longer
desirable in the conduct of the business of the Company and its Subsidiaries,
taken as a whole, and that the loss thereof is not adverse in any material
respect to the Holders.

Section 3.15.  Line of Business

          The Company shall not, and shall not permit any of its Subsidiaries
to, engage to any material extent in any business other than the ownership,
operation and management of Hospitals and Related Businesses.

Section 3.16.  Limitations on Issuances of Guarantees of Indebtedness by
               Subsidiaries

          The Company shall not permit any Subsidiary, directly or indirectly,
to Guarantee or secure the payment of any other Indebtedness of the Company or
any of its Subsidiaries (except Indebtedness of a Subsidiary of such Subsidiary
or Physician Support Obligations) unless such Subsidiary simultaneously executes
and delivers a supplemental indenture to this Indenture providing for the
Guarantee of the payment of the Securities by such Subsidiary, which Guarantee
shall be senior to or pari passu with such Subsidiary's Guarantee of or pledge
to secure such other Indebtedness.  Notwithstanding the foregoing, any such
Guarantee by a Subsidiary of the Securities shall be substantially in the form
of Exhibit B hereto and shall provide by its terms that it shall be
automatically and unconditionally released and discharged upon the sale or other
disposition, by way of merger or otherwise, to any Person not an Affiliate of
the Company, of all of the Company's stock in, or all or substantially all the
assets of, such Subsidiary, which sale or other disposition is made in
compliance with, and the Net Proceeds therefrom are applied in accordance with,
the applicable provisions hereof.  The foregoing provisions will not be
applicable to any one or more Guarantees of up to $10.0 million in aggregate
principal amount of Indebtedness of the Company at any time outstanding.

                                       35
<PAGE>
 
Section 3.17.  No Amendment to Subordination Provisions of Senior Subordinated
               Note Indenture

          The Company shall not amend, modify or alter the Senior Subordinated
Note Indenture in any way that would (i) increase the principal of, advance the
final maturity date of or shorten the Weighted Average Life to Maturity of any
Senior Subordinated Notes such that the final maturity date of the Senior
Subordinated Notes is earlier than the 91st day following the final maturity
date of the Securities or (ii) amend the provisions of Article 10 of the Senior
Subordinated Indenture (which relates to subordination) in a manner that would
be adverse to the Holders of the Securities.

                                   ARTICLE 4
                                  SUCCESSORS

Section 4.01.  Limitations On Mergers, Consolidations or Sales of Assets

          The Company may not consolidate or merge with or into (whether or not
the Company is the surviving corporation), or sell, assign, transfer, lease,
convey or otherwise dispose of all or substantially all of its properties or
assets in one or more related transactions to another corporation, Person or
entity unless:

          (i)  the Company is the surviving corporation or the entity or the
               Person formed by or surviving any such consolidation or merger
               (if other than the Company) or to which such sale, assignment,
               transfer, lease, conveyance or other disposition shall have been
               made is a corporation organized or existing under the laws of the
               United States, any state thereof or the District of Columbia;

         (ii)  the entity or Person formed by or surviving any such
               consolidation or merger (if other than the Company) or the entity
               or Person to which such sale, assignment, transfer, lease,
               conveyance or other disposition shall have been made assumes all
               the Obligations of the Company pursuant to a supplemental
               indenture in a form reasonably satisfactory to the Trustee, under
               the Securities and the Indenture;

        (iii)  immediately after such transaction no Default or Event of
               Default exists; and

         (iv)  the Company or any entity or Person formed by or surviving any
               such consolidation or merger (if other than the Company), or to
               which such sale, assignment, transfer, lease, conveyance or other
               disposition shall have been made (a) will have Consolidated Net
               Worth (immediately after giving effect to the transaction) equal
               to or greater than the Consolidated Net Worth of the Company
               immediately preceding the transaction and (b) will, at the time
               of such transaction and after giving pro forma effect thereto as
               if such transaction had occurred at the

                                       36
<PAGE>
 
               beginning of the applicable four-quarter period, be permitted to
               incur at least $1.00 of additional Indebtedness pursuant to the
               Fixed Charge Coverage Ratio test set forth in the first paragraph
               of Section 3.09.

          The Company shall deliver to the Trustee prior to the consummation of
the proposed transaction an Officers' Certificate to the foregoing effect and an
Opinion of Counsel, covering clauses (i) through (iv) above, stating that the
proposed transaction and such supplemental indenture comply with this Indenture.
The Trustee shall be entitled to conclusively rely upon such Officers'
Certificate and Opinion of Counsel.

          Section 4.02.  Successor Corporation Substituted.

          Upon any consolidation or merger, or any sale, assignment, transfer,
lease, conveyance or other disposition of all or substantially all of the assets
of the Company in accordance with Section 4.01 hereof, the successor corporation
formed by such consolidation or into or with which the Company is merged or to
which such sale, assignment, transfer, lease, conveyance or other disposition is
made shall succeed to, and be substituted for (so that from and after the date
of such consolidation, merger, sale, assignment, transfer, lease, conveyance or
other disposition, the provisions of this Indenture referring to the "Company"
shall refer instead to the successor corporation), and may exercise every right
and power of the Company under this Indenture with the same effect as if such
successor Person has been named as the Company, herein.

                                   ARTICLE 5
                             DEFAULTS AND REMEDIES

Section 5.01.  Events of Default.

          Each of the following constitutes an "Event of Default":

               (i)  a default for 30 days in the payment when due of interest on
                    the Securities;

              (ii)  a default in payment when due of principal of or premium, if
                    any, on the Securities at maturity or otherwise;

             (iii)  a default in the performance or breach of Sections 3.07,
                    3.09, 3.10, or 3.13;

              (iv)  a failure by the Company to comply with any other covenant
                    or agreement in the Indenture or the Securities for the
                    period and after the notice specified below;

               (v)  any default that occurs under any mortgage, indenture or
                    instrument under which there may be issued or by which there
                    may be secured or evidenced any Indebtedness for money

                                       37
<PAGE>
 
                    borrowed by the Company or any of its Significant
                    Subsidiaries (or the payment of which is Guaranteed by the
                    Company or any of its Significant Subsidiaries), whether
                    such Indebtedness or Guarantee exists on the date hereof or
                    is created after the date hereof, which default (i)
                    constitutes a Payment Default or (ii) results in the
                    acceleration of such Indebtedness prior to its express
                    maturity and, in each case, the principal amount of any such
                    Indebtedness, together with the principal amount of any
                    other such Indebtedness under which there has been a Payment
                    Default or that has been so accelerated, aggregates $25.0
                    million or more;

              (vi)  a failure by the Company or any of its Significant
                    Subsidiaries to pay a final judgment or final judgments
                    aggregating in excess of $25.0 million entered by a court or
                    courts of competent jurisdiction against the Company or any
                    of its Significant Subsidiaries if such final judgment or
                    judgments remain unpaid or undischarged for a period (during
                    which execution shall not be effectively stayed) of 60 days
                    after their entry;

             (vii)  the Company or any Significant Subsidiary thereof
                    pursuant to or within the meaning of any Bankruptcy Law:

                    (a)  commences a voluntary case,

                    (b)  consents to the entry of an order for relief against it
                         in an involuntary case in which it is the debtor,

                    (c)  consents to the appointment of a Custodian of it or for
                         all or substantially all of its property,

                    (d)  makes a general assignment for the benefit of its
                         creditors, or

                    (e)  admits in writing its inability generally to pay its
                         debts as the same become due; and

            (viii)  a court of competent jurisdiction enters an order or decree
                    under any Bankruptcy Law that:

                    (a)  is for relief against the Company or any Significant
                         Subsidiary thereof in an involuntary case in which it
                         is the debtor,

                    (b)  appoints a Custodian of the Company or any Significant
                         Subsidiary thereof or for all or substantially all of
                         the

                                       38
<PAGE>
 
                         property of the Company or any Significant Subsidiary
                         thereof, or

                    (c)  orders the liquidation of the Company or any
                         Significant Subsidiary thereof,

               and the order or decree remains unstayed and in effect for 60
          days.

          The term "Bankruptcy Law" means title 11, U.S. Code or any similar
federal or state law for the relief of debtors.  The term "Custodian" means any
receiver, trustee, assignee, liquidator or similar official under any Bankruptcy
Law.

          A Default under clause (iv) is not an Event of Default until the
Trustee notifies the Company in writing, or the Holders of at least 25% in
principal amount of the then outstanding Securities notify the Company and the
Trustee in writing, of the Default and the Company does not cure the Default
within 60 days after receipt of such notice.  The written notice must specify
the Default, demand that it be remedied and state that the notice is a "Notice
of Default."

          If an Event of Default occurs prior to the maturity of the Securities
by reason of any willful action (or inaction) taken (or not taken) by or on
behalf of the Company the primary purpose of which was to allow the Company to
avoid the prohibition on redemption of the Securities prior to the date of
maturity, then, in addition to all amounts otherwise payable with respect to
such Securities, a premium with respect thereto (expressed as a percentage of
the amount that would otherwise be due but for the provisions of this sentence),
shall also become and be immediately due and payable if such Securities are
repaid during the 12-month period beginning on March __ of the years set forth
below:
<TABLE> 
<CAPTION> 
               Year                         Percentage
               ----                         ----------
               <S>                          <C> 
               1994........................          %
               1995........................          %
               1996........................          %
               1997........................          %
               1998........................          %
               1999........................          %
               2000........................          %
               2001........................          %
</TABLE> 

          Any determination regarding the primary purpose of any such action or
inaction, as the case may be, shall be made by and set forth in a resolution of
the Board of Directors (including the concurrence of a majority of the
independent directors of the Company then serving) delivered to the Trustee
after consideration of the business reasons for such action or inaction, other
than the avoidance of payment of such premium or prohibition on redemption.  In
the absence of fraud, each such determination shall be final and binding upon
the Holders of Securities.  Subject to Section 6.01 hereof, the Trustee shall

                                       39
<PAGE>
 
be entitled to rely on the determination set forth in any such resolutions
delivered to the Trustee.

Section 5.02.  Acceleration.

          If an Event of Default (other than an Event of Default specified in
clauses (vii) and (viii) of Section 5.01) occurs and is continuing, the Trustee
by notice to the Company, or the Holders of not less than 25% in aggregate
principal amount of the then outstanding Securities by written notice to the
Company and the Trustee, may declare the unpaid principal of, premium, if any,
and any accrued and unpaid interest on all the Securities to be due and payable.
Upon such declaration the principal, premium, if any, and interest shall be due
and payable immediately.  If an Event of Default specified in clause (vii) or
(viii) of Section 5.01 occurs with respect to the Company or any Significant
Subsidiary thereof such an amount shall ipso facto become and be immediately due
and payable without any declaration or other act on the part of the Trustee or
any Holder.

Section 5.03.  Other Remedies.

          If an Event of Default occurs and is continuing, the Trustee may
pursue any available remedy to collect the payment of principal or interest on
the Securities or to enforce the performance of any provision of the Securities
or this Indenture.

          The Trustee may maintain a proceeding even if it does not possess any
of the Securities or does not produce any of them in the proceeding.  A delay or
omission by the Trustee or any Holder in exercising any right or remedy accruing
upon an Event of Default shall not impair the right or remedy or constitute a
waiver of or acquiescence in the Event of Default.  All remedies are cumulative
to the extent permitted by law.

Section 5.04.  Waiver of Past Defaults.

          Holders of not less than a majority in aggregate principal amount of
the then outstanding Securities by written notice to the Trustee may waive an
existing Default or Event of Default and its consequences under this Indenture,
except a continuing Default or Event of Default in the payment of the principal
of, premium, if any, or interest on any Security.  Upon any such waiver, such
Default shall cease to exist, and any Event of Default arising therefrom shall
be deemed to have been cured for every purpose of this Indenture; but no such
waiver shall extend to any subsequent or other Default or impair any right
consequent thereon.

Section 5.05.  Control by Majority.

          Holders of a majority in principal amount of the then outstanding
Securities may direct the time, method and place of conducting any proceeding
for any remedy available to the Trustee or exercising any trust or power
conferred on it.  However, the Trustee may refuse to follow any direction that
conflicts with law or this Indenture that the Trustee determines may be unduly
prejudicial to the rights of other Holders or that may involve the

                                       40
<PAGE>
 
Trustee in personal liability.  The Trustee may take any other action which it
deems proper which is not inconsistent with any such direction.

Section 5.06.  Limitation on Suits.

          A Holder may pursue a remedy with respect to this Indenture or the 
Securities only if:

          (i)  the Holder gives to the Trustee written notice of a continuing
               Event of Default;

          (ii) the Holders of at least 25% in principal amount of the then
               outstanding Securities make a written request to the Trustee to
               pursue the remedy;

          (iii)such Holder or Holders offer and, if requested, provide to the
               Trustee indemnity satisfactory to the Trustee against any loss,
               liability or expense;

          (iv) the Trustee does not comply with the request within 60 days after
               receipt of the request and the offer and, if requested, the
               provision of indemnity; and

          (v)  during such 60-day period the Holders of a majority in principal
               amount of the then outstanding Securities do not give the Trustee
               a direction inconsistent with the request.

A Holder may not use this Indenture to prejudice the rights of another Holder or
to obtain a preference or priority over another Holder.

Section 5.07.  Rights of Holders to Receive Payment.

          Notwithstanding any other provision of this Indenture, the right of
any Holder to receive payment of principal, premium, if any, and interest on the
Security, on or after the respective due dates expressed in the Security, or to
bring suit for the enforcement of any such payment on or after such respective
dates, shall not be impaired or affected without the consent of the Holder.

Section 5.08.  Collection Suit by Trustee.

          If an Event of Default specified in Section 5.01(i) or (ii) occurs and
is continuing, the Trustee is authorized to recover judgment in its own name and
as trustee of an express trust against the Company or any other obligor for the
whole amount of principal, premium, if any, and interest remaining unpaid on the
Securities and interest on overdue principal and, to the extent lawful, interest
and such further amount as shall be sufficient to cover amounts due the Trustee
under Section 6.07, including the costs and expenses of collection, including
the reasonable compensation, expenses, disbursements and advances of the
Trustee, its agents and counsel.

                                       41
<PAGE>
 
Section 5.09.  Trustee May File Proofs of Claim.

          The Trustee is authorized to file such proofs of claim and other
papers or documents as may be necessary or advisable in order to have the claims
of the Trustee (including any claim for the reasonable compensation, expenses,
disbursements and advances of the Trustee, its agents and counsel) and the
Holders allowed in any judicial proceedings relative to the Company (or any
other obligor upon the Securities), its creditors or its property and shall be
entitled and empowered to collect, receive and distribute any money or other
property payable or deliverable on any such claims and any custodian in any such
judicial proceeding is hereby authorized by each Holder to make such payments to
the Trustee, and in the event that the Trustee shall consent to the making of
such payments directly to the Holders, to pay to the Trustee any amount due to
it for the reasonable compensation, expenses, disbursements and advances of the
Trustee, its agents and counsel, and any other amounts due the Trustee under
Section 6.07 hereof.  To the extent that the payment of any such compensation,
expenses, disbursements and advances of the Trustee, its agents and counsel, and
any other amounts due the Trustee under Section 6.07 hereof out of the estate in
any such proceeding, shall be denied for any reason, payment of the same shall
be secured by a Lien on, and shall be paid out of, any and all distributions,
dividends, money, securities and other properties which the Holders may be
entitled to receive in such proceeding whether in liquidation or under any plan
of reorganization or arrangement or otherwise.  Nothing herein contained shall
be deemed to authorize the Trustee to authorize or consent to or accept or adopt
on behalf of any Holder any plan of reorganization, arrangement, adjustment or
composition affecting the Securities or the rights of any Holder thereof, or to
authorize the Trustee to vote in respect of the claim of any Holder in any such
proceeding.

Section 5.10.  Priorities.

          If the Trustee collects any money pursuant to this Article, it shall
pay out the money in the following order:

          First:  to the Trustee, its agents and attorneys for amounts due under
Section 6.07, including payment of all compensation, expense and liabilities
incurred, and all advances made, by the Trustee and the costs and expenses of
collection;

          Second:  to Holders for amounts due and unpaid on the Securities for
principal, premium, if any, and interest, ratably, without preference or
priority of any kind, according to the amounts due and payable on the Securities
for principal, premium, if any and interest, respectively; and

          Third:  to the Company or to such party as a court of competent
jurisdiction shall direct.

          The Trustee may fix a record date and payment date for any payment to
Holders pursuant to this Section 5.10 upon five Business Days prior notice to
the Company.

                                       42
<PAGE>
 
Section 5.11.  Undertaking for Costs.

          In any suit for the enforcement of any right or remedy under this
Indenture or in any suit against the Trustee for any action taken or omitted by
it as a Trustee, a court in its discretion may require the filing by any party
litigant in the suit of an undertaking to pay the costs of the suit, and the
court in its discretion may assess reasonable costs, including reasonable
attorneys' fees and expenses, against any party litigant in the suit, having due
regard to the merits and good faith of the claims or defenses made by the party
litigant.  This Section does not apply to a suit by the Trustee, a suit by a
Holder pursuant to Section 5.07, or a suit by Holders of more than 10% in
principal amount of the then outstanding Securities.

                                   ARTICLE 6
                                    TRUSTEE

Section 6.01.  Duties of Trustee.

          (i) If an Event of Default has occurred and is continuing, the Trustee
shall exercise such of the rights and powers vested in it by this Indenture, and
use the same degree of care and skill in their exercise, as a prudent man would
exercise or use under the circumstances in the conduct of his own affairs.

          (ii) Except during the continuance of an Event of Default known to the
Trustee:

          (a)  the duties of the Trustee shall be determined solely by the
               express provisions of this Indenture or the TIA and the Trustee
               need perform only those duties that are specifically set forth in
               this Indenture or the TIA and no others, and no implied covenants
               or obligations shall be read into this Indenture against the
               Trustee, and

          (b)  in the absence of bad faith on its part, the Trustee may
               conclusively rely, as to the truth of the statements and the
               correctness of the opinions expressed therein, upon certificates
               or opinions furnished to the Trustee and conforming to the
               requirements of this Indenture.  However, the Trustee shall
               examine the certificates and opinions to determine whether or not
               they conform to the requirements of this Indenture.

          (iii)  The Trustee may not be relieved from liabilities for its own
negligent action, its own negligent failure to act, or its own willful
misconduct, except that:

               (a)  this paragraph does not limit the effect of paragraph (ii)
                    of this Section;

                                       43
<PAGE>
 
               (b)  the Trustee shall not be liable for any error of judgment
                    made in good faith by a Responsible Officer, unless it is
                    proved that the Trustee was negligent in ascertaining the
                    pertinent facts; and

               (c)  the Trustee shall not be liable with respect to any action
                    it takes or omits to take in good faith in accordance with a
                    direction received by it pursuant to Section 5.05 hereof.

          (iv) Whether or not therein expressly so provided, every provision of
this Indenture that in any way relates to the Trustee is subject to paragraphs
(i), (ii), and (iii) of this Section.

          (v) No provision of this Indenture shall require the Trustee to expend
or risk its own funds or incur any liability.  The Trustee may refuse to perform
any duty or exercise any right or power unless it receives security and
indemnity satisfactory to it against any loss, liability or expense.

          (vi) The Trustee shall not be liable for interest on any money
received by it except as the Trustee may agree in writing with the Company.
Absent written instruction from the Company, the Trustee shall not be required
to invest any such money.  Money held in trust by the Trustee need not be
segregated from other funds except to the extent required by law.

          (vii)  The Trustee shall not be deemed to have knowledge of any matter
unless such matter is actually known to a Responsible Officer.

Section 6.02.  Rights of Trustee.

          (i) The Trustee may conclusively rely upon any document believed by it
to be genuine and to have been signed or presented by the proper Person.  The
Trustee need not investigate any fact or matter stated in the document.

          (ii) Before the Trustee acts or refrains from acting, it may require
an Officers' Certificate or an Opinion of Counsel or both.  The Trustee shall
not be liable for any action it takes or omits to take in good faith in reliance
on such Officers' Certificate or Opinion of Counsel.  The Trustee may consult
with counsel and the written advice of such counsel or any Opinion of Counsel
shall be full and complete authorization and protection from liability in
respect of any action taken, suffered or omitted by it hereunder in good faith
and in reliance thereon.

          (iii)  The Trustee may act through its attorneys and agents and shall
not be responsible for the misconduct or negligence of any agent appointed with
due care.

          (iv) The Trustee shall not be liable for any action it takes or omits
to take in good faith which it believes to be authorized or within its rights or
powers conferred upon

                                       44
<PAGE>
 
it by this Indenture.  A permissive right granted to the Trustee hereunder shall
not be deemed an obligation to act.

          (v) Unless otherwise specifically provided in this Indenture, any
demand, request, direction or notice from the Company shall be sufficient if
signed by an Officer of the Company.

Section 6.03.  Individual Rights of Trustee.

          The Trustee in its individual or any other capacity may become the
owner or pledgee of Securities and may otherwise deal with the Company or any
Affiliate of the Company with the same rights it would have if it were not
Trustee.  Any Agent may do the same with like rights.  However, the Trustee is
subject to Sections 6.10 and 6.11 hereof.

Section 6.04.  Trustee's Disclaimer.

          The Trustee shall not be responsible for and makes no representation
as to the validity or adequacy of this Indenture or the Securities, nor shall it
be accountable for the Company's use of the proceeds from the Securities or any
money paid to the Company or upon the Company's direction under any provision of
this Indenture, nor shall it be responsible for the use or application of any
money received by any Paying Agent other than the Trustee, nor shall it be
responsible for any statement or recital herein or any statement in the
Securities or any other document in connection with the sale of the Securities
or pursuant to this Indenture other than its certificate of authentication.

Section 6.05.  Notice of Defaults.

          If a Default or Event of Default occurs and is continuing and if it is
known to the Trustee, the Trustee shall mail to Holders a notice of the Default
or Event of Default within 90 days after it occurs.  Except in the case of a
Default or Event of Default in payment on any Security, the Trustee may withhold
the notice if and so long as a committee of its Responsible Officers in good
faith determines that withholding the notice is in the interests of the Holders.

Section 6.06.  Reports by Trustee to Holders.

          Within 60 days after each December 31 beginning with the December 31
following the date hereof, the Trustee shall mail to the Holders a brief report
dated as of such reporting date that complies with TIA (S) 313(a) (but if no
event described in TIA (S) 313(a) has occurred within the twelve months
preceding the reporting date, no report need be transmitted).  The Trustee also
shall comply with TIA (S) 313(b).  The Trustee shall also transmit by mail all
reports as required by TIA (S) 313(c).

          A copy of each report at the time of its mailing to the Holders shall
be mailed to the Company and filed with the Commission and each stock exchange
on which the

                                       45
<PAGE>
 
Securities are listed.  The Company shall promptly notify the Trustee when the
Securities are listed on any stock exchange.

Section 6.07.  Compensation and Indemnity.

          The Company shall pay to the Trustee from time to time such
compensation for its acceptance of this Indenture and services hereunder as the
Company and Trustee shall agree in writing.  The Trustee's compensation shall
not be limited by any law on compensation of a trustee of an express trust.  The
Company shall reimburse the Trustee promptly upon request for all reasonable
disbursements, advances and expenses incurred or made by it in addition to the
compensation for its services.  Such expenses shall include the reasonable
compensation, disbursements and expenses of the Trustee's agents and counsel.

          The Company shall indemnify the Trustee against any and all losses,
liabilities, damages, claims or expenses incurred by it arising out of or in
connection with the acceptance of its duties and the administration of the
trusts under this Indenture, except as set forth below.  The Trustee shall
notify the Company promptly of any claim for which it may seek indemnity.
Failure by the Trustee to so notify the Company shall not relieve the Company of
its obligations hereunder.  The Company shall defend the claim and the Trustee
shall cooperate in the defense.  The Trustee may have separate counsel and the
Company shall pay the reasonable fees and expenses of such counsel.  The Company
need not pay for any settlement made without its consent, which consent shall
not be unreasonably withheld.

          The obligations of the Company under this Section 6.07 shall survive
the satisfaction and discharge of this Indenture.

          The Company need not reimburse any expense or indemnify against any
loss or liability incurred by the Trustee through its own negligence or bad
faith.

          To secure the Company's payment obligations in this Section, the
Trustee shall have a Lien prior to the Securities on all money or property held
or collected by the Trustee, except that held in trust to pay principal and
interest on particular Securities.  Such Lien shall survive the satisfaction and
discharge of this Indenture.

          When the Trustee incurs expenses or renders services after an Event of
Default specified in Section 5.01(vii) or (viii) hereof occurs, the expenses and
the compensation for the services (including the fees and expenses of its agents
and counsel) are intended to constitute expenses of administration under any
Bankruptcy Law.

Section 6.08.  Replacement of Trustee.

          A resignation or removal of the Trustee and appointment of a successor
Trustee shall become effective only upon the successor Trustee's acceptance of
appointment as provided in this Section.

                                       46
<PAGE>
 
          The Trustee may resign in writing at any time and be discharged from
the trust hereby created by so notifying the Company.  The Holders of a majority
in principal amount of the then outstanding Securities may remove the Trustee by
so notifying the Trustee and the Company in writing.  The Company may remove the
Trustee if:

          (1) the Trustee fails to comply with Section 6.10 hereof;

          (2) the Trustee is adjudged a bankrupt or an insolvent or an order for
     relief is entered with respect to the Trustee under any Bankruptcy Law;

          (3) a Custodian or public officer takes charge of the Trustee or its
     property; or

          (4) the Trustee becomes incapable of acting.

          If the Trustee resigns or is removed or if a vacancy exists in the
office of Trustee for any reason, the Company shall promptly appoint a successor
Trustee.  Within one year after the successor Trustee takes office, the Holders
of a majority in principal amount of the then outstanding Securities may appoint
a successor Trustee to replace the successor Trustee appointed by the Company.

          If a successor Trustee does not take office within 60 days after the
retiring Trustee resigns or is removed, the retiring Trustee, the Company, or
the Holders of at least 10% in principal amount of the then outstanding
Securities may petition any court of competent jurisdiction for the appointment
of a successor Trustee.

          If the Trustee after written request by any Holder who has been a
Holder for at least six months fails to comply with Section 6.10, such Holder
may petition any court of competent jurisdiction for the removal of the Trustee
and the appointment of a successor Trustee.

          A successor Trustee shall deliver a written acceptance of its
appointment to the retiring Trustee and to the Company.  Thereupon, the
resignation or removal of the retiring Trustee shall become effective, and the
successor Trustee shall have all the rights, powers and duties of the Trustee
under this Indenture.  The successor Trustee shall mail a notice of its
succession to Holders.  The retiring Trustee shall promptly transfer all
property held by it as Trustee to the successor Trustee, provided all sums owing
to the Trustee hereunder have been paid and subject to the Lien provided for in
Section 6.07 hereof.  Notwithstanding replacement of the Trustee pursuant to
this Section 6.08, the Company's obligations under Section 6.07 hereof shall
continue for the benefit of the retiring Trustee.

Section 6.09.  Successor Trustee or Agent by Merger, etc.

          If the Trustee or any Agent consolidates, merges or converts into, or
transfers all or substantially all of its corporate trust business to, another
corporation, the successor corporation without any further act shall be the
successor Trustee or Agent.

                                       47
<PAGE>
 
Section 6.10.  Eligibility; Disqualification.

          There shall at all times be a Trustee hereunder which shall be a
corporation organized and doing business under the laws of the United States of
America or of any state thereof authorized under such laws to exercise corporate
trustee power, shall be subject to supervision or examination by federal or
state authority and shall have a combined capital and surplus of at least $100.0
million as set forth in its most recent published annual report of condition.

          This Indenture shall always have a Trustee who satisfies the
requirements of TIA (S) 310(a)(1), (2) and (5).  The Trustee is subject to TIA
(S) 310(b).

Section 6.11.  Preferential Collection of Claims Against Company.

          The Trustee is subject to TIA (S) 311(a), excluding any creditor
relationship listed in TIA (S) 311(b).  A Trustee who has resigned or been
removed shall be subject to TIA (S) 311(a) to the extent indicated therein.


                                   ARTICLE 7
                             DISCHARGE OF INDENTURE

Section 7.01.  Defeasance and Discharge of this Indenture and the Securities.

          The Company may, at the option of its Board of Directors evidenced by
a resolution set forth in an Officers' Certificate, at any time, with respect to
the Securities, elect to have either Section 7.02 or 7.03 be applied to all
outstanding Securities upon compliance with the conditions set forth below in
this Article 7.

Section 7.02.  Legal Defeasance and Discharge.

          Upon the Company's exercise under Section 7.01 of the option
applicable to this Section 7.02, the Company shall be deemed to have been
discharged from its obligations with respect to all outstanding Securities on
the date the conditions set forth below are satisfied (hereinafter, "Legal
Defeasance").  For this purpose, such Legal Defeasance means that the Company
shall be deemed to have paid and discharged the entire Indebtedness represented
by the outstanding Securities, which shall thereafter be deemed to be
"outstanding" only for the purposes of Section 7.05 and the other Sections of
this Indenture referred to in clauses (i) and (ii) of this Section 7.02, and to
have satisfied all its other obligations under such Securities and this
Indenture (and the Trustee, on demand of and at the expense of the Company,
shall execute proper instruments acknowledging the same), except for the
following which shall survive until otherwise terminated or discharged
hereunder:  (i) the rights of Holders of outstanding Securities to receive
solely from the trust fund described in Section 7.04, and as more fully set
forth in such Section, payments in respect of the principal of, premium, if any,
and interest on such Securities when such payments are due, (ii) the Company's
obligations with respect to such Securities under

                                       48
<PAGE>
 
Sections 2.04, 2.06, 2.07, 2.10 and 3.02, (iii) the rights, powers, trusts,
duties and immunities of the Trustee hereunder, including, without limitation,
the Trustee's rights under Section 6.07, and the Company's obligations in
connection therewith and (iv) this Article 7.  Subject to compliance with this
Article 7, the Company may exercise its option under this Section 7.02
notwithstanding the prior exercise of its option under Section 7.03 with respect
to the Securities.

Section 7.03.  Covenant Defeasance.

          Upon the Company's exercise under Section 7.01 of the option
applicable to this Section 7.03, the Company shall be released from its
obligations under the covenants contained in Sections 2.15, 3.07, 3.08, 3.09,
3.10, 3.11, 3.12, 3.13, 3.15, 3.16 and 3.17 and Article 4 with respect to the
outstanding Securities on and after the date the conditions set forth below are
satisfied (hereinafter, "Covenant Defeasance"), and the Securities shall
thereafter be deemed not "outstanding" for the purposes of any direction,
waiver, consent or declaration or act of Holders (and the consequences of any
thereof) in connection with such covenants, but shall continue to be deemed
"outstanding" for all other purposes hereunder (it being understood that such
Securities shall not be deemed outstanding for accounting purposes).  For this
purpose, such Covenant Defeasance means that, with respect to the outstanding
Securities, the Company may omit to comply with and shall have no liability in
respect of any term, condition or limitation set forth in any such covenant,
whether directly or indirectly, by reason of any reference elsewhere herein to
any such covenant or by reason of any reference in any such covenant to any
other provision herein or in any other document and such omission to comply
shall not constitute a Default or an Event of Default under Section 5.01(iii),
but, except as specified above, the remainder of this Indenture and such
Securities shall be unaffected thereby.  In addition, upon the Company's
exercise under Section 7.01 of the option applicable to this Section 7.03,
Sections 5.01(iv) through 5.01(viii) shall not constitute Events of Default.

Section 7.04.  Conditions to Legal or Covenant Defeasance.

          The following shall be the conditions to application of either Section
7.02 or Section 7.03 to the outstanding Securities:

          (i) The Company shall irrevocably have deposited or caused to be
     deposited with the Trustee (or another trustee satisfying the requirements
     of Section 6.10 who shall agree to comply with the provisions of this
     Article 7 applicable to it) as trust funds in trust for the purpose of
     making the following payments, specifically pledged as security for, and
     dedicated solely to, the benefit of the Holders of such Securities, (a)
     cash in U.S. Dollars in an amount, or (b) non-callable Government
     Securities which through the scheduled payment of principal and interest in
     respect thereof in accordance with their terms will provide, not later than
     one day before the due date of any payment, cash in U.S. Dollars in an
     amount, or (c) a combination thereof, in such amounts, as will be
     sufficient, in the opinion of a nationally recognized firm of independent
     public accountants expressed in a written certification thereof delivered
     to the Trustee, to pay and discharge and which shall be

                                       49
<PAGE>
 
     applied by the Trustee (or other qualifying trustee) to pay and discharge
     the principal of, premium, if any, and interest on the outstanding
     Securities on the stated maturity date of such principal or installment of
     principal, premium, if any, or interest.

          (ii) In the case of an election under Section 7.02, the Company shall
     have delivered to the Trustee an Opinion of Counsel in the United States
     confirming that (a) the Company has received from, or there has been
     published by, the Internal Revenue Service a ruling or (b) since the date
     hereof, there has been a change in the applicable federal income tax law,
     in either case to the effect that, and based thereon such opinion shall
     confirm that, the Holders of the outstanding Securities will not recognize
     income, gain or loss for federal income tax purposes as a result of such
     Legal Defeasance and will be subject to federal income tax on the same
     amounts, in the same manner and at the same times as would have been the
     case if such Legal Defeasance had not occurred.

          (iii) In the case of an election under Section 7.03, the Company shall
     have delivered to the Trustee an Opinion of Counsel in the United States
     confirming that the Holders of the outstanding Securities will not
     recognize income, gain or loss for federal income tax purposes as a result
     of such Covenant Defeasance and will be subject to federal income tax in
     the same amount, in the same manner and at the same times as would have
     been the case if such Covenant Defeasance had not occurred.

          (iv) No Default or Event of Default with respect to the Securities
     shall have occurred and be continuing on the date of such deposit (other
     than a Default or Event of Default resulting from the borrowing of funds to
     be applied to such deposit) or, insofar as Subsection 5.01(vii) or
     5.01(viii) is concerned, at any time in the period ending on the 91st day
     after the date of such deposit (it being understood that this condition
     shall not be deemed satisfied until the expiration of such period).

          (v) Such Legal Defeasance or Covenant Defeasance shall not result in a
     breach or violation of, or constitute a default under any other material
     agreement or instrument (other than this Indenture) to which the Company or
     any of its Subsidiaries is a party or by which the Company or any of its
     Subsidiaries is bound.

          (vi) In the case of an election under either Section 7.02 or 7.03, the
     Company shall have delivered to the Trustee an Opinion of Counsel to the
     effect that after the 91st day following the deposit, the trust funds will
     not be subject to the effect of any applicable Bankruptcy Law.

