INTEGRATED HEALTH SERVICES INC
10-Q, 1997-05-15
SKILLED NURSING CARE FACILITIES
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                                  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, 1997
                     --------------------------

                                       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 12, 1997: 24,882,292 shares.





<PAGE>






                        INTEGRATED HEALTH SERVICES, INC.
                                      INDEX




PART I.           FINANCIAL INFORMATION
                                                                        Page

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

                  Consolidated Balance Sheets
                    March 31, 1997 and December 31, 1996                  3

                  Consolidated Statements of Earnings
                    for the three months ended March 31, 1997
                    and 1996                                              4

                  Consolidated Statement of Changes in
                    Stockholders' Equity for the three
                    months ended March 31, 1997                           5

                  Consolidated Statements of Cash Flows
                    for the three months ended March 31, 1997
                    and 1996                                              6

                  Notes to Consolidated Financial Statements              7

Item 2.           Management's Discussion and Analysis of
                    Financial Condition and Results of
                    Operations                                            11


PART II:          OTHER INFORMATION

Item 5.           Other Information                                       17

Item 6.           Exhibits and Reports on Form 8-K                        18














                                  Page 2 of 19

<PAGE>


                INTEGRATED HEALTH SERVICES, INC. AND SUBSIDIARIES
                           CONSOLIDATED BALANCE SHEETS
                             (dollars in thousands)
<TABLE>
<CAPTION>
                                                                                          MARCH 31,          DECEMBER 31,
                                                                                             1997                   1996
                                                                                      -------------------    -------------------
<S>                                                                                <C>                                   <C>
     Assets
   Current Assets:
     Cash and cash equivalents                                                     $              38,767                 39,028
     Temporary investments                                                                         1,737                  2,044
     Patient accounts and third-party payor settlements
       receivable, less allowance for doubtful receivables
       of $36,194 at March 31, 1997 and $41,527 at December 31, 1996                             339,496                326,883
     Inventories, prepaid expenses
       and other current assets                                                                   31,887                 26,243
     Income taxes receivable                                                                      10,379                 20,992
                                                                                      -------------------    -------------------
                  Total current assets                                                           422,266                415,190
                                                                                      -------------------    -------------------

   Property, plant and equipment, net                                                            887,395                864,335
   Intangible assets                                                                             605,487                572,159
   Investments in and  advances to affiliates                                                     74,499                 76,047
   Other assets                                                                                   68,431                 65,376
                                                                                      -------------------    -------------------

                  Total assets                                                     $           2,058,078              1,993,107
                                                                                      ===================    ===================

     Liabilities and Stockholders' Equity
   Current Liabilities:
     Current maturities of long-term debt                                          $              15,738                 16,547
     Accounts payable and accrued expenses                                                       322,642                341,094
                                                                                      -------------------    -------------------
                  Total current liabilities                                                      338,380                357,641
                                                                                      -------------------    -------------------

   Long-term Debt:
     Convertible subordinated debentures                                                         258,750                258,750
     Revolving and long-term debt, less current maturities                                       822,201                779,450
                                                                                      -------------------    -------------------
                  Total long-term debt                                                         1,080,951              1,038,200
                                                                                      -------------------    -------------------

   Other long-term liabilities                                                                    34,562                 33,851
   Deferred income taxes                                                                          23,431                 22,283
   Deferred gain on sale-leaseback transactions                                                    5,968                  6,267
   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 24,748,680 at March 31, 1997 and 23,628,250 at
       December 31, 1996                                                                              25                     24
     Additional paid-in capital                                                                  475,878                445,667
     Retained earnings                                                                            98,883                 79,814
     Unrealized gain on available for sale securities                                                  -                  9,360
                                                                                      -------------------    -------------------
                  Net stockholders' equity                                                       574,786                534,865
                                                                                      -------------------    -------------------

                  Total liabilities and stockholders' equity                       $           2,058,078              1,993,107
                                                                                      ===================    ===================
</TABLE>


           See accompanying Notes to Consolidated Financial Statements

                                  Page 3 of 19
<PAGE>
                INTEGRATED HEALTH SERVICES, INC. AND SUBSIDIARIES
                       CONSOLIDATED STATEMENT OF EARNINGS
                             (dollars in thousands)

<TABLE>
<CAPTION>
                                                                               THREE MONTHS ENDED
                                                                                 MARCH 31,
                                                                    -------------------------------------
                                                                         1997                 1996
                                                                    ----------------     ----------------
Net revenues:
<S>                                                              <C>                          <C>
       Basic medical services                                    $           88,755               97,216
       Specialty medical services                                           362,689              219,525
       Management services and other                                          9,499               10,532
                                                                    ----------------     ----------------
            Total revenues                                                  460,943              327,273
                                                                    ----------------     ----------------

Costs and expenses:
       Operating expenses                                                   352,412              249,895
       Corporate administrative and general                                  18,016               15,093
       Depreciation and amortization                                         15,030                8,274
       Rent                                                                  24,009               17,656
       Interest, net                                                         21,421               14,214
       Other non-recurring income                                            (1,025)                   -
                                                                    ----------------     ----------------
            Total costs and expenses                                        429,863              305,132
                                                                    ----------------     ----------------

            Earnings before equity in earnings
            of affiliates and income taxes                                   31,080               22,141

Equity in earnings of affiliates                                                181                  300
                                                                    ----------------     ----------------


            Earnings before income taxes                                     31,261               22,441

Federal and state income taxes                                               12,192                8,640
                                                                    ----------------     ----------------

            Net earnings                                         $           19,069               13,801
                                                                    ================     ================

Per Common Shares:
            Net earnings-primary                                 $             0.74                 0.62
            Net earnings-fully diluted                           $             0.63                 0.54
                                                                    ================     ================
</TABLE>




           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>

                                                                                                  UNREALIZED
                                                                                                   GAIN ON
                                                                ADDITIONAL                        AVAILABLE
                                                  COMMON          PAID-IN        RETAINED          FOR SALE
                                                   STOCK          CAPITAL        EARNINGS         SECURITIES          TOTAL
                                              -----------------------------------------------------------------------------------
<S>                                         <C>                <C>              <C>                 <C>           <C>
Balance at December 31, 1996                $        24         445,667          79,814              9,360         534,865

Issuance of 976,504 shares of
common stock in payment of earn-out
in connection with prior acquisition                  1          26,438              --                 --          26,439

Issuance of 30,248 shares of common
stock in connection with employee
stock purchase plan                                  --             647              --                 --             647

Exercise of employee stock options
for 113,678 shares of common stock                   --           3,126              --                 --           3,126

Realized gain on available for sale
securities                                           --              --              --             (9,360)         (9,360)

Net earnings                                         --              --          19,069                 --          19,069
                                              -----------------------------------------------------------------------------

Balance at March 31, 1997                   $        25        475,878           98,883                 --         574,786
                                              =============================================================================
</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)
<TABLE>
<CAPTION>

                                                                                          THREE MONTHS ENDED
                                                                                              MARCH 31,
                                                                                  -----------------------------------
                                                                                       1997               1996
                                                                                  ---------------    ----------------

Cash flows from operating activities:
<S>                                                                             <C>                    <C>
   Net earnings                                                                 $         19,069              13,801
   Adjustments  to  reconcile  net  earnings to net cash  
     provided (used) by operating activities:
       Other non-recurring income                                                         (1,025)                  0
       Undistributed results of joint ventures                                                 0                 (55)
       Depreciation and amortization                                                      15,030               8,274
       Deferred income taxes and other non-cash items                                      1,396               1,142
       Amortization of gain on sale-leaseback transactions                                  (299)               (285)
       Increase in patient accounts and third-party
         payor settlements receivable, net                                               (10,386)            (15,260)
       Increase in inventories, prepaid
         expenses and other current assets                                                (5,581)               (788)
       Decrease in accounts payable and accrued expenses                                 (18,935)            (22,493)
       Decrease in income taxes receivable                                                10,613               2,950
                                                                                  ---------------    ----------------

         Net cash provided (used) by operating activities                                  9,882             (12,714)
                                                                                  ---------------    ----------------

Cash flows from financing activities:
   Proceeds from issuance of capital stock, net                                            3,773               1,259
   Proceeds from long-term borrowings                                                    139,928              96,737
   Repayment of long-term debt                                                           (97,639)            (11,286)
   Dividends paid                                                                           (471)               (435)
   Deferred financing costs                                                                 (698)               (329)
                                                                                  ---------------    ----------------

         Net cash provided by financing activities                                        44,893              85,946
                                                                                  ---------------    ----------------

Cash flows from investing activities:
   Sale of temporary investments                                                             355                  67
   Purchase of temporary investments                                                         (48)                  0
   Business acquisitions                                                                 (10,975)            (16,581)
   Purchase of property, plant and equipment                                             (41,096)            (35,705)
   Other assets                                                                           (3,272)            (30,370)
                                                                                  ---------------    ----------------

         Net cash used by investing activities                                           (55,036)            (82,589)
                                                                                  ---------------    ----------------

         Decrease in cash and cash equivalents                                              (261)             (9,357)

Cash and cash equivalents, beginning of period                                            39,028              38,917
                                                                                  ---------------    ----------------

Cash and cash equivalents, end of period                                        $         38,767              29,560
                                                                                  ===============    ================
</TABLE>

           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 notes thereto included in the Company's
 Annual  Report on Form  10-K for the year  ended  December  31,  1996.  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.

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,
 1997 and 1996, respectively:

                                                                1997       1996
                                                             --------     ------
Net earnings                                                  $19,069     13,801

Adjustment for interest and underwriting
costs on convertible debentures                                 2,452      2,472
                                                             --------     ------
Net earnings for fully diluted EPS                            $21,521     16,273
                                                             ========     ======
Weighted average shares-Primary                                25,783     22,257
Weighted average shares-Fully Diluted                          34,044     30,317
                                                             ========     ======


                                  Page 7 of 19

<PAGE>





NOTE 3:          NEW ACQUISITIONS

                 ACQUISITIONS DURING THE THREE MONTHS ENDED MARCH 31, 1997

                 Acquisitions  for the three months ended March 31, 1997 and the
                 manner of payment are summarized as follows:
<TABLE>
<CAPTION>
                                                             COMMON
                                                    TOTAL     STOCK       ACCRUED             CASH
MONTH            TRANSACTION DESCRIPTION            COST      ISSUED      LIABILITIES         PAID
- -----            -----------------------            ----      ------      -----------         ----
<S>              <C>                            <C>        <C>           <C>               <C>
January          Stock of In-Home Health
                 Care, Inc.                     $  3,450   $    --        $  250            $ 3,200

February         Assets of Professional
                 Health Services, Inc.               350        --           100                250

February         Assets of Portable X-Ray
                 Labs, Inc.                        6,200        --         1,300              4,900

March            Assets of Laboratory
                 Corporation of America               35        --            --                 35

March            Assets of Doctor's Home
                 Health Agency, Inc.                 445        --            95                350

March            Payment of earnout in
                 connection with Achievement
                 Rehab acquisition in December
                 1993                             26,439    26,439            --                 --

                 Cash payments of
                 acquisitions costs
                 accrued in 1995 and 1996             --        --        (2,240)             2,240
                                                  ------    -------       -------            ------

                                                $ 36,919   $26,439        $ (495)           $10,975
                                                  ======    =======       =======            ======
</TABLE>


                                                  Page 8 of 19

<PAGE>
                 The  allocation of the total cost of the 1997  acquisitions  to
                 the assets acquired and the  liabilities  assumed is summarized
                 as follows:
<TABLE>
<CAPTION>
                                     PROPERTY
                         CURRENT      PLANT &         OTHER      INTANGIBLE        CURRENT      LONG-TERM        TOTAL
TRANSACTION              ASSETS      EQUIPMENT       ASSETS        ASSETS        LIABILITIES   LIABILITIES       COSTS
- -----------              ------      ---------       ------        ------        -----------   -----------       -----
<S>                     <C>           <C>           <C>           <C>            <C>            <C>            <C>
In-Home Health
Care, Inc.              $    989      $    229      $      7      $  3,856       ($   797)      ($   834)      $  3,450

Professional
Health Services,
Inc.                          --            20             9           321             --             --            350

Portable X-Ray
Labs, Inc.                 1,309            --            11         5,653           (297)          (476)         6,200

Laboratory Corp.
of America,
Indianapolis                  --            10            --            25             --             --             35

Doctors's Home
Health Agency,
Inc.                          --             6            --           439             --             --            445

Achievement Rehab             --            --            --        26,439             --             --         26,439
                        --------      --------      --------      --------       --------       --------       --------

                        $  2,298      $    265      $     27      $ 36,733       ($ 1,094)      ($ 1,310)      $ 36,919
                        ========      ========      ========      ========       ========       ========       ========
</TABLE>

NOTE 4:   PHARMACY GAIN          

          In July 1996,  the  Company  sold its  pharmacy  division  to Capstone
          Pharmacy  Services,  Inc.  ("Capstone")  for a purchase  price of $150
          million,  consisting of cash of $125  million,  and shares of Capstone
          stock having a value of $25 million. At the date of sale the Company's
          investment  in the shares of  Capstone's  common stock was recorded at
          its carry over cost of $14.7 million,  which represented less than 20%
          of the total  Capstone  shares.  During the first  quarter  1997,  the
          Company  realized  a gain of $7.6  million  on its  investment  in the
          Capstone shares.

NOTE 5:   RECENT ACCOUNTING PRONOUNCEMENTS

          In February  1997,  the Financial  Accounting  Standards  Board issued
          Statement  No.  128,   "Earnings  Per  Share,"  ("SFAS  128"),   which
          simplifies  the standards for  computing  earnings per share  ("EPS").
          SFAS 128 is effective for the Company's fourth quarter and year ending
          December 31, 1997. Early application is not permitted and prior period
          EPS data will be restated.

          Under SFAS 128, primary EPS will be replaced with basic EPS. Basic EPS
          excludes the dilutive effect of common stock equivalents.  Also, under
          SFAS 128,  fully-diluted  EPS will be replaced by diluted EPS. Diluted
          EPS  is  calculated   similarly  to  fully-diluted   EPS  pursuant  to
          Accounting Principles Board Opinion 15.

          The change in  calculation  method is not  expected to have a material
          impact on previously reported earnings per common share data.

NOTE 6:   SUBSEQUENT EVENTS
                 
          Acquisitions
          ------------

          In  April   1997,   the  Company   acquired   the  assets  of  Coastal
          Rehabilitation,   Inc.,  a  rehabilitation  company  in  Florida,  for
          approximately  $1.25  million,  and the assets of Mobile  Diagnostics,
          Inc.,  a mobile  x-ray  company in North  Carolina  for  $225,000.  In
          addition, the Company has reached agreements in principle to acquire a
          mobile x-ray company in New Jersey for approximately  $1.2 million,  a
          mobile  x-ray  company  in  Maryland  for  approximately  $300,000,  a
          contract rehabilitation company in the Midwest for approximately $19.7
          million,   a  home   healthcare   services   company  in  Indiana  for
          approximately   $330,000,  a  home  healthcare  services  company  for
          approximately $7.5 million,  and a home healthcare services company in
          the  Southeast  for  approximately  $37.5  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.


                                  Page 9 of 19
<PAGE>
          Settlement with Coram
          ---------------------

          On October 19, 1996, IHS and Coram entered into a definitive agreement
          and plan of merger (the "Merger  Agreement")  providing for the merger
          of a wholly-owned  subsidiary of IHS into Coram, with Coram becoming a
          wholly-owned  subsidiary  of  IHS.  Under  the  terms  of  the  Merger
          Agreement,  holders of Coram  common  stock  were to receive  for each
          share of Coram common stock 0.2111 of a share of the Company's  Common
          Stock. As a result of the merger, IHS would have assumed approximately
          $375 million of  indebtedness.  On April 4, 1997,  IHS notified  Coram
          that it had exercised  its rights to terminate  the Merger  Agreement.
          IHS also terminated the March 30, 1997 letter amendment, setting forth
          proposed  revisions  to the  terms of the  merger  (which  included  a
          reduction in the exchange ratio to 0.15 of a share of IHS Common Stock
          for each share of Coram common stock), prior to the revisions becoming
          effective  at the close of business on April 4, 1997.  On May 5, 1997,
          IHS and Coram  entered into a settlement  agreement  pursuant to which
          the Company  paid Coram $21 million in full  settlement  of all claims
          Coram might have against IHS pursuant to the Merger  Agreement,  which
          the Company will recognize in the second quarter. In addition,  during
          the first  quarter the Company  incurred  $6.6 million of  accounting,
          legal and other costs related to the merger.

          Tender Offer for Senior Subordinated Notes
          ------------------------------------------

          On April 30, 1997,  the Company  announced  that it had commenced cash
          tender  offers,  subject  to  certain  conditions  including,  without
          limitation,  obtaining  financing  from  debt or equity  offerings  or
          borrowings under its credit facility,  to purchase all its outstanding
          9-5/8%  Senior  Subordinated  Notes  due 2002  Series  A (the  "9-5/8%
          Notes"),  its 10-3/4% Senior Subordinated Notes due 2004 (the "10-3/4%
          Notes" and together  with the 9-5/8%  Notes,  the "Tender  Notes") and
          related  consent   solicitations  to  eliminate  certain   restrictive
          covenants and other provisions in the indentures pursuant to which the
          Tender  Notes  were  issued  in order to  improve  the  operating  and
          financial flexibility of the Company.

          The total  consideration  payable  pursuant  to the  tender  offer and
          consent  solicitation  to holders of the 9-5/8% Notes who tender their
          notes (and thereby deliver consents to the proposed  amendments to the
          indenture  pursuant  to which the 9 5/8% Notes were  issued) is $1,094
          plus accrued and unpaid  interest to, but not  including,  the payment
          date,  consisting of $1,089 plus accrued and unpaid interest as tender
          offer  consideration and $5 as a consent payment.  Total consideration
          payable  pursuant  to the tender  offer and  consent  solicitation  to
          holders of the  10-3/4%  Notes who  tender  their  notes (and  thereby
          deliver consents to the proposed  amendments to the indenture pursuant
          to which the 10 3/4% Notes were issued) is $1,119.50  plus accrued and
          unpaid  interest to but not including the payment date,  consisting of
          $1,114.50   plus   accrued  and  unpaid   interest  as  tender   offer
          consideration and $5 as a consent payment.

