INTEGRATED HEALTH SERVICES INC
10-Q, 1997-11-13
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             September 30, 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 October 20,
  1997: 27,400,896 shares.


<PAGE>


                        INTEGRATED HEALTH SERVICES, INC.
                                      INDEX




PART I.           FINANCIAL INFORMATION
                                                                     Page

Item 1.  - Condensed Financial Statements - (Unaudited)

         Consolidated Balance Sheets
           September 30, 1997 and December 31, 1996                    3

         Consolidated Statements of Earnings
           for the three and nine months ended
           September 30, 1997 and 1996                                 4

         Consolidated Statement of Changes in
           Stockholders' Equity for the nine
           months ended September 30, 1997                             5

         Consolidated Statements of Cash Flows
           for the nine months ended September 30, 1997
           and 1996                                                    6

         Notes to Consolidated Financial Statements                    7

Item 2.  Management's Discussion and Analysis of
           Financial Condition and Results of
           Operations                                                 12


PART II:          OTHER INFORMATION

Item 2.  Changes in Securities                                        32

Item 6.  Exhibits and Reports on Form 8-K                             32


                                  Page 2 of 35


<PAGE>

<TABLE>
<CAPTION>
                          INTEGRATED HEALTH SERVICES, INC. AND SUBSIDIARIES
                                  CONSOLIDATED BALANCE SHEETS
                                    (Dollars In Thousands)
                                                                             SEPTEMBER 30,             DECEMBER 31,
                                                                                1997                      1996
                                                                         --------------------     ---------------------
                                                                             (UNAUDITED)
<S>                                                                  <C>                                        <C>   
        Assets
        ------
Current Assets:
        Cash and cash equivalents                                        $       58,915               39,028
        Temporary investments                                                   821,965                2,044
        Patient accounts and third-party payor settlements
          receivable, less allowance for doubtful receivables
          of $47,223 at September 30, 1997 and $41,527 at
          December 31, 1996                                                     377,546              326,883
        Inventories, prepaid expenses and other current
          assets                                                                 36,457               26,243
        Income tax receivable                                                    25,630               20,992
                                                                         ---------------     ----------------
               Total current assets                                           1,320,513              415,190
                                                                         ---------------     ----------------

Property, plant and equipment, net                                              948,120              864,335
Assets held for sale (Note 12)                                                   12,109                   --
Intangible assets                                                               836,804              572,159
Investments in and advances to affiliates                                        31,437               76,047
Other assets                                                                     79,097               65,376
                                                                         ---------------     ----------------
               Total assets                                              $    3,228,080            1,993,107
                                                                         ===============     ================


        Liabilities and Stockholders' Equity
        ------------------------------------
Current Liabilities:
        Current maturities of long-term debt                             $        6,782               16,547
        Accounts payable and accrued expenses                                   332,813              341,094
                                                                         ---------------     ----------------
           Total current liabilities                                            339,595              357,641
                                                                         ---------------     ----------------

Long-term Debt:
        Convertible  subordinated debentures                                    258,750              258,750
        Other long-term debt less current maturities                          1,933,233              779,450
                                                                         ---------------     ----------------
               Total long-term debt                                           2,191,983            1,038,200
                                                                         ---------------     ----------------

Other long-term liabilities                                                      36,114               33,851
Deferred income taxes                                                            27,501               22,283
Deferred gain on sale-leaseback transactions                                      5,463                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;  outstanding 27,081,463 at September 30, 1997 and
          23,628,250 at December 31, 1996 (including 324,800
          treasury shares at September 30, 1997)                                     27                   24
        Additional paid-in capital                                              531,500              445,667
        Retained earnings                                                       108,221               79,814
        Unrealized gain on available for sale securities                              0                9,360
        Treasury stock at cost (324,800 shares at September 30, 1997)          (12,324)                    0
                                                                         ---------------     ----------------
               Net stockholders' equity                                         627,424              534,865
                                                                         ---------------     ----------------

               Total liabilities and stockholders' equity                $    3,228,080            1,993,107
                                                                         ===============     ================
</TABLE>

      See accompanying Notes to Unaudited Consolidated Financial Statements


                                  Page 3 of 35


<PAGE>

<TABLE>
<CAPTION>
                                  INTEGRATED HEALTH SERVICES, INC.
                           CONSOLIDATED STATEMENT OF EARNINGS (UNAUDITED)
                          (DOLLARS IN THOUSANDS, EXCEPT PER SHARE AMOUNTS)

                                                                    THREE MONTHS ENDED                 NINE MONTHS ENDED
                                                                       SEPTEMBER 30,                     SEPTEMBER 30,
                                                              ----------------------------    ------------------------------
                                                                   1997            1996            1997               1996
                                                              -----------      -----------    -------------      -----------
<S>                                                           <C>              <C>            <C>                <C>       
Net revenues:
       Basic medical services                                 $   91,458       $  101,189     $    268,268       $  296,468
       Specialty medical services                                370,769          211,904        1,093,571          658,297
       Management services and other                              10,694           12,572           29,998           33,953
                                                              -----------      -----------    -------------      -----------
              Total revenues                                     472,921          325,665        1,391,837          988,718
                                                              -----------      -----------    -------------      -----------

Costs and expenses:
       Operating expenses                                        348,470          241,177        1,039,618          745,346
       Corporate administrative and general                       19,917           14,943           56,068           44,890
       Depreciation and amortization                              16,974            9,130           47,818           25,909
       Rent                                                       25,527           18,445           75,322           53,980
       Interest, net                                              27,346           15,931           71,991           46,033
       Non-recurring charges (income), net (Note 7)                    0          (34,298)          20,047          (34,298)
                                                              -----------      -----------    -------------      -----------
              Total costs and expenses                           438,234          265,328        1,310,864          881,860
                                                              -----------      -----------    -------------      -----------

              Earnings before equity in earnings
                   (loss) of affiliates, income taxes
                   and extraordinary items                        34,687           60,337           80,973          106,858

       Equity in earnings (loss) of affiliates                      (811)             323             (713)           1,083
                                                              -----------      -----------    -------------      -----------

              Earnings before income taxes
                   and extraordinary items                        33,876           60,660           80,260          107,941

Federal and state income taxes                                    13,212           44,149           31,301           62,352
                                                              -----------      -----------    -------------      -----------

              Earnings before extraordinary items                 20,664           16,511           48,959           45,589

Extraordinary items (Note 8)                                       2,384                0           20,552            1,431
                                                              -----------      -----------    -------------      -----------

              Net earnings                                    $   18,280       $   16,511     $     28,407       $   44,158
                                                              ===========      ===========    =============      ===========


Per Common Share - primary
              Earnings before extraordinary item              $     0.73       $     0.69     $       1.78       $     1.95
              Net earnings                                          0.65             0.69             1.03             1.89
                                                              ===========      ===========    ===============    ===========

Per Common Share - fully diluted
              Earnings before extraordinary items             $     0.65       $     0.58     $       1.57       $     1.68
              Net earnings                                          0.59             0.58             1.00             1.64
                                                              ===========      ===========    ===============    ===========
</TABLE>


      See accompanying Notes to Unaudited Consolidated Financial Statements

                                  Page 4 of 35


<PAGE>

<TABLE>
<CAPTION>

                          INTEGRATED HEALTH SERVICES, INC. AND SUBSIDIARIES
                CONSOLIDATED STATEMENT OF CHANGES IN STOCKHOLDERS' EQUITY (UNAUDITED)
                                       (DOLLARS IN THOUSANDS)

                                                                                               UNREALIZED  
                                                                                                GAIN ON
                                                                   ADDITIONAL                  AVAILABLE
                                                     COMMON          PAID-IN     RETAINED       FOR SALE      TREASURY   
                                                      STOCK          CAPITAL     EARNINGS      SECURITIES       STOCK        TOTAL
                                                 ----------------------------------------------------------------------------------

<S>                                            <C>                  <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 (Note 3)                1          26,438           --              --           --       26,439

Issuance of 1,394,817 shares of
common stock in connection with 1997
acquisitions (Note 3)                                     1          44,753           --              --           --       44,754

Issuance of 81,434 shares of common
stock in connection with employee
stock purchase plan                                      --           1,757           --              --           --        1,757

Exercise of employee stock options
for 1,325,258 shares of common stock                      1          12,885           --              --           --       12,886

Repurchase of 324,800 shares of treasury
stock (Note 9)                                           --              --           --              --      (12,324)     (12,324)

Realized gain on available for sale
securities (Note 7)                                      --              --           --          (9,360)          --       (9,360)

Net earnings                                             --              --       28,407              --           --       28,407
                                                 ----------------------------------------------------------------------------------

Balance at September 30, 1997                  $         27         531,500      108,221               0      (12,324)     627,424
                                                 ==================================================================================
</TABLE>


      See accompanying Notes to Unaudited Consolidated Financial Statements


                                  Page 5 of 35


<PAGE>

                INTEGRATED HEALTH SERVICES, INC. AND SUBSIDIARIES
                CONSOLIDATED STATEMENTS OF CASH FLOWS (UNAUDITED)
                             (DOLLARS IN THOUSANDS)
<TABLE>
<CAPTION>

                                                                                NINE MONTHS ENDED
                                                                                  SEPTEMBER 30,
                                                                         -------------------------------
                                                                              1997            1996
                                                                         --------------  -------------
<S>                                                                    <C>                     <C>   
Cash flows from operating activities:
    Net earnings                                                       $        28,407         44,158
    Adjustments to reconcile net earnings to net
       cash provided by operating activities:
          Extraordinary item (Note 8)                                           33,690          2,327
          Non-recurring charges (income), net (Note 7)                          20,047        (34,298)
          Undistributed results of joint ventures                                  958           (348)
          Depreciation and amortization                                         47,818         25,909
          Deferred income taxes and other non-cash items                         6,781          3,162
          Amortization of gain on sale-leaseback transactions                     (804)          (749)
          Increase in patient accounts and third-party
             payor settlements receivable, net                                 (28,379)       (21,724)
          Increase in supplies inventory, prepaid
             expenses and other current assets                                  (4,047)          (979)
          Decrease in accounts payable and accrued expenses                    (73,127)       (26,591)
          (Increase) decrease in income taxes receivable                        (4,638)        23,479
                                                                         --------------  -------------

             Net cash provided by operating activities                          26,706         14,346
                                                                         --------------  -------------

Cash flows from financing activities:
    Proceeds from issuance of capital stock, net                                14,643          3,150
    Proceeds from long-term borrowings                                       2,544,918        832,653
    Repayment of long-term debt                                             (1,419,179)      (766,450)
    Payment of pre-payment premiums and fees on debt
       extinguishment  (Note 8)                                                (23,598)            --
    Deferred financing costs                                                   (33,085)        (8,128)
    Dividends paid                                                                (471)          (435)
    Purchase of treasury stock                                                 (12,324)             0
                                                                         --------------  -------------

             Net cash provided by financing activities                       1,070,904         60,790
                                                                         --------------  -------------

Cash flows from investing activities:
    Sale of pharmacy division (Note 7)                                              --        125,000
    Sale of temporary investments                                                  639          5,086
    Purchase of temporary investments                                         (820,560)        (4,595)
    Business acquisitions (Note 3)                                            (166,822)       (46,106)
    Payment of termination fees and other costs of
       terminated merger (Note 7)                                              (27,555)            --
    Purchase of property, plant and equipment                                  (86,656)      (104,647)
    Sale of investments in affiliates                                           54,137             --
    Other assets                                                               (30,906)       (47,664)
                                                                         --------------  -------------

             Net cash used by investing activities                          (1,077,723)       (72,926)
                                                                         --------------  -------------

             Increase in cash and cash equivalents                              19,887          2,210

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

Cash and cash equivalents, end of period                               $        58,915         41,127
                                                                         ==============  =============
</TABLE>

      See accompanying Notes to Unaudited Consolidated Financial Statements

                                  Page 6 of 35


<PAGE>


                                      NOTES
                                       TO
                   UNAUDITED 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  principals.  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 nine months  ended  September  30, 1997 and 1996,
respectively:

                                               1997        1996
                                              -------     ------
                                                  (in 000's)
Net earnings                                  $28,407    $44,158

Adjustment for interest and underwriting
costs on convertible debentures                 7,356      7,416
                                              -------     ------

        Net earnings for fully diluted EPS    $35,763    $51,574
                                              =======    =======

        Weighted average shares-Primary        27,512     23,393
        Weighted average shares-Fully Diluted  35,803     31,477
                                              =======    =======


                                  Page 7 of 35


<PAGE>


NOTE 3: NEW ACQUISITIONS

        ACQUISITIONS DURING THE NINE MONTHS ENDED SEPTEMBER 30, 1997

        Acquisitions  for the nine months ended September 30,1997 and the manner
        of payment are summarized as follows:

                                               COMMON
                                        TOTAL  STOCK    ACCRUED       CASH
MONTH     TRANSACTION DESCRIPTION       COST   ISSUED   LIABILITIES   PAID
- -----     -----------------------       ----   ------   -----------   ---- 
                                                  (in 000's)
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 Achieve-
          ment Rehab acquisition
          in December 1993             26,439  26,439     ----         ----

April     Assets of Coastal
          Rehabilitation, Inc.          1,450    ----      200        1,250

April     Assets of Mobile
          Diagnostics, Inc.               225    ----       75          150

June      Stock of Health Care
          Industries, Inc.              2,325    ----      500        1,825

June      Assets of The Nursing
          Connection, Inc.                330    ----     ----          330

June      Assets of Rehab Dynamics,
          Inc. and Restorative
          Therapy, Ltd.                22,163  11,460    2,500         8,203


                                  Page 8 of 35


<PAGE>


                                                 COMMON
                                        TOTAL    STOCK    ACCRUED        CASH
MONTH     TRANSACTION DESCRIPTION       COST     ISSUED   LIABILITIES    PAID
- -----     -----------------------       ----     ------   -----------    ----

July      Assets of Darkroom
          Engineering                     300    ----      125           175

August    Assets of Healthcare
          Personnel, Inc.                 785    ----      110           675

August    Assets of Portable
          Radiology Services            1,200    ----      600           600

August    Stock of Ambulatory
          Pharmaceutical Services,
          Inc. & APS American,
          Inc.                         36,200  16,125    1,950        18,125

August    Stock of Arcadia
          Services, Inc.               30,016  17,169    3,000         9,847

September Stock and assets of
          Barton Creek Healthcare,
          Inc.                          5,137    ----      280         4,857

September Stock of Community Care
          of America, Inc.            103,900    ----    5,900        98,000

Various   Cash payments of
          acquisition costs
          accrued                        ----    ----  (14,050)       14,050
                                       ------  ------  --------       ------

                                     $240,950 $71,193   $2,935      $166,822
                                     ======== =======  =======      ========


                                  Page 9 of 35


<PAGE>


The allocation of the total cost of the 1997 acquisitions to the assets acquired
and liabilities assumed is summarized as follows:

<TABLE>
<CAPTION>


                                           ASSETS
                             PROPERTY,     HELD
                   CURRENT   PLANT &       FOR        OTHER       INTANGIBLE    CURRENT       LONG-TERM        TOTAL
TRANSACTION        ASSETS    EQUIPMENT     SALE       ASSETS      ASSETS        LIABILITIES   LIABILITIES      COSTS
- -----------        -------   ---------     ----       ------      ------        -----------   -----------      -----         
                                                       (in 000's)
<S>               <C>        <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             --         10        --           --           25             --             --            35

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

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

Coastal
Rehabilitation,
Inc.                  257         85        --           --        1,764           (576)           (80)        1,450

Mobile
Diagnostics,
Inc.                   --         38        --           --          187             --             --           225

Health Care
Industries,
Inc.                  805        204        --           41        2,505         (1,080)          (150)        2,325

The Nursing
Connection,
Inc.                   14         62        --           --          254             --             --           330

Rehab Dynamics,
Inc. & Restorative
Therapy, Ltd.       4,140        954        --          107       21,478         (3,204)        (1,312)       22,163

Darkroom
Engineering            --         45        --           --          255             --             --           300

Healthcare
Personnel, Inc.         6          2        --           25          752             --             --           785

Portable Radiology
Services               --         90        --           --        1,110             --             --         1,200

Ambulatory
Pharmaceutical
Services, Inc. &
APS America, Inc.   1,987         48        --            8       39,624         (5,467)            --        36,200

Arcadia Services,
Inc.                3,980        348        --        2,464       39,233        (16,009)            --        30,016

Barton Creek
Healthcare, Inc.      884         96        --           --        7,293         (3,136)            --         5,137

Community Care of
America, Inc.      12,342     36,090    12,109          870       97,009        (27,520)       (27,000)      103,900
                  -------     ------    ------       -------    --------        --------       --------      -------

                  $26,713    $38,327   $12,109      $ 3,542     $248,197       $(58,086)      $(29,852)     $240,950
                  =======     ======    ======       =======    ========        ========       ========      =======

</TABLE>


                                  Page 10 of 35


<PAGE>


NOTE 4:     9-1/2% SENIOR SUBORDINATED NOTES DUE 2007

              In May 1997, the Company issued $450 million  aggregate  principal
              amount of its 9-1/2% Senior  Subordinated  Notes due 2007 (the "9-
              1/2%  Senior  Notes").  Interest  on the  9-1/2%  Senior  Notes is
              payable  semiannually  on March 15 and  September  15,  commencing
              September  15, 1997.  The 9-1/2% Senior Notes are  redeemable  for
              cash at any time on or after  September 15, 2002, at the option of
              the  Company,  in whole or in part,  initially  at the  redemption
              price equal to 104.75% of principal  amount,  declining to 100% of
              principal  amount on  September  15, 2005,  plus accrued  interest
              thereon to the date fixed for  redemption.  In  addition,  IHS may
              redeem up to $150 million aggregate principal amount of the 9-1/2%
              Senior  Notes at any time and from time to time prior to September
              15, 2000, at a redemption  price equal to 108.50% of the aggregate
              principal amount thereof,  plus accrued interest  thereon,  out of
              the net cash proceeds of one or more Public  Equity  Offerings (as
              defined in the indenture  under which the 9-1/2% Senior Notes were
              issued (the "9-1/2%  Senior Notes  Indenture")),  provided that at
              least $300  million in  aggregate  principal  amount of the 9-1/2%
              Senior  Notes remain  outstanding  after such  redemption.  In the
              event of a change in  control  of IHS (as  defined  in the  9-1/2%
              Senior Notes  Indenture),  each holder of 9-1/2%  Senior Notes may
              require IHS to repurchase  such holder's  9-1/2% Senior Notes,  in
              whole or in part, at 101% of the principal  amount  thereof,  plus
              accrued  interest to the repurchase  date. The 9-1/2% Senior Notes
              Indenture  contains  covenants,  including  but  not  limited  to,
              covenants with respect to the following  matters:  (1) limitations
              on additional indebtedness unless certain coverage ratios are met;
              (2)  limitations on other  subordinated  debt; (3)  limitations on
              liens;  (4)  limitations on the issuance of preferred stock by the
              Company's  subsidiaries;  (5)  limitations  on  transactions  with
              affiliates;   (6)   limitations   on   restricted   payments   and
              investments;  (7)  application  of the  proceeds of certain  asset
              sales;  (8) limitations on  restrictions on subsidiary  dividends;
              and (9) restrictions on mergers,  consolidations  and the transfer
              of  all or  substantially  all of the  assets  of the  Company  to
              another person. The Company used  approximately  $247.2 million of
              the net  proceeds  from the  sale of the  9-1/2%  Senior  Notes to
              repurchase  substantially  all of its 9- 5/8% Senior  Subordinated
              Notes due 2002 and its 10-3/4% Senior  Subordinated Notes due 2004
              and to pay pre-payment premiums, consent fees and accrued interest
              related to the  repurchase;  the  remaining  approximately  $191.0
              million  was used to repay a portion  of the $436.0  million  then
              outstanding  under its revolving  credit  facility.  In connection
              with the repurchase, the Company recorded an extraordinary loss of
              $18.2 million (net of tax). (See Note 8: Extraordinary Item)

NOTE 5:     9-1/4% SENIOR SUBORDINATED NOTES DUE 2008

            In  September  1997,  the  Company  issued  $500  million  aggregate
            principal  amount of its 9-1/4% Senior  Subordinated  Notes due 2008
            (the "9-1/4% Senior Notes").  Interest on the 9-1/4% Senior Notes is
            payable  semi-annually on January 15 and July 15, commencing January
            15, 1998. The 9-1/4% Senior Notes are redeemable for cash


                                  Page 11 of 35


<PAGE>


            at any time on or after  January  15,  2003,  at the  option  of the
            Company, in whole or in part,  initially at a redemption price equal
            to 104.625% of  principal  amount,  declining  to 100% of  principal
            amount on January 15,  2006,  plus accrued  interest  thereon to the
            date fixed for redemption. In addition, the Company may redeem up to
            $166,667,000  aggregate  principal amount of the 9-1/4% Senior Notes
            at any time and from time to time prior to January  15,  2001,  at a
            redemption price equal to 109.25% of the aggregate  principal amount
            thereof,  plus  accrued  interest  thereon  to the  date  fixed  for
            redemption,  out of the net  cash  proceeds  of one or  more  Public
            Equity Offerings (as defined in the indenture under which the 9-1/4%
            Senior  Notes were issued (the "9-1/4%  Senior  Notes  Indenture")),
            provided that at least $333,333,000 in aggregate principal amount of
            the 9-1/4% Senior Notes remain outstanding after such redemption. In
            the event of a change in  control  of IHS (as  defined in the 9-1/4%
            Senior  Notes  Indenture),  each holder of 9-1/4%  Senior  Notes may
            require IHS to  repurchase  such holder's  9-1/4%  Senior Notes,  in
            whole or in part,  at 101% of the  principal  amount  thereof,  plus
            accrued  interest to the  repurchase  date.  The 9-1/4% Senior Notes
            Indenture  contains   covenants,   including  but  not  limited  to,
            covenants with respect to the following matters:  (1) limitations on
            additional  indebtedness unless certain coverage ratios are met; (2)
            limitations on other  subordinated  debt; (3)  limitations on liens;
            (4)  limitations on the issuance of preferred stock by the Company's
            subsidiaries;  (5) limitations on transactions with affiliates;  (6)
            limitations on restricted payments and investments;  (7) application
            of  the  proceeds  of  certain  asset  sales;   (8)  limitations  on
            restrictions  on  subsidiary  dividends;  and  (9)  restrictions  on
            mergers, consolidations and the transfer of all or substantially all
            of the assets of the Company to another person. The Company used the
            proceeds  from  the  sale  of  the  9-1/4%  Senior  Notes  to  repay
            outstanding   indebtedness  under  the  Company's  revolving  credit
            facility and for general corporate purposes.