          (vii)  In the case of an election under either Section 7.02 or 7.03,
     the Company shall have delivered to the Trustee an Officers' Certificate
     stating that the deposit made by the Company pursuant to its election under
     Section 7.02 or 7.03 was not made by the Company with the intent of
     preferring the Holders of the Securities over other creditors of the
     Company with the intent of defeating, hindering, delaying or defrauding
     creditors of the Company or others.

                                       50
<PAGE>
 
     (viii)  The Company shall have delivered to the Trustee an Officers'
     Certificate and an Opinion of Counsel in the United States, each stating
     that all conditions precedent provided for relating to either the Legal
     Defeasance under Section 7.02 or the Covenant Defeasance under Section 7.03
     (as the case may be) have been complied with as contemplated by this
     Section 7.04.

Section 7.05.  Deposited Money and Government Securities to be Held in Trust;
               Other Miscellaneous Provisions.

          Subject to Section 7.06, all money and non-callable Government
Securities (including the proceeds thereof) deposited with the Trustee (or other
qualifying trustee, collectively for purposes of this Section 7.05, the
"Trustee") pursuant to Section 7.04 in respect of the outstanding Securities
shall be held in trust and applied by the Trustee, in accordance with the
provisions of such Securities and this Indenture, to the payment, either
directly or through any Paying Agent (including the Company acting as Paying
Agent) as the Trustee may determine, to the Holders of such Securities of all
sums due and to become due thereon in respect of principal, premium, if any, and
interest, but such money need not be segregated from other funds except to the
extent required by law.

          The Company shall pay and indemnify the Trustee against any tax, fee
or other charge imposed on or assessed against the cash or non-callable
Government Securities deposited pursuant to Section 7.04 or the principal and
interest received in respect thereof other than any such tax, fee or other
charge which by law is for the account of the Holders of the outstanding
Securities.

          Anything in this Article 7 to the contrary notwithstanding, the
Trustee shall deliver or pay to the Company from time to time upon the Company's
request any money or non-callable Government Securities held by it as provided
in Section 7.04 which, in the opinion of a nationally recognized firm of
independent public accountants expressed in a written certification thereof
delivered to the Trustee (which may be the opinion delivered under Section
7.04(i)), are in excess of the amount thereof which would then be required to be
deposited to effect an equivalent Legal Defeasance or Covenant Defeasance.

Section 7.06.  Repayment to Company.

          Any money deposited with the Trustee or any Paying Agent, or then held
by the Company, in trust for the payment of the principal of, premium, if any,
or interest on any Security and remaining unclaimed for two years after such
principal, and premium, if any, or interest has become due and payable shall be
paid to the Company on its written request or (if then held by the Company)
shall be discharged from such trust; and the Holder of such Security shall
thereafter, as an unsecured general creditor, look only to the Company for
payment thereof, and all liability of the Trustee or such Paying Agent with
respect to such trust money, and all liability of the Company as trustee
thereof, shall thereupon cease; provided, however, that the Trustee or such
Paying Agent, before being required to make any such repayment, may at the
expense of the Company cause to be published once, in the New York Times and The
Wall Street Journal (national edition), notice that such money

                                       51
<PAGE>
 
remains unclaimed and that, after a date specified therein, which shall not be
less than 30 days from the date of such notification or publication, any
unclaimed balance of such money then remaining will be repaid to the Company.

Section 7.07.  Reinstatement.

          If the Trustee or Paying Agent is unable to apply any U.S. Dollars or
non-callable Government Securities in accordance with Section 7.02 or 7.03, as
the case may be, by reason of any order or judgment of any court or governmental
authority enjoining, restraining or otherwise prohibiting such application, then
the Company's obligations under this Indenture and the Securities shall be
revived and reinstated as though no deposit had occurred pursuant to Section
7.02 or 7.03 until such time as the Trustee or Paying Agent is permitted to
apply all such money in accordance with Section 7.02 or 7.03, as the case may
be; provided, however, that, if the Company makes any payment of principal of,
premium, if any, or interest on any Security following the reinstatement of its
obligations, the Company shall be subrogated to the rights of the Holders of
such Security to receive such payment from the money held by the Trustee or
Paying Agent.

                                   ARTICLE 8
                        AMENDMENT, SUPPLEMENT AND WAIVER

Section 8.01.  Without Consent of Holders.

          The Company and the Trustee may amend or supplement this Indenture or
the Securities without the consent of any Holder:

            (i)     to cure any ambiguity, defect or inconsistency;

           (ii)     to provide for uncertificated Securities in addition to or
                    in place of certificated Securities;

          (iii)     to provide for any supplemental indenture required pursuant 
                    to Section 3.16 hereof;

           (iv)     to provide for the assumption of the Company's obligations
                    to the Holders of the Securities in the case of a merger,
                    consolidation or sale of assets pursuant to Article 4
                    hereof;

            (v)     to make any change that would provide any additional rights
                    or benefits to the Holders of the Securities or that does
                    not adversely affect the legal rights hereunder of any
                    Holder; or

           (vi)     to comply with requirements of the Commission in order to
                    effect or maintain the qualification of this Indenture under
                    the TIA.

          Upon the request of the Company accompanied by a resolution of its
Board of Directors authorizing the execution of any such supplemental indenture,
and upon receipt by the Trustee of the documents described in Section 8.06
hereof, the Trustee shall join with the

                                       52
<PAGE>
 
Company in the execution of any supplemental indenture authorized or permitted
by the terms of this Indenture and to make any further appropriate agreements
and stipulations which may be therein contained, but the Trustee shall not be
obligated to enter into such supplemental indenture which affects its own
rights, duties or immunities under this Indenture or otherwise.

Section 8.02.  With Consent of Holders.

          Except as provided in the next succeeding paragraphs, the Indenture or
the Securities may be amended or supplemented with the consent of the Holders of
at least a majority in principal amount of the Securities then outstanding
(including consents obtained in connection with a tender offer or exchange offer
for such Securities), and any existing default or compliance with any provision
of the Indenture or the Securities may be waived with the consent of the Holders
of a majority in principal amount of the then outstanding Securities (including
consents obtained in connection with a tender offer or exchange offer for such
Securities).

          Upon the request of the Company accompanied by a resolution of its
Board of Directors authorizing the execution of any such supplemental indenture,
and upon the filing with the Trustee of evidence satisfactory to the Trustee of
the consent of the Holders as aforesaid, and upon receipt by the Trustee of the
documents described in Section 8.06 hereof, the Trustee shall join with the
Company in the execution of such supplemental indenture unless such supplemental
indenture affects the Trustee's own rights, duties or immunities under this
Indenture or otherwise, in which case the Trustee may in its discretion, but
shall not be obligated to, enter into such supplemental indenture.

          It shall not be necessary for the consent of the Holders under this
Section 8.02 to approve the particular form of any proposed amendment or waiver,
but it shall be sufficient if such consent approves the substance thereof.

          After an amendment, supplement or waiver under this Section becomes
effective, the Company shall mail to the Holders affected thereby a notice
briefly describing the amendment, supplement or waiver.  Any failure of the
Company to mail such notice, or any defect therein, shall not, however, in any
way impair or affect the validity of any such supplemental indenture or waiver.
Subject to Sections 5.04 and 5.07 hereof, the Holders of a majority in aggregate
principal amount of the Securities then outstanding may waive compliance in a
particular instance by the Company with any provision of this Indenture or the
Securities.  Without the consent of each Holder affected, however, an amendment
or waiver may not (with respect to any Security held by a non-consenting
Holder):

          (i)  reduce the principal amount of Securities whose Holders must
               consent to an amendment, supplement or waiver;

          (ii) reduce the principal of or change the fixed maturity of any
               Security;

                                       53
<PAGE>
 
         (iii) reduce the rate of or change the time for payment of interest
               on any Security;

          (iv) waive a Default or Event of Default in the payment of principal
               of or premium, if any, or interest on the Securities (except a
               rescission of acceleration of the Securities by the Holders of at
               least a majority in aggregate principal amount of the Securities
               and a waiver of the payment default that resulted from such
               acceleration);

          (v)  make any Security payable in money other than that stated in the
               Securities;

          (vi) make any change in Section 5.04 or 5.07 hereof, or

         (vii) make any change in this sentence of this Section 8.02.

Section 8.03.  Compliance with TIA.

               Every amendment to this Indenture or the Securities shall be set
forth in a supplemental indenture that complies with the TIA as then in effect.

Section 8.04.  Revocation and Effect of Consents.

               Until an amendment or waiver becomes effective, a consent to it
by a Holder is a continuing consent by the Holder and every subsequent Holder of
a Security or portion of a Security that evidences the same debt as the
consenting Holder's Security, even if notation of the consent is not made on any
Security. However, any such Holder or subsequent Holder may revoke the consent
as to its Security if the Trustee receives written notice of revocation before
the date the waiver or amendment becomes effective. An amendment or waiver
becomes effective in accordance with its terms and thereafter binds every
Holder.

               The Company may, but shall not be obligated to, fix a record date
for determining which Holders must consent to such amendment or waiver. If the
Company fixes a record date, the record date shall be fixed at (i) the later of
30 days prior to the first solicitation of such consent or the date of the most
recent list of Holders furnished to the Trustee prior to such solicitation
pursuant to Section 2.05 or (ii) such other date as the Company shall designate.

Section 8.05.  Notation on or Exchange of Securities.

               The Trustee may place an appropriate notation about an amendment
or waiver on any Security thereafter authenticated. The Company in exchange for
all Securities may issue and the Trustee shall authenticate new Securities that
reflect the amendment or waiver.

                                       54
<PAGE>
 
               Failure to make the appropriate notation or issue a new Security
shall not affect the validity and effect of such amendment or waiver.

Section 8.06.  Trustee to Sign Amendments, etc.

               The Trustee shall sign any amendment or supplemental indenture
authorized pursuant to this Article 8 if the amendment does not adversely affect
the rights, duties, liabilities or immunities of the Trustee. If it does, the
Trustee may, but need not, sign it. In signing or refusing to sign such
amendment or supplemental indenture, the Trustee shall be entitled to receive
and, subject to Section 6.01, shall be fully protected in relying upon, an
Officers' Certificate and an Opinion of Counsel as conclusive evidence that such
amendment or Supplemental Indenture is authorized or permitted by this
Indenture, that it is not inconsistent herewith, and that it will be valid and
binding upon the Company in accordance with its terms. The Company may not sign
an amendment or supplemental indenture until the Board of Directors approves it.


                                   ARTICLE 9
                                 MISCELLANEOUS

Section 9.01.  TIA Controls.

               If any provision of this Indenture limits, qualifies or conflicts
with the duties imposed by TIA (S)318(c), the imposed duties shall control.

Section 9.02.  Notices.

               Any notice or communication by the Company or the Trustee to the
other is duly given if in writing and delivered in person or mailed by first
class mail (registered or certified, return receipt requested), telex,
telecopier or overnight air courier guaranteeing next day delivery, to the
other's address:

               If to the Company:

               National Medical Enterprises, Inc.
               2700 Colorado Avenue
               Santa Monica, California  90404
               Telecopier No.:  (310) 998-______
               Attention:  Treasurer

               With a copy to:

               Skadden, Arps, Slate, Meagher & Flom
               300 South Grand Avenue, Suite 3400
               Los Angeles, California  90071
               Telecopier No.:  (213) 687-5600

                                       55
<PAGE>
 
               Attention:  Thomas C. Janson, Jr.

               If to the Trustee:

               The Bank of New York
               101 Barclay Street, 21 West
               New York, New York  10286
               Telecopier No.: (212) 815-5915
               Attention: Corporate Trust Trustee Administration


               The Company or the Trustee, by notice to the others may designate
additional or different addresses for subsequent notices or communications.

               All notices and communications (other than those sent to Holders)
shall be deemed to have been duly given: at the time delivered by hand, if
personally delivered; five Business Days after being deposited in the mail,
postage prepaid, if mailed; when answered back, if telexed; when receipt
acknowledged, if telecopied; and the next Business Day after timely delivery to
the courier, if sent by overnight air courier guaranteeing next day delivery.

               Any notice or communication to a Holder shall be mailed by first
class mail, certified or registered, return receipt requested, or by overnight
air courier guaranteeing next day delivery to its address shown on the register
kept by the Registrar. Any notice or communication shall also be so mailed to
any Person described in TIA (S) 313(c), to the extent required by the TIA.
Failure to mail a notice or communication to a Holder or any defect in it shall
not affect its sufficiency with respect to other Holders.

               If a notice or communication is mailed in the manner provided
above within the time prescribed, it is duly given, whether or not the addressee
receives it.

               If the Company mails a notice or communication to Holders, it
shall mail a copy to the Trustee and each Agent at the same time.

Section 9.03.  Communication by Holders with Other Holders.

               Holders may communicate pursuant to TIA (S) 312(b) with other
Holders with respect to their rights under this Indenture or the Securities. The
Company, the Trustee, the Registrar and anyone else shall have the protection of
TIA (S) 312(c).

Section 9.04.  Certificate and Opinion as to Conditions Precedent.

               Upon any request or application by the Company to the Trustee to
take any action under this Indenture, the Company shall furnish to the Trustee:

               (1) an Officers' Certificate (which shall include the statements
set forth in Section 9.05 hereof)

                                       56
<PAGE>
 
     stating that, in the opinion of the signers, all conditions precedent and
     covenants, if any, provided for in this Indenture relating to the proposed
     action have been satisfied; and

          (2) an Opinion of Counsel (which shall include the statements set
     forth in Section 9.05 hereof) stating that, in the opinion of such counsel,
     all such conditions precedent and covenants have been satisfied.

Section 9.05.  Statements Required in Certificate or Opinion.

               Each certificate or opinion with respect to compliance with a
condition or covenant provided for in this Indenture (other than a certificate
provided pursuant to TIA (S) 314(a)(4)) shall include:

          (1) a statement that the person making such certificate or opinion has
     read such covenant or condition;

          (2) a brief statement as to the nature and scope of the examination or
     investigation upon which the statements or opinions contained in such
     certificate or opinion are based;

          (3) a statement that, in the opinion of such person, he has made such
     examination or investigation as is necessary to enable him to express an
     informed opinion as to whether or not such covenant or condition has been
     satisfied; and

          (4) a statement as to whether or not, in the opinion of such person,
     such condition or covenant has been satisfied; provided, however, that with
     respect to matters of fact, an Opinion of Counsel may rely on an Officers'
     Certificate or certificates of public officials.

Section 9.06.  Rules by Trustee and Agents.

               The Trustee may make reasonable rules for action by or at a
meeting of Holders. The Registrar or Paying Agent may make reasonable rules and
set reasonable requirements for its functions.

Section 9.07.  Legal Holidays.

               A "Legal Holiday" is a Saturday, a Sunday or a day on which
banking institutions in The City of New York or at a place of payment are
authorized or obligated by law, regulation or executive order to remain closed.
If a payment date is a Legal Holiday at a place of payment, payment may be made
at that place on the next succeeding day that is not a Legal Holiday, and no
interest shall accrue for the intervening period.

                                       57
<PAGE>
 
Section 9.08.  No Personal Liability of Directors, Officers, Employees and
               Stockholders

     No director, officer, employee, incorporator or stockholder of the Company,
as such, shall have any liability for any obligations of the Company under the
Securities, the Indenture or for any claim based on, in respect of, or by reason
of, such obligations or their creation.  Each Holder of the Securities by
accepting a Security waives and releases all such liability.  The waiver and
release are part of the consideration for issuance of the Securities.  Such
waiver may not be effective to waive liabilities under the federal securities
laws and it is the view of the Commission that such a waiver is against public
policy.

Section 9.09.  Duplicate Originals.

     The parties may sign any number of copies of this Indenture.  One signed
copy is enough to prove this Indenture.

Section 9.10.  Governing Law.

     The internal law of the State of New York, shall govern and be used to
construe this Indenture and the Securities, without regard to the conflict of
laws provisions thereof.

Section 9.11.  No Adverse Interpretation of Other Agreements.

     This Indenture may not be used to interpret another indenture, loan or debt
agreement of the Company or its Subsidiaries.  Any such indenture, loan or debt
agreement may not be used to interpret this Indenture.

Section 9.12.  Successors.

     All agreements of the Company in this Indenture and the Securities shall
bind its successors.  All agreements of the Trustee in this Indenture shall bind
its successor.

Section 9.13.  Severability.

     In case any provision in this Indenture or in the Securities shall be
invalid, illegal or unenforceable, the validity, legality and enforceability of
the remaining provisions shall not in any way be affected or impaired thereby,
it being intended that all of the provisions hereof shall be enforceable to the
full extent permitted by law.

Section 9.14.  Counterpart Originals.

     The parties may sign any number of copies of this Indenture.  Each signed
copy shall be an original, but all of them together represent the same
agreement.

                                       58
<PAGE>
 
Section 9.15.  Table of Contents, Headings, etc.

     The Table of Contents, Cross-Reference Table and Headings of the Articles
and Sections of this Indenture have been inserted for convenience of reference
only, are not to be considered a part of this Indenture and shall in no way
modify or restrict any of the terms or provisions hereof.

                                       59
<PAGE>
 
                                  SIGNATURES



Dated as of _______________          NATIONAL MEDICAL ENTERPRISES, INC.



                                     By:_______________________________
                                        Name:
                                        Title:
Attest:


_____________________  (SEAL)
    

Dated as of _______________          THE BANK OF NEW YORK, as Trustee



                                     By:______________________________
                                        Name:
                                        Title:


Attest:


_____________________  (SEAL)
                       

                                       60
<PAGE>
 
                                                                       EXHIBIT A
                               
                              (Face of Security)

                                ___% Senior Note
                            due September ___, 2002
CUSIP: _________
No.                                                      $____________

                       NATIONAL MEDICAL ENTERPRISES, INC.


promises to pay to

_________________________________________________________________________

or its registered assigns, the principal sum of _________________________

Dollars on September __, 2002.


Interest Payment Dates:  March ___ and September ___, commencing 

September ___,1995.


Record Dates:  ___________ and _________ (whether or not a Business Day).
 

NATIONAL MEDICAL ENTERPRISES, INC.

By: _________________________

                                      A-1
<PAGE>
 
Dated: ___________, 1995

(SEAL)

Trustee's Certificate of Authentication:

This is one of the Securities referred
to in the within-mentioned Indenture:


The Bank of New York, as Trustee

By: ___________________________
       Authorized Signatory

                                      A-2
<PAGE>
 
                               (Back of Security)

                                ___% SENIOR NOTE
                            Due September ___, 2002

     Capitalized terms used herein have the meanings assigned to them in the
Indenture (as defined below) unless otherwise indicated.

     1.  Interest.  National Medical Enterprises, Inc., a Nevada corporation
(the "Company"), promises to pay interest on the principal amount of this
Security at the rate and in the manner specified below.

         The Company shall pay interest in cash on the principal amount of this
Security at the rate per annum of _____%.  The Company will pay interest
semiannually in arrears on March __ and September __ of each year, commencing
September __, 1995, or if any such day is not a Business Day on the next
succeeding Business Day (each an "Interest Payment Date").

         Interest will be computed on the basis of a 360-day year consisting of
twelve 30-day months.  Interest shall accrue from the most recent date to which
interest has been paid or, if no interest has been paid, from the date of the
original issuance of the Securities.  To the extent lawful, the Company shall
pay interest on overdue principal at the rate of 1% per annum in excess of the
interest rate then applicable to the Securities; it shall pay interest on
overdue installments of interest (without regard to any applicable grace
periods) at the same rate to the extent lawful.

     2.  Method of Payment.  The Company will pay interest on the Securities
(except defaulted interest) to the Persons who are registered Holders of
Securities at the close of business on the record date next preceding the
Interest Payment Date, even if such Securities are cancelled after such record
date and on or before such Interest Payment Date.  The Holder hereof must
surrender this Security to a Paying Agent to collect principal payments.  The
Company will pay principal and interest in money of the United States that at
the time of payment is legal tender for payment of public and private debts.
The Company, however, may pay principal, premium, if any, and interest by check
payable in such money.  It may mail an interest check to a Holder's registered
address.  Notwithstanding the foregoing, all payments with respect to Securities
having a principal amount of $10.0 million or more the Holders of which have
given wire transfer instructions, on or before the relevant record date, to the
Paying Agent shall be made by wire transfer of immediately available funds to
the accounts specified by such Holders.

     3.  Paying Agent and Registrar.  Initially, the Trustee will act as Paying
Agent and Registrar.  The Company may change any Paying Agent or Registrar or
co-registrar without prior notice to any Holder.  The Company and any of its
Subsidiaries may act in any such capacity.

                                      A-3
<PAGE>
 
     4.  Indenture.  The Company issued the Securities under an Indenture, dated
as of March ___, 1995 (the "Indenture"), between the Company and the Trustee.
The terms of the Securities include those stated in the Indenture and those made
part of the Indenture by reference to the Trust Indenture Act of 1939, as
amended (15 U.S. Code (S)(S) 77aaa-77bbbb) (the "TIA") as in effect on the date
of the Indenture.  The Securities are subject to all such terms, and Holders are
referred to the Indenture and such act for a statement of such terms.  The terms
of the Indenture shall govern any inconsistencies between the Indenture and the
Securities.  The Securities are unsecured general obligations of the Company.
The Securities are limited to $300,000,000 in aggregate principal amount.

     5.  Mandatory Redemption.  Subject to the Company's obligation to make an
offer to repurchase Securities under certain circumstances pursuant to Sections
3.10 and 3.13 of the Indenture (as described in paragraph 6 below), the Company
shall have no mandatory redemption or sinking fund obligations with respect to
the Securities.

     6.  Repurchase at Option of Holder.  (i)  If there is a Change of Control
Triggering Event, the Company shall be required to offer to repurchase on the
Change of Control Payment Date all outstanding Securities at 101% of the
aggregate principal amount thereof, plus accrued and unpaid interest to the
Change of Control Payment Date.  Holders that are subject to an offer to
purchase will receive a Change of Control Offer from the Company prior to any
related Change of Control Payment Date and may elect to have such Securities
purchased by completing the form entitled "Option of Holder to Elect Purchase"
appearing below.

     (ii)  If the Company or a Subsidiary consummates an Asset Sale, within 365
days after the receipt of any Net Proceeds from such Asset Sale, the Company may
elect to apply the Net Proceeds therefrom (a) to purchase one or more Hospitals
or Related Businesses and/or a controlling interest in the Capital Stock of a
Person owning one or more Hospitals and/or one or more Related Businesses, (b)
to make a capital expenditure or to acquire other tangible assets, in each case,
that are used or useful in any business in which the Company is permitted to be
engaged pursuant to Section 3.15 of the Indenture, (c) to permanently reduce
Senior Term Debt or Existing Indebtedness of a Subsidiary or (d) to permanently
reduce Senior Revolving Debt (and to correspondingly reduce commitments with
respect thereto), except that up to an aggregate of $200.0 million of Net
Proceeds from Asset Sales may be applied after the date of the Senior Note
Indenture to reduce Senior Revolving Debt without a corresponding reduction in
commitments with respect thereto.  Pending the final application of any such Net
Proceeds, the Company may temporarily reduce Senior Revolving Debt or otherwise
invest such Net Proceeds in any manner that is not prohibited by the Indenture.
Any Net Proceeds from any Asset Sale that are not so invested or applied shall
be deemed to constitute "Excess Proceeds."  When the aggregate amount of Excess
Proceeds that have not been so invested or applied in accordance with (a), (b),
(c) or (d) above exceeds $25.0 million, the Company shall be required to make an
offer to all Holders of Securities and any other Indebtedness of the Company
ranking on a parity with the Securities from time to time outstanding with
similar provisions requiring the Company to make an offer to purchase or to
redeem such Indebtedness with the proceeds from any asset sales, pro rata in
proportion to the respective principal amounts of the Securities and such

                                      A-4
<PAGE>
 
other Indebtedness then outstanding (a "Senior Asset Sale Offer") to purchase
the maximum principal amount of Securities and such other Indebtedness that may
be purchased out of the Excess Proceeds, at an offer price in cash in an amount
equal to 100% of the principal amount thereof, plus accrued and unpaid interest
thereon, if any, to the date of purchase in accordance with the terms of the
Indenture.  If the aggregate principal amount of Securities and such other
Indebtedness surrendered by Holders thereof exceeds the amount of Excess
Proceeds, the Securities and such other Indebtedness to be redeemed shall be
selected on a pro rata basis.  Holders that are the subject of an offer to
purchase will receive a Senior Asset Sale Offer from the Company prior to any
related purchase date and may elect to have such Securities purchased by
completing the form entitled "Option of Holder to Elect Purchase" appearing
below.

     7.  Denominations, Transfer, Exchange.  The Securities are in registered
form without coupons, and in denominations of $1,000 and integral multiples of
$1,000.  The transfer of Securities may be registered and Securities may be
exchanged as provided in the Indenture.  The Registrar and the Trustee may
require a Holder, among other things, to furnish appropriate endorsements and
transfer documents and to pay any taxes and fees required by law or permitted by
the Indenture.  The Registrar need not exchange or register the transfer of any
Securities between a record date and the corresponding Interest Payment Date.

     8.  Persons Deemed Owners.  Prior to due presentment to the Trustee for
registration of the transfer of this Security, the Trustee, any Agent and the
Company may deem and treat the Person in whose name this Security is registered
as its absolute owner for the purpose of receiving payment of principal of,
premium, if any, and interest on this Security and for all other purposes
whatsoever, whether or not this Security is overdue, and neither the Trustee,
any Agent nor the Company shall be affected by notice to the contrary.  The
registered Holder of a Security shall be treated as its owner for all purposes.

     9.  Amendment, Supplement and Waivers.  Except as provided in the next
succeeding paragraphs, the Indenture or the Securities may be amended or
supplemented with the consent of the Holders of at least a majority in principal
amount of the Securities then outstanding (including consents obtained in
connection with a tender offer or exchange offer for Securities) and any
existing default or compliance with any provision of the Indenture or the
Securities may be waived with the consent of the Holders of a majority in
principal amount of the then outstanding Securities (including consents obtained
in connection with a tender offer or exchange offer for Securities).

     Without the consent of each Holder affected, an amendment or waiver may not
(with respect to any Securities held by a non-consenting Holder of Securities):
(i) reduce the principal amount of Securities whose Holders must consent to an
amendment, supplement or waiver, (ii) reduce the principal of or change the
fixed maturity of any Security, (iii) reduce the rate of or change the time for
payment of interest on any Security, (iv) waive a Default or Event of Default in
the payment of principal of or premium, if any, or interest on the Securities,
(except a rescission of acceleration of the Securities by the Holders of at
least a majority aggregate principal amount of the Securities and a waiver of
the payment default

                                      A-5
<PAGE>
 
that resulted from such acceleration), (v) make any Security payable in money
other than that stated in the Securities, (vi) make any change in the provisions
of the Indenture relating to waivers of past Defaults or the rights of Holders
of Securities to receive payments of principal of or premium, if any, or
interest on the Securities or (vii) make any change in the foregoing amendment
and waiver provisions.

     Notwithstanding the foregoing, without the consent of any Holder of
Securities, the Company and the Trustee may amend or supplement the Indenture or
the Securities to cure any ambiguity, defect or inconsistency, to provide for
uncertificated Securities in addition to or in place of certificated Securities,
to provide for any supplemental indenture required pursuant to Section 3.16 of
the Indenture to provide for the assumption of the Company's obligations to
Holders of the Securities in the case of a merger, consolidation or sale of
assets, to make any change that would provide any additional rights or benefits
to the Holders of the Securities or that does not adversely affect the legal
rights under the Indenture of any such Holder, or to comply with requirements of
the Securities and Exchange Commission (the "Commission") in order to effect or
maintain the qualification of the Indenture under the TIA.

     10.  Defaults and Remedies.  Events of Default under the Indenture include:
(i) a default for 30 days in the payment when due of interest on the Securities;
(ii) a default in payment when due of principal of or premium, if any, on the
Securities, at maturity or otherwise; (iii) a failure by the Company to comply
with the provisions described under the covenants "Limitations on Restricted
Payments," "Limitations on Incurrence of Indebtedness and Issuance of Preferred
Stock," "Asset Sales," and "Change of Control;" (iv) a failure by the Company
for 60 days after notice to comply with any of its other agreements in the
Indenture or the Securities; (v) any default that occurs under any mortgage,
indenture or instrument under which there may be issued or by which there may be
secured or evidenced any Indebtedness for money borrowed by the Company or any
of its Significant Subsidiaries (or the payment of which is Guaranteed by the
Company or any of its Significant Subsidiaries) whether such Indebtedness or
Guarantee exists on the date hereof, or is created after the date hereof, which
default (a) constitutes a Payment Default or (b) results in the acceleration of
such Indebtedness prior to its express maturity and, in each case, the principal
amount of any such Indebtedness, together with the principal amount of any other
such Indebtedness under which there has been a Payment Default or that has been
so accelerated, aggregates $25.0 million or more; (vi) failure by the Company or
any of its Significant Subsidiaries to pay a final judgment or final judgments
aggregating in excess of $25.0 million entered by a court or courts or competent
jurisdiction against the Company or any of its Significant Subsidiaries if such
final judgments remain undischarged for a period (during which execution shall
not be effectively stayed) of 60 days after their entry; and (vii) certain
events of bankruptcy or insolvency with respect to the Company or any of its
Significant Subsidiaries. If any Event of Default occurs and is continuing, the
Trustee or the Holders of at least 25% in aggregate principal amount of the then
outstanding Securities by written notice to the Company and the Trustee, may
declare all the Securities to be due and payable immediately (plus, in the case
of an Event of Default that is the result of willful actions (or inactions) by
the Company intended to avoid prohibitions on, or premiums related to,
redemptions of the Securities contained in the Indenture or the Securities, an
amount of premium that would have been applicable pursuant to the Securities).
Notwithstanding the

                                      A-6
<PAGE>
 
foregoing, in the case of an Event of Default arising from certain events of
bankruptcy or insolvency with respect to the Company, all outstanding Securities
will become due and payable without further action or notice.  Holders of the
Securities may not enforce the Indenture or the Securities except as provided in
the Indenture.  Subject to certain limitation, Holders of a majority in
principal amount of the then outstanding Securities may direct the Trustee in
its exercise of any trust or power.  The Trustee may withhold from Holders of
the Securities notice of any continuing Default or Event of Default (except a
Default or Event of Default relating to the payment of principal or interest) if
it determines that withholding notice is in such Holders' interest.

     The Holders of a majority in aggregate principal amount of the Securities
then outstanding by notice to the Trustee may on behalf of the Holders of all of
the Securities waive any existing Default or Event of Default and its
consequences under the Indenture except a continuing Default or Event of Default
in the payment of interest or premium on, or the principal of, the Securities.

     The Company is required to deliver to the Trustee annually a statement
regarding compliance with the Indenture, and the Company is required upon
becoming aware of any Default or Event of Default, to deliver to the Trustee a
statement specifying such Default or Event of Default.

     The above description of Events of Default and remedies is qualified by
reference, and subject in its entirety, to the more complete description thereof
contained in the Indenture.

     11.  Restrictive Covenants.  The Indenture imposes certain limitations on
the ability of the Company and its Subsidiaries to incur additional indebtedness
and issue preferred stock, pay dividends or make other distributions, repurchase
Equity Interests or subordinated indebtedness, create certain liens, enter into
certain transactions with affiliates, sell assets of the Company or its
Subsidiaries, issue or sell Equity Interests of the Company's Subsidiaries,
issue Guarantees of Indebtedness by the Company's Subsidiaries and enter into
certain mergers and consolidations.

     12.  Trustee Dealings with Company.  The Trustee under the Indenture, in
its individual or any other capacity, may make loans to, accept deposits from,
and perform services for the Company or its Affiliates, and may otherwise deal
with the Company or its Affiliates, as if it were not Trustee.

     13.  No Personal Liability of Directors, Officers, Employees and
Stockholders.  No director, officer, employee, incorporator or stockholder of
the Company, as such, shall have any liability for any obligations of the
Company under the Securities, the Indenture or for any claim based on, in
respect of, or by reason of, such obligations or their creation.  Each Holder by
accepting a Security waives and releases all such liability.  The waiver and
release are part of the consideration for the issuance of the Securities.  Such
waiver may not be effective to waive liabilities under the federal securities
laws and it is the view of the Commission that such a waiver is against public
policy.

                                      A-7
<PAGE>
 
     14.  Authentication.  This Security shall not be valid until authenticated
by the manual signature of the Trustee or an authenticating agent.

     15.  Abbreviations.  Customary abbreviations may be used in the name of a
Holder or an assignee, such as:  TEN COM (= tenants in common), TEN ENT (=
tenants by the entireties), JT TEN (= joint tenants with right of survivorship
and not as tenants in common), CUST (= Custodian), and U/G/M/A (= Uniform Gifts
to Minors Act).

     16.  CUSIP Numbers.  Pursuant to a recommendation promulgated by the
Committee on Uniform Security Identification Procedures, the Company has caused
CUSIP numbers to be printed on the Securities and has directed the Trustee to
use CUSIP numbers as a convenience to Holders.  No representation is made as to
the accuracy of such numbers either as printed on the Securities and reliance
may be placed only on the other identification numbers placed thereon.

                                      A-8
<PAGE>
 
     The Company will furnish to any Holder upon written request and without
charge a copy of the Indenture.  Request may be made to:

     
     National Medical Enterprises, Inc.
     2700 Colorado Avenue
     Santa Monica, California  90404
     Attention:  Treasurer

                                      A-9
<PAGE>
 
                                ASSIGNMENT FORM


     To assign this Security, fill in the form below:  (I) or (we) assign and
transfer this Security to

______________________________________________________________________________
                 (Insert assignee's soc. sec. or tax I.D. no.)

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________
             (Print or type assignee's name, address and zip code)

and irrevocably appoint _____________________________________________________
agent to transfer this Security on the books of the Company.  The agent may
substitute another to act for him.

______________________________________________________________________________

Date:  ______________

                              Your Signature:________________________________
              (Sign exactly as your name appears on the face of this Security)

Signature Guarantee.*




__________

*Participant in a recognized Signature Guarantee Medallion Program (or other
signature guarantor acceptable to the Trustee).

                                     A-10
<PAGE>
 
                       OPTION OF HOLDER TO ELECT PURCHASE


     If you want to elect to have all or any part of this Security purchased by
the Company pursuant to Section 3.10 or Section 3.13 of the Indenture, check the
appropriate box:

     [_] Section 3.10                                 [_] Section 3.13
         (Asset Sale)                                     (Change of Control)

     If you want to have only part of the Security purchased by the Company
pursuant to Section 3.10 or Section 3.13 of the Indenture, state the amount you
elect to have purchased:

$ _______________


Date:____________


                              Your Signature:________________________________
             (Sign exactly as your name appears on the face of this Security)

Signature Guarantee.*



__________

*Participant in a recognized Signature Guarantee Medallion Program (or other
signature guarantor acceptable to the Trustee).