          The tender offer and consent solicitation for each of the 9 5/8% Notes
          and the 10 3/4% Notes expires at 12:00  midnight,  New York City time,
          on May 29, 1997, unless extended (the "Expiration Date"). Holders must
          validly  tender  their  Tender  Notes  prior to 12:00  midnight on the
          Expiration Date in order to receive the tender offer consideration. In
          order to receive the consent payment, holders must validly tender ther
          Tender  Notes (and  thereby  deliver  their  consent  to the  proposed
          amendments to the indenture  pursuant to which their Tender Notes were
          issued)  prior to 12:00  midnight,  New York City time, on the Consent
          Date.  The  Consent  Date for each of the 9 5/8% Notes and the 10 3/4%
          Notes is the later of May 14, 1997 or the Consent Achievement Date for
          such Tender Notes. The Consent Achievement Date for each of the 9 5/8%
          Notes and the 10 3/4% Notes is the date that the Company receives duly
          executed  consents from holders  representing  a majority in principal
          amount of such Tender Notes outstanding.

          An  aggregate  of $115  million  principal  amount of 9-5/8%  Notes is
          presently  outstanding.  An aggregate of $100 million principal amount
          of 10-3/4%  Notes is  presently  outstanding.  Each  tender  offer and
          consent  solicitation  is conditioned  upon,  among other things,  the
          availability  to the Company of funds  sufficient to pay the aggregate
          consideration  and related  costs and  expenses of the offers on terms
          and conditions satisfactory to the Company in its sole discretion. The
          Company intends to pay the aggregate  consideration  due in connection
          with the tender offer and consent solicitations with the proceeds of a
          private debt financing.

                                  Page 10 of 19
<PAGE>



                      MANAGEMENT'S DISCUSSION AND ANALYSIS
                             OF FINANCIAL CONDITION
                                       AND
                              RESULTS OF OPERATIONS

THREE MONTHS ENDED MARCH 31, 1997
COMPARED TO THREE MONTHS ENDED MARCH 31, 1996

         Net revenues for the three months ended March 31, 1997 increased $133.7
million,  or 41%, to $460.9 million from the  comparable  period in 1996. Of the
$133.7 million increase,  $119.0 million,  or 89%, was due to the acquisition of
companies  providing  home  health,   mobile  x-ray,   rehabilitation   therapy,
respiratory therapy and electrocardiogram services subsequent to March 31, 1996,
partially  offset  by a  reduction  in  revenue  resulting  from the sale of the
Company's  pharmacy division in July 1996 and the sale of a majority interest in
its assisted  living  services  division in October 1996.  Revenues in the first
quarter of 1996 include revenues of $22.4 million for the pharmacy  division and
revenues  of $5.6  million  from its  assisted  living  services  division.  The
remaining  increase was due  primarily to  facilities  and  ancillary  companies
acquired  during the first  quarter of 1996,  subsequent to the first quarter of
1996 and increased revenues from facilities and ancillary companies in operation
during both periods.

         Basic medical services revenue decreased 9% from $97.2 million to $88.8
million.  This decrease  primarily results from the conversion by the Company of
its skilled  nursing beds to Medical  Specialty  Unit (MSU) beds after March 31,
1996,  and the sale of a  majority  interest  in its  assisted  living  services
division in October 1996.

         Specialty medical services revenue increased $143.2 million from $219.5
million to $362.7 million.  Of the $143.2 million increase,  $124.6 million,  or
87%, was attributable to revenue from acquisitions subsequent to March 31, 1996,
partially  offset by a reduction  in  specialty  medical  services  revenue as a
result  of the  sale  of the  Company's  pharmacy  division  in July  1996.  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 1996, facilities  and ancillary  companies
acquired  subsequent to the first  quarter of 1996,  as well as skilled  nursing
beds being  converted to MSU beds after March 31, 1996.

         Management services and other revenues decreased 10% from $10.5 million
to $9.5 million.

                                  Page 11 of 19

<PAGE>




         Total  expenses for the period  increased to $429.9 million from $305.1
million,  an increase of 41%. Of the $124.8 million  increase in total expenses,
$102.5  million,  or 82%,  was  due to an  increase  in  operating  expenses.  A
substantial   portion  of  the  increase  in  operating   expenses  was  due  to
acquisitions  consummated  subsequent to March 31, 1996, partially offset by the
disposal  of the  Company's  pharmacy  division  in July  1996 and the sale of a
majority  interest in its assisted  living  services  division in October  1996.

         During the first quarter 1997, the Company realized a $7.6 million gain
on its  investment  in Capstone  Shares,  offset by $6.6 million of  accounting,
legal and other costs  resulting from the Coram  transaction.  As a result,  the
Company has recorded in its statement of earnings $1.0 million of  non-recurring
income.

         Corporate  administrative  and general  expenses  for the three  months
ended March 31, 1997  increased by $2.9  million,  or 19%,  over the  comparable
period  in 1996.  This  increase  primarily  represents  additional  operations,
information  systems,  accounting,  finance and other  personnel  to support the
growth  through   acquisition   of  ancillary   businesses.   Depreciation   and
amortization  increased to $15.0 million during the three months ended March 31,
1997,  an 82%  increase as compared to $8.3  million in the same period in 1996.
This increase is primarily the result of acquisitions  consummated subsequent to
the first quarter of 1996. Rent expense increased by $6.4 million,  or 36%, over
the  comparable  period  in  1996,  primarily  as a  result  of an  increase  in
contingent  rentals  which  are  based  on  gross  revenues  of  certain  leased
facilities  and rent at ancillary  companies  acquired  subsequent  to March 31,
1996,  partially  offset by a reduction  resulting from the sale of the pharmacy
division  and the sale of a majority  interest in its assisted  living  services
division. Interest expense, net increased 51%, or $7.2 million, during the three
months ended March 31, 1997 to $21.4 million in the first  quarter of 1997.  The
increase in interest expense was primarily due to the Company's issuance of $150
million principal amount of 10-1/4% Senior Subordinated Notes issued in May 1996
and  increased  borrowings  under the Company's  current $700 million  revolving
credit facility.

         Earnings  before  equity in earnings  of  affiliates  and income  taxes
increased  40% to $31.1  million for the three months  ended March 31, 1997,  as
compared to $22.1 million for the comparable period in the prior year.


                                  Page 12 of 19

<PAGE>




         Earnings  before  income taxes  increased  39% to $31.3 million for the
three  months  ended  March 31,  1997,  as  compared  to $22.4  million  for the
comparable  period in the prior year. The provision for federal and state income
taxes was $12.2  million for the three  months  ended March 31,  1997,  and $8.6
million for the same period in the prior year.  Net earnings  and fully  diluted
earnings per share for the quarter were $19.1  million in 1997,  or 63 cents per
share, as compared to $13.8 million or 54 cents per share for the same period in
1996.  Weighted average shares (fully-diluted)  increased 3.7 million shares, or
12%, to 34.0 million shares from the comparable period in 1996.

                                  Page 13 of 19

<PAGE>



LIQUIDITY AND CAPITAL RESOURCES

         At March 31, 1997, the Company had working capital of $83.9 million, as
compared  with $57.5  million at  December  31,  1996.  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, 1997. Net patient accounts and third-party
payor settlements  receivable increased $12.6 million to $339.5 million at March
31,  1997,  as compared to $326.9  million at December  31,  1996.  Of the $12.6
million  increase in accounts  receivable,  $2.2  million  was  attributable  to
related services  businesses  acquired subsequent to December 31, 1996 and $10.4
million was due to increased  accounts  receivable  at  facilities  and services
businesses owned at both December 31, 1996 and March 31, 1997.  Patient accounts
receivable  were  $356.1  million at March 31,  1997,  as  compared  with $340.8
million at December 31, 1996.  Third-party  payor  settlements  receivable  from
federal and state  governments  (i.e.,  Medicare and Medicaid  cost reports) was
$19.6  million at March 31, 1997,  as compared to $27.6  million at December 31,
1996.  Approximately $10.3 million, or 52%, of the third-party payor settlements
receivable  from federal and state  governments  at March 31, 1997 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 Company's ability
to obtain  reimbursement  for those costs which exceed the Medicare  established
reimbursement limits will depend on obtaining waivers of these cost limitations.
The Company has submitted  waiver  requests for 225 cost  reports,  covering all
cost report periods  through  December 31, 1995. To date,  final action has been
taken by the Health  Care  Financing  Administration  ("HCFA") on all 221 waiver
requests  covering cost report periods through  December 31, 1995. The Company's
final rates as approved

                                  Page 14 of 19

<PAGE>



by HCFA represent  approximately  95% 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  provided by operating  activities  for the three months ended
March 31, 1997,  was $9.9 million as compared to $12.7 million used by operating
activities for the comparable period in 1996.

         Net cash  provided by financing  activities  was $44.9  million for the
three  month  period in 1997 as compared  to $85.9  million  for the  comparable
period  in 1996.  In both  periods,  the  Company  received  net  proceeds  from
long-term borrowings and issuance of common stock and made repayments on certain
debt.

         Net cash used by investing  activities  was $55.0 million for the three
month  period  ended March 31,  1997 as compared to $82.6  million for the three
month period ended March 31, 1996.  Cash used for the  acquisition of facilities
and service  businesses  was $11.0  million in 1997 as compared to $16.6 million
for 1996. Cash used for the purchase of property,  plant and equipment was $41.1
million in 1997 and $35.7 million in 1996.

         The Company's contingent liabilities (other than liabilities in respect
of  litigation  and the  contingent  payments  in respect of the First  American
acquisition)  aggregated  approximately  $72.3 million as of March 31, 1997. 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 Company has guaranteed approximately

                                  Page 15 of 19

<PAGE>



$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  entered into a guaranty  agreement  whereby the Company  guaranteed
approximately  $4.0 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  $8.9 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 $15.7 million at March
31,  1997 to secure  certain  of the  Company's  workers'  compensation,  health
benefits and other obligations. The Company has guaranteed a maximum of $539,062
owed by Dunns Creek to National  Health  Investors.  The Company  entered into a
guaranty  agreement whereby the Company has guaranteed a maximum of $49,900 owed
by Newco  Management to First Union  National  Bank of Florida.  The Company has
guaranteed approximately $4.8 million owed by Community Care of America ("CCA"),
a related party company to which IHS provides certain  management  services,  to
Daiwa  Health  Company.  The Company  has also  guaranteed  approximately  $10.0
million owed by CCA to Health and Retirement  Properties  Trust under a loan and
lease  financing  agreement.   In  addition,  the  Company  has  established  an
irrevocable  standby  line of credit with CCA with a maximum  amount of $500,000
available  to CCA at March 31,  1997.  The  Company has also  established  three
Irrevocable  Standby Letter of Credit in the total amount of $10.0  million.  In
addition,  the  Company  has  obligations  under  operating  leases  aggregating
approximately  $224.0  million at March 31, 1997.  The Company owns  warrants to
purchase  approximately  14.9% of CCA,  and the  Company's  Chairman  and  Chief
Executive  Officer  beneficially owns  approximately  21.1% of CCA's outstanding
common  stock.  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 Company is also
obligated under certain  circumstances to make contingent payments of up to $155
million in respect of its acquisition of First American.

         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 16 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
1997. The Company expects to continue to be growth oriented in 1997 by expanding
acquiring its existing  operations, continuing to implement its MSU programs and
by the acquisition of additional facilities and ancillary service companies, and
obtaining agreements to manage additional facilities.

PART II:    OTHER INFORMATION

Item 5.  -  Other Information
            -----------------

            Settlement with Coram
            ---------------------


            On  October  19,  1996,  IHS and  Coram  entered  into a  definitive
            agreement and plan of merger (the "Merger Agreement")  providing for
            the merger of a  wholly-owned  subsidiary  of IHS into  Coram,  with
            Coram becoming a wholly-owned  subsidiary of IHS. Under the terms of
            the Merger Agreement,  holders of Coram common stock were to receive
            for each  share  of  Coram  common  stock  0.2111  of a share of the
            Company's  Common Stock.  As a result of the merger,  IHS would have
            assumed  approximately  $375  million of  indebtedness.  On April 4,
            1997,  IHS  notified  Coram  that it had  exercised  its  rights  to
            terminate the Merger  Agreement.  IHS also  terminated the March 30,
            1997 letter amendment, setting forth proposed revisions to the terms
            of the merger (which  included a reduction in the exchange  ratio to
            0.15 of a share of IHS Common  Stock for each share of Coram  common
            stock),  prior to the revisions  becoming  effective at the close of
            business  on April 4, 1997.  On May 5, 1997,  IHS and Coram  entered
            into a settlement agreement pursuant to which the Company paid Coram
            $21  million  in full  settlement  of all  claims  Coram  might have
            against IHS pursuant to the Merger  Agreement which the Company will
            recognize  in the  second  quarter.  In  addition,  during the first
            quarter the Company  incurred $6.6 million of accounting,  legal and
            other costs related to the merger.

 
                                  Page 17 of 19

<PAGE>
             Tender Offer for Senior Subordinated Notes
            ------------------------------------------

            On April 30, 1997, the Company  announced that it had commenced cash
            tender  offers,  subject to certain  conditions  including,  without
            limitation,  obtaining  financing  from debt or equity  offerings or
            borrowings   under  its  credit   facility,   to  purchase  all  its
            outstanding 9-5/8% Senior  Subordinated Notes due 2002 Series A (the
            "9-5/8% Notes"),  and its 10-3/4% Senior Subordinated Notes due 2004
            (the "10-3/4% Notes" and together with the 9-5/8% Notes, the "Tender
            Notes") and  related  consent  solicitations  to  eliminate  certain
            restrictive   covenants  and  other  provisions  in  the  indentures
            pursuant  to which the Tender  Notes were issued in order to improve
            the operating and financial flexibility of the Company.

            The total  consideration  payable  pursuant to the tender  offer and
            consent solicitation to holders of the 9-5/8% Notes who tender their
            notes (and thereby  deliver  consents to the proposed  amendments to
            the  indenture  pursuant  to which the 9 5/8% Notes were  issued) is
            $1,094 plus accrued and unpaid  interest to, but not including,  the
            payment date,  consisting of $1,089 plus accrued and unpaid interest
            as tender offer  consideration  and $5 as a consent  payment.  Total
            consideration  payable  pursuant  to the  tender  offer and  consent
            solicitation  to holders of the 10-3/4% Notes who tender their notes
            (and  thereby  deliver  consents to the proposed  amendments  to the
            indenture  pursuant  to which  the 10 3/4%  Notes  were  issued)  is
            $1,119.50 plus accrued and unpaid  interest to but not including the
            payment  date,  consisting  of  $1,114.50  plus  accrued  and unpaid
            interest as tender offer consideration and $5 as a consent payment.

            The tender  offer and  consent  solicitation  for each of the 9 5/8%
            Notes and the 10 3/4% Notes expires at 12:00 midnight, New York City
            time,  on May 29, 1997,  unless  extended (the  "Expiration  Date").
            Holders  must  validly  tender  their  Tender  Notes  prior to 12:00
            midnight on the Expiration Date in order to receive the tender offer
            consideration. In order to receive the consent payment, holders must
            validly tender ther Tender Notes (and thereby  deliver their consent
            to the proposed  amendments to the indenture pursuant to which their
            Tender Notes were  issued)  prior to 12:00  midnight,  New York City
            time, on the Consent  Date.  The Consent Date for each of the 9 5/8%
            Notes  and the 10 3/4%  Notes is the  later  of May 14,  1997 or the
            Consent  Achievement  Date for such such Tender  Notes.  The Consent
            Acheivement  Date for each of the 9 5/8% Notes and the 10 3/4% Notes
            is the date that the Company  receives duly  executed  consents from
            holders  representing a majority in principal  amount of such Tender
            Notes outstanding.

            An  aggregate of $115  million  principal  amount of 9-5/8% Notes is
            presently outstanding. An aggregate of $100 million principal amount
            of 10-3/4%  Notes is  presently  outstanding.  Each tender offer and
            consent  solicitation is conditioned  upon, among other things,  the
            availability to the Company of funds sufficient to pay the aggregate
            consideration  and related costs and expenses of the offers on terms
            and conditions  satisfactory to the Company in its sole  discretion.
            The  Company  intends  to pay  the  aggregate  consideration  due in
            connection with the tender offer and consent  solicitation  with the
            proceeds of a private debt financing.

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

        (a) Exhibits
            --------

           10.1     Settlement  Agreement and Mutual  Release,  made and entered
                    into as of Monday,  May 5, 1997,  by and between  Integrated
                    Health Services, Inc. and Coram Healthcare Corporation

            10.2    Amendment No. 3 to Revolving Credit Agreemment,  dated as of
                    May 15, 1996, as amended,  among Integrated Health Services,
                    Inc., Citibank N.A., as administrative  agent thereunder and
                    the other financial institutions party thereto.
            
            10.3    Guaranty  dated  as of April  14,  1997  made by  Integrated
                    Health Services, Inc. in favor of Daiwa Healthco 2 LLC

            10.4    Guaranty  dated  as of April  14,  1997  made by  Integrated
                    Health Services,  Inc. and Health and Retirement  Properties
                    Trust

            10.5    Reimbursement   agreement   dated  April  14,  1997  between
                    Community  Care  of  America,  Inc.  and  Integrated  Health
                    Services, Inc.
               
            10.6    Subordination agreement,  dates as of April 30, 1997 between
                    Integrated  Living  Communities,  Integrated Health Services
                    and Nations Bank.