NOTE 6:     REVOLVING CREDIT AND TERM LOAN FACILITY

            On September  15,  1997,  the Company  entered into a $1.75  billion
            revolving  credit and term loan  facility  with  Citibank,  N.A., as
            Administrative  Agent,  and certain  other  lenders (the "New Credit
            Facility")  to replace its existing  $700 million  revolving  credit
            facility.  The New Credit  Facility  consists of a $750 million term
            loan  facility  (the "Term  Facility")  and a $1  billion  revolving
            credit   facility,   including  a  $100  million  letter  of  credit
            subfacility and a $10 million swing line subfacility (the "Revolving
            Facility").  The  Term  Facility,  all  of  which  was  borrowed  on
            September  17,  1997,  matures  on  September  30,  2004 and will be
            amortized  beginning  December  31,  1998  as  follows:  1998 - $7.5
            million;  each of 1999,  2000, 2001 and 2002 - $7.5 million (payable
            in equal quarterly installments);  2003 - $337.5 million (payable in
            equal quarterly  installments);  and 2004 - $375 million (payable in
            equal quarterly installments). Any unpaid balance will be due on the
            maturity  date. The Term Facility will bear interest at a rate equal
            to,  at the  option  of the  Company,  either  (i)  in the  case  of
            Eurodollar loans, the sum of (x) one and  three-quarters  percent or
            two percent  (depending on the ratio of IHS'


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<PAGE>


            Debt (as  defined in the New Credit  Facility)  to  earnings  before
            interest, taxes, depreciation,  amortization and rent, pro forma for
            any acquisitions or divestitures  during the measurement period (the
            "Debt/EBITDAR  Ratio"))  and (y)  the  interest  rate in the  London
            interbank market for loans in an amount  substantially  equal to the
            amount of borrowing and for the period of borrowing  selected by IHS
            or (ii) the sum of (a) the higher of (1) Citibank,  N.A.'s base rate
            or (2) one percent plus the latest overnight federal funds rate plus
            (b) a margin of one-half  percent or  three-quarters  of one percent
            (depending  on the  Debt/EBITDAR  Ratio).  The Term  Facility can be
            prepaid at any time in whole or in part without penalty.

            The Revolving  Facility will reduce to $800 million on September 30,
            2001 and $500 million on September 30, 2002,  with a final  maturity
            on September 15, 2004;  however,  the $100 million  letter of credit
            subfacility  and $10 million swing line  subfacility  will remain at
            $100 million and $10 million,  respectively,  until final  maturity.
            The Revolving Facility will bear interest at a rate equal to, at the
            option of IHS, either (i) in the case of Eurodollar  loans,  the sum
            of  (x)   between   three-quarters   of  one  percent  and  one  and
            three-quarters  (depending  on the  Debt/EBITDAR  Ratio) and (y) the
            interest rate in the London  interbank market for loans in an amount
            substantially equal to the amount of borrowing and for the period of
            borrowing  selected  by IHS or (ii) the sum of (a) the higher of (1)
            Citibank,  N.A.'s  base  rate or (2) one  percent  plus  the  latest
            overnight  federal  funds  rate  plus (b) a margin of  between  zero
            percent and one-half percent (depending on the Debt/EBITDAR  Ratio).
            Amounts repaid under the Revolving  Facility may be reborrowed prior
            to the maturity date.

            The New  Credit  Facility  limits  the  Company's  ability  to incur
            indebtedness   or  contingent   obligations,   to  make   additional
            acquisitions, to sell or dispose of assets, to create or incur liens
            on assets, to pay dividends, to purchase or redeem IHS' stock and to
            merge or  consolidate  with any other person.  In addition,  the New
            Credit  Facility  requires  that the Company meet certain  financial
            ratios, and provides the banks with the right to require the payment
            of all amounts  outstanding  under the facility and to terminate all
            commitments  under the facility,  if there is a change in control of
            IHS or if any person other than Dr. Robert N. Elkins,  IHS' Chairman
            and Chief Executive Officer,  or a group managed by Dr. Elkins, owns
            more than 40% of IHS' stock.  The New Credit  Facility is guaranteed
            by all of IHS' subsidiaries  (other than inactive  subsidiaries) and
            secured by a pledge of all of the stock of substantially all of IHS'
            subsidiaries.

            The New Credit  Facility  replaced the Company's $700 million credit
            facility  ("Prior  Credit  Facility").  As  a  result,  the  Company
            recorded an  extraordinary  loss on  extinguishment  of debt of $2.4
            million (net of related tax benefit of  approximately  $1.5 million)
            in the  third  quarter  of 1997  resulting  from  the  write-off  of
            deferred financing costs of $3.9 million related to the Prior Credit
            Facility. (See Note 8: Extraordinary Item)


                                  Page 13 of 35


<PAGE>


NOTE 7:     NON-RECURRING CHARGES (INCOME)

            PHARMACY GAIN:

            In July 1996,  the Company  sold its  pharmacy  division to Capstone
            Pharmacy,  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.  The Company  recorded a pre-tax gain
            related to the sale of $34.3  million  during the three months ended
            September  30, 1996  ($300,000  gain after tax).  At the date of the
            sale the Company's  investment  in the shares of  Capstone's  common
            stock was recorded at its  carryover  cost of $14.7  million,  which
            represented less than 20% of the total Capstone  shares.  During the
            first quarter 1997, the Company  recorded the remaining gain of $7.6
            million on its investment in the Capstone shares.  Previously,  such
            gain was accounted  for as an unrealized  gain on available for sale
            securities.

            SETTLEMENT WITH CORAM:

            On October 19, 1996,  the Company and Coram  Healthcare  Corporation
            ("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, and 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
            recognized  as a  non-recurring  charge in the  second  quarter.  In
            addition,  during the first  quarter of 1997 the Company  incurred a
            non-recurring  charge of $6.6 million relating to accounting,  legal
            and other costs related to the merger.

            SALE OF REMAINING INTEREST IN INTEGRATED LIVING COMMUNITIES, INC.

            In July  1997,  the  Company  sold  its  remaining  37.3%  ownership
            interest   in   Integrated   Living   Communities,    Inc.   ("ILC")
            (representing 2,498,000 shares of ILC) to Living Centers of America,
            Inc.  for  approximately  $28.7  million.  This sale  resulted  in a
            non-recurring  gain of approximately  $4.6 million which the Company
            recorded in the third quarter of 1997.


                                  Page 14 of 35


<PAGE>


            EXIT COSTS RELATED TO ROTECH MEDICAL CORPORATION

            In  September  1997,  the  Company  recorded an  approximately  $4.6
            million  non-recurring  charge resulting from the closure of certain
            redundant  activities in connection  with its fourth  quarter merger
            with RoTech Medical Corporation.

NOTE 8:     EXTRAORDINARY ITEM

            In the second quarter 1997,  the Company  recorded a pre-tax loss of
            $29.8 million  representing (1) approximately  $23.6 million of cash
            payments  for  pre-payment  premium  and  tender  and  consent  fees
            relating  to the early  extinguishment  of debt  resulting  from the
            Company's  repurchase  pursuant to cash tender offers of $99,893,000
            principal  amount of the Company's $100 million of  outstanding  10-
            3/4% Senior  Subordinated Notes due 2004 and $114,975,000  principal
            amount of the Company's  9-5/8% Senior  Subordinated  Notes due 2002
            and (2)  approximately  $6.2  million  relating to the  write-off of
            deferred  financing costs. Such loss,  reduced by the related income
            tax  effect of $11.6  million,  is  presented  in the  statement  of
            earnings as an extraordinary loss of $18.2 million.

            In the third quarter of 1997, the Company  replaced its $700 million
            revolving  credit facility with the $1.75 billion  revolving  credit
            and term loan facility (See Note 6:  Revolving  Credit and Term Loan
            Facility). This event has been accounted for as an extinguishment of
            debt and the Company has recorded a loss on  extinguishment  of debt
            of $3.9  million,  relating  primarily to the  write-off of deferred
            costs.  Such loss,  reduced by the related income tax effect of $1.5
            million,   is  presented   in  the   statement  of  earnings  as  an
            extraordinary item of $2.4 million.

            In the second quarter of 1996, the Company replaced its $500 million
            revolving  credit  and  term  loan  facility  with  a  $700  million
            revolving credit  facility.  This event has been accounted for as an
            extinguishment  of  debt  and the  Company  has  recorded  a loss on
            extinguishment  of debt of $2.3 million,  relating  primarily to the
            write-off  of  deferred  costs.  Such loss,  reduced by the  related
            income tax effect of  $896,000,  is  presented  in the  statement of
            earnings as an extraordinary item of $1.4 million.

NOTE 9:     STOCK REPURCHASE

            The Company's  Board of Directors has  authorized  the repurchase in
            the open market of up to $20 million of the Company's  Common Stock.
            The purpose of the repurchase  program is to have available treasury
            shares of Common Stock to (i) satisfy  contingent  earn-out payments
            under prior  business  combinations  accounted  for by the  purchase
            method, (ii) issue in connection with acquisitions,  and (iii) issue
            upon exercise of outstanding options. The repurchases will be funded
            from cash flow from  operations  and  drawings  under the  Company's
            revolving  credit  facility.  During the nine months ended September
            30, 1997, the Company repurchased 324,800 shares 


                                  Page 15 of 35


<PAGE>


            of Common Stock for an  aggregate  purchase  price of  approximately
            $12.3 million.

NOTE 10:    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 11:    MERGER WITH COMMUNITY CARE OF AMERICA, INC.

            On September 25, 1997,  the Company  acquired  through a cash tender
            offer and subsequent merger Community Care of America,  Inc. ("CCA")
            for a purchase  price of  approximately  $34.3 million in cash ("CCA
            Acquisition").  In addition,  in connection with the CCA Acquisition
            the  Company  repaid  approximately  $58.5  million of  indebtedness
            assumed in the CCA Acquisition with the proceeds from the term loans
            under its new credit facility,  assumed  approximately $27.0 million
            of   indebtedness   and  incurred   costs  of  the   transaction  of
            approximately  $5.2  million.  CCA  develops  and  operates  skilled
            nursing facilities in medically  underserved rural communities.  CCA
            currently  operates 54 licensed long-term care facilities with 4,450
            licensed beds (of which 19 facilities are being held for sale),  one
            rural healthcare clinic, two outpatient  rehabilitation centers, one
            child day care center and 124 assisted  living units within seven of
            the  facilities  which  CCA  operates.  CCA  currently  operates  in
            Alabama, Colorado, Florida, Georgia, Iowa, Kansas, Louisiana, Maine,
            Missouri,  Nebraska,  Texas and Wyoming.  According to CCA's filings
            with the  Securities  and Exchange  Commission,  CCA had revenues of
            $127.5 million,  earnings before interest,  taxes,  depreciation and
            amortization  ("EBITDA")  of $2.1  million  and a net  loss of $18.9
            million for the year ended  December  31, 1996 and revenues of $65.5
            million,  EBITDA of $4.0  million and a net loss of $2.4 million for
            the six months ended June 30, 1997.  Dr. Robert N. Elkins,  Chairman
            of the Board and Chief Executive Officer of IHS,  beneficially owned
            approximately  21.0% of CCA's  outstanding  common stock  (excluding
            warrants to purchase approximately 13.5% of CCA's common stock owned
            by IHS).

            In  connection  with the CCA  Acquisition,  IHS,  CCA and Health and
            Retirement Properties Trust ("HRPT"), CCA's principal landlord and a
            significant lender to CCA, restructured the lease and loan


                                  Page 16 of 35


<PAGE>

            agreements  between  CCA and  HRPT.  Under  the  agreement,  (i) CCA
            purchased for $33.5 million 14 facilities,  aggregating  1,238 beds,
            previously owned by HRPT and leased to CCA, (ii) approximately $12.2
            million  principal  amount of loans from HRPT to CCA was prepaid and
            the collateral  security released,  (iii) three facilities  mortgage
            financed  by HRPT were sold to HRPT and leased to CCA,  and (iv) the
            leases  and  mortgages  were  modified  to  reduce  future  rent and
            mortgage interest rate increases and release cash security deposits.
            IHS has guaranteed all lease and mortgage obligations to HRPT, which
            received a $3.7 million modification fee.

NOTE 12:    ASSETS HELD FOR SALE

            Assets held for sale represent the assets of nineteen geriatric care
            facilities  acquired in connection with the acquisition of CCA which
            are intended to be sold within one year. Such amounts are carried at
            estimated net realizable value, less estimated  carrying costs to be
            incurred during the holding period.

NOTE 13:    SUBSEQUENT EVENTS

            MERGER WITH ROTECH MEDICAL CORPORATION

            On October 21, 1997, the Company acquired RoTech Medical Corporation
            ("RoTech")  through merger of a wholly-owned  subsidiary of IHS into
            RoTech  (the   "Merger"),   with  RoTech   becoming  a  wholly-owned
            subsidiary  of IHS.  RoTech  provides home  healthcare  products and
            services,  with  an  emphasis  on  home  respiratory,  home  medical
            equipment and infusion therapy, primarily in non-urban areas. RoTech
            currently  operates  631 home  health  locations  in 36  states  and
            approximately  26 primary care  physicians  practices.  According to
            RoTech's filings with the Securities and Exchange Commission, RoTech
            had revenues of $422.7 million and net earnings of $30.8 million for
            the year ended July 31, 1997.

            Under the  terms of the  Merger,  holders  of  RoTech  Common  Stock
            received for each share of RoTech  Common Stock 0.5806 of a share of
            IHS Common Stock (the  "Exchange  Ratio"),  having a market value of
            $19.16 based on the $33.00  closing price of the IHS Common Stock on
            October 21,  1997,  the  effective  date of the  Merger.  Options to
            purchase  RoTech Common Stock (the "RoTech  Options") were converted
            at the closing  date into options to purchase IHS Common Stock based
            on the Exchange Ratio. IHS issued approximately 15,350,670 shares of
            IHS  Common   Stock  in  the  Merger,   and  reserved  for  issuance
            approximately  1,841,700  shares of IHS Common Stock  issuable  upon
            exercise of RoTech Options. In addition, RoTech's outstanding 5-1/4%
            convertible  subordinated debentures in the principal amount of $110
            million become  convertible into  approximately  2,433,000 shares of
            IHS Common  Stock at a  conversion  price of $45.21 per share of IHS
            Common Stock (the  "RoTech  Debentures").  The Merger  consideration
            aggregated approximately $514.8 million,  substantially all of which
            will be recorded as goodwill.  The transaction  will be treated as a
            purchase for accounting and financial reporting 


                                  Page 17 of 35


<PAGE>


            purposes.  IHS repaid the $199.7 million of RoTech bank debt assumed
            in the transaction  with the proceeds of the term loan under its new
            revolving  credit and term loan  facility.  Pursuant to the terms of
            the indenture under which the RoTech Debentures were issued,  RoTech
            has offered to repurchase all such debentures for a price of 100% of
            the principal amount thereof.

            PROPOSED  ACQUISITION OF LONG-TERM  FACILITIES AND OTHER ASSETS FROM
            HEALTHSOUTH CORPORATION

            On  November 3, 1997,  IHS signed a  definitive  purchase  agreement
            pursuant  to which the  Company  will  acquire  139  long-term  care
            facilities,  12 specialty  hospitals,  a contract  therapy  business
            holding over 1,000 contracts and an institutional  pharmacy business
            serving  approximately  38,000  beds  from  HEALTHSOUTH  Corporation
            ("HEALTHSOUTH").  Under  the  terms of the  agreement,  IHS will pay
            $1.15 billion in cash and assume approximately $100 million in debt.
            The Company will fund the purchase  price with  available  cash from
            term loan borrowings  under its $1.75 billion  revolving  credit and
            term loan facility, the sale of its 9-1/4% Senior Subordinated Notes
            due 2008 and  borrowings  under the revolving  credit portion of its
            new credit  facility.  Consummation of the transaction is subject to
            certain  regulatory  approvals,  bank approvals and  satisfaction of
            certain other  conditions.  IHS has deposited with  HEALTHSOUTH  $50
            million, which amount will be credited against the purchase price at
            the closing or retained by HEALTHSOUTH  under certain  circumstances
            if the  transaction  is not  consummated.  There can be no assurance
            that  this  transaction  will be  consummated  on  these  terms,  on
            different terms, or at all.

            ACQUISITION OF CORAM HEALTHCARE CORPORATION LITHOTRIPSY DIVISION

            IHS acquired  substantially all of the assets of Coram's Lithotripsy
            Division,   which  operates  20  mobile  lithotripsy  units  and  13
            fixed-site  machines  in  180  locations  in 18  states.  The  Coram
            Lithotripsy  Division also provides  maintenance services to its own
            and third-party  equipment.  Lithotripsy is a non-invasive technique
            that utilizes shock waves to disintegrate kidney stones. The closing
            occurred on October 2, 1997.

            The Company paid approximately  $131.0 million in cash for the Coram
            Lithotripsy Division,  and assumed $1.0 million of intercompany debt
            to Coram.  The Coram  Lithotripsy  Division  had  revenues  of $49.0
            million  and  earnings  before  interest,  taxes,  depreciation  and
            amortization  ("EBITDA") of $28.8 million (before minority interest)
            for the year ended  December 31, 1996 and revenues of $23.9  million
            and EBITDA of $14.3 million (before  minority  interest) for the six
            months ended June 30, 1997.

            The Company  has assumed  Coram's  agreements  with its  lithotripsy
            partners,  which  contemplate  that IHS will  acquire the  remaining
            interest in each  partnership  at a defined  price in the event that
            legislation is passed or regulations are adopted or interpreted that
            would prevent the physician  partners from owning an interest in the
            partnership and using the  partnership's  lithotripsy  equipment for
            the treatment of his or her patients.  Coram has  represented to IHS
            that its partnership arrangements with


                                  Page 18 of 35


<PAGE>


            physicians  in  its  lithotripsy  business  are in  compliance  with
            current law.

            OTHER ACQUISITIONS

            IHS has reached a definitive  agreement to purchase a home  infusion
            company for approximately $15.6 million.

            The Company has reached  agreements  in principle to purchase  three
            mobile  diagnostic  companies for approximately  $8.2 million,  four
            home  healthcare   companies  for  approximately  $48.3  million,  a
            rehabilitation  company  for  approximately  $11.1  million,  and  a
            lithotripsy company for approximately $11.2 million. The Company has
            also reached  agreements in principle to lease three skilled nursing
            facilities.

            There  can  be  no  assurance  that  these   acquisitions   will  be
            consummated on these terms, on different terms, or at all.


                                  Page 19 of 35


<PAGE>


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



Statements  in this  Quarterly  Report on Form  10-Q  concerning  the  Company's
business  outlook  or future  economic  performance  anticipated  profitability,
revenues,  expenses or other financial items, and product line growth,  together
with other  statements  that are not  historical  facts,  are  "forward  looking
statements"   as  that  term  is  defined   under   Federal   Securities   Laws.
Forward-looking statements are subject to risks, uncertainties and other factors
which could cause actual results to differ  materially from those stated in such
statements.  Such risks,  uncertainties and factors include, but are not limited
to, the  Company's  substantial  indebtedness,  growth  strategy,  managed  care
strategy, capital requirements and recent acquisitions,  as well as competition,
government  regulation,  general economic conditions and other risks detailed in
the Company's filings with the Securities and Exchange Commission, including the
Company's Annual Report on Form 10-K for the year ended December 31, 1996.

THREE MONTHS ENDED  SEPTEMBER 30, 1997 COMPARED TO THREE MONTHS ENDED  SEPTEMBER
30, 1996

Net  revenues for the three months ended  September  30, 1997  increased  $147.3
million,  or 45%,  to  $472.9  million  from  the  comparable  period  in  1996.
Approximately  82%  of the  increase  is  attributable  to  the  acquisition  of
companies   providing   rehabilitation,    home   health,   mobile   x-ray   and
electrocardiogram services subsequent to September 30, 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 three months ended September
30, 1996  included  revenues of $9.1  million  from the  pharmacy  division  and
revenues  of $5.8  million  from its  assisted  living  services  division.  The
remaining increase was due primarily to


                                  Page 20 of 35


<PAGE>


facilities and ancillary companies acquired during the third quarter of 1996 and
increased  revenues from facilities and ancillary  companies in operation during
both  periods.  The  Company  derived  approximately  49% and 17% of its patient
revenues  from Medicare and  Medicaid,  respectively,  in the three months ended
September 30, 1997,  compared to 34% and 23%,  respectively,  in the  comparable
period in 1996.

Basic  medical  services  revenue  decreased  10% from  $101.2  million to $91.5
million.  This decrease primarily resulted from the conversion by the Company of
certain  skilled  nursing  beds to  Medical  Specialty  Unit  (MSU)  beds  after
September  30, 1996 and the sale of a majority  interest in its assisted  living
services division in October 1996.

Specialty  medical services revenue  increased 75% from $211.9 million to $370.8
million.   Of  the  $158.9  million  increase,   $120.5  million,  or  76%,  was
attributable  to revenue from  acquisitions  subsequent  to September  30, 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 was due to increased  revenue from  facilities and ancillary
companies in operation in both periods,  ancillary companies acquired during the
third  quarter of 1996, as well as skilled  nursing beds being  converted to MSU
beds after September 30, 1996.

Management services and other revenues decreased 15% from $12.6 million to $10.7
million.

Total  expenses  for the period  increased  65% to $438.2  million  from  $265.3
million in the comparable period of 1996. Of the $172.9 million increase, $107.3
million, or 62%, resulted from an increase in operating expenses.  A substantial
portion  of  the  increase  in  operating   expenses  was  due  to  acquisitions
consummated  subsequent to September 30, 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.


                                  Page 21 of 35


<PAGE>



Corporate  administrative  and  general  expenses  for the  three  months  ended
September 30, 1997 increased by $5.0 million, or 33%, over the comparable period
in 1996. This increase primarily represents additional  operations,  information
systems, accounting, finance and other personnel to support the growth resulting
from the  acquisition of ancillary  businesses.  Depreciation  and  amortization
increased to $17.0 million during the three months ended  September 30, 1997, an
increase  of 86% as  compared  to $9.1  million  in the  same  period  in  1996,
primarily  as a result of increases in goodwill  amortization  and  depreciation
related to ancillary company acquisitions consummated during 1996 and 1997. Rent
expense  increased by $7.1 million,  or 38%, over the comparable period in 1996,
primarily  as a result of increases in  contingent  rentals,  which are based on
gross revenues of certain leased  facilities,  increased  equipment  rentals and
rent at ancillary companies acquired subsequent to September 30, 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  $11.4 million,  or 72%, during the three months ended
September  30, 1997 to $27.3  million.  The  increase  in  interest  expense was
primarily a result of $750 million of term loan  borrowings  under the Company's
new $1.75  billion  revolving  credit  and term loan  facility  entered  into in
September  1997,  the Company's $500 million  principal  amount of 9-1/4% Senior
Subordinated  Notes  issued  in  September  1997,  the  Company's  $450  million
principal amount of 9-1/2% Senior Subordinated Notes issued in May 1997, as well
as increased  borrowings under the Company's prior $700 million revolving credit
facility,  partially  offset  by a  reduction  in  interest  resulting  from the
repurchase in May 1997 of substantially  all of the Company's 9-5/8% and 10-3/4%
Senior  Subordinated  Notes,  and the payoff of the Company's prior $700 million
revolving  credit  facility with the proceeds from the sale of the 9-1/4% Senior
Subordinated Notes.