                                     A-11

<PAGE>
 
                                                                     EXHIBIT 4.2

================================================================================








                       NATIONAL MEDICAL ENTERPRISES, INC.






                       ----------------------------------

                                  $700,000,000

                     ___ SENIOR SUBORDINATED NOTES due 2005

                       ----------------------------------




                            ------------------------
                             
                                   INDENTURE

                          Dated as of March ___, 1995

                            ------------------------





                       ----------------------------------

                              THE BANK OF NEW YORK

                       ----------------------------------

                                   as Trustee


===============================================================================
<PAGE>
 
                            CROSS-REFERENCE TABLE*

<TABLE>
<CAPTION>
     TRUST INDENTURE
        ACT SECTION                                           INDENTURE SECTION
      ---------------                                         -----------------
<S>                                                           <C>
310 (a)(1)...............................................                  7.10
    (a)(2)...............................................                  7.10
    (a)(3)...............................................                  N.A.
    (a)(4)...............................................                  N.A.
    (a)(5)...............................................                  7.10
    (b)..................................................            7.08; 7.10
    (c)..................................................                  N.A.
311 (a)..................................................                  7.11
    (b)..................................................                  7.11
    (c)..................................................                  N.A.
312 (a)..................................................                  2.05
    (b)..................................................                 11.03
    (c)..................................................                 11.03
313 (a)..................................................                  7.06
    (b)(1)...............................................                  N.A.
    (b)(2)...............................................                  8.06
    (c)..................................................           7.06; 11.02
    (d)..................................................                  7.06
314 (a)..................................................           4.03; 11.02
    (b)..................................................                  N.A.
    (c)(1)...............................................                 11.04
    (c)(2)...............................................                 11.04
    (c)(3)...............................................                  N.A.
    (d)..................................................                  N.A.
    (e)..................................................                 11.05
    (f)..................................................                  N.A.
315 (a)..................................................           7.01(ii)(b)
    (b)..................................................           7.05; 11.02
    (c)..................................................               7.01(i)
    (d)..................................................             7.01(iii)
    (e)..................................................                  6.11
316 (a)(last sentence)...................................                  2.09
    (a)(1)(A)............................................                  6.05
    (a)(1)(B)............................................                  6.04
    (a)(2)...............................................                  N.A.
    (b)..................................................                  6.07
    (c)..................................................            2.13; 8.04
</TABLE>

<PAGE>
 
<TABLE>

<S>                                                            <C>
317 (a)(1).................................................      6.08
    (a)(2).................................................      6.09
    (b)....................................................      2.04
318 (a)....................................................     11.01
    (b)....................................................      N.A.
    (c)....................................................     11.01
</TABLE>

N.A. means not applicable.

- ----------------------------

     *THIS CROSS-REFERENCE TABLE IS NOT PART OF THE INDENTURE.

                            
<PAGE>
 
                               TABLE OF CONTENTS

<TABLE>
<CAPTION> 
                                                                            PAGE
                                                                            
ARTICLE 1 - DEFINITIONS AND INCORPORATION BY REFERENCE

<S>                  <C>                                                    <C>
    Section 1.01.    Definitions..........................................     1
    Section 1.02.    Other Definitions....................................    13
    Section 1.03.    Incorporation by Reference of TIA....................    14
    Section 1.04.    Rules of Construction................................    14
 
ARTICLE 2 - THE SECURITIES
 
    Section 2.01.    Form and Dating......................................    15
    Section 2.02.    Execution and Authentication........................     15
    Section 2.03.    Registrar and Paying Agent...........................    16
    Section 2.04.    Paying Agent to Hold Money in Trust..................    16
    Section 2.05.    Holder Lists.........................................    17
    Section 2.06.    Transfer and Exchange................................    17
    Section 2.07.    Replacement Securities...............................    18
    Section 2.08.    Outstanding Securities...............................    18
    Section 2.09.    Treasury Securities..................................    18
    Section 2.10.    Temporary Securities.................................    19
    Section 2.11.    Cancellation.........................................    19
    Section 2.12.    Defaulted Interest...................................    19
    Section 2.13.    Record Date..........................................    19
    Section 2.14.    CUSIP Number.........................................    19
 
ARTICLE 3 - REDEMPTION     
 
    Section 3.01.    Notice to Trustee....................................    20
    Section 3.02.    Selection of Securities to Be Redeemed...............    20
    Section 3.03.    Notice of Redemption.................................    21
    Section 3.04.    Effect of Notice of Redemption.......................    22
    Section 3.05.    Deposit of Redemption Price..........................    22
    Section 3.06.    Securities Redeemed in Part..........................    22
    Section 3.07.    Optional Redemption..................................    22
    Section 3.08.    Mandatory Redemption.................................    23
    Section 3.09.    Offer to Purchase By Application of Net Proceeds.....    23

ARTICLE 4 - COVENANTS
 
    Section 4.01.    Payment of Securities................................    25
    Section 4.02.    Maintenance of Office or Agency......................    26
    Section 4.03.    Commission Reports...................................    26
</TABLE> 
                                       i
<PAGE>

<TABLE> 
<CAPTION> 
                                                                            PAGE
<S>                  <C>                                                    <C> 
    Section 4.04.    Compliance Certificate...............................    28
    Section 4.05.    Taxes................................................    28
    Section 4.06.    Stay, Extension and Usury Laws.......................    29
    Section 4.07.    Limitations on Restricted Payments...................    29
    Section 4.08.    Limitations on Dividends and Other Payment
                     Restrictions Affecting Subsidiaries..................    31
    Section 4.09.    Limitations on Incurrence of Indebtedness
                     and Issuance of Preferred Stock......................    32
    Section 4.10.    Asset Sales..........................................    34
    Section 4.11.    Limitations on Transactions with Affiliates..........    36
    Section 4.12.    Limitations on Liens.................................    36
    Section 4.13.    Change of Control....................................    36
    Section 4.14.    Corporate Existence..................................    38
    Section 4.15.    Line of Business.....................................    39
    Section 4.16.    Limitations on Issuances of Guarantees of
                     Indebtedness by Subsidiaries.........................    39
    Section 4.17.    No Senior Subordinated Debt..........................    39
 
ARTICLE 5 - SUCCESSORS
 
    Section 5.01.    Limitations On Mergers, Consolidations or
                     Sales of Assets......................................    39
    Section 5.02.    Successor Corporation Substituted....................    40
 
ARTICLE 6 - DEFAULTS AND REMEDIES
 
    Section 6.01.    Events of Default....................................    41
    Section 6.02.    Acceleration.........................................    43
    Section 6.03.    Other Remedies.......................................    43
    Section 6.04.    Waiver of Past Defaults..............................    43
    Section 6.05.    Control by Majority..................................    44
    Section 6.06.    Limitation on Suits..................................    44
    Section 6.07.    Rights of Holders to Receive Payment.................    44
    Section 6.08.    Collection Suit by Trustee...........................    45
    Section 6.09.    Trustee May File Proofs of Claim.....................    45
    Section 6.10.    Priorities...........................................    45
    Section 6.11.    Undertaking for Costs................................    46
 
ARTICLE 7 - TRUSTEE
 
    Section 7.01.    Duties of Trustee....................................    46
    Section 7.02.    Rights of Trustee....................................    47
    Section 7.03.    Individual Rights of Trustee.........................    48
    Section 7.04.    Trustee's Disclaimer.................................    48
</TABLE> 
                                      ii
<PAGE>

<TABLE> 
<CAPTION> 
                                                                            PAGE
<S>                  <C>                                                    <C> 
    Section 7.05.    Notice of Defaults...................................    48
    Section 7.06.    Reports by Trustee to Holders........................    49
    Section 7.07.    Compensation and Indemnity...........................    49
    Section 7.08.    Replacement of Trustee...............................    50
    Section 7.09.    Successor Trustee or Agent by Merger, etc............    51
    Section 7.10.    Eligibility; Disqualification........................    51
    Section 7.11.    Preferential Collection of Claims Against
                     Company..............................................    51
 
 
ARTICLE 8 - DISCHARGE OF INDENTURE
 
    Section 8.01.    Defeasance and Discharge of this Indenture
                     and the Securities...................................    51
    Section 8.02.    Legal Defeasance and Discharge.......................    51
    Section 8.03.    Covenant Defeasance..................................    52
    Section 8.04.    Conditions to Legal or Covenant Defeasance...........    52
    Section 8.05.    Deposited Money and Government Securities
                     to be Held in Trust; Other Miscellaneous
                     Provisions...........................................    54
    Section 8.06.    Repayment to Company.................................    55
    Section 8.07.    Reinstatement........................................    55

ARTICLE 9 - AMENDMENT, SUPPLEMENT AND WAIVER
 
    Section 9.01.    Without Consent of Holders...........................    55
    Section 9.02.    With Consent of Holders..............................    56
    Section 9.03.    Compliance with TIA..................................    58
    Section 9.04.    Revocation and Effect of Consents....................    58
    Section 9.05.    Notation on or Exchange of Securities................    58
    Section 9.06.    Trustee to Sign Amendments, etc......................    58
 
ARTICLE 10 - SUBORDINATION
 
    Section 10.01.   Agreement to Subordinate.............................    59
    Section 10.02.   Certain Definitions..................................    59
    Section 10.03.   Liquidation; Dissolution; Bankruptcy.................    59
    Section 10.04.   Default on Designated Senior Debt....................    60
    Section 10.05.   Acceleration of Securities...........................    61
    Section 10.06.   When Distribution Must Be Paid Over..................    61
    Section 10.07.   Notice by Company....................................    61
    Section 10.08.   Subrogation..........................................    61
    Section 10.09.   Relative Rights......................................    62
    Section 10.10.   Subordination May Not Be Impaired by Company.........    62
</TABLE>
                                      iii

<PAGE>
 
     INDENTURE dated as of March ___, 1995 between National Medical Enterprises,
Inc., a Nevada corporation (the "Company"), and The Bank of New York, as trustee
(the "Trustee").

     The Company and the Trustee agree as follows for the benefit of each other
and for the equal and ratable benefit of the Holders of the ____% Senior
Subordinated Notes due 2005 (the "Securities"):


                                   ARTICLE 1
                         DEFINITIONS AND INCORPORATION
                                  BY REFERENCE

Section 1.01.  Definitions.

     "Acquired Debt" means, with respect to any specified Person, (i)
Indebtedness of any other Person existing at the time such other Person is
merged with or into or became a Subsidiary of such specified Person, including,
without limitation, Indebtedness incurred in connection with, or in
contemplation of, such other Person merging with or into or becoming a
Subsidiary of such specified Person, and (ii) Indebtedness secured by a Lien
encumbering any asset acquired by such specified Person.

     "Affiliate" of any specified Person means any other Person directly or
indirectly controlling or controlled by or under direct or indirect common
control with such specified Person.  For purposes of this definition, "control"
(including, with correlative meanings, the terms "controlling," "controlled by"
and "under common control with"), as used with respect to any Person, shall mean
the possession, directly or indirectly, of the power to direct or cause the
direction of the management or policies of such Person, whether through the
ownership of voting securities, by agreement or otherwise; provided, however,
that beneficial ownership of 10% or more of the voting securities of a Person
shall be deemed to be control.

     "Agent" means any Registrar, Paying Agent or co-registrar.

     "Asset Sale" means (i) the sale, lease, conveyance or other disposition of
any assets (including, without limitation, by way of a sale and leaseback
transaction) other than in the ordinary course of business consistent with past
practice (provided that the sale, lease, conveyance or other disposition of all
or substantially all of the assets of the Company and its Subsidiaries taken as
a whole shall be governed by Section 4.13 and/or Article 5 hereof and not by
Section 4.10 hereof) and (ii) the issuance or sale by the Company or any of its
Subsidiaries of Equity Interests of any of the Company's Subsidiaries, in the
case of either clause (i) or (ii), whether in a single transaction or a series
of related transactions (a) that have a fair market value in excess of $25.0
million or (b) for net proceeds in excess of $25.0 million.  Notwithstanding the
foregoing:  (a) a transfer of assets by the Company to a

<PAGE>
 
Subsidiary or by a Subsidiary to the Company or to another Subsidiary, (b) an
issuance of Equity Interests by a Subsidiary to the Company or to another
Subsidiary, (c) a Restricted Payment that is permitted by Section 4.07 hereof
and (d) a Hospital Swap will not be deemed to be an Asset Sale.

     "Board of Directors" means the Board of Directors of the Company or any
authorized committee thereof.

     "Business Day" means any day other than a Legal Holiday.

     "Capital Lease" means, at the time any determination thereof is to be made,
any lease of property, real or personal, in respect of which the present value
of the minimum rental commitment would be capitalized on a balance sheet of the
lessee in accordance with GAAP.

     "Capital Lease Obligation" means, at the time any determination thereof is
to be made, the amount of the liability in respect of a Capital Lease that would
at such time be so required to be capitalized on a balance sheet in accordance
with GAAP.

     "Capital Stock" means (i) in the case of a corporation, corporate stock,
(ii) in the case of an association or business entity, any and all shares,
interests, participations, rights or other equivalents (however designated) of
corporate stock, (iii) in the case of a partnership, partnership interests
(whether general or limited) and (iv) any other interest or participation that
confers on a Person the right to receive a share of the profits and losses of,
or distributions of assets of, the issuing Person.

     "Change of Control" means the occurrence of any of the following:  (i) the
sale, lease, transfer, conveyance or other disposition, in one or a series of
related transactions, of all or substantially all of the assets of the Company
and its Subsidiaries taken as a whole to any Person or group (as such term is
used in Sections 13(d)(3) and 14(d)(2) of the Exchange Act), other than to (a) a
Person or group who, prior to such transaction, held a majority of the voting
power of the voting stock of the Company, (ii) the acquisition by any Person or
group, as defined above, of a direct or indirect interest in more than 50% of
the voting power of the voting stock of the Company by way of merger,
consolidation or otherwise, or (iii) the first day on which a majority of the
members of the Board of Directors of the Company are not Continuing Directors.

     "Change of Control Triggering Event" means the occurrence of both a Change
of Control and a Rating Decline.

     "Commission" means the Securities and Exchange Commission.

     "Company" means National Medical Enterprises, Inc., as obligor under the
Securities, unless and until a successor replaces National Medical Enterprises,
Inc., in accordance with Article 5 hereof and thereafter includes such
successor.

                                       2
<PAGE>
 
     "Consolidated Cash Flow" means, with respect to any Person for any period,
the Consolidated Net Income of such Person for such period plus (i) an amount
equal to any extraordinary loss of such Person plus any net loss realized in
connection with an Asset Sale (to the extent such losses were deducted in
computing such Consolidated Net Income), plus (ii) provision for taxes based on
income or profits of such Person and its Subsidiaries, for such period, to the
extent such provision for taxes was included in computing such Consolidated Net
Income, plus (iii) the Fixed Charges of such Person and its Subsidiaries for
such period, to the extent such Fixed Charges were deducted in computing such
Consolidated Net Income, plus (iv) depreciation and amortization (including
amortization of goodwill and other intangibles but excluding amortization of
prepaid cash expenses that were paid in a prior period) of such Person and its
Subsidiaries for such period to the extent such depreciation and amortization
were deducted in computing such Consolidated Net Income, in each case, on a
consolidated basis and determined in accordance with GAAP.  Notwithstanding the
foregoing, the provision for taxes on the income or profits of, and the
depreciation and amortization of, a Subsidiary of the referent Person shall be
added to Consolidated Net Income to compute Consolidated Cash Flow only to the
extent (and in same proportion) that the Net Income of such Subsidiary was
included in calculating the Consolidated Net Income of such Person and only if a
corresponding amount would be permitted at the date of determination to be
dividended to the Company by such Subsidiary without prior approval (that has
not been obtained), pursuant to the terms of its charter and all agreements,
instruments, judgments, decrees, orders, statutes, rules and governmental
regulations applicable to that Subsidiary or its stockholders.

     "Consolidated Net Income" means, with respect to any Person for any period,
the aggregate of the Net Income of such Person and its Subsidiaries for such
period, on a consolidated basis, determined in accordance with GAAP but
excluding any one-time charge or expense incurred in order to consummate the
Refinancing; provided, that (i) the Net Income of any Person that is not a
Subsidiary or that is accounted for by the equity method of accounting shall be
included only to the extent of the amount of dividends or distributions paid in
cash to the referent Person or a Wholly Owned Subsidiary thereof, (ii) the Net
Income of any Subsidiary shall be excluded to the extent that the declaration or
payment of dividends or similar distributions by that Subsidiary of that Net
Income is not at the date of determination permitted without any prior
governmental approval (that has not been obtained) or, directly or indirectly,
by operation of the terms of its charter or any agreement, instrument, judgment,
decree, order, statute, rule or governmental regulation applicable to that
Subsidiary or its stockholders, (iii) the Net Income of any Person acquired in a
pooling of interests transaction for any period prior to the date of such
acquisition shall be excluded, and (iv) the cumulative effect of a change in
accounting principles shall be excluded.

     "Consolidated Net Worth" means, with respect to any Person as of any date,
the sum of (i) the consolidated equity of the common stockholders of such Person
and its consolidated Subsidiaries as of such date plus (ii) the respective
amounts reported on such Person's balance sheet as of such date with respect to
any series of preferred stock (other than Disqualified Stock), less all write-
ups (other than write-ups resulting from foreign currency translations and
write-ups of tangible assets of a going concern business made in accordance with
GAAP as a result of the acquisition of such business) subsequent to the date

                                       3
<PAGE>
 
hereof in the book value of any asset owned by such Person or a consolidated
Subsidiary of such Person, and excluding the cumulative effect of a change in
accounting principles, all as determined in accordance with GAAP.

     "Continuing Directors" means, as of any date of determination, any member
of the Board of Directors of the Company who (i) was a member of such Board of
Directors on the date hereof or (ii) was nominated for election or elected to
such Board of Directors with the affirmative vote of a majority of the
Continuing Directors who were members of such Board at the time of such
nomination or election.

     "Corporate Trust Office of the Trustee" shall be at the address of the
Trustee specified in Section 11.02 or such other address as to which the Trustee
may give notice to the Company.

     "Default" means any event that is or with the passage of time or the giving
of notice or both would be an Event of Default.

     "Disqualified Stock" means any Capital Stock that, by its terms (or by the
terms of any security into which it is convertible or for which it is
exchangeable), or upon the happening of any event, matures or is mandatorily
redeemable, pursuant to a sinking fund obligation or otherwise, or is redeemable
at the option of the Holder thereof, in whole or in part, on or prior to March
__, 2005.

     "Equity Interests" means Capital Stock and all warrants, options or other
rights to acquire Capital Stock (but excluding any debt security that is
convertible into, or exchangeable for, Capital Stock).

     "Exchange Act" means the Securities Exchange Act of 1934, as amended.

     "Existing Indebtedness" means Indebtedness of the Company and its
Subsidiaries (other than Indebtedness under the New Credit Facility) in
existence on the date hereof, until such amounts are repaid, including all
reimbursement obligations with respect to letters of credit outstanding as of
the date hereof (other than letters of credit issued pursuant to the New Credit
Facility).

     "Fixed Charge Coverage Ratio" means with respect to any Person for any
period, the ratio of the Consolidated Cash Flow of such Person for such period
to the Fixed Charges of such Person for such period; provided, however, that in
the event that the Company or any of its Subsidiaries incurs, assumes,
Guarantees or redeems any Indebtedness (other than revolving credit borrowings)
or issues preferred stock subsequent to the commencement of the period for which
the Fixed Charge Coverage Ratio is being calculated but prior to the date on
which the event for which the calculation of the Fixed Charge Coverage Ratio is
made (the "Calculation Date"), then the Fixed Charge Coverage Ratio shall be
calculated giving pro forma effect to such incurrence, assumption, Guarantee or
redemption of Indebtedness, or such issuance or redemption of preferred stock,
as if the same had occurred at the beginning of the applicable four-quarter
reference period; and

                                       4
<PAGE>
 
provided further that for purposes of making the computation referred to above,
(i) acquisitions that have been made by the Company or any of its Subsidiaries,
including through mergers or consolidations and including any related financing
transactions, during the four-quarter reference period or subsequent to such
reference period and on or prior to the Calculation Date shall be deemed to have
occurred on the first day of the four-quarter reference period, and (ii) the
Consolidated Cash Flow and Fixed Charges attributable to discontinued
operations, as determined in accordance with GAAP, and operations or businesses
disposed of prior to the Calculation Date, shall be excluded.

     "Fixed Charges" means, with respect to any Person for any period, the sum
of (i) the consolidated interest expense of such Person and its Subsidiaries for
such period, whether paid or accrued, (including, without limitation,
amortization of original issue discount, non-cash interest payments, the
interest component of any deferred payment obligations, the interest component
of all payments associated with Capital Lease Obligations, commissions,
discounts and other fees and charges incurred in respect of letters of credit or
bankers' acceptance financings, and net payments (if any) pursuant to Hedging
Obligations) and (ii) the consolidated interest expense of such Person and its
Subsidiaries that was capitalized during such period, and (iii) any interest
expense on Indebtedness of another Person that is Guaranteed by such Person or
one of its Subsidiaries or secured by a Lien on assets of such Person or one of
its Subsidiaries (whether or not such Guarantee or Lien is called upon) and (iv)
the product of (a) all cash dividend payments (and non-cash dividend payments in
the case of a Person that is a Subsidiary) on any series of preferred stock of
such Person, times (b) a fraction, the numerator of which is one and the
denominator of which is one minus the then current combined federal, state and
local statutory tax rate of such Person, expressed as a decimal, in each case,
on a consolidated basis and in accordance with GAAP.

     "GAAP" means generally accepted accounting principles set forth in the
opinions and pronouncements of the Accounting Principles Board of the American
Institute of Certified Public Accountants and statements and pronouncements of
the Financial Accounting Standards Board or in such other statements by such
other entity as have been approved by a significant segment of the accounting
profession, as in effect from time to time.

     "Government Securities" means direct obligations of, or obligations
guaranteed by, the United States of America for the payment of which guarantee
or obligations the full faith and credit of the United States is pledged.

     "Guarantee" means a guarantee (other than by endorsement of negotiable
instruments for collection in the ordinary course of business), direct or
indirect, in any manner (including, without limitation, letters of credit and
reimbursement agreements in respect thereof), of all or any part of any
Indebtedness.

     "Hedging Obligations" means, with respect to any Person, the obligations of
such Person under (i) interest rate swap agreements, interest rate cap
agreements and interest rate collar agreements, (ii) foreign exchange contracts
or currency swap agreements and

                                       5
<PAGE>
 
(iii) other agreements or arrangements designed to protect such Person against
fluctuations in interest rates or currency values.

     "Holder" means a Person in whose name a Security is registered.

     "Hospital" means a hospital, outpatient clinic, long-term care facility or
other facility that is used or useful in the provision of healthcare services.

     "Hospital Swap" means an exchange of assets by the Company or a Subsidiary
of the Company for one or more Hospitals and/or one or more Related Businesses
or for the Capital Stock of any Person owning one or more Hospitals and/or one
or more Related Businesses.

     "Indebtedness" means with respect to any Person any indebtedness of such
Person, whether or not contingent, in respect of borrowed money or evidenced by
bonds, notes, debentures or similar instruments or letters of credit (or
reimbursement agreements in respect thereof) or banker's acceptances or
representing Capital Lease Obligations or the balance deferred and unpaid of the
purchase price of any property or representing any Hedging Obligations, except
any such balance that constitutes an accrued expense or trade payable, if and to
the extent any of the foregoing indebtedness (other than letter of credit and
Hedging Obligations) would appear as a liability upon a balance sheet of such
Person prepared in accordance with GAAP, as well as all indebtedness of others
secured by a Lien on any asset of such Person (whether or not such indebtedness
is assumed by such Person) and, to the extent not otherwise included, the
Guarantee by such Person of any indebtedness of any other Person.

     "Indenture" means this Indenture, as amended or supplemented from time to
time.

     "International Subsidiaries" means International-NME, Inc., NME (Australia)
Pty. Limited, and National Medical Enterprises Corp., and each of such Person's
respective Subsidiaries.

     "Investment Grade" means a rating of BBB- or higher by S&P or Baa3 or
higher by Moody's or the equivalent of such ratings by S&P or Moody's.  In the
event that the Company shall select any other Rating Agency, the equivalent of
such ratings by such Rating Agency shall be used.

     "Investments" means, with respect to any Person, all investments by such
Person in other Persons (including Affiliates) in the form of direct or indirect
loans (including Guarantees of Indebtedness or other obligations), advances or
capital contributions, purchases or other acquisitions for consideration of
Indebtedness, Equity Interests or other securities and all other items that are
or would be classified as investments on a balance sheet prepared in accordance
with GAAP; provided that an acquisition of assets, Equity Interests or other
securities by the Company for consideration consisting of common equity
securities for the Company shall not be deemed to be an Investment.

                                       6
<PAGE>
 
     "Lien" means, with respect to any asset, any mortgage, lien, pledge,
charge, security interest or encumbrance of any kind in respect of such asset
given to secure Indebtedness, whether or not filed, recorded or otherwise
perfected under applicable law (including any conditional sale or other title
retention agreement, any lease in the nature thereof, any option or other
agreement to sell or give a security interest in and any filing of or agreement
to give any financing statement under the Uniform Commercial Code (or equivalent
statutes) of any jurisdiction with respect to any such lien, pledge, charge or
security interest).

     "Moody's" means Moody's Investors Services, Inc. and its successors.

     "Net Income" means, with respect to any Person, the net income (loss) of
such Person, determined in accordance with GAAP and before any reduction in
respect of preferred stock dividends, excluding, however, (i) any gain (but not
loss), together with any related provision for taxes on such gain (but not
loss), realized in connection with (a) any Asset Sale (including, without
limitation, dispositions pursuant to sale and leaseback transactions) or (b) the
disposition of any securities by such Person or any of its Subsidiaries or the
extinguishment of any Indebtedness of such Person or any of its Subsidiaries,
and (ii) any extraordinary or nonrecurring gain (but not loss), together with
any related provision for taxes on such extraordinary or nonrecurring gain (but
not loss).

     "Net Proceeds" means the aggregate cash proceeds received by the Company or
any of its Subsidiaries in respect of any Asset Sale (including, without
limitation, any cash received upon the sale or other disposition of any
Permitted Non-Cash Consideration received in any Asset Sale), net of the direct
costs relating to such Asset Sale (including, without limitation, legal,
accounting and investment banking fees, and sales commissions) and any other
expenses incurred or to be incurred by the Company or a Subsidiary as a direct
result of the sale of such assets (including, without limitation, severance,
relocation, lease termination and other similar expenses), taxes actually paid
or payable as a result thereof, amounts required to be applied to the repayment
of Indebtedness (other than Senior Term Debt or Senior Revolving Debt) secured
by a Lien permitted hereunder on the asset or assets that were the subject of
such Asset Sale and any reserve for adjustment in respect of the sale price of
such asset or assets established in accordance with GAAP.

     "New Credit Facility" means that certain Credit Agreement, dated as of
February __, 1995, by and among the Company and Morgan Guaranty Trust Company of
New York and the other banks that are party thereto, providing for $2.0 billion
in aggregate principal amount of Senior Term Debt and up to $500.0 million in
aggregate principal amount of Senior Revolving Debt, including any related
notes, collateral documents, instruments and agreements executed in connection
therewith, and in each case as amended, modified, extended, renewed, refunded,
replaced or refinanced, in whole or in part, from time to time.

     "Non-Cash Consideration" means any non-cash consideration received by the
Company or a Subsidiary of the Company in connection with an Asset Sale and any
non-cash consideration received by the Company or any of its Subsidiaries upon
disposition thereof.

                                       7
<PAGE>
 
     "Non-Recourse Debt" means Indebtedness of an International Subsidiary (i)
as to which neither the Company nor any of its Subsidiaries (other than the
International Subsidiaries) (a) provides credit support of any kind (including
any undertaking, agreement or instrument that would constitute Indebtedness of
the Company or any of its Subsidiaries), or (b) is directly or indirectly liable
(as a guarantor or otherwise) and (ii) no default with respect to which
(including any rights that the holders thereof may have to take enforcement
action against an International Subsidiary) would permit (upon notice, lapse of
time or both) any holder of any other Indebtedness of the Company or any of its
Subsidiaries (other than the International Subsidiaries) to declare a default on
such other Indebtedness or cause the payment thereof to be accelerated or
payable prior to its stated maturity (except any provisions set forth in
Existing Indebtedness until the same is repaid or refinanced).

     "Obligations" means any principal, interest, penalties, fees,
indemnifications, reimbursements, damages and other liabilities payable under
the documentation governing any Indebtedness.

     "Officers" means the Chairman of the Board, the Chief Executive Officer,
the President, the Chief Operating Officer, the Chief Financial Officer, the
Treasurer, any Assistant Treasurer, the Controller, the Secretary and any Vice
President of the Company or any Subsidiary, as the case may be.

     "Officers' Certificate" means a certificate signed by two Officers, one of
whom must be the principal executive officer, principal financial officer or
principal accounting officer of the Company.

     "Opinion of Counsel" means an opinion from legal counsel who is reasonably
acceptable to the Trustee.  The counsel may be an employee of or counsel to the
Company, any Subsidiary or the Trustee.

     "Performance Investment Plan" means the 1989 Performance Investment Plan 
adopted by the Company's Board of Directors on March 10, 1989.

     "Permitted Collateral" means, collectively, (i) all Capital Stock and other
Equity Interests of the Company's present and future direct Subsidiaries, (ii)
all intercompany Indebtedness owed to the Company and (iii) all Capital Stock
and other Equity Interests in Westminster Health Care Holdings PLC and The
Hillhaven Corporation owned by the Company.

     "Permitted Liens" means (i) Liens on Permitted Collateral securing Senior
Term Debt of the Company under the New Credit Facility in an aggregate principal
amount at any time outstanding not to exceed an amount equal to $2.0 billion
less the aggregate amount of all repayments, optional or mandatory, of the
principal of any Senior Term Debt (other than repayments that are immediately
reborrowed) that have been made since the date

                                       8
<PAGE>
 
hereof; (ii) Liens on Permitted Collateral securing Senior Revolving Debt and
letters of credit of the Company incurred pursuant to the New Credit Facility in
an aggregate principal amount at any time outstanding (with letters of credit
being deemed to have a principal amount equal to the maximum potential
reimbursement obligation of the Company with respect thereto) not to exceed an
amount equal to $500.0 million less the aggregate amount of all Net Proceeds of
Asset Sales applied to permanently reduce commitments with respect to such
Indebtedness pursuant to Section 4.10 hereof; (iii) Liens in favor of the
Company; (iv) Liens on property of a Person existing at the time such Person is
merged into or consolidated with the Company or any Subsidiary of the Company;
provided, that such Liens were in existence prior to the contemplation of such
merger or consolidation and do not extend to any assets other than those of the
Person merged into or consolidated with the Company; (v) Liens on property
existing at the time of acquisition thereof by the Company or any Subsidiary of
the Company; provided that such Liens were in existence prior to the
contemplation of such acquisition; (vi) Liens to secure the performance of
statutory obligations, surety or appeal bonds, performance bonds or other
obligations of a like nature incurred in the ordinary course of business; (vii)
Liens existing or created on the date hereof; (viii) Liens for taxes,
assessments or governmental charges or claims that are not yet delinquent or
that are being contested in good faith by appropriate proceedings promptly
instituted and diligently concluded; provided that any reserve or other
appropriate provision as shall be required in conformity with GAAP shall have
been made therefor, (ix) other Liens on assets of the Company or any Subsidiary
of the Company securing Indebtedness that is permitted by the terms hereof to be
outstanding having an aggregate principal amount at any one time outstanding not
to exceed 10% of the Stockholders' Equity of the Company; and (x) Liens to
secure Permitted Refinancing Indebtedness incurred to refinance Indebtedness
that was secured by a Lien permitted hereunder and that was incurred in
accordance with the provisions hereof; provided, that such Liens do not extend
to or cover any property or assets of the Company or any Subsidiary other than
assets or property securing the Indebtedness so refinanced.

     "Permitted Refinancing Indebtedness" means any Indebtedness of the Company
or any of its Subsidiaries issued in exchange for, or the net proceeds of which
are used solely to extend, refinance, renew, replace, defease or refund, other
Indebtedness of the Company or any of its Subsidiaries; provided that, except in
the case of Indebtedness of the Company issued in exchange for, or the net
proceeds of which are used solely to extend, refinance, renew, replace, defease
or refund Indebtedness of a Subsidiary of the Company:  (i) the principal amount
of such Permitted Refinancing Indebtedness does not exceed the principal amount
of the Indebtedness so extended, refinanced, renewed, replaced, defeased or
refunded (plus the amount of any premiums paid and reasonable expenses incurred
in connection therewith); (ii) such Permitted Refinancing Indebtedness has a
final maturity date later than the final maturity date of, and has a Weighted
Average Life to Maturity equal to or greater than the Weighted Average Life to
Maturity of, the Indebtedness being extended, refinanced, renewed, replaced,
defeased or refunded; (iii) if the Indebtedness being extended, refinanced,
renewed, replaced, defeased or refunded is subordinated in right of payment to
the Securities, such Permitted Refinancing Indebtedness has a final maturity
date later than the final maturity date of, and is subordinated in right of
payment to, the Securities on terms at least as favorable to the Holders of
Securities as those contained in the documentation

                                       9
<PAGE>
 
governing the Indebtedness being extended, refinanced, renewed, replaced,
defeased or refunded; and (iv) such Indebtedness is incurred either by the
Company or by the Subsidiary who is the obligor on the Indebtedness being
extended, renewed, replaced, defeased or refunded.

     "Person" means any individual, corporation, partnership, joint venture,
association, joint-stock company, trust, unincorporated organization (including
any subdivision or ongoing business of any such entity or substantially all of
the assets of any such entity, subdivision or business).

     "Physician Joint Venture Distributions" means distributions made by the
Company or any of its Subsidiaries to any physician, pharmacist or other allied
healthcare professional in connection with the unwinding, liquidation or other
termination of any joint venture or similar arrangement between any such Person
and the Company or any of its Subsidiaries.