                                  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
                                          Executive Vice President and
                                          Chief Accounting Officer



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













Dated:  May 15, 1997


                                  Page 19 of 19


                     SETTLEMENT AGREEMENT AND MUTUAL RELEASE

         This Settlement Agreement and Mutual Release  ("Agreement") is made and
entered  into  as of  Monday,  May 5,  1997  by and  between  Integrated  Health
Services,  Inc.  (referred  to herein  as  "IHS") , on the one  hand,  and Coram
Healthcare Company (referred to herein as "Coram"), on the other hand.

                              W I T N E S S E T H:

         WHEREAS,  on October 19, 1996, Coram and IHS entered into an "Agreement
and Plan of Merger" ("Merger Agreement");

         WHEREAS,  on March 30, 1997,  Coram and IHS executed a letter agreement
amending the Merger Agreement;

         WHEREAS,  by letter  dated April 4, 1997 IHS advised  Coram that it was
terminating  the March 30,  1997 letter  agreement  and  terminating  the Merger
Agreement;

         WHEREAS,  certain disputes have arisen between IHS and Coram concerning
their  respective   rights  and  liabilities   arising  out  of  the  actual  or
contemplated  merger  between IHS and Coram,  including but not limited to those
arising  out  of  the  negotiations,   drafting,  execution,   amendment  and/or
termination  of  that  contemplated   merger  and  various  related  agreements,
including  without  limitation  the Merger  Agreement  and March 30, 1997 letter
agreement (hereinafter referred to as "the dispute");

         WHEREAS, IHS and Coram desire to compromise, settle and release any and
all claims, whether known or unknown, arising out of the dispute;

         NOW,  THEREFORE,  in consideration of the mutual covenants  hereinafter
set forth, the parties hereto agree as follows:

         1. Payment of Money.  Upon complete  execution of this  Agreement,  IHS
agrees to pay to "Coram  Healthcare  Corporation"  $21 million by wire transfer.
IHS will make good faith efforts to  accomplish  such wire transfer on or before
5:00 p.m. (eastern daylight time), Monday, May 5, 1997.

            2.     Mutual Release and Convenant Not to Sue.

           (a) IHS, for itself, its predecessors,  successors,  parent entities,
subsidiaries,  affiliates,  related entities of any nature, as well as on behalf
of  their  respective  officers,   directors,   employees,   heirs,   executors,
administrators,  agents and assigns, hereby forever releases, waives, discharges
and  covenants  not to sue Coram,  or any of Coram's  predecessors,  successors,
parent entities,  subsidiaries,  affiliates,  related entities of any nature, as
well as their  respective  officers,  directors,  employees,  heirs,  executors,
administrators,  agents and assigns, collectively or individually,  with respect
to any and all claims, assertions of claims, debts, demands, actions,


<PAGE>



suits, expenses,  attorneys' fees, costs, damages and liabilities of any nature,
type and description, known or unknown, arising out of any fact or matter in any
way related to or connected with the dispute.

         (b) Coram, for itself, its predecessors,  successors,  parent entities,
subsidiaries,  affiliates,  related entities of any nature, as well as on behalf
of  their  respective  officers,   directors,   employees,   heirs,   executors,
administrators,  agents and assigns, hereby forever releases, waives, discharges
and covenants not to sue IHS, or any of IHS's predecessors,  successors,  parent
entities,  subsidiaries,  affiliates, related entities of any nature, as well as
their   respective   officers,    directors,    employees,   heirs,   executors,
administrators,  agents and assigns, collectively or individually,  with respect
to any and all claims,  assertions of claims,  debts, demands,  actions,  suits,
expenses,  attorneys' fees, costs,  damages and liabilities of any nature,  type
and description,  known or unknown, arising out of any fact or matter in any way
related to or connected with the dispute.

            (c) The parties  hereto  understand  and for valuable  consideration
hereby  expressly  waive all of the rights and  benefits of Section  1542 of the
California  Civil Code (and any similar or  equivalent  statute under the law of
any state or jurisdiction), which section reads as follows:

                  A general release does not extend to claims which the creditor
                  does not know or  suspect to exist in his favor at the time of
                  executing  the  release,  which  if  known  by him  must  have
                  materially affected his settlement with the debtor.

             3. Nonadmission of Liability.  The parties hereto  acknowledge that
this  Agreement  does not  constitute  an admission  of  liability  and/or loss,
express or  implied,  on the part of either  party  with  respect to any fact or
matter  which may be involved in the  dispute.  The parties  further  agree that
nothing  herein shall  constitute  evidence of any fact or matter related to any
such liability and/or loss that may be involved in the dispute.


             4.



             5.  Construction  of  Agreement.  This  Agreement is the product of
negotiation  by and among the  parties  hereto and their  respective  attorneys.
Accordingly,  the parties hereto acknowledge and agree that this Agreement shall
not be deemed prepared or drafted by one party or another,  or the attorneys for
one party or another, and shall be construed accordingly.

         6. Counterparts.  This Agreement may be executed in counterparts,  each
of which shall be deemed an original, and all of which together shall constitute
one and the same instrument.

                                        2

<PAGE>


         7. Captions.  The captions herein have been inserted for identification
and  reference  purposes  only  and  shall  not be used in the  construction  or
interpretation of this Agreement.

         8. Assignment of Claims.  The parties hereto represent and warrant that
they have not  assigned or  transferred  or  purported  to assign or transfer to
anyone any claim, demand, action or cause of action based upon, arising out of ,
pertaining  to ,  concerning  or  connected  with any of the  matters  or things
released herein.

         9. Delaware Law. This Agreement will be interpreted in accordance  with
Delaware law.

         10.  Severability.  If any provision or  provisions  of this  Agreement
shall be held invalid, illegal or unenforceable,  the validity,  legality and/or
enforceability  of the remaining  provisions shall not in any way be affected or
impaired  thereby.  If any terms or sections of this Agreement are determined to
be  unenforceable,  they shall be  modified  so that the  unenforceable  term or
section is enforceable to the greatest extent possible.

         11. Entire Agreement.  This Agreement contains the entire understanding
among the parties to this Agreement with regard to the matters herein set forth,
and  is  intended  to be  and  is a  final  integration  thereof.  There  are no
representations,  warranties,  agreements,  arrangements,  undertakings, oral or
written,  between or among the parties hereto relating to the dispute or to this
Agreement which are not fully expressed herein.

         IN WITNESS WHEREOF,  the parties hereto have executed this Agreement as
of the date first above written.

Dated:     May 5, 1997                      Dated:     May  1, 1997


  /s/Marshall A. Elkins                       /s/Paul J. Quiner
- -------------------------------------       -----------------------------------
Integrated Health Services, Inc.            Coram Healthcare Corporation



By:   Marshall A. Elkins                    By:    Paul J. Quiner
   ---------------------------------           -------------------------------
Its:  Executive V.P. & Gen. Counsel         Its:   SR. V.P. & Gen. Counsel
   ---------------------------------           -------------------------------


                                        3


                        INTEGRATED HEALTH SERVICES, INC.
                             10065 Red Run Boulevard
                          Owings Mills, Maryland 21117


                                 March 24, 1997


To the Administrative Agent and
the Lenders parties to the Revolving
Credit Agreement referred to below


                  Amendment No.3 to Revolving Credit Agreement


Ladies and Gentlemen:

     Reference is made to the Revolving  Credit  Agreement,  dated as of May 15,
1996, as amended by Amendment No. 1 dated  September 6, 1996 and Amendment No. 2
dated November 8, 1996 (such Revolving  Credit Agreement as so amended being the
"Credit Agreement"),  among Integrated Health Services,  Inc. ("IHS"),  Citibank
N.A., as administrative agent thereunder (the "Agent"),  and the other financial
institutions party thereto,  as lenders  thereunder.  Capitalized terms used and
not otherwise defined herein are used herein as defined in the Credit Agreement.

     IHS has  proposed to (i) issue  senior  subordinated  notes in an aggregate
principal  amount  of up to  $450,000,000  and (ii)  purchase  the  indebtedness
outstanding under the 1994 Subordinated Debt Indenture and the 1995 Subordinated
Debt  Indenture.  In connection  with the foregoing,  IHS has requested that the
Lenders  agree to amend certain  covenants  contained in Article V of the Credit
Agreement to permit such transactions.  We understand that the Requisite Lenders
are, on the terms and conditions stated below, willing to grant our request, and
the Requisite  Lenders have agreed to amend the Credit  Agreement as hereinafter
set forth.

     Effective  as of the date  hereof and  subject to the  satisfaction  of the
condition  precedents set forth below, the Credit Agreement is hereby amended as
follows:

     (a) The definition of "1996 Subordinated Debt Indenture" in Section 1.01 is
amended in full to read as follows:

          "'1996  SUBORDINATED DEBT INDENTURE' means the Indenture,  dated as of
          May 15,  1996,  between  the  Borrower,  as Issuer,  and Signet  Trust
          Company, as Trustee."

     (b) In Section 1.01, the following  definition of "1997  Subordinated  Debt
Indenture" is added in the appropriate alphabetical order:


<PAGE>


                                        2

          "'1997  SUBORDINATED DEBT INDENTURE' means the Indenture to be entered
          into after April 7, 1997  between  the  Borrower,  as Issuer,  and the
          trustee  thereunder in connection with a proposed senior  subordinated
          note offering."

     (c) The  definition of  "Subordinated  Debt  Indentures" in Section 1.01 is
amended in full to read as follows:

          "'SUBORDINATED   DEBT   INDENTURES'   means   the   1992   Convertible
          Subordinated  Debt Indenture,  the 1993 Convertible  Subordinated Debt
          Indenture, the 1994 Subordinated Debt Indenture, the 1995 Subordinated
          Debt  Indenture,  the 1996  Subordinated  Debt Indenture and, upon the
          effectiveness thereof, the 1997 Subordinated Debt Indenture"

     (d)  Section  5.03(d)  is  amended  by  deleting  the  period at the end of
subsection  (v)  thereof  and  substituting  therefor  "; and" and  adding a new
subsection (vi) following such subsection (v) to read as follows:

          "(vi)  Subordinated  Debt incurred  under the 1997  Subordinated  Debt
          Indenture in an aggregate principal amount of up to $450,000,000, with
          an interest rate not in excess of 10.25%,  and any extension,  renewal
          or refinancing of such Debt so long as either (A) the principal amount
          of such Debt is not  increased  or (B) any  increase in the  principal
          amount of such Debt is  permitted  pursuant to another  clause of this
          Section  5.03(d);  provided that the terms and conditions of such 1997
          Subordinated Debt Indenture shall be (1) substantially  similar to the
          terms and conditions contained in the 1996 Subordinated Debt Indenture
          and (2) satisfactory to the Agent in its sole discretion."

     (e) Section 5.03(h)(G) is amended in full to read as follows:

          "(G) so long as no Event of Default  exists or would result and unless
          otherwise  prohibited  under this  Agreement and the 1993  Convertible
          Subordinated  Debt Indenture,  the Borrower may pay on January 1, 2001
          any principal  amount then due and payable under the 1993  Convertible
          Subordinated Debt Indenture; and"

     (f) Section  5.03(h) is amended by adding a new  subsection  (H)  following
subsection (G) to read as follows:

          "(H)  purchase by tender or otherwise  any or all of the  indebtedness
          outstanding  under the 1994  Subordinated  Debt Indenture and the 1995
          Subordinated Debt Indenture for an amount not in excess of 116% of the
          principal amount purchased, provided that the aggregate amount of such
          purchases  cannot be in excess of the  aggregate  net  proceeds of the
          Subordinated Debt referred to in Section 5.03(d)(vi)."

<PAGE>


                                        3


     This  Amendment  shall become  effective on the date when and only when the
Agent shall have received (A) counterparts of this Amendment executed by IHS and
the Requisite Lenders, or as to any of such Lenders,  advice satisfactory to the
Agent that such Lender has executed this Amendment and (B)  counterparts  of the
Consent appended hereto (the "Consent"), executed by each Guarantor.

     IHS represents and warrants as follows:

     (a) IHS is duly organized and validly  existing under the laws of Delaware.
Each  Guarantor is a  corporation  or  partnership  duly  organized  and validly
existing under the laws of the jurisdiction in which it is organized.

     (b) Each of IHS and each Guarantor has the corporate or  partnership  power
to execute,  deliver and perform this Amendment and the Consent, as the case may
be, and to take all action necessary to consummate the transactions contemplated
hereunder. The execution,  delivery and performance by IHS and each Guarantor of
this Amendment and the Consent,  respectively,  have been duly authorized by all
necessary  action and do not  contravene  (i) its  certificate  or  articles  of
incorporation (or, in case of a partnership,  governing  agreements) or (ii) any
law or any indenture, lease or written agreement binding on or affecting it.

     (c) No  authorization  or approval or other  action by, and no notice to or
filing with,  any  Governmental  Authority  is required  for the due  execution,
delivery  and  performance  by IHS or any  Guarantor  of this  Amendment  or the
Consent, respectively.

     (d) This  Amendment and the Consent  constitutes  legal,  valid and binding
obligations of IHS and each Guarantor, respectively, enforceable against IHS and
each Guarantor,  respectively, in accordance with their respective terms subject
to laws generally affecting the enforcement of creditors' rights.

     (e) The Credit Agreement is a "Credit  Agreement" within the meaning of the
1997 Subordinated Debt Indenture,  upon its  effectiveness,  and the obligations
under the Credit  Agreement when incurred will be "Senior  Indebtedness"  within
the meaning of the 1997 Subordinated Debt Indenture.

     Upon the effectiveness of this Amendment, on and after the date hereof each
reference in the Credit Agreement to "this Agreement",  "hereunder", "hereof" of
words of like import  referring to the Credit  Agreement,  and each reference in
the other Loan Documents to "the Credit Agreement",  "thereunder",  "thereof" or
words of like  import  referring  to the Credit  Agreement,  shall mean and be a
reference to the Credit  Agreement  as amended  hereby.  Except as  specifically
amended above, the Credit Agreement, and all other Loan Documents, are and shall
continue to be in full force and effect and are hereby in all respects  ratified
and confirmed. The execution, delivery and effectiveness of this Amendment shall
not,  except as  expressly  provided  herein,  operate as a waiver of any right,
power or remedy of any Lender or the Agent


<PAGE>


                                        4

under any of the Loan Documents, not constitute a waiver of any provision of any
of the Loan  Documents.  This  Amendment  shall be governed by, and construed in
accordance with, the laws of the State of New York.

     Please evidence your  acknowledgement  of and agreement to the foregoing by
executing  and  returning  not later than the close of business on April 4, 1997
three  counterparts  of this Amendment No. 3 to Citicorp  Securities,  Inc., 399
Park Avenue, 9th Floor, New York, New York 10043, Attention: Rosemary Bell. This
Amendment  No. 3 is subject  to the  provisions  of  Section  8.01 of the Credit
Agreement.

     This Amendment No. 3 may be executed in any number of  counterparts  and by
any  combination of the parties hereto in separate  counterparts,  each of which
counterparts  shall  be an  original  and  all of  which  taken  together  shall
constitute one and the same Amendment No. 3.

                                      Very truly yours,

                                      INTEGRATED HEALTH
                                         SERVICES, INC.


                                      By:
                                         ------------------------------------
                                           Name:
                                                -----------------------------
                                           Title:
                                                 ----------------------------

     ACKNOWLEDGED, AGREED AND CONSENTED TO as of the date first above written:

CITIBANK, N.A.,
   as Administrative Agent and as a Lender


By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------


<PAGE>


                                        5

BANK OF AMERICA NATIONAL TRUST
   AND SAVINGS ASSOCIATION,
   as a Lender and Co-Agent


By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------


THE BANK OF NOVA SCOTIA,
   as LC Bank, a Lender and Co-Agent


By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------


CORESTATES BANK, N.A.,
   as a Lender and Co-Agent

By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------

CREDIT LYONNAIS,
   NEW YORK BRANCH,
   as a Lender and Co-Agent

By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------


<PAGE>


                                        6

DEUTSCHE BANK AG,
   NEW YORK BRANCH AND/OR
   CAYMAN ISLANDS BRANCH,
   as a Lender and Co-Agent


By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------


FIRST UNION NATIONAL BANK
   OF NORTH CAROLINA,
   as a Lender and Co-Agent


By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------


NATIONSBANK, N.A.,
   as a Lender and Co-Agent


By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------


PNC BANK, NATIONAL ASSOCIATION,
   as a Lender and Co-Agent


By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------



<PAGE>


                                        7

TORONTO DOMINION (TEXAS), INC.,
   as a Lender and Co-Agent


By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------

VAN KAMPEN AMERICAN CAPITAL
   PRIME RATE INCOME TRUST,
   as a Lender and Co-Agent


By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------


CREDITANSTALT CORPORATE
   FINANCE, INC.,
   as a Lender

By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------

By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------


FLEET NATIONAL BANK,
   as a Lender

By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------



<PAGE>


                                        8

GENERAL ELECTRIC
   CAPITAL CORPORATION,
   as a Lender


By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------


HIBERNIA NATIONAL BANK,
   as a Lender


By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------

AMSOUTH BANK OF ALABAMA,
   as a Lender


By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------

THE BANK OF TOKYO-MITSUBISHI
   TRUST COMPANY,
   as a Lender


By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------



<PAGE>


                                        9

THE SANWA BANK, LIMITED,
  NEW YORK BRANCH
   as a Lender


By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------

SIGNET BANK,
   as a Lender


By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------


THE SUMITOMO BANK, LIMITED,
   as a Lender


By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------


FIRST AMERICAN NATIONAL BANK,
   as a Lender


By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------


ALLIED IRISH BANK,
   as a Lender


By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------


<PAGE>




PROVIDENT BANK OF MARYLAND,
   as a Lender


By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------


BANK OF AMERICA ILLINOIS
   as a Lender


By:
    --------------------------------
     Name: 
           -------------------------
     Title:
           -------------------------

<PAGE>


                                        2

                                     CONSENT

         The undersigned,  as Guarantors under the Subsidiary Guaranty, dated as
of May 15,  1996 or under  Agreements  to be Bound by such  Subsidiary  Guaranty
(collectively, the "Guaranty"), in favor of the Agent for the Lenders parties to
the Credit Agreement referred to in the foregoing Amendment No. 3 hereby consent
to such  Amendment No. 3 and hereby confirm and agree that  notwithstanding  the
effectiveness  of such  Amendment No. 3, the Guaranty is, and shall  continue to
be, in full  force  and  effect  and is hereby  confirmed  and  ratified  in all
respects.