Earnings  before  equity in  earnings  (loss) of  affiliates,  income  taxes and
extraordinary items decreased by 43% to $34.7 million for the three months ended
September 30, 1997, as compared to $60.3  million for the  comparable  period in
the prior year. This decrease primarily resulted


                                  Page 22 of 35


<PAGE>


from the gain the  Company  recognized  from the sale of the  pharmacy  division
during the three  months  ended  September  30, 1996 (See Note 7:  Non-Recurring
Charges  (Income)).  Excluding  non-recurring  income in 1996,  earnings  before
equity in earnings (loss) of affiliates, income taxes and extraordinary items in
1997 increased $8.6 million, or 33%, over the comparable prior period in 1996.

Earnings before income taxes and  extraordinary  items decreased by 44% to $33.9
million for the three months  ended  September  30,  1997,  as compared to $60.7
million for the  comparable  period in the prior year.  This  decrease  resulted
primarily  from  the  non-recurring   income  described  above.   Excluding  the
non-recurring  income in 1996,  earnings  before income taxes and  extraordinary
items in 1997 increased $7.5 million,  or 29%, over the comparable  prior period
in 1996.  The provision for federal and state income taxes was $13.2 million for
the three months ended September 30, 1997, and $44.1 million for the same period
in the prior year. Because the Company's investment in the common stock received
in the sale of the Company's  pharmacy  division had a very small tax basis, the
taxable gain on the sale significantly exceeded the gain for financial reporting
purposes,  thereby resulting in a disproportionately higher income tax provision
related to the sale in 1996.  During the three months ended  September 30, 1997,
the Company incurred an extraordinary loss on the extinguishment of debt of $2.4
million (net of tax),  or 6 cents per share  (fully-diluted),  representing  the
write-off of deferred  financing fees in connection  with the replacement of its
$700 million  revolving credit facility with its $1.75 billion  revolving credit
and term loan  facility as discussed  in Note 8. Net earnings and  fully-diluted
earnings  per share for the quarter was $18.3  million in 1997,  or 59 cents per
share, as compared to net earnings and fully diluted earnings per share of $16.5
million or 58 cents per share for the same period in 1996.


                                  Page 23 of 35


<PAGE>


NINE MONTHS ENDED SEPTEMBER 30, 1997 COMPARED TO NINE MONTHS ENDED SEPTEMBER 30,
1996

Net revenues  for the nine months  ended  September  30, 1997  increased  $403.1
million,  or 41%,  to  $1,391.8  million  from the  comparable  period  in 1996.
Approximately  83%  of the  increase  is  attributable  to  the  acquisition  of
companies   providing   rehabilitation,    home   health,   mobile   x-ray   and
electrocardiogram services subsequent to September 30, 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 nine months ended September
30,  1996  include  revenues  of $56.5  million for the  pharmacy  division  and
revenues of $17.1  million  from its  assisted  living  services  division.  The
remaining  increase was due  primarily to  facilities  and  ancillary  companies
acquired during the nine months ended September 30, 1996 and increased  revenues
from facilities and ancillary  companies in operation  during both periods.  The
Company derived  approximately 49% and 17% of its patient revenues from Medicare
and  Medicaid,  respectively,  in the nine  months  ended  September  30,  1997,
compared to 34% and 23%, respectively, in the comparable period in 1996.

Basic  medical  services  revenue  decreased  10% from $296.5  million to $268.3
million.  This decrease primarily resulted from the conversion by the Company of
certain  skilled  nursing  beds to  Medical  Specialty  Unit  (MSU)  beds  after
September  30, 1996 and the sale of a majority  interest in its assisted  living
services division in October 1996.

Specialty medical services revenue increased 66% from $658.3 million to $1,093.6
million.   Of  the  $435.3  million  increase,   $335.2  million,  or  77%,  was
attributable  to revenue from  acquisitions  subsequent  to  September  30, 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 was due to increased revenue from facilities in operation in
both periods and ancillary companies


                                  Page 24 of 35


<PAGE>


acquired  during the nine months ended  September  30, 1996,  as well as skilled
nursing beds being converted to MSU beds after September 30, 1996.

Management services and other revenues decreased 12% from $34.0 million to $30.0
million.

Total expenses for the period increased to $1,310.9 million from $881.9 million,
an increase of 49%. Of the $429.0 million increase,  $294.3 million, or 69%, was
due to an increase in operating expenses.  A substantial portion of the increase
in  operating  expenses  was  due  to  acquisitions  consummated  subsequent  to
September  30,  1996,  partially  offset by 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.

Corporate  administrative  and  general  expenses  for  the  nine  months  ended
September  30, 1997  increased by $11.2  million,  or 25%,  over the  comparable
period  in 1996.  This  increase  primarily  represents  additional  operations,
information  systems,  accounting,  finance and other  personnel  to support the
growth resulting from the acquisition of ancillary businesses.  Depreciation and
amortization  increased  85% to  $47.8  million  during  the nine  months  ended
September  30,  1997 as compared  to $25.9  million  for the nine  months  ended
September 30, 1996. This increase is primarily the result of increased  goodwill
amortization  and  depreciation   related  to  ancillary  company   acquisitions
consummated  during 1996 and 1997. Rent expense  increased by $21.3 million,  or
40%, over the comparable  period in 1996, as a result of increases in contingent
rentals,  which  are  based on gross  revenues  of  certain  leased  facilities,
increased  equipment rentals and rent at ancillary companies acquired subsequent
to September 30, 1996,  partially  offset by a reduction in rent  resulting from
the sale of the  pharmacy  division  and the sale of  majority  interest  in the
Company's  assisted living services  division.  Interest expense,  net increased
$26.0 million,  or 56%, during the nine months ended September 30, 1997 to $72.0
million. This increase in interest


                                  Page 25 of 35


<PAGE>



expense was primarily a result of $750 million of term loan borrowings under the
Company's new $1.75 billion  revolving  credit and term loan  facility,  entered
into in September  1997, the Company's $500 million  principal  amount of 9-1/4%
Senior  Subordinated  Notes issued in September 1997, the Company's $450 million
principal  amount of 9-1/2% Senior  Subordinated  Notes issued in May 1997,  the
Company's $150 million  principal  amount of 10-1/4% Senior  Subordinated  Notes
issued in May 1996, as well as increased  borrowings  under the Company's  prior
$700  million  revolving  credit  facility,  partially  offset by a reduction in
interest  resulting  from the repurchase of  substantially  all of the Company's
9-5/8% and 10-3/4% Senior Subordinated Notes in May 1997, and the paydown on the
Company's  prior $700 million  revolving  credit facility with the proceeds from
the  sale  of the  9-1/2%  Senior  Subordinated  Notes  and  the  9-1/4%  Senior
Subordinated Notes.

Earnings  before  equity in  earnings  (loss) of  affiliates,  income  taxes and
extraordinary  items decreased by 24% to $81.0 million for the nine months ended
September 30, 1997, as compared to $106.9 million for the  comparable  period in
the prior year. This decrease is primarily the result of  non-recurring  charges
which  were  incurred  during  the nine  months  ended  September  30,  1997 and
non-recurring  income  the  Company  recognized  during  the nine  months  ended
September 30, 1996 (See Note 7: Non-Recurring  Charges (Income)).  Excluding the
non-recurring  charges  and  income in both  years,  earnings  before  equity in
earnings  (loss) of  affiliates,  income taxes and  extraordinary  items in 1997
increased $28.5 million, or 39%, over the comparable period in 1996.

Earnings before income taxes and  extraordinary  items decreased by 26% to $80.3
million for the nine months  ended  September  30,  1997,  as compared to $107.9
million for the comparable  period in the prior year. This decrease is primarily
the result of the  non-recurring  charges and income discussed above.  Excluding
the  non-recurring  charges  and  income,   earnings  before  income  taxes  and
extraordinary  items  in 1997  increased  by  $26.7  million,  or 36%,  over the
comparable  prior  period in 1996.  The  provision  for federal and state income
taxes was $31.3 million for the nine months ended  September 30, 1997, and $62.4
million  for the same  period in the prior  year.  Taxes in the 1996 period were
substantially  higher because of the sale of the pharmacy  division as discussed
above under the three month results of operations. During the nine months


                                  Page 26 of 35


<PAGE>


ended September 30, 1997 and 1996, the Company incurred  extraordinary losses of
$20.6  million  (net of tax),  or 57 cents  per share  (fully-diluted)  and $1.4
million  (net of  tax),  or 4 cents  per  share  (fully-diluted),  respectively,
representing  in 1997 the payment of premium and consent fees and the  write-off
of deferred  financing costs in connection with the repurchase of  substantially
all the Company's 9-5/8% and 10-3/4% Senior Subordinated Notes and the write-off
of deferred  financing  costs in  connection  with the  replacement  of its $700
million revolving credit facility with a $1.75 billion revolving credit and term
loan facility and in 1996 the write-off of deferred  financing  costs related to
replacement  of the  Company's  $500  million  revolving  credit  and term  loan
facility  with  the  $700  million   revolving  credit  facility  (See  Note  8:
Extraordinary  Item).  Net earnings and fully diluted earnings per share for the
nine months were $28.4 million in 1997, or $1.00 per share, as compared to $44.2
million or $1.64 per share for the same period in 1996.  Weighted average shares
(fully-diluted)  increased by 14%,  from  31,447,000  at  September  30, 1996 to
35,803,000 at September 30, 1997.


                                  Page 27 of 35


<PAGE>


LIQUIDITY AND CAPITAL RESOURCES

At September 30, 1997,  the Company had working  capital of $980.9  million,  as
compared  with $57.5  million at  December  31,  1996.  The  increase in working
capital was a result of an  increase in cash,  as well as 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
commitments  for capital  expenditures  as of September  30,  1997.  Net patient
accounts and third-party payor settlements receivable increased $50.7 million to
$377.5  million at September 30, 1997, as compared to $326.9 million at December
31, 1996. Of the $50.7 million  increase in accounts  receivable,  $22.9 million
was attributable to related service businesses  acquired  subsequent to December
31,  1996  and  $27.8  million  was  due to  increased  accounts  receivable  at
facilities in operation and related  service  businesses  owned at both December
31, 1996 and September 30, 1997. Gross patient  accounts  receivable were $398.6
million at  September  30, 1997,  as compared to $340.8  million at December 31,
1996.  Net  third-party  payor  settlements  receivable  from  federal and state
governments  (i.e.,  Medicare and Medicaid  cost  reports) was $26.1  million at
September  30,  1997,  as  compared  to $27.6  million  at  December  31,  1996.
Approximately  $11.8  million,  or 45%,  of the  third-party  payor  settlements
receivable  from federal and state  governments  at September 30, 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 success of the Company's
MSU  strategy  will  depend in part on its ability to obtain  reimbursement  for
those  costs  which  exceed the  Medicare  established  reimbursement  limits by
obtaining  waivers of these cost  limitations.  The Company has submitted waiver
requests for 325 cost reports, covering all cost report periods through December
31,  1996.  To date,  final  action has been taken by the Health Care  Financing
Administration  ("HCFA") on 232 waiver  requests  covering  cost report  periods
through  December  31,  1996.  The  Company's  final  rates as  approved by HCFA
represent  approximately  95% of the requested  rates as submitted in the waiver
requests. There


                                  Page 28 of 35


<PAGE>


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.

As discussed in Note 4, in May 1997, the Company  issued $450 million  principal
amount of 9-1/2% Senior Subordinated Notes. The Company used the net proceeds to
repurchase  substantially all of its 9- 5/8% Senior  Subordinated Notes due 2002
and its 10-3/4% Senior Subordinated Notes due 2004, to pay pre-payment premiums,
consent fees and accrued interest related to the repurchase, as well as to repay
a  portion  of the  $436.0  million  then  outstanding  under  its $700  million
revolving  credit  facility.  In  connection  with the  repurchase,  the Company
recorded an extraordinary loss of $18.2 million (net of tax).

As  discussed  in Note 5, in  September  1997,  the Company  issued $500 million
principal  amount of 9-1/4%  Senior  Subordinated  Notes.  The Company  used the
proceeds to repay  outstanding  indebtedness  under the  Company's  $700 million
revolving credit facility and for general corporate purposes.

As discussed in Note 6, in September 1997, the Company replaced its $700 million
credit  facility with a $1.75 billion  revolving  credit and term loan facility.
Upon the closing of the  facility,  the Company  borrowed  $750  million of term
loans.  In  connection   with  this   transaction,   the  Company   recorded  an
extraordinary  loss of $2.4 million (net of tax) on the  extinguishment  of debt
related to the prior credit facility.

The Company intends to use  substantially  all cash proceeds  remaining from the
sale of the  9-1/4%  Senior  Subordinated  Notes  and term loan  borrowings  and
borrowings  under its  revolving  credit  facility to pay the $1.15 billion cash
purchase  price for the assets  which the Company  has agreed to  purchase  from
HEALTHSOUTH. (See Note 13)

The other asset and liability increases were due to acquisitions and


                                  Page 29 of 35


<PAGE>


normal growth in operations  which was consistent with the growth in revenues of
such operations in 1997.

Net cash provided by operating  activities  for the nine months ended  September
30,  1997,  was $26.7  million as compared to $14.3  million for the  comparable
period in 1996.

Net cash  provided by financing  activities  was  $1,070.9  million for the nine
month period in 1997 as compared to $60.8 million for the  comparable  period in
1996.  In both  periods,  the  Company  received  net  proceeds  from  long-term
borrowings and made repayments on certain debt.

Net cash used by investing  activities  was $1,077.7  million for the nine month
period ended  September 30, 1997 as compared to $72.9 million for the nine month
period ended September 30, 1996. Cash used for business  acquisitions was $166.8
million  in 1997 as  compared  to $46.1  million  for  1996.  Cash  used for the
purchase of property,  plant and  equipment was $86.7 million in 1997 and $104.6
million in 1996. Cash used for the purchase of temporary  investments was $820.6
million in 1997 compared to $4.6 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  $48.0 million as of September 30, 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  $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 the 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 established  several
irrevocable  letters  of  credit  with the Bank of Nova  Scotia  totaling  $26.3
million at September 30, 1997 to secure


                                  Page 30 of 35


<PAGE>


certain  of the  Company's  workers'  compensation,  health  benefits  and other
obligations.  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.  In  addition,  the Company  has  obligations  under
operating leases aggregating approximately $200.3 million at September 30, 1997.
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
of which $36.1  million was recorded on the balance sheet at September 30, 1997.
The Company is obligated to purchase the remaining  interests in its lithotripsy
partnerships  at  a  defined  price  in  the  event  legislation  is  passed  or
regulations  adopted that would  prevent the  physician  partners from owning an
interest in the partnership and using the  partnership's  lithotripsy  equipment
for the treatment of his or her patients.

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.

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 and 1998.
The Company  expects to continue to be growth  oriented in 1997 and 1998 through
the  expansion of its existing  operations,  by the  acquisition  of  additional
facilities  and  ancillary  companies  and the entry into  agreements  to manage
additional facilities.


                                  Page 31 of 35


<PAGE>




PART II:          OTHER INFORMATION

ITEM 2:           CHANGES IN SECURITIES

(C)                     On August 29, 1997, the Company  acquired  substantially
                        all   of   the    outstanding    stock   of   Ambulatory
                        Pharmaceutical Services, Inc. ("APSI") and APS American,
                        Inc. ("APSA"),  which provide blood factoring  services.
                        The purchase price was approximately  $34.3 million,  of
                        which  $18.1  million  was paid in cash at  closing  and
                        $16.2  million was paid  through the issuance of 532,240
                        shares of the Company's common stock to the stockholders
                        of APSI and APSA (based on the average closing price for
                        the thirty day trading period immediately  preceding the
                        date which is two trading  days before the closing  date
                        of the acquisition).

                        On August 28, 1997, the Company  acquired  substantially
                        of the  outstanding  stock  of  Arcadia  Services,  Inc.
                        ("Arcadia"),  which provides home health  services.  The
                        purchase price was approximately $27.0 million, of which
                        $9.8  million  was  paid in cash at  closing  and  $17.2
                        million was paid through the issuance of 531,198  shares
                        of the  Company's  common  stock to the  stockholder  of
                        Arcadia  (based  on the  average  closing  price for the
                        thirty day trading period immediately preceding the date
                        which is two  trading  days  before  the  closing of the
                        acquisition).

                        The  Common   Stock  issued  by  the  Company  in  these
                        transactions was not registered under the Securities Act
                        of  1933,  as  amended,   in  reliance  upon  exemptions
                        contained  in  Section   4(2)   thereof.   Each  of  the
                        stockholders made representations to the effect that (i)
                        the shares were being  acquired  for its own account and
                        not with a view to, or for sale in connection  with, any
                        distribution;  (ii)  acknowledging  that the shares were
                        restricted  securities under Rule 144; (iii) that it had
                        knowledge  and  experience  in  business  matters,   was
                        capable  of  evaluating  the  merits  and  risks  of the
                        investment,  and was able to bear the risk of loss; (iv)
                        had the  opportunity  to make  inquiries  of and  obtain
                        information  from  IHS.  The  Company  is  obligated  to
                        register   the  Common   Stock  for  resale   under  the
                        Securities Act of 1993, as amended.


ITEM 6:            EXHIBITS AND REPORTS ON FORM 8-K

A.                EXHIBITS

                  4.1         Indenture, dated as of September 11, 1997, between
                              Integrated  Health Services,  Inc. And First Union
                              National Bank of Virginia, as Trustee, relating to
                              the Company's 9-1/4% Senior Subordinated Notes due
                              2008.


                                  Page 32 of 35


<PAGE>


                 10.1         Credit Agreement,  dated as of September 15, 1997,
                              by and among Integrated Health Services, Inc., the
                              lenders  named  therein,  and  Citibank,  N.A., as
                              administrative  agent  (incorporated  by reference
                              from the  Company's  Current  Report  on 8-K dated
                              September 15, as amended).

                 10.2         Purchase   Agreement,   dated  September 8,  1997,
                              between Integrated Health Services, Inc. and Smith
                              Barney,  Inc., Morgan Stanley & Co.  Incorporated,
                              Donaldson,    Lufkin   &    Jenrette    Securities
                              Corporation   and   Citicorp   Securities,   Inc.,
                              relating   to   the   Company's    9-1/4%   Senior
                              Subordinated Notes due 2008.

                 10.3         Registration Rights Agreement,  dated September 8,
                              1997,  between  Integrated Health Services,  Inc.,
                              and  Smith  Barney,  Inc.,  Morgan  Stanley  & Co.
                              Incorporated,   Donaldson,   Lufkin   &   Jenrette
                              Securities  Corporation  and Citicorp  Securities,
                              Inc.,  relating  to the  Company's  9-1/4%  Senior
                              Subordinated Notes due 2008.

                 10.4         Purchase and Sale Agreement,  dated as of November
                              3, 1997, between Integrated Health Services, Inc.,
                              HEALTHSOUTH Corporation and Horizon/CMS Healthcare
                              Corporation  (incorporated  by reference  from the
                              Company's   Current   Report  on  Form  8-K  dated
                              November 3, 1997).

B.             REPORTS ON FORM 8-K

               The Company filed a Current Report on Form 8-K dated July 6, 1997
               reporting the execution of the Agreement and Plan of Merger among
               the Company,  IHS  Acquisition  XXIV,  Inc.,  and RoTech  Medical
               Corporation   ("RoTech")   relating  to  the  Company's  proposed
               acquisition of RoTech.

               The Company filed a Current Report on Form 8-K dated September 9,
               1997 relating to the private  issuance of $500,000,000  aggregate
               principal amount 9-1/4% Senior Subordinated Notes due 2008.

               The Company  filed a Current  Report on Form 8-K dated  September
               15, 1997 reporting the agreement with Citibank,  N.A. and certain
               other lenders relating to the $1.75 billion  revolving credit and
               term loan facility.

               The Company  filed a Current  Report on Form 8-K dated  September
               25,  1997  reporting  the cash  tender and  subsequent  merger of
               Community  Care  of  America,  Inc  and  the  acquisition  of the
               lithotripsy division of Coram Healthcare Corporation.


                                  Page 33 of 35


<PAGE>


               The Company filed a Current  Report on Form 8-K dated October 21,
               1997 reporting the  completion of the RoTech Medical  Corporation
               acquisition.

               The Company filed a Current  Report on Form 8-K dated November 3,
               1997,  reporting the execution of an agreement to acquire certain
               assets from HEALTHSOUTH Corporation.


                                  Page 34 of 35


<PAGE>


                                 - SIGNATURES -


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



                                   INTEGRATED HEALTH SERVICES, INC.
                                   -------------------------------- 


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



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



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



Dated: November 13, 1997


                                  Page 35 of 35



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





                        INTEGRATED HEALTH SERVICES, INC.,

                             A DELAWARE CORPORATION,

                                    AS ISSUER


                                       TO

                            FIRST UNION NATIONAL BANK

                                   AS TRUSTEE


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


                                    INDENTURE


                          Dated as of September 11,1997


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



                                  $500,000,000


                    9 1/4% Senior Subordinated Notes due 2008



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


<PAGE>
<TABLE>
<CAPTION>


                                          CROSS REFERENCE TABLE*

Trust Indenture
Act Section                                                                              Indenture Section
- -----------                                                                              -----------------

<S>                                                                                         <C>
310(a)(1)               ...............................................................                7.9
   (a)(2)               ...............................................................                7.9
   (a)(3)               ...............................................................     Not Applicable
   (a)(4)               ...............................................................     Not Applicable
   (a)(5)               ...............................................................                7.9
   (b)                  ...............................................................                7.9
   (c)                  ...............................................................     Not Applicable
311(a)                  ...............................................................                 **
   (b)                  ...............................................................                 **
   (c)                  ...............................................................     Not Applicable
312                     ...............................................................                 **
313(a)                  ...............................................................                 **
   (b)(1)               ...............................................................     Not Applicable
   (b)(2)               ...............................................................                 **
   (c)                  ...............................................................                 **
   (d)                  ...............................................................                 **
314(a)                  ...............................................................            4.3,4.4
   (b)                  ...............................................................     Not Applicable
   (c)(1)               ...............................................................               11.3
   (c)(2)               ...............................................................               11.3
   (c)(3)               ...............................................................     Not Applicable
   (d)                  ...............................................................     Not Applicable
   (e)                  ...............................................................               11.4
   (f)                  ...............................................................     Not Applicable
315(a)                  ...............................................................             7.1(2)
   (b)                  ...............................................................           7.5,11.2
   (c)                  ...............................................................             7.1(1)
   (d)                  ...............................................................             7.1(3)
   (e)                  ...............................................................               6.11
316(a)(last sentence)   ...............................................................                2.8
   (a)(1)(A)            ...............................................................                6.5
   (a)(1)(B)            ...............................................................                6.4
   (a)(2)               ...............................................................     Not Applicable
   (b)                  ...............................................................                6.7
   (c)                  ...............................................................                9.4
317(a)(1)               ...............................................................                6.8
   (a)(2 )              ...............................................................                6.9
   (b)                  ...............................................................                2.4
318(a)                  ...............................................................               11.1
</TABLE>



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

*This Cross-Reference Table is not part of the Indenture.

