INTEGRATED HEALTH SERVICES INC
10-Q, 1996-05-15
SKILLED NURSING CARE FACILITIES
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<PAGE>

                                  UNITED STATES

                       SECURITIES AND EXCHANGE COMMISSION

                             Washington, D.C. 20549


                                    FORM 10-Q



[X]  Quarterly Report Pursuant to Section 13 or 15(d) of the Securities
Exchange Act of 1934

For the period ended          March 31, 1996
                     ----------------------------------  

                                       or

[ ]  Transition Report Pursuant to Section 13 or 15(d) of the
Securities Exchange Act of 1934

For the transition period from _______________ to ________________

Commission File Number:      1-12306
                         -------------

                        Integrated Health Services, Inc.
          ------------------------------------------------------------
             (Exact name of registrant as specified in its charter)


               DELAWARE                                   23-2428312
   -------------------------------                  --------------------
   (State or other jurisdiction of                   (I.R.S. Employer
    incorporation or organization)                   Identification No.)

  10065 Red Run Boulevard, Owings Mills, MD                 21117
 ------------------------------------------------------------------------
   (Address of principal executive offices)              (Zip Code)

                                 (410) 998-8400
   ----------------------------------------------------------------------
                  (Registrant's telephone, including area code)


Indicate by check mark whether the registrant (1) has filed all reports required
to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during
the  preceding 12 months (or for such  shorter  period that the  registrant  was
required  to file  such  reports),  and  (2) has  been  subject  to such  filing
requirements for the past 90 days.

                          [X] Yes         [ ] No

Number of shares of common stock of the registrant outstanding as of
May 8, 1996: 22,423,264 shares.



<PAGE>

                        INTEGRATED HEALTH SERVICES, INC.
                                      INDEX




PART I.     FINANCIAL INFORMATION
                                                                     Page
                                                                    ------

Item 1.     - Condensed Financial Statements -
           ------------------------------------

            Consolidated Balance Sheets
              March 31, 1996 and December 31, 1995                     3

            Consolidated Statements of Earnings
              for the three months ended March 31, 1996
              and 1995                                                 4

            Consolidated Statement of Changes in
              Stockholders' Equity for the three
              months ended March 31, 1996                              5

            Consolidated Statements of Cash Flows
              for the three months ended March 31, 1996
              and 1995                                                 6

            Notes to Consolidated Financial Statements                 7

Item 2.     Management's Discussion and Analysis of
              Financial Condition and Results of
              Operations                                               10


PART II:    OTHER INFORMATION

Item 5.     Other Information                                          17

Item 6.     Exhibits and Reports on Form 8-K                           17




                                  Page 2 of 19

<PAGE>
<TABLE>
<CAPTION>

                               INTEGRATED HEALTH SERVICES, INC. AND SUBSIDIARIES
                                          CONSOLIDATED BALANCE SHEETS
                                            (dollars in thousands)
   
                                                                             March 31,       December 31,
                                                                               1996             1995
                                                                          --------------   --------------
<S>                                                                    <C>                      <C>   
  Assets
  ------
Current Assets:
  Cash and cash equivalents                                            $        29,560          38,917
  Temporary investments                                                          2,320           2,387
  Patient accounts and third-party payor settlements
    receivable, less allowance for doubtful receivables
    of $31,093 at March 31, 1996 and $29,570 at December 31, 1995              247,065         230,282
  Supplies, inventories, prepaid expenses
    and other current assets                                                    26,467          25,629
  Income tax receivable                                                         13,567          16,517
                                                                          -------------    ------------
               Total current assets                                            318,979         313,732
                                                                          -------------    ------------

Property, plant and equipment, net                                             790,200         747,870
Intangible assets                                                              311,919         298,290
Other assets                                                                   104,486          73,838
                                                                          -------------    ------------

               Total assets                                            $     1,525,584       1,433,730
                                                                          =============    ============

  Liabilities and Stockholders' Equity                                     
  ------------------------------------
Current Liabilities:
  Current maturities of long-term debt                                 $         5,179           5,404
  Accounts payable and accrued expenses                                        152,972         172,013
                                                                          -------------    ------------
               Total current liabilities                                       158,151         177,417
                                                                          -------------    ------------

Long-term Debt:
  Convertible subordinated debentures                                          258,750         258,750
  Revolving and long-term debt, less current maturities                        593,354         506,507
                                                                          -------------    ------------
               Total long-term debt                                            852,104         765,257
                                                                          -------------    ------------

Deferred income taxes                                                           53,777          52,279
Deferred gain on sale-leaseback transactions                                     6,964           7,249
Stockholders' equity:
  Preferred stock, authorized 15,000,000 shares; no shares
     issued and outstanding                                                          -              -
  Common stock, $0.001 par value.  Authorized 150,000,000
    shares; issued 22,259,520 at March 31, 1996 and 21,785,334 at
    December 31, 1995 (including 400,600 treasury shares)                           22              22
  Additional paid-in capital                                                   419,604         410,345
  Retained earnings                                                             47,752          33,951
  Treasury stock, at cost (400,600 shares at March 31, 1996
     and December 31, 1995)                                                    (12,790)        (12,790)
                                                                          -------------    ------------
               Net stockholders' equity                                        454,588         431,528
                                                                          -------------    ------------

               Total liabilities and stockholders' equity              $     1,525,584       1,433,730
                                                                          =============    ============
</TABLE>

           See accompanying Notes to Consolidated Financial Statements


                                  Page 3 of 19
<PAGE>
               INTEGRATED HEALTH SERVICES, INC. AND SUBSIDIARIES
                      CONSOLIDATED STATEMENTS OF EARNINGS
                (dollars in thousands, except per share amounts)




                                                   Three Months Ended
                                                        March 31,
                                                 --------------------
                                                      1996     1995
                                                 ---------- ---------

Net Revenues:
  Basic medical services                        $   97,216   $ 89,336
  Specialty medical services                       219,525    176,158
  Management services and other                     10,532      9,141
                                                    ------      -----
     Total revenues                                327,273    274,635
                                                   -------    -------

Costs and expenses:
  Operating expenses                               248,973    207,304
  Corporate administrative and general              15,093     12,402
  Depreciation and amortization                      9,196      8,960
  Rent                                              17,656     16,066
  Interest, net                                     14,214      7,330
                                                    ------      -----
     Total costs and expenses                      305,132    252,062
                                                   -------    -------


     Earnings before equity in earnings of 
      affiliates and income taxes                   22,141     22,573

Equity in earnings of affiliates                       300        315
                                                    ------     ------

     Earnings before income taxes                   22,441     22,888

Federal and state income taxes                       8,640      8,812
                                                     -----      -----

     Net earnings                               $   13,801   $ 14,076
                                                    ======     ======

Per Common Share:
  Net earnings - Primary                        $     0.62   $   0.61
  Net earnings - Fully Diluted                        0.54       0.53
                                                    ======     ======



          See accompanying Notes to Consolidated Financial Statements


                                  Page 4 of 19

<PAGE>

               INTEGRATED HEALTH SERVICES, INC. AND SUBSIDIARIES
           CONSOLIDATED STATEMENT OF CHANGES IN STOCKHOLDERS' EQUITY
                             (dollars in thousands)

<TABLE>
<CAPTION>

                                                  Additional
                                          Common   Paid-In     Retained     Treasury
                                          Stock    Capital     Earnings      Stock       Total
                                         ------------------------------------------------------

<S>                                      <C>        <C>          <C>        <C>         <C>    
Balance at December 31, 195              $   22    $410,345     $33,951    $(12,790)   $431,528

Issuance of 385,542 shares of
common stock in connection with
acquisitions                                  -       8,000           -           -       8,000

Issuance of 34,287 shares of common 
stock in connection with employee  
stock purchase plan                           -         771           -           -         771

Exercise of employee stock options
for 54,357 shares of common                   -         488           -           -         488

Net earnings                                  -           -      13,801           -      13,801
                                         ------------------------------------------------------
Balance at March 31, 1996               $    22    $419,604     $47,752   $(12,790)    $454,588
                                         ======================================================
</TABLE>


          See accompanying Notes to Consolidated Financial Statements

                                  Page 5 of 19

<PAGE>
                INTEGRATED HEALTH SERVICES, INC. AND SUBSIDIARIES
                      CONSOLIDATED STATEMENTS OF CASH FLOWS
                             (dollars in thousands)

                                                            Three Months Ended
                                                                  March 31,
                                                             ---------------
                                                             1996       1995
                                                             ----       ----

Cash flows from operating activities:
 Net earnings                                           $   13,801    $14,076
 Adjustments to reconcile net earnings to net
  cash provided (used) by operating activities:
   Undistributed results of joint ventures                     (55)      (192)
   Depreciation and amortization                             9,196      8,960
   Deferred income taxes and other non-cash items            1,142      1,250
   Amortization of gain on sale-leaseback transactions        (285)      (234)
   Increase in patient accounts and third-party
    payor settlements receivable, net                      (15,260)   (18,597)
   Increase in supplies, inventory, prepaid 
    expenses and other current assets                         (788)    (3,629)
   Increase (decrease) in accounts payable and 
     accrued expenses                                      (22,928)     1,015
   Decrease in income taxes receivable                       2,950          -
   Increase in income taxes payable                              -      4,243
                                                            ------     ------ 
    Net cash provided (used) by operating activitie        (12,227)     6,892

Cash flows from financing activities:
 Proceeds from issuance of capital stock, net                1,259      5,584
 Proceeds from long-term borrowings                         96,737     52,054
 Repayment of long-term debt                               (11,286)   (29,636)
 Deferred financing costs                                      (73)      (184)
                                                            ------     ------ 

    Net cash provided by financing activities               86,637     27,818
                                                            ------     ------

Cash flows from investing activities:
 Sale of temporary investments                                  67        311
 Purchase of temporary investments                               -     (3,106)
 Business acquisitions                                     (16,581)   (24,000)
 Purchase of property, plant and equipment                 (34,936)   (24,395)
 Intangible assets                                          (1,947)    (2,400)
 Other assets                                              (30,370)   (18,444)
                                                           -------    ------- 
     
    Net cash used by investing activities                  (83,767)   (72,034)
                                                           -------    ------- 

    Decrease in cash and cash equivalents                   (9,357)   (37,324)

Cash and cash equivalents, beginning of period              38,917     60,689
                                                            ------     ------

Cash and cash equivalents, end of period                $   29,560    $23,365
                                                        ==========     ======

          See accompanying Notes to Consolidated Financial Statements


                                  Page 6 of 19

<PAGE>


                                      NOTES
                                       TO
                        CONSOLIDATED FINANCIAL STATEMENTS


Note 1: Basis of Presentation and Significant Accounting Policies

        The consolidated financial statements included herein do not contain all
        information  and  footnote  disclosures  normally  included in financial
        statements  prepared in accordance  with generally  accepted  accounting
        principles. For further information,  such as the significant accounting
        policies  followed  by  Integrated  Health  Services,   Inc.  ("IHS"  or
        "Company"), refer to the consolidated financial statements and footnotes
        thereto  included in the Company's  Annual Report on Form 10-K/A for the
        year  ended  December  31,  1995.  In the  opinion  of  management,  the
        consolidated  financial  statements  include all  necessary  adjustments
        (consisting of only normal recurring  accruals) for a fair  presentation
        of the  financial  position  and results of  operations  for the interim
        periods  presented.  The results of operations  for the interim  periods
        presented  are not  necessarily  indicative  of the results  that may be
        expected  for  the  full  year.  The  Company's   historical   financial
        statements  for the three months ended March 31, 1995 have been restated
        to include the results of operations  of  IntegraCare,  Inc.,  which the
        Company  merged with in August 1995 in a transaction  accounted for as a
        pooling of interest for accounting and financial reporting purposes.

Note 2:          Earnings Per Share

        Primary  earnings per share is computed  based on the  weighted  average
        number of common and common  equivalent  shares  outstanding  during the
        periods.  Common  stock  equivalents  include  options  and  warrants to
        purchase common stock,  assumed to be exercised using the treasury stock
        method. Fully diluted earnings per share is computed as described above,
        except that the weighted average number of common  equivalent  shares is
        determined  assuming  the  dilution  resulting  from the issuance of the
        aforementioned  options and warrants at the higher of the  end-of-period
        price per share, or the weighted  average price for the period,  and the
        issuance of common shares upon the assumed conversion of the convertible
        subordinated debentures. Additionally, interest expense and amortization
        of underwriting  costs related to such debentures are added, net of tax,
        to income for the purpose of  calculating  fully  diluted  earnings  per
        share.  Such amounts and the  resulting  net earnings for fully  diluted
        earnings  per share  purposes  are  summarized  as follows for the three
        months ended March 31, 1996 and 1995, respectively:

                                  Page 7 of 19


<PAGE>

                                                             1996       1995
                                                             ----       ----

                 Net earnings                               $13,801     14,076

     `           Adjustment for interest and underwriting
                 costs on convertible debentures              2,472      2,472
                                                              -----      -----

                 Net earnings for fully diluted EPS         $16,273     16,548
                                                            =======     ======

                 Weighted average shares-Primary             22,257     23,204
                 Weighted average shares-Fully Diluted       30,317     31,272
                                                             ======     ======

Note 3:          New Acquisitions and Management Contracts

                 In January 1996, the Company  entered into agreements to manage
                 four assisted living facilities in California and Ohio having a
                 total of 234 beds.

                 On January 29, 1996, the Company  purchased Vintage Health Care
                 Center,  a 220 bed skilled nursing and assisted living facility
                 in Denton, Texas for $6.9 million.

                 On March  19,  1996,  the  Company  acquired  Rehab  Management
                 Systems, Inc. ("RMS"),  which operates  rehabilitation  therapy
                 clinics in central  Florida.  RMS also  manages one therapy and
                 one physician  clinic.  Total purchase price was $10.0 million,
                 including  $8.0  million  representing  the issuance of 385,542
                 shares.  In  addition,  the Company  incurred  direct  costs of
                 acquisitions  of $2.9  million.  Total  goodwill at the date of
                 acquisition was $12.7 million.

                 In addition, during the first quarter, the Company acquired two
                 mobile  x-ray   companies.   Total  purchase  price  aggregated
                 approximately  $1.3  million.  Total  goodwill  at the  date of
                 acquisition aggregated $1.2 million.

Note 4:          Proposed New Revolving Credit Facility

                 In  May  1996,  the  Company  accepted  commitments  for a $700
                 million  revolving  credit  facility,  including a $100 million
                 letter  of  credit   subfacility,   from  Citibank,   N.A.,  as
                 Administrative  Agent,  and  certain  other  lenders  (the "New
                 Credit  Facility").  The New  Credit  Facility  will  initially
                 consist of a $700 million  revolving loan which reduces to $560
                 million on June 30,  2000 and $315  million  on June 30,  2001,
                 with a final  maturity  on June  30,  2002.  The  $100  million
                 subcommitment for letters of credit will remain at $100 million
                 until  final   maturity.   The  New  Credit  Facility  will  be
                 guaranteed  by the  Company's  subsidiaries  and  secured  by a
                 pledge  of  all  of  the  stock  of  substantially  all  of the
                 Company's  subsidiaries.  The new credit  facility will replace
                 the  Company's  existing  $500  million  credit  facility.  The
                 Company  expects to record an  extraordinary  loss on the early
                 extinguishment of debt in the second quarter of 1996.

Note 5:          Proposed Divestitures

                 In developing its  post-acute  healthcare  system,  the Company
                 continuously  evaluates whether owning and operating businesses
                 which provide certain ancillary  services,  or contracting with
                 third

                                  Page 8 of 19

<PAGE>
                 parties for such services, is more cost-effective. As a result,
                 the Company is continuously  evaluating its existing operations
                 to   determine   whether   to  retain  or  divest   operations.
                 Accordingly, the Company may divest certain divisions or assets
                 in the future.

Note 6:          Subsequent Events

                 In May 1996, the Company acquired a geriatric care facility for
                 $4.25 million. In addition,  the Company has reached agreements
                 in principle to purchase a hospice company in Chicago, Illinois
                 for  approximately  $8.0  million,  a  home  health  agency  in
                 Memphis,   Tennessee  for  approximately  $2.0  million,   four
                 diagnostic  companies  for  approximately  $20.4 million and an
                 outpatient clinic for approximately $2.3 million.  There can be
                 no assurance  that any of these  pending  acquisitions  will be
                 consummated on the proposed  terms,  on different  terms, or at
                 all.

                 In February  1996,  the Company  entered  into an  agreement to
                 acquire First  American  Health Care of Georgia,  Inc.  ("First
                 American"),  a provider of home  health  services in 23 states,
                 principally Alabama,  California,  Florida, Georgia,  Michigan,
                 Pennsylvania and Tennessee for $150 million, plus an earnout of
                 up to $127.5  million based on the home health care  operations
                 of First American in the years 1999 through 2002. Subsequent to
                 the  execution of the  acquisition  agreement,  First  American
                 filed  for  protection  under  the  federal   bankruptcy  laws.
                 Consummation  of the  acquisition  is  subject  to a number  of
                 conditions,  some of which are  beyond the  Company's  control,
                 including  approval of the acquisition by the bankruptcy court,
                 resolution  of the HCFA  claims  seeking  repayment  from First
                 American of certain disallowed  reimbursements  under Medicare,
                 which  claims IHS  believes  relate to  personal  or  corporate
                 expenses,   rather  than  care-related   expenses,   regulatory
                 approvals  and approval  from the  Company's  lenders and other
                 third  parties.  During the first quarter of 1996,  the Company
                 loaned $18.1 million to First American to fund certain of First
                 American's  liabilities.  There can be no assurance  that these
                 conditions will be satisfied.  Also,  there can be no assurance
                 that the First American  acquisition will be consummated on the
                 proposed terms or at all.

                                  Page 9 of 19


<PAGE>
                      MANAGEMENT'S DISCUSSION AND ANALYSIS
                             OF FINANCIAL CONDITION
                                       AND
                              RESULTS OF OPERATIONS


Three Months Ended March 31, 1996
Compared to Three Months Ended March 31, 1995

    Net  revenues  for the three  months  ended March 31, 1996  increased  $52.6
million,  or 19%,  to  $327.3  million  from  the  comparable  period  in  1995.
Approximately  19% of the increase in revenues was  attributable to the addition
of 11  facilities  (4 owned,  3 leased and 4 managed  facilities)  subsequent to
March  31,  1995  and  approximately  18% due to the  acquisition  of  companies
providing  home  health and mobile  x-ray and  electrocardiogram  services.  The
remaining  increase was due  primarily to  facilities  and  ancillary  companies
acquired during the first quarter of 1995 and increased revenues from facilities
and ancillary companies in operation during both periods.

    Basic  medical  services  revenue  increased 9% from $89.3  million to $97.2
million.  Of the $97.2 million in basic medical  services  revenue in 1996, $8.1
million,  or 8%, was  attributable to the acquisition of 433 leased beds and 662
owned  beds  representing  3  leased  and  4  owned  facilities,   respectively,
subsequent to March 31, 1995.  Basic medical  services  revenue of facilities in
operation during both periods  decreased during the three months ended March 31,
1996, as a result of skilled nursing beds being  converted to Medical  Specialty
Unit (MSU) beds after March 31, 1995.

    Specialty  medical  services  revenue  increased 25% from $176.2  million to
$219.5  million.  Of the $43.4  million  increase,  $11.4  million,  or 26%, was
attributable  to revenue from  acquisitions  subsequent  to March 31, 1995.  The
remaining  increase is due to increased  revenue from  facilities  and ancillary
companies in operation  in both  periods,  facilities  and  ancillary  companies
acquired  during the first quarter of 1995 as well as skilled nursing beds being
converted to MSU beds after March 31, 1995 and increases in ancillary revenue.