ABC GP, INC.
ABC HOME HEALTH AND HOSPICE OF ALBANY, INC.
ABC HOME HEALTH AND HOSPICE OF ATHENS, INC.
ABC HOME HEALTH AND HOSPICE OF BRUNSWICK, INC.
ABC HOME HEALTH AND HOSPICE OF DUBLIN, INC.
ABC HOME HEALTH AND HOSPICE OF MACON, INC.
ABC HOME HEALTH AND HOSPICE OF SAVANNAH, INC.
ABC HOME HEALTH AND HOSPICE OF TIFTON, INC.
ABC HOME HEALTH AND HOSPICE OF VIDALIA, INC.
ABC HOME HEALTH AND HOSPICE OF WAYCROSS, INC.
ABC HOME NURSING, INC.
ABC NEWCO, INC.
ABC PHARMACEUTICALS, INC.
ALABAMA SENIOR LIFE CARE, INC.
ALPINE MANOR, INC.
ARBOR LIVING CENTERS OF FLORIDA, INC.
ARBOR LIVING CENTERS OF TEXAS, INC.
ASIA CARE, INC.
BETHAMY LIVING CENTER MANAGEMENT COMPANY
BETHAMY LIVING CENTERS LIMITED PARTNERSHIP
BRIAR HILL, INC.
BRIARCLIFF NURSING HOME, INC.
CAMBRIDGE CARE CENTERS, INC.
CAMBRIDGE GROUP OF INDIANA, INC.
CAMBRIDGE GROUP OF PENNSYLVANIA, INC.
CAMBRIDGE GROUP OF TEXAS, INC.
CARE CENTERS HOLDING, INC.
CARRIAGE-By-THE-LAKE OF IHS, INC.
CEDARCROFT HEALTH SERVICES, INC.
CENTRAL PARK LODGES, INC.
CENTRAL PARK LODGES OF WEST PALM BEACH, INC.
CENTRAL PARK LODGES (TARPON SPRINGS), INC.
CLARA BURKE NURSING HOME, INC.
CLAREMONT INTEGRATED HEALTH, INC.
COMPREHENSIVE POSTACUTE SERVICES, INC.
DERRY INTEGRATED HEALTH, INC.
ELIZABELL CO., INC.
ELM CREEK OF IHS, INC.


<PAGE>


                                       3

F.L.C. BENEVA NURSING PAVILION, INC.
F.L.C. SARASOTA NURSING PAVILION, INC.
FERRIGAN MOBILE X-RAY, INC.
FIRELANDS OF IHS, INC.
FIRST AMERICAN HOME CARE OF ALABAMA, INC.
FIRST AMERICAN HOME CARE OF ARKANSAS, INC.
FIRST AMERICAN HOME CARE OF CALIFORNIA, INC.
FIRST AMERICAN HOME CARE OF COLORADO, INC.
FIRST AMERICAN HOME CARE OF FLORIDA, INC.
FIRST AMERICAN HOME CARE OF FT. LAUDERDALE, INC.
FIRST AMERICAN HOME CARE OF GEORGIA, INC.
FIRST AMERICAN HOME CARE OF ILLINOIS, INC.
FIRST AMERICAN HOME CARE OF INDIANA, INC.
FIRST AMERICAN HOME CARE OF LOUISIANA, INC.
FIRST AMERICAN HOME CARE OF MICHIGAN, INC.
FIRST AMERICAN HOME CARE OF MISSISSIPPI, INC.
FIRST AMERICAN HOME CARE OF MISSOURI, INC.
FIRST AMERICAN HOME CARE OF NAPLES, INC.
FIRST AMERICAN HOME CARE OF NEBRASKA, INC.
FIRST AMERICAN HOME CARE OF NEW MEXICO, INC.
FIRST AMERICAN HOME CARE OF NORTH CAROLINA, INC.
FIRST AMERICAN HOME CARE OF OHIO, INC.
FIRST AMERICAN HOME CARE OF OKLAHOMA, INC.
FIRST AMERICAN HOME CARE OF PENNSYLVANIA, INC.
FIRST AMERICAN HOME CARE OF SOUTH CAROLINA, INC.
FIRST AMERICAN HOME CARE OF TENNESSEE, INC.
FIRST AMERICAN HOME CARE OF TEXAS, INC.
FIRST AMERICAN HOME CARE OF VALDOSTA, INC.
FIRST AMERICAN HOME CARE OF VIRGINIA, INC.
FIRST AMERICAN HOME CARE OF WEST VIRGINIA, INC.
FIRST AMERICAN INTERNATIONAL, INC.
FLORIDA LIFE CARE, INC.
GAINESVILLE HEALTH CARE CENTER, INC.
GRAVOIS HEALTH CARE, INC.
HEALTH CARE SYSTEMS, INC.
HOME HEALTH INTEGRATED HEALTH SERVICES OF FLORIDA, INC.
HOSPICE INTEGRATED HEALTH SERVICES OF DISTRICT I, INC.
HOSPICE INTEGRATED HEALTH SERVICES OF DISTRICT VII-B, INC.
HOSPICE INTEGRATED HEALTH SERVICES OF FLORIDA, INC.
HOSPICE OF INTEGRATED HEALTH SERVICES, INC.
IHS ACQUISITION XIII, INC.
IHS ACQUISITION XV, INC.
IHS ACQUISITION XVIII, INC.
IHS ACQUISITION XIX, INCL
IHS ACQUISITION XXII, INC.


<PAGE>


                                        4

IHS AT LANSING, INC.
IHS CHICAGO POST-ACUTE NETWORK, INC.
IHS DEVELOPMENT-HIGHLANDS PARK, INC.
IHS HOME CARE, INC.
IHS LAND ACQUISITION-HIGHLANDS PARK, INC.
IHS MANAGEMENT GROUP, INC.
IHS NETWORK SERVICES, INC.
IHS OF DANA, INC.
IN-HOME HEALTH CARE, INC.
INTEGRACARE, INC.
INTEGRATED-BALLARD, INC.
INTEGRATED HEALTH GROUP LIMITED PARTNERSHIP
INTEGRATED HEALTH OF LOCUST VALLEY ROAD, INC.
INTEGRATED HEALTH OF WATERFORD COMMONS, INC.
INTEGRATED HEALTH SERVICES AT ALEXANDRIA, INC.
INTEGRATED HEALTH SERVICES AT BIG SAIL, INC.
INTEGRATED HEALTH SERVICES AT BLUE RIDGE MANOR, INC.
INTEGRATED HEALTH SERVICES AT BRIARCLIFF HAVEN, INC.
INTEGRATED HEALTH SERVICES AT CADIZ, INC.
INTEGRATED HEALTH SERVICES AT CENTRAL FLORIDA, INC.
INTEGRATED HEALTH SERVICES AT CHEYENNE, INC.
INTEGRATED HEALTH SERVICES AT COLORADO SPRINGS, INC.
INTEGRATED HEALTH SERVICES AT COLUMBUS, INC.
INTEGRATED HEALTH SERVICES AT DAYTON, INC.
INTEGRATED HEALTH SERVICES AT DRIFTWOOD, INC.
INTEGRATED HEALTH SERVICES AT EASTERN MASSACHUSETTS, INC.
INTEGRATED HEALTH SERVICES AT GRANDVIEW CARE CENTER, INC.
INTEGRATED HEALTH SERVICES AT GREAT BEND, INC.
INTEGRATED HEALTH SERVICES AT HIGHLANDS PARK, INC.
INTEGRATED HEALTH SERVICES AT HOPEDALE, INC.
INTEGRATED HEALTH SERVICES AT HOUSTON, INC.
INTEGRATED HEALTH SERVICES AT INDIAN CREEK, INC.
INTEGRATED HEALTH SERVICES AT KENT, INC.
INTEGRATED HEALTH SERVICES AT KING DAVID CENTER, INC.
INTEGRATED HEALTH SERVICES AT NEWARK, INC.
INTEGRATED HEALTH SERVICES AT ORMOND BEACH, INC.
INTEGRATED HEALTH SERVICES AT PARK REGENCY, INC.
INTEGRATED HEALTH SERVICES AT PENN, INC.
INTEGRATED HEALTH SERVICES AT SILVERCREST, INC.
INTEGRATED HEALTH SERVICES AT SOMERSET VALLEY, INC.
INTEGRATED HEALTH SERVICES AT SOUTHERN HILLS, INC.
INTEGRATED HEALTH SERVICES AT STEUBENVILLE
INTEGRATED HEALTH SERVICES AT SYCARMORE CREEK, INC.
INTEGRATED HEALTH SERVICES AT THREE RIVERS, INC.
INTEGRATED HEALTH SERVICES AT TREYBURN, INC.


<PAGE>


                                        5

INTEGRATED HEALTH SERVICES FINANCIAL HOLDINGS, INC.
INTEGRATED HEALTH SERVICES HOLDINGS, INC.
INTEGRATED HEALTH SERVICES NPR, INC.
INTEGRATED HEALTH SERVICES OF ARCADIA, INC.
INTEGRATED HEALTH SERVICES OF ATHENS, INC.
INTEGRATED HEALTH SERVICES OF BRENTWOOD, INC.
INTEGRATED HEALTH SERVICES OF BRUNSWICK, INC.
INTEGRATED HEALTH SERVICES OF CALIFORNIA, INC.
INTEGRATED HEALTH SERVICES OF CLIFF MANOR, INC.
INTEGRATED HEALTH SERVICES OF COLORADO AT CHERRY CREEK, INC.
INTEGRATED HEALTH SERVICES OF EAGLE CREEK, INC.
INTEGRATED HEALTH SERVICES OF GREEN BRIAR, INC.
INTEGRATED HEALTH SERVICES OF HERITAGE MANOR, INC.
INTEGRATED HEALTH SERVICES OF HICKORY CREEK, INC.
INTEGRATED HEALTH SERVICES OF INDIAN HILLS, INC.
INTEGRATED HEALTH SERVICES OF JACKSONVILLE, INC.
INTEGRATED HEALTH SERVICES OF KURT, INC.
INTEGRATED HEALTH SERVICES OF LESTER, INC.
INTEGRATED HEALTH SERVICES OF MELISSA, INC.
INTEGRATED HEALTH SERVICES OF MISSOURI, INC.
INTEGRATED HEALTH SERVICES OF ORANGE PARK, INC.
INTEGRATED HEALTH SERVICES OF RIVERBEND, INC.
INTEGRATED HEALTH SERVICES OF SCENIC HILLS, INC.
INTEGRATED HEALTH SERVICES OF SKYVIEW, INC.
INTEGRATED HEALTH SERVICES OF SKYVIEW II, INC.
INTEGRATED HEALTH SERVICES OF SUNSET, INC.
INTEGRATED MANAGED CARE, INC. (formerly Isabeth Co., Inc.)
INTEGRATED MANAGEMENT-GOVERNOR'S PARK, INC.
INTEGRATED OF AMARILLO, INC.
INTEGRATED PHYSICIAN GROUP SERVICES, INC.
J.R. REHAB ASSOCIATES, INC.
LIFEWAY, INC.
LPC BETHAMY HEALTH CORPORATION, L.P.
MANCHESTER INTEGRATED HEALTH, INC.
MOBILE RAY OF NEW ORLEANS, INC.
MOUNTAIN VIEW NURSING CENTER, INC.
NEW SOUTHWOOD ASSOCIATES, INC.
PALESTINE NURSING CENTER, INC.
PINELLAS PARK NURSING HOME, INC.
PREFERRED HOME HEALTH SERVICES, INC.
PROFESSIONAL REVIEW NETWORK, INC.
REHAB MANAGEMENT SYSTEMS, INC.
REST HAVEN NURSING CENTERS, INC.
REST HAVEN NURSING CENTERS (CHESTNUT HILL), INC.
REST HAVEN NURSING CENTERS (WHITEMARSH), INC.


<PAGE>


                                        6

RIKAD PROPERTIES, INC.
SAMARITAN CARE, INC. (Illinois Domestic)
SAMARITAN CARE, INC. (Michigan Domestic)
SAMARITAN MANAGEMENT, INC.
SHC OF ARIZONA, L.P.
SHC SERVICES OF ARIZONA, L.P.
SIGNATURE HOME CARE GROUP, INC.
SIGNATURE HOME CARE, INC.
SIGNATURE HOME CARE OF ARLINGTON, INC.
SIGNATURE HOME CARE OF FLORIDA, INC.
SIGNATURE HOME CARE OF GEORGIA, INC.
SIGNATURE HOME CARE OF KANSAS, INC.
SIGNATURE HOME CARE OF NEW JERSEY, INC.
SIGNATURE HOME CARE OF NEW JERSEY GENERAL PARTNERSHIP
SIGNATURE HOME CARE OF SAN ANTONIO, INC.
SIGNATURE HOME CARE SERVICES OF FLORIDA, INC.
SIGNATURE HOME CARE SERVICES OF SAN ANTONIO, INC.
SIGNATURE MANAGEMENT SERVICES, INC.
SIGNATURE RECEIVABLES CORP.
SLC COMMUNITY CARE, INC.
SOUTHWOOD HOLDINGS, INC.
SPRING CREEK OF IHS, INC.
SYMPHONY ANCILLARY SERVICES, INC.
SYMPHONY DIAGNOSTIC SERVICES, INC.
SYMPHONY DIAGNOSTIC SERVICES NO. 1, INC.
SYMPHONY DIAGNOSTIC SERVICES NO. 2, INC.
SYMPHONY HEALTH CARE CONSULTING, INC.
SYMPHONY HEALTH SERVICES, INC.
SYMPHONY HOME CARE SERVICES, INC.
SYMPHONY HOME CARE SERVICES NO. 1, INC.
SYMPHONY HOME CARE SERVICES NO. 2, INC.
SYMPHONY HOME CARE SERVICES NO. 3, INC.
SYMPHONY HOME CARE SERVICES NO. 4, INC.
SYMPHONY HOME CARE SERVICES NO. 5, INC.
SYMPHONY HOME CARE SERVICES NO. 6, INC.
SYMPHONY HOME CARE SERVICES NO. 7, INC.
SYMPHONY HOME CARE SERVICES NO. 8, INC.
SYMPHONY HOME CARE SERVICES NO. 9, INC.
SYMPHONY HOME CARE SERVICES NO. 10, INC.
SYMPHONY HOME CARE SERVICES NO. 11, INC.
SYMPHONY HOME CARE SERVICES NO. 12, INC.
SYMPHONY HOME CARE SERVICES NO. 13, INC.
SYMPHONY HOME CARE SERVICES NO. 14, INC.
SYMPHONY HOME CARE SERVICES NO. 15, INC.
SYMPHONY HOME CARE SERVICES NO. 16, INC.


<PAGE>


                                        7

SYMPHONY HOME CARE SERVICES NO. 17, INC.
SYMPHONY HOME CARE SERVICES NO. 18- CALIFORNIA, INC.
SYMPHONY HOME CARE SERVICES NO. 18- LOUISIANA, INC.
SYMPHONY HOME CARE SERVICES NO. 18- OKLAHOMA, INC.
SYMPHONY HOME CARE SERVICES NO. 18- TEXAS. INC.
SYMPHONY HOME CARE SERVICES NO. 19, INC.
SYMPHONY HOME CARE SERVICES NO. 100, INC.
SYMPHONY HOME CARE SERVICES NO. 101, INC.
SYMPHONY HOME CARE SERVICES NO. 102, INC.
SYMPHONY HOME CARE SERVICES NO. 103, INC.
SYMPHONY HOME CARE SERVICES NO. 104, INC.
SYMPHONY HOME CARE SERVICES NO. 105, INC.
SYMPHONY HOME CARE SERVICES NO. 106, INC.
SYMPHONY HOME CARE SERVICES NO. 107, INC.
SYMPHONY HOME CARE SERVICES NO. 108, INC.
SYMPHONY HOME CARE SERVICES NO. 109, INC.
SYMPHONY HOME CARE SERVICES NO. 110, INC.
SYMPHONY HOME CARE SERVICES NO. 113, INC.
SYMPHONY HOME CARE SERVICES NO. 114, INC.
SYMPHONY HOME CARE SERVICES NO. 115, INC.
SYMPHONY HOME CARE SERVICES NO. 116, INC.
SYMPHONY HOME CARE SERVICES NO. 117, INC.
SYMPHONY HOME CARE SERVICES NO. 118, INC.
SYMPHONY HOME CARE SERVICES NO. 119, INC.
SYMPHONY HOME CARE SERVICES NO. 120, INC.
SYMPHONY HOME CARE SERVICES NO. 121, INC.
SYMPHONY HOME CARE SERVICES NO. 122, INC.
SYMPHONY REHABILITATION SERVICES, INC.
SYMPHONY REHABILITATION SERVICES NO. 1, INC.
SYMPHONY REHABILITATION SERVICES NO. 2, INC.
SYMPHONY REHABILITATION SERVICES NO. 3, INC.
SYMPHONY REHABILITATION SERVICES NO. 4, INC.
SYMPHONY RESPIRATORY SERVICES, INC.
TEXAS LPC, INC.
THE BESTON CORPORATION
WEST COAST CAMBRIDGE, INC.
WOODRIDGE CONVALESCENT CENTER, INC.


      By:
          ---------------------------------------
           Name:
                ---------------------------------
           Title:
                 --------------------------------
                of Each Guarantor or of the
                General Partner of such Guarantor



               GUARANTY,  dated as of April 14, 1997, made by INTEGRATED  HEALTH
SERVICES, INC. (the "Guarantor") in favor of DAIWA HEALTHCO-2 LLC ("Daiwa").


               PRELIMINARY STATEMENTS.