**  Included pursuant to Section 318(c) of the Trust Indenture Act of 1939.

<PAGE>




                                            TABLE OF CONTENTS
<TABLE>
<CAPTION>

                                                                                                      Page

<S>      <C>                                                                                    <C>      <C>
ARTICLE 1. DEFINITIONS AND INCORPORATION  BY REFERENCE...................................................1
         SECTION 1.1   DEFINITIONS...............................................................1
         SECTION 1.2   OTHER DEFINITIONS.........................................................12
         SECTION 1.3   INCORPORATION BY REFERENCE OF TRUST INDENTURE ACT.........................12
         SECTION 1.4   RULES OF CONSTRUCTION.....................................................12

ARTICLE 2. THE SECURITIES...............................................................................13

         SECTION 2.1   FORM AND DATING...........................................................13
         SECTION 2.2   EXECUTION AND AUTHENTICATION..............................................13
         SECTION 2.3   REGISTRAR AND PAYING AGENT................................................14
         SECTION 2.4   PAYING AGENT TO HOLD MONEY IN TRUST.......................................14
         SECTION 2.5   REGISTRATION OF TRANSFER AND EXCHANGE.....................................14
         SECTION 2.6   REPLACEMENT SECURITIES....................................................18
         SECTION 2.7   OUTSTANDING SECURITIES....................................................18
         SECTION 2.8   TREASURY SECURITIES.......................................................19
         SECTION 2.9   TEMPORARY SECURITIES......................................................19
         SECTION 2.10  CANCELLATION..............................................................19
         SECTION 2.11  DEFAULTED INTEREST........................................................19
         SECTION 2.12  SECURITIES ISSUABLE IN THE FORM OF A GLOBAL SECURITY......................19

ARTICLE 3. OPTIONAL REDEMPTION AND ASSET SALE OFFER.....................................................21

         SECTION 3.1   NOTICES TO TRUSTEE........................................................21
         SECTION 3.2   SELECTION OF SECURITIES TO BE REDEEMED OR PURCHASED.......................21
         SECTION 3.3   NOTICES TO HOLDERS........................................................22
         SECTION 3.4   EFFECT OF NOTICE OF REDEMPTION............................................23
         SECTION 3.5   DEPOSIT OF REDEMPTION PRICE OR PURCHASE PRICE.............................23
         SECTION 3.6   SECURITIES REDEEMED OR PURCHASED IN PART..................................23
         SECTION 3.7   OPTIONAL REDEMPTION.......................................................23
         SECTION 3.8   ASSET SALE OFFER..........................................................24

ARTICLE 4. COVENANTS....................................................................................25

         SECTION 4.1   PAYMENT OF SECURITIES.....................................................25
         SECTION 4.2   MAINTENANCE OF OFFICE OR AGENCY...........................................25
         SECTION 4.3   SEC REPORTS...............................................................25
         SECTION 4.4   COMPLIANCE CERTIFICATE....................................................26
         SECTION 4.5   CORPORATE EXISTENCE, TAXES, ETC...........................................26
         SECTION 4.6   STAY, EXTENSION AND USURY LAWS............................................27
         SECTION 4.7   LIMITATIONS ON RESTRICTED PAYMENTS........................................27
         SECTION 4.8   LIMITATIONS ON RESTRICTIONS ON DISTRIBUTIONS FROM SUBSIDIARIES............27
         SECTION 4.9   LIMITATIONS ON ADDITIONAL INDEBTEDNESS....................................28
         SECTION 4.10  CHANGE IN CONTROL.........................................................29
         SECTION 4.11  LIMITATIONS ON ASSET SALES................................................30
         SECTION 4.12  LIMITATIONS ON TRANSACTIONS WITH AFFILIATES...............................31
         SECTION 4.13  LIMITATIONS ON LIENS......................................................31
         SECTION 4.14  LIMITATIONS ON SUBSIDIARY PREFERRED STOCK.................................31
         SECTION 4.15  LIMITATIONS ON CERTAIN OTHER SUBORDINATED INDEBTEDNESS....................32
         SECTION 4.16  LIMITATIONS ON SUBSIDIARIES AND UNRESTRICTED SUBSIDIARIES.................32

ARTICLE 5. SUCCESSORS...................................................................................33

         SECTION 5.1   LIMITATIONS ON MERGERS AND CONSOLIDATIONS.................................33
</TABLE>

                                       i
<PAGE>
<TABLE>

<S>      <C>                                                                                     <C>    <C>
         SECTION 5.2   SUCCESSOR CORPORATION SUBSTITUTED.........................................33

ARTICLE 6. DEFAULTS AND REMEDIES........................................................................33

         SECTION 6.1   EVENTS OF DEFAULT.........................................................33
         SECTION 6.2   ACCELERATION..............................................................35
         SECTION 6.3   OTHER REMEDIES............................................................35
         SECTION 6.4   WAIVER OF PAST DEFAULTS...................................................35
         SECTION 6.5   CONTROL BY MAJORITY.......................................................35
         SECTION 6.6   LIMITATIONS ON SUITS......................................................36
         SECTION 6.7   RIGHTS OF HOLDERS TO RECEIVE PAYMENT......................................36
         SECTION 6.8   COLLECTION SUIT BY TRUSTEE................................................36
         SECTION 6.9   TRUSTEE MAY FILE PROOFS OF CLAIM..........................................36
         SECTION 6.10  PRIORITIES................................................................37
         SECTION 6.11  UNDERTAKING FOR COSTS.....................................................37

ARTICLE 7. TRUSTEE......................................................................................37

         SECTION 7.1   DUTIES OF TRUSTEE.........................................................37
         SECTION 7.2   RIGHTS OF TRUSTEE.........................................................38
         SECTION 7.3   INDIVIDUAL RIGHTS OF TRUSTEE..............................................38
         SECTION 7.4   TRUSTEE'S DISCLAIMER......................................................39
         SECTION 7.5   NOTICE OF DEFAULTS........................................................39
         SECTION 7.6   COMPENSATION AND INDEMNITY................................................39
         SECTION 7.7   REPLACEMENT OF TRUSTEE....................................................40
         SECTION 7.8   SUCCESSOR TRUSTEE BY MERGER, ETC..........................................40
         SECTION 7.9   ELIGIBILITY; DISQUALIFICATION.............................................40

ARTICLE 8. DISCHARGE OF INDENTURE.......................................................................41

         SECTION 8.1   TERMINATION OF COMPANY'S OBLIGATIONS......................................41
         SECTION 8.2   APPLICATION OF TRUST MONEY................................................43
         SECTION 8.3   REPAYMENT TO THE COMPANY..................................................43
         SECTION 8.4   REINSTATEMENT.............................................................43

ARTICLE 9. AMENDMENTS...................................................................................43

         SECTION 9.1   WITHOUT CONSENT OF HOLDERS................................................43
         SECTION 9.2   WITH CONSENT OF HOLDERS...................................................44
         SECTION 9.3   COMPLIANCE WITH TRUST INDENTURE ACT.......................................45
         SECTION 9.4   REVOCATION AND EFFECT OF CONSENTS.........................................45
         SECTION 9.5   NOTATION ON OR EXCHANGE OF SECURITIES.....................................46
         SECTION 9.6   TRUSTEE TO SIGN AMENDMENTS, ETC...........................................46

ARTICLE 10. SUBORDINATION...............................................................................46

         SECTION 10.1  SECURITIES SUBORDINATED TO SENIOR INDEBTEDNESS............................46
         SECTION 10.2  PAYMENT OVER OF PROCEEDS UPON DISSOLUTION, ETC............................46
         SECTION 10.3  PRIOR PAYMENT TO SENIOR INDEBTEDNESS UPON ACCELERATION OF SECURITIES......47
         SECTION 10.4  NO PAYMENT UPON CERTAIN DEFAULTS WITH RESPECT TO SENIOR INDEBTEDNESS.............48
         SECTION 10.5  PAYMENT PERMITTED IF NO DEFAULT...........................................49
         SECTION 10.6  SUBROGATION TO RIGHTS OF HOLDERS OF SENIOR INDEBTEDNESS...................49
         SECTION 10.7  PROVISIONS SOLELY TO DEFINE RELATIVE RIGHTS...............................49
         SECTION 10.8  APPLICATION BY TRUSTEE OF MONIES DEPOSITED WITH IT........................50
         SECTION 10.9  TRUSTEE TO EFFECTUATE SUBORDINATION.......................................50
         SECTION 10.10 NO WAIVER OF SUBORDINATION PROVISIONS.....................................50
         SECTION 10.11 NOTICE TO TRUSTEE.........................................................51
         SECTION 10.12 RELIANCE ON JUDICIAL ORDER OR CERTIFICATE OF LIQUIDATING AGENT............51
         SECTION 10.13 TRUSTEE NOT FIDUCIARY FOR HOLDERS OF SENIOR INDEBTEDNESS..................51
         SECTION 10.14 RIGHTS OF TRUSTEE AS HOLDER OF SENIOR INDEBTEDNESS; PRESERVATION OF
                       TRUSTEE'S RIGHTS..........................................................51
</TABLE>

                                       ii
<PAGE>

<TABLE>

<S>      <C>                                                                                    <C>      <C>
ARTICLE 11. MISCELLANEOUS...............................................................................52

         SECTION 11.1  TRUST INDENTURE ACT CONTROLS..............................................52
         SECTION 11.2  NOTICES...................................................................52
         SECTION 11.3  CERTIFICATE AND OPINION AS TO CONDITIONS PRECEDENT........................52
         SECTION 11.4  STATEMENTS REQUIRED IN CERTIFICATE OR OPINION.............................53
         SECTION 11.5  RULES BY TRUSTEE AND AGENTS...............................................53
         SECTION 11.6  LEGAL HOLIDAYS............................................................53
         SECTION 11.7  NO RECOURSE AGAINST OTHERS................................................53
         SECTION 11.8  GOVERNING LAW.............................................................53
         SECTION 11.9  NO ADVERSE INTERPRETATION OF OTHER AGREEMENTS.............................53
         SECTION 11.10 SUCCESSORS................................................................54
         SECTION 11.11 SEVERABILITY..............................................................54
         SECTION 11.12 COUNTERPART ORIGINALS.....................................................54
         SECTION 11.13 TRUSTEE AS PAYING AGENT AND REGISTRAR.....................................54
         SECTION 11.14 TABLE OF CONTENTS, HEADINGS, ETC..........................................54


</TABLE>







                                      iii
<PAGE>


EXHIBIT A     FORM OF RULE 144A NOTE
EXHIBIT B     FORM OF EXCHANGE NOTE
EXHIBIT C     TRANSFER CERTIFICATION














                                       iv
<PAGE>

             INDENTURE dated as of September 11, 1997, between INTEGRATED HEALTH
SERVICES, INC., a Delaware corporation (the "Company"), and FIRST UNION NATIONAL
BANK,  a national  banking  association  organized  under the laws of the United
States, as Trustee (the "Trustee").

             Each party  agrees as follows for the benefit of the other  parties
and for the equal and ratable  benefit of the Holders of the Rule 144A Notes and
the Exchange Notes (each as defined below):

                                   ARTICLE 1.

                          DEFINITIONS AND INCORPORATION
                                  BY REFERENCE

SECTION 1.1 DEFINITIONS

             "Acquired  Indebtedness"  means  (a)  with  respect  to any  Person
(including an Unrestricted  Subsidiary) that becomes a Subsidiary of the Company
after the date hereof, Indebtedness of such Person and its Subsidiaries existing
at the time  such  Person  becomes  a  Subsidiary  of the  Company  that was not
incurred in connection  with,  or in  contemplation  of, such Person  becoming a
Subsidiary  of the  Company  and (b) with  respect to the  Company or any of its
Subsidiaries, any Indebtedness assumed by the Company or any of its Subsidiaries
in connection  with the acquisition of an asset from another Person that was not
incurred by such other Person in connection with, or in  contemplation  of, such
acquisition.  Acquired  Indebtedness  shall be deemed to be incurred on the date
such person becomes a Subsidiary or the date of the related asset acquisition.

             "Affiliate" of any specified Person means any other Person directly
or  indirectly  controlling,  controlled  by or under direct or indirect  common
control with such specified Person.  For purposes of this definition,  "control"
when used with  respect to any  specified  Person  means the power to direct the
management and policies of such Person, directly or indirectly,  whether through
the  ownership of voting  securities,  by contract or  otherwise,  and the terms
"controlling" and "controlled" have meanings correlative to the foregoing.

             "Agent" means any Registrar or Paying Agent.

             "Allowed and  Disallowed  Post-Commencement  Interest and Expenses"
means all interest, at the rate provided in the applicable document or documents
(including  any rate  applicable  upon any default or event of  default,  to the
extent lawful), and all reimbursements,  costs, expenses and indemnities, to the
extent provided in the applicable document or documents,  accruing or claimed at
any time after  commencement of any insolvency or bankruptcy case or proceeding,
or any  receivership,  liquidation,  reorganization,  dissolution,  winding  up,
assignment for the benefit of creditors,  marshalling of assets and  liabilities
or  other   similar  case  or   proceeding,   whether  or  not  such   interest,
reimbursement,  cost or expense  is an allowed  claim  enforceable  against  the
Company in a case or proceeding  under  Bankruptcy Law or in any other such case
or proceeding.

             "Asset Sale" for any Person means the sale,  lease,  conveyance  or
other disposition  (including,  without limitation,  by merger or consolidation,
and whether by operation of law or  otherwise)  of any of that  Person's  assets
(including,  without limitation,  the sale or other disposition of Capital Stock
of any Subsidiary of such Person, whether by such Person or by such Subsidiary),
whether owned on the date hereof or subsequently acquired, in one transaction or
a series of related  transactions,  in which such Person and/or its Subsidiaries
sell, lease,  convey or otherwise dispose of (i) all or substantially all of the
Capital Stock of any of such Person's Subsidiaries, (ii) assets which constitute
substantially  all of an operating unit or business of such Person or any of its
Subsidiaries,  or (iii) any health care facility;  provided,  however,  that the
following  shall not  constitute  Asset Sales:  (i) a  transaction  or series of
related  transactions  that  results in a Change in Control,  (ii)  transactions
between  the  Company  and any of its Wholly  Owned  Subsidiaries  or among such
Wholly  Owned  Subsidiaries  or  (iii) a  transaction  or a  series  of  related
transactions in which either (x) the fair market value of the asset(s)  disposed
of does not exceed 2.5% of the  Consolidated  Tangible  Assets of the Company

<PAGE>

or (y) the Consolidated EBITDA of the company associated with the asset disposed
of does not exceed 2.5% of the Consolidated EBITDA of the Company.

             "Attributable Indebtedness," when used with respect to any Sale and
Leaseback  Transaction  or an  operating  lease with  respect  to a health  care
facility means, as at the time of  determination,  the present value (discounted
at a rate equivalent to the interest rate implicit in the lease, compounded on a
semi-annual  basis) of the total  obligations of the lessee for rental payments,
after  excluding all amounts  required to be paid on account of maintenance  and
repairs,  insurance,  taxes, utilities and other similar expenses payable by the
lessee  pursuant  to the terms of the lease,  during the  remaining  term of the
lease  included in any such Sale and  Leaseback  Transaction  or such  operating
lease or until the earliest  date on which the lessee may  terminate  such lease
without  penalty or upon payment of a penalty (in which case the rental payments
shall include such penalty);  provided, that the Attributable  Indebtedness with
respect  to a Sale and  Leaseback  Transaction  shall  be no less  than the fair
market value of the property subject to such Sale and Leaseback Transaction.

             "Bank Agent" means Citibank,  N.A., as  Administrative  Agent under
the Credit Agreement or any successor Administrative Agent thereunder.

             "Bank  Debt"  means  all   obligations   of  the  Company  and  its
Subsidiaries,  now or hereafter existing under the Credit Agreement, whether for
principal,  interest,  reimbursement  of amounts  drawn under  letters of credit
issued  pursuant  thereto,   guarantees  in  respect  thereof,  fees,  expenses,
premiums,  indemnities or otherwise,  including such obligations incurred by the
Company or its  Subsidiaries  in  connection  with any  extension,  refunding or
refinancing of the Credit Agreement.

             "Bankruptcy  Law" means Title 11, U.S. Code or any similar  federal
or state law for the relief of debtors.

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

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

             "Capital  Stock" of any Person means any and all shares,  rights to
purchase,   warrants  or  options   (whether  or  not  currently   exercisable),
participation or other  equivalents of or interests in (however  designated) the
equity  (including,  without  limitation,  common  stock,  preferred  stock  and
partnership and joint venture interests) of such Person.  Solely for purposes of
clause  (ii)(2) of Section 4.7  hereof,  "the  Company's  Capital  Stock"  shall
include  Capital  Stock (other than  Disqualified  Stock) issued by a subsidiary
trust of the Company which is not conducting business operations, provided, that
the  calculation  pursuant  to clause  (ii)(2) of Section  4.7 hereof  shall not
include (i) the subsequent  issuance of Capital Stock of the Company in exchange
for or upon  conversion  of such  subsidiary  trust's  Capital Stock or (ii) any
proceeds received by the subsidiary trust from the sale of Capital Stock by such
trust to the Company or any Subsidiary or Affiliate of the Company, and provided
further that to the extent the subsidiary trust uses the proceeds of its sale of
Capital  Stock to  purchase  debt  securities  of the  Company,  (i)  such  debt
securities  are  subordinated  in right of  payment to the  Securities  and (ii)
distributions  on the Capital Stock of the subsidiary  trust may be suspended at
the option of the Company or the subsidiary  trust for a period  extending up to
the lesser of five years or the maturity of the underlying  debt security of the
Company issued to the subsidiary trust.

             "Capitalized  Lease  Obligation" of any Person means the obligation
of such Person to pay rent or other amounts under a lease that is required to be
capitalized  for financial  reporting  purposes in accordance with GAAP, and the
amount of such obligation shall be the capitalized  amount thereof determined in
accordance with GAAP.

             "Cash  Equivalents"  means,  at  any  time,  (i)  any  evidence  of
Indebtedness  with a maturity of 180 days or less  issued or directly  and fully
guaranteed  or  insured  by the  United  States  of  America  or any  agency  or
instrumentality  thereof  (provided that the full faith and credit of the United
States of America is pledged in


                                       2
<PAGE>

support thereof);  (ii) certificates of deposit or acceptance with a maturity of
180 days or less of any  financial  institution  that is a member of the Federal
Reserve System having combined capital and surplus and undivided  profits of not
less than $500.0 million or (iii) commercial  paper,  maturing not more than 180
days after the date of  acquisition,  issued by any  corporation  (other than an
Affiliate or Subsidiary of the Company) organized and existing under the laws of
the  United  States  of  America  with a  rating,  at the time as of  which  any
investment  therein is made, of "P-1" (or higher)  according to Moody's Investor
Service,  Inc. or any successor rating agency, or "A-1" (or higher) according to
Standard and Poor's Corporation or any successor rating agency.

             "Change  in  Control"  means  any  of  the  following:  (i)  all or
substantially all of the Company's assets are sold, leased, conveyed or disposed
of as an  entirety or  substantially  as an  entirety,  to any Person or related
"group" of Persons (other than a Permitted  Holder);  (ii)  stockholders  of the
Company shall approve any plan or proposal for the liquidation or dissolution of
the Company; (iii) there shall be consummated any consolidation or merger of the
Company (A) in which the Company is not the continuing or surviving  corporation
(other than a  consolidation  or merger with a Wholly  Owned  Subsidiary  of the
Company in which all shares of Common Stock outstanding immediately prior to the
effectiveness  thereof are changed into or exchanged for the same consideration)
or (B)  pursuant  to which  the  Common  Stock  would be  converted  into  cash,
securities or other property,  in each case other than a consolidation or merger
of the Company in which the holders of the Common Stock immediately prior to the
consolidation or merger have, directly or indirectly, at least a majority of the
common stock of the continuing or surviving  corporation  immediately after such
consolidation  or merger;  or (iv) any Person,  or any Persons  acting  together
which would  constitute a "group" for purposes of Section  13(d) of the Exchange
Act (other than a Permitted Holder),  together with any affiliates thereof shall
beneficially  own (as defined in Rule 13d-3 under the Exchange Act) at least 50%
of the  total  voting  power of all  classes  of  capital  stock of the  Company
entitled to vote generally in the election of directors of the Company.

             "Common  Equity"  of any  Person  means all  Capital  Stock of such
Person that is  generally  entitled to (i) vote in the  election of directors of
such  Person or (ii) if such  Person  is not a  corporation,  vote or  otherwise
participate in the selection of the governing body, partners, managers or others
that will control the management and policies of such Person.

             "Company" means (i) Integrated  Health  Services,  Inc., a Delaware
corporation, and (ii) any successor of Integrated Health Services, Inc.

             "Consolidated  Amortization  Expense"  of any Person for any period
means the  amortization  expense of such  Person and its  Subsidiaries  for such
period (to the extent included in the computation of Consolidated  Net Income of
such Person), determined on a consolidated basis in accordance with GAAP.