     "Physician Support Obligations" means any obligation or Guarantee incurred
in the ordinary course of business by the Company or a Subsidiary of the Company
in connection with any advance, loan or payment to, or on behalf of or for the
benefit of any physician, pharmacist or other allied healthcare professional for
the purpose of recruiting, redirecting or retaining the physician, pharmacist or
other allied healthcare professional to provide service to patients in the
service area of any Hospital or Related Business owned or operated by the
Company or any of its Subsidiaries; excluding, however, compensation for
services provided by physicians, pharmacists or other allied healthcare
professionals to any Hospital or Related Business owned or operated by the
Company or any of its Subsidiaries.

     "Qualified Equity Interests" shall mean all Equity Interests of the Company
other than Disqualified Stock of the Company.

     "Rating Agencies" means (i) S&P and (ii) Moody's or (iii) if S&P or Moody's
or both shall not make a rating of the Securities publicly available, a
nationally recognized securities rating agency or agencies, as the case may be,
selected by the Company, shall be substituted for S&P or Moody's or both, as the
case may be.

     "Rating Category" means (i) with respect to S&P, any of the following
categories:  BB, B, CCC, CC, C and D (or equivalent successor categories); (ii)
with respect to Moody's, any of the following categories:  Ba, B, Caa, Ca, C and
D (or equivalent successor categories); and (iii) the equivalent of any such
category of S&P or Moody's used by another Rating Agency.  In determining
whether the rating of the Securities has decreased by one or more gradations,
gradations within Rating Categories (+ and - for S&P, 1, 2 and 3 for Moody's; or
the equivalent gradations for another Rating Agency) shall be taken into account
(e.g., with respect to S&P, a decline in a rating from BB+ to BB, as well as
from BB- to B+, will constitute a decrease of one gradation).

                                       10
<PAGE>
 
     "Rating Date" means the date which is 90 days prior to the earlier of (i) a
Change of Control and (ii) the first public notice of the occurrence of a Change
of Control or of the intention by the Company to effect a Change of Control.

     "Rating Decline" means the occurrence on or within 90 days after the date
of the first public notice of the occurrence of a Change of Control or of the
intention by the Company to effect a Change of Control (which period shall be
extended so long as the rating of the Securities is under publicly announced
consideration for possible downgrade by any of the Rating Agencies) of:  (a) in
the event the Securities are rated by either Moody's or S&P on the Rating Date
as Investment Grade, a decrease in the rating of the Securities by both Rating
Agencies to a rating that is below Investment Grade, or (b) in the event the
Securities are rated below Investment Grade by both Rating Agencies on the
Rating Date, a decrease in the rating of the Securities by either Rating Agency
by one or more gradations (including gradations within Rating Categories as well
as between Rating Categories).

     "Refinancing" has the meaning ascribed to it in the prospectus dated
January 31, 1995 relating to the Securities.

     "Related Business" means a healthcare business affiliated or associated
with a Hospital or any business related or ancillary to the provision of
healthcare services or the operation of a Hospital.

     "Responsible Officer" when used with respect to the Trustee, means any
officer within the corporate trust department of the Trustee (or any successor
group of the Trustee) or any other officer of the Trustee customarily performing
functions similar to those performed by any of the above designated officers and
also means, with respect to a particular corporate trust matter, any other
officer to whom such matter is referred because of his knowledge of and
familiarity with the particular subject.

     "Restricted Investment" means an Investment in any of the International
Subsidiaries.

     "Securities" means the securities described above, issued under this
Indenture.

     "Securities Act" means the Securities Act of 1933, as amended.

     "Senior Asset Sale Offer" means the offer to purchase Senior Notes made by
the Company to holders of Senior Notes under Section 3.10 of the Senior Note
Indenture.

     "Senior Notes" means the ____% Senior Notes due 2002 of the Company limited
in aggregate principal amount of $300.0 million, issued pursuant to the Senior
Note Indenture.

     "Senior Note Indenture" means the Indenture dated as of March __, 1995
between the Company and The Bank of New York, as trustee, under which the Senior
Notes were issued.

                                       11
<PAGE>
 
     "Senior Revolving Debt" means revolving credit loans outstanding from time
to time under the New Credit Facility.

     "Senior Term Debt" means term loans outstanding from time to time under the
New Credit Facility.

     "Significant Subsidiary" means any Subsidiary that would be a "significant
subsidiary" as defined in Article 1, Rule 1-02 of Regulation S-X, promulgated
pursuant to the Act, as such Regulation is in effect on the date hereof.

     "S&P" means Standard & Poor's Corporation and its successors.

     "Specified Assets" means the Company's and its Subsidiaries' interest in
The Hillhaven Corporation and Westminster Healthcare Holdings PLC owned as of
the date hereof and the Capital Stock and assets of the International
Subsidiaries.

     "Stockholders' Equity" means, with respect to any Person as of any date,
the stockholders' equity of such Person determined in accordance with GAAP as of
the date of the most recent available internal financial statements of such
Person, and calculated on a pro forma basis to give effect to any acquisition or
disposition by such Person consummated or to be consummated since the date of
such financial statements and on or prior to the date of such calculation.

     "Subsidiary" means, with respect to any Person, (i) any corporation,
association or other business entity of which more than 50% of the total voting
power of shares of Capital Stock entitled (without regard to the occurrence of
any contingency) to vote in the election of directors, managers or trustees
thereof is at the time owned or controlled, directly or indirectly, by such
Person or one or more of the other Subsidiaries of that Person (or a combination
thereof) and (ii) any partnership (a) the sole general partner or the managing
general partner of which is such Person or a Subsidiary of such Person or (b)
the only general partners of which are such Person or of one or more
Subsidiaries of such Person (or any combination thereof), provided that no
International Subsidiary shall be deemed to be a "Subsidiary" for any purpose
hereunder for so long as such International Subsidiary:  (a) has no Indebtedness
other than Existing Indebtedness and Non-Recourse Debt; (b) is not a party to
any agreement, contract, arrangement or understanding with the Company or any of
its other Subsidiaries (other than International Subsidiaries) except any such
agreement, contract, arrangement or understanding that (i) was in effect on the
date hereof, or (ii) meets the requirements of Section 4.11 hereof; (c) is a
Person with respect to which neither the Company nor any of its Subsidiaries
(other than International Subsidiaries) has any direct or indirect obligation
(x) to subscribe for additional Equity Interests or (y) to maintain or preserve
such Person's financial condition or to cause such Person to achieve any
specified level of operating results except, in each case, any such obligation
in existence on the date hereof or created pursuant to the terms of any
Investment permitted by Section 4.07; and (d) has not Guaranteed or otherwise
directly or indirectly provided credit support for any Indebtedness of the
Company or any of its Subsidiaries (other than International Subsidiaries).  If,
at any time, any International Subsidiary would fail to meet the foregoing

                                       12
<PAGE>
 
requirements, it shall thereafter be deemed to be a Subsidiary for all purposes
of this Indenture and any Indebtedness of such International Subsidiary shall be
deemed to be incurred by a Subsidiary of the Company as of such date (and, if
such Indebtedness is not permitted to be incurred as of such date under Section
4.09 hereof the Company shall be in default of such covenant).

     "TIA" means the Trust Indenture Act of 1939, as amended (15 U.S.C. (S)
77aaa-77bbbb) as in effect on the date on which this Indenture is qualified
under the TIA, except as provided in Section 9.03 hereof.

     "Transfer Restriction" means, with respect to the Company's Subsidiaries,
any encumbrance or restriction on the ability of any Subsidiary to (i) pay
dividends or make any other distributions to the Company or any of its
Subsidiaries (a) on its Capital Stock or (b) with respect to any other interest
or participation in, or measured by, its profits, (ii) pay any Indebtedness owed
to the Company or any of its Subsidiaries, (iii) make loans or advances to the
Company or any of its Subsidiaries, or (iv) transfer any of its properties or
assets to the Company or any of its Subsidiaries.

     "Trustee" means the party named as such above until a successor replaces it
in accordance with the applicable provisions of this Indenture and thereafter
means the successor serving hereunder.

     "Weighted Average Life to Maturity" means, when applied to any Indebtedness
at any date, the number of years obtained by dividing (i) the sum of the
products obtained by multiplying (a) the amount of each then remaining
installment, sinking fund, serial maturity or other required payments of
principal, including payment at final maturity, in respect thereof, by (b) the
number of years (calculated to the nearest one-twelfth) that will elapse between
such date and the making of such payment, by (ii) the then outstanding principal
amount of such Indebtedness.

     "Wholly Owned Subsidiary" of any Person means any Subsidiary of such Person
all of the outstanding Capital Stock or other ownership interests of which
(other than directors' qualifying shares) shall at the time be owned by such
Person or by one or more Wholly Owned Subsidiaries of such Person and one or
more Wholly Owned Subsidiaries of such Person.
 
Section 1.02.  Other Definitions.
<TABLE> 
<CAPTION> 
                                               Defined in
     Term                                        Section
     ----------                                ----------
     <S>                                         <C>  
     "Affiliate Transaction"..................      4.11
     "Bankruptcy Law".........................      6.01
     "Change of Control Offer"................      4.13
     "Change of Control Payment"..............      4.13
     "Change of Control Payment Date".........      4.13
     "Commencement Date"......................      3.09
     "Covenant Defeasance"....................      8.03
 </TABLE>

                                       13
<PAGE>
 
<TABLE>
     <S>                                              <C>
     "Custodian"..............................      6.01             
     "Designated Senior Debt".................     10.02             
     "Event of Default".......................      6.01             
     "Excess Proceeds"........................      4.10             
     "incur"..................................      4.09             
     "Legal Defeasance".......................      8.02             
     "Legal Holiday"..........................     11.07             
     "Notice of Default"......................      6.01             
     "Offer Amount"...........................      3.09             
     "Offer Period"...........................      3.09             
     "Paying Agent"...........................      2.03             
     "Payment Blockage Notice"................     10.04             
     "Purchase Date"..........................      3.09             
     "Purchase Price".........................      4.10             
     "Registrar"..............................      2.03             
     "Representative".........................     10.02             
     "Restricted Payments"....................      4.07             
     "Senior Subordinated Asset Sale Offer"...      4.10             
     "Senior Debt"............................     10.02             
</TABLE>                                                              

Section 1.03.  Incorporation by Reference of TIA.

          Whenever this Indenture refers to a provision of the TIA, the
provision is incorporated by reference in and made a part of this Indenture.

          The following TIA terms used in this Indenture have the following
meanings:

          "indenture securities" means the Securities;

          "indenture security holder" means a Holder;

          "indenture to be qualified" means this Indenture;

          "indenture trustee" or "institutional trustee" means the Trustee;

          "obligor" on the Securities means the Company and any successor
obligor upon the Securities.

          All other terms used in this Indenture that are defined by the TIA,
defined by TIA reference to another statute or defined by the Commission rule
under the TIA have the meanings so assigned to them.

Section 1.04.  Rules of Construction.

          Unless the context otherwise requires:

                                       14
<PAGE>
 
          (1) a term has the meaning assigned to it;

          (2) an accounting term not otherwise defined has the meaning assigned
     to it in accordance with GAAP;

          (3) "or" is not exclusive;

          (4) words in the singular include the plural, and in the plural
     include the singular; and

          (5) provisions apply to successive events and transactions.


                                   ARTICLE 2
                                 THE SECURITIES

     Section 2.01.  Form and Dating.

               The Securities and the Trustee's certificate of authentication
     shall be substantially in the form of Exhibit A hereto, the terms of which
     are incorporated in and made a part of this Indenture.  The Securities may
     have notations, legends or endorsements approved as to form by the Company
     and required by law, stock exchange rule, agreements to which the Company
     is subject or usage.  Each Security shall be dated the date of its
     authentication.  The Securities shall be issuable only in registered form,
     without coupons, in denominations of $1,000 and integral multiples thereof.

     Section 2.02.  Execution and Authentication.

               An Officer of the Company shall sign the Securities for the
     Company by manual or facsimile signature.  The Company's seal shall be
     reproduced on the Securities and may be in facsimile form.

               If an Officer whose signature is on a Security no longer holds
     that office at the time the Security is authenticated, the Security shall
     nevertheless be valid.

               A Security shall not be valid until authenticated by the manual
     signature of the Trustee.  The signature of the Trustee shall be conclusive
     evidence that the Security has been authenticated under this Indenture.
     The form of Trustee's certificate of authentication to be borne by the
     Securities shall be substantially as set forth in Exhibit A hereto.

               The Trustee shall, upon a written order of the Company signed by
     two Officers of the Company, authenticate Securities for original issue up
     to an aggregate principal amount stated in paragraph 4 of the Securities.
     The aggregate principal amount of Securities outstanding at any time shall
     not exceed the amount set forth herein except as provided in Section 2.07.

                                       15
<PAGE>
 
               The Trustee may appoint an authenticating agent acceptable to the
     Company to authenticate Securities.  Unless limited by the terms of such
     appointment, an authenticating agent may authenticate Securities whenever
     the Trustee may do so.  Each reference in this Indenture to authentication
     by the Trustee includes authentication by such agent.  An authenticating
     agent has the same rights as an Agent to deal with the Company or an
     Affiliate of the Company.

     Section 2.03.  Registrar and Paying Agent.

               The Company shall maintain (i) an office or agency where
     Securities may be presented for registration of transfer or for exchange
     (including any co-registrar, the "Registrar") and (ii) an office or agency
     where Securities may be presented for payment (the "Paying Agent").  The
     Registrar shall keep a register of the Securities and of their transfer and
     exchange.  The Company may appoint one or more co-registrars and one or
     more additional paying agents.  The term "Paying Agent" includes any
     additional paying agent.  The Company may change any Paying Agent,
     Registrar or co-registrar without prior notice to any Holder.  The Company
     shall notify the Trustee and the Trustee shall notify the Holders of the
     name and address of any Agent not a party to this Indenture. If the Company
     fails to appoint or maintain another entity as Registrar or Paying Agent,
     the Trustee shall act as such.  The Company or any of its Subsidiaries may
     act as Paying Agent, Registrar or co-registrar.  The Company shall enter
     into an appropriate agency agreement with any Agent not a party to this
     Indenture, which shall incorporate the provisions of the TIA.  The
     agreement shall implement the provisions of this Indenture that relate to
     such Agent.  The Company shall notify the Trustee of the name and address
     of any such Agent.  If the Company fails to maintain a Registrar or Paying
     Agent, or fails to give the foregoing notice, the Trustee shall act as
     such, and shall be entitled to appropriate compensation in accordance with
     Section 7.07 hereof.

               The Company initially appoints the Trustee as Registrar, Paying
     Agent and agent for service of notices and demands in connection with the
     Securities.

     Section 2.04.  Paying Agent to Hold Money in Trust.

               On or prior to the due date of principal of, premium, if any, and
     interest on any Securities, the Company shall deposit with the Trustee or
     the Paying Agent money sufficient to pay such principal, premium, if any,
     and interest becoming due.  The Company shall require each Paying Agent
     other than the Trustee to agree in writing that the Paying Agent shall hold
     in trust for the benefit of the Holders or the Trustee all money held by
     the Paying Agent for the payment of principal of, premium, if any, and
     interest on the Securities, and shall notify the Trustee of any Default by
     the Company in making any such payment.  While any such Default continues,
     the Trustee may require a Paying Agent to pay all money held by it to the
     Trustee.  The Company at any time may require a Paying Agent to pay all
     money held by it to the Trustee.  Upon payment over to the Trustee, the
     Paying Agent (if other than the Company) shall have no further liability
     for the money delivered to the Trustee.  If the Company acts as Paying
     Agent, it shall segregate and hold in a separate trust fund for the benefit
     of the Holders all money held by it as Paying Agent.

                                       16
<PAGE>
 
     Section 2.05.  Holder Lists.

               The Trustee shall preserve in as current a form as is reasonably
     practicable the most recent list available to it of the names and addresses
     of Holders and shall otherwise comply with TIA (S) 312(a).  If the Trustee
     is not the Registrar, the Company shall furnish to the Trustee at least
     seven Business Days before each interest payment date and at such other
     times as the Trustee may request in writing a list in such form and as of
     such date as the Trustee may reasonably require of the names and addresses
     of Holders, including the aggregate principal amount of the Securities held
     by each thereof, and the Company shall otherwise comply with TIA (S)
     312(a).

     Section 2.06.  Transfer and Exchange.

               When Securities are presented to the Registrar with a request to
     register the transfer or to exchange them for an equal principal amount of
     Securities of other denominations, the Registrar shall register the
     transfer or make the exchange if its requirements for such transactions are
     met; provided, however, that any Security presented or surrendered for
     registration of transfer or exchange shall be duly endorsed or accompanied
     by a written instruction of transfer in form satisfactory to the Registrar
     and the Trustee duly executed by the Holder thereof or by his attorney duly
     authorized in writing.  To permit registrations of transfer and exchanges,
     the Company shall issue and the Trustee shall authenticate Securities at
     the Registrar's request, subject to such rules as the Trustee may
     reasonably require.

               Neither the Company nor the Registrar shall be required to (i)
     issue, register the transfer of or exchange Securities during a period
     beginning at the opening of business on a Business Day 15 days before the
     day of any selection of Securities for redemption under Section 3.02 and
     ending at the close of business on the day of selection, (ii) register the
     transfer of or exchange any Security so selected for redemption in whole or
     in part, except the unredeemed portion of any Security being redeemed in
     part or (iii) register the transfer or exchange of a Security between the
     record date and the next succeeding interest payment date.

               No service charge shall be made to any Holder for any
     registration of transfer or exchange (except as otherwise expressly
     permitted herein), but the Company may require payment of a sum sufficient
     to cover any transfer tax or similar governmental charge payable in
     connection therewith (other than such transfer tax or similar governmental
     charge payable upon exchanges pursuant to Sections 2.10 or 9.05 hereof,
     which shall be paid by the Company).

               Prior to due presentment for registration of transfer of any
     Security, the Trustee, any Agent and the Company may deem and treat the
     Person in whose name any Security is registered as the absolute owner of
     such Security for the purpose of receiving payment of principal of,
     premium, if any, and interest on such Security and for all other purposes
     whatsoever, whether or not such Security is overdue, and neither the
     Trustee, any Agent nor the Company shall be affected by notice to the
     contrary.

                                       17
<PAGE>
 
     Section 2.07.  Replacement Securities.

               If any mutilated Security is surrendered to the Trustee or the
     Company, or the Trustee receives evidence to its satisfaction of the
     destruction, loss or theft of any Security, the Company shall issue and the
     Trustee, upon the written order of the Company signed by two Officers of
     the Company, shall authenticate a replacement Security if the Trustee's
     requirements for replacements of Securities are met.  If required by the
     Trustee or the Company, an indemnity bond must be supplied by the Holder
     that is sufficient in the judgment of the Trustee and the Company to
     protect the Company, the Trustee, any Agent and any authenticating agent
     from any loss which any of them may suffer if a Security is replaced.  Each
     of the Company and the Trustee may charge for its expenses in replacing a
     Security.

               Every replacement Security is an additional obligation of the
     Company.

     Section 2.08.  Outstanding Securities.

               The Securities outstanding at any time are all the Securities
     authenticated by the Trustee except for those cancelled by it, those
     delivered to it for cancellation and those described in this Section as not
     outstanding.

               If a Security is replaced pursuant to Section 2.07 hereof, it
     ceases to be outstanding unless the Trustee receives proof satisfactory to
     it that the replaced Security is held by a bona fide purchaser.

               If the principal amount of any Security is considered paid under
     Section 4.01 hereof, it ceases to be outstanding and interest on it ceases
     to accrue.

               Subject to Section 2.09 hereof, a Security does not cease to be
     outstanding because the Company or an Affiliate of the Company holds the
     Security.

     Section 2.09.  Treasury Securities.

               In determining whether the Holders of the required principal
     amount of Securities then outstanding, have concurred in any demand,
     direction, waiver or consent, Securities owned by the Company or any
     Affiliate of the Company shall be considered as though not outstanding,
     except that for purposes of determining whether the Trustee shall be
     protected in relying on any such demand, direction, waiver or consent, only
     Securities which a Responsible Officer actually knows to be so owned shall
     be so considered.  Notwithstanding the foregoing, Securities that are to be
     acquired by the Company or an Affiliate of the Company pursuant to an
     exchange offer, tender offer or other agreement shall not be deemed to be
     owned by the Company or an Affiliate of the Company until legal title to
     such Securities passes to the Company or Affiliate, as the case may be.

                                       18
<PAGE>
 
     Section 2.10.  Temporary Securities.

               Until definitive Securities are ready for delivery, the Company
     may prepare and the Trustee, upon receipt of the written order of the
     Company signed by two Officers of the Company, shall authenticate temporary
     Securities.  Temporary Securities shall be substantially in the form of
     definitive Securities but may have variations that the Company and the
     Trustee consider appropriate for temporary Securities.  Without
     unreasonable delay, the Company shall prepare and the Trustee, upon receipt
     of the written order of the Company signed by two Officers of the Company,
     shall authenticate definitive Securities in exchange for temporary
     Securities.  Until such exchange, temporary Securities shall be entitled to
     the same rights, benefits and privileges as definitive Securities.

     Section 2.11.  Cancellation.

               The Company at any time may deliver Securities to the Trustee for
     cancellation.  The Registrar and Paying Agent shall forward to the Trustee
     any Securities surrendered to them for registration of transfer, exchange
     or payment.  The Trustee shall cancel all Securities surrendered for
     registration of transfer, exchange, payment, replacement or cancellation
     and shall return such cancelled Securities to the Company.  The Company may
     not issue new Securities to replace Securities that it has paid or that
     have been delivered to the Trustee for cancellation.

     Section 2.12.  Defaulted Interest.

               If the Company defaults in a payment of interest on the
     Securities, it shall pay the defaulted interest in any lawful manner plus,
     to the extent lawful, interest payable on the defaulted interest, to the
     Persons who are Holders on a subsequent special record date, which date
     shall be at the earliest practicable date but in all events at least five
     Business Days prior to the payment date, in each case at the rate provided
     in the Securities and in Section 4.01 hereof.  The Company shall, with the
     consent of the Trustee, fix or cause to be fixed each such special record
     date and payment date.  At least 15 days before the special record date,
     the Company (or the Trustee, in the name of and at the expense of the
     Company) shall mail to Holders a notice that states the special record
     date, the related payment date and the amount of such interest to be paid.

     Section 2.13.  Record Date.

               The record date for purposes of determining the identity of
     Holders entitled to vote or consent to any action by vote or consent
     authorized or permitted under this Indenture shall be determined as
     provided for in TIA (S) 316(c).

     Section 2.14.  CUSIP Number.

               The Company in issuing the Securities may use a "CUSIP" number,
     and if it does so, the Trustee shall use the CUSIP number in notices to
     Holders; provided that any such notice may state that no representation is
     made as to the

                                       19
<PAGE>
 
     correctness or accuracy of the CUSIP number printed in the notice or on the
     Securities, and that reliance may be placed only on the other
     identification numbers printed on the Securities.  The Company will
     promptly notify the Trustee of any change in the CUSIP number.


                                   ARTICLE 3
                                   REDEMPTION

     Section 3.01.  Notices to Trustee.

               If the Company elects to redeem Securities pursuant to the
     optional redemption provisions of Section 3.07 hereof, it shall furnish to
     the Trustee, at least 45 days but not more than 60 days before a redemption
     date, an Officers' Certificate setting forth (i) the Section of this
     Indenture pursuant to which the redemption shall occur, (ii) the redemption
     date, (iii) the principal amount of Securities to be redeemed and (iv) the
     redemption price.

               If the Company is required to make an offer to purchase
     Securities pursuant to the provisions of Section 4.10 or 4.13 hereof, it
     shall furnish to the Trustee an Officers' Certificate setting forth (i) the
     Section of this Indenture pursuant to which the redemption shall occur,
     (ii) the redemption date, (iii) the principal amount of Securities to be
     redeemed, (iv) the redemption price and (v) a statement to the effect that
     (a) the Company or one of its Subsidiaries has effected an Asset Sale and
     the conditions set forth in Section 4.10 have been satisfied or (b) a
     Change of Control has occurred and the conditions set forth in Section 4.13
     have been satisfied, as applicable.

     Section 3.02.  Selection of Securities to Be Redeemed.

               If less than all of the Securities are to be redeemed at any
     time, the Trustee shall select the Securities to be redeemed among the
     Holders in compliance with the requirements of the principal national
     securities exchange, if any, on which the Securities are then listed, or,
     if the Securities are not so listed, on a pro rata basis, by lot or by such
     method the Trustee shall deem fair and appropriate; provided, that
     Securities with a principal amount of $1,000 shall not be redeemed in part.

               The Trustee shall promptly notify the Company in writing of the
     Securities selected for redemption and, in the case of any Security
     selected for partial redemption, the principal amount thereof to be
     redeemed.  Securities and portions of them selected shall be in amounts of
     $1,000 or whole multiples of $1,000; except that if all of the Securities
     of a Holder are to be redeemed, the entire outstanding amount of Securities
     held by such Holder, even if not a multiple of $1,000, shall be redeemed.
     Except as provided in the preceding sentence, provisions of this Indenture
     that apply to Securities called for redemption also apply to portions of
     Securities called subject to an offer to purchase.

               In the event the Company is required to make an offer to purchase
     Securities pursuant to Sections 3.09 and 4.10 hereof and the amount of the
     Excess Proceeds from the

                                       20
<PAGE>
 
     Asset Sale are not evenly divisible by $1,000, the Trustee shall promptly
     refund to the Company any remaining Excess Proceeds.

     Section 3.03.  Notice of Redemption.

               Subject to the provisions of Section 3.09 hereof, at least 30
     days but not more than 60 days before a redemption date, the Company shall
     mail or cause to be mailed by first class mail a notice of redemption to
     each Holder of Securities to be redeemed at its registered address.

               The notice shall identify the Securities to be redeemed and shall
     state:

               (1)  the redemption date;

               (2)  the redemption price;

               (3)  if any Security is being redeemed in part, the portion of
                    the principal amount of such Security to be redeemed and
                    that, after the redemption date upon surrender of such
                    Security, a new Security or Securities in principal amount
                    equal to the unredeemed portion shall be issued;

               (4)  the name and address of the Paying Agent;

               (5)  that Securities called for redemption must be surrendered to
                    the Paying Agent to collect the redemption price;

               (6)  that, unless the Company defaults in making such redemption
                    payment, interest on Securities called for redemption ceases
                    to accrue on and after the redemption date;

               (7)  the paragraph of the Securities and/or Section of this
                    Indenture pursuant to which the Securities called for
                    redemption are being redeemed; and

               (8)  that no representation is made as to the correctness or
                    accuracy of the CUSIP number, if any, listed in such notice
                    or printed on the Securities.

          At the Company's request, the Trustee shall give the notice of
redemption in the Company's name and at its expense; provided, however, that the
Company shall have delivered to the Trustee, at least 45 days prior to the
redemption date, an Officers' Certificate requesting that the Trustee give such
notice and setting forth the information to be stated in such notice as provided
in the preceding paragraph.  The notice mailed in the manner herein provided
shall be conclusively presumed to have been duly given whether or not the Holder
receives such notice.  In any case, failure to give such notice by mail or any
defect in the notice to the Holder of any Security shall not affect the validity
of the proceeding for the redemption of any other Security.

                                       21
<PAGE>
 
Section 3.04.  Effect of Notice of Redemption.

          Once notice of redemption is mailed in accordance with Section 3.03
hereof, Securities called for redemption become due and payable on the
redemption date at the redemption price plus accrued and unpaid interest, if
any, to such date.

Section 3.05.  Deposit of Redemption Price.

          One Business Day prior to the redemption date, the Company shall
deposit with the Trustee or with the Paying Agent money sufficient to pay the
redemption price of, and accrued interest on, all Securities to be redeemed on
that date.  The Trustee or the Paying Agent shall promptly return to the Company
any money deposited with the Trustee or the Paying Agent by the Company in
excess of the amounts necessary to pay the redemption price of (including any
applicable premium), and accrued interest on, all Securities to be redeemed.

          On and after the redemption date, interest ceases to accrue on the
Securities or the portions of Securities called for redemption.  If a Security
is redeemed on or after an interest record date but on or prior to the related
interest payment date, then any accrued and unpaid interest shall be paid to the
Person in whose name such Security was registered at the close of business on
such record date.  If any Security called for redemption shall not be so paid
upon surrender for redemption because of the failure of the Company to comply
with the preceding paragraph, interest shall be paid on the unpaid principal,
from the redemption date until such principal is paid, and to the extent lawful
on any interest not paid on such unpaid principal, in each case at the rate
provided in the Securities and in Section 4.01 hereof.

Section 3.06.  Securities Redeemed in Part.

          Upon surrender of a Security that is redeemed in part, the Company
shall issue and the Trustee shall authenticate for the Holder at the expense of
the Company a new Security equal in principal amount to the unredeemed portion
of the Security surrendered.

Section 3.07.  Optional Redemption.

          On or after March __, 2000, the Company may redeem all or any portion
of the Securities at a redemption price (expressed as a percentage of the
principal amount thereof), as set forth in the immediately succeeding paragraph,
plus accrued and unpaid interest, if any, to the redemption date.

                                       22
<PAGE>
 
          The redemption price as a percentage of the principal amount shall be
as follows, if the Securities are redeemed during the 12-month period beginning
March __ of the following years:

          
<TABLE> 
<CAPTION> 
          Year                                        Percentage
          ----                                        ----------
          <S>                                         <C> 
          2000......................................         %
          2001......................................         %
          2002......................................         %
          2003 and thereafter.......................  100.000%
</TABLE> 

Section 3.08.  Mandatory Redemption.

          Subject to the Company's obligation to make an offer to repurchase
Securities under certain circumstances pursuant to Sections 4.10 and 4.13
hereof, the Company shall have no mandatory redemption or sinking fund
obligations with respect to the Securities.

Section 3.09.  Offer to Purchase By Application of Net Proceeds.

          In the event that the Company shall commence a Senior Subordinated
Asset Sale Offer pursuant to Section 4.10 hereof, it shall follow the procedures
specified below:

          No later than the date on which the aggregate amount of Excess
Proceeds exceeds $25.0 million, the Company shall notify the Trustee of such
Senior Subordinated Asset Sale Offer and provide the Trustee with an Officers'
Certificate setting forth, in addition to the information to be included therein
pursuant to Section 4.10 the calculations used in determining the amount of Net
Proceeds to be applied to the purchase of Securities.  The Company shall
commence or cause to be commenced the Senior Subordinated Asset Sale Offer on a
date no later than 10 Business Days after such notice (the "Commencement Date").

          The Senior Subordinated Asset Sale Offer shall remain open for at
least 20 Business Days after the Commencement Date relating to such Senior
Subordinated Asset Sale Offer and shall remain open for no more than such 20
Business Days, except to the extent required by applicable law (as so extended,
the "Offer Period").  No later than one Business Day after the termination of
the Offer Period (the "Purchase Date"), the Company shall purchase the principal
amount (the "Offer Amount") of Securities required to be purchased in such
Senior Subordinated Asset Sale Offer pursuant to Sections 3.09 and 4.10 hereof
or, if less than the Offer Amount has been tendered, all Securities tendered in
response to the Senior Subordinated Asset Sale Offer.

          If the Purchase Date is on or after an interest payment record date
and on or before the related interest payment date, any accrued interest shall
be paid to the Person in whose name a Security is registered at the close of
business on such record date, and no

                                       23
<PAGE>
 
additional interest shall be payable to Holders who tender Securities pursuant
to the Senior Subordinated Asset Sale Offer.

          On the Commencement Date of any Senior Subordinated Asset Sale Offer,
the Company shall send, by first class mail, a notice to each of the Holders at
their last registered address, with a copy to the Trustee.  Such notice, which
shall govern the terms of the Senior Subordinated Asset Sale Offer, shall
contain all instructions and materials necessary to enable the Holders to tender
Securities pursuant to the Senior Subordinated Asset Sale Offer and shall state:

               (1)  that the Senior Subordinated Asset Sale Offer is being made
                    pursuant to this Section 3.09 and Section 4.10 hereof and
                    the length of time the Senior Subordinated Asset Sale Offer
                    shall remain open;

               (2)  the Offer Amount, the Purchase Price and the Purchase Date;

               (3)  that any Security not tendered or accepted for payment shall
                    continue to accrue interest;

               (4)  that, unless the Company defaults in the payment of the
                    Purchase Price, any Security accepted for payment pursuant
                    to the Senior Subordinated Asset Sale Offer shall cease to
                    accrue interest after the Purchase Date;

               (5)  that Holders electing to have a Security purchased pursuant
                    to any Senior Subordinated Asset Sale Offer shall be
                    required to surrender the Security, with the form entitled
                    "Option of Holder to Elect Purchase" on the reverse of the
                    Security completed, to the Company, a depositary, if
                    appointed by the Company, or a Paying Agent at the address
                    specified in the notice prior to the close of business on
                    the Business Day preceding the Purchase Date;

               (6)  that Holders shall be entitled to withdraw their election if
                    the Company, depositary or Paying Agent, as the case may be,
                    receives, not later than the close of business on the
                    Business Day preceding the termination of the Offer Period,
                    a facsimile transmission or letter setting forth the name of
                    the Holder, the principal amount of the Security the Holder
                    delivered for purchase and a statement that such Holder is
                    withdrawing his election to have the Security purchased;

               (7)  that, if the aggregate principal amount of Securities
                    surrendered by Holders exceeds the Offer Amount, the Trustee
                    shall select the Securities to be purchased on a pro rata
                    basis (with such

                                       24
<PAGE>
 
                    adjustments as may be deemed appropriate by the Trustee so
                    that only Securities in denominations of $1,000, or integral
                    multiples thereof, shall be purchased); and

               (8)  that Holders whose Securities were purchased only in part
                    shall be issued new Securities equal in principal amount to
                    the unpurchased portion of the Securities surrendered.

          On or before the Purchase Date, the Company shall irrevocably deposit
with the Trustee or Paying Agent in immediately available funds the aggregate
Purchase Price with respect to a principal amount of Securities equal to the
Offer Amount, together with accrued interest thereon, to be held for payment in
accordance with the terms of this Section.  On the Purchase Date, the Company
shall, to the extent lawful, (i) accept for payment, on a pro rata basis to the
extent necessary, an aggregate principal amount equal to the Offer Amount of
Securities tendered pursuant to the Senior Subordinated Asset Sale Offer, or if
less than the Offer Amount has been tendered, all Securities or portion thereof
tendered, (ii) deliver or cause the Paying Agent or depositary, as the case may
be, to deliver to the Trustee Securities so accepted and (iii) deliver to the
Trustee an Officers' Certificate stating that such Securities or portions
thereof were accepted for payment by the Company in accordance with the terms of
this Section 3.09.  The Company, depositary or Paying Agent, as the case may be,
shall promptly (but in any case not later than two Business Days after the
Purchase Date) mail or deliver to each tendering Holder an amount equal to the
Purchase Price plus accrued and unpaid interest with respect to the Securities
tendered by such Holder and accepted by the Company for purchase, and the
Company shall promptly issue a new Security, and the Trustee shall authenticate
and mail or deliver such new Security, to such Holder, equal in principal amount
to any unpurchased portion of such Holder's Securities surrendered.  Any
Security not accepted in the Senior Subordinated Asset Sale Offer shall be
promptly mailed or delivered by the Company to the Holder thereof.  The Company
shall publicly announce in a newspaper of general circulation the results of the
Senior Subordinated Asset Sale Offer on the Purchase Date.