               Daiwa  is  the  lender  under  that  certain  Loan  and  Security
Agreement,  dated as of December 23, 1996 (as amended on the date hereof, and as
the same may be further amended, modified, supplemented or restated from time to
time in accordance with its terms,  the "LSA"),  between CCA Funding LLC ("CCA")
and Daiwa. All terms not otherwise  defined herein shall have meanings set forth
in the LSA.

               Daiwa and CCA are entering into a certain  Waiver and  Amendment,
dated as of the date hereof,  to the LSA. The Guarantor will derive  substantial
benefit  from  the  transactions  contemplated  by the LSA as  amended.  It is a
condition  precedent to the  effectiveness  of the Waiver and Amendment that the
Guarantor shall have executed and delivered this Guaranty.

               NOW, THEREFORE,  in consideration of the premises,  the Guarantor
hereby agrees as follows:


                SECTION 1. Guaranty; Limitation of Liability

                (a)  The  Guarantor  hereby   unconditionally   and  irrevocably
guarantees the punctual payment when due of all amounts owing from CCA under the
LSA in excess of the Basic Borrowing Amount (the "Guaranteed  Obligations")  and
agrees to pay any and all reasonable  costs and expenses  (including  reasonable
counsel fees and  expenses)  paid or incurred in enforcing any rights under this
Guaranty.  Without  limiting the  generality of the foregoing,  the  Guarantor's
liability  shall extend to all amounts that  constitute  part of the  Guaranteed
Obligations  and  would be owed by CCA  under the LSA but for the fact that they
are  unenforceable  or  not  allowable  due to the  existence  of a  bankruptcy,
reorganization or similar proceeding involving a Provider.

                (b)  Any and  all  payments  by or on  behalf  of the  Guarantor
hereunder  shall be made free and clear of and without  deduction or withholding
for any and all present or future taxes unless required by law.

                SECTION 2. Guaranty Absolute.  The Guarantor guarantees that the
Guaranteed  Obligations  will be paid in  accordance  with the  terms of the LSA
regardless  of any law,  regulation  or order now or  hereafter in effect in any
jurisdiction  affecting  any of such  terms or the  rights of CCA or Daiwa  with
respect  thereto.  The obligations of the Guarantor  hereunder is independent of
the  obligations  of CCA under the LSA and a separate  action or actions  may be
brought  or  prosecuted   against  the  Guarantor  to  enforce  this   Guaranty,
irrespective  of whether action is brought  against CCA or whether CCA is joined
in any such action or actions. The liability of the Guarantor under this


<PAGE>

Guaranty  shall be  absolute  and  unconditional,  and shall not be  affected or
released in any way, irrespective of-.

                (a) any lack of  validity  or  enforceability  of the LSA or any
agreement or instrument relating thereto (collectively, the "Documents");

                (b) any change in the time, manner or place of payment of, or in
any  other  term of,  all or any of the  Guaranteed  Obligations,  or any  other
amendment or waiver of or any consent to departure from any Document  including,
without limitation, any increase in the Guaranteed Obligations;

                (c)  any  taking  and  holding  of   collateral   or  additional
guarantees  for  all or any of the  Guaranteed  Obligations,  or any  amendment,
alteration,    exchange,    substitution,    transfer,   enforcement,    waiver,
subordination,  termination or release of any collateral or such guarantees,  or
non-perfection  or delay in  perfection  of any  collateral,  or any  consent to
departure from any such guaranty, for all or any of the Guaranteed Obligations;

                (d)  any  manner  of  application  of  collateral,  or  proceeds
thereof,  to  all or any of  the  Guaranteed  Obligations,  or any  commercially
reasonable  manner of sale or other disposition of any collateral for all or any
of the Guaranteed Obligations or any other assets of CCA or any other Person;

                (e) any consent by Daiwa, CCA or any other Person to the change,
restructure or termination of the corporate structure or existence of CCA, Daiwa
or any of their affiliates and any  corresponding  restructure of the Guaranteed
Obligations,   or  any  other  restructure  or  refinancing  of  the  Guaranteed
Obligations or any portion thereof; or

                (f) any other  circumstance  which might otherwise  constitute a
defense available to, or a discharge of CCA.

                Without limiting the generality of the foregoing,  the Guarantor
hereby consents to, and hereby agrees,  that the rights of Daiwa hereunder,  and
the liability of the Guarantor  hereunder,  shall not be affected by any and all
releases of any  collateral,  whether for  purposes of  commercially  reasonable
sales or other  dispositions  of assets or for any other purpose.  

                Section 3. Waivers. The Guarantor hereby waives:

                      (a)  promptness,  diligence,  notice of acceptance and any
                other notice with respect to any of the  Guaranteed  Obligations
                and this Guaranty;

                      (b) any  requirement  that Daiwa,  CCA or any other Person
                protect,  secure,  perfect  or insure  any Lien or any  property
                subject  thereto or exhaust any right or take any action against
                CCA or any other Person or any collateral; and


                                       2

<PAGE>

                      (c) any duty on the part of Daiwa, CCA or any other Person
                to disclose to the Guarantor any matter,  fact or thing relating
                to the  business,  operation  or condition of CCA and its assets
                now known or hereafter known by such Person.

               SECTION 4.  Waiver of  Subrogation  and  Contribution.  Until the
later to occur  of the  Maturity  Date  and  payment  in full of all  Guaranteed
Obligations,  the Guarantor hereby  irrevocably waives any claim or other rights
which  it may  now or  hereafter  acquire  against  CCA  that  arises  from  the
existence,  payment,  performance or enforcement of the Guarantor's  obligations
under this Guaranty,  including,  without limitation,  any right of subrogation,
reimbursement,  exoneration,  contribution or  indemnification  and any right to
participate in any claim or remedy against CCA or any collateral which Daiwa now
has or hereafter acquires,  whether or not such claim, remedy or right arises in
equity, or under contract, statute or common law, including, without limitation,
the right to take or receive  from CCA or,  directly or  indirectly,  in cash or
other  property  or by set-off or in any other  manner,  payment or  security on
account of such claim, remedy or other right. If any amount shall be paid to the
Guarantor in violation of the preceding  sentence at any time prior to the later
to occur of the Maturity Date and payment in full of all Guaranteed Obligations,
such amount shall be deemed to have been paid to the  Guarantor  for the benefit
of, and held in trust for the benefit of, Daiwa,  and shall forthwith be paid to
Daiwa to be credited  and applied to the  Guaranteed  Obligations  and all other
amounts payable under this Guaranty, whether matured or unmatured, in accordance
with the terms of the Documents,  or to be held as collateral for any Guaranteed
Obligations or other amounts payable under this Guaranty thereafter arising. The
Guarantor  acknowledges  that it will receive direct and indirect  benefits from
the financing arrangements contemplated by the Documents and that the waiver set
forth in this subsection is knowingly made in contemplation of such benefits.


                SECTION 5. Representations and Warranties.  The Guarantor hereby
represents and warrants as follows:

                      (a) no  authorization,  consent,  approval or other action
                by, and no notice to or filing with, any governmental  authority
                or  regulatory  body or any other Person is required for the due
                execution,  delivery and  performance  by the  Guarantor of this
                Guaranty except for consents which have been obtained.

                      (b) it has,  independently and without reliance upon Daiwa
                or CCA and based on such  documents  and  information  as it has
                deemed appropriate, made its own credit analysis and decision to
                enter into this Guaranty.

               SECTION  6.  Amendments,  Etc.  No  amendment  or  waiver  of any
provision  of this  Guaranty  nor  consent  to any  departure  by the  Guarantor
therefrom  shall in any event be  effective  unless the same shall be in writing
and signed by Daiwa (and,  if an  amendment,  by the  Guarantor),  and then such
waiver or consent shall be effective  only in the specific  instance and for the
specific purpose for which given.


                                       3

 
<PAGE>

               SECTION 7. No Waiver;  Remedies. No failure on the part of Daiwa,
to exercise, and no delay in exercising,  any right hereunder shall operate as a
waiver thereof,  nor shall any single or partial exercise of any right hereunder
preclude  any other or further  exercise  thereof or the  exercise  of any other
right.  The remedies  herein  provided are  cumulative  and not exclusive of any
remedies provided by law or any other Document.

               SECTION 8. Continuing  Guaranty;  Assignment.  This Guaranty is a
continuing  guaranty  and shall (a)  subject to the last  sentence  of Section 2
hereof, remain in full force and effect until the later to occur of the Maturity
Date and payment in full of all Guaranteed Obligations,  (b) be binding upon the
Guarantor,  its successors  and assigns,  and (c) inure to the benefit of and be
enforceable by Daiwa and its successors and assigns.

               SECTION 9. Financial  Condition of CCA. The Guarantor  represents
to Daiwa  that it is now and will be  completely  familiar  with the  prospects,
business,  operations  and condition  (financial  and otherwise) of CCA, and the
Guarantor  hereby waives and  relinquishes  any duty on the part of Daiwa or any
other Person to disclose any matter,  fact or thing  relating to the  prospects,
business, assets, liabilities,  operations or condition (financial or otherwise)
of CCA now known or hereafter known by Daiwa or any other Person.

                SECTION 10.  GOVERNING LAW. THIS AGREEMENT SHALL BE GOVERNED BY,
AND  CONSTRUED IN  ACCORDANCE  WITH,  THE LAW OF THE STATE OF NEW YORK  (WITHOUT
GIVING EFFECT TO THE CONFLICT OF LAWS PRINCIPLES THEREOF).

               SECTION 11.  WAIVER OF JURY TRIAL,  JURISDICTION  AND VENUE.  THE
PARTIES  HERETO  HEREBY  WAIVE ALL RIGHTS TO A TRIAL BY JURY IN THE EVENT OF ANY
LITIGATION  WITH  RESPECT TO ANY MATTER  RELATED TO THIS  AGREEMENT,  AND HEREBY
IRREVOCABLY  CONSENT TO THE JURISDICTION OF THE STATE AND FEDERAL COURTS LOCATED
IN NEW YORK COUNTY,  NEW YORK CITY,  NEW YORK IN  CONNECTION  WITH ANY ACTION OR
PROCEEDING ARISING OUT OF OR RELATING TO THIS AGREEMENT. IN ANY SUCH LITIGATION,
THE PARTIES  HERETO WAIVE  PERSONAL  SERVICE OF ANY SUMMONS,  COMPLAINT OR OTHER
PROCESS AND AGREES THAT SERVICE  THEREOF MAY BE MADE BY CERTIFIED OR  REGISTERED
MAIL DIRECTED TO THE OTHER PARTY AT ITS ADDRESS SET FORTH ON THE SIGNATURE  PAGE
HEREOF. THE PARTIES HERETO SHALL APPEAR IN ANSWER TO SUCH SUMMONS,  COMPLAINT OR
OTHER  PROCESS  WITHIN THE TIME  PRESCRIBED  BY LAW,  FAILING  WHICH THE PARTIES
FAILING TO SO APPEAR  SHALL BE DEEMED IN DEFAULT AND  JUDGMENT MAY BE ENTERED BY
THE OTHER PARTY FOR THE AMOUNT OF THE CLAIM AND OTHER RELIEF REQUESTED THEREIN.

                SECTION  12.  Severabilitv.  If any  term or  provision  of this
Guaranty  is  or  shall  become  illegal,   invalid  or   unenforceable  in  any
jurisdiction, all other terms and provisions of this

                                        4

<PAGE>

Guaranty shall remain legal, valid and enforceable in such jurisdiction and such
illegal,   invalid  or  unenforceable   provision  shall  be  legal,  valid  and
enforceable in all other jurisdictions.

                SECTION 13. Section Titles. The Section titles contained in this
Guaranty  are and shall be  without  substantive  meaning or content of any kind
whatsoever and are not a part of the agreement between the parties hereto.

               IN WITNESS  WHEREOF, this __ day of April 1997, the Guarantor has
caused this Guaranty to be duly executed and delivered by its officer  thereunto
duly authorized as of the date first above written.


                                INTEGRATED HEALTH SERVICES, INC.


                                By: /s/ W. Bradley Bennet
                                    --------------------------------------------
                                    Name:  W. Bradley Bennet
                                    Title: Executive Vice President and 
                                           Chief Accounting Officer

AGREED:

CCA FUNDING LLC



By: /s/ Timothy J. Trybus
    --------------------------------------------
    Name: Timothy J. Trybus
    Title: Vice President and Treasurer
    Address: 3050 N. Horseshoe Drive, Suite 260
             Naples FL 34104

                                        5



               GUARANTY  dated as of April  14, 1997 made by  INTEGRATED  HEALTH
SERVICES,  INC.,  a  Delaware  corporation  (the  "Guarantor")  and  HEALTH  AND
RETIREMENT  PROPERTIES  TRUST, a Maryland real estate investment trust (with its
successor and assigns, "HRP").

                                   WITNESSETH:

     WHEREAS, Community Care of America, Inc. ("CCA") and its subsidiaries (with
CCA, collectively, the "CCA Companies") have entered into certain loan and lease
financings with HRP governed by certain documents, instruments and agreements to
which the various CCA Companies  and/or HRP are a party (as from time to time in
effect, collectively, the "CCA Documents");

     WHEREAS,  the CCA  Companies  have  requested  that HRP (a)  consent to the
waiver through February 28, 1998 of the covenants in the CCA Documents requiring
the CCA  Companies  (i) to  maintain  a  ratio  of  current  assets  to  current
liabilities of at least 1.0 to 1.0 and (ii) not to permit its tangible net worth
to be less than  $5,000,000  and (b) agree to apply a portion of the  $6,185,000
security  deposit  held  by HRP as  collateral  for the  obligations  of the CCA
Companies  under the CCA Documents  (the  "Security  Deposit") to the payment of
existing  arrearages under the CCA Documents,  to pay a restructuring fee to HRP
and to pay 50% of future monthly payments of regularly scheduled installments of
Minimum and Additional Rent, Mortgage Facilities Fees and principal and interest
on loans by HRP, as and when due;

     WHEREAS,  HRP is willing to so consent and agree,  subject to the terms and
conditions  of a letter  agreement  dated as of April 14, 1997 by HRP to the CCA
Companies (the "Letter Agreement");

     WHEREAS,  it is a condition to the  effectiveness  of the Letter  Agreement
that, among other things, the Guarantor deliver this Guaranty in favor of HRP;

     WHEREAS,  the  Guarantor  holds  warrants to purchase  ___ shares of common
stock of CCA,  the value of which  would be  adversely  affected  if the  Letter
Agreement, were not to become affected;

     NOW,  THEREFORE,  in  consideration  of the premises and for other good and
valuable   consideration,   the  receipt  and   adequacy  of  which  are  hereby
acknowledged, the Guarantor hereby agrees with HRP as follows:

1. Defined Terms.  Unless otherwise  defined herein,  terms which are defined in
the CCA  Documents and used herein are so used as so defined.  In addition,  the
following terms shall have the meanings set forth below:


<PAGE>

                                     - 2 -
  
     "Applicable-Law" shall mean any law of any governmental authority,  whether
domestic or foreign, including without limitation all federal and state laws, to
which the Person in question is subject or by which it or any of its property is
bound,  and including  without  limitation any: (a)  administrative,  executive,
judicial,  legislative  or other action,  code,  consent  decree,  constitution,
decree, directive,  enactment, finding, guideline,  injunction,  interpretation,
judgment, law, order, ordinance, policy statement,  proclamation,  promulgation,
regulation,  requirement,  rule, rule of law, rule of public policy,  settlement
agreement, statute, or writ, of any governmental authority, domestic or foreign,
whether  or not  having  the  force of law;  (b)  common  law or other  legal or
quasi-legal  precedent;  or (c)  arbitrator's,  mediator's  or referee's  award,
decision,  finding or recommendation,  or, in any case, any particular  section,
part or provision thereof

     "CCA  Event of  Default"  shall  mean an  "Event of  Default"  under and as
defined in any CCA Document.

     "Default  Amount" shall mean $10,000,000 or such lesser amount to which the
Guarantor's  maximum liability hereunder has been reduced pursuant to the second
paragraph of Section 2 hereof.

     "Default Rate" shall mean 4% per annum above the prime rate or base rate on
corporate loans at large U.S. money center  commercial banks as published in The
Wall  Street  Joumal  or, if  publication  of such rate  shall be  suspended  or
terminated,  the annual rate of interest,  determined  daily and  expressed as a
percentage,   from  time  to  time   announced   by  one  of  the  five  largest
national-chartered  banking  institutions  having their principal  office in New
York, New York and selected by HRP at the time such  publication is suspended or
terminated.  Each change in the Interest  Rate shall take effect  simultaneously
with  the  date  of  publication  or  announcement,   as  applicable,   of  each
corresponding change in such prime rate or base rate.

     "Material  Adverse  Effect"  means a  material  adverse  effect  on (a) the
business, operations,  property, condition (financial or otherwise) or prospects
of the Guarantor, or of the Guarantor and its Subsidiaries taken as a whole, (b)
the ability of the Guarantor to perform its obligations under this Guaranty,  or
(c) the  validity  or  enforceability  of this  Guaranty,  or the  rights of HRP
hereunder.

     "Obligations"  shall mean the  payment  and  performance  of each and every
obligation and liability of any CCA Company to HRP, whether under a CCA Document
or  otherwise,  whether now existing or hereafter  arising or created,  joint or
several,  direct or  indirect,  absolute  or  contingent,  due or to become due,
matured or unmatured, liquidated or unliquidated, arising by contract, operation
of law or otherwise,  and  including,  without  limitation,  (i) all  principal,
premium or prepayment fee and interest (including,  without limitation,  Minimum
Interest and Additional  Interest,  as such terms are defined in the various CCA
Documents)  under any  promissory  note payable to HRP,  (ii) all rent under any
lease with HRP as landlord  (including,  without  limitation,  any Minimum Rent,
Additional Rent and Additional Charges, as such terms are defined in the


<PAGE>
                                     - 3 -

various  CCA  Documents),  and (iii)  all fees and  charges  (including  without
limitation,  any Mortgage Facilities Fee, as such term is defined in the various
CCA Documents).