             "Consolidated Coverage Ratio" with respect to the Company means the
ratio of (i) Consolidated  EBITDA of the Company to (ii) the aggregate amount of
Consolidated  Interest  Expense of the Company for the four full fiscal quarters
immediately  preceding  the date of the  transaction  giving rise to the need to
calculate the Consolidated Coverage Ratio and for which such quarters' financial
results have been reported;  provided,  however,  that if any calculation of the
Company's  Consolidated  Coverage Ratio requires the use of any quarter prior to
the date of the Indenture,  such calculation shall be made on a pro forma basis,
giving effect to the issuance of the  Securities and the use of the net proceeds
therefrom  as if the same had  occurred  at the  beginning  of the  four-quarter
period used to make such  calculation;  and  provided  further that if any Asset
Sale was  consummated  or any  acquisition  of a  hospital  or other  healthcare
facility or any assets  purchased  outside the  ordinary  course of business was
effected by the  Company or any of its  Subsidiaries  during  such four  quarter
period or on any later  date on or prior to the date of the  transaction  giving
rise to the need to calculate the Consolidated  Coverage Ratio, such calculation
shall be made on a pro forma  basis,  giving  effect to each such  Asset Sale or
acquisition  (including  the  Consolidated  EBITDA  relating  to  the  hospital,
healthcare  facility or other assets acquired),  as the case may be, and the use
of any proceeds  therefrom,  as if the same had occurred at the beginning of the
four-quarter   period  used  to  make  such  calculation  (except  that  if  any
calculation of the  Consolidated  Coverage Ratio requires the use of any quarter
prior to the acquisition of First American Health Care of Georgia,  Inc. ("First
American"), then the results of operations for First American

                                       3
<PAGE>

shall be reflected in such calculation from the date of the acquisition of First
American (on an  annualized  basis for the four  quarter  period  following  the
acquisition)  and pro  forma  effect  shall  not be  given  to such  results  of
operations (but shall be given effect to any financing, including the incurrence
of Indebtedness,  in connection with such  acquisition) as if it had occurred at
the beginning of the  four-quarter  period used to make such  calculation).  The
calculation of the Consolidated  Coverage Ratio shall also give pro forma effect
to (i) the incurrence,  repayment or retirement of any other  Indebtedness,  and
the  issuance  or  redemption  of any  Preferred  Stock,  by the Company and its
Subsidiaries  and (ii) the  discontinuance  of any operations by the Company and
its  Subsidiaries,  in any case occurring  during such four quarter period or on
any later  date on or prior to the date of the  transaction  giving  rise to the
need to calculate the  Consolidated  Coverage Ratio as if such  Indebtedness was
incurred,  repaid or retired or such  Preferred  Stock was issued or redeemed at
the  beginning of such  four-quarter  period.  For purposes of  calculating  the
Consolidated  Coverage Ratio, (i) the Consolidated Interest Expense attributable
to interest on any Indebtedness  computed on a pro forma basis and (A) bearing a
floating  interest  rate  shall be  computed  as if the  average  rate  over the
applicable  period had been the  applicable  rate for the entire  period and (B)
which was not  outstanding  during the period for which the computation is being
made but which bears, at the option of the Company,  a fixed or floating rate of
interest,  shall be computed by applying at the option of the Company either the
fixed or floating  rate and (ii) in making such  calculation,  the  Consolidated
Interest  Expense of the Company  attributable  to interest on any  Indebtedness
under a  revolving  credit  facility  computed  on a pro  forma  basis  shall be
computed  based upon the average daily balance of such  Indebtedness  during the
applicable period.

             "Consolidated  Depreciation  Expense"  of any Person for any period
means the  depreciation  expense of such  Person and its  Subsidiaries  for such
period (to the extent included in the computation of Consolidated  Net Income of
such Person), determined on a consolidated basis in accordance with GAAP.

             "Consolidated  EBITDA" of any  Person  means,  with  respect to any
determination  date,  Consolidated Net Income,  plus (i) Consolidated Income Tax
Expense,  plus (ii) Consolidated  Depreciation  Expense, plus (iii) Consolidated
Amortization  Expense,  plus (iv)  Consolidated  Interest Expense (to the extent
reducing  Consolidated  Net Income),  plus (v) all other non-cash items reducing
Consolidated  Net Income of such Person and its  Subsidiaries,  determined  on a
consolidated  basis  in  accordance  with  GAAP,  and less  all  non-cash  items
increasing  Consolidated  Net  Income  of  such  Person  and  its  Subsidiaries,
determined on a  consolidated  basis in accordance  with GAAP, in each case, for
such Person's prior four full fiscal quarters for which  financial  results have
been reported immediately preceding the determination date.

             "Consolidated  Income Tax  Expense"  means,  for any Person for any
period,  the  provision for taxes based on income and profits of such Person and
its Subsidiaries to the extent such income or profits were included in computing
Consolidated Net Income of such Person for such period.

             "Consolidated  Interest Expense" of any Person for any period means
the  Interest  Expense of such  Person  and its  Subsidiaries  for such  period,
determined on a consolidated  basis in accordance  with GAAP, plus any dividends
accrued for such period on any Preferred Stock of any Subsidiary not held by the
Company or any Wholly Owned Subsidiary of the Company.

             "Consolidated  Net  Income" of any Person for any period  means the
net  income  (or  loss) of such  Person  and its  Subsidiaries  for such  period
determined on a  consolidated  basis in  accordance  with GAAP,  without  giving
effect to dividends on any series of preferred  stock of any  Subsidiary of such
Person,  whether or not in cash, to the extent such  consolidated net income was
reduced thereby;  provided that there shall be excluded from such net income (to
the extent otherwise included therein), without duplication:  (i) the net income
(or loss) of any Person  (other than a  Subsidiary  of the  referent  Person) in
which any Person  other than the  referent  Person  has an  ownership  interest,
except to the extent  that any such  income has  actually  been  received by the
referent  Person or any of its  Subsidiaries in the form of dividends or similar
distributions  during such period;  (ii) except to the extent  includible in the
consolidated  net income of the referent Person pursuant to the foregoing clause
(i), the net income (or loss) of any Person that accrued  prior to the date that
(a) such Person becomes a Subsidiary of the referent Person or is merged into or
consolidated  with the  referent  Person or any of its  Subsidiaries  or (b) the
assets  of  such  Person  are  acquired  by the  referent  Person  or any of its
Subsidiaries;  (iii) the net income of any  Subsidiary  of the  referent  Person
(other than a Wholly


                                        4
<PAGE>

Owned  Subsidiary) to the extent that the declaration or payment of dividends or
similar  distributions  by such  Subsidiary  of that income is not  permitted by
operation of the terms of its charter or any  agreement,  instrument,  judgment,
decree,  order,  statute,  rule or  governmental  regulation  applicable to that
Subsidiary during such period;  (iv) any gain or loss, together with any related
provisions  for taxes on any such gain or loss,  realized  during such period by
the referent Person or any of its  Subsidiaries  upon (a) the acquisition of any
securities, or the extinguishment of any Indebtedness, of the referent Person or
any of its  Subsidiaries  or (b) any Asset Sale by the referent Person or any of
its Subsidiaries;  (v) any extraordinary gain or loss, together with any related
provision  for taxes on any such  extraordinary  gain or loss,  realized  by the
referent Person or any of its Subsidiaries  during such period; (vi) any unusual
or  nonrecurring   non-cash  charge  which  is  not,  under  generally  accepted
accounting  principles,  an  extraordinary  item;  and  (vii)  in the  case of a
successor to such Person by consolidation, merger or transfer of its assets, any
earnings of the  successor  prior to such merger,  consolidation  or transfer of
assets. For purposes of calculating the Consolidated Coverage Ratio, any unusual
or  non-recurring  charge shall be excluded from the calculation of Consolidated
Net Income.

             "Consolidated  Net  Worth" of any  Person as of any date  means the
stockholders' equity (including any preferred stock that is classified as equity
under GAAP, other than  Disqualified  Stock) of such Person and its Subsidiaries
(excluding any equity adjustment for foreign currency translation for any period
subsequent to the date of this Indenture) on a consolidated  basis at such date,
as determined in accordance with GAAP, less all write-ups  (other than write-ups
in connection with acquisitions) subsequent to the date of this Indenture in the
book value of any asset owned by such Person or any of its Subsidiaries.

             "Consolidated  Tangible  Assets" of any Person as of any date means
the total assets of such Person and its Subsidiaries  (excluding any assets that
would be classified as "intangible  assets" under GAAP) on a consolidated  basis
at such date, as determined in accordance with GAAP,  less all write-ups  (other
than write-ups in connection with  acquisitions)  subsequent to the date of this
Indenture  in the book value of any asset  (except any such  intangible  assets)
owned by such Person or any of its Subsidiaries.

             "Corporate  Trust Office of the Trustee" shall be at the address of
the Trustee  specified in Section 11.2 or such other  address as the Trustee may
give notice to the Company.

             "Credit Agreement" means the Revolving Credit Agreement,  dated May
15,  1996,  among  the  Company,   the  Bank  Agent,  and  the  other  financial
institutions  signatory  thereto,  together with the related documents  thereto,
including,  without  limitation,  any  security  documents  and all exhibits and
schedules  thereto,  and any agreement or agreements  relating to any extension,
refunding,  refinancing,  successor or replacement facility, whether or not with
the same lenders,  and whether or not the principal  amount or amount of letters
of credit outstanding thereunder or the interest rate payable in respect thereof
shall be thereby  increased,  in each case as amended and in effect from time to
time.

             "Credit  Facility"  means  the  Credit  Agreement  and  one or more
borrowing  arrangements to be entered into by and between the Company and/or one
or more of its Subsidiaries and a commercial bank or other institutional lender,
including any related  notes,  security  documentation,  guarantees,  collateral
documents,  instruments and agreements executed in connection therewith, in each
case  as  amended,  modified,  supplemented,  restructured,  renewed,  restated,
refunded,  replaced or  refinanced  or extended from time to time on one or more
occasions.

             "Default"  means  any  event,  act or  condition  that is, or after
notice or the passage of time or both would be, an Event of Default.

             "Definitive  Securities"  means any Securities  other than a Global
Security.

             "Depositary"  means, with respect to Securities  issuable or issued
in whole or in part in global form hereunder,  unless otherwise specified by the
Company  pursuant to Section 2.12, The Depository  Trust Company,  New York, New
York,  or any  successor  thereto  registered  as a  clearing  agency  under the
Exchange Act or other applicable statute or regulation.


                                       5
<PAGE>

             "Disqualified Stock" means any Capital Stock that, by its terms (or
by the terms of any  security  into which it is  convertible  or for which it is
exchangeable),  or upon the  happening of any event,  matures or is  mandatorily
redeemable, pursuant to a sinking fund obligation or otherwise, or is redeemable
at the option of the  holder  thereof,  in whole or in part,  on or prior to the
final maturity date of the  Securities  for cash or debt  securities at any time
prior to any such final maturity,  or is convertible  into or  exchangeable  for
debt securities at any time prior to any such final maturity.

             "Eligible  Investments"  of any Person  means  Investments  of such
Person in (i)  securities  issued or fully  guaranteed  or insured by the United
States  Government or any agency thereof and backed by the full faith and credit
of the  United  States  maturing  not  more  than  one  year  from  the  date of
acquisition;  (ii)  certificates  of deposit,  time  deposits,  Eurodollar  time
deposits,  bankers'  acceptances  or  deposit  accounts  having  in each  case a
remaining term to maturity of not more than one year, which are either (a) fully
insured by the Federal Deposit Insurance Corporation or (b) issued by any lender
or by any  commercial  bank under the laws of any State or any national  banking
association that has combined capital and surplus of not less than  $500,000,000
and whose short-term securities are rated at least A-1 by S&P or P-1 by Moody's;
(iii)  commercial  paper  that is rated at least  A-1 by S&P or P-1 by  Moody's,
issued by a company that is incorporated  under the laws of the United States or
of any State and directly issues its own commercial  paper,  and has a remaining
term to maturity of not more than one year; (iv) a repurchase agreement with (A)
any  commercial  bank  that is  organized  under  the  laws of any  State or any
national banking association and that has total assets of at least $500,000,000,
or (B) any  investment  bank that is  organized  under the laws of any state and
that has total assets of at least  $500,000,000,  which  agreement is secured by
any one or more of the securities and obligations described in clauses (i), (ii)
or (iii) of this definition of Eligible  Investments,  which shall have a market
value (exclusive of accrued interest and valued at least monthly) at least equal
to the  principal  amount  of such  investment;  (v) any  money  market or other
investment fund the investments of which are limited to investments described in
clauses (i), (ii), (iii) and (iv) of this definition of Eligible Investments and
which is managed by (A) a commercial  bank that is  organized  under the laws of
any State or any national  banking  association  and that has total assets of at
least $500,000,000,  or (B) any investment bank that is organized under the laws
of  any  State  and  that  has  total  assets  of at  least  $500,000,000;  (vi)
obligations,  debentures,  notes, bonds or other evidences of indebtedness rated
at least A- by  Moody's  or A3 by S&P;  provided  that the  aggregate  amount of
investments by any Person  permitted under this clause (vi) shall not exceed 25%
of the total  amount  invested  by such Person in  eligible  investments;  (vii)
investments  in investment  grade  auction rate and  adjustable  rate  preferred
equities for issuers whose actual or implied  senior  long-term debt is rated at
least A- by Moody's or A3 by S&P; (viii)  investments in investment  grade fixed
rate  preferred  equities for issuers whose actual or implied  senior  long-term
debt is rated at least A- by Moody's or A3 by S&P;  provided  that the aggregate
amount of investments by any Person permitted under this clause (viii) shall not
exceed 10% of the total amount invested by such Person in Eligible  Investments;
(ix) adjustable rate  mortgage-backed  securities rated at least AA by S&P or Aa
by Moody's; and (x) fixed rate  mortgage-backed  securities rated at least AA by
S&P or Aa by Moody's,  provided that the aggregate  amount of investments by any
Person  permitted under this clause (x) shall not exceed 25% of the total amount
invested by such Person in Eligible Investments.

             "Equity  Interest" means,  with respect to any Person,  any and all
shares or other equivalents (however  designated) of capital stock,  partnership
interests or any other participation,  right or other interests in the nature of
an equity  interest  in such  Person or any  option,  warrant or other  security
convertible into or exchangeable for the foregoing.

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

             "Exchange Notes" means Notes having terms  substantially  identical
in all respects to the Rule 144A Notes for which they are to be exchanged in the
Exchange  Offer,  except that (i) the Exchange  Notes will have been  registered
under the Securities Act and,  therefore,  will not bear legends restricting the
transfer  thereof,  and (ii)  Holders of Exchange  Notes will not be entitled to
certain  rights of  holders  of Rule 144A Notes  under the  Registration  Rights
Agreement.


                                       6
<PAGE>

             "Exchange Offer" means the offer the Company is to make pursuant to
the  Registration  Rights  Agreement  to exchange  Rule 144A Notes for  Exchange
Notes.

             "Existing  Indebtedness"  means  all  of  the  Indebtedness  of the
Company and its Subsidiaries that is outstanding on the date hereof.

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

             "Global Security" means a Security which is executed by the Company
and  authenticated and delivered by the Trustee to the Depositary or pursuant to
the Depositary's instruction, all in accordance with this Indenture and pursuant
to a written order of the Company,  which shall be registered in the name of the
Depositary or its nominee and which shall represent, and shall be denominated in
an amount equal to the aggregate  principal  amount of, all of the Securities or
any  portion  thereof,  but not  including  any  Securities  that are no  longer
outstanding,  and having the same terms, including, without limitation, the same
original  issue  date,  date or  dates on which  principal  is due,  and rate of
interest.

             "Guarantee"  by any  Person  means any  obligation,  contingent  or
otherwise,  of such Person directly or indirectly  guaranteeing any Indebtedness
or other  obligation of any other Person and, without limiting the generality of
the foregoing, any obligation,  direct or indirect,  contingent or otherwise, of
such Person (i) to purchase or pay (or advance or supply  funds for the purchase
or payment  of) such  Indebtedness  or other  obligation  of such  other  Person
(whether  arising  by  virtue  of  partnership  arrangements,  by  agreement  to
keepwell, to purchase assets, goods, securities or services, to take-or-pay,  or
to maintain  financial  statement  conditions or otherwise) or (ii) entered into
for the purpose of assuring in any other manner the obligee of such Indebtedness
or other  obligation of the payment  thereof or to protect such obligee  against
loss in respect thereof (in whole or in part);  provided that the term Guarantee
shall not include  endorsements for collection or deposit in the ordinary course
of business. The term "Guarantee" used as a verb has a corresponding meaning.

             "Hedging  Obligations"  of any Person means the obligations of such
Person pursuant to any interest rate swap agreement,  foreign currency  exchange
agreement,  interest rate collar agreement,  option or futures contract or other
similar agreement or arrangement  relating to interest rates or foreign exchange
rates.

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

             "Indebtedness"   of  any   Person  at  any  date   means,   without
duplication:  (i) all Bank Debt; (ii) all other  indebtedness of such Person for
borrowed  money  (whether  or not  recourse of the lender is to the whole of the
assets of such Person or only to a portion  thereof);  (iii) all  obligations of
such Person evidenced by bonds, debentures,  notes or other similar instruments;
(iv) all  obligations  of such  Person in  respect of letters of credit or other
similar instruments (or reimbursement obligations with respect thereto); (v) all
obligations of such Person with respect to Hedging Obligations (other than those
that fix the interest rate on variable rate indebtedness  otherwise permitted by
this  Indenture  or that  protect the Company  and/or its  Subsidiaries  against
changes in foreign exchange  rates);  (vi) all obligations of such Person to pay
the deferred  and unpaid  purchase  price of property or services,  except trade
payables and accrued expenses incurred in the ordinary course of business; (vii)
all Capitalized  Lease  Obligations of such Person;  (viii) all  Indebtedness of
others  secured  by a Lien on any  asset  of such  Person,  whether  or not such
Indebtedness  is  assumed  by such  Person;  (ix)  all  Indebtedness  of  others
guaranteed  by  such  Person  to the  extent  of  such  guarantee;  and  (x) all
Attributable Indebtedness.  The amount of Indebtedness of any Person at any date
shall be the outstanding  balance at such date of all unconditional  obligations
as  described  above;  and in the case of  clauses  (iv) and (ix),  the  maximum
liability of such Person for any such  contingent  obligations at such date, and
in the case of clause (viii), the amount of the Indebtedness secured.


                                       7
<PAGE>

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

             "Interest Expense" of any Person for any period means the aggregate
amount of interest  which,  in accordance  with GAAP,  would be set opposite the
caption  "interest  expense" or any like caption on an income statement for such
Person (including, without limitation or duplication,  imputed interest included
in Capitalized Lease Obligations, all commissions,  discounts and other fees and
charges  owed  with  respect  to  letters  of  credit  and  bankers'  acceptance
financing,  the net costs associated with Hedging  Obligations,  amortization of
financing  fees and  expenses,  the  interest  portion of any  deferred  payment
obligation, amortization of discount and all other non-cash interest expense).

             "Interest  Payment  Date" shall have the  meaning  assigned to such
term in the Securities.

             "Investments"  of any  Person  means  (i) all  investments  by such
Person  in  any  other  Person  in  the  form  of  loans,  advances  or  capital
contributions (excluding commission, travel and similar advances to officers and
employees  made in the ordinary  course of  business),  (ii) all  guarantees  of
Indebtedness or other obligations of any other Person by such Person,  (iii) all
purchases  (or  other   acquisitions  for   consideration)  by  such  Person  of
Indebtedness, Capital Stock or other securities of any other Person and (iv) all
other  items  that  would  be  classified  as  investments  (including,  without
limitation,  purchases of assets  outside the ordinary  course of business) on a
balance sheet of such Person prepared in accordance with GAAP.

             "Lien"  means,  with  respect to any  asset,  any  mortgage,  lien,
pledge,  charge,  security interest or other similar  encumbrance of any kind in
respect of such asset,  whether or not filed,  recorded or  otherwise  perfected
under  applicable law (including,  without  limitation,  any conditional sale or
other title retention agreement,  any financing lease in the nature thereof, any
agreement  to sell,  and any  filing of, or  agreement  to give,  any  financing
statement  (other than notice filings not perfecting a security  interest) under
the Uniform Commercial Code (or equivalent statutes) of any jurisdiction).

             "Net  Proceeds"  with  respect to any Asset Sale means (i) cash (in
U.S. dollars or freely convertible into U.S. dollars) received by the Company or
any of its  Subsidiaries  from such Asset Sale (including,  without  limitation,
cash received as  consideration  for the assumption or incurrence of liabilities
incurred in connection with or in  anticipation  of such Asset Sale),  after (a)
provision for all income or other taxes measured by or resulting from such Asset
Sale or the transfer of the proceeds of such Asset Sale to the Company or any of
its Subsidiaries,  (b) payment of all brokerage commissions and the underwriting
and other fees and expenses  related to such Asset Sale and (c)  deduction of an
appropriate amount to be provided by the Company or any of its Subsidiaries as a
reserve,  in accordance with GAAP,  against any liabilities  associated with the
assets  sold or  otherwise  disposed  of in such Asset Sale and  retained by the
Company or any of its  Subsidiaries  after such Asset Sale  (including,  without
limitation,   pension  and  other   post-employment   benefit   liabilities  and
liabilities  related to  environmental  matters) or against any  indemnification
obligations  associated with the sale or other disposition of the assets sold or
otherwise  disposed  of in such Asset Sale and (ii) all  non-cash  consideration
received by the Company or any of its Subsidiaries from such Asset Sale upon the
liquidation or conversion of such consideration into cash.

             "Officer"  means the Chief Executive  Officer,  the Chief Financial
Officer, the Treasurer,  any Assistant Treasurer,  Controller,  Secretary or any
Vice President of the Company.

             "Officers' Certificate" means a certificate signed by two Officers,
one of whom must be the Company's  Chief  Executive  Officer or Chief  Financial
Officer.

             "Opinion of  Counsel"  means an opinion  from legal  counsel who is
acceptable to the Trustee in its sole discretion. The counsel may be an employee
of or counsel to the Company or the Trustee.

             "Payment or Distribution in Respect of the Securities"  means,  for
purposes  of Article  10 hereof,  any  payment  or  distribution  of any kind or
character, whether in cash, property or securities, on account of the payment of
the  principal  of and premium,  if any, and interest on any of the  Securities,
including,  without limitation,  any redemption or repurchase price paid for any
optional or mandatory redemption, Asset Sale


                                       8
<PAGE>

Offer,  Change in Control  Repurchase  or other  repurchase or retirement of the
Securities or any other payment on account of the Securities (including payments
with  respect to claims  related to the issuance of the  Securities);  provided,
however,  that the  exchange  of Rule 144A Notes for a like  amount of  Exchange
Notes  shall  not  constitute  a  Payment  or  Distribution  in  Respect  of the
Securities.  For  purposes  of this  definition,  the words  "cash,  property or
securities"  shall  not be  deemed  to  include  securities  of the  Company  as
reorganized or readjusted, or securities of the Company or any other corporation
provided for by a plan of reorganization or readjustment  which are subordinated
in right of payment  to all  Senior  Indebtedness  which may be  outstanding  to
substantially  the same extent as, or to a greater  extent than,  the Securities
are so  subordinated  as  provided  in Article 10 and which  securities  are not
subject to maturity or mandatory  prepayment prior to the maturity of any Senior
Indebtedness then outstanding.

             "Permitted Holder" means Robert N. Elkins and any group (within the
meaning  of  Section  13(d)(3)  of the  Exchange  Act) of which Mr.  Elkins is a
member;  so long as, with respect to any group, Mr. Elkins owns more than 20% of
the total voting power of all classes of Capital Stock of the  acquiring  entity
entitled to vote generally in the election of directors of the acquiring entity.

             "Permitted Investment" means (i) capital contributions, advances or
loans to the  Company  by any  Subsidiary,  by the  Company  to a  Wholly  Owned
Subsidiary or by a Subsidiary to a Wholly Owned Subsidiary; (ii) the acquisition
or holding by the Company or any Subsidiary of receivables  owing to the Company
or such  Subsidiary,  if created or acquired in the ordinary  course of business
and payable or dischargeable in accordance with customary trade terms; (iii) the
acquisition  or holding by the Company or any  Subsidiary  of cash and  Eligible
Investments;  (iv) the  Company and its  Subsidiaries  may make  Investments  in
Persons at least a majority of whose  revenues  result from  healthcare  related
businesses  or  facilities;  (v)  Investments  acquired or retained from another
Person  in  connection  with  any  sale,  conveyance,  transfer,  lease or other
disposition  of any  properties or assets to such Person in accordance  with the
covenant  described in Section 4.11 hereof;  and (vi)  Investments not otherwise
permitted by clauses (i) through (v) above in an aggregate  amount not exceeding
$10 million.