          The Senior Subordinated Asset Sale Offer shall be made by the Company
in compliance with all applicable laws, including, without limitation,
Regulation 14E of the Exchange Act and the rules thereunder and all other
applicable federal and state securities laws.


                                   ARTICLE 4
                                   COVENANTS

Section 4.01.  Payment of Securities.

          The Company shall pay or cause to be paid the principal of, premium,
if any, and interest on the Securities on the dates and in the manner provided
in this Indenture and the Securities.  Principal, premium, if any, and interest
shall be considered paid on the date due if the Paying Agent, if other than the
Company or a Subsidiary of the Company, holds

                                       25
<PAGE>
 
as of 10:00 a.m. Eastern Time on the due date money deposited by the Company in
immediately available funds and designated for and sufficient to pay all
principal, premium, if any, and interest then due.  Such Paying Agent shall
return to the Company, no later than five days following the date of payment,
any money (including accrued interest) that exceeds such amount of principal,
premium, if any, and interest to be paid on the Securities.

          The Company shall pay interest (including post-petition interest in
any proceeding under any Bankruptcy Law) on overdue principal at the rate equal
to 1% per annum in excess of the interest rate then applicable to the Securities
to the extent lawful.  In addition, it shall pay interest (including post-
petition interest in any proceeding under any Bankruptcy Law) on overdue
installments of interest (without regard to any applicable grace period) at the
same rate to the extent lawful.

Section 4.02.  Maintenance of Office or Agency.

          The Company shall maintain in the Borough of Manhattan, the City of
New York, an office or agency (which may be an office of the Trustee or an
affiliate of the Trustee, Registrar or co-registrar) where Securities may be
surrendered for registration of transfer or exchange and where notices and
demands to or upon the Company in respect of the Securities and this Indenture
may be served.  The Company shall give prompt written notice to the Trustee of
the location, and any change in the location, of such office or agency.  If at
any time the Company shall fail to maintain any such required office or agency
or shall fail to furnish the Trustee with the address thereof, such
presentations, surrenders, notices and demands may be made or served at the
Corporate Trust Office of the Trustee.

          The Company may also from time to time designate one or more other
offices or agencies where the Securities may be presented or surrendered for any
or all such purposes and may from time to time rescind such designations;
provided, however, that no such designation or rescission shall in any manner
relieve the Company of its obligation to maintain an office or agency in the
Borough of Manhattan, the City of New York for such purposes.  The Company shall
give prompt written notice to the Trustee of any such designation or rescission
and of any change in the location of any such other office or agency.

          The Company hereby designates The Bank of New York, 101 Barclay
Street, 21 West, New York, New York 10286 as one such office or agency of the
Company in accordance with Section 2.03.

Section 4.03.  Commission Reports.

          (i) So long as any of the Securities remain outstanding, the Company
shall file with the Trustee within 15 days after the filing thereof with the
Commission copies of the annual reports and of the information, documents and
other reports (or copies of such portions of any of the foregoing as the
Commission may by rule and regulations prescribe) which the Company is required
to file with the Commission pursuant to Section 13 or 15(d) of the Exchange Act.
All obligors on the Securities shall comply with the provisions of TIA

                                       26
<PAGE>
 
(S) 314(a).  Notwithstanding that the Company may not be required to be subject
to the reporting requirements of Section 13 or 15(d) of the Exchange Act or
otherwise report on an annual and quarterly basis on forms provided for such
annual and quarterly reporting pursuant to rules and regulations promulgated by
the Commission, the Company will file with the Commission and provide the
Trustee (a) within 90 days after the end of each fiscal year, annual reports on
Form 10-K (or any successor or comparable form) containing the information
required to be contained therein (or required in such successor or comparable
form), including a "Management's Discussion and Analysis of Financial Condition
and Results of Operations" and a report thereon by the Company's certified
public accountants; (b) within 45 days after the end of each of the first three
fiscal quarters of each fiscal year, reports on Form 10-Q (or any successor or
comparable form) containing the information required to be contained therein (or
required in any successor or comparable form) including a "Management's
Discussion and Analysis of Financial Condition and Results of Operations"; and
(c) promptly from time to time after the occurrence of an event required to be
therein reported, such other reports on Form 8-K (or any successor or comparable
form) containing the information required to be contained therein (or required
in any successor or comparable form); provided, however, that the Company shall
not be in default of the provisions of this Section 4.03(i) for any failure to
file reports with the Commission solely by the refusal of the Commission to
accept the same for filing.  Each of such reports will be prepared in accordance
with generally accepted accounting principles.  The Company will in all cases,
without cost to each recipient, provide copies of such information to the
Holders.

          (ii) The Trustee, at the Company's expense, will promptly mail copies
of such annual reports, information, documents and other reports filed with the
Trustee pursuant to Section 4.03 to the Holders at their addresses appearing in
the register of Securities maintained by the Registrar.

          (iii)  If filing such annual reports, information, documents and other
reports with the Commission is not permitted under the Exchange Act or the rules
and regulations of the Commission, the Company shall, after the dates for filing
set forth above, promptly upon written request make copies of such annual
reports, information, documents and other reports available to prospective
purchasers of the Securities, and to securities analysts and broker-dealers upon
their request.

          (iv) The Company shall provide the Trustee with a sufficient number of
copies of all reports and other documents and information that the Trustee may
be required to deliver to the Holders under this Section 4.03.

          (v) Delivery of such reports, information and documents to the
Trustee is for informational purposes only and the Trustee's receipt of such
shall not constitute constructive notice of any information contained therein or
determinable from information contained therein, including the Company's
compliance with any of its covenants hereunder (as to which the Trustee is
entitled to rely exclusively on Officers' Certificates).

                                       27
<PAGE>
 
Section 4.04.  Compliance Certificate.

          (i) The Company shall deliver to the Trustee, within 120 days after
the end of each fiscal year, an Officers' Certificate stating that a review of
the activities of the Company and its Subsidiaries during the preceding fiscal
year has been made under the supervision of the signing Officers with a view to
determining whether each has kept, observed, performed and fulfilled its
obligations under this Indenture, and further stating, as to each such Officer
signing such certificate, that to the best of his or her knowledge each entity
has kept, observed, performed and fulfilled each and every covenant contained in
this Indenture and is not in default in the performance or observance of any of
the terms, provisions and conditions of this Indenture (or, if a Default or
Event of Default shall have occurred, describing all such Defaults or Events of
Default of which he or she may have knowledge and what action each is taking or
proposes to take with respect thereto), all without regard to periods of grace
or notice requirements, and that to the best of his or her knowledge no event
has occurred and remains in existence by reason of which payments on account of
the principal of or interest, if any, on the Securities is prohibited or if such
event has occurred, a description of the event and what action each is taking or
proposes to take with respect thereto.

          (ii) So long as not contrary to the then current recommendations of
the American Institute of Certified Public Accountants, the year-end financial
statements delivered pursuant to Section 4.03 above shall be accompanied by a
written statement of the Company's certified independent public accountants (who
shall be a firm of established national reputation) that in making the
examination necessary for certification of such financial statements nothing has
come to their attention which would lead them to believe that the Company or any
Subsidiary of the Company has violated any provisions of Article 4 or of Article
5 of this Indenture or, if any such violation has occurred, specifying the
nature and period of existence thereof, it being understood that such
accountants shall not be liable directly or indirectly to any Person for any
failure to obtain knowledge of any such violation.

          (iii)  The Company shall, so long as any of the Securities are
outstanding, deliver to the Trustee, forthwith upon any Officer becoming aware
of (a) any Default or Event of Default or (b) any event of default under any
other mortgage, indenture or instrument, an Officers' Certificate specifying
such Default, Event of Default or event of default and what action the Company
is taking or proposes to take with respect thereto.

Section 4.05.  Taxes.

          The Company shall pay, and shall cause each of its Subsidiaries to
pay, prior to delinquency, all material taxes, assessments, and governmental
levies except (i) as contested in good faith by appropriate proceedings and with
respect to which appropriate reserves have been taken in accordance with GAAP or
(ii) where the failure to effect such payment is not adverse in any material
respect to the Holders.

                                       28
<PAGE>
 
Section 4.06.  Stay, Extension and Usury Laws.

          The Company covenants (to the extent that it may lawfully do so) that
it shall not at any time insist upon, plead, or in any manner whatsoever claim
or take the benefit or advantage of, any stay, extension or usury law wherever
enacted, now or at any time hereafter in force, that may affect the covenants or
the performance of this Indenture; and the Company (to the extent that it may
lawfully do so) hereby expressly waives all benefit or advantage of any such
law, and covenants that it shall not, by resort to any such law, hinder, delay
or impede the execution of any power herein granted to the Trustee, but shall
suffer and permit the execution of every such power as though no such law has
been enacted.

Section 4.07.  Limitations on Restricted Payments.

          The Company shall not, and shall not permit any of its Subsidiaries
to, directly or indirectly:  (i) declare or pay any dividend or make any
distribution on account of the Company's or any of its Subsidiaries' Equity
Interests (other than (w) Physician Joint Venture Distributions, (x) dividends
or distributions payable in Qualified Equity Interests of the Company, (y)
dividends or distributions payable to the Company or any Subsidiary of the
Company and (z) dividends or distributions by any Subsidiary of the Company
payable to all holders of a class of Equity Interests of such Subsidiary on a
pro rata basis); (ii) purchase, redeem or otherwise acquire or retire for value
any class of Equity Interests of the Company; (iii) make any principal payment
on, or purchase, redeem, defease or otherwise acquire or retire for value any
Indebtedness that is subordinated to the Securities issued hereunder, except at
the original final maturity date thereof or pursuant to the Refinancing; or (iv)
make any Restricted Investment (all such payments and other actions set forth in
clauses (i) through (iv) above being collectively referred to as "Restricted
Payments"), unless at the time of and after giving effect to such Restricted
Payment (the amount of any such Restricted Payment, if other than cash, shall be
the fair market value (as conclusively evidenced by a resolution of the Board of
Directors set forth in an Officers' Certificate delivered to the Trustee within
60 days prior to the date of such Restricted Payment) of the asset(s) proposed
to be transferred by the Company or such Subsidiary, as the case may be,
pursuant to such Restricted Payment):

          (a)  no Default or Event of Default shall have occurred and be
               continuing at the time of such Restricted Payment or would occur
               as a consequence thereof; and

          (b)  the Company would, at the time of such Restricted Payment and
               after giving pro forma effect thereto as if such Restricted
               Payment had been made at the beginning of the most recently ended
               four full fiscal quarter period for which internal financial
               statements are available immediately preceding the date of such
               Restricted Payment, have been permitted to incur at least $1.00
               of additional Indebtedness pursuant to the Fixed Charge Coverage
               Ratio test set forth in the first paragraph of Section 4.09; and

                                       29
<PAGE>
 
          (c)  such Restricted Payment, together with the aggregate of all other
               Restricted Payments (other than Restricted Payments made pursuant
               to clauses (ii), (iii), (iv) and (v) of the following paragraph)
               made by the Company and its Subsidiaries after the date hereof,
               is less than the sum of (1) 50% of the Consolidated Net Income of
               the Company for the period (taken as one accounting period) from
               the first day of the first full fiscal quarter commencing after
               the date hereof to the end of the Company's most recently ended
               full fiscal quarter for which internal financial statements are
               available at the time of such Restricted Payment (or, if such
               Consolidated Net Income for such period is a deficit, less 100%
               of such deficit), plus (2) 100% of the aggregate net cash
               proceeds received by the Company from the issue or sale (other
               than to a Subsidiary of the Company) since the date hereof of (A)
               Qualified Equity Interests of the Company or (B) debt securities
               of the Company or any of its Subsidiaries that have been
               converted into or exchanged for such Qualified Equity Interests
               of the Company, plus (3) $20.0 million.

          If no Default or Event of Default has occurred and is continuing, the
foregoing provisions will not prohibit:

          (i)  the payment of any dividend within 60 days after the date of
               declaration thereof, if at said date of declaration such
               payment would have complied with the provisions hereof;

         (ii)  the payment of cash dividends on any series of Disqualified
               Stock issued after the date hereof in an aggregate amount not
               to exceed the cash received by the Company since the date
               hereof upon issuance of such Disqualified Stock;

        (iii)  the repurchase of the Performance Investment Plan investment
               options from the holders thereof;

         (iv)  the redemption, repurchase, retirement or other acquisition of
               any Equity Interests of the Company or any Subsidiary in
               exchange for, or out of the net cash proceeds of, the
               substantially concurrent sale (other than to a Subsidiary of
               the Company) of Qualified Equity Interests of the Company);
               provided that the amount of any such net cash proceeds that are
               utilized for any such redemption, repurchase, retirement or
               other acquisition shall be excluded from clause (c)(2) of the
               preceding paragraph;

          (v)  the defeasance, redemption or repurchase of subordinated
               Indebtedness with the net cash proceeds from an incurrence of
               Permitted Refinancing Indebtedness or in exchange for or out of
               the net cash proceeds from the substantially concurrent sale
               (other than to a Subsidiary of the

                                       30
<PAGE>
 
               Company) of Qualified Equity Interests of the Company; provided,
               that the amount of any such net cash proceeds that are utilized
               for any such redemption, repurchase, retirement or other
               acquisition shall be excluded from clause (c)(2) of the preceding
               paragraph;

          (vi) the repurchase, redemption or other acquisition or retirement for
               value of any Equity Interests of the Company or any Subsidiary of
               the Company held by any member of the Company's (or any of its
               Subsidiaries') management pursuant to any management equity
               subscription agreement or stock option agreement in effect as of
               the date hereof or entered into thereafter; provided, however,
               that the aggregate price paid for all such repurchased, redeemed,
               acquired or retired Equity Interests in any twelve-month period
               shall not exceed $5.0 million and no Default or Event of Default
               shall have occurred and be continuing immediately after such
               transaction; and

          (vii)the making and consummation of (A) a Senior Subordinated Asset
               Sale Offer in accordance with the provisions of this Indenture
               with any Excess Proceeds that remain after consummation of a
               Senior Asset Sale Offer, within 120 days of the consummation of
               such Senior Asset Sale Offer, or (B) a Change of Control Offer
               with respect to the Securities in accordance with the provisions
               of this Indenture.

          Not later than the date of making any Restricted Payment, the Company
shall deliver to the Trustee an Officers' Certificate stating that such
Restricted Payment is permitted and setting forth the basis upon which the
calculations required by this covenant were computed, which calculations may be
based upon the Company's latest available financial statements.

Section 4.08.  Limitations on Dividends and Other Payment Restrictions Affecting
               Subsidiaries.

          The Company shall not, and shall not permit any of its Subsidiaries
to, directly or indirectly, create or otherwise cause or suffer to exist or
become effective any consensual Transfer Restriction, except for such Transfer
Restrictions existing under or by reason of:

          (a)  Existing Indebtedness as in effect on the date hereof,

          (b)  the Indenture and the Securities,

          (c)  applicable law,

          (d)  any instrument governing Indebtedness or Capital Stock of a
               Person acquired by the Company or any of its Subsidiaries as in
               effect at the time of such acquisition (except to the extent such
               Indebtedness was incurred in connection with or in contemplation
               of such acquisition or

                                       31
<PAGE>
 
               in violation of Section 4.09 hereof), which encumbrance or
               restriction is not applicable to any Person, or the properties or
               assets of any Person, other than the Person, or the property or
               assets of the Person, so acquired, provided that the Consolidated
               Cash Flow of such Person shall not be taken into account in
               determining whether such acquisition was permitted by the terms
               hereof except to the extent that such Consolidated Cash Flow
               would be permitted to be dividends to the Company without the
               prior consent or approval of any third party,

          (e)  customary non-assignment provisions in leases entered into in the
               ordinary course of business and consistent with past practice,

          (f)  purchase money obligations for property acquired in the ordinary
               course of business that impose restrictions on the ability of any
               of the Company's Subsidiaries to transfer the property so
               acquired to the Company or any of its Subsidiaries,

          (g)  Permitted Refinancing Indebtedness, provided that the
               restrictions contained in the agreements governing such Permitted
               Refinancing Indebtedness are no more restrictive than those
               contained in the agreements governing the Indebtedness being
               refinanced, or

          (h)  the New Credit Facility and related documentation as the same is
               in effect on the date hereof and as amended or replaced from time
               to time, provided that no such amendment or replacement is more
               restrictive as to the matters enumerated above than the New
               Credit Facility and related documentation as in effect on the
               date hereof.

Section 4.09.  Limitations on Incurrence of Indebtedness and Issuance of
               Preferred Stock

          The Company shall not, and shall not permit any of its Subsidiaries
to, directly or indirectly, create, incur, issue, assume, Guarantee or otherwise
become directly or indirectly liable, contingently or otherwise, with respect to
(collectively, "incur") after the date hereof any Indebtedness (including
Acquired Debt) and the Company shall not issue any Disqualified Stock, and shall
not permit any of its Subsidiaries to issue any shares of preferred stock;
provided, however, that the Company may incur Indebtedness (including Acquired
Debt) and the Company may issue shares of Disqualified Stock, if the Fixed
Charge Coverage Ratio for the Company's most recently ended four full fiscal
quarters for which internal financial statements are available immediately
preceding the date on which such additional Indebtedness is incurred or such
Disqualified Stock is issued would have been at least (x) 2.25 to 1 if such
incurrence or issuance occurs on or before March 31, 1996, or (y) 2.5 to 1 if
such incurrence or issuance occurs at any time thereafter, in each case
determined on a pro forma basis (including a pro forma application of the net
proceeds therefrom), as if the additional Indebtedness had been incurred or the
Disqualified Stock had been issued, as the case may be, at the beginning of such
four-quarter period.  Indebtedness

                                       32
<PAGE>
 
consisting of reimbursement obligations in respect of a letter of credit will be
deemed to be incurred when the letter of credit is first issued.  The Company
will not permit any of the International Subsidiaries to incur any Indebtedness
other than Non-Recourse Debt.

          The foregoing provisions will not apply to:

          (a)  the incurrence by the Company of Senior Term Debt pursuant to the
               New Credit Facility in an aggregate principal amount at any time
               outstanding not to exceed an amount equal to $2.0 billion less
               the aggregate amount of all repayments, optional or mandatory, of
               the principal of any Senior Term Debt (other than repayments that
               are immediately reborrowed) that have been made since the date
               hereof;

          (b)  the incurrence by the Company of Senior Revolving Debt and
               letters of credit pursuant to the New Credit Facility in an
               aggregate principal amount at any time outstanding (with letters
               of credit being deemed to have a principal amount equal to the
               maximum potential reimbursement obligation of the Company with
               respect thereto) not to exceed an amount equal to $500.0 million
               less the aggregate amount of all Net Proceeds of Asset Sales
               applied to permanently reduce the commitments with respect to
               such Indebtedness pursuant to Section 4.10 hereof;

          (c)  the incurrence by the Company of Indebtedness represented by the
               Securities;

          (d)  the incurrence by the Company and its Subsidiaries of the
               Existing Indebtedness;

          (e)  the incurrence by the Company or any of its Subsidiaries of
               Permitted Refinancing Indebtedness in exchange for, or the
               proceeds of which are used to extend, refinance, renew, replace,
               defease, or refund, Indebtedness that was permitted by this
               Indenture to be incurred (including, without limitation, Existing
               Indebtedness);

          (f)  the incurrence by the Company of Hedging Obligations that are
               incurred for the purpose of fixing or hedging interest rate or
               currency risk with respect to any fixed or floating rate
               Indebtedness that is permitted by the terms hereof to be
               outstanding or any receivable or liability the payments of which
               is determined by reference to a foreign currency; provided, that
               the notional principal amount of any such Hedging Obligation does
               not exceed the principal amount of the Indebtedness to which such
               Hedging Obligation relates;

          (g)  the incurrence by the Company or any of its Subsidiaries of
               Physician Support Obligations;

                                       33
<PAGE>
 
          (h)  the incurrence by the Company or any of its Subsidiaries of
               intercompany Indebtedness between or among the Company and any of
               its Subsidiaries;

          (i)  the incurrence by the Company or any of its Subsidiaries of
               Indebtedness represented by performance bonds, standby letters of
               credit or appeal bonds, in each case to the extent incurred in
               the ordinary course of business of the Company or such
               Subsidiary;

          (j)  the incurrence by any Subsidiary of the Company of Indebtedness,
               the aggregate principal amount of which, together with all other
               Indebtedness of the Company's Subsidiaries at the time
               outstanding (excluding the Existing Indebtedness until repaid or
               refinanced and excluding Physician Support Obligations), does not
               exceed the greater of (1) 10% of the Company's Stockholders'
               Equity or (2) $10.0 million; provided that, in case of clause (1)
               only, the Fixed Charge Coverage Ratio for the Company's most
               recently ended four full fiscal quarters for which internal
               financial statements are available immediately preceding the date
               on which such Indebtedness is incurred would have been at least
               (x) 2.25 to 1 if such incurrence occurs on or before March 31,
               1996, or (y) 2.5 to 1 if such incurrence occurs at any time
               thereafter, in each case determined on a pro forma basis
               (including a pro forma application of the net proceeds
               therefrom), as if such Indebtedness has been incurred at the
               beginning of such four-quarter period; and

          (k)  the incurrence by the Company of Indebtedness (in addition to
               Indebtedness permitted by any other clause of this paragraph) in
               an aggregate principal amount not exceeding $250.0 million at any
               one time outstanding.

Section 4.10.  Asset Sales.

          The Company shall not, and shall not permit any of its Subsidiaries to
consummate an Asset Sale, unless (i) the Company (or the Subsidiary as the case
may be) receives consideration at the time of such Asset Sale at least equal to
the fair market value (as conclusively determined by a resolution of the Board
of Directors set forth in an Officers' Certificate delivered to the Trustee) of
the assets or Equity Interests issued or sold or otherwise disposed of and (ii)
except in the case of a sale of Specified Assets, at least 80% of the
consideration therefor received by the Company or such Subsidiary is in the form
of cash; provided, however, that for purposes of this provision, (x) the amount
of (A) any liabilities (as shown on the Company's or such Subsidiary's most
recent balance sheet or in the notes thereto), of the Company or any Subsidiary
(other than, in the case of an Asset Sale by the Company, liabilities that are
by their terms subordinated to the Securities that are assumed by the transferee
of any such assets and (B) any securities or other obligations received by the
Company or any such Subsidiary from such transferee that are immediately

                              34
<PAGE>
 
converted by the Company or such Subsidiary into cash (or as to which the
Company or such Subsidiary has received at or prior to the consummation of the
Asset Sale a commitment (which may be subject to customary conditions) from a
nationally recognized investment, merchant or commercial bank to convert into
cash within 90 days of the consummation of such Asset Sale and which are
thereafter actually converted into cash within such 90-day period) will be
deemed to be cash (but shall not be deemed to be Net Proceeds for purposes of
the following provisions until reduced to cash); and (y) the fair market value
of any Non-Cash Consideration received by the Company or a Subsidiary in any
Asset Sale shall be deemed to be cash (but shall not be deemed to be Net
Proceeds for purposes of the following provisions until reduced to cash) to the
extent that the aggregate fair market value (as conclusively determined by a
resolution of the Board of Directors set forth in an Officers' Certificate
delivered to the Trustee) of all Non-Cash Consideration (measured at the time
received and without giving effect to any subsequent changes in value) held by
the Company immediately after consummation of such Asset Sale does not exceed
10% of the Company's Stockholders' Equity.

          Within 465 days after the receipt of any Net Proceeds from an Asset
Sale, the Company may apply the Net Proceeds from such Asset Sale (i) to
purchase one or more Hospitals or Related Businesses and/or a controlling
interest in the Capital Stock of a Person owning one or more Hospitals and/or
one or more Related Businesses, (ii) to make a capital expenditure or to acquire
other tangible assets, in each case, that are used or useful in any business in
which the Company is permitted to be engaged pursuant to Section 4.15 hereof,
(iii) to permanently reduce Senior Term Debt or Existing Indebtedness of a
Subsidiary, (iv) to permanently reduce Senior Revolving Debt (and to
correspondingly reduce commitments with respect thereto), except that up to an
aggregate of $200.0 million of Net Proceeds from Asset Sales may be applied
after the date hereof to reduce Senior Revolving Debt without a corresponding
reduction in commitments with respect thereto, or (v) to repurchase Senior Notes
or redeem or repurchase other Senior Debt. Pending the final application of any
such Net Proceeds, the Company may temporarily reduce Senior Revolving Debt or
otherwise invest such Net Proceeds in any manner that is not prohibited by the
terms hereof. Any Net Proceeds from Asset Sales that are not so invested or
applied will be deemed to constitute "Excess Proceeds." When the aggregate
amount of Excess Proceeds exceeds $25.0 million, the Company shall make an offer
to all Holders of Securities (a "Senior Subordinated Asset Sale Offer") to
purchase the maximum principal amount of Securities that may be purchased out of
the Excess Proceeds, at an offer price in cash equal to 100% of the principal
amount thereof (the "Purchase Price") plus accrued and unpaid interest thereon,
if any, to the date of purchase, in accordance with the procedures set forth in
Section 3.09 hereof. To the extent that aggregate amount of Securities tendered
pursuant to a Senior Subordinated Asset Sale Offer is less than the Excess
Proceeds, the Company may use any remaining Excess Proceeds for general
corporate purposes. If the aggregate principal amount of Securities surrendered
by holders pursuant to a Senior Subordinated Asset Sale Offer exceeds the amount
of Excess Proceeds, the Trustee shall select the Securities to be purchased on a
pro rata basis. Upon completion of a Senior Subordinated Asset Sale Offer, the
amount of Excess Proceeds shall be reset at zero.

                                       35
<PAGE>
 
Section 4.11.  Limitations on Transactions with Affiliates.

          The Company shall not, and shall not permit any of its Subsidiaries
to, sell, lease, transfer or otherwise dispose of any of its properties or
assets to, or purchase any property or assets from, or enter into or make any
contract, agreement, understanding, loan, advance or Guarantee with, or for the
benefit of, any Affiliate (each of the foregoing, an "Affiliate Transaction")
unless (i) such Affiliate Transaction is on terms that are no less favorable to
the Company or the relevant Subsidiary than those that could have been obtained
in a comparable transaction by the Company or such Subsidiary with an unrelated
Person and (ii) the Company delivers to the Trustee (a) with respect to any
Affiliate Transaction involving aggregate consideration in excess of $5.0
million, a resolution of the Board of Directors set forth in an Officers'
Certificate certifying that such Affiliate Transaction complies with clause (i)
above and that such Affiliate Transaction was approved by a majority of the
disinterested members of the Board of Directors and (b) with respect to any
Affiliate Transaction involving aggregate consideration in excess of $15.0
million, an opinion as to the fairness of such Affiliate Transaction to the
Company or such Subsidiary from a financial point of view issued by an
unaffiliated investment banking firm of national standing; provided, however,
that (x) transactions or payments pursuant to any employment arrangements or
employee or director benefit plans entered into by the Company or any of its
Subsidiaries in the ordinary course of business and consistent with the past
practice of the Company or such Subsidiary, (y) transactions between or among
the Company and/or its Subsidiaries and (z) Restricted Payments permitted under
Section 4.07, in each case, shall not be deemed Affiliate Transactions.

Section 4.12.  Limitations on Liens.

          The Company shall not, and shall not permit any of its Subsidiaries
to, directly or indirectly create, incur, assume or suffer to exist any Lien to
secure Indebtedness that is pari passu with or subordinated in right of payment
to the Securities (except Permitted Liens) on any asset now owned or hereafter
acquired, or on any income or profits therefrom, or assign or convey any right
to receive income therefrom, unless all payments due hereunder and under the
Securities are secured on an equal and ratable basis with the Obligations so
secured until such time as such Obligations are no longer secured by a Lien.

Section 4.13.  Change of Control.

          Upon the occurrence of a Change of Control Triggering Event, each
Holder of Securities shall have the right to require the Company to repurchase
all or any part (equal to $1,000 or an integral multiple thereof) of such
Holder's Securities pursuant to an offer described below (the "Change of Control
Offer") at an offer price in cash equal to 101% of the aggregate principal
amount thereof, plus accrued and unpaid interest, if any, thereon to the date of
repurchase (the "Change of Control Payment") on a date that is not more than 90
days after the occurrence of such Change of Control Triggering Event (the
"Change of Control Payment Date"). The Company shall comply with the
requirements of Regulation 14e-1 under the Exchange Act and any other securities
laws and regulations thereunder to the

                                       36
<PAGE>
 
extent such laws and regulations are applicable in connection with the
repurchase of the Securities as a result of a Change of Control.

          Within 30 days following any Change of Control Triggering Event, the
Company shall mail, or at the Company's request the Trustee shall mail, a notice
of a Change of Control to each Holder (at its last registered address with a
copy to the Trustee and the Paying Agent) offering to repurchase the Securities
held by such Holder pursuant to the procedure specified in such notice. The
Change of Control Offer shall remain open from the time of mailing until the
close of business on the Business Day preceding the Change of Control Payment
Date. The notice, which shall govern the terms of the Change of Control Offer,
shall state:

          (1)  that the Change of Control Offer is being made pursuant to this
               Section 4.13 and that all Securities tendered will be accepted
               for payment;

          (2)  the Change of Control Payment and the Change of Control Payment
               Date, which date shall be no earlier than 30 days nor later than
               60 days from the date such notice is mailed;

          (3)  that any Securities not tendered will continue to accrue interest
               in accordance with the terms of the Indenture;

          (4)  that, unless the Company defaults in the payment of the Change of
               Control Payment, all Securities accepted for payment pursuant to
               the Change of Control Offer shall cease to accrue interest after
               the Change of Control Payment Date;

          (5)  that Holders electing to have Securities purchased pursuant to
               the Change of Control Offer will be required to surrender their
               Securities, with the form entitled "Option of Holder to Elect
               Purchase" on the reverse of the Security completed, to the Paying
               Agent at the address specified in the notice prior to the close
               of business on the Business Day preceding the Change of Control
               Payment Date;

          (6)  that Holders will be entitled to withdraw their election if the
               Paying Agent receives, not later than the close of business on
               the Business Day preceding the Change of Control Payment Date, a
               facsimile transmission or letter setting forth the name of the
               Holder, the principal amount of Securities the Holder delivered
               for purchase, and a statement that such Holder is withdrawing his
               election to have such Securities purchased;

          (7)  that Holders whose Securities are being purchased only in part
               will be issued new Securities equal in principal amount to the
               unpurchased portion of the Securities surrendered, which
               unpurchased portion must

                                       37
<PAGE>
 
               be equal to $1,000 in principal amount or an integral multiple
               thereof; and

          (8)  the circumstances and relevant facts regarding such Change of
               Control (including, but not limited to, information with respect
               to pro forma historical and, if available, projected financial
               information after giving effect to such Change of Control,
               information regarding the Person or Persons acquiring control and
               such Person's or Persons' business plans going forward).

          On the Change of Control Payment Date, the Company shall, to the
extent lawful, (i) accept for payment Securities or portions thereof properly
tendered and not withdrawn pursuant to the Change of Control Offer, (ii) deposit
with the Paying Agent an amount equal to the Change of Control Payment in
respect of all Securities or portions thereof so tendered and (iii) deliver or
cause to be delivered to the Trustee the Securities so accepted together with an
Officers' Certificate stating the aggregate principal amount of Securities or
portions thereof being purchased by the Company.  The Paying Agent shall
promptly mail to each Holder of Securities so tendered payment in an amount
equal to the Change of Control Payment for such Securities, and the Trustee
shall promptly authenticate and mail or deliver (or cause to be transferred by
book entry) a new Security to such Holder equal in principal amount to any
unpurchased portion of the Securities surrendered, if any; provided, that each
such new Security shall be in a principal amount of $1,000 or an integral
multiple thereof.

          Prior to complying with the provisions of this Section 4.13, but in
any event within 90 days following a Change of Control Triggering Event, the
Company shall either repay all outstanding Senior Debt or obtain the requisite
consents, if any, under all agreements governing outstanding Senior Debt to
permit the repurchase of Securities required by this Section 4.13.

          The Company shall publicly announce the results of the Change of
Control Offer on or as soon as practicable after the Change of Control Payment
Date.

Section 4.14.  Corporate Existence.

          Subject to Section 4.13 and Article 5 hereof, the Company shall do or
cause to be done all things necessary to preserve and keep in full force and
effect (i) its corporate existence, and the corporate, partnership or other
existence of each of its Subsidiaries, in accordance with the respective
organizational documents (as the same may be amended from time to time) of each
Subsidiary and (ii) the rights (charter and statutory), licenses and franchises
of the Company and its Subsidiaries; provided, however, that the Company shall
not be required to preserve any such right, license or franchise, or the
corporate, partnership or other existence of any of its Subsidiaries, if the
Board of Directors shall determine that the preservation thereof is no longer
desirable in the conduct of the business of the Company and its Subsidiaries,
taken as a whole, and that the loss thereof is not adverse in any material
respect to the Holders.

                                       38
<PAGE>
 
Section 4.15.  Line of Business

          The Company shall not, and shall not permit any of its Subsidiaries
to, engage to any material extent in any business other than the ownership,
operation and management of Hospitals and Related Businesses.

Section 4.16.  Limitations on Issuances of Guarantees of Indebtedness by
               Subsidiaries

          The Company shall not permit any Subsidiary, directly or indirectly,
to Guarantee or secure the payment of any other Indebtedness of the Company or
any of its Subsidiaries (except Indebtedness of a Subsidiary of such Subsidiary
or Physician Support Obligations) unless such Subsidiary simultaneously executes
and delivers a supplemental indenture to this Indenture providing for the
Guarantee of the payment of the Securities by such Subsidiary, which Guarantee
shall be subordinate to such Subsidiary's Guarantee of or pledge to secure such
other Indebtedness to the same extent as the Securities are subordinated to such
other Indebtedness under this Indenture.  Notwithstanding the foregoing, any
such Guarantee by a Subsidiary of the Securities shall be substantially in the
form of Exhibit B hereto and shall provide by its terms that it shall be
automatically and unconditionally released and discharged upon the sale or other
disposition, by way of merger or otherwise, to any Person not an Affiliate of
the Company, of all of the Company's stock in, or all or substantially all the
assets of, such Subsidiary, which sale or other disposition is made in
compliance with, and the Net Proceeds therefrom are applied in accordance with,
the applicable provisions hereof.  The foregoing provisions will not be
applicable to any one or more Guarantees of up to $10.0 million in aggregate
principal amount of Indebtedness of the Company at any time outstanding.