                                  Page 10 of 19

<PAGE>
    Management  services and other  revenues  increased 15% from $9.1 million to
$10.5 million. This increase was primarily attributable to the addition of 4 new
management contracts in the first quarter of 1996 and the addition of 34 managed
facilities during the first quarter of 1995, partially offset by the termination
in the fourth  quarter of 1995 of a managed  contract  to manage 23  facilities.
Also, the Company  purchased two  facilities  that were  previously  managed and
currently leases three facilities that were previously managed.

    Total  expenses  for the period  increased  to $305.1  million  from  $252.1
million,  an increase of 21%. Of the $53.0 million increase,  $41.7 million,  or
79%,  was due to an increase in  operating  expenses.  The increase in operating
expenses  resulting from acquisitions  consummated  subsequent to March 31, 1995
was $16.1  million,  or 39%,  for the three  months  ended March 31,  1996.  The
remainder of the increase in operating  expense  primarily  resulted  from costs
related to the increased medical activity level of the Company's  patients,  and
facilities and ancillary  companies acquired during the three months ended March
31, 1995.

    Corporate  administrative  and general  expenses  for the three months ended
March 31, 1996 increased by $2.7 million,  or 22%, over the comparable period in
1995. This increase  primarily  represents  additional  operations,  information
systems,  accounting,  finance  and other  personnel  to  support  the growth in
acquisition of owned,  leased and managed  facilities and ancillary  businesses.
Depreciation and amortization  increased to $9.2 million during the three months
ended March 31,  1996,  a 3%  increase  as compared to $9.0  million in the same
period  in 1995.  Rent  expense  increased  by $1.6  million,  or 10%,  over the
comparable period in 1995,  primarily as a result of the addition  subsequent to
March 31,  1995 of 3 leased  facilities  which  were  previously  managed by the
Company,  which  increase was partially  offset by the reduction in rent expense
resulting from the acquisition  subsequent to March 31, 1995, of two facilities,
which were previously  leased by the Company.  Interest  expense,  net increased
94%,  or $6.9  million,  during the three  months  ended March 31, 1996 to $14.2
million in the first quarter of 1996.


                                  Page 11 of 19

<PAGE>

The  increase  in  interest  expense was  primarily  due to the  addition of the
Company's $115 million,  9-5/8% Senior  Subordinated  Debentures due 2002 in May
1995 and increased borrowings under the Company's current $500
million credit and term loan facility.

    Earnings  before equity in earnings of affiliates and income taxes decreased
by 2% to $22.1 million for the three months ended March 31, 1996, as compared to
$22.6 million for the comparable period in the prior year.

    Earnings  before income taxes decreased by 2% to $22.4 million for the three
months ended March 31,  1996,  as compared to $22.9  million for the  comparable
period in the prior year.  The  provision for federal and state income taxes was
$8.6 million for the three months ended March 31, 1996, and $8.8 million for the
same period in the prior year. Net earnings and fully diluted earnings per share
for the quarter were $13.8 million in 1996,  or 54 cents per share,  as compared
to $14.1  million  or 53 cents per share for the same  period in 1995.  Weighted
average  shares  (fully  diluted)  decreased 1.0 million  shares,  or 3% to 30.3
million shares from the comparable period in 1995.






                                  Page 12 of 19

<PAGE>
Liquidity and Capital Resources

    At March 31, 1996,  the Company had working  capital of $160.8  million,  as
compared  with $136.3  million at December  31,  1995.  The  increase in working
capital was  primarily  due to an increase in patient  accounts  and third party
payor settlements receivable and other current assets and a decrease in accounts
payable and accrued  expenses.  There were no material  capital  commitments for
capital  expenditures as of March 31, 1996. Net patient accounts and third-party
payor settlements  receivable increased $16.8 million to $247.1 million at March
31,  1996,  as compared to $230.3  million at December  31,  1995.  Of the $16.8
million  increase in accounts  receivable,  $1.5  million  was  attributable  to
related services  businesses  acquired subsequent to December 31, 1995 and $15.3
million was due to increased accounts  receivable at facilities in operation and
related services  businesses owned at both December 31, 1995 and March 31, 1996.
Patient  accounts  receivable were $243.1 million at March 31, 1996, as compared
with  $226.8  million  at  December  31,  1995.  Third-party  payor  settlements
receivable from federal and state governments (i.e.,  Medicare and Medicaid cost
reports) was $35.1  million at March 31, 1996,  as compared to $33.0  million at
December 31, 1995. Approximately $10.2 million, or 29%, of the third-party payor
settlements  receivable  from  federal and state  governments  at March 31, 1996
represent  the costs for its MSU patients  which exceed  regional  reimbursement
limits established under Medicare.

    The Company's cost of care for its MSU patients  generally  exceeds regional
reimbursement  limits  established under Medicare.  The success of the Company's
MSU  strategy  will  depend in part on its ability to obtain  reimbursement  for
those  costs  which  exceed the  Medicare  established  reimbursement  limits by
obtaining  waivers of these cost  limitations.  The Company has submitted waiver
requests for 133 cost reports, covering all cost report periods through December
31,  1994.  To date,  final  action has been taken by the Health Care  Financing
Administration  ("HCFA") on all 133 waiver requests covering cost report periods
through December 31, 1994. The Company's final rates as approved

                                  Page 13 of 19


<PAGE>

by HCFA represent  approximately  96% of the requested rates as submitted in the
waiver requests.  There can be no assurance,  however,  that the Company will be
able to  recover  its  excess  costs  under  any  waiver  requests  which may be
submitted in the future.  The  Company's  failure to recover  substantially  all
these excess costs would  adversely  affect its results of operations  and could
adversely affect its MSU strategy.

    Net cash used by operating  activities  for the three months ended March 31,
1996,  was $12.2  million as compared  to $6.9  million  provided  by  operating
activities for the  comparable  period in 1995.  This resulted  primarily from a
decrease in accounts  payable and accrued  expenses  and an increase in accounts
receivable.

    Net cash  provided by financing  activities  was $86.6 million for the three
month  period  in 1996 as  compared  to  $27.8  million  provided  by  financing
activities  for the  comparable  period in 1995.  In both  periods,  the Company
received net proceeds from long-term  borrowings and made  repayments on certain
debt.

    Net cash used by investing  activities was $83.8 million for the three month
period  ended  March 31, 1996 as compared  to $72.0  million  used by  investing
activities  for the three month period  ended March 31, 1995.  Cash used for the
acquisition of facilities and ancillary  company  acquisitions was $16.6 million
in 1996 as compared to $24.0  million  for 1995.  Cash used for the  purchase of
property,  plant and  equipment  was $34.9  million in 1996 and $24.4 million in
1995.

    The Company's  contingent  liabilities (other than liabilities in respect of
litigation)  aggregated  approximately  $54.3 million as of March 31, 1996.  The
Company is  obligated  to  purchase  its  GreenBriar  facility  upon a change in
control of the Company.  The net purchase price of the facility is approximately
$4.0  million.  The lessor of this  facility  has the right to  require  Messrs.
Robert Elkins and Timothy Nicholson to purchase all or any part of 13,944 shares
of common  stock owned by it at a per share  purchase  price equal to the sum of
$12.25  per share plus 9% simple  interest  per annum from May 8, 1988 until the
date of such

                                  Page 14 of 19

<PAGE>

purchase.  The Company has agreed to purchase such shares if Messrs.  Elkins and
Nicholson fail to do so. The amount aggregated  approximately  $338,000 at March
31, 1996. The Company has guaranteed  approximately $6.6 million of the lessor's
indebtedness. The Company is required, upon certain defaults under the lease, to
purchase its Orange Hills  facility at a purchase  price equal to the greater of
$7.1 million or the  facility's  fair market value.  The Company has jointly and
severally guaranteed a $1.2 million construction loan made to River City Limited
Partnership  in which the Company has a 30% general  partnership  interest.  The
Company has guaranteed  approximately  $3.9 million of a  construction  loan for
Trizec,  the entity from which the  Company  purchased  the Central  Park Lodges
facilities.  The Company entered into a guaranty  agreement  whereby the Company
guaranteed  approximately  $4.2  million owed by Tutera  Group,  Inc. and Sunset
Plaza Limited Partnership,  a partnership affiliated with a partnership in which
the Company has a 49% interest,  to Finova Capital Corporation.  The Company has
guaranteed  approximately  $8.7  million  owed by  Litchfield  Asset  Management
Corporation  to National  Health  Investors,  Inc.  The Company has  established
several  irrevocable  letters of credit with the Bank of Nova  Scotia  totalling
$15.3  million at March 31,  1996 to secure  certain of the  Company's  workers'
compensation,  health benefits and other obligations. The Company has guaranteed
a maximum  of $3.0  million  owed by Dunns  Creek and Lanier  Manor to  National
Health  Investors.  In addition,  the Company has  obligations  under  operating
leases aggregating  approximately $256.5 million at March 31, 1996. In addition,
with  respect to certain  acquired  businesses  the Company is obligated to make
certain  contingent  payments if earnings of the acquired  business  increase or
earnings targets are met.

    The  liquidity  of the  Company  will  depend in large part on the timing of
payments by private third-party and governmental  payors,  including payments in
excess of regional cost  reimbursement  limitations  established under Medicare.
Costs in excess of the regional  reimbursement  limits  relate  primarily to the
delivery of services and patient care to the Company's MSU patients.

                                  Page 15 of 19


<PAGE>
    The Company  anticipates  that cash from  operations  and  borrowings  under
revolving  credit  facilities  will be  adequate  to cover  its  scheduled  debt
payments and future  anticipated  capital  expenditure  requirements  throughout
1996. The Company  expects to continue to be growth oriented in 1996 through the
expansion  of its  existing  operations,  continued  implementation  of its  MSU
programs and by the acquisition of additional facilities and ancillary companies
and the entry into agreements to manage additional facilities.























                                  Page 16 of 19
<PAGE>


Part II:                 Other Information

Item 5.          -       Other Information

                         None

Item 6.          -       Exhibits and Reports on Form 8-K

 (a)             Exhibits

                 10.1    Employment Agreement dated January 1, 1994 between
                         Integrated Health Services, Inc. and Robert N.
                         Elkins

                 10.2    Amendment No. 1 to Employment Agreement dated as of
                         January 1, 1995 between Integrated Health Services,
                         Inc. and Robert N. Elkins

                 10.3    Employment Agreement dated as of January 1, 1994
                         between Integrated Health Services, Inc. and
                         Lawrence P. Cirka

                 10.4    Amendment to Employment Agreement dated as of
                         January 1, 1995 between Integrated Health Services,
                         Inc. and Lawrence P. Cirka

                 10.5    Employment Agreement dated as of October 1, 1995
                         between Integrated Health Services, Inc. and C.
                         Christian Winkle

                 10.6    Amendment to Employment Agreement dated as of
                         January 1, 1996 between Integrated Health Services,
                         Inc. and Dennis A. Cahill

                                  Page 17 of 19

<PAGE>

                 10.7    Amendment to Employment Agreement dated as of April
                         1, 1996 between Asia Care and John L. Silverman

                 27      Financial Data Schedule

 (b)             Reports on Form 8-K

                         None





















                                  Page 18 of 19


<PAGE>
                                 - SIGNATURES -


Pursuant  to the  requirements  of the  Securities  Exchange  Act of  1934,  the
registrant  has duly  caused  this  report  to be  signed  on its  behalf by the
undersigned thereunto duly authorized.



                                           INTEGRATED HEALTH SERVICES, INC.



                                           By: /s/ Robert N. Elkins
                                              ---------------------------------
                                               Robert N. Elkins
                                                  Chief Executive Officer



                                           By: /s/ W. Bradley Bennett
                                              ---------------------------------
                                               W. Bradley Bennett
                                                  Senior Vice President and
                                                  Chief Accounting Officer



                                           By: /s/ Eleanor C. Harding
                                               ---------------------------------
                                               Eleanor C. Harding
                                                  Senior Vice President Finance






Dated:      May 14, 1996


                                  Page 19 of 19

<PAGE>



                              EMPLOYMENT AGREEMENT

                  This AGREEMENT is made  effective as of January 1, 1994,  (the
"Effective Date"), by and between  INTEGRATED HEALTH SERVICES,  INC., a Delaware
corporation  (hereinafter  referred to as the  "Company"),  and ROBERT N. ELKINS
(hereinafter referred to as the "Executive").
                                          
                              W I T N E S S E T H:

                  WHEREAS,  the Company  wishes to employ the  Executive  and to
ensure the  continued  services of the  Executive  for the Term (as  hereinafter
defined), and the Executive desires to be employed by the Company for such Term,
upon the terms and conditions hereinafter set forth.
                  NOW, THEREFORE,  in consideration of the foregoing premise and
the mutual  agreements herein  contained,  the parties,  intending to be legally
bound, hereby agree as follows:

                                    ARTICLE I
                             EMPLOYMENT RELATIONSHIP

                  1.1 Employment. During the Term, the Company and the Executive
agree that the  Executive  shall be employed as  President  and Chief  Executive
Officer of the Company and shall have the customary powers, responsibilities and
authorities of presidents and chief  executive  officers of  corporations of the
size, type and nature of the Company as they exist from time to time. During the
Term,  the Company shall also  recommend and propose the Executive as a Director
and as Chairman of the Board of Directors of the Company.  The  Executive  shall
only  report to and be  responsible  directly to the Board of  Directors  of the
Company (the "Board").

<PAGE>
                  1.2  Exclusive  Employment.  During  the Term,  the  Executive
agrees  to  devote  all such  working  time as is  reasonably  required  for the
discharge of his duties hereunder and to perform such services faithfully and to
the  best  of his  ability.  Notwithstanding  the  foregoing,  nothing  in  this
Agreement  shall  preclude  the  Executive  from (a)  performing  his duties and
responsibilities  hereunder  at a location  other than the  Company's  executive
offices;  (b) engaging in charitable and community affairs,  so long as they are
consistent  with his  duties and  responsibilities  under  this  Agreement,  (c)
managing his personal investments,  and (d) serving on the Board of Directors of
Speciality  Care PLC  ("Speciality  Care") and Community  Care of America,  Inc.
("Community Care") and on the boards of directors of other companies.  From time
to time, the Executive may furnish  services to other  companies,  provided that
furnishing  such  services  does  not  materially   interfere  with  his  duties
hereunder.
                  1.3 Term.  Unless  sooner  terminated  pursuant to Article III
below,  the term of this  Agreement (the "Term") shall commence on the Effective
Date,  and be in effect for three (3)  years;  provided,  however,  that on each
January 1st after the date of this Agreement (an "Anniversary  Date"),  the then
current term of this Agreement  automatically shall be extended by an additional
period of  twelve  (12)  months,  so that,  as of each  Anniversary  Date,  this
Agreement shall have an unexpired Term of three (3) years.  Notwithstanding  the
foregoing,  either  party  hereto may elect not to so extend this  Agreement  by
giving  written notice of his or its election to the other party hereto at least
ninety (90) days prior to any  Anniversary  Date.  If the Company  elects not to
renew the Agreement,  the Executive shall be entitled to severance at the end of
the Term as set forth in Section 3.4.


                                      -2-
<PAGE>
                                   ARTICLE II
                                  COMPENSATION

                  2.1 Salary.  The  Executive  shall receive a base salary at an
initial rate of $500,000 per year (the "Salary"), payable in substantially equal
installments in accordance  with the pay policy  established by the Company from
time to time, but not less frequently than monthly.  On each  Anniversary  Date,
the Salary shall be increased or decreased (but not below Five Hundred  Thousand
Dollars  ($500,000)),  by a percentage which is equal to the percentage increase
or  decrease,  as  applicable,  in the  "Consumer  Price  Index  for  All  Urban
Consumers"  published by the United States Department of Labor's Bureau of Labor
Statistics for the then most recently  ended  12-month  period as of the date of
such adjustment,  and increased by such additional  amounts as may be determined
at the  discretion  of the Board.  Once  adjusted,  such  adjusted  amount shall
constitute Salary for purposes of this Agreement.

                  2.2 Bonuses.  (a) If the Company's earnings per share equal or
exceed the earnings goals set by the Board (the "Target") then, no more than ten
(10) days following the date the Company  publicly  announces its earnings,  the
Company shall pay the Executive a bonus ("Bonus") determined as follows:

                  (1) with respect to each  calendar  quarter,  if the Company's
         earnings  equal  or  exceed  the  Target,  the  Company  shall  pay the
         Executive a lump sum cash amount equal to 12-1/2% of Salary;

                  (2) with  respect  to each  calendar  year,  if the  Company's
         earnings  equal  or  exceed  the  Target,  the  Company  shall  pay the
         Executive  a lump  sum  cash  amount  equal  to 50% of  Salary  plus an
         additional  12 1/2% of Salary for each  quarter  within  such year with
         respect  to  which  the  Executive  did not  receive  a  payment  under
         paragraph (1).

                  (b)   Notwithstanding   anything  in  Section  2.2(a)  to  the
contrary, if in any calendar year the Company pays an amount with respect to the
Company's quarterly earnings

                                      - 3 -
<PAGE>

pursuant to Section  2.2(a)(1) but (because the Company's  earnings do not equal
or exceed the Target for the calendar  year  containing  any of the quarters for
which a payment  under  Section  2.2(a)(1) is made) the Company does not pay the
Executive an amount pursuant to Section 2.2(a)(2), then the Company shall either
treat the quarterly amounts paid to the Executive  pursuant to Section 2.2(a)(1)
in such year as a prepayment of its Salary, Severance, or Disability obligations
under Sections 2.1, 3.4 or 3.5, respectively, or, shall require the Executive to
repay such amounts to the Company  with  interest at the prime rate of Citibank,
N.A.

                  2.3 Employee  Benefits and  Perquisites.  During the Term, the
Company shall provide and/or pay for employee benefits and perquisites that are,
in the aggregate,  no less favorable than the employee  benefits and perquisites
that the Executive  enjoys as of the Effective  Date, as increased  from time to
time, including, without limitation:

                  (a) life insurance coverage in the amount of $2,000,000;

                  (b) medical and dental benefits;

                  (c) disability  insurance coverage in a monthly benefit amount
         equal to the sum of 100% of Executive's  Salary plus "Bonus Amount" (as
         defined in Section 3.4(a));

                  (d) one-half (1/2) of the cost of dues,  assessments and other
         charges  for a full  membership  in a country  club of the  Executive's
         choice;

                  (e) an  automobile  allowance  (including an allowance for all
         operating and maintenance  expenses) and automobile  insurance coverage
         at least equal to the allowance and coverage the Executive  receives as
         of the Effective Date, and as increased from time to time; and

                  (f) use of the Company-provided  airplane,  that Executive has
         use of as of the Effective Date.

                  Once increased,  the level of benefits and  perquisites  shall
not be decreased without the Executive's consent.

                  2.4   Equity-based   Compensation.   During   the  Term,   the
Compensation Committee, in its complete discretion,  may select the Executive to
participate in programs or


                                      - 4 -
<PAGE>
enter  into  agreements  which  provide  for the grant of  certain  equity-based
compensation or rights to the Executive.

                                   ARTICLE III
                            TERMINATION AND SEVERANCE

                  3.1 Termination;  Nonrenewal. The Company shall have the right
to terminate the Executive's employment,  and the Executive shall have the right
to resign his employment with the Company,  at any time during the Term, for any
reason or for no  stated  reason,  upon no less than  ninety  (90)  days'  prior
written notice (or such shorter notice to the extent provided for herein).  Upon
the  Executive's  termination  without  "Cause" (as  defined in Section  3.2) or
resignation for "Good Reason" (as defined in Section 3.3) or upon the expiration
of the Term  following  the Company's  election not to renew this  Agreement (in
accordance  with Section 1.3),  the Executive  shall be entitled to severance as
set  forth  in  Section  3.4.  Upon the  Executive's  termination  for  Cause or
resignation  without  Good  Reason,  the  Executive  shall  not be  entitled  to
severance.  If the Executive's  employment is terminated  because of a Permanent
Disability (as defined in Section 3.5), the Executive shall receive the benefits
and  payments  described  in Section 3.5. 