             "Person"  means  any  individual,  corporation,  limited  liability
company, partnership, joint venture, incorporated or unincorporated association,
joint-stock company, trust,  unincorporated  organization or government or other
agency or political subdivision thereof or other entity of any kind.

             "Preferred  Stock"  means with  respect  to any Person all  Capital
Stock of such Person which has a preference in liquidation or a preference  with
respect to the payment of dividends.

             "Public Equity  Offering" means a public offering by the Company of
shares of its common stock (however  designated and whether voting or non-voting
but excluding Disqualified Stock) and any and all rights, warrants or options to
acquire such common stock pursuant to a registration  statement registered under
the Securities Act.

             "Refinancing   Indebtedness"   means   Indebtedness  that  refunds,
refinances or extends any Existing Indebtedness or other Indebtedness  permitted
to be incurred under the Indenture (other than Existing  Indebtedness  under the
Credit  Agreement);  provided  that:  (i) the  Refinancing  Indebtedness  is the
obligation  of the  same  Person  as was  obligated  on the  Indebtedness  being
refinanced and has a ranking in priority  relative to the Securities equal to or
junior to that of the Indebtedness being refunded,  refinanced or extended; (ii)
the  Refinancing  Indebtedness  is  scheduled  to  mature  no  earlier  than the
Indebtedness  being  refunded,  refinanced  or extended;  (iii) the  Refinancing
Indebtedness  has  a  Weighted  Average  Life  to  Maturity  at  the  time  such
Refinancing  Indebtedness  is  incurred  that is  equal to or  greater  than the
Weighted  Average  Life to  Maturity of the  portion of the  Indebtedness  being
refunded,  refinanced or extended; (iv) the Refinancing  Indebtedness is secured
only to the extent,  if at all,  and by the assets that the  Indebtedness  being
refunded,   refinanced  or  extended  is  secured;   and  (v)  such  Refinancing
Indebtedness is in an aggregate  principal  amount that is equal to or less than
the aggregate  principal  amount then outstanding  under the Indebtedness  being
refunded,  refinanced  or extended  (except for issuance  costs and increases in
Attributable   Indebtedness  due  solely  to  increases  in  the  present  value
calculations  resulting  from  renewals  or  extensions  of  the  terms  of  the
underlying leases in effect on the date of this Indenture).


                                       9
<PAGE>

             "Registration  Rights  Agreement"  means  the  Registration  Rights
Agreement  dated as of  September  8, 1997 by and  between the Company and Smith
Barney Inc.,  Morgan Stanley & Co.  Incorporated,  Donaldson,  Lufkin & Jenrette
Securities Corporation and Citicorp Securities,  Inc., as Initial Purchasers, as
such agreement may be amended, modified or supplemented from time to time.

             "Restricted  Payment"  means,  with respect to any Person:  (i) the
declaration  of any dividend or the making of any other payment or  distribution
of cash,  securities  or other  property  or assets in respect of such  Person's
Capital  Stock  (except that a dividend  payable  solely in Capital Stock (other
than  Disqualified  Stock) of such  Person  shall not  constitute  a  Restricted
Payment); (ii) any payment on account of the purchase, redemption, retirement or
other acquisition for value of such Person's Capital Stock or options,  warrants
or other  rights  to  acquire  such  Capital  Stock,  or any  other  payment  or
distribution made in respect thereof,  either directly or indirectly;  (iii) the
making of any payment of  principal,  premium or interest  on, or any payment on
account of the purchase, redemption, retirement, defeasance or other acquisition
for value  (prior to any  scheduled  maturity,  scheduled  repayment,  scheduled
sinking fund payment or scheduled interest payment date) of, Indebtedness of the
Company or its Subsidiaries which is pari passu with or subordinated in right of
payment to the  Securities and has a scheduled  maturity date  subsequent to the
maturity of the  Securities;  or (iv) the making of any Investment in any Person
other  than a  Permitted  Investment;  provided,  however,  with  respect to the
Company  and its  Subsidiaries,  Restricted  Payments  shall not include (I) any
payment described (a) in clause (i), (ii) or (iii) above made (1) to the Company
or any of its Wholly Owned Subsidiaries by any of the Company's  Subsidiaries or
(2) by the  Company to any of its  Wholly  Owned  Subsidiaries  or (b) in clause
(iii)  above  made with the Net  Proceeds  from any Asset Sale  remaining  after
completion of the Asset Sale Offer made in connection  with such Asset Sale, all
as contemplated under Section 4.11 hereof,  (II) any payment described in clause
(i) above made by a  Subsidiary  that is not a Wholly  Owned  Subsidiary  to all
holders of  Capital  Stock of such  Subsidiary  on a pro rata basis or (III) the
purchase by the Company of up to an  aggregate  of $50 million of the  Company's
Capital Stock pursuant to one or more stock repurchase programs. Notwithstanding
the foregoing,  the following shall not constitute Restricted Payments:  (X) the
retirement,  repurchase,  redemption or other acquisition of Indebtedness of the
Company or any Subsidiary out of the net proceeds of a substantially  concurrent
sale (other than to a  Subsidiary  of the  Company) of new  Indebtedness  of the
Company;  provided (a) the principal  amount of such new  Indebtedness  does not
exceed the principal amount of Indebtedness so retired, repurchased, redeemed or
otherwise  acquired  (plus the  amount  of any  premium  required  to be paid in
connection with such retirement,  repurchase,  redemption or  acquisition),  (b)
such  Indebtedness has a ranking in priority relative to the Securities equal to
or junior to that of the  Indebtedness  so  retired,  repurchased,  redeemed  or
otherwise  acquired,  (c) such  Indebtedness has a Stated Maturity for its final
scheduled  principal  payment  later  than the  Stated  Maturity  for the  final
scheduled  principal  payment of the Securities and (d) such  Indebtedness has a
Weighted  Average  Life to  Maturity  equal to or  greater  than  the  remaining
Weighted  Average Life to Maturity of the  Securities;  and (Y) the  retirement,
repurchase,  redemption or other  acquisition of shares of the Company's Capital
Stock or  Indebtedness  of the Company or a Subsidiary of the Company out of the
proceeds of a  substantially  concurrent sale (other than to a Subsidiary of the
Company) of shares of the  Company's  Capital  Stock  (other  than  Disqualified
Stock);  provided,  however,  that the proceeds of such a sale of Capital  Stock
shall not be included in the calculation of aggregate net cash proceeds from the
issuance and sale of the Company's  Capital Stock  pursuant to clause (ii)(2) of
Section 4.7 hereof.

             "Rule 144 A Notes" means the  Company's 9 1/4% Senior  Subordinated
Notes due 2008, as initially issued under this Indenture.

             "Sale and Leaseback Transaction" means, with respect to any Person,
an arrangement with any bank,  insurance  company or other lender or investor or
to which such lender or investor is a party,  providing  for the leasing by such
Person or any of its Subsidiaries of any property or asset of such Person or any
of its  Subsidiaries  which  has been or is being  sold or  transferred  by such
Person or such  Subsidiary  to such  lender or investor or to any Person to whom
funds have been or are to be advanced by such lender or investor on the security
of such property or asset.

             "SEC" means the Securities and Exchange Commission.


                                       10
<PAGE>

             "Securities"  means the Rule 144A Notes and  Exchange  Notes issued
under this Indenture.

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

             "Senior  Indebtedness"  means the principal of and premium, if any,
and interest on and other amounts due on or in connection with any  Indebtedness
of  the  Company  permitted  under  Section  4.9  hereof   (including,   without
limitation,  all Allowed and Disallowed  Post-Commencement Interest and Expenses
in  respect  of such  Indebtedness)  and any  amounts  with  respect  to Hedging
Obligations that fix the interest rate on variable rate  indebtedness  otherwise
permitted by this Indenture,  other than the Securities,  the Company's  10-1/4%
Senior  Subordinated  Notes due 2006, the Company's  9-5/8% Senior  Subordinated
Notes due 2002,  Series A, the Company's 10-1/4% Senior  Subordinated  Notes due
2004,  the Company's  9-1/2% Senior  Subordinated  Notes due 2007, the Company's
5-3/4% Convertible Senior Subordinated  Debentures due 2001 and the Company's 6%
Convertible Subordinated Debentures due 2003, whether outstanding on the date of
this Indenture or thereafter created,  incurred or assumed,  unless, in the case
of any particular  Indebtedness,  the instrument creating or evidencing the same
or  pursuant  to which  the same is  outstanding  expressly  provides  that such
Indebtedness shall not be senior in right of payment to the Securities; provided
that Senior  Indebtedness  will not include (i) any  Indebtedness,  liability or
obligation of the Company to (A) any of its Subsidiaries, (B) trade creditors or
(C) any person  arising  out of any  lawsuit  against  the Company or any of its
Subsidiaries  or any  settlement  thereof  (other than any lawsuit or settlement
thereof respecting amounts payable with regard to Senior Indebtedness), (ii) any
redemption or other payments on Preferred Stock, (iii) any Indebtedness incurred
in violation of the  provisions  of this  Indenture or (iv) amounts  owing under
leases (other than Capitalized Lease Obligations).

             "Shelf  Registration  Statement" means the  Registration  Statement
with respect to the Securities which the Company is required to file pursuant to
the Registration Rights Agreement.

             "Significant  Subsidiary"  has the  meaning  ascribed  to it  under
Regulation C promulgated under the Securities Act of 1933, as amended.

             "Stated  Maturity" means, when used with respect to any security or
any installment of interest thereon, that date specified in such security as the
fixed  date on which the  principal  of such  security  or such  installment  of
interest is due and payable.

             "Subsidiary"  of any  Person  means  (i) any  corporation  of which
Common Equity having  ordinary voting power to elect a majority of the directors
of such  corporation  is owned by such  Person  directly  or through one or more
other  Subsidiaries of such Person, and (ii) any entity other than a corporation
in which such Person,  directly or  indirectly,  owns at least a majority of the
Common Equity of such entity.  Notwithstanding  the foregoing,  an  Unrestricted
Subsidiary  shall not be  deemed a  Subsidiary  of the  Company  other  than for
purposes of the definition of Unrestricted Subsidiary,  unless the Company shall
have designated such Unrestricted Subsidiary as a "Subsidiary" by written notice
to the Trustee. An Unrestricted  Subsidiary may be designated as a Subsidiary at
any time by the Company by written  notice to the  Trustee;  provided,  however,
that (i) no Default or Event of Default shall have occurred and be continuing or
would arise therefrom and (ii) if such Unrestricted  Subsidiary is an obligor of
any Indebtedness, any such designation shall be deemed to be an incurrence as of
the date of such designation by the Company of such Indebtedness and immediately
after  giving  effect to such  designation,  the  Company  could  incur $1.00 of
additional Indebtedness pursuant to clause (a) of Section 4.9 hereof.

             "TIA" means the Trust  Indenture Act of 1939, as amended (15 U.S.C.
ss.ss.  77aaa-77bbbb),  as in  effect  on  the  date  hereof  (unless  otherwise
specifically provided herein).

             "Transfer Restricted  Securities" means Securities that bear or are
required to bear the legend set forth in Section 2.5 hereof.

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





                                       11
<PAGE>

             "Trust  Officer"  means any  officer  or  assistant  officer of the
Trustee assigned by the Trustee to administer its corporate trust matters.

             "U.S.  Government  Obligations"  means  direct  obligations  of the
United  States of America  for the payment of which the full faith and credit of
the United States of America is pledged.

             "Unrestricted Subsidiary" means any Subsidiary of the Company which
shall have been designated as an Unrestricted  Subsidiary in accordance with the
Indenture.  An  Unrestricted  Subsidiary  may be designated as a Subsidiary at a
later date in the manner provided in the definition of "Subsidiary" above.

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

             "Wholly Owned  Subsidiary"  of any Person means (i) a Subsidiary of
which 100% of the Common  Equity  (except for  directors'  qualifying  shares or
certain  minority  interests  owned by other  Persons  solely  due to local  law
requirements that there be more than one stockholder,  but which interest is not
in excess of what is required for such purpose) is owned directly by such Person
or through one or more other Wholly Owned  Subsidiaries  of such Person and (ii)
any  entity  other  than  a  corporation  in  which  such  Person,  directly  or
indirectly, owns all of the Common Equity of such entity.

SECTION 1.2  OTHER DEFINITIONS

        Defined
                 Term                                                 in Section
                 ----                                                 ----------

                 "Affiliate Transaction"...........................     4.12
                 "Asset Sale Offer"................................     4.11
                 "Asset Sale Offer Period".........................     3.8
                 "Custodian".......................................     6.1
                 "Change in Control Repurchase"....................     4.10
                 "Event of Default"................................     6.1
                 "incur"...........................................     4.9(a)
                 "Legal Holiday"...................................    11.6
                 "Payment Blockage Period".........................    10.4
                 "Paying Agent"....................................     2.3
                 "Payment Account".................................     4.1
                 "Registrar".......................................     2.3
                 "Repurchase Date".................................     4.10
                 "Successor".......................................     5.1

SECTION 1.3 INCORPORATION BY REFERENCE OF TRUST INDENTURE ACT

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

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

SECTION 1.4 RULES OF CONSTRUCTION

             Unless the context otherwise requires:


                                       12
<PAGE>

          1.    a term has the meaning assigned to it;
          2.    an  accounting  term  not  otherwise  defined  has  the  meaning
                assigned to it in accordance with GAAP;
          3.    "or" is not exclusive;
          4.    words in the  singular  include  the  plural,  and in the plural
                include the singular;
          5.    provisions apply to successive events and transactions;  
          6.    any  amount  may be  negative;  and
          7.    "herein",  "hereof"  and other words of similar  import refer to
                this  Indenture  as a whole and not to any  particular  Article,
                Section or Subdivision.

                                   ARTICLE 2.

                                 THE SECURITIES

SECTION 2.1 FORM AND DATING

             The Rule 144A Notes and the Trustee's certificate of authentication
shall be  substantially  in the form of Exhibit A.  Subject to Section  2.6, the
Rule 144A  Notes  shall be in an  aggregate  principal  amount no  greater  than
$500,000,000;  provided, that if Exchange Notes are issued hereunder pursuant to
the Exchange Offer,  the aggregate  maximum  principal amount of Rule 144A Notes
shall be reduced  by the  principal  amount of  Exchange  Notes so  issued.  The
Exchange  Notes,  when  and  if  issued,   and  the  Trustee's   certificate  of
authentication  shall be  substantially  in the form of  Exhibit  B.  Subject to
Section  2.6, the Exchange  Notes shall be in an aggregate  principal  amount no
greater  than  $500,000,000  less the  principal  amount of Rule 144A  Notes not
exchanged for the Exchange Notes in the Exchange Offer.  The Securities may have
notations,  legends or  endorsements  required by law,  stock  exchange  rule or
usage.  Each  Security  shall  be  dated  the  date of its  authentication.  The
Securities shall be in denominations of $1,000 and integral multiples thereof.

             The  Securities  may be  initially  issued  either in the form of a
Global Security or Securities or in the form of Definitive Securities or both. A
Global Security shall  represent such of the outstanding  Securities as shall be
specified therein and shall provide that it shall represent the aggregate amount
of  outstanding  Securities  from  time to time  endorsed  thereon  and that the
aggregate amount of outstanding  Securities represented thereby may from time to
time  be  reduced  or  increased,  as  appropriate,  to  reflect  exchanges  and
redemptions.  Any  endorsement of a Global Security to reflect the amount of any
increase or decrease in the amount of outstanding Securities represented thereby
shall  be made by the  Trustee  or an Agent  thereof,  at the  direction  of the
Trustee,  in accordance with written  instructions  given by the Holder thereof.
Definitive Securities shall be printed,  lithographed or engraved or produced by
any combination of these methods on steel engraved borders or may be produced in
any other manner permitted by the rules of any securities  exchange on which the
Securities  may be listed,  all as  determined  by the officers  executing  such
Securities, as evidenced by their execution of such Securities.

             The  terms  and  provisions   contained  in  the  Securities  shall
constitute,  and are hereby  expressly made, a part of this Indenture and to the
extent applicable,  the Company and the Trustee, by their execution and delivery
of this Indenture,  expressly agree to such terms and provisions and to be bound
thereby.

SECTION 2.2 EXECUTION AND AUTHENTICATION

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

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




                                       13
<PAGE>

             A Security  shall not be valid  until  authenticated  by the manual
signature of the Trustee.  The signature  shall be conclusive  evidence that the
Security has been authenticated under this Indenture.

             The Trustee shall authenticate  Securities for original issue up to
the aggregate  principal amount stated in paragraph 4 of the Securities,  upon a
written  order of the Company  signed by two Officers.  The aggregate  principal
amount of Securities  outstanding  at any time may not exceed such amount except
as provided in Section 2.6.

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

SECTION 2.3 REGISTRAR AND PAYING AGENT

             The Company shall  maintain or cause to be  maintained  through the
Trustee or such other Person as may be  appointed  hereunder an office or agency
where  Securities may be presented for  registration of transfer or for exchange
("Registrar")  and an office or agency where  Securities  may be  presented  for
payment ("Paying Agent").  The Registrar shall keep a register of the Securities
and of  their  transfer  and  exchange.  The  Company  may  appoint  one or more
co-registrars  and one or more additional  paying agents.  The term  "Registrar"
includes any  co-registrar  and the term "Paying Agent"  includes any additional
paying  agent.  The Company  may change any Paying  Agent or  Registrar  without
notice to any  Holder.  The Company  shall  notify the Trustee in writing of the
name and address of any Agent not a party to this Indenture,  such  notification
to be delivered,  together  with a  certificate  of such Agent that it agrees to
perform its duties in accordance with the procedures  established by the Trustee
and with the  terms of this  Indenture,  to the  Trustee  prior to the date such
Agent assumes its duties hereunder.  If the Company fails to appoint or maintain
another entity as Registrar or Paying Agent,  the Trustee shall act as such. The
Company or any of its Subsidiaries may act as Paying Agent or Registrar.

SECTION 2.4 PAYING AGENT TO HOLD MONEY IN TRUST

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

SECTION 2.5 REGISTRATION OF TRANSFER AND EXCHANGE

             (a)  With  respect  to the  transfer  and  exchange  of  Definitive
Securities:  when  Definitive  Securities  are presented to the Trustee with the
request (x) to register  the  transfer of the  Definitive  Securities  or (y) to
exchange such Definitive  Securities for an equal principal amount of Definitive
Securities of other  authorized  denominations,  the Trustee shall  register the
transfer  or make  the  exchange  as  requested  if its  requirements  for  such
transactions  are  met;  provided,   however,  that  the  Definitive  Securities
presented or surrendered for register of transfer or exchange:

             (i)    shall  be  duly  endorsed  or   accompanied   by  a  written
                    instruction of transfer in form  satisfactory to the Trustee
                    duly executed by the Holder thereof or by its attorney, duly
                    authorized in writing; and


                                       14
<PAGE>

             (ii)   shall,  in the case of Transfer  Restricted  Securities that
                    are  Definitive  Securities,  except  if  exchanged  for  an
                    Exchange Note in the Exchange  Offer,  be accompanied by the
                    following   additional   information   and   documents,   as
                    applicable

                 (A) if such Transfer  Restricted Security is being delivered to
                 the Registrar by a Holder for  registration in the name of such
                 Holder,  without transfer,  a certification from such Holder to
                 that effect (in substantially the form of Exhibit C hereto); or

                 (B) if such Transfer  Restricted  Security is being transferred
                 to a "qualified  institutional  buyer" (as defined in Rule 144A
                 under the  Securities  Act) in  reliance on Rule 144A under the
                 Securities Act or pursuant to an exemption from registration in
                 accordance  with Rule 144 under the  Securities Act or pursuant
                 to an effective  registration  statement  under the  Securities
                 Act, a certification to that effect (in  substantially the form
                 of Exhibit C hereto); or

                 (C) if such Transfer  Restricted  Security is being transferred
                 in  reliance  on  another   exemption  from  the   registration
                 requirements  of the Securities  Act, a  certification  to that
                 effect (in  substantially  the form of Exhibit C hereto) and an
                 opinion of counsel reasonably  acceptable to the Company and to
                 the Registrar to the effect that such transfer is in compliance
                 with the Securities Act.

             (b)  The  following   restrictions  apply  to  any  transfer  of  a
Definitive Security for a beneficial interest in a Global Security. A Definitive
Security may not be exchanged  for a  beneficial  interest in a Global  Security
except,  until and upon  satisfaction of the requirements set forth below.  Upon
receipt by the Trustee of a Definitive Security, duly endorsed or accompanied by
appropriate  written  instruments  of  transfer,  in  form  satisfactory  to the
Trustee, together with:

             (i)    if  such  Definitive   Security  is  a  Transfer  Restricted
                    Security and such  transfer is not being made in  connection
                    with the Exchange Offer, certification, substantially in the
                    form of Exhibit C hereto,  that such Definitive  Security is
                    being transferred to a "qualified  institutional  buyer" (as
                    defined in Rule 144A under the Securities Act) in accordance
                    with Rule 144A under the Securities Act; and

             (ii)   whether  or  not  such  Definitive  Security  is a  Transfer
                    Restricted  Security,  written  instructions  directing  the
                    Trustee to make an  endorsement  on the Global  Security  to
                    reflect an increase in the aggregate principal amount of the
                    Securities represented by the Global Security,

then the Trustee shall cancel such Definitive  Security and cause, in accordance
with the  standing  instructions  and  procedures  existing  between  it and the
Depositary,  the aggregate  principal  amount of Securities  represented  by the
Global Security to be increased  accordingly.  If no Global  Securities are then
outstanding,   the  Company   shall  issue  and,   upon  receipt  of  a  written
authentication order in the form of an Officers' Certificate,  the Trustee shall
authenticate a new Global Security in the appropriate principal amount.

             (c) The transfer and exchange of Global  Securities  or  beneficial
interests  therein shall be effected through the Depositary,  in accordance with
this Indenture (including the restrictions on transfer set forth herein) and the
procedures of the Depositary therefor.