Section 4.17.  No Senior Subordinated Debt

          The Company shall not incur any Indebtedness that is subordinate or
junior in right of payment to any Senior Debt and senior in any respect in right
of payment to the Securities.

                                   ARTICLE 5
                                   SUCCESSORS

Section 5.01.  Limitations On Mergers, Consolidations or Sales of Assets

          The Company may not consolidate or merge with or into (whether or not
the Company is the surviving corporation), or sell, assign, transfer, lease,
convey or otherwise dispose of all or substantially all of its properties or
assets in one or more related transactions to another corporation, Person or
entity unless:

          (i)  the Company is the surviving corporation or the entity or the
               Person formed by or surviving any such consolidation or merger
               (if other than

                                       39
<PAGE>
 
                the Company) or to which such sale, assignment, transfer, lease,
                conveyance or other disposition shall have been made is a
                corporation organized or existing under the laws of the United
                States, any state thereof or the District of Columbia;

          (ii)  the entity or Person formed by or surviving any such
                consolidation or merger (if other than the Company) or the
                entity or Person to which such sale, assignment, transfer,
                lease, conveyance or other disposition shall have been made
                assumes all the Obligations of the Company pursuant to a
                supplemental indenture in a form reasonably satisfactory to the
                Trustee, under the Securities and the Indenture;

          (iii) immediately after such transaction no Default or Event of
                Default exists; and

          (iv)  the Company or any entity or Person formed by or surviving any
                such consolidation or merger (if other than the Company), or to
                which such sale, assignment, transfer, lease, conveyance or
                other disposition shall have been made (a) will have
                Consolidated Net Worth (immediately after giving effect to the
                transaction) equal to or greater than the Consolidated Net Worth
                of the Company immediately preceding the transaction and (b)
                will, at the time of such transaction and after giving pro forma
                effect thereto as if such transaction had occurred at the
                beginning of the applicable four-quarter period, be permitted to
                incur at least $1.00 of additional Indebtedness pursuant to the
                Fixed Charge Coverage Ratio test set forth in the first
                paragraph of Section 4.09.

          The Company shall deliver to the Trustee prior to the consummation of
the proposed transaction an Officers' Certificate to the foregoing effect and an
Opinion of Counsel, covering clauses (i) through (iv) above, stating that the
proposed transaction and such supplemental indenture comply with this Indenture.
The Trustee shall be entitled to conclusively rely upon such Officers'
Certificate and Opinion of Counsel.

Section 5.02.  Successor Corporation Substituted.

          Upon any consolidation or merger, or any sale, assignment, transfer,
lease, conveyance or other disposition of all or substantially all of the assets
of the Company in accordance with Section 5.01 hereof, the successor corporation
formed by such consolidation or into or with which the Company is merged or to
which such sale, assignment, transfer, lease, conveyance or other disposition is
made shall succeed to, and be substituted for (so that from and after the date
of such consolidation, merger, sale, assignment, transfer, lease, conveyance or
other disposition, the provisions of this Indenture referring to the "Company"
shall refer instead to the successor corporation), and may exercise every right
and power of the Company under this Indenture with the same effect as if such
successor Person has been named as the Company, herein.

                                       40
<PAGE>
 
                                 ARTICLE 6
                             DEFAULTS AND REMEDIES

Section 6.01.  Events of Default.

          Each of the following constitutes an "Event of Default":

          (i) a default for 30 days in the payment when due of interest on the
     Securities whether or not such payment is prohibited by the provisions of
     Article 10 hereof;

          (ii) a default in payment when due of principal of or premium, if any,
     on the Securities at maturity, upon redemption or otherwise, whether or not
     such payment is prohibited by the provisions of Article 10 hereof;

          (iii)  a default in the performance or breach of Sections 4.07, 4.09,
     4.10 or 4.13 hereof;

          (iv) a failure by the Company to comply with any other covenant or
     agreement in the Indenture or the Securities for the period and after the
     notice specified below;

          (v) any default occurs under any mortgage, indenture or instrument
     under which there may be issued or by which there may be secured or
     evidenced any Indebtedness for money borrowed by the Company or any of its
     Significant Subsidiaries (or the payment of which is Guaranteed by the
     Company or any of its Significant Subsidiaries), whether such Indebtedness
     or Guarantee exists on the date of this Indenture or is created hereafter,
     which default (a) constitutes a failure to pay principal at final maturity
     or (b) results in the acceleration of such Indebtedness prior to its
     express maturity and, in each case, the principal amount of such
     Indebtedness, together with the principal amount of any other Indebtedness
     that has not been paid at final maturity or that has been so accelerated,
     aggregates $25.0 million or more;

          (vi) a failure by the Company or any of its Significant Subsidiaries
     to pay a final judgment or final judgments aggregating in excess of $25.0
     million entered by a court or courts of competent jurisdiction against the
     Company or any of its Significant Subsidiaries if such final judgment or
     judgments remain unpaid or undischarged for a period (during which
     execution shall not be effectively stayed) of 60 days after their entry;

          (vii) the Company or any Significant Subsidiary thereof pursuant to or
     within the meaning of any Bankruptcy Law:

               (a)  commences a voluntary case,

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<PAGE>
 
               (b) consents to the entry of an order for relief against it in an
          involuntary case in which it is the debtor,

               (c) consents to the appointment of a Custodian of it or for all
          or substantially all of its property,

               (d) makes a general assignment for the benefit of its creditors,
          or

               (e) admits in writing its inability generally to pay its debts as
          the same become due; and

          (viii)  a court of competent jurisdiction enters an order or decree
     under any Bankruptcy Law that:

               (a) is for relief against the Company or any Significant
          Subsidiary in an involuntary case in which it is the debtor,

               (b) appoints a Custodian of the Company or any Significant
          Subsidiary thereof or for all or substantially all of the property of
          the Company or any Significant Subsidiary thereof, or

               (c) orders the liquidation of the Company or any Significant
          Subsidiary thereof,

     and the order or decree remains unstayed and in effect for 60 days.

          The term "Bankruptcy Law" means title 11, U.S. Code or any similar
                    --------------                                          
federal or state law for the relief of debtors.  The term "Custodian" means any
                                                           ---------           
receiver, trustee, assignee, liquidator or similar official under any Bankruptcy
Law.

          A Default under clause (iv) is not an Event of Default until the
Trustee notifies the Company, or the Holders of at least 25% in principal amount
of the then outstanding Securities notify the Company and the Trustee, of the
Default and the Company does not cure the Default within 60 days after receipt
of the notice.  The notice must specify the Default, demand that it be remedied
and state that the notice is a "Notice of Default."

          In the case of any Event of Default occurring by reason of any willful
action (or inaction) taken (or not taken) by or on behalf of the Company with
the intention of avoiding payment of the premium that the Company would have had
to pay if the Company then had elected to redeem the Securities pursuant to
Section 3.07 hereof, an equivalent premium shall also become and be immediately
due and payable to the extent permitted by law upon the acceleration of the
Securities, anything in this Indenture or in the Securities to the contrary
notwithstanding.  If an Event of Default occurs prior to March ___, 2000 by
reason of any willful action (or inaction) taken (or not taken) by or on behalf
of the Company with the intention of avoiding the prohibition on redemption of
the Securities prior to March ___, 2000 pursuant to Section 3.07 hereof, then
the premium payable for purposes

                                       42
<PAGE>
 
of this paragraph for each of the years beginning on March __ of the years set
forth below shall be as set forth in the following table expressed as a
percentage of the amount that would otherwise be due but for the provisions of
this sentence, plus accrued interest, if any, to the date of payment:

               Year           Percentage
               ----           ----------

               1995           [implied call price during non-call period]
               1996           [implied call price during non-call period]
               1997           [implied call price during non-call period]
               1998           [implied call price during non-call period]
               1999           [implied call price during non-call period]


Section 6.02.  Acceleration.

          If an Event of Default (other than an Event of Default specified in
clauses (vii) and (viii) of Section 6.01) occurs and is continuing, the Trustee
by notice to the Company, or the Holders of at least 25% in principal amount of
the then outstanding Securities by written notice to the Company and the Trustee
may declare the unpaid principal of and any accrued interest on all the
Securities to be due and payable.  Upon such declaration the principal and
interest shall be due and payable immediately (together with the premium
referred to in Section 6.01, if applicable). If an Event of Default specified in
clause (vii) or (viii) of Section 6.01 relating to the Company or any
Significant Subsidiary thereof occurs, such an amount shall ipso facto become
                                                            ---- -----       
and be immediately due and payable without any declaration or other act on the
part of the Trustee or any Holder.

Section 6.03.  Other Remedies.

          If an Event of Default occurs and is continuing, the Trustee may
pursue any available remedy to collect the payment of principal or interest on
the Securities or to enforce the performance of any provision of the Securities
or this Indenture.

          The Trustee may maintain a proceeding even if it does not possess any
of the Securities or does not produce any of them in the proceeding.  A delay or
omission by the Trustee or any Holder in exercising any right or remedy accruing
upon an Event of Default shall not impair the right or remedy or constitute a
waiver of or acquiescence in the Event of Default.  All remedies are cumulative
to the extent permitted by law.

Section 6.04.  Waiver of Past Defaults.

          Holders of not less than a majority in aggregate principal amount of
the then outstanding Securities by written notice to the Trustee may waive an
existing Default or Event of Default and its consequences under this Indenture,
except a continuing Default or Event of Default in the payment of the principal
of, premium, if any, or interest on any Security.  Upon any such waiver, such
Default shall cease to exist, and any Event of Default

                                       43
<PAGE>
 
arising therefrom shall be deemed to have been cured for every purpose of this
Indenture; but no such waiver shall extend to any subsequent or other Default or
impair any right consequent thereon.

Section 6.05.  Control by Majority.

          Holders of a majority in principal amount of the then outstanding
Securities may direct the time, method and place of conducting any proceeding
for any remedy available to the Trustee or exercising any trust or power
conferred on it.  However, the Trustee may refuse to follow any direction that
conflicts with law or this Indenture that the Trustee determines may be unduly
prejudicial to the rights of other Holders or that may involve the Trustee in
personal liability.  The Trustee may take any other action which it deems proper
which is not inconsistent with any such direction.

Section 6.06.  Limitation on Suits.

          A Holder may pursue a remedy with respect to this Indenture or the
Securities only if:

          (i)  the Holder gives to the Trustee written notice of a continuing
               Event of Default;

          (ii) the Holders of at least 25% in principal amount of the then
               outstanding Securities make a written request to the Trustee to
               pursue the remedy;

        (iii)  such Holder or Holders offer and, if requested, provide to the
               Trustee indemnity satisfactory to the Trustee against any loss,
               liability or expense;

          (iv) the Trustee does not comply with the request within 60 days after
               receipt of the request and the offer and, if requested, the
               provision of indemnity; and

          (v)  during such 60-day period the Holders of a majority in principal
               amount of the then outstanding Securities do not give the Trustee
               a direction inconsistent with the request.

A Holder may not use this Indenture to prejudice the rights of another Holder or
to obtain a preference or priority over another Holder.

Section 6.07.  Rights of Holders to Receive Payment.

          Notwithstanding any other provision of this Indenture, the right of
any Holder to receive payment of principal, premium, if any, and interest on the
Security, on or after the respective due dates expressed in the Security, or to
bring suit for the enforcement of any such payment on or after such respective
dates, shall not be impaired or affected without the consent of the Holder.

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<PAGE>
 
Section 6.08.  Collection Suit by Trustee.

          If an Event of Default specified in Section 5.01(i) or (ii) occurs and
is continuing, the Trustee is authorized to recover judgment in its own name and
as trustee of an express trust against the Company or any other obligor for the
whole amount of principal, premium, if any, and interest remaining unpaid on the
Securities and interest on overdue principal and, to the extent lawful, interest
and such further amount as shall be sufficient to cover amounts due the Trustee
under Section 7.07, including the costs and expenses of collection, including
the reasonable compensation, expenses, disbursements and advances of the
Trustee, its agents and counsel.

Section 6.09.  Trustee May File Proofs of Claim.

          The Trustee is authorized to file such proofs of claim and other
papers or documents as may be necessary or advisable in order to have the claims
of the Trustee (including any claim for the reasonable compensation, expenses,
disbursements and advances of the Trustee, its agents and counsel) and the
Holders allowed in any judicial proceedings relative to the Company (or any
other obligor upon the Securities), its creditors or its property and shall be
entitled and empowered to collect, receive and distribute any money or other
property payable or deliverable on any such claims and any custodian in any such
judicial proceeding is hereby authorized by each Holder to make such payments to
the Trustee, and in the event that the Trustee shall consent to the making of
such payments directly to the Holders, to pay to the Trustee any amount due to
it for the reasonable compensation, expenses, disbursements and advances of the
Trustee, its agents and counsel, and any other amounts due the Trustee under
Section 7.07 hereof.  To the extent that the payment of any such compensation,
expenses, disbursements and advances of the Trustee, its agents and counsel, and
any other amounts due the Trustee under Section 7.07 hereof out of the estate in
any such proceeding, shall be denied for any reason, payment of the same shall
be secured by a Lien on, and shall be paid out of, any and all distributions,
dividends, money, securities and other properties which the Holders may be
entitled to receive in such proceeding whether in liquidation or under any plan
of reorganization or arrangement or otherwise.  Nothing herein contained shall
be deemed to authorize the Trustee to authorize or consent to or accept or adopt
on behalf of any Holder any plan of reorganization, arrangement, adjustment or
composition affecting the Securities or the rights of any Holder thereof, or to
authorize the Trustee to vote in respect of the claim of any Holder in any such
proceeding.

Section 6.10.  Priorities.

          If the Trustee collects any money pursuant to this Article, it shall
pay out the money in the following order:

          First:  to the Trustee, its agents and attorneys for amounts due under
Section 7.07, including payment of all compensation, expense and liabilities
incurred, and all advances made, by the Trustee and the costs and expenses of
collection;

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<PAGE>
 
          Second:  to Holders for amounts due and unpaid on the Securities for
principal, premium, if any, and interest, ratably, without preference or
priority of any kind, according to the amounts due and payable on the Securities
for principal, premium, if any and interest, respectively; and

          Third:  to the Company or to such party as a court of competent
jurisdiction shall direct.

          The Trustee may fix a record date and payment date for any payment to
Holders pursuant to this Section 6.10 upon five Business Days prior notice to
the Company.

Section 6.11.  Undertaking for Costs.

          In any suit for the enforcement of any right or remedy under this
Indenture or in any suit against the Trustee for any action taken or omitted by
it as a Trustee, a court in its discretion may require the filing by any party
litigant in the suit of an undertaking to pay the costs of the suit, and the
court in its discretion may assess reasonable costs, including reasonable
attorneys' fees and expenses, against any party litigant in the suit, having due
regard to the merits and good faith of the claims or defenses made by the party
litigant.  This Section does not apply to a suit by the Trustee, a suit by a
Holder pursuant to Section 6.07, or a suit by Holders of more than 10% in
principal amount of the then outstanding Securities.

                                   ARTICLE 7
                                    TRUSTEE

Section 7.01.  Duties of Trustee.

          (i) If an Event of Default has occurred and is continuing, the Trustee
shall exercise such of the rights and powers vested in it by this Indenture, and
use the same degree of care and skill in their exercise, as a prudent man would
exercise or use under the circumstances in the conduct of his own affairs.

          (ii) Except during the continuance of an Event of Default known to the
Trustee:

               (a)  the duties of the Trustee shall be determined solely by the
                    express provisions of this Indenture or the TIA and the
                    Trustee need perform only those duties that are specifically
                    set forth in this Indenture or the TIA and no others, and no
                    implied covenants or obligations shall be read into this
                    Indenture against the Trustee, and

               (b)  in the absence of bad faith on its part, the Trustee may
                    conclusively rely, as to the truth of the statements and the
                    correctness of the opinions expressed therein, upon
                    certificates

                                       46
<PAGE>
 
                    or opinions furnished to the Trustee and conforming to the
                    requirements of this Indenture.  However, the Trustee shall
                    examine the certificates and opinions to determine whether
                    or not they conform to the requirements of this Indenture.

          (iii)  The Trustee may not be relieved from liabilities for its own
negligent action, its own negligent failure to act, or its own willful
misconduct, except that:

               (a)  this paragraph does not limit the effect of paragraph (ii)
                    of this Section;

               (b)  the Trustee shall not be liable for any error of judgment
                    made in good faith by a Responsible Officer, unless it is
                    proved that the Trustee was negligent in ascertaining the
                    pertinent facts; and

               (c)  the Trustee shall not be liable with respect to any action
                    it takes or omits to take in good faith in accordance with a
                    direction received by it pursuant to Section 6.05 hereof.

          (iv) Whether or not therein expressly so provided, every provision of
this Indenture that in any way relates to the Trustee is subject to paragraphs
(i), (ii), and (iii) of this Section.

          (v) No provision of this Indenture shall require the Trustee to expend
or risk its own funds or incur any liability.  The Trustee may refuse to perform
any duty or exercise any right or power unless it receives security and
indemnity satisfactory to it against any loss, liability or expense.

          (vi) The Trustee shall not be liable for interest on any money
received by it except as the Trustee may agree in writing with the Company.
Absent written instruction from the Company, the Trustee shall not be required
to invest any such money.  Money held in trust by the Trustee need not be
segregated from other funds except to the extent required by law.

          (vii)  The Trustee shall not be deemed to have knowledge of any matter
unless such matter is actually known to a Responsible Officer.

Section 7.02.  Rights of Trustee.

          (i) The Trustee may conclusively rely upon any document believed by it
to be genuine and to have been signed or presented by the proper Person.  The
Trustee need not investigate any fact or matter stated in the document.

          (ii) Before the Trustee acts or refrains from acting, it may require
an Officers' Certificate or an Opinion of Counsel or both.  The Trustee shall
not be liable for

                                       47
<PAGE>
 
any action it takes or omits to take in good faith in reliance on such Officers'
Certificate or Opinion of Counsel.  The Trustee may consult with counsel and the
written advice of such counsel or any Opinion of Counsel shall be full and
complete authorization and protection from liability in respect of any action
taken, suffered or omitted by it hereunder in good faith and in reliance
thereon.

          (iii)  The Trustee may act through its attorneys and agents and shall
not be responsible for the misconduct or negligence of any agent appointed with
due care.

          (iv) The Trustee shall not be liable for any action it takes or omits
to take in good faith which it believes to be authorized or within its rights or
powers conferred upon it by this Indenture.  A permissive right granted to the
Trustee hereunder shall not be deemed an obligation to act.

          (v) Unless otherwise specifically provided in this Indenture, any
demand, request, direction or notice from the Company shall be sufficient if
signed by an Officer of the Company.

Section 7.03.  Individual Rights of Trustee.

          The Trustee in its individual or any other capacity may become the
owner or pledgee of Securities and may otherwise deal with the Company or any
Affiliate of the Company with the same rights it would have if it were not
Trustee.  Any Agent may do the same with like rights.  However, the Trustee is
subject to Sections 7.10 and 7.11 hereof.

Section 7.04.  Trustee's Disclaimer.

          The Trustee shall not be responsible for and makes no representation
as to the validity or adequacy of this Indenture or the Securities, nor shall it
be accountable for the Company's use of the proceeds from the Securities or any
money paid to the Company or upon the Company's direction under any provision of
this Indenture, nor shall it be responsible for the use or application of any
money received by any Paying Agent other than the Trustee, nor shall it be
responsible for any statement or recital herein or any statement in the
Securities or any other document in connection with the sale of the Securities
or pursuant to this Indenture other than its certificate of authentication.

Section 7.05.  Notice of Defaults.

          If a Default or Event of Default occurs and is continuing and if it is
known to the Trustee, the Trustee shall mail to Holders a notice of the Default
or Event of Default within 90 days after it occurs.  Except in the case of a
Default or Event of Default in payment on any Security, the Trustee may withhold
the notice if and so long as a committee of its Responsible Officers in good
faith determines that withholding the notice is in the interests of the Holders.

                                       48
<PAGE>
 
Section 7.06.  Reports by Trustee to Holders.

          Within 60 days after each December 31 beginning with the December 31
following the date hereof, the Trustee shall mail to the Holders a brief report
dated as of such reporting date that complies with TIA (S) 313(a) (but if no
event described in TIA (S) 313(a) has occurred within the twelve months
preceding the reporting date, no report need be transmitted).  The Trustee also
shall comply with TIA (S) 313(b).  The Trustee shall also transmit by mail all
reports as required by TIA (S) 313(c).

          A copy of each report at the time of its mailing to the Holders shall
be mailed to the Company and filed with the Commission and each stock exchange
on which the Securities are listed.  The Company shall promptly notify the
Trustee when the Securities are listed on any stock exchange.

Section 7.07.  Compensation and Indemnity.

          The Company shall pay to the Trustee from time to time such
compensation for its acceptance of this Indenture and services hereunder as the
Company and Trustee shall agree in writing.  The Trustee's compensation shall
not be limited by any law on compensation of a trustee of an express trust.  The
Company shall reimburse the Trustee promptly upon request for all reasonable
disbursements, advances and expenses incurred or made by it in addition to the
compensation for its services.  Such expenses shall include the reasonable
compensation, disbursements and expenses of the Trustee's agents and counsel.

          The Company shall indemnify the Trustee against any and all losses,
liabilities, damages, claims or expenses incurred by it arising out of or in
connection with the acceptance of its duties and the administration of the
trusts under this Indenture, except as set forth below.  The Trustee shall
notify the Company promptly of any claim for which it may seek indemnity.
Failure by the Trustee to so notify the Company shall not relieve the Company of
its obligations hereunder.  The Company shall defend the claim and the Trustee
shall cooperate in the defense.  The Trustee may have separate counsel and the
Company shall pay the reasonable fees and expenses of such counsel.  The Company
need not pay for any settlement made without its consent, which consent shall
not be unreasonably withheld.

          The obligations of the Company under this Section 7.07 shall survive
the satisfaction and discharge of this Indenture.

          The Company need not reimburse any expense or indemnify against any
loss or liability incurred by the Trustee through its own negligence or bad
faith.

          To secure the Company's payment obligations in this Section, the
Trustee shall have a Lien prior to the Securities on all money or property held
or collected by the Trustee, except that held in trust to pay principal and
interest on particular Securities.  Such Lien shall survive the satisfaction and
discharge of this Indenture.

                                       49
<PAGE>
 
          When the Trustee incurs expenses or renders services after an Event of
Default specified in Section 6.01(vii) or (viii) hereof occurs, the expenses and
the compensation for the services (including the fees and expenses of its agents
and counsel) are intended to constitute expenses of administration under any
Bankruptcy Law.

Section 7.08.  Replacement of Trustee.

          A resignation or removal of the Trustee and appointment of a successor
Trustee shall become effective only upon the successor Trustee's acceptance of
appointment as provided in this Section.

          The Trustee may resign in writing at any time and be discharged from
the trust hereby created by so notifying the Company.  The Holders of a majority
in principal amount of the then outstanding Securities may remove the Trustee by
so notifying the Trustee and the Company in writing.  The Company may remove the
Trustee if:

          (1) the Trustee fails to comply with Section 7.10 hereof;

          (2) the Trustee is adjudged a bankrupt or an insolvent or an order for
     relief is entered with respect to the Trustee under any Bankruptcy Law;

          (3) a Custodian or public officer takes charge of the Trustee or its
     property; or

          (4) the Trustee becomes incapable of acting.

          If the Trustee resigns or is removed or if a vacancy exists in the
office of Trustee for any reason, the Company shall promptly appoint a successor
Trustee.  Within one year after the successor Trustee takes office, the Holders
of a majority in principal amount of the then outstanding Securities may appoint
a successor Trustee to replace the successor Trustee appointed by the Company.

          If a successor Trustee does not take office within 60 days after the
retiring Trustee resigns or is removed, the retiring Trustee, the Company, or
the Holders of at least 10% in principal amount of the then outstanding
Securities may petition any court of competent jurisdiction for the appointment
of a successor Trustee.

          If the Trustee after written request by any Holder who has been a
Holder for at least six months fails to comply with Section 7.10, such Holder
may petition any court of competent jurisdiction for the removal of the Trustee
and the appointment of a successor Trustee.

          A successor Trustee shall deliver a written acceptance of its
appointment to the retiring Trustee and to the Company.  Thereupon, the
resignation or removal of the retiring Trustee shall become effective, and the
successor Trustee shall have all the rights, powers and duties of the Trustee
under this Indenture.  The successor Trustee shall mail a notice of

                                       50
<PAGE>
 
its succession to Holders.  The retiring Trustee shall promptly transfer all
property held by it as Trustee to the successor Trustee, provided all sums owing
to the Trustee hereunder have been paid and subject to the Lien provided for in
Section 7.07 hereof.  Notwithstanding replacement of the Trustee pursuant to
this Section 7.08, the Company's obligations under Section 7.07 hereof shall
continue for the benefit of the retiring Trustee.

Section 7.09.  Successor Trustee or Agent by Merger, etc.

          If the Trustee or any Agent consolidates, merges or converts into, or
transfers all or substantially all of its corporate trust business to, another
corporation, the successor corporation without any further act shall be the
successor Trustee or Agent.

Section 7.10.  Eligibility; Disqualification.

          There shall at all times be a Trustee hereunder which shall be a
corporation organized and doing business under the laws of the United States of
America or of any state thereof authorized under such laws to exercise corporate
trustee power, shall be subject to supervision or examination by federal or
state authority and shall have a combined capital and surplus of at least $100.0
million as set forth in its most recent published annual report of condition.

          This Indenture shall always have a Trustee who satisfies the
requirements of TIA (S) 310(a)(1), (2) and (5).  The Trustee is subject to TIA
(S) 310(b).

Section 7.11.  Preferential Collection of Claims Against Company.

          The Trustee is subject to TIA (S) 311(a), excluding any creditor
relationship listed in TIA (S) 311(b).  A Trustee who has resigned or been
removed shall be subject to TIA (S) 311(a) to the extent indicated therein.


                                   ARTICLE 8
                             DISCHARGE OF INDENTURE

Section 8.01.  Defeasance and Discharge of this Indenture and the Securities.

          The Company may, at the option of its Board of Directors evidenced by
a resolution set forth in an Officers' Certificate, at any time, with respect to
the Securities, elect to have either Section 8.02 or 8.03 be applied to all
outstanding Securities upon compliance with the conditions set forth below in
this Article 8.

Section 8.02.  Legal Defeasance and Discharge.

          Upon the Company's exercise under Section 8.01 of the option
applicable to this Section 8.02, the Company shall be deemed to have been
discharged from its obligations with respect to all outstanding Securities on
the date the conditions set forth below are

                                       51
<PAGE>
 
satisfied (hereinafter, "Legal Defeasance").  For this purpose, such Legal
Defeasance means that the Company shall be deemed to have paid and discharged
the entire Indebtedness represented by the outstanding Securities, which shall
thereafter be deemed to be "outstanding" only for the purposes of Section 8.05
and the other Sections of this Indenture referred to in clauses (i) and (ii) of
this Section 8.02, and to have satisfied all its other obligations under such
Securities and this Indenture (and the Trustee, on demand of and at the expense
of the Company, shall execute proper instruments acknowledging the same), except
for the following which shall survive until otherwise terminated or discharged
hereunder:  (i) the rights of Holders of outstanding Securities to receive
solely from the trust fund described in Section 8.04, and as more fully set
forth in such Section, payments in respect of the principal of, premium, if any,
and interest on such Securities when such payments are due, (ii) the Company's
obligations with respect to such Securities under Sections 2.04, 2.06, 2.07,
2.10 and 4.02, (iii) the rights, powers, trusts, duties and immunities of the
Trustee hereunder, including, without limitation, the Trustee's rights under
Section 7.07, and the Company's obligations in connection therewith and (iv)
this Article 8.  Subject to compliance with this Article 8, the Company may
exercise its option under this Section 8.02 notwithstanding the prior exercise
of its option under Section 8.03 with respect to the Securities.

Section 8.03.  Covenant Defeasance.

          Upon the Company's exercise under Section 8.01 of the option
applicable to this Section 8.03, the Company shall be released from its
obligations under the covenants contained in Sections 3.09, 4.07, 4.08, 4.09,
4.10, 4.11, 4.12, 4.13, 4.15, 4.16 and 4.17 and Article 5 with respect to the
outstanding Securities on and after the date the conditions set forth below are
satisfied (hereinafter, "Covenant Defeasance"), and the Securities shall
thereafter be deemed not "outstanding" for the purposes of any direction,
waiver, consent or declaration or act of Holders (and the consequences of any
thereof) in connection with such covenants, but shall continue to be deemed
"outstanding" for all other purposes hereunder (it being understood that such
Securities shall not be deemed outstanding for accounting purposes).  For this
purpose, such Covenant Defeasance means that, with respect to the outstanding
Securities, the Company may omit to comply with and shall have no liability in
respect of any term, condition or limitation set forth in any such covenant,
whether directly or indirectly, by reason of any reference elsewhere herein to
any such covenant or by reason of any reference in any such covenant to any
other provision herein or in any other document and such omission to comply
shall not constitute a Default or an Event of Default under Section 6.01(iii),
but, except as specified above, the remainder of this Indenture and such
Securities shall be unaffected thereby.  In addition, upon the Company's
exercise under Section 8.01 of the option applicable to this Section 8.03,
Sections 6.01(iv) through 6.01(viii) shall not constitute Events of Default.

Section 8.04.  Conditions to Legal or Covenant Defeasance.

          The following shall be the conditions to application of either Section
8.02 or Section 8.03 to the outstanding Securities:

                                       52
<PAGE>
 
          (i) The Company shall irrevocably have deposited or caused to be
     deposited with the Trustee (or another trustee satisfying the requirements
     of Section 7.10 who shall agree to comply with the provisions of this
     Article 8 applicable to it) as trust funds in trust for the purpose of
     making the following payments, specifically pledged as security for, and
     dedicated solely to, the benefit of the Holders of such Securities, (a)
     cash in U.S. Dollars in an amount, or (b) non-callable Government
     Securities which through the scheduled payment of principal and interest in
     respect thereof in accordance with their terms will provide, not later than
     one day before the due date of any payment, cash in U.S. Dollars in an
     amount, or (c) a combination thereof, in such amounts, as will be
     sufficient, in the opinion of a nationally recognized firm of independent
     public accountants expressed in a written certification thereof delivered
     to the Trustee, to pay and discharge and which shall be applied by the
     Trustee (or other qualifying trustee) to pay and discharge the principal
     of, premium, if any, and interest on the outstanding Securities on the
     stated maturity date or on the applicable redemption date, as the case may
     be, of such principal or installment of principal, premium, if any, or
     interest and the Company must specify whether the Securities are being
     defeased to maturity or to a particular redemption date (in which case the
     Company shall issue an irrevocable notice of redemption as of a specified
     date that will be delivered by the Trustee in accordance with the
     redemption provisions of this Indenture).

          (ii) In the case of an election under Section 8.02, the Company shall
     have delivered to the Trustee an Opinion of Counsel in the United States
     confirming that (a) the Company has received from, or there has been
     published by, the Internal Revenue Service a ruling or (b) since the date
     hereof, there has been a change in the applicable federal income tax law,
     in either case to the effect that, and based thereon such opinion shall
     confirm that, the Holders of the outstanding Securities will not recognize
     income, gain or loss for federal income tax purposes as a result of such
     Legal Defeasance and will be subject to federal income tax on the same
     amounts, in the same manner and at the same times as would have been the
     case if such Legal Defeasance had not occurred.

          (iii) In the case of an election under Section 8.03, the Company shall
     have delivered to the Trustee an Opinion of Counsel in the United States
     confirming that the Holders of the outstanding Securities will not
     recognize income, gain or loss for federal income tax purposes as a result
     of such Covenant Defeasance and will be subject to federal income tax in
     the same amount, in the same manner and at the same times as would have
     been the case if such Covenant Defeasance had not occurred.

          (iv) No Default or Event of Default with respect to the Securities
     shall have occurred and be continuing on the date of such deposit (other
     than a Default or Event of Default resulting from the borrowing of funds to
     be applied to such deposit) or, insofar as Subsection 6.01(vii) or
     6.01(viii) is concerned, at any time in the period ending on the 91st day
     after the date of such deposit (it being understood that this condition
     shall not be deemed satisfied until the expiration of such period).

                                       53
<PAGE>
 
          (v) Such Legal Defeasance or Covenant Defeasance shall not result in a
     breach or violation of, or constitute a default under any other material
     agreement or instrument (other than this Indenture) to which the Company or
     any of its Subsidiaries is a party or by which the Company or any of its
     Subsidiaries is bound.

          (vi) In the case of an election under either Section 8.02 or 8.03, the
     Company shall have delivered to the Trustee an Opinion of Counsel to the
     effect that after the 91st day following the deposit, the trust funds will
     not be subject to the effect of any applicable Bankruptcy Law.

          (vii)  In the case of an election under either Section 8.02 or 8.03,
     the Company shall have delivered to the Trustee an Officers' Certificate
     stating that the deposit made by the Company pursuant to its election under
     Section 8.02 or 8.03 was not made by the Company with the intent of
     preferring the Holders of the Securities over other creditors of the
     Company with the intent of defeating, hindering, delaying or defrauding
     creditors of the Company or others.

          (viii)  The Company shall have delivered to the Trustee an Officers'
     Certificate and an Opinion of Counsel in the United States, each stating
     that all conditions precedent provided for relating to either the Legal
     Defeasance under Section 8.02 or the Covenant Defeasance under Section 8.03
     (as the case may be) have been complied with as contemplated by this
     Section 8.04.

Section 8.05.  Deposited Money and Government Securities to be Held in Trust;
               Other Miscellaneous Provisions.

          Subject to Section 8.06, all money and non-callable Government
Securities (including the proceeds thereof) deposited with the Trustee (or other
qualifying trustee, collectively for purposes of this Section 8.05, the
"Trustee") pursuant to Section 8.04 in respect of the outstanding Securities
shall be held in trust and applied by the Trustee, in accordance with the
provisions of such Securities and this Indenture, to the payment, either
directly or through any Paying Agent (including the Company acting as Paying
Agent) as the Trustee may determine, to the Holders of such Securities of all
sums due and to become due thereon in respect of principal, premium, if any, and
interest, but such money need not be segregated from other funds except to the
extent required by law.