2. Guaranty.  The Guarantor hereby unconditionally and irrevocably guarantees to
HRP the prompt and complete  payment and  performance  by the CCA Companies (and
each of  them),  when due  (whether  at  stated  maturity,  by  acceleration  or
otherwise), of the Obligations.  The Guarantor further agrees to pay any and all
reasonable  expenses  (including,  without  limitation,  all reasonable fees and
disbursements  of  counsel  to HRP)  which  may be paid  or  incurred  by HRP in
enforcing any of its rights under this Guaranty.  This Guaranty is a guaranty of
payment and not of  collectibility  and is absolute and in no way conditional or
contingent.  The Guarantor's liability hereunder is direct and unconditional and
(without  limiting the  provisions  of Section 15 hereof) may be enforced  after
nonpayment  or  nonperformance  by any CCA  Company  of any  Obligation  without
requiring HRP to resort to any other Person (including  without  limitation such
CCA Company) or any other  right,  remedy or  collateral.  This  Guaranty  shall
remain in full force and effect until the Obligations are paid in full.

     Notwithstanding the aggregate amount of the Obligations at any time or from
time to time payable or to be payable by the CCA Companies to HRP, the liability
of the Guarantor to HRP hereunder in respect of the Obligations shall not exceed
$10,000,000 in the aggregate.  The Guarantor  agrees that the Obligations may at
any time  and from  time to time  exceed  the  amount  of the  liability  of the
Guarantor  hereunder without impairing this Guaranty or affecting the rights and
remedies of HRP hereunder.  The Guarantor agrees that whenever,  at any time, or
from time to time,  it shall make any payment to HRP on account of its liability
hereunder,  it will notify HRP in writing  that such  payment is made under this
Guaranty for such purpose. No payment or payments made by any CCA Company or any
other  Person or received or  collected by HRP from any CCA Company or any other
Person by virtue of any action or proceeding or any set-off or  appropriation or
application,  at any time or from time to time, in reduction of or in payment of
the Obligations shall be deemed to modify,  reduce,  release or otherwise affect
the liability of the Guarantor  hereunder which shall,  notwithstanding any such
payment or payments,  remain liable for the amount of the Obligations  until the
Obligations are paid in full.

3. Costs and Expenses of Collection.  The Guarantor agrees, as principal obligor
and not as a guarantor only, to pay to HRP forthwith upon demand, in immediately
available  funds, all costs and expenses  (including,  without  limitation,  all
court  costs and all fees and  disbursements  of  counsel  to HRP)  incuffed  or
expended by HRP in connection  with the  enforcement of this Guaranty,  together
with  interest  on such  amounts  from the time such  amounts  become  due until
payment at the Default Rate. The Guarantor's  covenants and agreements set forth
in this Section 3 shall survive the termination of this Guaranty.

4. Right of Setoff.  Regardless of the adequacy of any collateral or other means
of obtaining  repayment of the Obligations,  HRP is hereby  authorized,  without
notice to the Guarantor or compliance with any other condition  precedent now or
hereafter imposed by Applicable Law (all of which are hereby expressly waived to
the extent  permitted by Applicable Law) and to the fullest extent  permitted by
Applicable Law, to set off and apply any securities,  deposits or other property
belonging to the Guarantor now or hereafter held by HRP against the  obligations
of the

<PAGE>

                                     - 4 -

Guarantor  under  this  Guaranty,  whether or not HRP shall have made any demand
under this Guaranty, at any time and from time to time after the occurrence of a
Guarantor  Event of Default,  in such manner as HRP in its sole  discretion  may
determine, and the Guarantor hereby grants HRP a continuing security interest in
such  securities,  deposits and property for the payment and performance of such
obligations.

5. Subrogation and Contribution.  Until the Obligations shall have been paid and
performed in full, the Guarantor irrevocably and unconditionally  waives any and
all rights to which it may be entitled, by operation of law or otherwise,  to be
subrogated,  with respect to any payment made by the Guarantor hereunder, to the
rights  of  HRP  against  any  CCA  Company,  or  otherwise  to  be  reimbursed,
indemnified  or exonerated  by any CCA Company in respect  thereof or to receive
any payment,  in the nature of  contribution  or for any other reason,  from any
other  guarantor  of the  Obligations  with  respect to any payment  made by the
Guarantor hereunder. Until the Obligations shall have been paid and performed in
full,  the  Guarantor  waives any defense it may have based upon any election of
remedies  by  HRP  which  impairs  the  Guarantor's  subrogation  rights  or the
Guarantor's  rights  to  proceed  against  any  CCA  Company  for  reimbursement
(including  without  limitation  any loss of rights the  Guarantor may suffer by
reason of any rights,  powers or remedies of such CCA Company in connection with
any anti-deficiency  laws or any other laws limiting,  qualifying or discharging
any indebtedness to HRP). Until the Obligations shall have been paid,  performed
and  satisfied in full,  the Guarantor  further  waives any right to enforce any
remedy which HRP now has or may in the future have against any CCA Company,  any
other  guarantor  or any  other  Person  and any  benefit  of,  or any  right to
participate in, any security whatsoever now or in the future held by HRP.

6.  Effect of  Bankruptcy  Stay.  If  acceleration  of the time for  payment  or
performance of any of the Obligations is stayed upon the insolvency, bankruptcy
or reorganization of any CCA Company or any other Person or otherwise,  all such
amounts  otherwise  subject to acceleration  shall nonetheless be payable by the
Guarantor under this Guaranty forthwith upon demand.

7.  Receipt of CCA  Documents,  etc.  The  Guarantor  confirms,  represents  and
warrants  to HRP  that  (i) it has  received  true and  complete  copies  of all
existing CCA Documents from the CCA Companies, has read the contents thereof and
reviewed the same with legal counsel of its choice;  (ii) no  representations or
agreements  of any kind have been made to the  Guarantor  which  would  limit or
qualify in any way the terrns of this Guaranty;  (iii) this Guaranty is executed
at the CCA  Companies'  request and not at the request of HRP; (iv) HRP has made
no  representation  to the  Guarantor  as to  the  creditworthiness  of any  CCA
Company;  and (v) the Guarantor has established adequate means of obtaining from
each CCA Company on a continuing basis information  regarding such CCA Company's
financial condition.  The Guarantor agrees to keep adequately informed from such
means of any facts,  events, or circumstances  which might in any way affect the
Guarantor's risks under this Guaranty, and the Guarantor further agrees that HRP
shall have no  obligation  to  disclose  to the  Guarantor  any  information  or
documents  acquired  by HRP in the  course  of its  relationship  with  the  CCA
Companies .

8.  Amendments,  etc. with Respect to the  Obligations.  The  obligations of the
Guarantor  under this  Guaranty  shall  remain in full force and effect  without
regard to, and shall not be


<PAGE>

                                      - 5 -

released,  altered,  exhausted,  discharged  or  in  any  way  affected  by  any
circumstance  or  condition  (whether  or not any CCA  Company  shall  have  any
knowledge or notice thereof),  including without limitation (a) any amendment or
modification of or supplement to any CCA Document,  or any  obligation,  duty or
agreement  of the CCA  Companies or any other  Person  thereunder  or in respect
thereof;  (b) any  assignment  or  transfer  in  whole  or in part of any of the
Obligations; any fumishing,  acceptance, release, nonperfection or invalidity of
any direct or indirect security or guaranty for any of the Obligations;  (c) any
waiver, consent, extension, renewal, indulgence, settlement, compromise or other
action or inaction  under or in respect of any CCA Document,  or any exercise or
nonexercise of any right,  remedy, power or privilege under or in respect of any
such instrument (whether by operation of law or otherwise);  (d) any bankruptcy,
insolvency, reorganization,  arrangement, readjustment, composition, liquidation
or similar proceeding with respect to any CCA Company or any other Person or any
of  their  respective  properties  or  creditors  or any  resulting  release  or
discharge of any Obligation  (including  without limitation any rejection of any
lease pursuant to Section 365 of the Federal  Bankruptcy  Code);  (e) any new or
additional  financing  arrangements  entered  into by any CCA  Company or by any
other Person on behalf of or for the benefit of any CCA Company;  (f) the merger
or  consolidation  of any CCA  Company  with or into any other  Person or of any
other Person with or into any CCA Company; (g) the voluntary or involuntary sale
or other  disposition of all or substantially  all the assets of any CCA Company
or any other Person; (h) the voluntary or involuntary  liquidation,  dissolution
or  termination  of any CCA Company or any other Person;  (i) any  invalidity or
unenforceability,  in  whole  or in  part,  of any  term  hereof  or of any  CCA
Document,  or any obligation,  duty or agreement of any CCA Company or any other
Person thereunder or in respect thereof; (j) any provision of any applicable law
or  regulation  purporting  to prohibit  the payment or  performance  by any CCA
Company or any other  Person of any  Obligation;  (k) any failure on the part of
any CCA Company or any other Person for any reason to perform or comply with any
term of any CCA Document or any other agreement;  or (1) any other act, omission
or occurrence  whatsoever, whether  similar or dissimilar to the foregoing.  The
Guarantor  authorizes  each CCA Company,  each other guarantor in respect of the
Obligations and HRP at any time in its discretion,  as the case may be, to alter
any of the terms of any of the Obligations.

9. Guarantor as Principal.  If for any reason the CCA Companies, or any of them,
or any other Person is under no legal obligation to discharge any Obligation, or
if any other moneys included in the Obligations have become  unrecoverable  from
the CCA  Companies,  or any of them,  or any other Person by operation of law or
for  any  other  reason,  including,   without  limitation,  the  invalidity  or
irregularity  in whole or in part of any Obligation or of any CCA Document,  the
legal  disability  of any  CCA  Company  or any  other  obligor  in  respect  of
Obligations,  any discharge of or limitation on the liability of any CCA Company
or any other Person or any  limitation  on the method or terms of payment  under
any Obligation,  or of any CCA Document, which may now or hereafter be caused or
imposed in any manner whatsoever  (whether consensual or arising by operation of
law or  otherwise),  this Guaranty shall  nevertheless  remain in full force and
effect  and shall be binding  upon the  Guarantor  to the same  extent as if the
Guarantor at all times had been the principal obligor on all Obligations.

10. Waiver of Demand,  Notice,  Etc, The Guarantor hereby waives,  to the extent
not prohibited by applicable  law, all  presentments,  demands for  performance,
notice of


<PAGE>

                                      - 6 -

nonperformance,  protests,  notices  of  protests  and  notices of  dishonor  in
connection with the  Obligations or any CCA Document,  including but not limited
to (a) notice of the  existence,  creation or incurring of any new or additional
obligation  or of any action or  failure to act on the part of any CCA  Company,
HRP,  any endorser or creditor of any CCA Company or any other  Person;  (b) any
notice of any  indulgence,  extensions  or renewals  granted to any obligor with
respect to the  Obligations;  (c) any  requirement of diligence or promptness in
the  enforcement  of rights under any CCA  Document,  or any other  agreement or
instrument  directly or indirectly  relating thereto or to the Obligations;  (d)
any  enforcement  of any  present or future  agreement  or  instrument  relating
directly or indirectly  thereto or to the Obligations;  (e) notice of any of the
matters  referred  to in Section 9 above;  (f) any defense of any kind which the
Guarantor may now have with respect to his liability  under this  Guaranty;  (g)
any right to require HRP, as a condition of  enforcement  of this  Guaranty,  to
proceed  against  any CCA Company or any other  Person or to proceed  against or
exhaust  any  security  held by HRP at any time or to pursue any other  right or
remedy in HRP's power before proceeding  against the Guarantor;  (h) any defense
that  may  arise  by  reason  of the  incapacity,  lack of  authority,  death or
disability  of any other  Person or  Persons  or the  failure  of HRP to file or
enforce a claim against the estate (in administration,  bankruptcy, or any other
proceeding)  of any other  Person or  Persons;  (i) any  defense  based  upon an
election  of  remedies  by HRP;  0) any  defense  arising  by reason of any "one
action" or  "anti-deficiency"  law or any other law which may  prevent  HRP from
bringing any action,  including a claim for  deficiency,  against the Guarantor,
before or after HRP's  commencement  of  completion of any  foreclosure  action,
either  judicially or by exercise of a power of sale; (k) any defense based upon
any lack of diligence by HRP in the collection of any  Obligation;  (1) any duty
on the  part  of HRP to  disclose  to the  Guarantor  any  facts  HRP may now or
hereafter  know  about  any CCA  Company  or any other  obligor  in  respect  of
Obligations;  (m) any defense  arising  because of an election made by HRP under
Section 1 1 1 1 (b) (2) of the Federal Bankruptcy Code; (n) any defense based on
any borrowing or grant of a security  interest  under Section 364 of the Federal
Bankruptcy  Code;  (o) and any defense  based upon or arising out of any defense
which any CCA Company or any other Person may have to the payment or performance
of the  Obligations  (including  but not  limited to  failure of  consideration,
breach of warranty, fraud, payment, accord and satisfaction, strict foreclosure,
statute of frauds, bankruptcy, infancy, statute of limitations, lender liability
and usury). Guarantor acknowledges and agrees that each of the waivers set forth
herein on the part of the Guarantor is made with  Guarantor's  full knowledge of
the significance and consequences thereof and that, under the circumstances, the
waivers  are  reasonable.  If any such  waiver is  determined  to be contrary to
Applicable  Law such waiver shall be effective only to the extent not prohibited
by such Applicable Law.

ii.  Reinstatement.  This  Guaranty  shall  continue  to  be  effective,  or  be
reinstated,  as the case may be, if at any time payment, or any part thereof, of
any of the Obligations is rescinded or must otherwise be restored or returned by
HRP upon the insolvency, bankruptcy, dissolution,  liquidation or reorganization
of any CCA  Company  or upon or as a result of the  appointment  of a  receiver,
intervenor or conservator of, or trustee or similar officer for, any CCA Company
or any  substantial  part of its  property,  or  otherwise,  all as though  such
payments had not been made.


<PAGE>
                                     - 7 -

12. The Guarantor hereby agrees that the Obligations will be paid to HRP without
set-off or  counterclaim  in U.S.  Dollars  at the office of HRP  located at 400
Centre Street,  Newton,  Massachusetts  02158,  or to such other location as HRP
shall notify the Guarantor.

13. Representations and Warranties. The Guarantor represents and warrants that:

                      (i)  Corporate  Existence.  The Guarantor is a corporation
                duly  incorporated  and validly  existing  under the laws of the
                jurisdiction  of its  incorporation,  and is  duly  licensed  or
                qualified  as a foreign  corporation  in all states  wherein the
                nature of its property owned or business  transacted by it makes
                such  licensing  or  qualification  necessary,  except where the
                failure  to be  licensed  or to so  qualify  could  not  have  a
                Material Adverse Effect.

                      (ii) No Violation. The execution, delivery and performance
                of this  Guaranty  will not  contravene  any  provision  of law,
                statute, rule or regulation to which the Guarantor or any of its
                Subsidiaries  is subject  or any  judgment,  decree,  franchise,
                order  or  permit  applicable  to  the  Guarantor  or any of its
                Subsidiaries,  or conflict or be inconsistent  with or result in
                any  breach  of,  any of the  terms,  covenants,  conditions  or
                provisions of, or constitute a default  under,  or result in the
                creation  or  imposition  of (or the  obligation  to  create  or
                impose) any lien or security  interest  upon any of the property
                or assets of the Guarantor or any of its  Subsidiaries  pursuant
                to the  terms  of any  agreement  or  instrument  to  which  the
                Guarantor or any of its  Subsidiaries  is party,  or violate any
                provision of the respective  corporate charters or bylaws of the
                Guarantor or any of its Subsidiaries.

                      (iii)  Corporate   Authority  and  Power.  The  execution,
                delivery  and   performance  of  this  Guaranty  is  within  the
                corporate  powers of the Guarantor and has been duly  authorized
                by all necessary corporate action.

                      (iv) Enforceability.  This Guaranty has been duly executed
                and delivered by the  Guarantor,  and this Guaranty  constitutes
                the valid and binding  obligation of the  Guarantor  enforceable
                against the  Guarantor in accordance  with its terms,  except as
                enforceability   may  be  limited  by   applicable   bankruptcy,
                insolvency, reorganization, moratorium or similar laws affecting
                the  enforcement  of creditors'  rights  generally and except as
                enforceability  may be subject to general  principles of equity,
                whether such  principles  are applied in a court of equity or at
                law.

                      (v) Governmental Approvals. No order, permission, consent,
                approval, license, authorization, registration or validation of,
                or filing with, or exemption by, any  governmental  authority is
                required to authorize,  or is required in connection  with,  the
                execution,  delivery and  performance of this  Guaranty,  or the
                taking of any action contemplated hereby or thereby.

                      (vi) Litigation.  The Guarantor has no notice or knowledge
                of any action,  suit or proceeding pending or threatened against
                or  affecting  it at  law  or in  equity  or  before  or by  any
                governmental  department,   court,  commission,  board,  bureau,
                agency or


<PAGE>

                                     - 8 -

                instrumentality,  domestic or foreign,  or before any arbitrator
                of any kind that would, if adversely determined, have a Material
                Adverse Effect.