                  3.2 Termination For Cause.  (a) The Company may terminate this
Agreement for Cause  following a  determination  by the Board that Cause exists.
For purposes of this  Agreement,  Cause shall mean any or all of the  following:
(i) the Executive's willful and continuing neglect of his duties hereunder;

                  (ii) a material breach by the Executive of his covenants under
         Sections 4.1 or 4.2;

                  (iii) the  conviction of the Executive of a felony  (including
         the  theft,  larceny  or  embezzlement  of the  Company's  tangible  or
         intangible property).

                  (b)   Notwithstanding   anything  in  Section  3.2(a)  to  the
contrary, a termination shall not be for Cause unless (i) the determination that
Cause exists is made by the Board at a special


                                      - 5 -

<PAGE>

meeting  called  for the  purpose  of  determining  whether  Cause  exists,  the
Executive is provided  with at least thirty (30) days' prior  written  notice of
such  Board  meeting  (which  notice  shall  set forth the  conduct  alleged  to
constitute  Cause)  (the  "Cause  Notice"),  and  the  Executive  is  given  the
opportunity to be represented by counsel at such meeting; and (ii) the Executive
does not cure his conduct (to the reasonable  satisfaction  of the Board) within
sixty (60) days after the receipt of the Cause Notice.

                  3.3  Termination  for  Good  Reason.  (a)  The  Executive  may
terminate  this  Agreement for Good Reason,  provided he gives the Company prior
written notice that Good Reason exists (the "Good Reason Notice").  For purposes
of this Agreement, Good Reason shall mean one or more of the following:

                  (1)  a  material  breach  of  the  Agreement  by  the  Company
         (including,  without  limitation,  one or more of the following without
         the Executive's prior written consent:

                  (i) a material diminution of the Executive's responsibilities,
         title, authority or status,

                  (ii) the failure of the Company to pay the  Executive  amounts
         when due under this Agreement,

                  (iii) the Executive's removal or dismissal from, or failure to
         be reelected President or Chief Executive Officer; and

                  (iv) a reduction in salary or a material reduction in benefits
         (other than a reduction in salary permitted by Section 2.1).

                   (2) the  resignation  by the  Executive  within  one (1) year
         following a "Change of Control", as defined in Section 3.3(b), provided
         that the  Executive  gives the Company at least  ninety (90) days prior
         written  notice of his intent to resign and the effective  date of such
         resignation  is at least one hundred eighty (180) days after the Change
         of Control.

                  (3) the  Executive's  removal or dismissal from, or failure to
         be reelected Chairman of the Board of the Company.

Notwithstanding the foregoing, a termination on account of a reason described in
paragraph  (1),  shall be deemed not to be for Good Reason  unless the Executive
(i) gives the Company the  opportunity  to cure the  condition  that purports to
constitute Good Reason, and (ii) the Company


                                      - 6 -
<PAGE>
fails to cure that  condition  within  sixty (60) days after the  receipt of the
Good Reason Notice (or, with respect to the failure to make any payment when due
to the Executive within ten (10) days after the receipt of such notice).

                  (b) For  purposes  of this  Agreement,  a "Change of  Control"
shall  be  deemed  to  occur  if  (i)  there  shall  be   consummated   (x)  any
consolidation,  reorganization  or merger of the Company in which the Company is
not the  continuing or surviving  corporation or pursuant to which shares of the
Company's  common  stock  would be  converted  into  cash,  securities  or other
property,  other  than a merger  of the  Company  in which  the  holders  of the
Company's  common  stock   immediately   prior  to  the  merger  have  the  same
proportionate ownership of common stock of the surviving corporation immediately
after the merger,  or (y) any sale,  lease,  exchange or other  transfer (in one
transaction or a series of related  transactions) of all, or substantially  all,
of the assets of the  Company,  or (ii) the  stockholders  of the Company  shall
approve any plan or proposal for  liquidation or dissolution of the Company,  or
(iii) any person (as such term is used in  Sections  13(d) and  14(d)(2)  of the
Exchange  Act,  including  any "group"  (as  defined in Section  13(d)(3) of the
Exchange  Act),  (other  than  the  Executive  or any  group  controlled  by the
Executive))  shall become the beneficial owner (within the meaning of Rule 13d-3
under the Exchange Act) of 20% or more of the Company's outstanding common stock
(other than  pursuant to a plan or  arrangement  entered into by such person and
the  Company)  and such  person  discloses  its intent to effect a change in the
control  or  ownership  of the  Company in any filing  with the  Securities  and
Exchange Commission,  or (iv) within any twenty-four (24) month period beginning
on or after the Effective  Date,  the persons who were  directors of the Company
immediately  before the  beginning  of such period (the  "Incumbent  Directors")
shall  cease (for any reason  other than death,  disability  or  retirement)  to
constitute  at least a majority  of the Board or the board of  directors  of any
successor to the Company,  provided that, any director who was not a director as
of the  Effective  Date  shall be deemed  to be an  Incumbent  Director  if such
director


                                      - 7 -
<PAGE>
was elected to the Board by, or on the  recommendation  of or with the  approval
of,  at least  two-thirds  of the  directors  who then  qualified  as  Incumbent
Directors  either  actually or by prior  operation  of this  Section  3.3(b)(iv)
unless such election, recommendation or approval was the result of any actual or
threatened  election  contest  of the type  contemplated  by  Regulation  14a-11
promulgated under the Exchange Act or any successor provision.

                  3.4 Severance.  (a) If the Executive  resigns for Good Reason,
or is terminated  without Cause, or if the Company gives the Executive notice of
its intention not to extend the Term, in accordance with Article II, the Company
shall  cause the  Executive's  outstanding  options  which  are not  immediately
exercisable to vest and become  immediately  exercisable and the restrictions on
equity held by the  Executive  which are  scheduled to lapse solely  through the
passage of time to lapse (such events collectively  referred to as "Acceleration
of Equity Rights").  In addition,  the Company shall pay the Executive an amount
(the "Severance Amount") equal to three (3) times the sum of (1) his Salary; and
(2) the "Bonus Amount" which shall be the greater of i) 100% of the  Executive's
Salary (the "Bonus Amount") in the year of  termination;  or ii) the Executive's
Bonus in the immediately preceding calendar year. Such Severance Amount shall be
payable in cash as follows:

                  (x) no  later  than  10  days  after  the  effective  date  of
         Executive's  termination,  the Company shall pay the Executive one-half
         (1/2) of the Severance Amount in a lump sum;

                  (y)  commencing  on the first day of the month  following  the
         effective date of Executive's  termination  and on the first day of the
         month  thereafter  for a period of eighteen  (18)  months,  the Company
         shall pay the remaining  one-half (1/2) of the Severance  Amount to the
         Executive in equal monthly installments;

provided,  however, that if the Executive's employment terminates other than for
Cause, within one (1) year following a Change of Control,  the Company shall, in
lieu of the making the


                                      - 8 -

<PAGE>
payments  described in (x) and (y), pay the Executive the Severance  Amount,  in
one lump sum cash  payment  within  ten (10) days  after the  effective  date of
Executive's termination.

                  In addition,  for a period of thirty-six (36) months following
the effective  date of the  Executive's  termination,  the Company shall provide
continued employee benefits and coverage for the Executive and his dependents of
the type and at a level of coverage  comparable to the coverage in effect at the
time of termination  ("Continued Benefits") and shall provide the Executive with
the following  additional  benefits:  (i) secretarial  services  provided by the
Executive's  secretary at the time of his  termination  or a secretary  with the
same skill and experience as such secretary, who is reasonably acceptable to the
Executive; (ii) office space with office equipment and furnishings, all of which
are comparable to that provided to the Executive at the time of his termination;
(iii) a continued automobile allowance (including an allowance for operating and
maintenance  expenses)  and continued  automobile  insurance  coverage,  in both
cases,  at a level,  which is not less than the allowance and coverage in effect
on the effective date of Executive's termination;  and (iv) continued use of the
Company-provided  airplane  used  by  the  Executive  immediately  prior  to the
effective   date  of   Executive's   termination   or  a  comparable   airplane.
Notwithstanding  the  foregoing,  if any  of the  Continued  Benefits  or  other
benefits to be provided  hereunder have been  decreased or otherwise  negatively
affected  within  twelve  (12)  months  prior  to  the  effective  date  of  the
Executive's  termination,  the reference for measuring such benefit shall be the
date prior to such reduction rather than the date of such termination.

                  (b) If the Executive is required,  pursuant to Section 4999 of
the  Internal  Revenue  Code of 1986,  as amended  (the  "Code") to pay (through
withholding  or  otherwise)  an excise tax on  "excess  parachute  payments"  as
defined  in  Section  280G of the Code,  the  Company  shall  pay the  Executive
three-quarters (3/4) of the amount or amounts that are necessary to place the


                                      - 9 -

<PAGE>
Executive in the same after-tax financial position that he would have been in if
he had not incurred any tax liability under Section 4999 of the Code.

                  3.5 Termination for Disability.  (a) The Company may terminate
the Executive  following a  determination  by the Board that the Executive has a
Permanent  Disability;  provided,  however,  that no such  termination  shall be
effective (i) prior to the expiration of the six (6) month period  following the
date the  Executive  first  incurred  the  condition  which is the basis for the
Permanent  Disability or (ii) if the Executive begins to  substantially  perform
the  significant  aspects of his regular duties prior to the proposed  effective
date of such termination. For purposes of this Agreement, "Permanent Disability"
shall  mean the  Executive's  inability,  by  reason of any  physical  or mental
impairment,  to  substantially  perform the  significant  aspects of his regular
duties,  as  contemplated  by this  Agreement,  which  inability  is  reasonably
contemplated  to continue for at least one (1) year from its  incurrence  and at
least  ninety  (90)  days from the date of such  vote.  Any  question  as to the
existence, extent, or potentiality of the Executive's Permanent Disability shall
be determined  by a qualified  independent  physician  selected by the Executive
(or, if the  Executive is unable to make such  selection,  by an adult member of
the Executive's immediate family) and reasonably acceptable to the Board.

                  (b) If the  Executive is  terminated  because of his Permanent
Disability, the Company shall provide for the Acceleration of Equity Rights and,
the  Company  shall,  (i) for a period  of  thirty  (30)  months  following  the
effective date of such termination  (the "Disability  Period") pay the Executive
one  hundred  (100%)  percent of his Salary  plus  Bonus  Amount,  offset by the
amount,  if any, paid to the Executive under the salary  replacement  portion of
disability  benefits  paid  under a  disability  plan or policy  paid for by the
Company;  and (ii) provide him with  Continued  Benefits  during the  Disability
Period.

                  3.6  Death  or  Disability  After   Termination.   Should  the
Executive die or become  disabled before receipt of any or all payments to which
the Executive is entitled to under Section


                                     - 10 -

<PAGE>
3.4 (or in the  case of the  Executive's  death  following  his  termination  on
account of Permanent  Disability,  before  receipt of all payments under Section
3.5),  then the balance of the payments to which the Executive is entitled shall
continue  to paid to the  Executive  (in the case of his  disability)  or to the
executors  or  administrators  of the  Executive's  estate  (in the event of the
Executive's death); provided,  however, that the Company may, at any time within
its discretion,  accelerate any payments and pay the Executive or his estate the
present  value of such  payments  in a lump sum cash  payment.  For  purposes of
determining the present value under this Section 3.6, the interest rate shall be
the prime rate of Citibank, N.A.

                                   ARTICLE IV

                           COVENANTS OF THE EXECUTIVE
                           --------------------------

     4.1  Confidential  Information.  In connection  with his  employment at the
Company, the Executive will have access to confidential  information  consisting
of some or all of the following categories of information:

                  (a)  Financial  Information,  including  but  not  limited  to
         information relating to the Company's earnings,  assets, debts, prices,
         pricing structure, volume of purchases or sales or other financial data
         whether related to the Company or generally, or to particular products,
         services, geographic areas, or time periods;

                  (b) Supply and Service Information,  including but not limited
         to  information  relating to goods and  services,  suppliers'  names or
         addresses,  terms of  supply  or  service  contracts  or of  particular
         transactions,  or related  information about potential suppliers to the
         extent that such information is not generally known to the public,  and
         the extent that the  combination  of  suppliers  or use of a particular
         supplier, though generally known or available, yields advantages to the
         Company details of which are not generally known;

                  (c)  Marketing  Information,  including  but  not  limited  to
         information  relating to details  about  ongoing or proposed  marketing
         programs or agreements by or on behalf of the Company, sales forecasts,
         advertising  formats  and  methods or results of  marketing  efforts or
         information about impending transactions;

                  (d)  Personnel  Information,  including  but  not  limited  to
         information  relating to  employees'  personnel  or medical  histories,
         compensation   or  other  terms  of   employment   actual  or  proposed
         promotions, hirings, resignation, disciplinary actions, terminations or
         reasons  therefor,  training  methods,  performance,  or other employee
         information; and

                                     - 11 -
<PAGE>
                  (e)  Customer  Information,   including  but  not  limited  to
         information relating to past, existing or prospective customers' names,
         addresses or backgrounds,  records of agreements and prices,  proposals
         or agreements  between customers and the Company,  status of customers'
         accounts or credit, or related  information about actual or prospective
         customers as well as customer lists.

                  All of the  foregoing  are  hereinafter  referred to as "Trade
Secrets."  The  Company  and  the  Executive  consider  their  relation  one  of
confidence  with  respect  to Trade  Secrets.  Therefore,  during  and after the
employment by the Company,  regardless of the reasons that such employment ends,
the Executive agrees:
                  (aa) To hold all Trade Secrets in confidence  and not discuss,
         communicate or transmit to others,  or make any unauthorized copy of or
         use the Trade Secrets in any capacity,  position or business  except as
         it directly relates to the Executive's employment by the Company;

                  (bb) To use the Trade  Secrets only in  furtherance  of proper
         employment  related  reasons of the Company to further the interests of
         the Company;

                  (cc) To take all  reasonable  actions  that the Company  deems
         necessary or appropriate,  to prevent unauthorized use or disclosure of
         or to protect the Company's interest in the Trade Secrets; and

                  (dd) That any of the Trade  Secrets,  whether  prepared by the
         Executive or which may come into the Executive's  possession during the
         Executive's  employment  hereunder,  are and remain the property of the
         Company  and its  affiliates,  and all such  Trade  Secrets,  including
         copies  thereof,  together  with all other  property  belonging  to the
         Company  or its  affiliates,  or used in their  respective  businesses,
         shall be delivered to or left with the Company.

                  This Agreement does not apply to (i) information that by means
other than the Executive's deliberate or inadvertent disclosure becomes known to
the public; (ii) disclosure compelled by judicial or administrative  proceedings
provided the Executive  affords the Company the opportunity to obtain  assurance
that  compelled  disclosures  will  receive  confidential  treatment;  and (iii)
information  independently developed by the Executive,  the development of which
was not a breach of this Agreement.

                  4.2  Non-Competition.  During the Term and for a period of two
(2)  years  thereafter  (or  in the  event  of the  Executive's  termination  of
employment other than for Cause

                                     - 12 -
<PAGE>

within  one (1) year  after a Change  of  Control,  for a period of one (1) year
thereafter),  the Executive agrees that he will not, without the express written
consent of the Company,  directly or indirectly,  for the Executive or on behalf
of any other person, firm, entity or other enterprise (i) directly or indirectly
solicit for employment or recommend to any subsequent  employer of the Executive
the  solicitation  for  employment  of any  person  who,  at the  time  of  such
solicitation is employed by Company or any affiliate  thereof,  (ii) directly or
indirectly  solicit,  divert,  or endeavor  to entice  away any  customer of the
Company or any affiliate  thereof,  or otherwise engage in any activity intended
to  terminate,  disrupt,  or interfere  with the  Company's  or any  affiliate's
relationship  with a customer,  supplier,  lessor or other  person,  or (iii) be
employed by, be a director, officer or manager of, act as a consultant for, be a
partner in,  have a  proprietary  interest  in, give advice to, loan money to or
otherwise  associate  with, any person,  enterprise,  partnership,  association,
corporation,  joint venture or other entity which is directly in the business of
owning,  operating or managing any subacute  healthcare  facility which competes
with any such  type of  facility  then  operated  by the  Company  or any of its
subsidiaries.  This  provision  shall not be construed to prohibit the Executive
from (i) acting as an employee, director, or consultant for, or owning more than
10% of, the outstanding  voting shares of the equity  securities of,  Speciality
Care or  Community  Care,  or (ii)  owning up to 10% of the  outstanding  voting
shares of the equity  securities of any company whose common stock is listed for
trading on any  national  securities  exchange or on the NASDAQ  System or (iii)
serving as a director of any company  which is not  directly in the  business of
owning,  operating  or managing  any subacute  healthcare  facility  (other than
Speciality  Care or Community  Care).  The  provisions of this Section 4.2 shall
only apply to businesses and operations  located in, or otherwise  conducted in,
the United States.

                  4.3  Remedies   For  Breach  of  Article  IV.  The   Executive
acknowledges  and  agrees  that  the  amount  of  damages  in the  event  of the
Executive's breach of this Article IV will be

                                     - 13 -
<PAGE>

difficult, if not impossible,  to ascertain. The Executive therefore agrees that
the Company,  in addition to, and without  limiting any other remedy or right it
may have,  shall  have the right to an  injunction  enjoining  any breach of the
covenants made by the Executive in this Article IV.


                                    ARTICLE V

                            AMENDMENT AND ASSIGNMENT
                            ------------------------

                  5.1 Right of the  Executive to Assign.  The  Executive may not
assign,  transfer,  pledge or  hypothecate  or  otherwise  transfer  his rights,
obligations,  interests and benefits  under this Agreement and any attempt to do
so shall be null and void.

                  5.2  Right of  Company  to  Assign.  This  Agreement  shall be
assignable and  transferable  by the Company and any such assignment or transfer
shall inure to the benefit of and be binding upon the Executive, the Executive's
heirs and  personal  representatives,  and the  Company and its  successors  and
assigns.  The Executive agrees to execute all documents  necessary to ratify and
effectuate such assignment. An assignment of this Agreement by the Company shall
not release the Company from its monetary obligations under this Agreement.

                  5.3  Amendment/Waiver.  No  change  or  modification  of  this
Agreement  shall be valid  unless it is in writing  and  signed by both  parties
hereto.  No waiver of any provisions of this Agreement  shall be valid unless in
writing and signed by the person or party to be charged.

                                   ARTICLE VI
                                     GENERAL

                  6.1  Governing  Law.  This  Agreement  shall be subject to and
governed by the laws of the State of Delaware, irrespective of the fact that the
Executive may become a resident of a different state.


                                     - 14 -
<PAGE>
                  6.2 Binding  Effect.  This Agreement shall be binding upon and
inure to the  benefit of the  Company  and the  Executive  and their  respective
heirs,  legal  representatives,   executors,   administrators,   successors  and
permitted assigns.

                  6.3 Entire  Agreement.  This Agreement  constitutes the entire
agreement  between the parties and supersedes the Prior  Agreement and all other
prior agreements,  either oral or written, between the parties hereto; provided,
however,  that this Agreement  does not supersede any  agreements  pertaining to
stock options which have been granted as of the  Effective  Date,  except to the
extent that any such option agreement contains  provisions which are contrary to
the  provisions  of  this   Agreement   (including   provisions   regarding  the
Acceleration of Equity Rights).

                  6.4  Mitigation.  The  Executive  shall  not  be  required  to
mitigate  damages or the amount of any payment provided for under this Agreement
by seeking other employment or otherwise nor may any payments provided for under
this Section be reduced by any amounts  earned by the Executive as a result of a
breach of the Executive's covenants in Article IV.