          The Company shall pay and indemnify the Trustee against any tax, fee
or other charge imposed on or assessed against the cash or non-callable
Government Securities deposited pursuant to Section 8.04 or the principal and
interest received in respect thereof other than any such tax, fee or other
charge which by law is for the account of the Holders of the outstanding
Securities.

          Anything in this Article 8 to the contrary notwithstanding, the
Trustee shall deliver or pay to the Company from time to time upon the Company's
request any money or non-callable Government Securities held by it as provided
in Section 8.04 which, in the opinion of a nationally recognized firm of
independent public accountants expressed in a

                                       54
<PAGE>
 
written certification thereof delivered to the Trustee (which may be the opinion
delivered under Section 8.04(i)), are in excess of the amount thereof which
would then be required to be deposited to effect an equivalent Legal Defeasance
or Covenant Defeasance.

Section 8.06.  Repayment to Company.

          Any money deposited with the Trustee or any Paying Agent, or then held
by the Company, in trust for the payment of the principal of, premium, if any,
or interest on any Security and remaining unclaimed for two years after such
principal, and premium, if any, or interest has become due and payable shall be
paid to the Company on its written request or (if then held by the Company)
shall be discharged from such trust; and the Holder of such Security shall
thereafter, as an unsecured general creditor, look only to the Company for
payment thereof, and all liability of the Trustee or such Paying Agent with
respect to such trust money, and all liability of the Company as trustee
thereof, shall thereupon cease; provided, however, that the Trustee or such
Paying Agent, before being required to make any such repayment, may at the
expense of the Company cause to be published once, in the New York Times and The
Wall Street Journal (national edition), notice that such money remains unclaimed
and that, after a date specified therein, which shall not be less than 30 days
from the date of such notification or publication, any unclaimed balance of such
money then remaining will be repaid to the Company.

Section 8.07.  Reinstatement.

          If the Trustee or Paying Agent is unable to apply any U.S. Dollars or
non-callable Government Securities in accordance with Section 8.02 or 8.03, as
the case may be, by reason of any order or judgment of any court or governmental
authority enjoining, restraining or otherwise prohibiting such application, then
the Company's obligations under this Indenture and the Securities shall be
revived and reinstated as though no deposit had occurred pursuant to Section
8.02 or 8.03 until such time as the Trustee or Paying Agent is permitted to
apply all such money in accordance with Section 8.02 or 8.03, as the case may
be; provided, however, that, if the Company makes any payment of principal of,
premium, if any, or interest on any Security following the reinstatement of its
obligations, the Company shall be subrogated to the rights of the Holders of
such Security to receive such payment from the money held by the Trustee or
Paying Agent.

                                   ARTICLE 9
                        AMENDMENT, SUPPLEMENT AND WAIVER

Section 9.01.  Without Consent of Holders.

          The Company and the Trustee may amend or supplement this Indenture or
the Securities without the consent of any Holder:

          (i)  to cure any ambiguity, defect or inconsistency;

                                       55
<PAGE>
 
           (ii)     to provide for uncertificated Securities in addition to or
                    in place of certificated Securities;

          (iii)     to provide for any supplemental indenture required pursuant 
                    to Section 4.16 hereof; 

           (iv)     to provide for the assumption of the Company's obligations
                    to the Holders of the Securities in the case of a merger,
                    consolidation or sale of assets pursuant to Article 5
                    hereof;

            (v)     to make any change that would provide any additional rights
                    or benefits to the Holders of the Securities or that does
                    not adversely affect the legal rights hereunder of any
                    Holder; or

           (vi)     to comply with requirements of the Commission in order to
                    effect or maintain the qualification of this Indenture under
                    the TIA.

          Upon the request of the Company accompanied by a resolution of its
Board of Directors authorizing the execution of any such supplemental indenture,
and upon receipt by the Trustee of the documents described in Section 9.06
hereof, the Trustee shall join with the Company in the execution of any
supplemental indenture authorized or permitted by the terms of this Indenture
and to make any further appropriate agreements and stipulations which may be
therein contained, but the Trustee shall not be obligated to enter into such
supplemental indenture which affects its own rights, duties or immunities under
this Indenture or otherwise.

Section 9.02.  With Consent of Holders.

          Except as provided in the next succeeding paragraphs, the Indenture or
the Securities may be amended or supplemented with the consent of the Holders of
at least a majority in principal amount of the Securities then outstanding
(including consents obtained in connection with a tender offer or exchange offer
for such Securities), and any existing default or compliance with any provision
of the Indenture or the Securities may be waived with the consent of the Holders
of a majority in principal amount of the then outstanding Securities (including
consents obtained in connection with a tender offer or exchange offer for such
Securities).

          Upon the request of the Company accompanied by a resolution of its
Board of Directors authorizing the execution of any such supplemental indenture,
and upon the filing with the Trustee of evidence satisfactory to the Trustee of
the consent of the Holders as aforesaid, and upon receipt by the Trustee of the
documents described in Section 9.06 hereof, the Trustee shall join with the
Company in the execution of such supplemental indenture unless such supplemental
indenture affects the Trustee's own rights, duties or immunities under this
Indenture or otherwise, in which case the Trustee may in its discretion, but
shall not be obligated to, enter into such supplemental indenture.

                                       56
<PAGE>
 
          It shall not be necessary for the consent of the Holders under this
Section 9.02 to approve the particular form of any proposed amendment or waiver,
but it shall be sufficient if such consent approves the substance thereof.

          After an amendment, supplement or waiver under this Section becomes
effective, the Company shall mail to the Holders affected thereby a notice
briefly describing the amendment, supplement or waiver.  Any failure of the
Company to mail such notice, or any defect therein, shall not, however, in any
way impair or affect the validity of any such supplemental indenture or waiver.
Subject to Sections 6.04 and 6.07 hereof, the Holders of a majority in aggregate
principal amount of the Securities then outstanding may waive compliance in a
particular instance by the Company with any provision of this Indenture or the
Securities.  Without the consent of each Holder affected, however, an amendment
or waiver may not (with respect to any Security held by a non-consenting
Holder):

          (i)   reduce the principal amount of Securities whose Holders must
                consent to an amendment, supplement or waiver;

          (ii)  reduce the principal of or change the fixed maturity of any
                Security or alter the provisions with respect to the redemption
                of the Securities (other than provisions relating to covenants
                in Sections 4.10 and 4.13 hereof);

          (iii) reduce the rate of or change the time for payment of interest
                on any Security;

          (iv)  waive a Default or Event of Default in the payment of principal
                of or premium, if any, or interest on the Securities (except a
                rescission of acceleration of the Securities by the Holders of
                at least a majority in aggregate principal amount of the
                Securities and a waiver of the payment default that resulted
                from such acceleration);

          (v)   make any Security payable in money other than that stated in the
                Securities;

          (vi)  make any change in Section 6.04 or 6.07 hereof;

          (vii) waive a redemption payment with respect to any Security (other
                than a payment required under Section 4.10 or 4.13 hereof); or

          (viii)make any change in this sentence of this Section 9.02.

     Notwithstanding the foregoing, any amendment to the provisions of Article
10 hereof shall require the consent of the Holders of at least 75% in aggregate
principal amount of the Securities then outstanding if such amendment would
adversely affect the rights of the Holders of the Securities.

                                       57
<PAGE>
 
Section 9.03.  Compliance with TIA.

     Every amendment to this Indenture or the Securities shall be set forth in a
supplemental indenture that complies with the TIA as then in effect.

Section 9.04.  Revocation and Effect of Consents.

     Until an amendment or waiver becomes effective, a consent to it by a Holder
is a continuing consent by the Holder and every subsequent Holder of a Security
or portion of a Security that evidences the same debt as the consenting Holder's
Security, even if notation of the consent is not made on any Security.  However,
any such Holder or subsequent Holder may revoke the consent as to its Security
if the Trustee receives written notice of revocation before the date the waiver
or amendment becomes effective.  An amendment or waiver becomes effective in
accordance with its terms and thereafter binds every Holder.

     The Company may, but shall not be obligated to, fix a record date for
determining which Holders must consent to such amendment or waiver.  If the
Company fixes a record date, the record date shall be fixed at (i) the later of
30 days prior to the first solicitation of such consent or the date of the most
recent list of Holders furnished to the Trustee prior to such solicitation
pursuant to Section 2.05 or (ii) such other date as the Company shall designate.

Section 9.05.  Notation on or Exchange of Securities.

     The Trustee may place an appropriate notation about an amendment or waiver
on any Security thereafter authenticated.  The Company in exchange for all
Securities may issue and the Trustee shall authenticate new Securities that
reflect the amendment or waiver.

     Failure to make the appropriate notation or issue a new Security shall not
affect the validity and effect of such amendment or waiver.

Section 9.06.  Trustee to Sign Amendments, etc.

     The Trustee shall sign any amendment or supplemental indenture authorized
pursuant to this Article 9 if the amendment does not adversely affect the
rights, duties, liabilities or immunities of the Trustee.  If it does, the
Trustee may, but need not, sign it.  In signing or refusing to sign such
amendment or supplemental indenture, the Trustee shall be entitled to receive
and, subject to Section 7.01, shall be fully protected in relying upon, an
Officers' Certificate and an Opinion of Counsel as conclusive evidence that such
amendment or Supplemental Indenture is authorized or permitted by this
Indenture, that it is not inconsistent herewith, and that it will be valid and
binding upon the Company in accordance with its terms.  The Company may not sign
an amendment or supplemental indenture until the Board of Directors approves it.

                                       58
<PAGE>
 
                                  ARTICLE 10

                                 SUBORDINATION

Section 10.01.  Agreement to Subordinate.

          The Company agrees, and each Holder by accepting a Security agrees,
that the Indebtedness evidenced by the Security is subordinated in right of
payment, to the extent and in the manner provided in this Article, to the prior
payment in full of all Senior Debt (whether outstanding on the date hereof or
hereafter created, incurred, assumed or Guaranteed), and that the subordination
is for the benefit of the holders of Senior Debt.

Section 10.02.  Certain Definitions.

          "Designated Senior Debt" means (i) so long as any Obligations are
outstanding under the New Credit Facility, such Obligations and (ii) thereafter,
any other Senior Debt permitted hereunder the principal amount of which is
$100.0 million or more and that has been designated by the Company as
"Designated Senior Debt".

          "Representative" means the indenture trustee or other trustee, agent
or representative for any Senior Debt.

          "Senior Debt" means (i) the Senior Term Debt and the Senior Revolving
Debt, (ii) the Senior Notes, (iii) any other Indebtedness that is permitted to
be incurred by the Company under the terms of this Indenture, unless the
instrument under which such Indebtedness is incurred expressly provides that it
is on a parity with or subordinated in right of payment to the Securities and
(iv) all Obligations with respect to any of the foregoing.  Notwithstanding
anything to the contrary in the foregoing, Senior Debt will not include (w) any
liability for federal, state, local or other taxes owed or owing by the Company,
(x) any Indebtedness of the Company to any of its Subsidiaries or other
Affiliates, (y) any trade payables or (z) any Indebtedness that is incurred in
violation of this Indenture.

          A distribution may consist of cash, securities or other property, by
set-off or otherwise.

Section 10.03.  Liquidation; Dissolution; Bankruptcy.

          Upon any distribution to creditors of the Company in a liquidation or
dissolution of the Company or in a bankruptcy, reorganization, insolvency,
receivership or similar proceeding relating to the Company or its property, an
assignment for the benefit of creditors or any marshalling of the Company's
assets and liabilities, holders of Senior Debt will be entitled to receive
payment in full of all Obligations due in respect of such Senior Debt (including
interest accruing after the commencement of any such proceeding at the rate
specified in the applicable Senior Debt, whether or not allowed or allowable as
a claim in such proceeding) before the Holders will be entitled to receive any
payment with respect to the Securities and until all Obligations with respect to
Senior Debt are paid in full, any distribution to which the Holders would be
entitled shall be made to the holders of Senior

                                       59
<PAGE>
 
Debt (except (a) that Holders may receive securities that (i) are subordinated
to at least the same extent as the Securities to Senior Debt and any securities
issued in exchange for Senior Debt, (ii) are unsecured (except to the extent the
Securities are secured), (iii) are not Guaranteed by any Subsidiary of the
Company (except to the extent the Securities are so Guaranteed), and (iv) have a
Weighted Average Life to Maturity and final maturity that are not shorter than
the Weighted Average Life to Maturity of the Securities or any securities issued
to Holders of Senior Debt under the New Credit Facility pursuant to a plan of
reorganization or readjustment and (b) payments made from the trust described in
Section 8.04).

Section 10.04.  Default on Designated Senior Debt.

          The Company may not make any payment upon or in respect of the
Securities (except in securities that (i) are subordinated to at least the same
extent as the Securities to Senior Debt and any securities issued in exchange
for Senior Debt, (ii) are unsecured (except to the extent the Securities are
secured), (iii) are not Guaranteed by any Subsidiary of the Company (except to
the extent the Securities are so Guaranteed), and (iv) have a Weighted Average
Life to Maturity and final maturity that are not shorter than the Weighted
Average Life to Maturity of the Securities or any securities issued to Holders
of Senior Debt under the New Credit Facility pursuant to a plan of
reorganization or readjustment or from the trust described in Section 8.04) if;

          (i) a default in the payment of the principal of, premium, if any or
     interest on Designated Senior Debt occurs and is continuing beyond any
     applicable period of grace in the agreement, indenture or other document
     governing such Designated Senior Debt; or

          (ii) any other default occurs and is continuing with respect to
     Designated Senior Debt that permits holders of the Designated Senior Debt
     as to which such default relates to accelerate its maturity and the Trustee
     receives a notice of such default (a "Payment Blockage Notice"), for so
     long as any Obligations are outstanding under the New Credit Facility, from
     the Representative thereunder and, thereafter, from the holders or
     Representative of any Designated Senior Debt.  If the Trustee receives any
     such notice, a subsequent notice received within 360 days thereafter shall
     not be effective for purposes of this Section 10.04.  No nonpayment default
     that existed or was continuing on the date of delivery of any such notice
     to the Trustee shall be, or be made, the basis for a subsequent notice.

          The Company may and shall resume payments on the Securities:

          (1) in the case of a payment default, upon the date which the default
     is cured or waived, and

          (2) in the case of a nonpayment default referred to in Section
     10.04(ii) hereof, the earlier of the date on which such nonpayment default
     is cured or waived

                                       60
<PAGE>
 
           or 179 days after the date on which the applicable Payment Blockage
           Notice is received, unless the maturity of any Designated Senior Debt
           has been accelerated.

     Section 10.05.  Acceleration of Securities.

               If payment of the Securities is accelerated because of an Event
     of Default, the Company shall promptly notify holders of Senior Debt of the
     acceleration.

     Section 10.06.  When Distribution Must Be Paid Over.

               In the event that the Trustee or any Holder receives any payment
     of any Obligations with respect to the Securities at a time when the
     Trustee or such Holder, as applicable, has actual knowledge that such
     payment is prohibited by Section 10.04 hereof, such payment shall be held
     by the Trustee or such Securityholder, in trust for the benefit of, and
     shall be paid forthwith over and delivered, upon written request, to, the
     holders of Senior Debt as their interests may appear or their
     Representative under the indenture or other agreement (if any) pursuant to
     which such Senior Debt may have been issued, as their respective interests
     may appear, for application to the payment of all Obligations with respect
     to Senior Debt remaining unpaid to the extent necessary to pay such
     Obligations in full in accordance with their terms, after giving effect to
     any concurrent payment or distribution to or for the holders of Senior
     Debt.

               With respect to the holders of Senior Debt, the Trustee
     undertakes to perform only such obligations on the part of the Trustee as
     are specifically set forth in this Article 10, and no implied covenants or
     obligations with respect to the holders of Senior Debt shall be read into
     this Indenture against the Trustee.  The Trustee shall not be deemed to owe
     any fiduciary duty to the holders of Senior Debt, and shall not be liable
     to any such holders if the Trustee shall pay over or distribute to or on
     behalf of Holders or the Company or any other Person money or assets to
     which any holders of Senior Debt shall be entitled by virtue of this
     Article 10, except if such payment is made as a result of the willful
     misconduct or gross negligence of the Trustee.

     Section 10.07.  Notice by Company.

               The Company shall promptly notify the Trustee and the Paying
     Agent of any facts known to the Company that would cause a payment of any
     Obligations with respect to the Securities to violate this Article, but
     failure to give such notice shall not affect the subordination of the
     Securities to the Senior Debt as provided in this Article.

     Section 10.08.  Subrogation.

               After all Senior Debt is paid in full and until the Securities
     are paid in full, Holders shall be subrogated (equally and ratably with all
     other Indebtedness pari passu with the Securities) to the rights of holders
     of Senior Debt to receive distributions applicable to Senior Debt to the
     extent that distributions otherwise payable to the Holders have been
     applied to the payment of Senior Debt.  A distribution made under this
     Article to holders of

                                       61
<PAGE>
 
Senior Debt that otherwise would have been made to Holders is not, as
between the Company and Holders, a payment by the Company on the Securities.

Section 10.09.  Relative Rights.

          This Article defines the relative rights of Holders and holders of
Senior Debt. Nothing in this Indenture shall:

          (1) impair, as between the Company and Holders, the obligation of the
     Company, which is absolute and unconditional, to pay principal of and
     interest on the Securities in accordance with their terms;

          (2) affect the relative rights of Holders and creditors of the Company
     other than their rights in relation to holders of Senior Debt; or

          (3) prevent the Trustee or any Holder from exercising its available
     remedies upon a Default or Event of Default, subject to the rights of
     holders and owners of Senior Debt to receive distributions and payments
     otherwise payable to Holders.

     If the Company fails because of this Article to pay principal of or
interest on a Security on the due date, the failure is still a Default or Event
of Default.

Section 10.10.  Subordination May Not Be Impaired by Company.

     No right of any holder of Senior Debt to enforce the subordination of the
Indebtedness evidenced by the Securities shall be impaired by any act or failure
to act by the Company or any Holder or by the failure of the Company or any
Holder to comply with this Indenture.

Section 10.11.  Distribution or Notice to Representative.

     Whenever a distribution is to be made or a notice given to holders of
Senior Debt, the distribution may be made and the notice given to their
Representative.

     Upon any payment or distribution of assets of the Company referred to in
this Article 10, the Trustee and the Holders shall be entitled to rely upon any
order or decree made by any court of competent jurisdiction or upon any
certificate of such Representative or of the liquidating trustee or agent or
other Person making any distribution to the Trustee or to the Holders for the
purpose of ascertaining the Persons entitled to participate in such
distribution, the holders of the Senior Debt and other Indebtedness of the
Company, the amount thereof or payable thereon, the amount or amounts paid or
distributed thereon and all other facts pertinent thereto or to this Article 10.

                                       62
<PAGE>
 
Section 10.12.  Rights of Trustee and Paying Agent.

     Notwithstanding the provisions of this Article 10 or any other provision of
this Indenture, the Trustee shall not be charged with knowledge of the existence
of any facts that would prohibit the making of any payment or distribution by
the Trustee, and the Trustee and the Paying Agent may continue to make payments
on the Securities, unless the Trustee shall have received at its Corporate Trust
Office at least five Business Days prior to the date of such payment written
notice of facts that would cause the payment of any Obligations with respect to
the Securities to violate this Article 10.  Only the Company or a Representative
may give the notice.  Nothing in this Article 10 shall impair the claims of, or
payments to, the Trustee under or pursuant to Section 7.07 hereof.

     The Trustee in its individual or any other capacity may hold Senior Debt
with the same rights it would have if it were not Trustee.  Any Agent may do the
same with like rights.

Section 10.13.  Authorization to Effect Subordination.

     Each Holder of a Security by the Holder's acceptance thereof authorizes and
directs the Trustee on the Holder's behalf to take such action as may be
necessary or appropriate to effectuate the subordination as provided in this
Article 10, and appoints the Trustee to act as the Holder's attorney-in-fact for
any and all such purposes.  

Section 10.14.  Amendments.

     The provisions of this Article 10 shall not be amended or modified without
the written consent of the holders of all Senior Debt.

                                   ARTICLE 11
                                 MISCELLANEOUS

Section 11.01.  TIA Controls.

     If any provision of this Indenture limits, qualifies or conflicts with the
duties imposed by TIA (S)318(c), the imposed duties shall control.

Section 11.02.  Notices.

     Any notice or communication by the Company or the Trustee to the other is
duly given if in writing and delivered in person or mailed by first class mail
(registered or certified, return receipt requested), telex, telecopier or
overnight air courier guaranteeing next day delivery, to the other's address:

                                       63
<PAGE>
 
     If to the Company:

     National Medical Enterprises, Inc.
     2700 Colorado Avenue
     Santa Monica, California  90404
     Telecopier No.:  (310) 998-______
     Attention:  Treasurer

     With a copy to:

     Skadden, Arps, Slate, Meagher & Flom
     300 South Grand Avenue, Suite 3400
     Los Angeles, California  90071
     Telecopier No.:  (213) 687-5600
     Attention:  Thomas C. Janson, Jr.

     If to the Trustee:

     The Bank of New York
     101 Barclay Street, 21 West
     New York, New York  10286
     Telecopier No.: (212) 815-5915
     Attention: Corporate Trust Trustee Administration


     The Company or the Trustee, by notice to the others may designate
additional or different addresses for subsequent notices or communications.

     All notices and communications (other than those sent to Holders) shall be
deemed to have been duly given:  at the time delivered by hand, if personally
delivered; five Business Days after being deposited in the mail, postage
prepaid, if mailed; when answered back, if telexed; when receipt acknowledged,
if telecopied; and the next Business Day after timely delivery to the courier,
if sent by overnight air courier guaranteeing next day delivery.

     Unless otherwise set forth above, any notice or communication to a Holder
shall be mailed by first class mail, certified or registered, return receipt
requested, or by overnight air courier guaranteeing next day delivery to its
address shown on the register kept by the Registrar. Any notice or communication
shall also be so mailed to any Person described in TIA (S) 313(c), to the extent
required by the TIA. Failure to mail a notice or communication to a Holder or
any defect in it shall not affect its sufficiency with respect to other Holders.

     If a notice or communication is mailed in the manner provided above within
the time prescribed, it is duly given, whether or not the addressee receives it.

     If the Company mails a notice or communication to Holders, it shall mail a
copy to the Trustee and each Agent at the same time.

                                       64
<PAGE>
 
Section 11.03.  Communication by Holders with Other Holders.

     Holders may communicate pursuant to TIA (S) 312(b) with other Holders with
respect to their rights under this Indenture or the Securities.  The Company,
the Trustee, the Registrar and anyone else shall have the protection of TIA (S)
312(c).

Section 11.04.  Certificate and Opinion as to Conditions Precedent.

     Upon any request or application by the Company to the Trustee to take any
action under this Indenture, the Company shall furnish to the Trustee:

          (1) an Officers' Certificate (which shall include the statements set
     forth in Section 11.05 hereof) stating that, in the opinion of the signers,
     all conditions precedent and covenants, if any, provided for in this
     Indenture relating to the proposed action have been satisfied; and

          (2) an Opinion of Counsel (which shall include the statements set
     forth in Section 11.05 hereof) stating that, in the opinion of such
     counsel, all such conditions precedent and covenants have been satisfied.

Section 11.05.  Statements Required in Certificate or Opinion.

          Each certificate or opinion with respect to compliance with a
condition or covenant provided for in this Indenture (other than a certificate
provided pursuant to TIA (S) 314(a)(4)) shall include:

          (1) a statement that the person making such certificate or opinion has
     read such covenant or condition;

          (2) a brief statement as to the nature and scope of the examination or
     investigation upon which the statements or opinions contained in such
     certificate or opinion are based;

          (3) a statement that, in the opinion of such person, he has made such
     examination or investigation as is necessary to enable him to express an
     informed opinion as to whether or not such covenant or condition has been
     satisfied; and

          (4) a statement as to whether or not, in the opinion of such person,
     such condition or covenant has been satisfied; provided, however, that with
     respect to matters of fact, an Opinion of Counsel may rely on an Officers'
     Certificate or certificates of public officials.

                                       65
<PAGE>
 
Section 11.06.  Rules by Trustee and Agents.

     The Trustee may make reasonable rules for action by or at a meeting of
Holders.  The Registrar or Paying Agent may make reasonable rules and set
reasonable requirements for its functions.

Section 11.07.  Legal Holidays.

     A "Legal Holiday" is a Saturday, a Sunday or a day on which banking
institutions in The City of New York or at a place of payment are authorized or
obligated by law, regulation or executive order to remain closed.  If a payment
date is a Legal Holiday at a place of payment, payment may be made at that place
on the next succeeding day that is not a Legal Holiday, and no interest shall
accrue for the intervening period.

Section 11.08. No Personal Liability of Directors, Officers, Employees and
               Stockholders

     No director, officer, employee, incorporator or stockholder of the Company,
as such, shall have any liability for any obligations of the Company under the
Securities, the Indenture or for any claim based on, in respect of, or by reason
of, such obligations or their creation.  Each Holder of the Securities by
accepting a Security waives and releases all such liability.  The waiver and
release are part of the consideration for issuance of the Securities.  Such
waiver may not be effective to waive liabilities under the federal securities
laws and it is the view of the Commission that such a waiver is against public
policy.

Section 11.09. Duplicate Originals.

     The parties may sign any number of copies of this Indenture.  One signed
copy is enough to prove this Indenture.

Section 11.10. Governing Law.

     The internal law of the State of New York shall govern and be used to
construe this Indenture and the Securities, without regard to the conflict of
laws provisions thereof.

Section 11.11. No Adverse Interpretation of Other Agreements.

     This Indenture may not be used to interpret another indenture, loan or debt
agreement of the Company or its Subsidiaries.  Any such indenture, loan or debt
agreement may not be used to interpret this Indenture.

Section 11.12. Successors.

     All agreements of the Company in this Indenture and the Securities shall
bind its successors.  All agreements of the Trustee in this Indenture shall bind
its successor.

                                       66
<PAGE>
 
Section 11.13.  Severability.

     In case any provision in this Indenture or in the Securities shall be
invalid, illegal or unenforceable, the validity, legality and enforceability of
the remaining provisions shall not in any way be affected or impaired thereby,
it being intended that all of the provisions hereof shall be enforceable to the
full extent permitted by law.

Section 11.14. Counterpart Originals.

     The parties may sign any number of copies of this Indenture.  Each signed
copy shall be an original, but all of them together represent the same
agreement.

Section 11.15. Table of Contents, Headings, etc.

     The Table of Contents, Cross-Reference Table and Headings of the Articles
and Sections of this Indenture have been inserted for convenience of reference
only, are not to be considered a part of this Indenture and shall in no way
modify or restrict any of the terms or provisions hereof.

                                       67
<PAGE>
 
                                   SIGNATURES



Dated as of                           NATIONAL MEDICAL ENTERPRISES, INC.
           ---------------------


                                      By:
                                         ---------------------------------------
                                         Name:
                                         Title:
Attest:



- ---------------------------------  (SEAL)


Dated as of                           THE BANK OF NEW YORK, as Trustee
            ---------------------


                                      By:
                                          --------------------------------------
                                          Name:
                                          Title:


Attest:


                                   
- ---------------------------------  (SEAL)

                                       68
<PAGE>
 
                                                                       EXHIBIT A
                               (Face of Security)

                         ___% Senior Subordinated Note
                              due March ___, 2005
CUSIP: _______
No.                     $____________

                       NATIONAL MEDICAL ENTERPRISES, INC.


promises to pay to

_________________________________________________________________________

or its registered assigns, the principal sum of

___________________________________

Dollars on September __, 2002.

Interest Payment Dates:  March ___ and September ___, commencing September ___,
1995.

Record Dates:  ___________ and _________ (whether or not a Business Day).
 

NATIONAL MEDICAL ENTERPRISES, INC.

By: _________________________

                                       
<PAGE>

Dated:  __________, 1995
 
(SEAL)
Trustee's Certificate of Authentication:

This is one of the Securities referred
to in the within-mentioned Indenture:


The Bank of New York, as Trustee

By: ___________________________
     Authorized Signatory

                                      A-2
<PAGE>
 
                               (Back of Security)

                         ___% SENIOR SUBORDINATED NOTE
                              due March ___, 2002

     Capitalized terms used herein have the meanings assigned to them in the
Indenture (as defined below) unless otherwise indicated.

     1.  Interest.  National Medical Enterprises, Inc., a Nevada corporation
(the "Company"), promises to pay interest on the principal amount of this
Security at the rate and in the manner specified below.

     The Company shall pay interest in cash on the principal amount of this
Security at the rate per annum of _____%.  The Company will pay interest
semiannually in arrears on March __ and September __ of each year, commencing
September __, 1995, or if any such day is not a Business Day on the next
succeeding Business Day (each an "Interest Payment Date").

     Interest will be computed on the basis of a 360-day year consisting of
twelve 30-day months.  Interest shall accrue from the most recent date to which
interest has been paid or, if no interest has been paid, from the date of the
original issuance of the Securities.  To the extent lawful, the Company shall
pay interest on overdue principal at the rate of 1% per annum in excess of the
interest rate then applicable to the Securities; it shall pay interest on
overdue installments of interest (without regard to any applicable grace
periods) at the same rate to the extent lawful.

     2.  Method of Payment.  The Company will pay interest on the Securities
(except defaulted interest) to the Persons who are registered Holders of
Securities at the close of business on the record date next preceding the
Interest Payment Date, even if such Securities are cancelled after such record
date and on or before such Interest Payment Date.  The Holder hereof must
surrender this Security to a Paying Agent to collect principal payments.  The
Company will pay principal and interest in money of the United States that at
the time of payment is legal tender for payment of public and private debts.
The Company, however, may pay principal, premium, if any, and interest by check
payable in such money.  It may mail an interest check to a Holder's registered
address.  Notwithstanding the foregoing, all payments with respect to Securities
having a principal amount of $10.0 million or more the Holders of which have
given wire transfer instructions, on or before the relevant record date, to the
Paying Agent shall be made by wire transfer of immediately available funds to
the accounts specified by such Holders.

     3.  Paying Agent and Registrar.  Initially, the Trustee will act as Paying
Agent and Registrar.  The Company may change any Paying Agent or Registrar or
co-registrar without prior notice to any Holder.  The Company and any of its
Subsidiaries may act in any such capacity.

                                      A-3
<PAGE>
 
     4.  Indenture.  The Company issued the Securities under an Indenture, dated
as of March ___, 1995 (the "Indenture"), between the Company and the Trustee.
The terms of the Securities include those stated in the Indenture and those made
part of the Indenture by reference to the Trust Indenture Act of 1939, as
amended (15 U.S. Code (S)(S) 77aaa-77bbbb) (the "TIA") as in effect on the date
of the Indenture.  The Securities are subject to all such terms, and Holders are
referred to the Indenture and such act for a statement of such terms.  The terms
of the Indenture shall govern any inconsistencies between the Indenture and the
Securities.  The Securities are unsecured general obligations of the Company.
The Securities are limited to $700,000,000 in aggregate principal amount.

     5.  Optional Redemption. On or after March   , 2000, the Company may redeem
                                                --
all or any portion of the Securities at a redemption price (expressed as a 
percentage of the principal amount thereof), as set forth in the immediately 
succeeding paragraph, plus accrued and unpaid interest, if any, to the 
redemption date.

         The redemption price as a percentage of the principal amount shall be 
as follows, if the Securities are redeemed during the 12-month period beginning 
March    of the following years:
      --

<TABLE> 
<CAPTION>
         Year                              Percentage
         ----                              ----------
         <S>                               <C>
         2000 .........................            %                          
         2001 .........................            %                                                
         2002 .........................            %                                                
         2003 and thereafter ..........     100.000%
</TABLE>                                                 
                                             
     6.  Mandatory Redemption.  Subject to the Company's obligation to make an
offer to repurchase Securities under certain circumstances pursuant to Sections
4.10 and 4.13 of the Indenture (as described in paragraph 7 below), the Company
shall have no mandatory redemption or sinking fund obligations with respect to
the Securities.

     7.  Repurchase at Option of Holder.  (i)  If there is a Change of Control
Triggering Event, the Company shall be required to offer to repurchase on the
Change of Control Payment Date all outstanding Securities at 101% of the
aggregate principal amount thereof, plus accrued and unpaid interest to the
Change of Control Payment Date.  Holders that are subject to an offer to
purchase will receive a Change of Control Offer from the Company prior to any
related Change of Control Payment Date and may elect to have such Securities
purchased by completing the form entitled "Option of Holder to Elect Purchase"
appearing below.

     (ii) If the Company or a Subsidiary consummates an Asset Sale, within 465
days after the receipt of any Net Proceeds from such Asset Sale, the Company may
elect to apply the Net Proceeds therefrom (a) to purchase one or more Hospitals
or Related Businesses and/or a controlling interest in the Capital Stock of a
Person owning one or more Hospitals and/or one or more Related Businesses, (b)
to make a capital expenditure or to acquire other tangible assets, in each case,
that are used or useful in any business in which the Company is permitted to be
engaged pursuant to Section 4.15 of the Indenture, (c) to permanently reduce
Senior Term Debt or Existing Indebtedness of a Subsidiary, (d) to permanently
reduce Senior Revolving Debt (and to correspondingly reduce commitments with
respect thereto), except that up to an aggregate of $200.0 million of Net
Proceeds from Asset Sales may be applied after the date of the Senior Note
Indenture to reduce Senior Revolving Debt without a corresponding reduction in
commitments with respect thereto or (e) to repurchase Senior Notes or redeem or
repurchase other Senior Debt. Pending the final application of any such Net
Proceeds, the Company may temporarily reduce Senior Revolving Debt or otherwise
invest such Net Proceeds in any manner that is not prohibited by the Indenture.
Any Net Proceeds from any Asset Sale that are not so invested or applied shall
be deemed to constitute "Excess Proceeds." When the aggregate amount of Excess
Proceeds that have not been so invested or applied in accordance with (a), (b),
(c) or (d) above exceeds $25.0 million, the Company shall be required to make an
offer to all Holders of Securities to purchase the maximum principal amount of
Securities that may be purchased out of the Excess Proceeds, at an offer price
in cash in an amount equal to 100% of the principal amount thereof, plus accrued
and unpaid interest thereon, if any, to the date of

                                      A-4
<PAGE>
 
purchase in accordance with the terms of the Indenture.  If the aggregate
principal amount of Securities surrendered by Holders thereof exceeds the amount
of Excess Proceeds, the Securities shall be selected on a pro rata basis.
Holders that are the subject of an offer to purchase will receive a Senior
Subordinated Asset Sale Offer from the Company prior to any related purchase
date and may elect to have such Securities purchased by completing the form
entitled "Option of Holder to Elect Purchase" appearing below.