             (d) With  respect to the  transfer  of a  beneficial  interest in a
Global Security for a Definitive Security:

             (i)    Any person having a beneficial interest in a Global Security
                    may upon request  exchange  such  beneficial  interest for a
                    Definitive Security.  Upon receipt by the Trustee of written
                    instructions  or  such  other  form  of  instructions  as is
                    customary for the Depositary or its nominee on behalf of any
                    person having a beneficial interest in



                                       15
<PAGE>

                    a  Global  Security   constituting  a  Transfer   Restricted
                    Security  only,  except if exchanged for an Exchange Note in
                    the Exchange Offer, the following additional information and
                    documents (all of which may be submitted by facsimile):

                 (A) if such  beneficial  interest is being  transferred  to the
                 person  designated by the  Depositary  as being the  beneficial
                 owner,  a  certification  from such  person to that  effect (in
                 substantially the form of Exhibit C hereto); or

                 (B) if such  beneficial  interest  is  being  transferred  to a
                 "qualified  institutional buyer" (as defined in Rule 144A under
                 the  Securities  Act) in  accordance  with Rule 144A  under the
                 Securities Act or pursuant to an exemption from registration in
                 accordance  with Rule 144 under the  Securities Act or pursuant
                 to an effective  registration  statement  under the  Securities
                 Act, a  certification  to that effect from the  transferor  (in
                 substantially the form of Exhibit C hereto); or

                 (C)  if  such  beneficial  interest  is  being  transferred  in
                 reliance   on   another   exemption   from   the   registration
                 requirements  of the Securities  Act, a  certification  to that
                 effect from the transferee or transferor (in  substantially the
                 form of Exhibit C hereto)  and an  opinion of counsel  from the
                 transferee or transferor  reasonably  acceptable to the Company
                 and to the  Registrar  to the effect  that such  transfer is in
                 compliance with the Securities Act,

then the Trustee will cause,  in accordance with the standing  instructions  and
procedures  existing  between it and the  Depositary,  the  aggregate  principal
amount of the Global Security to be reduced and,  following such reduction,  the
Company will execute and, upon receipt of a written  authentication order in the
form of an Officers'  Certificate,  the Trustee will authenticate and deliver to
the transferee a Definitive Security.

             (ii)   Definitive  Securities  issued in exchange  for a beneficial
                    interest in a Global  Security  pursuant to this Section 2.5
                    shall be  registered  in such  names and in such  authorized
                    denominations  as the  Depositary,  pursuant to instructions
                    from its direct or indirect participants or otherwise, shall
                    in writing  instruct the Trustee.  The Trustee shall deliver
                    such Definitive Securities to the persons in whose name such
                    Securities are so registered.

             (e)  Notwithstanding  any other provisions of this Indenture (other
than the  provisions  set forth in subsection (f) of this Section 2.5), a Global
Security may not be transferred as a whole except by the Depositary to a nominee
of the Depositary or by a nominee of the Depositary to the Depositary or another
nominee  of  the  Depositary  or by the  Depositary  or any  such  nominee  to a
successor Depositary or a nominee of such successor Depositary.

             (f) The  following  relates  to the  authentication  of  Definitive
Securities in the absence of the Depositary.  If at any time: (i) the Depositary
for the  Securities  notifies  the Company that the  Depositary  is unwilling or
unable to  continue  as  Depositary  for the Global  Securities  and a successor
Depositary  for the Global  Securities is not appointed by the Company within 90
days after delivery of such notice; or (ii) the Company, at its sole discretion,
notifies  the  Trustee  in  writing  that it  elects to cause  the  issuance  of
Definitive  Securities under this Indenture,  then the Company will execute, and
the  Trustee,  upon  receipt  of a  written  order in the  form of an  Officers'
Certificate requesting the authentication and delivery of Definitive Securities,
will authenticate and deliver Definitive  Securities,  in an aggregate principal
amount equal to the principal amount of the Global  Securities,  in exchange for
such Global  Securities.

             (g) (i) Except as otherwise  agreed to by the Company,  the Trustee
and the Holder  thereof or as permitted by the following  paragraph  (ii),  each
Rule 144A Note certificate  evidencing the Global  Securities and the Definitive
Securities  (and all  Securities  other than  Exchange  Notes issued in exchange
therefor  or  substitution  thereof)  shall bear a legend in  substantially  the
following form:


                                       16
<PAGE>

         THIS SECURITY HAS NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933,
         AS  AMENDED  (THE  "SECURITIES  ACT"),  OR ANY STATE  SECURITIES  LAWS.
         NEITHER THIS SECURITY NOR ANY INTEREST OR  PARTICIPATION  HEREIN MAY BE
         REOFFERED,  SOLD,  ASSIGNED,   TRANSFERRED,   PLEDGED,   ENCUMBERED  OR
         OTHERWISE  DISPOSED  OF IN THE ABSENCE OF SUCH  REGISTRATION  OR UNLESS
         SUCH TRANSACTION IS EXEMPT FROM, OR NOT SUBJECT TO,  REGISTRATION UNDER
         SUCH LAWS.

         THE HOLDER OF THIS  SECURITY  BY ITS  ACCEPTANCE  HERETO  AGREES NOT TO
         OFFER, SELL OR OTHERWISE TRANSFER SUCH SECURITY, PRIOR TO THE DATE (THE
         "RESALE  RESTRICTION  TERMINATION  DATE")  WHICH IS TWO YEARS AFTER THE
         LATER OF THE ORIGINAL  ISSUE DATE HEREOF AND THE LAST DATE ON WHICH THE
         COMPANY OR ANY  AFFILIATED  PERSON OF THE COMPANY WAS THE OWNER OF THIS
         SECURITY  UNLESS  SUCH  OFFER,  SALE OR  OTHER  TRANSFER  IS (A) TO THE
         COMPANY,  (B)  PURSUANT  TO A  REGISTRATION  STATEMENT  WHICH  HAS BEEN
         DECLARED  EFFECTIVE  UNDER THE  SECURITIES  ACT, (C) FOR SO LONG AS THE
         SECURITIES  ARE ELIGIBLE FOR RESALE  PURSUANT TO RULE 144A, TO A PERSON
         THE HOLDER REASONABLY BELIEVES IS A "QUALIFIED  INSTITUTIONAL BUYER" AS
         DEFINED IN RULE 144A UNDER THE  SECURITIES  ACT THAT  PURCHASES FOR ITS
         OWN ACCOUNT OR FOR THE ACCOUNT OF A  QUALIFIED  INSTITUTIONAL  BUYER TO
         WHOM  NOTICE IS GIVEN THAT THE  TRANSFER  IS BEING MADE IN  RELIANCE ON
         RULE 144A, (D) TO AN  INSTITUTIONAL  "ACCREDITED  INVESTOR"  WITHIN THE
         MEANING OF SUBPARAGRAPH  (a)(1),  (a)(2),  (a)(3) OR (a)(7) OF RULE 501
         UNDER THE  SECURITIES  ACT THAT IS  ACQUIRING  THE SECURITY FOR ITS OWN
         ACCOUNT,  OR FOR  THE  ACCOUNT  OF SUCH  AN  INSTITUTIONAL  "ACCREDITED
         INVESTOR," FOR INVESTMENT PURPOSES AND NOT WITH A VIEW TO, OR FOR OFFER
         OR SALE IN  CONNECTION  WITH,  ANY  DISTRIBUTION  IN  VIOLATION  OF THE
         SECURITIES ACT, OR (E) PURSUANT TO ANOTHER AVAILABLE EXEMPTION FROM THE
         REGISTRATION  REQUIREMENTS  OF THE  SECURITIES  ACT, AND IN EACH OF THE
         FOREGOING  CASES SUCH OFFER,  SALE OR OTHER  TRANSFER IS IN  COMPLIANCE
         WITH ANY APPLICABLE STATE SECURITIES LAWS, SUBJECT TO THE COMPANY'S AND
         THE TRUSTEE'S RIGHT PRIOR TO ANY SUCH OFFER,  SALE OR TRANSFER PURSUANT
         TO CLAUSES (D) OR (E) TO REQUIRE THE DELIVERY OF AN OPINION OF COUNSEL,
         CERTIFICATION  AND/OR OTHER  INFORMATION  SATISFACTORY TO EACH OF THEM,
         AND IN EACH OF THE FOREGOING  CASES,  A CERTIFICATE  OF TRANSFER IN THE
         FORM  CONTAINED  IN THE  INDENTURE IS  COMPLETED  AND  DELIVERED BY THE
         TRANSFEROR TO THE TRUSTEE. THIS LEGEND WILL BE REMOVED UPON THE REQUEST
         OF THE THEN  HOLDER  OF THIS  SECURITY  AFTER  THE  RESALE  RESTRICTION
         TERMINATION  DATE.  ANY  TRANSFEREE OF THIS SECURITY SHALL BE DEEMED TO
         HAVE  REPRESENTED  EITHER  (A) THAT IT IS NOT  USING  THE  ASSETS OF AN
         EMPLOYEE  BENEFIT  PLAN  SUBJECT  TO  THE  EMPLOYEE  RETIREMENT  INCOME
         SECURITY ACT  ("ERISA")  OR THE  INTERNAL  REVENUE CODE (THE "CODE") TO
         PURCHASE THIS  SECURITY OR (B) THAT ITS PURCHASE AND CONTINUED  HOLDING
         OF THE  SECURITY  WILL BE COVERED BY A U.S.  DEPARTMENT  OF LABOR CLASS
         EXEMPTION (WITH RESPECT TO PROHIBITED TRANSACTIONS UNDER SECTION 406(a)
         OF ERISA).

             (ii)   Upon any sale or transfer of a Transfer  Restricted Security
                    (including any Transfer Restricted Security represented by a
                    Global  Security)  pursuant to Rule 144 under the Securities
                    Act  or  an  effective   registration  statement  under  the
                    Securities Act (including the Shelf Registration Statement):

                 (A) in the case of any Transfer  Restricted  Security that is a
                 Definitive  Security,  the  Registrar  shall  permit the Holder
                 thereof to exchange  such  Transfer  Restricted  Security for a
                 Definitive  Security  that does not bear the  legend  set forth
                 above and  rescind  any  restriction  on the  transfer  of such
                 Transfer Restricted Security; and

                 (B) any such  Transfer  Restricted  Security  represented  by a
                 Global  Security  shall not be  subject to the  provisions  set
                 forth in (i) above (such sales or transfers  being subject only
                 to the provisions of Section 2.5(c) hereof); provided, however,
                 that with respect to any


                                       17
<PAGE>

                 request for an exchange of a Transfer  Restricted Security that
                 is represented by a Global  Security for a Definitive  Security
                 that does not bear a legend,  which request is made in reliance
                 upon  Rule  144 or an  effective  registration  statement,  the
                 Holder  thereof shall certify in writing to the Registrar  that
                 such request is being made pursuant to Rule 144 or an effective
                 registration  statement (such certification to be substantially
                 in the form of Exhibit C hereto.)

             (h) At such time as all beneficial  interests in a Global  Security
have either been exchanged for Definitive Securities,  redeemed,  repurchased or
cancelled,  such Global  Security shall be returned to or retained and cancelled
by the  Trustee.  At any time  prior  to such  cancellation,  if any  beneficial
interest in a Global Security is exchanged for Definitive Securities,  redeemed,
repurchased or cancelled, the principal amount of Securities represented by such
Global Security shall be reduced and an endorsement shall be made on such Global
Security,  by the Trustee or the Securities  Custodian,  at the direction of the
Trustee, to reflect such reduction.

             (i) All Definitive Securities and Global Securities issued upon any
registration  of  transfer  or  exchange  of  Definitive  Securities  or  Global
Securities  shall be the valid  obligations of the Company,  evidencing the same
debt, and entitled to the same benefits under this Indenture,  as the Definitive
Securities or Global  Securities  surrendered upon such registration of transfer
or exchange.

             No service charge shall be made to a Holder for any registration of
transfer or exchange (except as otherwise expressly  permitted herein),  but the
Company may require  payment of a sum  sufficient  to cover any  transfer tax or
similar  governmental  charge payable and any other expenses (including the fees
and expenses of the Trustee) in connection  therewith  (other than such transfer
tax or similar  governmental  charge payable upon exchanges  pursuant to Section
2.6 or 9.5).

SECTION 2.6 REPLACEMENT SECURITIES

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

             Every  replacement  Security  is an  additional  obligation  of the
Company.

SECTION 2.7 OUTSTANDING SECURITIES

             The  Securities  outstanding  at any  time  are all the  Securities
authenticated by the Trustee except for those canceled by it, those delivered to
it for cancellation and those described in this Section 2.7 as not outstanding.

             If a Security is replaced  pursuant to Section 2.6, it ceases to be
outstanding  unless  the  Trustee  receives  proof  satisfactory  to it that the
replaced Security is held by a bona fide purchaser.

             If the principal  amount of any Security is  considered  paid under
Section 4.1, it ceases to be outstanding  and interest on it ceases to accrue as
of the date it is deemed  paid.  Upon a "legal  defeasance"  pursuant to Section
8.1(b) or a "covenant  defeasance"  pursuant to Section  8.1(c),  the Securities
shall  be  deemed  to be  outstanding  or not  outstanding  as  provided  in the
applicable Section 8.1(b) or 8.1(c).

             Except as set forth in Section 2.8, a Security does not cease to be
outstanding because the Company or an Affiliate holds the Security.


                                       18
<PAGE>

SECTION 2.8 TREASURY SECURITIES

             In determining whether the Holders of the required principal amount
of Securities  have  concurred in any direction,  waiver or consent,  Securities
owned by the Company or by any Person  directly  or  indirectly  controlling  or
controlled by or under direct or indirect  common control with the Company shall
be  considered  as though  not  outstanding,  except  that for the  purposes  of
determining  whether  the  Trustee  shall be  protected  in  relying on any such
direction,  waiver or consent, only Securities which the corporate trust officer
having  responsibility for the administration of this Indenture on behalf of the
Trustee actually knows are so owned shall be so disregarded.

SECTION 2.9 TEMPORARY SECURITIES

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

SECTION 2.10 CANCELLATION

             The Company at any time may deliver  Securities  to the Trustee for
cancellation.  The  Registrar  and Paying Agent shall forward to the Trustee any
Securities  surrendered  to them  for  registration  of  transfer,  exchange  or
payment. The Trustee shall cancel all Securities surrendered for registration of
transfer, exchange, payment,  replacement or cancellation,  and, upon request of
the  Company,  certification  of their  destruction  shall be  delivered  to the
Company  unless,  by a written order signed by two  Officers,  the Company shall
direct that  canceled  Securities  be  returned to it after being  appropriately
designated  as  cancelled.  The Company may not issue new  Securities to replace
Securities  that it has paid or that  have been  delivered  to the  Trustee  for
cancellation.

SECTION 2.11 DEFAULTED INTEREST

             If the Company defaults in a payment of interest on the Securities,
it shall pay the  defaulted  interest in any lawful  manner plus,  to the extent
lawful,  interest  payable on the  defaulted  interest,  to the  Persons who are
Holders on a subsequent  special  record date, in each case at the rate provided
in the Securities.  The Company, with the consent of the Trustee, shall fix each
such special  record date and payment  date. At least 15 days before the special
record date, the Company (or, upon written request of the Company,  the Trustee,
in the name of and at the expense of the Company) shall mail to Holders a notice
that states the special record date, the related  payment date and the amount of
such interest to be paid.

SECTION 2.12 SECURITIES ISSUABLE IN THE FORM OF A GLOBAL SECURITY

(a) If the Company shall establish that the Securities are to be issued in whole
or in part in the form of one or more Global Securities,  then the Company shall
execute and the Trustee or an agent thereof  shall,  in accordance  with Section
2.2 and the written  order of the Company  delivered to the Trustee or its agent
thereunder,  authenticate and deliver such Global Security or Securities,  which
(i)  shall  represent,  and  shall  be  denominated  in an  amount  equal to the
aggregate  principal  amount of the outstanding  Securities to be represented by
such Global Security or Securities, or such portion thereof as the Company shall
specify in a written order of the Company signed by two Officers,  (ii) shall be
registered in the name of the Depositary for such Global  Security or Securities
or its  nominee,  (iii)  shall be  delivered  by the Trustee or its agent to the
Depositary  or pursuant to the  Depositary's  instruction  and (iv) shall bear a
legend substantially to the following effect:  "Unless and until it is exchanged
in whole or in part for securities in definitive  form, this security may not be
transferred  except as a whole by the  Depositary to a nominee of the Depositary
or by a nominee of the  Depositary to the  Depositary or another  nominee of the
Depositary or by the Depositary or any such nominee to a successor Depositary or
a nominee of such successor Depositary.  Unless this certificate is presented by
an authorized  representative  of the Depositary to the Company or its agent for


                                       19
<PAGE>

registration of transfer,  exchange,  or payment,  and any certificate issued is
registered in the name of the nominee of the Depositary or in such other name as
is requested by an authorized  representative of the Depositary (and any payment
is made to the nominee of the Depositary or to such other entity as is requested
by an authorized  representative  of the Depositary),  ANY TRANSFER,  PLEDGE, OR
OTHER USE HEREOF FOR VALUE OR OTHERWISE BY OR TO ANY PERSON IS WRONGFUL inasmuch
as the registered owner hereof,  the nominee of the Depositary,  has an interest
herein."

             (b)  Notwithstanding any other provision of this Section 2.12 or of
Section 2.5, and subject to the  provisions  of  paragraph  (c) below,  a Global
Security may be transferred, in whole but not in part and in the manner provided
in Section 2.5, only to a nominee of the Depositary for such Global Security, or
to the Depositary,  or a successor  Depositary for such Global Security selected
or approved by the Company, or to a nominee of such successor Depositary.

             (c)  (i)  If at any  time  the  Depositary  for a  Global  Security
notifies the Company  that it is  unwilling or unable to continue as  Depositary
for such Global  Security or if at any time the  Depositary  for the  Securities
shall no longer be eligible or in good  standing  under the  Exchange Act or any
other  applicable  statute or regulation,  the Company shall appoint a successor
Depositary with respect to such Global Security.  If a successor  Depositary for
such Global  Security is not  appointed by the Company  within 90 days after the
Company receives such notice or becomes aware of such ineligibility, the Company
will  execute,  and the Trustee or an agent  thereof,  upon receipt of a written
order of the Company signed by two Officers for the  authentication and delivery
of individual Definitive  Securities in exchange for such Global Security,  will
authenticate  and deliver,  individual  Definitive  Securities of like tenor and
terms in an  aggregate  principal  amount equal to the  principal  amount of the
Global Security in exchange for such Global Security.

             (ii)   The  Company  may at any  time  and in its  sole  discretion
                    determine that the  Securities  issued in the form of one or
                    more Global  Securities  shall no longer be  represented  by
                    such  Global  Security  or  Securities.  In such  event  the
                    Company will execute,  and the Trustee or an agent  thereof,
                    upon receipt of a written order of the Company signed by two
                    Officers for the  authentication  and delivery of individual
                    Definitive  Securities  in  exchange in whole or in part for
                    such  Global   Security,   will   authenticate  and  deliver
                    individual  Definitive Securities of like tenor and terms in
                    an aggregate  principal amount equal to the principal amount
                    of such Global  Security or  Securities in exchange for such
                    Global Security or Securities.

             (iii)  If specified by the Company  pursuant to a written  order of
                    the Company  signed by two Officers,  the  Depositary  for a
                    Global  Security  may  surrender  such  Global  Security  in
                    exchange  in  whole  or in part  for  individual  Definitive
                    Securities  of like  tenor  and  terms on such  terms as are
                    acceptable to the Company and such Depositary. Thereupon the
                    Company shall execute,  and the Trustee or an agent thereof,
                    upon a written order of the Company  signed by two Officers,
                    shall authenticate and deliver,  without service charge, (1)
                    to each Person specified by such Depositary a new Definitive
                    Security  or  Securities  of like tenor and terms and of any
                    authorized  denomination  as  requested by such Person in an
                    aggregate principal amount equal to and in exchange for such
                    Person's beneficial interest as specified by such Depositary
                    in the Global  Security;  and (2) to such  Depositary  a new
                    Global Security of like tenor and terms and in an authorized
                    denomination  equal to the difference,  if any,  between the
                    principal amount of the surrendered  Global Security and the
                    aggregate   principal   amount  of   Definitive   Securities
                    delivered to Holders thereof.

             (iv)   In any exchange  provided for in (i),  (ii) or (iii) of this
                    paragraph  (c),  the Company will execute and the Trustee or
                    an agent  thereof,  upon  receipt of a written  order of the
                    Company  signed  by  two  Officers,  will  authenticate  and
                    deliver individual  Definitive Securities in registered form
                    in authorized denominations. Upon the exchange of the entire
                    principal   amount  of  a  Global  Security  for  individual


                                       20
<PAGE>

                    Definitive  Securities,  such  Global  Securities  shall  be
                    cancelled  by the  Trustee  or an agent  thereof.  Except as
                    provided in (iii)  above,  Definitive  Securities  issued in
                    exchange  for a Global  Security  pursuant  to this  Section
                    shall be  registered  in such  names and in such  authorized
                    denominations  as the Depositary  for such Global  Security,
                    pursuant  to  instructions   from  its  direct  or  indirect
                    participants or otherwise, shall instruct either the Trustee
                    or  the  Registrar.  Such  Trustee  or the  Registrar  shall
                    deliver such  Definitive  Securities to the Persons in whose
                    names such Securities are so registered.

                                   ARTICLE 3.

                    OPTIONAL REDEMPTION AND ASSET SALE OFFER

SECTION 3.1 NOTICES TO TRUSTEE

             (a) If the  Company  elects to redeem  Securities  pursuant  to the
optional redemption  provisions of Section 3.7, it shall furnish to the Trustee,
at least  45 days  but not  more  than 60 days  before  a  redemption  date,  an
Officers'  Certificate  stating  that the  Company has  exercised  its option to
redeem Securities pursuant to Section 3.7 and setting forth the redemption date,
the principal amount of Securities to be redeemed and the redemption price.

             (b) If the Company  offers to purchase  Securities  pursuant to the
provisions  of Section 3.8, it shall  furnish to the  Trustee,  on or before the
fifth Business Day preceding the commencement of an Asset Sale Offer Period,  an
Officers'  Certificate  stating  that the  Company is making an Asset Sale Offer
pursuant to Section  3.8 and  setting  forth the Asset Sale  Payment  Date,  the
principal  amount of  Securities  the Company is  offering  to purchase  and the
purchase price of such Securities,  and further setting forth a statement to the
effect that (a) the Company has consummated an Asset Sale and (b) the conditions
set forth in the first sentence of Section 4.11 have been  satisfied.

SECTION 3.2 SELECTION OF SECURITIES TO BE REDEEMED OR PURCHASED

             (a) If less than all of the Securities are to be redeemed  pursuant
to Section 3.7, the Trustee shall select the  Securities to be redeemed on a pro
rata basis,  by lot or in such other  manner as the Trustee  shall deem fair and
equitable;  provided,  however,  that in the  case of a  partial  redemption  of
Securities made with the proceeds of a Public Equity Offering,  selection of the
Securities for redemption shall be made on a pro rata basis,  unless such method
is otherwise  prohibited (in which case the Securities to be purchased  shall be
selected  by lot or in such  other  manner as the  Trustee  shall  deem fair and
equitable).  The particular Securities to be redeemed shall be selected,  unless
otherwise provided herein, prior to the date notice of redemption is required to
be sent by the Trustee,  from the outstanding  Securities not previously  called
for redemption.