                  6.5 Survivorship. The respective rights and obligations of the
parties  hereunder shall survive the termination of this Agreement to the extent
necessary  to preserve  the rights and  obligations  of the  parties  under this
Agreement.

                  6.6  Notices.  All  notices,  demands,   requests,   consents,
approvals or other  communications  required or permitted  hereunder shall be in
writing and shall be delivered by hand, registered or certified mail with return
receipt requested or by a nationally  recognized  overnight delivery service, in
each case with all postage or other delivery charges prepaid, and to the address
of the party to whom it is directed as indicated below, or to such other address
as such party may specify by giving notice to the other in  accordance  with the
terms hereof. Any such notice shall be deemed to be received (i) when delivered,
if by hand,  (ii) on the next  business  day  following  timely  deposit  with a
nationally  recognized  overnight delivery service or (iii) on the date shown on
the return receipt as received or refused or on the date the postal

                                     - 15 -
<PAGE>
authorities state that delivery cannot be accomplished, if sent by registered of
certified mail, return receipt requested.
 
If to the Company:                              Integrated Health Services, Inc.
                                                10065 Red Run Boulevard
                                                Owings Mills, Maryland  21117
                                                Attn: Robert Walkingshaw

If to the Executive:                            Robert N. Elkins
                                                10600 Park Heights Avenue
                                                Owings Mills, MD  21117

             Copy to:                           Alvin Brown, Esq.
                                                Simpson Thacher & Bartlett
                                                425 Lexington Avenue
                                                New York, NY  10017

                  6.7 Indemnification. The Company agrees to maintain Director's
and Officer's  liability  insurance at a level not less than the level in effect
on the Effective Date, or to the extent such level is increased during the Term,
at such increased level;  provided,  however, that the level of insurance may be
decreased  with the  Executive's  consent.  To the  extent  not  covered by such
liability insurance, the Company shall indemnify and hold the Executive harmless
to the fullest extent  permitted by Delaware law against any  judgments,  fines,
amounts  paid  in  settlement  and  reasonable  expenses  (including  reasonable
attorneys'  fees),  and advance  amounts  necessary to pay the  foregoing at the
earliest time and to the fullest extent permitted by law, in connection with any
claim, action or proceeding (whether civil or criminal) against the Executive as
a result of his  serving  as an  officer or  director  of the  Company or in any
capacity at the  request of the  Company in or with regard to any other  entity,
employee  benefit plan or enterprise.  This  indemnification  shall be in effect
during the Term and  thereafter  and shall be in  addition to and not in lieu of
any other indemnification rights the Executive may otherwise have.

                  6.8 Attorney's  Fees.  Upon  presentation  of an invoice,  the
Company  shall pay  directly  or  reimburse  the  Executive  for all  reasonable
attorney's fees and costs incurred by the Executive:

                                     - 16 -
<PAGE>


                  (a)  in  connection  with  the  negotiation,  preparation  and
execution of this Agreement; and

                  (b) in  connection  with any dispute  brought by the Executive
over the  terms of this  Agreement  unless  there  is a  determination  that the
Executive had no reasonable basis for his claim.

                  6.9 Arbitration.  Except as otherwise provided in Section 4.3,
any dispute or  controversy  arising under or in connection  with this Agreement
shall be settled  exclusively by arbitration,  conducted before a panel of three
arbitrators in Baltimore, Maryland, in accordance with the rules of the American
Arbitration  Association  then in effect,  and  judgement  may be entered on the
arbitrators' award in any court having  jurisdiction.  The Company shall pay all
costs of the American  Arbitration  Association and the  arbitrator.  Each party
shall  select one  arbitrator,  and the two so  designated  shall select a third
arbitrator.  If either party shall fail to designate an arbitrator  within seven
(7) days after arbitration is requested, or if the two arbitrators shall fail to
select a third  arbitrator  within  fourteen  (14)  days  after  arbitration  is
requested,  then an  arbitrator  shall be selected by the  American  Arbitration
Association upon application of either party. Notwithstanding the foregoing, the
Executive  shall be entitled to seek  specific  performance  from a court of the
Executive's  right to be paid until the date of termination  during the pendency
of any dispute or controversy arising under or in connection with this Agreement
and the Company shall have the right to obtain injunctive relief from a court.

                  6.10 Voidability. If the options granted by the Company to the
Executive  on October 25,  1993,  and  November  22,  1993,  are not approved by
shareholders  by June 30, 1994,  this  Agreement  shall be deemed void as of the
Effective Date and shall have no force or effect.

                  6.11  Severability.  No  provision  in this  Agreement if held
unenforceable  shall  in  any  way  invalidate  any  other  provisions  of  this
Agreement, all of which shall remain in full

                                     - 17 -

<PAGE>
force and effect  except  that this  Section  6.11 shall not apply to the extent
Section 6.10 is held unenforceable.

                  IN WITNESS  WHEREOF,  the Company has caused this Agreement to
be signed by its duly authorized  officers and its corporate seal to be hereunto
affixed,  and the Executive has hereunto set the Executive's hand on the day and
year first above written.

COMPANY                                                  EXECUTIVE
- - -------                                                  ---------
Integrated Health Services,
Inc., a Delaware corporation

By:    /s/ Robert Walking Shaw                           /s/ Robert N. Elkins
       ------------------------                          -------------------
                                                         Robert N. Elkins
Name:  Robert Walking Shaw
       ------------------------

Title: Director
       ------------------------

By:    /s/ Lawrence P. Cirka
       ------------------------

Name:  Lawrence P. Cirka
       ------------------------

Title: Chief Operating Officer
       ------------------------

                                     - 18 -
<PAGE>

                     AMENDMENT NO. 1 TO EMPLOYMENT AGREEMENT
                     ---------------------------------------

         This  AMENDMENT  No. 1 is made  effective  as of  January  1, 1995 (the
"Effective Date"), by and between  INTEGRATED HEALTH SERVICES,  INC., a Delaware
corporation  (hereinafter  referred to as the  "Company"),  and ROBERT N. ELKINS
(hereinafter referred to as the "Executive").


                              W I T N E S S E T H:


         WHEREAS,  effective  January 1, 1994,  the  Executive  entered  into an
employment agreement with the Company (the "Agreement");

         WHEREAS, the parties desire to amend the Agreement;

         WHEREAS,  Section 5.3 of the Agreement permits the parties to amend the
Agreement in a writing signed by both parties.

         NOW,  THEREFORE,  in  consideration  of the foregoing  premises and the
mutual agreements herein contained, the parties,  intending to be legally bound,
hereby agree to amend the Agreement as follows:

         1. The Term of the  Agreement  as defined in Section  1.3 shall be five
(5) years and all  references  to three (3) years within  Section 1.3 are hereby
amended to read five (5) years.

         2. The  Executive's  Salary as defined in Section 2.1 of the  Agreement
shall be Seven Hundred Fifty Thousand  Dollars  ($750,000) and all references to
Five Hundred Thousand Dollars  ($500,000)  within Section 2.1 are hereby amended
to read Seven Hundred Fifty Thousand Dollars ($750,000).

         3.  Within  Section 2.2 of the  Agreement  concerning  the  Executive's
Bonus,  all  references to "cash" are hereby  amended to read "cash or shares of
the Company's common stock pursuant to the Company's Cash Bonus Replacement Plan
or any combination thereof."

         4. The  following  Section  2.3(g) shall be added to Section 2.3 of the
Agreement:

         "(g)  Executive  shall be  eligible  to  participate  in the  Company's
         Supplemental Executive Retirement Plan (SERP)."
<PAGE>
         5. The  definition of "Good  Reason" as set forth in Section  3.3(a) of
the Agreement is amended by adding a subparagraph (4) thereto as follows:

                  "(4) the  relocation  of the  Executive  to an office which is
         more than fifteen (15) miles from his then principal residence."

         6. The first two (2)  sentences of Section  3.4(a) of the Agreement are
amended to read in their entirety as follows:

                  "If the  Executive  resigns for Good Reason,  or is terminated
         without  Cause,  or if the Company  gives the  Executive  notice of its
         intention not to extend the Term,  in  accordance  with Article II, the
         Company shall cause to become fully vested any of the Executive's stock
         which is then  subject to any risk of  forfeiture,  and shall  cause to
         become  fully  vested  and  immediately   exercisable  the  Executive's
         outstanding  options  which  are not  immediately  exercisable  and any
         employee benefits  (including,  without limitation,  any benefits under
         the Company's  Supplemental  Executive  Retirement Plan) which are then
         held by the  Executive,  and shall cause to lapse any  restrictions  on
         equity  held by the  Executive  which  are  scheduled  to lapse  solely
         through the passage of time (such  events  collectively  referred to as
         "Acceleration  of Equity Rights").  In addition,  the Company shall pay
         the  Executive  an amount (the  "Severance  Amount")  equal to five (5)
         times the sum of (1) his Salary; and (2) the "Bonus Amount" which shall
         be the  greatest of (i) 100% of the  Executive's  Salary in the year of
         termination,  (ii) the Executive's  Bonus in the immediately  preceding
         calendar  year,  or (iii) the  Executive's  Bonus in the calendar  year
         which was immediately prior to the year immediately  preceding the year
         of termination."

         7. The second  paragraph  of  Section  3.4(a) of the  Agreement  (which
paragraph  begins with the phrase "In addition  ...") is amended by changing all
references  to thirty-six  (36) months to sixty (60) months and changing  clause
(ii) thereof to read in its entirety as follows:

                  "(ii) the right to continue to occupy and utilize,  at no cost
         to the  Executive,  for a period of sixty  (60)  months  following  the
         effective date of the Executive's  termination,  the  Executive's  then
         current Company office space with office equipment and furnishings,  or
         any other office space with office  equipment and  furnishings,  all of
         which are  comparable  to that provided to the Executive at the time of
         his termination and which is reasonably acceptable to the Executive;"

         8. The said second  paragraph  of Section  3.4(a) of the  Agreement  is
further amended by adding thereto a clause (v) as follows:


                                       -2-
<PAGE>

                  "(v) the  right,  but not the  obligation,  on the part of the
         Executive  to  purchase  from the  Company  the  Pilatus  C12  aircraft
         currently  owned  by the  Company,  or any  other  plane  owned  by the
         Company, at a price equal to the then book value of such aircraft,  and
         to lease or  purchase  from the  Company  at a fair  market  rental  or
         acquire  at  book  value  the  hangar   space   currently   under  such
         construction for such aircraft at the Naples, Florida, airport;"

         9. The said second  paragraph  of Section  3.4(a) of the  Agreement  is
further amended by adding thereto a clause (vi) as follows:

                  "(vi) the right,  but not the obligation,  to acquire from the
         Company,  for  no  additional  consideration,   an  assignment  of  the
         Company's  leasehold  interest  in the fourth  and fifth  floors of the
         Company's  offices  located at 8889 Pelican Bay  Boulevard,  Suite 500,
         Naples,  Florida 33963, in which event the Executive will assume all of
         the Company's obligations arising in respect of such leasehold interest
         from and after the date of such  assignment,  provided that the Company
         will  continue  to pay the rent and other  expenses  pertaining  to the
         Executive's  office,  equipment,  and  furnishings  in accordance  with
         clause (ii) above."

         10. Within Section 3.4(b)  concerning  excise tax on "excess  parachute
payments,"  the reference to  "three-quarters  (3/4)" is hereby  amended to read
"one-hundred percent (100%)."

         11.  Section  3.4(b) of the  Agreement  is  further  amended  by adding
thereto the following:


                  "To effect this  indemnification,  the  Company  shall pay the
                  Executive an  additional  amount that is sufficient to pay any
                  excise tax  imposed on the  Executive  by Section  4999 of the
                  Code,  plus the excise  tax,  income tax  (federal,  state and
                  local),  employment taxes and medicare  hospitalization  taxes
                  imposed  on  the   Executive  on  account  of  the   Company's
                  indemnification  payments. The determination of any additional
                  amount  that must be paid under this  section  must be made by
                  the Company in good faith."


         12. All capitalized terms within this Amendment shall have the meanings
set forth in the Agreement.

         13. The  amendments  contained  herein are the only  amendments  to the
Agreement and all other  provisions of the Agreement  shall remain in full force
and effect.


                                      -3-
<PAGE>

         14. This  Amendment  shall be binding  upon and inure to the benefit of
the Company and the Executive and their respective heirs, legal representatives,
executors, administrators, successors and permitted assigns.

         15. This Amendment constitutes the entire agreement between the parties
and  supersedes  the  Agreement and all other prior  agreements,  either oral or
written, with respect to the provisions stated herein;  provided,  however, that
this  Agreement  does not supersede any  agreements  pertaining to stock options
which have been  previously  granted,  except to the extent that any such option
agreement  contains  provisions  which are  contrary to the  provisions  of this
Agreement (including provisions regarding the Acceleration of Equity Rights).


         IN WITNESS WHEREOF,  the Company has caused this Amendment to be signed
by its duly authorized officers and its corporate seal to be hereto affixed, and
the  Executive has hereunto set the  Executive's  hand on the day and year first
above written.

COMPANY                                               EXECUTIVE
- - -------                                               ---------
INTEGRATED HEALTH SERVICES,
INC., a Delaware corporation


By:                                                   /s/Robert N. Elkins
    -------------------------                         -------------------------

                                                      Robert N. Elkins
Name:
     ------------------------

Title:
      -----------------------



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



                                      -4-






<PAGE>




                              EMPLOYMENT AGREEMENT
                              --------------------

                  This  AGREEMENT  is made  effective as of January 1, 1994 (the
"Effective Date"), by and between  INTEGRATED HEALTH SERVICES,  INC., a Delaware
corporation  (hereinafter  referred to as the "Company"),  and LAWRENCE P. CIRKA
(hereinafter referred to as the "Executive").

                              W I T N E S S E T H:

                  WHEREAS, effective July 1, 1992, the Executive entered into an
employment agreement with the Company (the "Prior Agreement");

                  WHEREAS, the parties desire to amend and restate the
Prior Agreement;

                  WHEREAS,  Section  7.3  of the  Prior  Agreement  permits  the
parties to amend the Prior Agreement in a writing signed by both parties; and

                  WHEREAS,   the  Company  wishes  to  continue  to  employ  the
Executive and to ensure his continued services of the Executive for the Term (as
hereinafter  defined),  and the Executive  desires to continue to be employed by
the Company for upon the terms and conditions hereinafter set forth.

                  NOW, THEREFORE, in consideration of the foregoing premises and
the mutual  agreements herein  contained,  the parties,  intending to be legally
bound, hereby agree, in lieu of the Prior Agreement, as follows:

<PAGE>
                                    ARTICLE I

                             EMPLOYMENT RELATIONSHIP
                             -----------------------

                  1.1  Employment.  The Company and the Executive agree that the
Executive shall be employed as Senior Vice President and Chief Operating Officer
of the  Company;  provided,  however,  that if the  Executive is promoted to the
position of Executive Vice President, he shall hold this position in lieu of his
position as Senior Vice President. During the Term, the Executive shall have the
customary  powers,  responsibilities  and  authorities  of persons  holding  his
position  in  corporations  of the size,  type and  nature of the  Company.  The
Executive  shall  only  report  to  and be  responsible  directly  to the  Chief
Executive Officer of the Company.

                  1.2  Exclusive  Employment.  During  the Term,  the  Executive
agrees to devote his working time, on  substantially  a full-time  basis, to the
performance of his services for the Company or its  affiliates and  subsidiaries
and  to  perform  such  services  faithfully  and to the  best  of his  ability.
Notwithstanding  the  foregoing,  nothing in this  Agreement  shall preclude the
Executive from (a) engaging in charitable and community affairs, so long as they
are consistent with his duties and  responsibilities  under this Agreement,  (b)
managing his personal  investments,  and (c) subject to the consent of the Chief
Executive Officer, serving on the boards of directors of other companies.

                  1.3 Term.  Unless  sooner  terminated  pursuant to Article III
below,  the term of this  Agreement (the "Term") shall commence on the Effective
Date, and be in effect for three (3)


                                     Page 2
<PAGE>
years;  provided,  however,  that on each  January  1st  after  the date of this
Agreement  (an  "Anniversary  Date"),  the then current  term of this  Agreement
automatically  shall be extended by an additional  period of twelve (12) months,
so that, as of each  Anniversary  Date,  this Agreement  shall have an unexpired
Term of three (3) years.  Notwithstanding the foregoing, either party hereto may
elect not to so extend this  Agreement  by giving  written  notice of his or its
election to the other party hereto at least one hundred  twenty (120) days prior
to any Anniversary  Date. If the Company elects not to renew the Agreement,  the
Executive  shall be entitled to severance at the end of the Term as set forth in
Section 3.4.

                                   ARTICLE II

                                  COMPENSATION
                                  ------------

                  2.1 Salary.  The  Executive  shall receive a base salary at an
initial  rate  of  Four  Hundred  Thousand  Dollars  ($400,000)  per  year  (the
"Salary"),  payable in substantially  equal  installments in accordance with the
pay policy established by the Company from time to time, but not less frequently
than  monthly.  On each  Anniversary  Date,  the Salary  shall be  increased  or
decreased  (but  not  below  Four  Hundred  Thousand  Dollars  ($400,000)  by  a
percentage which is equal to the percentage increase or decrease, as applicable,
in the "Consumer  Price Index for All Urban  Consumers"  published by the United
States  Department  of  Labor's  Bureau  of Labor  Statistics  for the then most
recently ended 12-month period as of the date of such adjustment,  and increased
by such additional amounts as may be determined at the

                                     Page 3
<PAGE>


discretion of the Board.  Once adjusted,  such adjusted amount shall  constitute
Salary for purposes of this Agreement.

                  2.2 Bonuses.  (a) If the Company's earnings per share equal or
exceed the earnings goals set by the Board (the "Target") then, no more than ten
(10) days following the date the Company  publicly  announces its earnings,  the
Company shall pay the Executive a bonus ("Bonus") determined as follows:

                  (1) with respect to each  calendar  quarter,  if the Company's
         earnings  equal  or  exceed  the  Target,  the  Company  shall  pay the
         Executive a lump sum cash amount equal to 6- 1/4% of Salary;

                  (2) with  respect  to each  calendar  year,  if the  Company's
         earnings  equal  or  exceed  the  Target,  the  Company  shall  pay the
         Executive  a lump sum cash  amount  equal to no less than 25% of Salary
         plus an additional  6-1/4% of Salary for each quarter  within such year
         with  respect to which the  Executive  did not receive a payment  under
         paragraph (1).

                  (b)   Notwithstanding   anything  in  Section  2.2(a)  to  the
contrary, if in any calendar year the Company pays an amount with respect to the
Company's  quarterly  earnings  pursuant to Section  2.2(a)(1)  but (because the
Company's  earnings  do not equal or exceed  the Target  for the  calendar  year
containing  any of the quarters for which a payment under  Section  2.2(a)(1) is
made) the  Company  does not pay the  Executive  an amount  pursuant  to Section
2.2(a)(2), then the Company shall either treat the quarterly amounts paid to the
Executive  pursuant to Section  2.2(a)(1)  in such year as a  prepayment  of its
Salary,  Severance,  or Disability  obligations  under Sections 2.1, 3.4 or 3.5,
respectively, or,


                                     Page 4
<PAGE>

shall  require the  Executive to repay such amounts to the Company with interest
at the prime rate of Citibank, N.A.