14.  Subordination  of  Claims  against  CCA  Companies.  Without  limiting  the
provisions of Section 5 hereof, the Guarantor hereby irrevocably agrees that any
and all claims which the  Guarantor  may now or  hereafter  have against any CCA
Company  or  any  other  guarantor  of  the  Obligations,   including,   without
limitation,  the  benefit  of any  set-off  or  counterclaim  or  proof  against
dividend,  composition  or payment by any CCA  Company or such other  guarantor,
shall be  subject  and  subordinate  to the prior  payment in full of all of the
Obligations  to HRP.  After the  occurrence  of an Event of Default under and as
defined in any CCA Document,  or any event or condition  that with the giving of
notice or lapse of time or both  could  become  such an Event of Default (a "CCA
Default"),  the  Guarantor  shall not claim  from any CCA  Company or such other
guarantor, or with respect to any of their respective properties, any sums which
may  be  owing  to the  Guarantor,  or  have  the  benefit  of  any  set-off  or
counterclaim  or proof  against  dividend,  composition  or  payment by such CCA
Company or such other guarantor,  until all Obligations  shall have been paid in
full.  Should any payment or distribution or security or the benefit of proceeds
thereof be received by the Guarantor  upon or with respect to amounts due to the
Guarantor from any CCA Company or any other guarantor of the Obligations after a
CCA Default has  occurred  and prior to the payment in full of all  Obligations,
the  Guarantor  shall  forthwith  deliver the same to HRP in precisely  the form
received (except for endorsement or assignment where necessary), for application
in or towards  repayment of the  Obligations  and, until so delivered,  the same
shall be held in trust as  property  of HRP.  In the event of the failure of the
Guarantor to make any such endorsement or assignment,  HRP is hereby irrevocably
authorized to make the same on behalf of the Guarantor.

15.  Guarantor  Events of  Default.  If one or more of the  following  events (a
"Guarantor Event of Default") shall have occurred:



                      (i) a CCA Event of  Default  shall  have  occurred  and be
                continuing for more than three Business Days after notice by HRP
                to the Guarantor;


                      (ii) the Guarantor shall fail to make punctual  payment of
                any amount  payable  hereunder  as the same shall become due and
                payable; or

                      (iii) any  representation  or  warranty  of the  Guarantor
                contained in this  Guaranty,  or any  statement  or  certificate
                furnished  pursuant  to any  provision  of this  Guaranty or the
                Amendment, shall have been false, incorrect or misleading in any
                material respect when made or so certified to; or

                      (iv) the Guarantor  shall breach any of the provisions of,
                or fail duly to observe or perform any  covenant,  agreement  or
                provision  contained  in, this  Guaranty,  and such breach shall
                continue for ten days after notice by HRP to the Guarantor; or

                      (v)  the  Guarantor  shall  apply  for or  consent  to the
                appointment  of, or the  taking of  possession  by, a  receiver,
                custodian, trustee or liquidator of itself or of all or a

<PAGE>

                                     - 9 -

                substantial part of its property,  make a general assignment for
                the benefit of its  creditors,  commence a voluntary  case under
                the Bankruptcy  Code, file a petition  seeking to take advantage
                of  any   other  law   relating   to   bankruptcy,   insolvency,
                reorganization,  winding-up,  or composition or  readjustment of
                debts, fail to controvert in a timely and appropriate manner, or
                acquiesce  in writing to, any  petition  filed  against it in an
                involuntary   case  under  the  Bankruptcy  Code,  or  take  any
                corporate  action  for  the  purpose  of  effecting  any  of the
                foregoing; or



                      (vi) a proceeding or case shall be commenced,  without the
                application or consent of the Guarantor  thereof in any court of
                competent jurisdiction, seeking its liquidation, reorganization,
                dissolution or winding-up, or the composition or readjustment of
                its debts,  the appointment of a trustee,  receiver,  custodian,
                liquidator  or  the  like  of  the  Guarantor  or of  all or any
                substantial part of its assets,  or similar relief in respect of
                the Guarantor under any law relating to bankruptcy,  insolvency,
                reorganization,  winding-up,  or  composition  or  adjustment of
                debts,  and such proceeding or case shall continue  undismissed,
                or an order, judgment or decree approving or ordering any of the
                foregoing shall be entered and continue  unstayed and in effect,
                for a period of 60 days;  or an order  for  relief  against  the
                Guarantor  shall be  entered  in an  involuntary  case under the
                Bankruptcy Code;

THEN,  irrespective of whether a CCA Event of Default may then have occurred and
be  continuing,  (a) in the event of a Guarantor  Event of Default  described in
paragraph (v) or (vi) above,  there shall become due and payable to HRP, and the
Guarantor  shall  immediately  pay HRP,  without  notice  or  demand of any kind
whatsoever,  an amount  in  immediately  available  funds  equal to the  Default
Amount,  and (b) in the  event of any other  Guarantor  Event of  Default,  upon
notice from HRP specifying such Guarantor  Event of Default,  there shall become
due and payable to HRP, and the Guarantor  shall  immediately pay HRP, an amount
in immediately  available funds equal to Default Amount.  The amounts so paid to
HRP shall be held as  collateral  for the  payment  of the  Obligations  and the
obligations of the Guarantor hereunder.  Such amounts shall be applied by HRP to
the  payment and  performance  of the  Obligations  and the  obligations  of the
Guarantor  hereunder  as and when the same become due and payable in  accordance
with the provisions thereof and hereof.

16.  Severability.  Any  provision  of this  Guaranty  which  is  prohibited  or
unenforceable in any jurisdiction shall, as to such jurisdiction, be ineffective
to the extent of such prohibition or unenforceability  without  invalidating the
remaining provisions hereof, and any such prohibition or unenforceability in any
jurisdiction shall not invalidate or render  unenforceable such provision in any
other jurisdiction.

17.  Additional  Guaranties.  This  Guaranty  shall be in  addition to any other
guaranty or other security for the  Obligations,  and it shall not be prejudiced
or  rendered  unenforceable  by the  invalidity  of any such other  guaranty  or
security.

<PAGE>

                                      - 10-

18.  Paragraph  Headings.  The paragraph  headings used in this Guaranty are for
convenience of reference only and are not to affect the  construction  hereof or
be taken into consideration in the interpretation hereof.

19. No  Waiver,  Cumulative  Remedies.  HRP shall  not by any act  (except  by a
written instrument pursuant to Paragraph-20 hereof), delay, indulgence, omission
or otherwise,  be deemed to have waived any right or remedy hereunder or to have
acquiesced  in any  Default or in any breach of any of the terms and  conditions
hereof. No failure to exercise, nor any delay in exercising, on the part of HRP,
any right,  power or privilege  hereunder shall operate as a waiver thereof.  No
single or partial  exercise of any right,  power or  privilege  hereunder  shall
preclude  any other or further  exercise  thereof or the  exercise  of any other
right,  power or privilege.  A waiver by HRP of any right or remedy hereunder on
any one  occasion  shall not be  construed as a bar to any right or remedy which
HRP would otherwise have on any future occasion.  The rights and remedies herein
provided are cumulative,  may be exercised  singly or  concurrently  and are not
exclusive of any rights or remedies provided by law.

20. Waivers and Amendments. None of the terms or provisions of this Guaranty may
be waived,  amended,  supplemented  or  otherwise  modified  except by a written
instrument  executed by the  Guarantor  and HRP,  provided that any provision of
this  Guaranty may be waived by HRP in a letter or agreement  executed by HRP or
by telecopy  from HRP. This Guaranty  shall be binding upon the  successors  and
assigns  of the  Guarantor  and  shall  inure  to the  benefit  of HRP  and  its
successors and assigns.

21. WAIVER OF JURY TRIAL; CONSENT TO JURISDICTION;  GOVERNING LAW. THE GUARANTOR
HEREBY  EXPRESSLY  WAIVES ANY RIGHT IT MAY NOW OR HEREAFTER HAVE TO A JURY TRIAL
IN ANY  SUIT,  ACTION OR  PROCEEDING  WHICH  ARISES  OUT OF OR BY REASON OF THIS
GUARANTY, ANY CCA DOCUMENT OR THE TRANSACTIONS CONTEMPLATED HEREBY AND THEREBY.

     BY ITS EXECUTION AND DELIVERY OF THIS  GUARANTY,  THE GUARANTOR (1) ACCEPTS
FOR ITSELF AND IN CONNECTION WITH ITS PROPERTIES, GENERALLY AND UNCONDITIONALLY,
THE  NONEXCLUSIVE  JURISDICTION  OF ANY  STATE OR  FEDERAL  COURT  OF  COMPETENT
JURISDICTION  IN THE  COMMONWEALTH  OF  MASSACHUSETTS  IN ANY  ACTION,  SUIT  OR
PROCEEDING  OF ANY KIND  AGAINST  IT WHICH  ARISES  OUT OF OR BY  REASON OF THIS
GUARANTY,  ANY CCA DOCUMENT OR THE TRANSACTIONS  CONTEMPLATED HEREBY OR THEREBY,
IN ADDITION TO ANY OTHER COURT IN WHICH SUCH ACTION,  SUIT OR PROCEEDING  MAY BE
BROUGHT; (2) IRREVOCABLY AGREES TO BE BOUND BY ANY JUDGMENT RENDERED BY ANY SUCH
COURT IN ANY SUCH ACTION,  SUIT OR PROCEEDING IN WHICH IT SHALL HAVE BEEN SERVED
WITH PROCESS IN THE MANNER HEREINAFTER  PROVIDED;  (3) TO THE EXTENT THAT IT MAY
LAWFULLY DO SO, WAIVES AND AGREES NOT TO ASSERT,  BY WAY OF MOTION, AS A DEFENSE
OR OTHERWISE, IN SUCH ACTION SUIT OR

<PAGE>
                                     - 11 -

PROCEEDING ANY CLAIM THAT IT IS NOT PERSONALLY  SUBJECT TO THE  JURISDICTION  OF
SUCH COURT,  THAT ITS PROPERTY IS EXEMPT OR IMMUNE FROM ATTACHMENT OR EXECUTION,
THAT THE ACTION,  SUIT OR PROCEEDING IS BROUGHT IN AN INCONVENIENT FORUM OR THAT
THE VENUE THEREOF IS IMPROPER; AND (4) AGREES THAT PROCESS MAY BE SERVED UPON IT
IN ANY SUCH ACTION, SUIT OR PROCEEDING IN THE MANNER PROVIDED BY CHAPTER 223A OF
THE GENERAL LAWS OF MASSACHUSETTS,  RULE 4 OF THE  MASSACHUSETTS  RULES OF CIVIL
PROCEDURE OR RULE 4 OF THE FEDERAL RULES OF CIVIL PROCEDURE.

      THIS GUARANTY  SHALL BE GOVERNED BY AND  CONSTRUED IN ACCORDANCE  WITH THE
LAWS OF THE COMMONWEALTH OF MASSACHUSETTS.

22. Notices.  All notices under this Guaranty shall be in writing,  and shall be
delivered by hand,  by a nationally  recognized  commercial  overnight  delivery
service,  by  first  class  mail  or  by  telecopy,   delivered,   addressed  or
transmitted,  if to HRP,  at 400 Centre  Street,  Newton,  Massachusetts  02158,
Attention:  President  (telecopy  no.  617-332-2261),  with a copy to Sullivan &
Worcester LLP, One Post Office Square, Boston,  Massachusetts 02109,  Attention:
Alexander  A.  Notopoulos,  Esq.  (telecopy  no.  617-338-2880),  and  if to the
Guarantor, at its address or telecopy number set out below its signature in this
Guaranty. Such notices shall be effective: in the case of hand deliveries,  when
received; in the case of an overnight delivery service, on the next business day
after being placed in the  possession  of such delivery  service,  with delivery
charges  prepaid;  in the case of mail,  three days after  deposit in the postal
system, first class postage prepaid;  and in the case of telecopy notices,  when
electronic  indication  of  receipt  is  received.  Either  party may change its
address  and  telecopy  number  by  written  notice to the  other  delivered  in
accordance with the provisions of this Section.


<PAGE>

                                     - 12 -
               IN WITNESS  WHEREOF,  the undersigned has caused this Guaranty to
be duly executed and delivered as of the date first above written.

                                       INTEGRATED HEALTH SERVICES, INC.



                                       By /s/ W. Bradley Bennett
                                          -------------------------------------
                                          Name: W. Bradley Bennett
                                          Title: Executive Vice President and
                                                 Chief Accounting Officer

                                          Address for Notices:

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

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

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



                                         Telecopy No.:____________





                             REIMBURSEMENT AGREEMENT


      REIMBURSEMENT AGREEMENT (the "Agreement"),  dated as of April 14, 1997, by
and between INTEGRATED HFALTH SERVICES,  INC., a Delaware  corporation having an
address at 10065 Red Run Boulevard,  Owings Mills,  Maryland 21117 ("IHS"),  and
COMMUNITY  CARE OF AMERICA,  INC., a Delaware  corporation  having an address at
3050 N. Horseshoe Drive, Naples, Florida 33942 ("CCA").

                                  WITNESSETH.

      WHEREAS,  CCA has entered into that  certain  Loan and Security  Agreement
with Daiwa  Healthco-2  LLC  ("Daiwa")  dated as of December 23, 1996 (the "Loan
Agreement");

      WHEREAS, as a condition to extending to CCA certain  accommodations  under
the Loan  Agreement,  Daiwa has required that IHS provide a guaranty (the "Daiwa
Guaranty")  securing the  repayment of all amounts owing from CCA to Daiwa under
the Loan  Agreement  in  excess of the Basic  Borrowing  Amount,  as well as the
payment  of any and all  reasonable  costs and  expenses  (including  reasonable
counsel fees and  expenses)  paid or incurred by Daiwa in  enforcing  its rights
under the Daiwa Guaranty;

      WHEREAS,  CCA  has  entered  into  a  letter  agreement  with  Health  and
Retirement  Properties,  Trust  ("HRPT") dated as of April 14, 1997 (the "Letter
Agreement"),

      WHEREAS,  in accordance with the Letter Agreement,  HRPT has required that
IHS provide a guaranty (the "HRPT Guaranty")  securing certain  obligations owed
by CCA to HRPT,

      WHEREAS,  as a condition  to  providing  the Daiwa  Guaranty  and the HRPT
Guaranty,  IHS  requires  that CCA agree to  reimburse  IHS for any amounts that
become payable by IHS in respect of the Daiwa Guaranty and the HRPT Guaranty.

      NOW,  THEREFORE,  in consideration of the mutual promises  hereinafter set
forth, and for other good and valuable  consideration,  the parties hereby agree
as follows:

      1.  Subject  to  any  waiver  by  IHS  of  the  right  to  subrogation  or
reimbursement  contained in the Daiwa  Guaranty  and/or the HRPT  Guaranty,  CCA
shall, on demand,  reimburse IHS for any amounts paid by IHS on behalf of CCA in
accordance  with the  terms of the Daiwa  Guaranty  and/or  the HRPT  Guarantee,
including any costs, fees, charges and expenses (including reasonable legal fees
and expenses of counsel) arising out of the negotiation, preparation or issuance
of,  or  performance  under,  the  Daiwa  Guaranty  and/or  the  HRPT  Guarantee
(collectively, the "Reimburstment Obligations").


      2. Any and all amounts  which became owing to IHS by CCA in respect of the
Reimbursement  Obligations  shall bear interest,  from the date such amounts are
advanced by IHS under the applicable guaranty until paid in full, at the rate of
fifteen (15%) percent per annum.


<PAGE>


         3. This  Agreement  shall  remain in full force and effect until all of
the  Reimbursement  Obligations  shall have been fully,  finally and irrevocably
satisfied  and IHS has been fully,  finally and  irrevocably  released  from all
obligations with respect to the Daiwa Guaranty and the HRPT Guaranty.

         4. All  agreements  between  CCA and IHS herein  are  hereby  expressly
limited so that in  contingency  or event  whatsoever,  shall the amount paid or
agreed  to be paid to IHS  for  the  use,  forbearance  or  detention  of  money
hereunder  exceed the maximum  permissible  under  applicable  law. If, from any
circumstance  whatsoever,  the  fulfillment  of any provision  hereof,  validity
prescribed by law, then,  ipso facto,  the  obligation to be fulfilled  shall be
reduced to the limit of such validity,  and if from any  circumstance IHS should
ever receive as interest an amount  which would exceed the highest  lawful rate,
such amount which would be excessive  interest shall be applied to the reduction
of the  principal  of the  Reimbursement  Obligations  and not to the payment of
interest.

         5. Any notice or other communication by either party to the other shall
be in writing and shall be given and be deemed to have been duly given, upon the
date  delivered  if  delivered  personally  or upon the date  received if mailed
postage pre-paid, registered, or certified mail, addressed as follows:

         To CCA:           Community Care of America, Inc.
                           3050 North Horseshoe Drive, Suite 260
                           Naples, Florida 33942
                           Attention: President

         To IHS:           Integrated Health Services, Inc.
                           10065 Red Run Boulevard
                           Owings Mills, MD 21117
                           Attention: General Counsel

or to such other  address,  and to the attention of such other person or officer
as either party may designate in writing by notice.

         6. The  substantive  laws of the State of  Maryland  shall  govern  the
validity, construction, enforcement and interpretation of this Agreement and all
other documents and instruments  referred to herein,  unless otherwise specified
therein.   Whenever  possible,   each  provision  of  this  Agreement  shall  be
interpreted  in such manner as to be effective and valid under  applicable  law,
but if any  provision of this  Agreement  shall be  prohibited  or invalid under
applicable law, such provision  shall be ineffective  only to the extent of such
prohibition or invalidity,  without invalidating the remainder of such provision
or the remaining provisions of this Agreement.

                                        2

<PAGE>

      7. Neither this Agreement nor any provision hereof may be changed, waived,
discharged or terminated  orally, but only by an instrument in writing signed by
the  party  against  which  enforcement  of the  change,  waiver,  discharge  or
termination  is  sought.  This  Agreement  shall  be  binding  upon  CCA and its
successors and assigns,  and shall inure to the benefit of and be enforceable by
the IHS and its successors and assigns.

      IN WITNESS  WHEREOF,  the parties  hereto have caused this Agreement to be
executed as of the day and year first written above.