     8.  Subordination.  The Securities are subordinated to Senior Debt (as
defined in the Indenture), which includes any Indebtedness arising under or in
connection with (a) Existing Indebtedness, (b) the New Credit Facility (but only
to the extent permitted under Section 4.09 of the Indenture), and (c) all other
Indebtedness permitted by the Indenture that is not expressly pari passu with or
                                                              ---- -----        
subordinated to the Securities, all Obligations (as defined in the Indenture) of
the Company with respect thereto and all permissible renewals, extensions,
refundings and refinancings thereof, in each case whether outstanding on the
date of the Indenture or thereafter created, incurred or assumed.  To the extent
provided in the Indenture, Senior Debt must be paid, in cash, cash equivalents
or otherwise in a manner satisfactory to the holders of Senior Debt, before the
Securities may be paid.  The Company agrees, and each Holder by accepting a
Security consents and agrees, to the subordination provided in the Indenture and
authorizes the Trustee to give it effect.

     9.  Notice of Redemption.  Notice of redemption shall be mailed at least 30
days but not more than 60 days before the redemption date to each Holder of 
Securities to be redeemed at its registered address. Securities may be redeemed 
in part but only in whole multiples of $1,000, unless all of the Securities held
by a Holder are to be redeemed. On and after the redemption date, interest 
ceases to accrue on Securities or portions of them called for redemption.

     10.  Denominations, Transfer, Exchange.  The Securities are in registered
form without coupons, and in denominations of $1,000 and integral multiples of
$1,000.  The transfer of Securities may be registered and Securities may be
exchanged as provided in the Indenture.  The Registrar and the Trustee may
require a Holder, among other things, to furnish appropriate endorsements and
transfer documents and to pay any taxes and fees required by law or permitted by
the Indenture.  The Registrar need not exchange or register the transfer of any
Securities between a record date and the corresponding Interest Payment Date.

     11.  Persons Deemed Owners.  Prior to due presentment to the Trustee for
registration of the transfer of this Security, the Trustee, any Agent and the
Company may deem and treat the Person in whose name this Security is registered
as its absolute owner for the purpose of receiving payment of principal of,
premium, if any, and interest on this Security and for all other purposes
whatsoever, whether or not this Security is overdue, and neither the Trustee,
any Agent nor the Company shall be affected by notice to the contrary.  The
registered Holder of a Security shall be treated as its owner for all purposes.

     12.  Amendment, Supplement and Waivers.  Except as provided in the next
succeeding paragraphs, the Indenture or the Securities may be amended or
supplemented with the consent of the Holders of at least a majority in principal
amount of the Securities then outstanding (including consents obtained in
connection with a tender offer or exchange offer for Securities) and any
existing default or compliance with any provision of the Indenture or the
Securities may be waived with the consent of the Holders of a majority in
principal amount of the then outstanding Securities (including consents obtained
in connection with a tender offer or exchange offer for Securities).

                                      A-5
<PAGE>
 
     Without the consent of each Holder affected, an amendment or waiver may not
(with respect to any Securities held by a non-consenting Holder of Securities):
(i) reduce the principal amount of Securities whose Holders must consent to an
amendment, supplement or waiver, (ii) reduce the principal of or change the
fixed maturity of any Security or alter the provisions with respect to the
redemption of the Securities (other than provisions relating to covenants in
Sections 4.10 and 4.13 hereof), (iii) reduce the rate of or change the time for
payment of interest on any Security, (iv) waive a Default or Event of Default in
the payment of principal of or premium, if any, or interest on the Securities,
(except a rescission of acceleration of the Securities by the Holders of at
least a majority aggregate principal amount of the Securities and a waiver of
the payment default that resulted from such acceleration), (v) make any Security
payable in money other than that stated in the Securities, (vi) make any change
in the provisions of the Indenture relating to waivers of past Defaults or the
rights of Holders of Securities to receive payments of principal of or premium,
if any, or interest on the Securities, (vii) waive a redemption payment with
respect to any Security (other than a payment required under Section 4.10 or
4.13 of the Indenture or (viii) make any change in the foregoing amendment and
waiver provisions.

     Any amendment to the provisions of Article 10 hereof shall require the 
consent of the Holders of at least 75% in aggregate principal amount of the 
Securities then outstanding if such amendment would adversely affect the rights 
of the Holders of the Securities.

     Notwithstanding the foregoing, without the consent of any Holder of
Securities, the Company and the Trustee may amend or supplement the Indenture or
the Securities to cure any ambiguity, defect or inconsistency, to provide for
uncertificated Securities in addition to or in place of certificated Securities,
to provide for any supplemental indenture required pursuant to Section 4.16 of
the Indenture, to provide for the assumption of the Company's obligations to
Holders of the Securities in the case of a merger, consolidation or sale of
assets, to make any change that would provide any additional rights or benefits
to the Holders of the Securities or that does not adversely affect the legal
rights under the Indenture of any such Holder, or to comply with requirements of
the Securities and Exchange Commission (the "Commission") in order to effect or
maintain the qualification of the Indenture under the TIA.

     13.  Defaults and Remedies.  Events of Default under the Indenture include:
(i) a default for 30 days in the payment when due of interest on the Securities;
(ii) a default in payment when due of principal of or premium, if any, on the
Securities, at maturity, upon redemption or otherwise; (iii) a failure by the
Company to comply with the provisions described under the covenants "Limitations
on Restricted Payments," "Limitations on Incurrence of Indebtedness and Issuance
of Preferred Stock," "Asset Sales," and "Change of Control;" (iv) a failure by
the Company for 60 days after notice to comply with any of its other agreements
in the Indenture or the Securities; (v) any default that occurs under any
mortgage, indenture or instrument under which there may be issued or by which
there may be secured or evidenced any Indebtedness for money borrowed by the
Company or any of its Significant Subsidiaries (or the payment of which is
Guaranteed by the Company or any of its Significant Subsidiaries) whether such
Indebtedness or Guarantee exists on the date hereof, or is created after the
date hereof, which default (a) constitutes a failure to pay principal at final 
maturity or (b) results in the acceleration of such Indebtedness prior to its
express maturity and, in each case, the principal amount of any such
Indebtedness, together with the principal amount of any other such Indebtedness
that has not been paid at final maturity or that has been so accelerated,
aggregates $25.0 million or more; (vi) failure by the Company or any of its
Significant Subsidiaries to pay a final judgment or final judgments aggregating
in excess of $25.0 million entered by a court or courts or competent
jurisdiction against the Company or any of

                                      A-6
<PAGE>
 
its Significant Subsidiaries if such final judgments remain undischarged for a
period (during which execution shall not be effectively stayed) of 60 days after
their entry; and (vii) certain events of bankruptcy or insolvency with respect
to the Company or any of its Significant Subsidiaries. If any Event of Default
occurs and is continuing, the Trustee or the Holders of at least 25% in
aggregate principal amount of the then outstanding Securities by written notice
to the Company and the Trustee, may declare all the Securities to be due and
payable immediately (plus, in the case of an Event of Default that is the result
of willful actions (or inactions) by the Company intended to avoid prohibitions
on, or premiums related to, redemptions of the Securities contained in the
Indenture or the Securities, an amount of premium that would have been
applicable pursuant to the Securities).  Notwithstanding the foregoing, in the
case of an Event of Default arising from certain events of bankruptcy or
insolvency with respect to the Company, all outstanding Securities will become
due and payable without further action or notice.  Holders of the Securities may
not enforce the Indenture or the Securities except as provided in the Indenture.
Subject to certain limitation, Holders of a majority in principal amount of the
then outstanding Securities may direct the Trustee in its exercise of any trust
or power.  The Trustee may withhold from Holders of the Securities notice of any
continuing Default or Event of Default (except a Default or Event of Default
relating to the payment of principal or interest) if it determines that
withholding notice is in such Holders' interest.

     The Holders of a majority in aggregate principal amount of the Securities
then outstanding by notice to the Trustee may on behalf of the Holders of all of
the Securities waive any existing Default or Event of Default and its
consequences under the Indenture except a continuing Default or Event of Default
in the payment of interest or premium on, or the principal of, the Securities.

     The Company is required to deliver to the Trustee annually a statement
regarding compliance with the Indenture, and the Company is required upon
becoming aware of any Default or Event of Default, to deliver to the Trustee a
statement specifying such Default or Event of Default.

     The above description of Events of Default and remedies is qualified by
reference, and subject in its entirety, to the more complete description thereof
contained in the Indenture.

     14.  Restrictive Covenants.  The Indenture imposes certain limitations on
the ability of the Company and its Subsidiaries to incur additional indebtedness
and issue preferred stock, pay dividends or make other distributions, repurchase
Equity Interests or subordinated indebtedness, create certain liens, enter into
certain transactions with affiliates, sell assets of the Company or its
Subsidiaries, issue or sell Equity Interests of the Company's Subsidiaries,
issue Guarantees of Indebtedness by the Company's Subsidiaries and enter into
certain mergers and consolidations.

     15.  Trustee Dealings with Company.  The Trustee under the Indenture, in
its individual or any other capacity, may make loans to, accept deposits from,
and perform

                                      A-7
<PAGE>
 
services for the Company or its Affiliates, and may otherwise deal with the
Company or its Affiliates, as if it were not Trustee.

     16.  No Personal Liability of Directors, Officers, Employees and
Stockholders.  No director, officer, employee, incorporator or stockholder of
the Company, as such, shall have any liability for any obligations of the
Company under the Securities, the Indenture or for any claim based on, in
respect of, or by reason of, such obligations or their creation.  Each Holder by
accepting a Security waives and releases all such liability.  The waiver and
release are part of the consideration for the issuance of the Securities.  Such
waiver may not be effective to waive liabilities under the federal securities
laws and it is the view of the Commission that such a waiver is against public
policy.

     17.  Authentication.  This Security shall not be valid until authenticated
by the manual signature of the Trustee or an authenticating agent.

     18.  Abbreviations.  Customary abbreviations may be used in the name of a
Holder or an assignee, such as:  TEN COM (= tenants in common), TEN ENT (=
tenants by the entireties), JT TEN (= joint tenants with right of survivorship
and not as tenants in common), CUST (= Custodian), and U/G/M/A (= Uniform Gifts
to Minors Act).

     19.  CUSIP Numbers.  Pursuant to a recommendation promulgated by the
Committee on Uniform Security Identification Procedures, the Company has caused
CUSIP numbers to be printed on the Securities and has directed the Trustee to
use CUSIP numbers as a convenience to Holders.  No representation is made as to
the accuracy of such numbers either as printed on the Securities and reliance
may be placed only on the other identification numbers placed thereon.

                                      A-8
<PAGE>
 
     The Company will furnish to any Holder upon written request and without
charge a copy of the Indenture.  Request may be made to:

     National Medical Enterprises, Inc.
     2700 Colorado Avenue
     Santa Monica, California  90404
     Attention:  Treasurer

                                      A-9
<PAGE>
 
                                ASSIGNMENT FORM


     To assign this Security, fill in the form below:  (I) or (we) assign and
transfer this Security to

________________________________________________________________________________
                 (Insert assignee's soc. sec. or tax I.D. no.)

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________
                                        
             (Print or type assignee's name, address and zip code)

and irrevocably appoint ________________________________________________________
agent to transfer this Security on the books of the Company.  The agent may
substitute another to act for him.

________________________________________________________________________________

Date:  ______________

                              Your Signature: __________________________________

  
     (Sign exactly as your name appears on the face of this Security)

Signature Guarantee.*



__________

*Participant in a recognized Signature Guarantee Medallion Program (or other
signature guarantor acceptable to the Trustee).

                                     A-10
<PAGE>
 
                       OPTION OF HOLDER TO ELECT PURCHASE


     If you want to elect to have all or any part of this Security purchased by
the Company pursuant to Section 4.10 or Section 4.13 of the Indenture, check the
appropriate box:

     [_] Section 4.10                              [_] Section 4.13
         (Asset Sale)                                  (Change of Control)

     If you want to have only part of the Security purchased by the Company
pursuant to Section 4.10 or Section 4.13 of the Indenture, state the amount you
elect to have purchased:

$ _______________


Date:____________


                              Your Signature:________________________________
              (Sign exactly as your name appears on the face of this Security)

Signature Guarantee.*



__________

*Participant in a recognized Signature Guarantee Medallion Program (or other
signature guarantor acceptable to the Trustee).

                                     A-11

<PAGE>
 
                               February 13, 1995



National Medical Enterprises, Inc.
2700 Colorado Avenue
Santa Monica, California  90404

          Re:  National Medical Enterprises, Inc.
               Registration Statement No. 33-57057
               -----------------------------------


Ladies and Gentlemen:

          I am the General Counsel of National Medical Enterprises, Inc. (the
"Company"), and have acted as counsel to the Company in connection with the
preparation of the above-referenced Registration Statement on Form S-3, filed by
the Company with the Securities and Exchange Commission (the "Commission") on
December 23, 1994 under the Securities Act of 1933, as amended (the "Act"),
Amendment No. 1 thereto, filed with the Commission on January 31, 1995 and
Amendment No. 2 thereto, filed with the Commission on February 13, 1995,
including information deemed to be a part of the Registration Statement at the
time of effectiveness pursuant to Rule 430A of the General Rules and Regulations
under the Act (such Registration Statement, as so amended, being hereinafter
referred to the "Registration Statement").  The Registration Statement relates
to the registration under the Act of $300,000,000 principal amount of Senior
Notes due 2002 (the "Senior Notes") and $700,000,000 principal amount of Senior
Subordinated Notes due 2005 (the "Senior Subordinated Notes") (collectively, the
"Debt Securities") to be issued by the Company.

          The Debt Securities are to be sold pursuant to an underwriting
agreement to be entered into among the Company and the underwriters named
therein (the "Underwriting Agreement").  The Senior Notes will be issued
pursuant to an Indenture (the "Senior Note Indenture") between the Company and
The Bank of New York, as Trustee. The Senior Subordinated Notes will be issued
pursuant to an Indenture (the "Senior Subordinated Note Indenture"

<PAGE>
 
and, together with the Senior Note Indenture, the "Indentures") between the
Company and The Bank of New York, as Trustee.  The terms of the Debt Securities
include those stated in the Indentures and those made part of the Indentures by
reference to the Trust Indenture Act of 1939, as amended.

          This opinion is delivered in accordance with the requirements of Item
601(b)(5) of Regulation S-K under the 1933 Act.

          In connection with this opinion, I have examined and am familiar with
originals or copies, certified or otherwise identified to my satisfaction, of
such records of the Company and all such agreements, certificates of public
officials, certificates of officers or other representatives of the Company and
others and such other documents, certificates and records as I have deemed
necessary or appropriate as a basis for the opinions set forth herein,
including, without limitation, (i) the Registration Statement (together with the
form of preliminary prospectus forming a part thereof), (ii) the Restated
Articles of Incorporation and Restated By-laws of the Company, as amended to
date, (iii) copies of certain resolutions adopted by the Board of Directors of
the Company relating to the filing of the Registration Statement and any
amendments or supplements thereto, the proposed issuance of the Debt Securities
and related matters, (iv) the form of Underwriting Agreement and (v) forms of
the Indentures.  In my examination, I have assumed the genuineness of all
signatures, the legal capacity of natural persons, the authenticity of all
documents submitted to me as originals, the conformity to original documents of
all documents submitted to me as certified, conformed or photostatic copies and
the authenticity of the originals of such copies.  As to any facts material to
the opinions expressed herein which I have not independently established or
verified, I have relied upon statements and representations of officers and
other representatives of the Company and others.

          I am a member of the California Bar and for purposes of this opinion
do not express any opinion as to the laws of any jurisdiction other than
California and the General Corporation Law of the State of Nevada.

                                       2
<PAGE>

National Medical Enterprises, Inc.
Page 3
 
          Based on and subject to the foregoing, I am of the opinion that the
Debt Securities will be, when issued and sold in accordance with the
Registration Statement and the respective Indenture, valid and binding
obligations of the Company, enforceable against the Company in accordance with
their terms, except that the enforcement of such obligations may be limited by
(i) applicable bankruptcy, insolvency, reorganization, moratorium, fraudulent
conveyance or similar laws affecting the enforcement of creditors' rights
generally, and (ii) general principles of equity (regardless of whether such
enforceability is considered in a proceeding in equity or at law).

          This opinion is furnished to you solely for your benefit in connection
with the filing of the Registration Statement and is not to be used, circulated,
quoted or otherwise referred to for any other purpose without my prior written
consent.  I hereby consent to the filing of this opinion with the Commission as
Exhibit 5 to the Registration Statement.  I also consent to the reference to me
under the heading "Legal Matters" in the Registration Statement.  In giving this
consent, I do not thereby admit that I am included in the category of persons
whose consent is required under Section 7 of the 1933 Act or the rules and
regulations of the Commission promulgated thereunder.  This opinion is expressed
as of the date hereof unless otherwise expressly stated and I disclaim any
undertaking to advise you of any subsequent changes of the facts stated or
assumed herein or any subsequent changes in applicable law.

                                                 Very truly yours,



                                                 Scott M. Brown

                                       3

<PAGE>
 
                                                                    EXHIBIT 23.4
 
                                    CONSENT
 
  I hereby consent to the reference to me under the caption "Management--
Executive Officers and Directors" in the Registration Statement on Form S-3
(File No. 33-57057) of National Medical Enterprises, Inc. and in the Prospectus
forming a part of the Registration Statement relating to the public offering of
debt securities by NME.
 
Date: January 30, 1995                            /s/  Robert O' Leary
                                          _____________________________________
                                                       Robert O' Leary


<PAGE>
                                                                 CONFORMED COPY 

================================================================================


                                    FORM T-1

                       SECURITIES AND EXCHANGE COMMISSION
                            Washington, D.C.  20549

                            STATEMENT OF ELIGIBILITY
                   UNDER THE TRUST INDENTURE ACT OF 1939 OF A
                    CORPORATION DESIGNATED TO ACT AS TRUSTEE

                      CHECK IF AN APPLICATION TO DETERMINE
                      ELIGIBILITY OF A TRUSTEE PURSUANT TO
                        SECTION 305(b)(2)           |__|

                             ----------------------

                              THE BANK OF NEW YORK
              (Exact name of trustee as specified in its charter)


New York                                                13-5160382
(State of incorporation                                 (I.R.S. employer
if not a U.S. national bank)                            identification no.)

48 Wall Street, New York, N.Y.                          10286
(Address of principal executive offices)                (Zip code)


                             ----------------------


                       NATIONAL MEDICAL ENTERPRISES, INC.
              (Exact name of obligor as specified in its charter)


Nevada                                                 95-2557091
(State or other jurisdiction of                        (I.R.S. employer
incorporation or organization)                         identification no.)


2700 Colorado Avenue
Santa Monica, California                               90404
(Address of principal executive offices)               (Zip code)


                             ______________________

                            % Senior Notes due 2002
                      (Title of the indenture securities)


================================================================================
<PAGE>
 
1.   GENERAL INFORMATION.  FURNISH THE FOLLOWING INFORMATION AS TO THE TRUSTEE:

     (A) NAME AND ADDRESS OF EACH EXAMINING OR SUPERVISING AUTHORITY TO WHICH IT
         IS SUBJECT.

- --------------------------------------------------------------------------------
          Name                                        Address
- --------------------------------------------------------------------------------

     Superintendent of Banks of the State of       2 Rector Street, New York,
     New York                                      N.Y.  10006, and Albany, N.Y.
                                                   12203

     Federal Reserve Bank of New York              33 Liberty Plaza, New York,
                                                   N.Y.  10045

     Federal Deposit Insurance Corporation         Washington, D.C.  20429

     New York Clearing House Association           New York, New York

     (B) WHETHER IT IS AUTHORIZED TO EXERCISE CORPORATE TRUST POWERS.

     Yes.

2.   AFFILIATIONS WITH OBLIGOR.

     IF THE OBLIGOR IS AN AFFILIATE OF THE TRUSTEE, DESCRIBE EACH SUCH
     AFFILIATION.

     None.  (See Note on page 3.)

16.  LIST OF EXHIBITS.

     EXHIBITS IDENTIFIED IN PARENTHESES BELOW, ON FILE WITH THE COMMISSION,
     ARE INCORPORATED HEREIN BY REFERENCE AS AN EXHIBIT HERETO, PURSUANT TO
     RULE 7A-29 UNDER THE TRUST INDENTURE ACT OF 1939 (THE "ACT") AND RULE 24 OF
     THE COMMISSION'S RULES OF PRACTICE.

     1.   A copy of the Organization Certificate of The Bank of New York
          (formerly Irving Trust Company) as now in effect, which contains the
          authority to commence business and a grant of powers to exercise
          corporate trust powers. (Exhibit 1 to Amendment No. 1 to Form T-1
          filed with Registration Statement No. 33-6215, Exhibits 1a and 1b to
          Form T-1 filed with Registration Statement No. 33-21672 and Exhibit 1
          to Form T-1 filed with Registration Statement No. 33-29637.)

     4.   A copy of the existing By-laws of the Trustee.  (Exhibit 4 to Form T-1
          filed with Registration Statement No. 33-31019.)

                                      -2-
<PAGE>
 
     6.   The consent of the Trustee required by Section 321(b) of the Act.
          (Exhibit 6 to Form T-1 filed with Registration Statement
          No. 33-44051.)

     7.   A copy of the latest report of condition of the Trustee published
          pursuant to law or to the requirements of its supervising or
          examining authority.



                                      NOTE


     Inasmuch as this Form T-1 is filed prior to the ascertainment by the
Trustee of all facts on which to base a responsive answer to Item 2, the answer
to said Item is based on incomplete information.

     Item 2 may, however, be considered as correct unless amended by an
amendment to this Form T-1.

                                      -3-
<PAGE>
 
                                   SIGNATURE



     Pursuant to the requirements of the Act, the Trustee, The Bank of New York,
a corporation organized and existing under the laws of the State of New York,
has duly caused this statement of eligibility to be signed on its behalf by the
undersigned, thereunto duly authorized, all in The City of New York, and State
of New York, on the 8th day of February, 1995.


                                         THE BANK OF NEW YORK



                                         By: /s/ WALTER N. GITLIN
                                             ___________________________
                                           Name:  WALTER N. GITLIN
                                           Title: VICE PRESIDENT

                                      -4-
<PAGE>
 
- --------------------------------------------------------------------------------

                      Consolidated Report of Condition of

                              THE BANK OF NEW YORK

                    of 48 Wall Street, New York, N.Y. 10286
                     And Foreign and Domestic Subsidiaries,

a member of the Federal Reserve System, at the close of business September 30,
1994, published in accordance with a call made by the Federal Reserve Bank of
this District pursuant to the provisions of the Federal Reserve Act.
<TABLE>
<CAPTION>
 
                                            Dollar Amounts
ASSETS                                       in Thousands
<S>                                         <C>
Cash and balances due from depos-
  itory institutions:
  Noninterest-bearing balances and
  currency and coin......................      $ 2,833,550
  Interest-bearing balances..............          701,828
Securities:
  Held-to-maturity securities............        1,359,569
  Available-for-sale securities..........        1,725,600
Federal funds sold in domestic
  offices of the bank....................        5,350,368
Loans and lease financing
  receivables:
  Loans and leases, net of unearned
    income .................24,252,467
  LESS: Allowance for loan and
    lease losses ..............629,631
  LESS: Allocated transfer risk
   reserve .....................30,661
  Loans and leases, net of unearned
    income, allowance, and reserve              23,592,175
Assets held in trading accounts..........        1,354,396
Premises and fixed assets (including
  capitalized leases)....................          629,219
Other real estate owned..................           51,372
Investments in unconsolidated
  subsidiaries and associated
  companies..............................          178,742
Customers' liability to this bank on
  acceptances outstanding................          996,184
Intangible assets........................           76,599
Other assets.............................        1,498,770
                                               -----------
Total assets.............................      $40,348,372
                                               ===========
 
LIABILITIES
Deposits:
  In domestic offices....................      $19,692,982
  Noninterest-bearing .......8,179,472
  Interest-bearing .........11,513,510
  In foreign offices, Edge and
  Agreement subsidiaries, and IBFs.......       10,034,789
  Noninterest-bearing ..........57,902
  Interest-bearing ..........9,976,887
Federal funds purchased and secu-
  rities sold under agreements to re-
  purchase in domestic offices of
  the bank and of its Edge and
  Agreement subsidiaries, and in
  IBFs:
  Federal funds purchased...............         1,240,870
  Securities sold under agreements
    to repurchase.......................            37,612
Demand notes issued to the U.S.
  Treasury..............................           197,519
Trading liabilities.....................           975,739
Other borrowed money:
  With original maturity of one year
    or less.............................         1,621,466
  With original maturity of more than
    one year............................            33,955
Bank's liability on acceptances exe-
  cuted and outstanding.................           997,024
Subordinated notes and debentures.......         1,062,320
Other liabilities.......................         1,450,981
                                                ----------
Total liabilities.......................        37,345,257
                                                ==========
 
EQUITY CAPITAL
Common stock............................           942,284
Surplus.................................           525,666
Undivided profits and capital
  reserves..............................         1,577,819
Net unrealized holding gains
  (losses) on available-for-sale
  securities............................           (36,779)
Cumulative foreign currency transla-
  tion adjustments......................            (5,875)
                                                ----------
Total equity capital....................         3,003,115
                                                ----------
Total liabilities and equity
</TABLE>
 capital ...........................           $40,348,372
                                               ===========


   I, Robert E. Keilman, Senior Vice President and Comptroller of the above-
named bank do hereby declare that this Report of Condition has been prepared in
conformance with the instructions issued by the Board of Governors of the
Federal Reserve System and is true to the best of my knowledge and belief.

                                                            Robert E. Keilman

   We, the undersigned directors, attest to the correctness of this Report of
Condition and declare that it has been examined by us and to the best of our
knowledge and belief has been prepared in conformance with the instructions
issued by the Board of Governors of the Federal Reserve System and is true and
correct.

             
   Thomas A. Renyi     ]
   J. Carter Bacot     ]     Directors
   Alan R. Griffith    ]
             

- --------------------------------------------------------------------------------

<PAGE>
 
                                                                  CONFORMED COPY
================================================================================


                                    FORM T-1

                       SECURITIES AND EXCHANGE COMMISSION
                            Washington, D.C.  20549

                            STATEMENT OF ELIGIBILITY
                   UNDER THE TRUST INDENTURE ACT OF 1939 OF A
                    CORPORATION DESIGNATED TO ACT AS TRUSTEE

                      CHECK IF AN APPLICATION TO DETERMINE
                      ELIGIBILITY OF A TRUSTEE PURSUANT TO
                        SECTION 305(b)(2)           |__|

                             ----------------------

                              THE BANK OF NEW YORK
              (Exact name of trustee as specified in its charter)


New York                                                13-5160382
(State of incorporation                                 (I.R.S. employer
if not a U.S. national bank)                            identification no.)

48 Wall Street, New York, N.Y.                          10286
(Address of principal executive offices)                (Zip code)


                             ----------------------


                       NATIONAL MEDICAL ENTERPRISES, INC.
              (Exact name of obligor as specified in its charter)


Nevada                                                    95-2557091
(State or other jurisdiction of                           (I.R.S. employer
incorporation or organization)                            identification no.)


2700 Colorado Avenue
Santa Monica, California                                  90404
(Address of principal executive offices)                  (Zip code)

                             ______________________

                      % Senior Subordinated Notes due 2005
                      (Title of the indenture securities)


================================================================================

                                       
<PAGE>
 
1.   GENERAL INFORMATION.  FURNISH THE FOLLOWING INFORMATION AS TO THE TRUSTEE:

     (A) NAME AND ADDRESS OF EACH EXAMINING OR SUPERVISING AUTHORITY TO WHICH IT
         IS SUBJECT.

- --------------------------------------------------------------------------------
          Name                                        Address
- --------------------------------------------------------------------------------

     Superintendent of Banks of the State of       2 Rector Street, New York,
     New York                                      N.Y.  10006, and Albany, N.Y.
                                                   12203

     Federal Reserve Bank of New York              33 Liberty Plaza, New York,
                                                   N.Y.  10045

     Federal Deposit Insurance Corporation         Washington, D.C.  20429

     New York Clearing House Association           New York, New York

     (B) WHETHER IT IS AUTHORIZED TO EXERCISE CORPORATE TRUST POWERS.

     Yes.

2.   AFFILIATIONS WITH OBLIGOR.

     IF THE OBLIGOR IS AN AFFILIATE OF THE TRUSTEE, DESCRIBE EACH SUCH
     AFFILIATION.

     None.  (See Note on page 3.)

16.  LIST OF EXHIBITS.

     EXHIBITS IDENTIFIED IN PARENTHESES BELOW, ON FILE WITH THE COMMISSION, ARE
     INCORPORATED HEREIN BY REFERENCE AS AN EXHIBIT HERETO, PURSUANT TO RULE
     7a-29 UNDER THE TRUST INDENTURE ACT OF 1939 (THE "ACT") AND RULE 24 OF THE
     COMMISSION'S RULES OF PRACTICE.

     1.   A copy of the Organization Certificate of The Bank of New York
          (formerly Irving Trust Company) as now in effect, which contains the
          authority to commence business and a grant of powers to exercise
          corporate trust powers. (Exhibit 1 to Amendment No. 1 to Form T-1
          filed with Registration Statement No. 33-6215, Exhibits 1a and 1b to
          Form T-1 filed with Registration Statement No. 33-21672 and Exhibit 1
          to Form T-1 filed with Registration Statement No. 33-29637.)

     4.   A copy of the existing By-laws of the Trustee.  (Exhibit 4 to Form T-1
          filed with Registration Statement No. 33-31019.)

                                       2
<PAGE>
 
     6.   The consent of the Trustee required by Section 321(b) of the Act.
          (Exhibit 6 to Form T-1 filed with Registration Statement No.
          33-44051.)

     7.   A copy of the latest report of condition of the Trustee published 
          pursuant to law or to the requirements of its supervising or examining
          authority.
 


                                      NOTE


     Inasmuch as this Form T-1 is filed prior to the ascertainment by the
Trustee of all facts on which to base a responsive answer to Item 2, the answer
to said Item is based on incomplete information.

     Item 2 may, however, be considered as correct unless amended by an
amendment to this Form T-1.

                                       3
<PAGE>
 
                                   SIGNATURE



     Pursuant to the requirements of the Act, the Trustee, The Bank of New York,
a corporation organized and existing under the laws of the State of New York,
has duly caused this statement of eligibility to be signed on its behalf by the
undersigned, thereunto duly authorized, all in The City of New York, and State
of New York, on the 8th day of February, 1995.


                                         THE BANK OF NEW YORK



                                         By:   /s/  LLOYD A. MCKENZIE
                                            -----------------------------------
                                           Name:    LLOYD A. MCKENZIE
                                           Title:   ASSISTANT VICE PRESIDENT

                                       4
<PAGE>
 
- --------------------------------------------------------------------------------

                      Consolidated Report of Condition of

                              THE BANK OF NEW YORK

                    of 48 Wall Street, New York, N.Y. 10286
                     And Foreign and Domestic Subsidiaries,

a member of the Federal Reserve System, at the close of business September 30,
1994, published in accordance with a call made by the Federal Reserve Bank of
this District pursuant to the provisions of the Federal Reserve Act.
 
                                            Dollar Amounts
ASSETS                                       in Thousands

Cash and balances due from depos-
  itory institutions:
  Noninterest-bearing balances and
  currency and coin......................      $ 2,833,550
  Interest-bearing balances..............          701,828
Securities:
  Held-to-maturity securities............        1,359,569
  Available-for-sale securities..........        1,725,600
Federal funds sold in domestic
  offices of the bank....................        5,350,368
Loans and lease financing
  receivables:
  Loans and leases, net of 
    unearned income..........  24,252,467
  LESS: Allowance for loan 
    and lease losses.........     629,631
  LESS: Allocated transfer 
    risk reserve.............      30,661
  Loans and leases, net of unearned
    income, allowance, and reserve              23,592,175
Assets held in trading accounts..........        1,354,396
Premises and fixed assets (including
  capitalized leases)....................          629,219
Other real estate owned..................           51,372
Investments in unconsolidated
  subsidiaries and associated
  companies..............................          178,742
Customers' liability to this bank on
  acceptances outstanding................          996,184
Intangible assets........................           76,599
Other assets.............................        1,498,770
                                               -----------
Total assets.............................      $40,348,372
                                               ===========
 
LIABILITIES
Deposits:
  In domestic offices....................      $19,692,982
  Noninterest-bearing .......   8,179,472
  Interest-bearing ..........  11,513,510
  In foreign offices, Edge and
  Agreement subsidiaries, and IBFs.......       10,034,789
  Noninterest-bearing .......      57,902
 Interest-bearing ..........    9,976,887
Federal funds purchased and securities 
sold under agreements to repurchase in 
domestic offices of the bank and of its 
Edge and Agreement subsidiaries, and in
  IBFs:
  Federal funds purchased...............         1,240,870
  Securities sold under agreements
    to repurchase.......................            37,612
Demand notes issued to the U.S.
  Treasury..............................           197,519
Trading liabilities.....................           975,739
Other borrowed money:
  With original maturity of one year
    or less.............................         1,621,466
  With original maturity of more than
    one year............................            33,955
Bank's liability on acceptances exe-
  cuted and outstanding.................           997,024
Subordinated notes and debentures.......         1,062,320
Other liabilities.......................         1,450,981
                                                ----------
Total liabilities.......................        37,345,257
                                                ==========
 
EQUITY CAPITAL
Common stock............................           942,284
Surplus.................................           525,666
Undivided profits and capital
  reserves..............................         1,577,819
Net unrealized holding gains
  (losses) on available-for-sale
  securities............................           (36,779)
Cumulative foreign currency transla-
  tion adjustments......................            (5,875)
                                                ----------
Total equity capital....................         3,003,115
                                                ----------
Total liabilities and equity
  capital...............................       $40,348,372
                                               ===========

   I, Robert E. Keilman, Senior Vice President and Comptroller of the above-
named bank do hereby declare that this Report of Condition has been prepared in
conformance with the instructions issued by the Board of Governors of the
Federal Reserve System and is true to the best of my knowledge and belief.

                                                            Robert E. Keilman

   We, the undersigned directors, attest to the correctness of this Report of
Condition and declare that it has been examined by us and to the best of our
knowledge and belief has been prepared in conformance with the instructions
issued by the Board of Governors of the Federal Reserve System and is true and
correct.

             
   Thomas A. Renyi     ]
   J. Carter Bacot     ]     Directors
   Alan R. Griffith    ]

- --------------------------------------------------------------------------------


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