                  2.3 Employee  Benefits and  Perquisites.  During the Term, the
Company shall provide and/or pay for employee benefits and perquisites that are,
in the aggregate,  no less favorable than the employee  benefits and perquisites
that the Executive  enjoys as of the Effective  Date, as increased  from time to
time, including, without limitation:

                  (a)  comprehensive  individual  health  insurance,   including
         dependent coverage;

                  (b) life insurance  coverage in the amount of $1,000,000,  any
         proceeds  of  which  shall be  payable  to the  Executive's  designated
         beneficiary or his estate;

                  (c) four (4) weeks paid vacation annually;

                  (d) disability  insurance coverage in a monthly benefit amount
         equal to the sum of 100% of Executive's  Salary plus "Bonus Amount" (as
         defined in Section 3.4(a));

                  (e) one-half (1/2) of the cost of dues,  assessments and other
         charges  for a full  membership  in a country  club of the  Executive's
         choice; and

                  (f) an  automobile  allowance  (including an allowance for all
         operating and maintenance  expenses) and automobile  insurance coverage
         at least equal to the allowance and coverage the Executive  receives as
         of the Effective Date, and as increased from time to time.

                  Once increased,  the level of benefits and  perquisites  shall
not be decreased without the Executive's consent.

                  2.4   Equity-based   Compensation.   During   the  Term,   the
Compensation Committee, in its complete discretion,  may select the Executive to
participate in programs or enter into agreements  which provide for the grant of
certain equity-based compensation or rights to the Executive.

                                     Page 5
<PAGE>
                                   ARTICLE III

                            TERMINATION AND SEVERANCE
                            -------------------------

                  3.1 Termination;  Nonrenewal. The Company shall have the right
to terminate the Executive's employment,  and the Executive shall have the right
to resign his employment with the Company,  at any time during the Term, for any
reason or for no stated reason,  upon no less than one hundred twenty (120) days
prior written notice (or such shorter notice to the extent provided for herein).
Upon the Executive's  termination without "Cause" (as defined in Section 3.2) or
resignation for "Good Reason" (as defined in Section 3.3) or upon the expiration
of the Term  following  the Company's  election not to renew this  Agreement (in
accordance  with Section 1.3),  the Executive  shall be entitled to severance as
set  forth  in  Section  3.4.  Upon the  Executive's  termination  for  Cause or
resignation  without  Good  Reason,  the  Executive  shall  not be  entitled  to
severance.  If the Executive's  employment is terminated  because of a Permanent
Disability (as defined in Section 3.5), the Executive shall receive the benefits
and payments described in Section 3.5.

                  3.2 Termination For Cause.  (a) The Company may terminate this
Agreement for Cause  following a determination  by the Chief  Executive  Officer
that Cause exists.  For purposes of this Agreement,  Cause shall mean any or all
of the following:

                  (i) the  Executive's  willful  and  continuing  neglect of his
         duties hereunder;

                  (ii) a material breach by the Executive of his covenants under
         Sections 4.1 or 4.2;

                  (iii) the  conviction of the Executive of a felony  (including
         the  theft,  larceny  or  embezzlement  of the  Company's  tangible  or
         intangible property).

                                     Page 6
<PAGE>
                  (b)   Notwithstanding   anything  in  Section  3.2(a)  to  the
contrary,  a termination  shall not be for Cause unless (i) the Chief  Executive
Officer  notifies the  Executive of his intention to terminate the Executive for
Cause (which  notice shall set forth the conduct  alleged to  constitute  Cause)
(the "Cause  Notice");  and (ii) the Executive does not cure his conduct (to the
reasonable  satisfaction of the Chief Executive  Officer) within sixty (60) days
after the receipt of the Cause Notice.

                  3.3  Termination  for  Good  Reason.  (a)  The  Executive  may
terminate  this  Agreement for Good Reason,  provided he gives the Company prior
written notice that Good Reason exists (the "Good Reason Notice").  For purposes
of this Agreement, Good Reason shall mean one or both of the following:

                  (1)  a  material  breach  of  the  Agreement  by  the  Company
         (including,  without  limitation,  one or more of the following without
         the Executive's prior written consent:


                           (i)  a  material   diminution   of  the   Executive's
                  responsibilities, title, authority or status,

                           (ii) the failure of the Company to pay the  Executive
                  amounts when due under this Agreement,

                           (iii) the Executive's  removal or dismissal from, the
                  position of Chief  Operating  Officer or Senior Vice President
                  of the  Company,  or if promoted to the  position of Executive
                  Vice  President,  removal or  dismissal  from the  position of
                  Executive Vice President; provided, however, that it shall not
                  be "Good Reason" if the Executive is removed from the position
                  of Senior Vice  President on the date he becomes,  or while he
                  holds the position of, Executive Vice President, and

                           (iv) a reduction in Salary or a material reduction in
                  benefits  (other  than a  reduction  in  Salary  permitted  by
                  Section 2.1); and

                  (2) the  resignation  by the Executive  within one (1) year of
         one or both of the following:

                                     Page 7

<PAGE>
                  (i) a "Change of Control", as defined in Section 3.3(b), or

                  (ii) the date the  individual who is Chief  Executive  Officer
                  and  Chairman of the Board of the Company as of the  Effective
                  Date ceases to hold such position,

         provided in the case of either (i) or (ii) that the Executive gives the
         Company at least ninety (90) days prior written notice of his intent to
         resign  and the  effective  date of such  resignation  is at least  two
         hundred seventy (270) days after the event described in (i) or (ii).

Notwithstanding the foregoing, a termination on account of a reason described in
paragraph  (1),  shall be deemed not to be for Good Reason  unless the Executive
(i) gives the Company the  opportunity to cure the condition that purports to be
Good Reason, and (ii) the Company fails to cure that condition within sixty (60)
days after the  receipt  of the Good  Reason  Notice  (or,  with  respect to the
failure to make any payment when due to the Executive within ten (10) days after
the receipt of such notice).

                  (b) For  purposes  of this  Agreement,  a "Change of  Control"
shall  be  deemed  to  occur  if  (i)  there  shall  be   consummated   (x)  any
consolidation,  reorganization  or merger of the Company in which the Company is
not the  continuing or surviving  corporation or pursuant to which shares of the
Company's  common  stock  would be  converted  into  cash,  securities  or other
property,  other  than a merger  of the  Company  in which  the  holders  of the
Company's  common  stock   immediately   prior  to  the  merger  have  the  same
proportionate ownership of common stock of the surviving corporation immediately
after the merger,  or (y) any sale,  lease,  exchange or other  transfer (in one
transaction or a series of related  transactions) of all, or

                                     Page 8
<PAGE>

substantially all, of the assets of the Company, or (ii) the stockholders of the
Company shall approve any plan or proposal for liquidation or dissolution of the
Company,  or (iii)  any  person  (as such  term is used in  Sections  13(d)  and
14(d)(2)  of the  Exchange  Act,  including  any  "group" (as defined in Section
13(d)(3) of the Exchange Act) (other than the Executive or any group  controlled
by the Executive)) shall become the beneficial owner (within the meaning of Rule
13d-3 under the Exchange Act) of 20% or more of the Company's outstanding common
stock (other than pursuant to a plan or arrangement  entered into by such person
and the Company) and such person  discloses its intent to effect a change in the
control  or  ownership  of the  Company in any filing  with the  Securities  and
Exchange Commission,  or (iv) within any twenty-four (24) month period beginning
on or after the Effective  Date,  the persons who were  directors of the Company
immediately  before the  beginning  of such period (the  "Incumbent  Directors")
shall  cease (for any reason  other than death,  disability  or  retirement)  to
constitute  at least a majority  of the Board or the board of  directors  of any
successor to the Company,  provided that, any director who was not a director as
of the  Effective  Date  shall be deemed  to be an  Incumbent  Director  if such
director  was elected to the Board by, or on the  recommendation  of or with the
approval  of,  at  least  two-thirds  of the  directors  who then  qualified  as
Incumbent  Directors  either  actually  or by prior  operation  of this  Section
3.3(b)(iv)  unless such election,  recommendation  or approval was the result of
any actual or threatened election contest of the type contemplated by 

                                     Page 9
<PAGE>
Regulation 14a-11 promulgated under the Exchange Act or any successor provision.

                  3.4 Severance.  (a) If the Executive  resigns for Good Reason,
or is terminated  without Cause, or if the Company gives the Executive notice of
its intention not to extend the Term, in accordance with Article II, the Company
shall  cause the  Executive's  outstanding  options  which  are not  immediately
exercisable to vest and become  immediately  exercisable and the restrictions on
equity held by the  Executive  which are  scheduled to lapse solely  through the
passage of time to lapse (such events collectively  referred to as "Acceleration
of Equity Rights").  In addition,  the Company shall pay the Executive an amount
(the "Severance Amount") equal to three (3) times the sum of (1) his Salary; and
(2) the "Bonus  Amount"  which  shall be  greater  of i) 50% of the  Executive's
Salary (the "Bonus Amount") in the year of  termination;  or ii) the Executive's
Bonus in the immediately preceding calendar year. Such Severance Amount shall be
payable in cash as follows:  

                  (x) no  later  than  10  days  after  the  effective  date  of
         Executive's  termination,  the Company shall pay the Executive one-half
         (1/2) of the Severance Amount in a lump sum;

                  (y)  commencing  on the first day of the month  following  the
         effective date of Executive's  termination  and on the first day of the
         month  thereafter  for a period of eighteen  (18)  months,  the Company
         shall pay the remaining  one-half (1/2) of the Severance  Amount to the
         Executive in equal monthly installments; 

                                    Page 10
<PAGE>
         provided,  however, that if the Executive's employment terminates other
         than for Cause, within one (1) year following a Change of Control,  the
         Company shall, in lieu of the making the payments  described in (x) and
         (y),  pay the  Executive  the  Severance  Amount  in one  lump sum cash
         payment  within ten (10) days after the effective  date of  Executive's
         termination.

                  In addition,  for a period of thirty-six (36) months following
the effective  date of the  Executive's  termination,  the Company shall provide
continued employee benefits and coverage for the Executive and his dependents of
the type and at a level of coverage  comparable to the coverage in effect at the
time of termination  ("Continued Benefits") and shall provide the Executive with
the following  additional  benefits:  (i) secretarial  services  provided by the
Executive's  secretary at the time of his  termination  or a secretary  with the
same skill and experience as such secretary, who is reasonably acceptable to the
Executive; (ii) office space with office equipment and furnishings, all of which
are comparable to that provided to the Executive at the time of his termination;
and (iii) a continued automobile allowance (including an allowance for operating
and maintenance  expenses) and continued automobile insurance coverage,  in both
cases,  at a level,  which is not less than the allowance and coverage in effect
on the effective date of Executive's termination. Notwithstanding the foregoing,
if any of the Continued Benefits or other benefits to be provided hereunder have
been decreased or otherwise  negatively affected within twelve (12) months prior
to the  effective  date  of  the  Executive's  termination,  the  reference  for
measuring such benefit

                                    Page 11
<PAGE>
shall  be the  date  prior  to  such  reduction  rather  than  the  date of such
termination.

                  (b) If the Executive is required,  pursuant to Section 4999 of
the  Internal  Revenue  Code of 1986,  as amended  (the  "Code") to pay (through
withholding  or  otherwise)  an excise tax on  "excess  parachute  payments"  as
defined  in  Section  280G of the Code,  the  Company  shall  pay the  Executive
three-quarters  (3/4) ofthe  amount or amounts  that are  necessary to place the
Executive in the same after-tax financial position that he would have been in if
he had not incurred any tax liability under Section 4999 of the Code.

                  3.5 Termination for Disability.  (a) The Company may terminate
the Executive  following a determination by the Chief Executive Officer that the
Executive  has  a  Permanent  Disability;   provided,   however,  that  no  such
termination  shall be effective (i) prior to the expiration of the six (6) month
period  following the date the Executive  first incurred the condition  which is
the  basis  for the  Permanent  Disability  or (ii) if the  Executive  begins to
substantially perform the significant aspects of his regular duties prior to the
proposed  effective date of such  termination.  For purposes of this  Agreement,
"Permanent  Disability" shall mean the Executive's  inability,  by reason of any
physical or mental impairment,  to substantially perform the significant aspects
of his regular duties,  as  contemplated  by this Agreement,  which inability is
reasonably  contemplated  to  continue  for at  least  one  (1)  year  from  its
incurrence  and at  least  ninety  (90)  days  from  the  effective  date of the
Executive's  termination.   Any  question  as  to  the  existence,   extent,  or

                                    Page 12
<PAGE>
potentiality of the Executive's  Permanent  Disability  shall be determined by a
qualified  independent physician selected by the Executive (or, if the Executive
is  unable  to make  such  selection,  by an  adult  member  of the  Executive's
immediate family) and reasonably acceptable to the Company.

                  (b) If the  Executive is  terminated  because of his Permanent
Disability, the Company shall provide for the Acceleration of Equity Rights and,
the  Company  shall,  (i) for a period  of  thirty  (30)  months  following  the
effective date of such termination  (the "Disability  Period") pay the Executive
one  hundred  (100%)  percent of his Salary  plus  Bonus  Amount,  offset by the
amount,  if any, paid to the Executive under the salary  replacement  portion of
disability  benefits  paid  under a  disability  plan or policy  paid for by the
Company;  and (ii) provide him with  Continued  Benefits  during the  Disability
Period.

                  3.6  Death  or  Disability  After   Termination.   Should  the
Executive die or become  disabled before receipt of any or all payments to which
the  Executive  is  entitled  to  under  Section  3.4  (or  in the  case  of the
Executive's death following his termination on account of Permanent  Disability,
before  receipt  of all  payments  under  Section  3.5) then the  balance of the
payments  to which the  Executive  is  entitled  shall  continue  to paid to the
Executive (in the case of his disability) or to the executors or  administrators
of the  Executive's  estate (in the event of the Executive's  death);  provided,
however, that the Company may, at any time within its discretion, accelerate any
payments and pay the  Executive or his estate the present value of such payments
in 

                                    Page 13
<PAGE>
a lump sum cash  payment.  For purposes of  determining  the present value under
this Section 3.6, the interest rate shall be the prime rate of Citibank, N.A.

                                   ARTICLE IV

                           COVENANTS OF THE EXECUTIVE
                           --------------------------

                  4.1   Confidential   Information.   In  connection   with  his
employment  at the  Company,  the  Executive  will have  access to  confidential
information   consisting  of  some  or  all  of  the  following   categories  of
information:

                  (a)  Financial  Information,  including  but  not  limited  to
         information relating to the Company's earnings,  assets, debts, prices,
         pricing structure, volume of purchases or sales or other financial data
         whether related to the Company or generally, or to particular products,
         services, geographic areas, or time periods;

                  (b) Supply and Service Information,  including but not limited
         to  information  relating to goods and  services,  suppliers'  names or
         addresses,  terms of  supply  or  service  contracts  or of  particular
         transactions,  or related  information about potential suppliers to the
         extent that such information is not generally known to the public,  and
         the extent that the  combination  of  suppliers  or use of a particular
         supplier, though generally known or available, yields advantages to the
         Company details of which are not generally known;

                  (c)  Marketing  Information,  including  but  not  limited  to
         information  relating to details  about  ongoing or proposed  marketing
         programs or agreements by or on behalf of the Company, sales forecasts,
         advertising  formats  and  methods or results of  marketing  efforts or
         information about impending transactions;

                  (d)  Personnel  Information,  including  but  not  limited  to
         information  relating to  employees'  personnel  or medical  histories,
         compensation   or  other  terms  of   employment   actual  or  proposed
         promotions, hirings, resignation, disciplinary actions, terminations or
         reasons  therefor,  training  methods,  performance,  or other employee
         information; and

                  (e)  Customer  Information,   including  but  not  limited  to
         information relating to past, existing or prospective customers' names,
         addresses or backgrounds,  records of agreements and prices,  proposals
         or agreements  between 

                                    Page 14
<PAGE>
         customers and the Company,  status of customers' accounts or credit, or
         related  information  about actual or prospective  customers as well as
         customer lists.

                  All of the  foregoing  are  hereinafter  referred to as "Trade
Secrets."  The  Company  and  the  Executive  consider  their  relation  one  of
confidence  with  respect  to Trade  Secrets.  Therefore,  during  and after the
employment by the Company,  regardless of the reasons that such employment ends,
the Executive agrees:

                  (aa) To hold all Trade Secrets in confidence  and not discuss,
         communicate or transmit to others,  or make any unauthorized copy of or
         use the Trade Secrets in any capacity,  position or business  except as
         it directly relates to the Executive's employment by the Company;

                  (bb) To use the Trade  Secrets only in  furtherance  of proper
         employment  related  reasons of the Company to further the interests of
         the Company;

                  (cc) To take all  reasonable  actions  that the Company  deems
         necessary or appropriate,  to prevent unauthorized use or disclosure of
         or to protect the Company's interest in the Trade Secrets; and

                  (dd) That any of the Trade  Secrets,  whether  prepared by the
         Executive or which may come into the Executive's  possession during the
         Executive's  employment  hereunder,  are and remain the property of the
         Company  and its  affiliates,  and all such  Trade  Secrets,  including
         copies  thereof,  together  with all other  property  belonging  to the
         Company  or its  affiliates,  or used in their  respective  businesses,
         shall be delivered to or left with the Company.

                  This Agreement does not apply to (i) information that by means
other than the Executive's deliberate or inadvertent disclosure becomes known to
the public; (ii) disclosure compelled by judicial or administrative  proceedings
provided the Executive  affords the Company the opportunity to obtain  assurance
that  compelled  disclosures  will  receive  confidential  treatment;  and (iii)
information  independently developed by the Executive,  the development of which
was not a breach of this Agreement.

                                    Page 15
<PAGE>

                  4.2  Non-Competition.  (a) During the Term and for a period of
two (2) years  thereafter  (or in the event of the  Executive's  termination  of
employment  other than for Cause  within one (1) year after a Change of Control,
for a period of one (1) year thereafter), the Executive agrees that he will not,
without the express  written  consent of the  Company,  for the  Executive or on
behalf of any other person,  firm,  entity or other  enterprise  (i) directly or
indirectly solicit for employment or recommend to any subsequent employer of the
Executive the solicitation for employment of any person who, at the time of such
solicitation is employed by Company or any affiliate  thereof,  (ii) directly or
indirectly  solicit,  divert,  or endeavor  to entice  away any  customer of the
Company or any affiliate  thereof,  or otherwise engage in any activity intended
to  terminate,  disrupt,  or interfere  with the  Company's  or any  affiliate's
relationship  with a customer,  supplier,  lessor or other  person,  or (iii) be
employed by, be a director, officer or manager of, act as a consultant for, be a
partner in,  have a  proprietary  interest  in, give advice to, loan money to or
otherwise  associate  with, any person,  enterprise,  partnership,  association,
corporation,  joint  venture or other entity which is directly or  indirectly in
the business of owning,  operating or managing  any (1)  healthcare  facility or
business,  including  but not  limited  to, any  subacute  healthcare  facility,
rehabilitation hospital,  nursing home, or home health care business, or (2) any
other business similar to a business which is or was owned,  operated or managed
by the Company  during the Term or during the period that this Section 4.2 shall
apply to the Executive, unless such business comprises

                                    Page 16
<PAGE>

(and has during the preceding twelve (12) month period comprised) less than five
percent (5%) of the Company's gross  revenues;  and, in the case of any facility
or business  described,  in either case,  which  competes  with any such type of
facility or business  then  operated by the Company or any of its  subsidiaries.
This  provision  shall not be construed to prohibit the Executive from owning up
to 10% of the outstanding  voting shares of the equity securities of any company
whose common stock is listed for trading on any national  securities exchange or
on the  NASDAQ  System  or  serving  as a  director  of any  such  company.  The
provisions  of this Section 4.2 shall only apply to  businesses  and  operations
located in, or otherwise conducted in, the United States.

                  4.3  Remedies  For Breach of Article IV. In the event that the
Executive  materially violates the covenants contained in this Article IV, after
his termination of employment under  circumstances which entitle him to payments
or benefits  under Section 3.4, the Company may, at its election,  upon ten (10)
days' prior  notice,  terminate  the  Severance  Period and cease  providing the
Executive  with  such  payments  and  benefits.   In  addition,   the  Executive
acknowledges  and  agrees  that  the  amount  of  damages  in the  event  of the
Executive's breach of this Article IV will be difficult,  if not impossible,  to
ascertain.  The Executive therefore agrees that the Company, in addition to, and
without  limiting any other remedy or right it may have, shall have the right to
an injunction  enjoining  any breach of the  covenants  made by the Executive in
this Article IV.