                                      INTEGRATED HEALTH  SERVICES, INC



                                      By: /s/ W. Bradley Bennett
                                          -------------------------------------
                                          Name: W. Bradley Bennett
                                          Title: Executive Vice President and
                                                 Chief Accounting Officer



                                     COMMUNITY CARE OF AMERICA, INC



                                      By: /s/ Debbie Lau
                                          -------------------------------------
                                          Name:  Debbie Lau
                                          Title: Chief Operating Officer

                              REVOLVING CREDIT NOTE


Date:             April 30, 1997            Maturity Date: April 30, 1998

Amount:           $5,000,000

Lender:           Integrated Health Services, Inc.
                  10065 Red Run Boulevard
                  Owings Mills, MD 21117

Borrower:         Integrated Living Communities, Inc.
                  24850 Old 41 Road, Suite 10
                  Bonita Springs, FL 34135-7022
- --------------------------------------------------------------------------------


FOR VALUE RECEIVED, the undersigned Borrower hereby unconditionally  promises to
pay in immediately  available funds to the order of Lender, its successors,  and
assigns,  at its offices  indicated at the  beginning  of this Note,  or at such
other  place as may be  designated  by Lender from time to time,  the  principal
amount of  $5,000,000.00  or so much thereof as may be outstanding  from time to
time (the "Principal"), together with interest computed daily on the outstanding
Principal balance hereunder, at the annual interest rate, and in accordance with
the payment schedule indicated below.

1. Rate.  This Note  shall bear  interest  from its date until  maturity  on the
Principal  outstanding  from to time to time hereunder at a rate per annum equal
to twelve (12%) percent (the "Interest Rate").

Notwithstanding any provision of this Note, Lender does not intend to charge and
Borrower  shall not be required to pay, any amount of interest or other  charges
in  excess  of the  maximum  permitted  by the  applicable  law of the  State of
Florida.  Any payment in excess of such maximum shall be refunded to Borrower or
credited against principal, at the Lender's option.

2. Accrual Method. Unless otherwise indicated, the Interest Rate set forth above
will be calculated by the  actual/360-day  method (a daily amount of interest is
computed for a hypothetical  year of 360 days;  that amount is multiplied by the
actual number of days for which any Principal is outstanding hereunder).

3. Payment Schedule. All Principal and other amounts outstanding under this Note
shall be due and payable on the first  anniversary of the date of this Note. Six
(6) months following the date hereof,  the maximum aggregate amount of Principal
permitted to be outstanding at any time shall be reduced to $4,500,000; and nine
months following the date hereof, the maximum


<PAGE>



aggregate  amount of Principal  permitted to be outstanding at any time shall be
further reduced to $4,000,000. Borrower shall make such payments of Principal as
shall be  necessary  to  comply  with the  foregoing  limits  on the  amount  of
Principal outstanding. Interest due hereunder shall be payable on each date that
a payment of  Principal is made  hereunder,  and monthly in arrears on the first
business day of each calendar month during the term of this Note. Any payment to
the Lender  hereunder  shall be  applied  first to the  payment  of all  accrued
interest and the balance shall be applied to Principal.  Borrower may prepay all
or any part of the  remaining  principal  balance  of this Note,  including  all
interest accrued thereon through the date of such prepayment,  at any time prior
to the maturity date without  penalty or premium.  The Lender is authorized  but
not  required  to record  the date and  amount of each loan  made,  the date and
amount of any payment,  and the balance  hereof on the Grid attached  hereto and
made a part hereof,  and any such recordation  shall, in the absence of manifest
error,  constitute  prima facie  evidence of the accuracy of the  information so
recorded;  provided  however,  that the Lender'  failure to so record  shall not
limit the  obligations of the Borrower  hereunder to pay the amount of all loans
hereunder.

4. Revolving Feature.  Until the day preceding the first anniversary of the date
hereof,  Borrower may borrow and reborrow hereunder at any time, up to a maximum
aggregate amount  outstanding not to exceed at any time the amounts as set forth
in  Paragraph 3, above,  provided,  that all of the  conditions  set forth below
shall have been satisfied as of the date of borrowing.

     (i) Borrower  shall have given Lender at least five (5) days prior  written
notice (the "Notice") of Borrower's intent to borrow under this Note;

     (ii) the Notice shall include the stated purpose for the proceeds  borrowed
under this Note and shall include a certification that no Event of Default shall
have occurred and be continuing;

     (iii)  Borrower shall only be permitted to use the proceeds under this Note
(a) to assist  Borrower in its working  capital needs,  or (b) to provide bridge
financing  for  acquisitions  by  Borrower  approved  by Lender,  or (c) to make
payments due under the Unsecured Credit Note issued by Borrower to Lender, dated
as of November 20, 1996, in the original  principal amount of $3,445,024.00,  as
amended as of the date hereof (the "Initial Note");

     (iv) no Event of Default shall have occurred and be continuing; and

     (v) the minimum amount that may be borrowed at any one time under this Note
shall be $250,000  (the  "Minimum  Draw").  The Minimum Draw may be increased in
$50,000 increments only.

     Lender shall incur no liability for its refusal to advance funds based upon
its  determination  that any  conditions of such further  advances have not been
met.




<PAGE>



5. Waivers, Consents and Covenants.  Borrower, any endorser or guarantor hereof,
or  any  other  party  hereto   (individually   an  "Obligor"  and  collectively
"Olbigors")  and each of them  jointly  and  severally:  (a) waive  presentment,
demand,  protest,  notice of demand,  notice of intent to accelerate,  notice of
acceleration  of maturity,  notice of protest,  notice of nonpayment,  notice of
dishonor, and any other notice required to be given under the law to any Obligor
in connection with the delivery, acceptance, performance, default or enforcement
of this Note, any  endorsement or guaranty of this Note, or any other  documents
executed in connection  with this Note or any other note or other loan documents
now or  hereafter  executed in  connection  with any  obligation  to Borrower to
Lender (the "Loan Documents");  (b) consent to all delays, extensions,  renewals
or other  modifications  of this Note or the Loan  Documents,  or waivers of any
term hereof or of the Loan  Documents,  or release or discharge by Lender of any
Obligors,  or release,  substitution or exchange of any security for the payment
hereof, or the failure to act on the part of the Lender, or any indulgence shown
by the Lender  (without  notice to or further  assent from any of the Obligors),
and agree that no such  action,  failure to act or failure to exercise any right
or remedy by the Lender shall in any way affect or impair the obligations of any
Obligors or be construed as a waiver by the Lender, or otherwise affect,  any of
Lender's rights under this Note, under any endorsement, or guaranty of this Note
or under any of the Loan Documents;  and (c) agree to pay, on demand,  all costs
and  expenses of  collection  or defense of this Note or of any  endorsement  or
guaranty  hereof  and/or the  enforcement  or defense of  Lender's  rights  with
respect to, or the administration,  supervision, preservation, or protection of,
or  realization  upon,  any property  securing  payment  hereof,  including with
limitation,  reasonable attorney's and paralegal's fees and expenses,  including
fees related to any suit,  mediation  or  arbitration  proceeding,  out of court
payment agreement, trial, appeal, bankruptcy proceedings or other proceeding, in
such  amount  as may  be  determined  reasonable  by any  arbitrator  or  court,
whichever is applicable.

6.  Idemnifaction.  Obligors  agree to promptly  pay,  indemnify and hold Lender
harmless from all State and Federal taxes of any kind and other liabilities with
respect to or resulting from the execution  and/or  delivery of this Note or any
advances made pursuant to this Note. If this Note has a revolving feature and is
secured  by a  mortgage,  Obligors  expressly  consent to the  deduction  of any
applicable taxes from each taxable advance extended by Lender.

7. Delinquency  Charge. To the extent permitted by law, a delinquency charge may
be imposed in an amount not to exceed four (4%)  percent of any payment  that is
more than fifteen days late.

8. Events of Default.  Upon the occurrence of any of the  following,  Lender may
declare an "Event of  Default"  to exist:  (a) the failure to pay or perform any
obligation,  liability  or  indebtedness  of any  Obligor to  Lender,  or to any
affiliate or subsidiary of Integrated Health Services,  Inc., whether under this
Note or any Loan  Documents or the Initial  Note,  as and when due (whether upon
demand, at maturity or by  acceleration);  (b) the failure to pay or perform any
other  obligation,  liability or  indebtedness of any Obligor to any other party
when  due  (whether  upon  demand,  at  maturity  or by  acceleration);  (c) the
commencement of a proceeding against any Obligor for dissolution or liquidation,
the voluntarily or involuntary termination or dissolution of


<PAGE>



any Obligor or the merger or  consolidation  of any Obligor with or into another
entity;  (d) the  insolvency of, the business  failure of, the  appointment of a
custodian,  trustee,  or  receiver  for or  for  any of  the  property  of,  the
assignment  for the benefit of creditors  by, or the filing of a petition  under
bankruptcy,  insolvency  or debtor's  relief law or the filing of a petition for
any  adjustment  or  indebtedness,  composition  or  extension by or against any
Obligor; (e) the determination by the Lender that any representation or warranty
made to the Lender by an Obligor in any Loan  Documents  or otherwise is or was,
when it was made,  untrue  or  materially  misleading;  (f) the  failure  of any
Obligor timely deliver such financial statements,  including tax returns,  other
statements of condition or other information,  as Lender shall request from time
to time;  (g) the entry of a judgment  against any Obligor or which Lender deems
to be a  material  nature,  in  Lender's  sole  discretion;  (h) the  seizure or
forfeiture  of,  or the  issuance  of any  writ of  possession,  garnishment  or
attachment,  or any  turnover  order for any  property of any  Obligor;  (i) the
determination  by Lender  that a material  adverse  change has  occurred  in the
financial  condition of any Obligor;  (j) the failure of Borrower's  business to
comply with any law or regulation controlling its operation;  or (k) a Change in
Control of the Borrower shall occur.  For purposes hereof, a "Change in Control"
of the Borrower  shall mean the occurrence of any of the following  events;  (i)
any  party  or two or  more  parties  acting  in  concert  shall  have  acquired
beneficial  ownership,  directly or  indirectly,  of, or shall have  acquired by
contract or  otherwise,  or shall have  entered  into a contract or  arrangement
that,  upon  consummation,  will result in its or their  acquisition of, control
over, Voting Stock of Borrower (or other securities convertible into such Voting
Stock) representing 25% or more of the combined voting power of all Voting Stock
of  Borrower,  (ii) Lender shall fail to own and have the right to vote at least
25% of the  outstanding  Voting Stock of Borrower  determined on a fully diluted
basis after giving  effect to the  conversion  and  exercise of all  outstanding
warrants,  options and other securities of Borrower that are convertible into or
exercisable  for Voting Stock of Borrower  (whether or not such  securities  are
then currently convertible or exercisable),  (iii) during any period of up to 24
consecutive  months,  commencing after the Closing Date,  individuals who at the
beginning of uch 24-month  period were directors of Borrower  (together with any
new director whose election by Borrower's Board of Directors or whose nomination
for  election  by  Borrower's  shareholders  was  approved by a vote of at least
two-thirds  of the directors  then still in office who either were  directors at
the beginning of such period or whose  election or  nomination  for election was
previously  so  approved)  cease for any reason to  constitute a majority of the
directors of Borrower then in office or (iv) Borrower shall fail to own and have
the  right  to vote  100%  of the  outstanding  Voting  Stock  of the  Borrower,
determined on a fully diluted  basis after giving effect to the  conversion  and
exercise  of all  outstanding  warrants,  options  and other  securities  of the
Borrower  that are  convertible  into or  exercisable  for  Voting  Stock of the
Borrower. As used herein, "beneficial ownership" shall have the meaning provided
in Rule 13d-3 of the  Securities  and Exchange  Commission  under the Securities
Exchange Act of 1934.

9. Remedies Upon Default. Whenever there is Event of Default under this Note (a)
the  entire  balance  outstanding  hereunder  and all other  obligations  of any
Obligor to Lender  (however  acquired or evidenced)  shall, at the option of the
Lender  immediately  due and  payable  and any  obligation  of  Lender to permit
further borrowing under this Note shall immediately cease and


<PAGE>



terminate,  and/or (b) to the extent  permitted by law, the Interest Rate on the
unpaid  Principal  shall be increased at Lender's  discretion up to the Interest
Rate plus five (5%)  percent  per annum,  or the  maximum  rate  allowed by law,
whichever is lower (the "Default  Rate").  The  provisions  herein for a Default
Rate  shall  not be deemed to extend  the time of any  payment  hereunder  or to
constitute a "grace  period"  giving  Obligors a right to cure any  default.  At
Lender's  option,  any accrued and unpaid  interest,  fees or charges  may,  for
purposes of computing and accruing  interest on a daily basis after the due date
of the Note or any installment  thereof, be deemed to be a part of the Principal
balance,  and Interest shall accrue on a daily  compounded basis after such date
at the Default Rate provided in this Note until the entire  outstanding  balance
of Principal and interest is paid in full,  and all such interest  thereon shall
thereafter be due on demand. Upon an Event of Default under this Note, Lender is
hereby  authorized at any time, at its option and without  notice of demand,  to
set off and charge  against any deposit  accounts of any Obligor (as well as any
money,  instruments,  securities,  documents,  chattel paper,  credits,  claims,
demands,  income and any other  property,  rights and interests of any Obligor),
which at any time shall come into the possession or custody or under the control
of  Lender  or any of its  agents,  affiliates  or  correspondents,  any and all
obligations  due  hereunder.  Additionally,  Lender  shall  have all  rights and
remedies  available under each of the Loan Documents,  as well as all rights and
remedies  available law or in equity.  Any judgment  rendered on this Note shall
bear interest at the highest rate of interest  permitted pursuant to Chapter 687
Florida Statutes.

10.  Non-Waiver.  The failure at any time of the Lender to  exercise  any of its
options or any other rights hereunder shall not constitute a waiver thereof, nor
shall it be a bar to the exercise of its options or rights at a later date.  All
rights and remedies of the Lender shall be cumulative and may be pursued singly,
successively  or together at the option of the Lender.  The acceptance by Lender
of any partial payment shall not constitute a waiver of any default or of any of
Lender's rights under this Note. No waiver of any of its rights  hereunder,  and
no  modification  or amendment of this Note shall be deemed to be made by Lender
unless the same shall be in writing,  duly signed on behalf of Lender; each such
waiver  shall apply only with  respect to the specific  instance  involved,  and
shall in no way impair the rights of the Lender or the  obligations  of Obligors
to Lender in any respect at any other time.

11.  Applicable  Law,  Venue  and  Jurisdiction.  This Note and the  rights  and
obligations  of  Borrower  and Lender  shall be governed  by and  interpreted  n
accordance with the law of the State of Florida.

12. Partial  Invalidity.  The  enforceability  or invalidity of any provision of
this Note shall not affect the enforceability or validity of any other provision
herein and the invalidity or  unenforceability  of any provision of this Note or
of the Loan  Documents  to any  person or  circumstances  shall not  affect  the
enforceability  o validity of such provision as it may apply to other persons or
circumstances.





<PAGE>



13. Binding Effect.  This Note shall be binding upon and inure to the benefit of
Borrower, Obligors and Lender and the respective successors,  assigns, heirs and
personal representatives,  provided, however, that no obligations of Borrower or
Obligors hereunder can be assigned without the prior written consent of Lender.

14. Controlling  Document.  To the extent that this Note conflicts with or is in
any way incomparable  wit any other document  related  specifically to the loans
evidenced by this Note,  this Note shall  control over any other such  document,
and if the Note does not address an issue,  then each other such document  shall
control to the extent that it deals most specifically with an issue.

15.  Notwithstanding  any provisions to the contrary contained herein, this Note
and all renewals,  extensions  and  modifications  hereof,  are and shall remain
subject to the terms of that certain Subordination Agreement,  dated as of April
9, 1997 (the "Subordination Agreement") among NationsBank,  N.A. (South), Lender
and Borrower,  as amended.  Each transferee of this Note, by acceptance of same,
absolutely  agrees  to be bound by all of the  provisions  of the  Subordination
Agreement.

Borrower  represents and warrants to the Lender that the proceeds of these loans
are to be used for business  purposes only and are therefore  commercial  loans.
Borrower acknowledges having read and understood, and agrees to be bound by, all
terms and  conditions of this Note and hereby  executes this Note as of the date
here above-written.

This  written  promissory  note may not be  contradicted  by  evidence of prior,
contemporaneous,  or subsequent  oral  agreements  of the parties.  There are no
unwritten oral agreements between the parties with respect to the subject matter
of this Note.

     IN WITNESS  WHEREOF,  the  undersigned  has executed  this Note on the date
first above written.


                                      INTEGRATED LIVING
                                      COMMUNITIES, INC.




                                      By: /s/ John Poole
                                          --------------------------------

                                      Title: Senior Vice President - Chief 
                                             Financial Officer



<TABLE> <S> <C>

<ARTICLE>                     5
<MULTIPLIER>                                   1,000
<CURRENCY>                                     US DOLLARS
       
<S>                             <C>
<PERIOD-TYPE>                   3-MOS
<FISCAL-YEAR-END>                              DEC-31-1997
<PERIOD-START>                                 JAN-01-1997
<PERIOD-END>                                   MAR-31-1997
<EXCHANGE-RATE>                                1
<CASH>                                         38,767
<SECURITIES>                                   1,737
<RECEIVABLES>                                  375,690
<ALLOWANCES>                                   36,194
<INVENTORY>                                    0
<CURRENT-ASSETS>                               422,266
<PP&E>                                         887,395
<DEPRECIATION>                                 0
<TOTAL-ASSETS>                                 2,058,078
<CURRENT-LIABILITIES>                          338,380
<BONDS>                                        365,000
                          0
                                    0
<COMMON>                                       25
<OTHER-SE>                                     574,761
<TOTAL-LIABILITY-AND-EQUITY>                   2,058,078
<SALES>                                        460,943
<TOTAL-REVENUES>                               460,943
<CGS>                                          0
<TOTAL-COSTS>                                  429,863
<OTHER-EXPENSES>                               0
<LOSS-PROVISION>                               0
<INTEREST-EXPENSE>                             21,421
<INCOME-PRETAX>                                31,261
<INCOME-TAX>                                   12,192
<INCOME-CONTINUING>                            19,069
<DISCONTINUED>                                 0
<EXTRAORDINARY>                                0
<CHANGES>                                      0
<NET-INCOME>                                   19,069
<EPS-PRIMARY>                                  0.74
<EPS-DILUTED>                                  0.63
        


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