                                    Page 17
<PAGE>

                                    ARTICLE V

                            AMENDMENT AND ASSIGNMENT
                            ------------------------

                  5.1 Right of the  Executive to Assign.  The  Executive may not
assign,  transfer,  pledge or  hypothecate  or  otherwise  transfer  his rights,
obligations,  interests and benefits  under this Agreement and any attempt to do
so shall be null and void.

                  5.2  Right of  Company  to  Assign.  This  Agreement  shall be
assignable and  transferable  by the Company and any such assignment or transfer
shall inure to the benefit of and be binding upon the Executive, the Executive's
heirs and  personal  representatives,  and the  Company and its  successors  and
assigns.  The Executive agrees to execute all documents  necessary to ratify and
effectuate such assignment. An assignment of this Agreement by the Company shall
not release the Company from its monetary obligations under this Agreement.

                  5.3  Amendment/Waiver.  No  change  or  modification  of  this
Agreement  shall be valid  unless it is in writing  and  signed by both  parties
hereto.  No waiver of any provisions of this Agreement  shall be valid unless in
writing and signed by the person or party to be charged.

                                   ARTICLE VI

                                     GENERAL
                                     -------

                  6.1  Governing Law.  This Agreement shall be subject to
and governed by the laws of the State of Delaware.

                  6.2 Binding  Effect.  This Agreement shall be binding upon and
inure to the  benefit of the  Company  and the  Executive 

                                    Page 18
<PAGE>
and their respective heirs, legal  representatives,  executors,  administrators,
successors and permitted assigns.

                  6.3 Entire  Agreement.  This Agreement  constitutes the entire
agreement  between the parties and supersedes the Prior  Agreement and all other
prior agreements,  either oral or written, between the parties hereto; provided,
however,  that this Agreement  does not supersede any  agreements  pertaining to
stock options which have been granted as of the  Effective  Date,  except to the
extent that any such option agreement contains  provisions which are contrary to
the  provisions  of  this   Agreement   (including   provisions   regarding  the
Acceleration of Equity Rights).

                  6.4  Mitigation.  The  Executive  shall  not  be  required  to
mitigate  damages or the amount of any payment provided for under this Agreement
by seeking other employment or otherwise nor may any payments provided for under
this  Section be  reduced  by any  amounts  earned by the  Executive,  except as
provided in Article IV.

                  6.5 Survivorship. The respective rights and obligations of the
parties  hereunder shall survive the termination of this Agreement to the extent
necessary  to preserve  the rights and  obligations  of the  parties  under this
Agreement.

                  6.6  Notices.  All  notices,  demands,   requests,   consents,
approvals or other  communications  required or permitted  hereunder shall be in
writing and shall be delivered by hand, registered or certified mail with return
receipt requested or by a nationally  recognized  overnight delivery service, in
each case with all postage or other delivery charges prepaid, and to the address
of the party to whom it is directed as indicated below, 

                                    Page 19
<PAGE>

or to such other address as such party may specify by giving notice to the other
in  accordance  with the terms  hereof.  Any such  notice  shall be deemed to be
received (i) when delivered, if by hand, (ii) on the next business day following
timely deposit with a nationally  recognized overnight delivery service or (iii)
on the date shown on the return  receipt as  received  or refused or on the date
the postal  authorities  state that delivery cannot be accomplished,  if sent by
registered of certified mail, return receipt requested.

If to the Company:                              Integrated Health Services, Inc.
                                                10065 Red Run Boulevard
                                                Owings Mills, Maryland  21117
                                                Attn:  Robert N. Elkins

If to the Executive:                            Lawrence P. Cirka
                                                13005 Jerome Jay Drive
                                                Hunt Valley, MD  21030

         Copy to:



                  6.7 Indemnification. The Company agrees to maintain Director's
and Officer's  liability  insurance at a level not less than the level in effect
on the Effective Date, or to the extent such level is increased during the Term,
at such increased level;  provided,  however, that the level of insurance may be
decreased  with the  Executive's  consent.  To the  extent  not  covered by such
liability insurance, the Company shall indemnify and hold the Executive harmless
to the fullest extent  permitted by Delaware law against any  judgments,  fines,
amounts  paid  in  settlement  and  reasonable  expenses  (including  reasonable
attorneys'  fees),  and advance  amounts  necessary to pay the  foregoing at the
earliest time and to the fullest extent permitted by law, in connection 

                                    Page 20
<PAGE>
with any claim,  action or proceeding  (whether  civil or criminal)  against the
Executive as a result of his serving as an officer or director of the Company or
in any  capacity  at the  request of the  Company in or with regard to any other
entity,  employee benefit plan or enterprise.  This indemnification  shall be in
effect  during the Term and  thereafter  and shall be in  addition to and not in
lieu of any other indemnification rights the Executive may otherwise have.

                  6.8 Attorney's  Fees.  Upon  presentation  of an invoice,  the
Company  shall pay  directly  or  reimburse  the  Executive  for all  reasonable
attorney's fees and costs incurred by the Executive:

                  (a)  in  connection  with  the  negotiation,  preparation  and
execution of this Agreement; and

                  (b) in  connection  with any dispute  brought by the Executive
over the  terms of this  Agreement  unless  there  is a  determination  that the
Executive had no reasonable basis for his claim.

                  6.9 Arbitration.  Except as otherwise provided in Section 4.3,
any dispute or  controversy  arising under or in connection  with this Agreement
shall be settled  exclusively by arbitration,  conducted before a panel of three
arbitrators in Baltimore, Maryland, in accordance with the rules of the American
Arbitration  Association  then in effect,  and  judgement  may be entered on the
arbitrators' award in any court having  jurisdiction.  The Company shall pay all
costs of the American  Arbitration  Association and the  arbitrator.  Each party
shall  select one  arbitrator,  and the two so  designated  shall select a third
arbitrator. If either party shall fail to designate an


                                    Page 21
<PAGE>

arbitrator within seven (7) days after  arbitration is requested,  or if the two
arbitrators  shall fail to select a third  arbitrator  within fourteen (14) days
after  arbitration  is requested,  then an  arbitrator  shall be selected by the
American   Arbitration   Association   upon   application   of   either   party.
Notwithstanding the foregoing,  the Executive shall be entitled to seek specific
performance  from a court of the Executive's  right to be paid until the date of
termination  during the pendency of any dispute or controversy  arising under or
in connection with this Agreement and the Company shall have the right to obtain
injunctive relief from a court.

         6.10 Shareholder Approval. If the options granted by the Company to the
Executive  on November 22, 1993,  are not approved by  shareholders  by June 30,
1994, this Agreement shall be deemed effective with the exception of Section 4.2
(Non-Competition) which shall be replaced in its entirety by the text of Section
5.2  (Non-Competition)  of the Prior  Agreement.  The  reference  in the text of
Section  5.2 to  Article  IV shall be  changed  to  refer  to  Section  3 of the
Agreement. The amendment and restatement of this Agreement or the failure of the
shareholders, by June 30, 1994, to approve the options granted by the Company to
the Executive on November 22, 1993, in no way changes any right of the Executive
to any options granted to date.

         6.11 Severability. No provision in this Agreement if held unenforceable
shall in any way invalidate any other provisions of this Agreement, all of which
shall  remain in full force and effect  except that this  Section 6.11 shall not
apply to the extent Section 6.10 is held unenforceable.

                                    Page 22
<PAGE>

                  IN WITNESS  WHEREOF,  the Company has caused this Agreement to
be signed by its duly authorized  officers and its corporate seal to be hereunto
affixed,  and the Executive has hereunto set the Executive's hand on the day and
year first above written.



COMPANY                                              EXECUTIVE
- - -------                                              ---------

Integrated Health Services
Inc., a Delaware corporation

By: /s/ Robert N. Elkins                             /s/ Lawrence P. Cirka
    ---------------------------                      ------------------------
                                                     Lawrence P. Cirka
Name: Robert N. Elkins
      -------------------------

Title: Chief Executive Officer
       ------------------------


                                    Page 23
<PAGE>



                        AMENDMENT TO EMPLOYMENT AGREEMENT
                        ---------------------------------


                  This  AMENDMENT  is made  effective as of January 1, 1995 (the
"Effective Date"), by and between  INTEGRATED HEALTH SERVICES,  INC., a Delaware
corporation  (hereinafter  referred to as the "Company"),  and LAWRENCE P. CIRKA
(hereinafter referred to as the "Executive").

                              W I T N E S S E T H:

                  WHEREAS, effective January 1, 1994, the Executive entered into
an employment agreement with the Company (the "Agreement");

                  WHEREAS,  the parties desire to amend the Agreement;  

                  WHEREAS,  Section 5.3 of the Agreement  permits the parties to
amend the Agreement in a writing signed by both parties.

                  NOW, THEREFORE, in consideration of the foregoing premises and
the mutual  agreements herein  contained,  the parties,  intending to be legally
bound, hereby agree to amend to the Agreement as follows:

         1. The first sentence of Section 1.1 of the Agreement  shall be revised
to read as follows:  "The  Company and the  Executive  agree that the  Executive
shall be employed as President and Chief Operating Officer of the Company."

         2. The Term of the  Agreement  as defined in Section  1.3 shall be five
(5) years and all  references  to three (3) years within  Section 1.3 are hereby
amended to read five (5) years.

         3. The  Executive's  Salary as defined in Section 2.1 of the  Agreement
shall be Five Hundred Fifty  Thousand  Dollars  ($550,000) and all references to
Four Hundred Thousand

<PAGE>
Dollars  ($400,000)  within  Section 2.1 are hereby amended to read Five Hundred
Fifty Thousand Dollars ($550,000).

         4.  Within  Section 2.2 of the  Agreement  concerning  the  Executive's
Bonus,  all  references to "6-1/4%" are hereby  amended to read  "12-1/2%";  all
references  to "no less than 25%" are  hereby  amended  to read  "50%";  and all
references to "cash" are hereby amended to read "cash or shares of the Company's
common  stock  pursuant  to the  Company's  Cash Bonus  Replacement  Plan or any
combination thereof."

         5. Within  Section 2.3 of the  Agreement,  Section 2.3(e) is revised to
read as follows:  "(e) one hundred  percent (100%) of a one-time  initiation fee
and one-half (1/2) of the cost of dues, assessments and other charges for a full
membership  in a country  club of the  Executive's  choice;"  and the  following
Section  2.3(g) shall be added to Section 2.3 of the  Agreement:  "(g) Executive
shall  be  eligible  to  participate  in the  Company's  Supplemental  Executive
Retirement Plan (SERP)."

         6. The  following  paragraph is added to Section 2.4 of the  Agreement:

         "As additional compensation for the performance by the Executive of his
         services  hereunder,  the  Company  shall  grant  to the  Executive  an
         incentive  stock option to purchase  300,000  shares of common stock of
         the Company pursuant to the Company's Senior  Executives'  Stock Option
         Plan,  as amended,  or any other plan,  subject to the  approval of the
         shareholders  of  the  Company  at  the  May  1996  Annual  Meeting  of
         Shareholders  (the  "Option").  The  Option  shall  become  exercisable
         according  to the  following  schedule:  25% shall  become  exercisable
         immediately   following  shareholder  approval  and  75%  shall  become
         exercisable in equal annual  installments  over four (4) years from the
         date on which the Option was  approved by the Board of Directors of the
         Company.  The price per share for purposes of this Section 2.4 shall be
         the  price on the date on which the Board of  Directors  approves  this
         Option.  In the event  that  Executive  is  terminated  by the  Company
         without cause or the Executive  terminates this Agreement  according to
         Section  3.3,  the unvested  portion of the Option  granted  under this
         Section 2.4 shall vest immediately.  In the event that the shareholders
         do not approve the Option at the May 1996 meeting, the

                                        2

<PAGE>
         Company  shall give  Executive a similar  economic  incentive  of equal
         value to be mutually agreed upon by Executive and the Company."

         7. The following  sentence is hereby added to the end of Section 1.2 of
the  Agreement:  "Subject  to the  consent of the Chief  Executive  Officer  and
subject to the  limitations  of Section 4.2, from time to time the Executive may
furnish services to other companies, provided that furnishing such services does
not materially interfere with his duties hereunder."

         8. The fist two (2)  sentences of Section  3.4(a) of the  Agreement are
amended to read in their entirety as follows:

                  "If the  Executive  resigns for Good Reason,  or is terminated
         without  Cause,  or if the Company  gives the  Executive  notice of its
         intention not to extend the Term,  in  accordance  with Article II, the
         Company shall cause to become fully vested and immediately  exercisable
         the   Executive's   outstanding   options  which  are  not  immediately
         exercisable and any employee benefits  (including,  without limitation,
         any benefits  under the  Company's  Supplemental  Executive  Retirement
         Plan)  which are then held by the  Executive,  and shall cause to lapse
         any restrictions on equity held by the Executive which are scheduled to
         lapse  solely  through  the passage of time (such  events  collectively
         referred to as  "Acceleration  of Equity  Rights").  In  addition,  the
         Company  shall pay the  Executive  an amount (the  "Severance  Amount")
         equal to five (5) times the sum of (1) his  Salary;  and (2) the "Bonus
         Amount"  which  shall be the  greatest  of (i) 100% of the  Executive's
         Salary in the year of termination,  (ii) the  Executive's  Bonus in the
         immediately  preceding calendar year, or (iii) the Executive's Bonus in
         the calendar year which was immediately  prior to the year  immediately
         preceding the year of termination."

         9. Within  Section 3.4 (a) concerning  Severance,  the reference in the
second  paragraph to  "thirty-six  (36) months" is hereby amended to read "sixty
(60) months."

         10. Within Section 3.4 (b) concerning  excise tax on "excess  parachute
payments,"  the reference to  "three-quarters  (3/4)" is hereby  amended to read
"one-hundred percent (100%)."

                                        3
<PAGE>
         11.  Section  3.4 (b) of the  Agreement  is  further  amended by adding
thereto the following:

         "To effect this indemnification, the Company shall pay the Executive an
         additional  amount that is  sufficient to pay any excise tax imposed on
         the Executive by Section 4999 of the Code,  plus the excise tax, income
         tax  (federal,   state  and  local),   employment  taxes  and  medicare
         hospitalization  taxes  imposed  on the  Executive  on  account  of the
         Company's indemnification payments. The determination of any additional
         amount that must be paid under this section must be made by the Company
         in good faith."


         12. The last  sentence of Section 4.2 of the Agreement is struck in its
entirety and the following  new sentence is added in its place:  "Subject to the
provisions of Section 1.2, this provision shall not be construed to prohibit the
Executive from (i) acting as an employee, director, or consultant for, or owning
more than 10% of, the  outstanding  voting shares of the equity  securities  of,
Speciality  Care PLC  ("Speciality  Care") or  Community  Care of America,  Inc.
("Community Care"), or (ii) owning up to 10% of the outstanding voting shares of
the equity securities of any company whose common stock is listed for trading on
any national  securities  exchange or on the NASDAQ System or (iii) serving as a
director  of any  company  which is not  directly  in the  business  of  owning,
operating or managing any subacute  healthcare  facility  (other than Speciality
Care or Community Care)."

         13. All capitalized terms within this Amendment shall have the meanings
set forth in the Agreement.

         14. The  amendments  contained  herein are the only  amendments  to the
Agreement and all other  provisions of the Agreement  shall remain in full force
and effect.

                                        4
<PAGE>
         15. This  Amendment  shall be binding  upon and inure to the benefit of
the Company and the Executive and their respective heirs, legal representatives,
executors, administrators, successors and permitted assigns.

         16. This Amendment constitutes the entire agreement between the parties
and  supersedes  the  Agreement and all other prior  agreements,  either oral or
written, with respect to the provisions stated herein;  provided,  however, that
this  Agreement  does not supersede any  agreements  pertaining to stock options
which have been  previously  granted,  except to the extent that any such option
agreement  contains  provisions  which are  contrary to the  provisions  of this
Agreement (including provisions regarding the Acceleration of Equity Rights).

         IN WITNESS WHEREOF,  the Company has caused this Amendment to be signed
by its duly authorized  officers and its corporate seal to be hereunto  affixed,
and the  Executive  has  hereunto set the  Executive's  hand on the day and year
first above written.

COMPANY                                                   EXECUTIVE
- - -------                                                   ---------

Integrated Health Services, Inc.,
a Delaware corporation

By: /s/ Robert Elkins                                     /s/ Lawrence P. Cirka
   ---------------------------                            ---------------------
                                                          Lawrence P. Cirka
Name: Robert Elkins
      ------------------------

Title: Chairman & CEO
      ------------------------


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


                                        5
<PAGE>


                              EMPLOYMENT AGREEMENT
                              --------------------

         This  AGREEMENT is made effective as of October,  1995 (the  "Effective
Date"), by and between INTEGRATED HEALTH SERVICES,  INC., a Delaware corporation
(hereinafter referred to as the "Company"), and C. CHRISTIAN WINKLE (hereinafter
referred to as the "Executive").

                              W I T N E S S E T H:

         WHEREAS,  the Company  wishes to employ the Executive and to ensure the
continued services of the Executive for the Term (as hereinafter  defined),  and
the  Executive  desires to be employed  by the  Company for such Term,  upon the
terms and conditions hereinafter set forth.

         NOW,  THEREFORE,  in  consideration  of the  foregoing  premise and the
mutual agreements herein contained, the parties,  intending to be legally bound,
hereby agree as follows:
                                    ARTICLE I

                             EMPLOYMENT RELATIONSHIP
                             -----------------------

         1.1  Employment.  The  Company  hereby  employs  the  Executive  in the
position of  Executive  Vice  President - Operations  of the Company,  with such
responsibilities  as may be  assigned  to  Executive  from  time  to time by the
Company's Chief Executive  Officer and/or  President.  Executive shall report to
and be  responsible  to the  individual  who is Chief  Executive  Officer and/or
President of the Company for the period hereinafter set forth, and the Executive
hereby accepts such employment.

         During the Term,  the Executive  agrees to devote all such working time
as is  reasonably  required  for the  discharge of his duties  hereunder  and to
perform such services faithfully and to

<PAGE>
the  best  of his  ability.  Notwithstanding  the  foregoing,  nothing  in  this
Agreement  shall  preclude the  Executive  from (a) engaging in  charitable  and
community  affairs,  so  long  as  they  are  consistent  with  his  duties  and
responsibilities  under this Agreement,  (b) managing his personal  investments,
and (c) serving on the boards of directors of other  companies  with the consent
of the President or the individual to whom the Executive reports.

         1.2 Term. Unless sooner  terminated  pursuant to Article III below, the
term of this Agreement (the "Term") shall commence on the Effective Date, and be
in effect for three (3) years; provided,  however, that on each anniversary date
of this  Agreement  (an  "Anniversary  Date"),  the  then  current  term of this
Agreement automatically shall be extended by an additional period of twelve (12)
months,  so that, as of each  Anniversary  Date,  this  Agreement  shall have an
unexpired Term of three (3) years.  Notwithstanding the foregoing,  either party
hereto may elect not to so extend this Agreement by giving written notice of his
or its election to the other party hereto at least one hundred twenty (120) days
prior to any Anniversary Date. In the event the Company elects not to renew this
Agreement with appropriate  notice as provided  herein,  the Company may buy out
the  remaining  term of the  Agreement  through the payment of  severance to the
Executive as provided in Section 3.4.

                                   ARTICLE II

                                  COMPENSATION
                                  ------------

         2.1 Salary.  The  Executive  shall  receive a base salary at an initial
rate of Three  Hundred  Thousand  Dollars  ($300,000)  per year (the  "Salary"),
payable in  substantially  equal  installments in accordance with the pay policy
established  by the  Company  from time to time,  but not less  frequently  than
monthly. On each Anniversary Date, the Salary shall be increased or decreased

                                      - 2 -
<PAGE>
(but not below Three Hundred Thousand Dollars  ($300,000)) by a percentage which
is equal to the percentage increase or decrease, as applicable, in the "Consumer
Price Index for All Urban Consumers"  published by the United States  Department
of Labor's  Bureau of Labor  Statistics  for the then most recently ended twelve
(12)  month  period as of the date of such  adjustment,  and  increased  by such
additional amounts as may be determined at the discretion of the Chief Executive
Officer or the President.  Once adjusted,  such adjusted amount shall constitute
Salary for purposes of this Agreement.

         2.2      Bonuses.
                  -------

                  (a) The Company shall pay  Executive a one-time  signing bonus
in the amount of Forty  Thousand  Dollars  ($40,000)  upon the execution of this
Agreement.

                  (b) If the  Company's  earnings  per share equal or exceed the
earnings goals set by the Board (the "Target"),  then no more than ten (10) days
following the date the Company  publicly  announces  its  earnings,  the Company
shall pay the Executive a discretionary bonus ("Bonus") based on the Executive's
performance,  benefit  to the  Company  at  large,  and the  extent to which the
Company equals or exceeds the Target.  Such Bonus shall be discretionary  except
that if the  Company's  earnings  per share  equal or exceed the Target then the
Executive  shall receive a bonus of not less than  twenty-five  percent (25%) of
his salary.

         2.3 Executive  Benefits and  Perquisites.  During the Term, the Company
shall provide and/or pay for employee  benefits and perquisites that are, in the
aggregate, no less favorable than the employee benefits and perquisites that the
Executive  enjoys as of the  Effective  Date,  as  increased  from time to time,
including, without limitation:

                  (a)  comprehensive  individual  health  insurance,   including
dependent coverage;

                                      - 3 -
<PAGE>
                  (b) life  insurance  coverage  in the  amount of Five  Hundred
         Thousand  Dollars  ($500,000) any proceeds of which shall be payable to
         the Executive's designated beneficiary or his estate;

                  (c)  three (3) weeks paid vacation annually;

                  (d) disability  insurance coverage in a monthly benefit amount
         equal to the sum of 100% of Executive's  Salary plus "Bonus Amount" (as
         defined in Section 3.4(a));

                  (e) an automobile  allowance and automobile insurance coverage
         in the total amount of One Thousand  Dollars ($1,000) per month, and as
         increased from time to time.

         Once  increased,  the level of benefits  and  perquisites  shall not be
decreased without the Executive's consent.

         2.4  Equity-based  Compensation.  During  the  Term,  the  Compensation
Committee,  in its complete discretion,  may select the Executive to participate
in  programs  or enter into  agreements  which  provide for the grant of certain
equity-based compensation or rights to the Executive.

                                   ARTICLE III

                            TERMINATION AND SEVERANCE
                            -------------------------

         3.1  Termination;  Nonrenewal.  The  Company  shall  have the  right to
terminate the Executive's employment,  and the Executive shall have the right to
resign his  employment  with the Company,  at any time during the Term,  for any
reason or for no stated reason, upon no less than ninety (90) days prior written
notice (or such shorter  notice to the extent  provided  for  herein).  Upon the
Executive's   termination  without  "Cause"  (as  defined  in  Section  3.2)  or
resignation for "Good Reason" (as defined in Section 3.3) or upon the expiration
of the Term  following  the Company's  election not to renew this  Agreement (in
accordance with Section 1.3),

                                      - 4 -
<PAGE>
the  Executive  shall be entitled to severance as set forth in Section 3.4. Upon
the expiry of the term hereof,  the Executive  shall be entitled to severance as
set  forth  in  Section  3.4.  Upon the  Executive's  termination  for  Cause or
resignation  without  Good  Reason,  the  Executive  shall  not be  entitled  to
severance.  If the Executive's  employment is terminated  because of a Permanent
Disability (as defined in Section 3.5), the Executive shall receive the benefits
and payments described in Section 3.5.

         3.2      Termination For Cause.
                  ----------------------

                  (a)  The  Company  may  terminate  this  Agreement  for  Cause
following a determination by the Chief Executive Officer that Cause exists.  For
purposes of this Agreement, Cause shall mean any or all of the following:

                           (i) the  Executive  materially  fails to perform  his
                  duties hereunder;

                           (ii)  a  material  breach  by  the  Executive  of his
                  covenants under Sections 4.1 or 4.2;

                           (iii) Executive is convicted of any felony.

                           (iv) Executive commits theft, larceny or embezzlement
                  of Company's tangible or intangible property.

                  (b)   Notwithstanding   anything  in  Section  3.2(a)  to  the
contrary,  a termination shall not be for Cause unless (i) the party to whom the
Executive  reports  notifies  the  Executive,  in writing,  of his  intention to
terminate  the  Executive  for Cause  (which  notice shall set forth the conduct
alleged to constitute  Cause) (the "Cause Notice");  and (ii) the Executive does
not cure his conduct (to the  reasonable  satisfaction  of the party to whom the
Executive  reports),  within  sixty  (60) days  after the  receipt  of the Cause
Notice.

                                      - 5 -
<PAGE>
         3.3 Termination  for Good Reason.  (a) The Executive may terminate this
Agreement for Good Reason,  provided he gives the Company  prior written  notice
that Good  Reason  exists  (the "Good  Reason  Notice").  For  purposes  of this
Agreement, Good Reason shall mean one or both of the following:

                  (1)  a  material  breach  of  the  Agreement  by  the  Company
         (including,  without  limitation,  one or more of the following without
         the Executive's prior written consent:

                           (i)  a  material   diminution   of  the   Executive's
                  responsibilities, title, authority or status,

                           (ii) the failure of the Company to pay the  Executive
                  amounts when due under this Agreement,

                           (iii) the Executive's  removal or dismissal from, the
                  position of Executive Vice President - Field  Operations which
                  is not concurrent  with a promotion in title and/or  position,
                  and

                           (iv) a reduction in Salary or a material reduction in
                  benefits  (other  than a  reduction  in  Salary  permitted  by
                  Section 2.1).

                  (2) the resignation by the Executive  within one (1) year of a
         "Change of Control," as defined in Section 3.3(b).

Notwithstanding the foregoing, a termination on account of a reason described in
paragraph  (1),  shall be deemed not to be for Good Reason  unless the Executive
(i) gives the Company the  opportunity to cure the condition that purports to be
Good Reason, and (ii) the Company fails to cure that condition within sixty (60)
days after the  receipt  of the Good  Reason  Notice  (or,  with  respect to the
failure to make any payment when due to the Executive within ten (10) days after
the receipt of such notice).

         Notwithstanding any of the foregoing, if there is a "Change of Control"
as defined  hereafter,  the  Company  shall  cause the  Executive's  outstanding
options which are not

                                      - 6 -
<PAGE>
immediately  exercisable  to vest and  become  immediately  exercisable  and the
restrictions on equity held by the Executive which are scheduled to lapse solely
through the passage of time to lapse (such  events  collectively  referred to as
"Acceleration of Equity Rights").

                  (b) For  purposes  of this  Agreement,  a "Change of  Control"
shall  be  deemed  to  occur  if  (i)  there  shall  be   consummated   (x)  any
consolidation,  reorganization  or merger of the Company in which the Company is
not the  continuing or surviving  corporation or pursuant to which shares of the
Company's  common  stock  would be  converted  into  cash,  securities  or other
property,  other  than a merger  of the  Company  in which  the  holders  of the
Company's  common  stock   immediately   prior  to  the  merger  have  the  same
proportionate ownership of common stock of the surviving corporation immediately
after the merger,  or (y) any sale,  lease,  exchange or other  transfer (in one
transaction or a series of related  transactions) of all, or substantially  all,
of the assets of the  Company,  or (ii) the  stockholders  of the Company  shall
approve any plan or proposal for  liquidation or dissolution of the Company,  or
(iii) any person (as such term is used in  Sections  13(d) and  14(d)(2)  of the
Exchange  Act,  including  any "group"  (as  defined in Section  13(d)(3) of the
Exchange  Act)  (other  than  the  Executive  or  any  group  controlled  by the
Executive))  shall become the beneficial owner (within the meaning of Rule 13d-3
under  the  Exchange  Act) of  twenty  percent  (20%)  or more of the  Company's
outstanding  common stock (other than pursuant to a plan or arrangement  entered
into by such person and the  Company)  and such person  discloses  its intent to
effect a change in the  control or  ownership  of the Company in any filing with
the  Securities and Exchange  Commission,  or (iv) within any  twenty-four  (24)
month period  beginning  on or after the  Effective  Date,  the persons who were
directors of the Company  immediately  before the  beginning of such period (the
"Incumbent Directors") shall


                                      - 7 -
<PAGE>
cease (for any reason other than death,  disability or retirement) to constitute
at least a majority of the Board or the board of directors  of any  successor to
the  Company,  provided  that,  any  director  who was not a director  as of the
Effective Date shall be deemed to be an Incumbent  Director if such director was
elected to the Board by, or on the recommendation of or with the approval of, at
least  two-thirds  of the directors  who then  qualified as Incumbent  Directors
either  actually or by prior  operation of this Section  3.3(b)(iv)  unless such
election,  recommendation or approval was the result of any actual or threatened
election contest of the type contemplated by Regulation 14a-11 promulgated under
the Exchange Act or any successor provision.

         3.4  Severance.  (a) If the  Executive  resigns for Good Reason,  or is
terminated  without  Cause or at the end of the term  hereof,  or if the Company
gives  the  Executive  notice  of its  intention  not to  extend  the  Term,  in
accordance with Article II, the Company shall cause an immediate Acceleration of
Equity Rights in favor of the Executive.  In addition, the Company shall pay the
Executive an amount (the  "Severance  Amount") equal to one and one-half (1 1/2)
times the sum of (1) his Salary in the year of  Termination  or the  immediately
preceding  year,  whichever is greater;  and (2) the Bonus Amount which shall be
the greater of i) the  Executive's  Bonus in the year of  termination  or in the
immediately preceding calendar year, whichever is greater. Such Severance Amount
shall be payable in cash as follows:

                  (x) no  later  than  10  days  after  the  effective  date  of
         Executive's  termination,  the Company shall pay the Executive one-half
         (1/2) of the Severance Amount in a lump sum;

                  (y)  commencing  on the first day of the month  following  the
         effective date of Executive's  termination  and on the first day of the
         month thereafter for a period of

                                      - 8 -

<PAGE>
         eighteen  (18) months,  the Company  shall pay the  remaining  one-half
         (1/2)  of the  Severance  Amount  to the  Executive  in  equal  monthly
         installments;

provided,  however, that if the Executive's employment terminates other than for
Cause, within one (1) year following a Change of Control,  the Company shall, in
lieu of the making the payments  described in (x) and (y), pay the Executive the
Severance  Amount in one lump sum cash  payment  within  ten (10) days after the
effective date of Executive's termination.

         In  addition,  for a period  of  eighteen  (18)  months  following  the
effective  date  of the  Executive's  termination,  the  Company  shall  provide
continued employee benefits and coverage for the Executive and his dependents of
the type and at a level of coverage  comparable to the coverage in effect at the
time of  termination  or the preceding  year,  whichever is greater  ("Continued
Benefits")  including,  but not limited to those  benefits and  perquisites  set
forth in Section 2.3 hereof. Such allowances,  benefits and coverages,  etc., to
be  not  less  than  those  in  effect  on the  Effective  Date  of  Executive's
termination or the preceding  year,  whichever is greater.  Notwithstanding  the
foregoing,  if any of the  Continued  Benefits or other  benefits to be provided
hereunder have been  decreased or otherwise  negatively  affected  within twelve
(12) months prior to the  effective  date of the  Executive's  termination,  the
reference for measuring  such benefit shall be the date prior to such  reduction
rather than the date of such termination.

         3.5  Termination  for  Disability.  (a) The Company may  terminate  the
Executive  following a  determination  by the Chief  Executive  Officer that the
Executive  has  a  Permanent  Disability;   provided,   however,  that  no  such
termination  shall be effective (i) prior to the expiration of the six (6) month
period  following the date the Executive  first incurred the condition  which is
the  basis  for the  Permanent  Disability  or (ii) if the  Executive  begins to
substantially

                                      - 9 -
<PAGE>
perform the  significant  aspects of his regular  duties  prior to the  proposed
effective date of such termination.  For purposes of this Agreement,  "Permanent
Disability" shall mean the Executive's  inability,  by reason of any physical or
mental  impairment,  to  substantially  perform the  significant  aspects of his
regular duties, as contemplated by this Agreement, which inability is reasonably
contemplated  to continue for at least one (1) year from its  incurrence  and at
least ninety (90) days from the effective date of the  Executive's  termination.
Any question as to the existence,  extent,  or  potentiality  of the Executive's
Permanent  Disability shall be determined by a qualified  independent  physician
selected  by the  Executive  (or,  if the  Executive  is  unable  to  make  such
selection,  by  an  adult  member  of  the  Executive's  immediate  family)  and
reasonably acceptable to the Company.

                  (b) If the  Executive is  terminated  because of his Permanent
Disability, the Company shall provide for the Acceleration of Equity Rights and,
the Company  shall,  (i) for a period of  eighteen  (18)  months  following  the
effective date of such termination  (the "Disability  Period") pay the Executive
one  hundred  (100%)  percent of his Salary  plus  Bonus  Amount,  offset by the
amount,  if any, paid to the Executive under the salary  replacement  portion of
disability  benefits  paid  under a  disability  plan or policy  paid for by the
Company;  and (ii) provide him with  Continued  Benefits  during the  Disability
Period.

         3.6 Death or Disability After Termination.  Should the Executive die or
become  disabled before receipt of any or all payments to which the Executive is
entitled to under Section 3.4 (or in the case of the Executive's death following
his  termination  on  account of  Permanent  Disability,  before  receipt of all
payments  under  Section  3.5) then the  balance  of the  payments  to which the
Executive is entitled shall continue to be paid to the Executive (in the case of
his

                                     - 10 -
<PAGE>
disability) or to the executors or administrators of the Executive's  estate (in
the event of the Executive's death); provided, however, that the Company may, at
any time within its discretion, accelerate any payments and pay the Executive or
his estate the present value of such  payments in a lump sum cash  payment.  For
purposes of  determining  the present value under this Section 3.6, the interest
rate shall be the prime rate of Citibank, N.A.

                                   ARTICLE IV

                           COVENANTS OF THE EXECUTIVE
                           --------------------------

         4.1 Confidential Information.  In connection with his employment at the
Company, the Executive will have access to confidential  information  consisting
of some or all of the following categories of information:

                  (a)  Financial  Information,  including  but  not  limited  to
         information relating to the Company's earnings,  assets, debts, prices,
         pricing structure, volume of purchases or sales or other financial data
         whether related to the Company or generally, or to particular products,
         services, geographic areas, or time periods;

                  (b) Supply and Service Information,  including but not limited
         to  information  relating to goods and  services,  suppliers'  names or
         addresses,  terms of  supply  or  service  contracts  or of  particular
         transactions,  or related  information about potential suppliers to the
         extent that such information is not generally known to the public,  and
         the extent that the  combination  of  suppliers  or use of a particular
         supplier, though generally known or available, yields advantages to the
         Company details of which are not generally known;

                  (c)  Marketing  Information,  including  but  not  limited  to
         information  relating to details  about  ongoing or proposed  marketing
         programs or agreements by or on behalf of the Company, sales forecasts,
         advertising  formats  and  methods or results of  marketing  efforts or
         information about impending transactions;

                  (d)  Personnel  Information,  including  but  not  limited  to
         information  relating to  employees'  personnel  or medical  histories,
         compensation   or  other  terms  of  employment,   actual  or  proposed
         promotions, hirings, resignation, disciplinary actions, terminations or
         reasons  therefor,  training  methods,  performance,  or other employee
         information; and

                                     - 11 -
<PAGE>

                  (e)  Customer  Information,   including  but  not  limited  to
         information relating to past, existing or prospective customers' names,
         addresses or backgrounds,  records of agreements and prices,  proposals
         or agreements  between customers and the Company,  status of customers'
         accounts or credit, or related  information about actual or prospective
         customers as well as customer lists.

         All of the foregoing are  hereinafter  referred to as "Trade  Secrets."
The Company and the Executive  consider  their  relation one of confidence  with
respect to Trade  Secrets.  Therefore,  during and after the  employment  by the
Company,  regardless  of the reasons that such  employment  ends,  the Executive
agrees:
                           (aa) To hold all Trade Secrets in confidence  and not
                  discuss,  communicate  or  transmit  to  others,  or make  any
                  unauthorized copy of or use the Trade Secrets in any capacity,
                  position  or  business  except as it  directly  relates to the
                  Executive's employment by the Company;

                           (bb) To use the Trade Secrets only in  furtherance of
                  proper  employment  related  reasons of the Company to further
                  the interests of the Company;

                           (cc) To take all reasonable  actions that the Company
                  deems necessary or appropriate, to prevent unauthorized use or
                  disclosure  of or to protect  the  Company's  interest  in the
                  Trade Secrets; and

                           (dd) That any of the Trade Secrets,  whether prepared
                  by the  Executive  or  which  may come  into  the  Executive's
                  possession during the Executive's  employment  hereunder,  are
                  and remain the property of the Company and its affiliates, and
                  all such Trade Secrets,  including  copies  thereof,  together
                  with  all  other  property  belonging  to the  Company  or its
                  affiliates,  or used in their respective businesses,  shall be
                  delivered to or left with the Company.

         This  Agreement does not apply to (i)  information  that by means other
than the Executive's  deliberate or inadvertent  disclosure becomes known to the
public;  (ii)  disclosure  compelled by judicial or  administrative  proceedings
provided the Executive  affords the Company the opportunity to obtain  assurance
that compelled disclosures will receive confidential treatment; and


                                     - 12 -
<PAGE>

(iii) information  independently developed by the Executive,  the development of
which was not a breach of this Agreement.

         4.2  Non-Competition.  (a) During the Term and for a period of eighteen
(18)  months  thereafter  (or in the  event of the  termination  of  Executive's
employment  under any  provision  herein  within  one (1) year after a Change of
Control, for a period of one (1) year thereafter),  the Executive agrees that he
will not, without the express written consent of the Company,  for the Executive
or on behalf of any other person,  firm, entity or other enterprise (i) directly
or indirectly solicit for employment or recommend to any subsequent  employer of
the Executive the  solicitation for employment of any person who, at the time of
such solicitation is employed by Company or any affiliate thereof, (ii) directly
or indirectly  solicit,  divert,  or endeavor to entice away any customer of the
Company or any affiliate  thereof,  or otherwise engage in any activity intended
to  terminate,  disrupt,  or interfere  with the  Company's  or any  affiliate's
relationship  with a customer,  supplier,  lessor or other  person,  or (iii) be
employed by, be a director, officer or manager of, act as a consultant for, be a
partner in,  have a  proprietary  interest  in, give advice to, loan money to or
otherwise  associate  with, any person,  enterprise,  partnership,  association,
corporation,  joint  venture or other entity which is directly or  indirectly in
the business of owning,  operating or managing  any (1)  healthcare  facility or
business,  including  but not  limited  to, any  subacute  healthcare  facility,
rehabilitation hospital,  nursing home, or home health care business, or (2) any
other business similar to a business which is or was owned,  operated or managed
by the Company  during the Term or during the period that this Section 4.2 shall
apply to the  Executive,  unless  such  business  comprises  (and has during the
preceding twelve (12) month period comprised) less than five percent (5%) of the
Company's gross revenues; and, in the case


                                     - 13 -
<PAGE>

of any facility or business  described,  in either case, which competes with any
such type of  facility or  business  then  operated by the Company or any of its
subsidiaries.  This  provision  shall not be construed to prohibit the Executive
from owning up to 10% of the outstanding  voting shares of the equity securities
of any  company  whose  common  stock is  listed  for  trading  on any  national
securities exchange or on the NASDAQ System or serving as a director of any such
company.  The  provisions of this Section 4.2 shall only apply to businesses and
operations located in, or otherwise conducted in, the United States.

         4.3 Remedies For Breach of Article IV. In the event that the  Executive
materially  violates  the  covenants  contained  in this  Article IV,  after his
termination of employment under  circumstances  which entitle him to payments or
benefits  under  Section 3.4, the Company  may, at its  election,  upon ten (10)
days' prior  notice,  terminate  the  Severance  Period and cease  providing the
Executive  with  such  payments  and  benefits.   In  addition,   the  Executive
acknowledges  and  agrees  that  the  amount  of  damages  in the  event  of the
Executive's breach of this Article IV will be difficult,  if not impossible,  to
ascertain.  The Executive therefore agrees that the Company, in addition to, and
without  limiting any other remedy or right it may have, shall have the right to
an injunction  enjoining  any breach of the  covenants  made by the Executive in
this Article IV.

                                     - 14 -
<PAGE>
                                    ARTICLE V

                            AMENDMENT AND ASSIGNMENT
                            ------------------------

         5.1 Right of the  Executive to Assign.  The  Executive  may not assign,
transfer,  pledge or hypothecate or otherwise transfer his rights,  obligations,
interests  and benefits  under this  Agreement and any attempt to do so shall be
null and void.

         5.2 Right of Company to Assign.  This Agreement shall be assignable and
transferable  by the Company and any such  assignment or transfer shall inure to
the benefit of and be binding  upon the  Executive,  the  Executive's  heirs and
personal  representatives,  and the Company and its successors and assigns.  The
Executive  agrees to execute all  documents  necessary to ratify and  effectuate
such  assignment.  An  assignment  of this  Agreement  by the Company  shall not
release the Company from its monetary obligations under this Agreement.

         5.3 Amendment/Waiver. No change or modification of this Agreement shall
be valid unless it is in writing and signed by both parties hereto. No waiver of
any provisions of this Agreement  shall be valid unless in writing and signed by
the person or party to be charged.

                                   ARTICLE VI

                                     GENERAL
                                     -------

         6.1 Governing Law. This  Agreement  shall be subject to and governed by
the laws of the State of Maryland.

         6.2 Binding  Effect.  This Agreement shall be binding upon and inure to
the benefit of the Company and the Executive and their respective  heirs,  legal
representatives, executors, administrators, successors and permitted assigns.


                                     - 15 -
<PAGE>
         6.3 Entire Agreement.  This Agreement  constitutes the entire agreement
between the  parties  and  supersedes  the Prior  Agreement  and all other prior
agreements,  either oral or  written,  between  the  parties  hereto;  provided,
however,  that this Agreement  does not supersede any  agreements  pertaining to
stock options which have been granted as of the  Effective  Date,  except to the
extent that any such option agreement contains  provisions which are contrary to
the  provisions  of  this   Agreement   (including   provisions   regarding  the
Acceleration of Equity Rights).

         6.4 Mitigation. The Executive shall not be required to mitigate damages
or the amount of any payment  provided for under this Agreement by seeking other
employment or otherwise nor may any payments  provided for under this Section be
reduced by any amounts  earned by the  Executive,  except as provided in Article
IV.

         6.5 Survivorship.  The respective rights and obligations of the parties
hereunder  shall  survive  the  termination  of  this  Agreement  to the  extent
necessary  to preserve  the rights and  obligations  of the  parties  under this
Agreement.

         6.6 Notices. All notices,  demands,  requests,  consents,  approvals or
other  communications  required or permitted  hereunder  shall be in writing and
shall be delivered by hand,  registered  or certified  mail with return  receipt
requested or by a nationally recognized overnight delivery service, in each case
with all postage or other delivery  charges  prepaid,  and to the address of the
party to whom it is directed as  indicated  below,  or to such other  address as
such party may  specify  by giving  notice to the other in  accordance  with the
terms hereof. Any such notice shall be deemed to be received (i) when delivered,
if by hand,  (ii) on the next  business  day  following  timely  deposit  with a
nationally  recognized  overnight delivery service or (iii) on the date shown on
the return receipt as received or refused or on the date the postal


                                     - 16 -
<PAGE>
authorities state that delivery cannot be accomplished, if sent by registered of
certified mail, return receipt requested.

         If to the Company:                     Integrated Health Services, Inc.
                                                10065 Red Run Boulevard
                                                Owings Mills, Maryland  21117
                                                Attn:  Lawrence P. Cirka

         If to the Executive:                   C. Christian Winkle
                                               -----------------------------
                                               -----------------------------

         6.7  Indemnification.  The Company  agrees to maintain  Director's  and
Officer's  liability  insurance  at a level not less than the level in effect on
the Effective Date, or to the extent such level is increased during the Term, at
such  increased  level;  provided,  however,  that the level of insurance may be
decreased  with the  Executive's  consent.  To the  extent  not  covered by such
liability insurance, the Company shall indemnify and hold the Executive harmless
to the fullest extent  permitted by Delaware law against any  judgments,  fines,
amounts  paid  in  settlement  and  reasonable  expenses  (including  reasonable
attorneys'  fees),  and advance  amounts  necessary to pay the  foregoing at the
earliest time and to the fullest extent permitted by law, in connection with any
claim, action or proceeding (whether civil or criminal) against the Executive as
a result of his  serving  as an  officer or  director  of the  Company or in any
capacity at the  request of the  Company in or with regard to any other  entity,
employee  benefit plan or enterprise.  This  indemnification  shall be in effect
during the Term and  thereafter  and shall be in  addition to and not in lieu of
any other indemnification rights the Executive may otherwise have.

         6.8 Attorneys' Fees. Upon presentation of an invoice, the Company shall
pay directly or reimburse the Executive for all reasonable  attorneys'  fees and
costs incurred by the Executive:


                                     - 17 -
<PAGE>
                  (a)  in  connection  with  the  negotiation,  preparation  and
         execution of this Agreement; and

                  (b) in  connection  with any dispute  brought by the Executive
         over the terms of this Agreement  unless there is a determination  that
         the Executive had no reasonable basis for his claim.

         6.9  Arbitration.  Except as  otherwise  provided in Section  4.3,  any
dispute or controversy  arising under or in connection with this Agreement shall
be  settled  exclusively  by  arbitration,  conducted  before  a panel  of three
arbitrators in Baltimore, Maryland, in accordance with the rules of the American
Arbitration  Association  then in effect,  and  judgement  may be entered on the
arbitrators' award in any court having  jurisdiction.  The Company shall pay all
costs of the American  Arbitration  Association and the  arbitrator.  Each party
shall  select one  arbitrator,  and the two so  designated  shall select a third
arbitrator.  If either party shall fail to designate an arbitrator  within seven
(7) days after arbitration is requested, or if the two arbitrators shall fail to
select a third  arbitrator  within  fourteen  (14)  days  after  arbitration  is
requested,  then an  arbitrator  shall be selected by the  American  Arbitration
Association upon application of either party. Notwithstanding the foregoing, the
Executive  shall be entitled to seek  specific  performance  from a court of the
Executive's  right to be paid until the date of termination  during the pendency
of any dispute or controversy arising under or in connection with this Agreement
and the Company shall have the right to obtain injunctive relief from a court.

         6.10 Severability. No provision in this Agreement if held unenforceable
shall in any way invalidate any other provisions of this Agreement, all of which
shall remain in full force and effect.


                                     - 18 -
<PAGE>
         IN WITNESS WHEREOF,  the Company has caused this Agreement to be signed
by its duly authorized  officers and its corporate seal to be hereunto  affixed,
and the  Executive  has  hereunto set the  Executive's  hand on the day and year
first above written.

COMPANY                                               EXECUTIVE
- - -------                                               ---------

Integrated Health Services, Inc.,
a Delaware corporation

By:  /s/ Lawrence P. Cirka                            /s/ C. Christian Winkle
     ----------------------------                     -------------------------
                                                      C. Christian Winkle
Name:  Lawrence P. Cirka
      ---------------------------
Title: President & C.O.O
      ---------------------------

                                     - 19 -
<PAGE>

                        AMENDMENT TO EMPLOYMENT AGREEMENT
                        ---------------------------------


                  This  AMENDMENT  is made  effective as of January 1, 1996 (the
"Effective Date"), by and between  INTEGRATED HEALTH SERVICES,  INC., a Delaware
corporation  (hereinafter  referred  to as the  "Company"),  and  DENNIS  CAHILL
(hereinafter referred to as the "Executive").

                              W I T N E S S E T H:

                  WHEREAS, effective January 1, 1994, the Executive entered into
an employment agreement with the Company (the "Agreement");

                  WHEREAS,  the parties desire to amend the Agreement;  WHEREAS,
                  Section 5.3 of the Agreement permits the parties to amend the
Agreement in a writing signed by both parties.

                  NOW, THEREFORE, in consideration of the foregoing premises and
the mutual  agreements herein  contained,  the parties,  intending to be legally
bound, hereby agree to amend to the Agreement as follows:

         1. The  Executive's  title as set forth in Section 1.1 of the Agreement
is hereby amended to be: Executive Vice President - Mergers and Acquisitions.

         2.  Section 1.1 of the  Agreement  is further  amended to read that the
Executive  shall  report to and shall be assigned  his  responsibilities  by the
Chief Executive Officer of the Company.

         3. The  Executive's  Salary as defined in Section 2.1 of the  Agreement
shall be Three Hundred Forty Thousand  Dollars  ($340,000) and all references to
Two Hundred Twenty-

<PAGE>


Five Thousand Dollars  ($225,000)  within Section 2.1 are hereby amended to read
Three Hundred Forty Thousand Dollars ($340,000).

         4. The following  Sections  2.3(g) and 2.3(h) are hereby inserted after
Section  2.3(f)  of the  Agreement:  "(g)  one  hundred  percent  of a  one-time
initiation  fee for  membership at the Caves Valley Golf Club, the membership of
which shall be in the name of the  Executive and shall be the  Executive's  upon
termination of this Agreement."

                           (h) Executive shall be eligible to participate in and
shall continue to participate in the Company's Supplemental Executive Retirement
Plan (SERP)."

         5. Section 3.1 of the  Agreement is hereby  deleted in its entirety and
the following Section 3.1 is inserted in its place:

                  "3.1 Termination; Nonrenewal. The Company shall have the right
                  to terminate  the  Executive's  employment,  and the Executive
                  shall  have  the  right  to  resign  his  employment  with the
                  Company, at any time during the Term, for any reason or for no
                  stated  reason,  upon no less  than  ninety  (90)  days  prior
                  written notice (or such shorter notice to the extent  provided
                  for herein). Upon the Executive's  termination without "Cause"
                  (as defined in Section 3.2) or  resignation  for "Good Reason"
                  (as defined in Section 3.3) or upon the expiration of the Term
                  following the Company's  election not to renew this  Agreement
                  (in  accordance  with Section  1.3),  the  Executive  shall be
                  entitled to severance  as set forth in Section  3.4.  Upon the
                  Executive's  termination  for  Cause  or  expiry  of the  term
                  hereof,  the  Executive  shall be entitled to severance as set
                  forth in Section 3.4. Upon the Executive's resignation without
                  Good Reason, the Executive shall not be entitled to severance.
                  If the  Executive's  employment  is  terminated  because  of a
                  Permanent   Disability   (as  defined  in  Section  3.5),  the
                  Executive shall receive the benefits and payments described in
                  Section 3.5."


                                        2
<PAGE>
         6. The  following  paragraph  is  hereby  added to  Section  3.4 of the
Agreement:

                  "If the Executive is  terminated  for Cause during the Term of
                  this  agreement  or  within  one (1) year  after a  Change  of
                  Control or thereafter, the Company shall pay the Executive his
                  Severance  Amount in one lump sum  within  ten (10) days after
                  the Executive's  date of Termination.  Such severance  amount,
                  however,  shall  not  include  any  calculation  based  on the
                  Executive's  Bonus Amount but only the  Executive's  salary in
                  his year of Termination or the immediately  preceding calendar
                  year, whichever is greater."

         7. All capitalized  terms within this Amendment shall have the meanings
set forth in the Agreement.

         8. The  amendments  contained  herein  are the only  amendments  to the
Agreement and all other  provisions of the Agreement  shall remain in full force
and effect.

         9. This Amendment shall be binding upon and inure to the benefit of the
Company and the Executive and their  respective  heirs,  legal  representatives,
executors, administrators, successors and permitted assigns.

         10. This Amendment constitutes the entire agreement between the parties
and  supersedes  the  Agreement and all other prior  agreements,  either oral or
written, with respect to the provisions stated herein;  provided,  however, that
this  Agreement  does not supersede any  agreements  pertaining to stock options
which have been  previously  granted,  except to the extent that any such option
agreement  contains  provisions  which are  contrary to the  provisions  of this
Agreement (including provisions regarding the Acceleration of Equity Rights).

                                        3
<PAGE>
         IN WITNESS WHEREOF,  the Company has caused this Amendment to be signed
by its duly authorized  officers and its corporate seal to be hereunto  affixed,
and the  Executive  has  hereunto set the  Executive's  hand on the day and year
first above written.

COMPANY                                                EXECUTIVE
- - -------                                                ---------

Integrated Health Services, Inc.,
a Delaware corporation

By:  /s/ Lawrence P. Cirka                             /s/Dennis Cahill
     ---------------------------                       -------------------------
                                                       Dennis Cahill
Name: Lawrence P. Cirka
      ---------------------------

Title: President/C.O.O.
      ---------------------------


                                        4
<PAGE>



                        Amendment To Employment Agreement
                        ---------------------------------


         This amendment  ("Amendment")  is made as of April 1, 1996 between Asia
Care, Inc.  ("Employer")  and John L. Silverman  ("Employee") as an amendment to
the Employment  Agreement dated June 5, 1995 between  Employer and Employee (the
"Agreement").

         Whereas, Employee and Employer desire to amend the Agreement to clarify
the terms of Section 3.4(e) concerning the definition of "Good Reason";

         Now, therefore, it is agreed:

         1.  Section  3.4(e)(2)  is deleted in its  entirety  and the  following
Section 3.4(e)(2) is substituted for the original text:

                  " (2) the resignation by the Executive  within one (1) year of
                  one or both of the following:

                           (i)      a "Change of Control", as defined in Section
                  3.4(e)(2), and/or

                           (ii) the date the individual  who is Chief  Executive
                  Officer and  Chairman of the Board of IHS as of the  Effective
                  Date  or  the  individual  who is  President  of IHS as of the
                  Effective Date ceases to hold such position,

         provided in the case of either (i) or (ii) that the Executive gives the
         Company at least ninety (90) days prior written notice of his intent to
         resign  and the  effective  date of such  resignation  is at least  two
         hundred seventy (270) days after the event described in (i) or (ii).

         Notwithstanding  the  foregoing,  a termination  on account of a reason
         described in Subsection  3.4(e)(1),  shall be deemed not to be for Good
         Reason unless the Executive  (i) gives the Company the  opportunity  to
         cure  the  condition  that  purports  to be Good  Reason,  and (ii) the
         Company fails to cure that  condition  within sixty (60) days after the
         receipt of the Good Reason  Notice (or,  with respect to the failure to
         make any payment when due to the Executive,  within ten (10) days after
         the receipt of such notice).

                  For purposes of this Agreement, a "Change of Control" shall be
         deemed  to  occur  if  (i)   there   shall  be   consummated   (x)  any
         consolidation,  reorganization or merger of IHS in which IHS is not the
         continuing or surviving corporation or pursuant to

                                           1
<PAGE>


         which  shares  of IHS'  common  stock  would be  converted  into  cash,
         securities or other  property,  other than a merger of IHS in which the
         holders of IHS' common stock  immediately  prior to the merger have the
         same   proportionate   ownership  of  common  stock  of  the  surviving
         corporation  immediately  after the  merger,  or (y) any  sale,  lease,
         exchange or other  transfer (in one  transaction or a series of related
         transactions)  of all, or  substantially  all, of the assets of IHS, or
         (ii) the  stockholders  of IHS shall  approve any plan or proposal  for
         liquidation or dissolution of IHS, or (iii) any person (as such term is
         used in Sections 13(d) and 14(d)(2) of the Exchange Act,  including any
         "group" (as defined in Section  13(d)(3)  of the  Exchange  Act) (other
         than the  Executive or any group  controlled by the  Executive))  shall
         become the beneficial owner (within the meaning of Rule 13d-3 under the
         Exchange  Act) of  twenty  percent  (20%)  or more of IHS'  outstanding
         common stock (other than pursuant to a plan or arrangement entered into
         by such person and IHS) and such person  discloses its intent to effect
         a change in the  control or  ownership  of IHS in any  filing  with the
         Securities and Exchange Commission, or (iv) within any twenty-four (24)
         month period  beginning on or after the Effective Date, the persons who
         were directors of IHS  immediately  before the beginning of such period
         (the  "Incumbent  Directors")  shall  cease (for any reason  other than
         death,  disability or  retirement) to constitute at least a majority of
         the Board or the board of  directors  of any  successor to IHS provided
         that,  any  director of IHS who was not a director as of the  Effective
         Date shall be deemed to be an Incumbent  Director if such  director was
         elected to the Board of IHS by, or on the recommendation of or with the
         approval of, at least two-thirds of the directors who then qualified as
         Incumbent  Directors  either  actually  or by prior  operation  of this
         Section 3.4(b)(iv) unless such election, recommendation or approval was
         the result of any  actual or  threatened  election  contest of the type
         contemplated by Regulation 14a-11 promulgated under the Exchange Act or
         any successor provision."

         2. All terms of the Agreement not modified herein, shall remain in full
force and effect.



                                        2
<PAGE>
In witness  whereof,  the parties have  executed  this  amendment as of the date
above written.

ASIA CARE, INC.



By: /s/ Lawrence P. Cirka                         /s/ John L. Silverman
   -----------------------------                  ------------------------------
                                                  JOHN L. SILVERMAN




                                        3
<PAGE>

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<ARTICLE>                     5
<MULTIPLIER>                                   1,000
<CURRENCY>                                     US DOLLARS
       
<S>                                            <C>
<PERIOD-TYPE>                                  3-MOS
<FISCAL-YEAR-END>                              DEC-31-1996
<PERIOD-START>                                 JAN-01-1996
<PERIOD-END>                                   MAR-31-1996
<EXCHANGE-RATE>                                1
<CASH>                                         29,560
<SECURITIES>                                   2,320
<RECEIVABLES>                                  278,158
<ALLOWANCES>                                   (31,093)
<INVENTORY>                                    0
<CURRENT-ASSETS>                               318,979
<PP&E>                                         790,200
<DEPRECIATION>                                 0
<TOTAL-ASSETS>                                 1,525,584
<CURRENT-LIABILITIES>                          158,151
<BONDS>                                        215,000
<COMMON>                                       22
                          0
                                    0
<OTHER-SE>                                     454,566
<TOTAL-LIABILITY-AND-EQUITY>                   1,525,584
<SALES>                                        327,273
<TOTAL-REVENUES>                               327,273
<CGS>                                          0
<TOTAL-COSTS>                                  305,132
<OTHER-EXPENSES>                               0
<LOSS-PROVISION>                               0
<INTEREST-EXPENSE>                             14,214
<INCOME-PRETAX>                                22,441
<INCOME-TAX>                                   8,640
<INCOME-CONTINUING>                            13,801
<DISCONTINUED>                                 0
<EXTRAORDINARY>                                0
<CHANGES>                                      0
<NET-INCOME>                                   13,801
<EPS-PRIMARY>                                  0.62
<EPS-DILUTED>                                  0.54



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