             The  Trustee  promptly  shall  notify the Company in writing of the
Securities selected for redemption and, in the case of any Security selected for
partial redemption, the principal amount thereof to be redeemed.  Securities and
portions of them selected shall be in amounts of $1,000 or integral multiples of
$1,000.  Provisions  of this  Indenture  that  apply to  Securities  called  for
redemption also apply to portions of Securities called for redemption.

             (b) If less than all of the Securities are to be purchased pursuant
to Section 3.8, the Trustee shall select the Securities to be purchased on a pro
rata  basis,  unless  such  method is  otherwise  prohibited  (in which case the
Securities  to be purchased  shall be selected by lot or in such other manner as
the Trustee  shall deem fair and  equitable).  The  particular  Securities to be
purchased shall be selected, unless otherwise provided herein, prior to the date
notice of purchase is required to be sent by the Trustee,  from the  outstanding
Securities tendered pursuant to the Asset Sale Offer.


                                       21
<PAGE>

             The  Trustee  promptly  shall  notify the Company in writing of the
Securities  selected for purchase and, in the case of any Security  selected for
partial purchase,  the principal amount thereof to be purchased.  Securities and
portions of them selected shall be in amounts of $1,000 or integral multiples of
$1,000.  Provisions  of this  Indenture  that  apply to  Securities  called  for
purchase also apply to portions of Securities called for purchase.

SECTION 3.3 NOTICES TO HOLDERS

             (a) At least 30 days but not more than 60 days before a  redemption
date, the Company shall mail a notice to each Holder whose  Securities are to be
redeemed.

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

             1.     the redemption date;
             2.     the redemption price;
             3.     if any  Security is being  redeemed in part,  the portion of
                    the  principal  amount of such  Security to be redeemed  and
                    that,  after the  redemption  date,  upon  surrender of such
                    Security,  a new Security or Securities in principal  amount
                    equal to the unredeemed portion will be issued;
             4.     the name and address of the Paying Agent;
             5.     that Securities called for redemption must be surrendered to
                    the Paying Agent at the address  specified in such notice to
                    collect the redemption price;
             6.     that interest on Securities  called for redemption ceases to
                    accrue on and after the redemption  date (unless the Company
                    defaults on its obligation to repurchase Securities);
             7.     the  paragraph  of the  Securities  pursuant  to  which  the
                    Securities are being redeemed; and
             8.     the aggregate  principal amount of Securities that are being
                    redeemed.

             (b) If the  Company  determines  to make an  Asset  Sale  Offer  as
provided  in Section  3.8,  the  Company  shall  promptly  mail a notice to each
Holder.

             The Notice shall state:

           1.       that an Asset Sale Offer is being made  pursuant  to Section
                    3.8 and the length of time the Asset Sale Offer will  remain
                    open;
           2.       the purchase price and the Asset Sale Payment Date;
           3.       the aggregate  principal amount of Securities the Company is
                    offering to purchase;
           4.       that any  Security not tendered or accepted for payment will
                    continue to accrue interest;
           5.       that any Security accepted for payment pursuant to the Asset
                    Sale Offer shall cease to accrue  interest on the Asset Sale
                    Payment Date;
           6.       that Holders electing to have a Security  purchased pursuant
                    to any Asset Sale Offer will be  required to  surrender  the
                    Security,  with the form entitled "Option of Holder to Elect
                    Purchase" on the reverse side of the Security completed,  to
                    the Company, a depositary, if appointed by the Company, or a
                    Paying Agent at the address specified in the notice prior to
                    expiration of the Asset Sale Offer Period;
           7.       that Holders will be entitled to withdraw  their election if
                    the Company, Depositary or Paying Agent, as the case may be,
                    receives,  not later than the  expiration  of the Asset Sale
                    Offer  Period,  or such longer  period as may be required by
                    law, a telegram,  telex,  facsimile  transmission  or letter
                    setting forth the name of the Holder,  the principal  amount
                    of the  Security  the Holder  delivered  for  purchase and a
                    statement  that such Holder is  withdrawing  his election to
                    have the Security purchased;
           8.       that,  if  the  aggregate  principal  amount  of  Securities
                    surrendered  by  Holders  exceeds  the  aggregate  principal
                    amount of Securities  offered to be  purchased,  the Trustee
                    shall

                                       22
<PAGE>

                    select the  Securities  to be purchased on a pro rata basis,
                    unless such method is  otherwise  prohibited  (in which case
                    the  Securities to be purchased  shall be selected by lot or
                    in such  other  manner as the  Trustee  shall  deem fair and
                    equitable); and

           9.       that Holders whose  Securities  are  purchased  only in part
                    will be issued new Securities  equal in principal  amount to
                    the unpurchased portion of the Securities surrendered.

             (c) At the  Company's  request,  the Trustee  shall give the notice
required in Section  3.3(a) or 3.3(b) in the Company's  name and at its expense;
provided,  however,  that the Company shall deliver to the Trustee,  at least 45
days  prior to the  redemption  date or not later  than the fifth  Business  Day
preceding the commencement of an Asset Sale Offer Period, as the case may be, an
Officers'  Certificate  requesting that the Trustee give such notice and setting
forth the  information to be stated in such notice as provided in Section 3.3(a)
or 3.3(b).

SECTION 3.4 EFFECT OF NOTICE OF REDEMPTION

             Once notice of redemption  under Section 3.7 is mailed,  Securities
called for  redemption  become due and  payable  on the  redemption  date at the
redemption  price.  However,  if a  redemption  date is on or before an Interest
Payment Date and on or after the related record date,  any interest  accrued and
unpaid to the redemption date shall be paid on such Interest Payment Date to the
person in whose name the Security is registered at the close of business on such
record date and the only remaining right of the Holders of Securities called for
redemption  shall be to receive the redemption  price  (excluding such interest)
upon surrender of such Securities to the Paying Agent.

SECTION 3.5 DEPOSIT OF REDEMPTION PRICE OR PURCHASE PRICE

             One  Business  Day prior to the  redemption  date or the Asset Sale
Payment  Date, as the case may be, the Company shall deposit with the Trustee or
with the  Paying  Agent  money  sufficient  to pay the  redemption  price or the
purchase  price of, and accrued  interest on, all  Securities  to be redeemed or
purchased  on that date.  The Trustee or the Paying  Agent  shall  return to the
Company any money not required for that purpose.

             If the Company complies with the preceding  paragraph,  interest on
the Securities or portions thereof to be redeemed or purchased (in the case of a
redemption, whether or not such Securities are presented for payment) will cease
to accrue on the applicable  redemption  date or Asset Sale Payment Date, as the
case may be. If any  Security  called for  redemption  shall not be so paid upon
surrender,  or if any Security to be purchased shall not be so paid on the Asset
Sale  Payment  Date,  because of the  failure of the  Company to comply with the
preceding paragraph, then interest will be paid on the unpaid principal from the
redemption  date or the Asset Sale Payment  Date, as the case may be, until such
principal is paid and on any interest not paid on such unpaid principal, in each
case, at the rate provided in the Securities and in Section 4.1.

SECTION 3.6 SECURITIES REDEEMED OR PURCHASED IN PART

             Upon surrender of a Security that is redeemed or purchased in part,
the Company shall issue, and the Trustee shall,  upon receipt of a written order
of the  Company  signed  by two  Officers,  authenticate  for the  Holder at the
expense  of the  Company,  a new  Security  equal  in  principal  amount  to the
unredeemed  portion or the portion not  purchased of the  Security  surrendered.

SECTION 3.7 OPTIONAL REDEMPTION

             The Company may redeem all or any of the  Securities at any time on
or after  January 15, 2003,  at the following  redemption  prices  (expressed as
percentages  of  principal  amount),  plus  accrued  and unpaid  interest to the
redemption date:


                                       23
<PAGE>

                    IF REDEEMED DURING                        REDEMPTION PRICE
              THE 12-MONTH PERIOD COMMENCING                  ----------------
              ------------------------------
                     January 15, 2003                             104.625%
                     January 15, 2004                             103.083%
                     January 15, 2005                             101.542%
             January 15, 2006 and thereafter                        100%

             Notwithstanding  the  foregoing,  the  Company  may  redeem  in the
aggregate up to $166,667,000 principal amount of Securities at any time and from
time to time prior to January 15, 2001 at a redemption price equal to 109.25% of
the  aggregate  principal  amount so  redeemed,  plus  accrued  interest  to the
redemption  date,  out of the net cash  proceeds  of one or more  Public  Equity
Offerings;  provided that at least  $333,333,000  aggregate  principal amount of
Securities  originally  issued remains  outstanding  after the occurrence of any
such redemption and that any such redemption occurs within 60 days following the
closing of any such Public Equity Offering.

             Any  redemption  pursuant to this Section 3.7 shall be made, to the
extent  applicable,  in accordance  with the  provisions of Sections 3.1 through
3.6.

SECTION 3.8 ASSET SALE OFFER

             If the Company  determines to make an Asset Sale Offer, the Company
shall  promptly  mail (with notice to the Trustee) or shall cause the Trustee to
promptly mail (in the Company's name and at its expense) notice of an Asset Sale
Offer to each Holder of  Securities  as set forth in Section  3.3(b).  The Asset
Sale Offer  shall be deemed to have  commenced  on the date of such  mailing and
shall terminate 30 days after its  commencement  unless a longer offering period
is required by law (the  "Asset  Sale Offer  Period").  On or prior to the fifth
Business  Day  following  the  termination  of the Asset Sale Offer  Period (the
"Asset Sale Payment Date"), the Company shall purchase,  or cause the Trustee to
purchase,  and mail or deliver  payment  for,  as  selected  on a pro rata basis
(unless such method is otherwise prohibited,  in which case the Securities to be
purchased  shall be  selected  by lot,  with such  adjustments  as may be deemed
appropriate by the Company so that only Securities in denominations of $1,000 or
integral  multiples  thereof shall be purchased,  or in such other manner as the
Trustee shall deem fair and equitable) from Holders  tendering their  Securities
pursuant  to the Asset Sale  Offer,  the  amount of  Securities  required  to be
purchased  pursuant to Section  4.11.  If the Asset Sale  Payment  Date is on or
after an interest  payment  record  date and on or before the  related  interest
payment  date,  any accrued  interest will be paid to the person in whose name a
Security is  registered  at the close of business  on such record  date,  and no
additional interest will be payable to Holders who tender Securities pursuant to
the Asset Sale Offer. Any Asset Sale Offer shall be conducted in compliance with
applicable  tender offer rules,  including Section 14(e) of the Exchange Act and
Rule 14e-1 thereunder.

             On or before any Asset  Sale  Payment  Date,  the  Company,  to the
extent  lawful,  shall (i) accept for  payment,  as selected on a pro rata basis
(unless such method is otherwise prohibited,  in which case the Securities to be
purchased  shall be  selected  by lot,  with  such  adjustment  as may be deemed
appropriate by the Company so that only Securities in denominations of $1,000 or
integral  multiples  thereof shall be purchased,  or in such other manner as the
Trustee shall deem fair and equitable),  Securities or portions thereof tendered
pursuant to the Asset Sale Offer,  (ii) if the Company  appoints a depositary or
Paying Agent,  deposit with such depositary or Paying Agent money  sufficient to
pay  the  purchase  price  (including  all  accrued  interest  on the  purchased
Securities) of all Securities or portions thereof so accepted,  (iii) deliver or
cause the  depositary  or Paying Agent to deliver to the Trustee  Securities  so
accepted and (iv) deliver an Officers' Certificate identifying the Securities or
portions  thereof  accepted  for payment by the Company in  accordance  with the
terms of this Section 3.8. The depositary,  the Paying Agent or the Company,  as
the case may be,  promptly  shall mail or deliver  to each  tendering  Holder an
amount  equal to the  purchase  price  (including  all  accrued  interest on the
purchased  Securities) of the Securities tendered by such Holder and accepted by
the Company for purchase,  and the Trustee promptly shall  authenticate and mail
or deliver to


                                       24
<PAGE>

such Holders a new Security equal in principal amount to any unpurchased portion
of the Security  surrendered.  Any Securities not so accepted  promptly shall be
mailed or  delivered  by the Company to the Holder  thereof.  The  Company  will
publicly  announce the results of the Asset Sale Offer on the Asset Sale Payment
Date.

             Other than as specifically  provided in this Section 3.8, any offer
to purchase  Securities pursuant to this Section 3.8 shall be made in accordance
with the other provisions of this Indenture.

                                   ARTICLE 4.

                                    COVENANTS

SECTION 4.1 PAYMENT OF SECURITIES

             The Company  shall pay the  principal of and  premium,  if any, and
interest  on the  Securities  on the dates  and in the  manner  provided  in the
Securities. Principal, premium, if any, and interest shall be considered paid on
the date due if the Paying Agent,  other than the Company or a Subsidiary of the
Company,  holds on that date money  deposited by the Company  designated for and
sufficient to pay all principal, premium, if any, and interest then due.

             The Company shall pay interest (including post-petition interest in
any proceeding under any Bankruptcy Law) on overdue  principal at the rate equal
to the  interest  rate on the  Securities  to the  extent  lawful;  it shall pay
interest on overdue  payments of premium,  if any, or  installments  of interest
(without  regard to any applicable  grace period) at the same rate to the extent
lawful.

             On or prior to the effective  date of this  Indenture,  the Trustee
shall establish a segregated  non-interest-bearing  corporate trust account (the
"Payment Account") maintained by the Trustee for the benefit of Holders in which
all amounts  paid in respect of the  Securities  will be held and from which the
Trustee shall make payments to the Holders in accordance with this Indenture and
the  Securities.  The Trustee and any Agent of the Trustee shall have  exclusive
control and sole right of withdrawal with respect to the Payment Account for the
purpose  of making  deposits  in and  withdrawals  from the  Payment  Account in
accordance with this Indenture.  All monies and other property deposited or held
from time to time in the  Payment  Account  shall be held by the  Trustee in the
Payment  Account  for  the  exclusive   benefit  of  the  Holders,   subject  to
subordination to Senior Indebtedness in accordance with Article 10 hereof.

SECTION 4.2 MAINTENANCE OF OFFICE OR AGENCY

             The Company will maintain an office or agency where  Securities may
be surrendered  for  registration  of transfer or exchange and where notices and
demands to or upon the Company with respect of the Securities and this Indenture
may be served  pursuant  to Section  2.3.  The  Company  hereby  designates  the
Corporate Trust Office of the Trustee as such office or agency of the Company.

             The Company also from time to time may  designate one or more other
offices or agencies where the Securities may be presented or surrendered for any
or all such  purposes and from time to time may rescind such  designations.  The
Company will give prompt written  notice to the Trustee of any such  designation
or  rescission  and of any change in the  location  of any such other  office or
agency.

SECTION 4.3 SEC REPORTS

             (a) The Company shall remain subject to the reporting  requirements
of Section 13 or Section  15(d) of the Exchange  Act and shall  continue to file
with the SEC such  annual  reports  and such  information,  documents  and other
reports which are specified in Sections 13 and 15(d) of the Exchange Act.

             (b) The  Company  shall  file  with  the  Trustee  and  cause to be
provided  to the  Holders,  within 15 days after it files the same with the SEC,
copies of its annual reports and of the information, documents


                                       25
<PAGE>

and other reports (or copies of such portions of any of the foregoing as the SEC
may by rules and regulations  prescribe)  which the Company or any subsidiary of
the Company is required to file with the SEC  pursuant to Section 13 or 15(d) of
the Exchange  Act. The Company  shall cause any annual  report  furnished to its
stockholders generally and any quarterly or other financial reports furnished by
it to its stockholders  generally to be filed with the Trustee and mailed to the
Holders at their addresses appearing in the register of Securities maintained by
the  Registrar.  The  Company  will  cause  to  be  disclosed  in  an  Officers'
Certificate  accompanying any annual report filed with the Trustee and mailed to
Holders or comparable  information  as of the date of the most recent  financial
statements in each such report or comparable  information  the amount  available
for payments  pursuant to Section 4.7. The Trustee  shall have no  obligation to
furnish  such  information  to the  Holders  unless  instructed  to do so by the
Company or requested by a Holder.

SECTION 4.4 COMPLIANCE CERTIFICATE

             (a) The Company shall deliver to the Trustee, within 120 days after
the end of each fiscal year of the  Company,  an Officers'  Certificate  stating
that a review of the activities of the Company and its  Subsidiaries  during the
preceding  fiscal  year has been  made  under  the  supervision  of the  signing
Officers  with a view to  determining  whether the  Company has kept,  observed,
performed  and  fulfilled  its  obligations  under this  Indenture,  and further
stating,  as to each such Officer signing such certificate,  that to the best of
his knowledge  the Company has kept,  observed,  performed  and  fulfilled  each
covenant contained in this Indenture and is not in default in the performance or
observance  of any of the terms,  provisions  and  conditions  hereof  (or, if a
Default or Event of Default shall have occurred, describing all such Defaults or
Events of Default of which he may have  knowledge and what action the Company is
taking or proposes  to take with  respect  thereto)  and that to the best of his
knowledge  no event has  occurred  and remains in  existence  by reason of which
payments on account of the principal of or premium, if any, or interest, if any,
on the Securities  are prohibited or, if such event has occurred,  a description
of the event and what  action  the  Company is taking or  proposes  to take with
respect thereto.

             (b) So long as (i) not contrary to the then current recommendations
of the American  Institute of Certified Public Accountants or (ii) the Company's
independent  public  accountants  do not have in  effect a  policy,  of  general
applicability  with respect to their  clients,  that such  accountants  will not
prepare  statements  on the subjects  specified  below,  the year-end  financial
statements  delivered  pursuant to Section 4.3 shall be accompanied by a written
statement of the Company's  independent  public accountants (who shall be a firm
of established national reputation) that in making the examination necessary for
certification of such financial  statements  nothing has come to their attention
that would lead them to believe that the Company has violated any  provisions of
Article 4 or 5 or, if any such violation has occurred, specifying the nature and
period of existence thereof, it being understood that such accountants shall not
be liable  directly  or  indirectly  to any  Person  for any  failure  to obtain
knowledge  of any  such  violation.

             (c) The Company,  so long as any of the Securities are outstanding,
will deliver to the Trustee,  forthwith  upon any Officer  becoming aware of any
Default  or Event of Default  under this  Indenture,  an  Officers'  Certificate
specifying  such  Default or Event of  Default  and what  action the  Company is
taking or proposes to take with respect  thereto.

SECTION 4.5  CORPORATE  EXISTENCE,  TAXES, ETC.

             Subject to the  provisions  of Section 5.1, the Company shall do or
cause to be done all things  necessary  to  preserve  and keep in full force and
effect its rights  (charter and statutory),  licenses and franchises;  provided,
however,  that the Company  shall not be required to preserve  any such right or
franchise  if the  Board of  Directors  shall  determine  that the  preservation
thereof is no longer desirable in the conduct of the business of the Company and
the loss thereof is not disadvantageous in any material respect to the Holders.


                                       26
<PAGE>

SECTION 4.6 STAY, EXTENSION AND USURY LAWS

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

SECTION 4.7 LIMITATIONS ON RESTRICTED PAYMENTS

             The   Company   shall  not,   and  shall  not  permit  any  of  its
Subsidiaries,  directly or indirectly,  to make any Restricted Payment if at the
time of such Restricted Payment:

             (i)    a Default or Event of Default  shall  have  occurred  and be
                    continuing or shall occur as a consequence thereof;

            (ii)    after giving effect to the proposed Restricted Payment,  the
                    amount  of  such  Restricted  Payment,  when  added  to  the
                    aggregate  amount of all Restricted  Payments made after May
                    15,  1996,  exceeds  the  sum  of (1)  50% of the  Company's
                    Consolidated  Net Income accrued during the period (taken as
                    a single  period)  commencing May 15, 1996, to and including
                    the most recent fiscal  quarter ended  immediately  prior to
                    the date of such Restricted  Payment and for which financial
                    results   have  been   reported   (or,  if  such   aggregate
                    Consolidated  Net Income  shall be a deficit,  minus 100% of
                    such aggregate deficit);  (2) the net cash proceeds from the
                    issuance and sale of the Company's (a) Capital Stock that is
                    not Disqualified Stock, including net cash proceeds received
                    upon the  exercise  of any  options or  warrants to purchase
                    shares of Capital Stock other than Disqualified Stock (other
                    than to a Subsidiary of the Company) and (b) debt securities
                    or other  securities  that are convertible or exercisable or
                    exchangeable for such Capital Stock that is not Disqualified
                    Stock  and that  have  been so  converted  or  exercised  or
                    exchanged,  after  May 15,  1996;  (3)  aggregate  net  cash
                    proceeds  received  by the  Company  after  the  date of the
                    Indenture as capital  contributions to the Company;  and (4)
                    $20.0 million; or

             (iii)  the Company would not be able to incur an  additional  $1.00
                    of Indebtedness  under the Consolidated  Coverage Ratio test
                    in Section 4.9(a).

             Notwithstanding  the foregoing,  the provisions of this Section 4.7
shall not prevent the following  Restricted  Payments (provided,  however,  that
such Restricted  Payments shall be included for purposes of computing the amount
of  Restricted  Payments  previously  made under  clause  (ii) of the  preceding
paragraph):  (x) the  payment of any  dividend  within 60 days after the date of
declaration  thereof  if the  payment  thereof  would  have  complied  with  the
limitations of this covenant on the date of declaration  and (y) the purchase of
stock held by officers,  directors or employees of the Company whose  employment
or term with the Company has been terminated or who have died or become disabled
in an aggregate amount not to exceed $5.0 million in any fiscal year.

SECTION 4.8 LIMITATIONS ON RESTRICTIONS ON DISTRIBUTIONS FROM SUBSIDIARIES

             The Company shall not, and shall not permit any of its Subsidiaries
to,  create  or  otherwise  cause or suffer  to exist or  become  effective  any
consensual  encumbrance or restriction  (other than encumbrances or restrictions
imposed by law or by judicial or regulatory action or by provisions in leases or
other agreements that restrict the assignability  thereof) on the ability of any
Subsidiary of the Company to (i) pay  dividends or make any other  distributions
on its Capital Stock or any other interest or participation  in, or measured by,
its


                                       27
<PAGE>

profits, owned by the Company or any of its other Subsidiaries,  or pay interest
on or  principal  of any  Indebtedness  owed to the  Company or any of its other
Subsidiaries,  (ii) make loans or  advances  to the  Company or any of its other
Subsidiaries or (iii) transfer any of its properties or assets to the Company or
any of its other Subsidiaries,  except for encumbrances or restrictions existing
under or by reason of (a)  applicable  law, (b) Existing  Indebtedness,  (c) any
restrictions under any agreement  evidencing any Acquired  Indebtedness that was
permitted  to  be  incurred   pursuant  to  Section  4.9,   provided  that  such
restrictions  and  encumbrances  only apply to assets that were  subject to such
restrictions  and  encumbrances  prior to the  acquisition of such assets by the
Company or its  Subsidiaries,  (d) restrictions or encumbrances  replacing those
permitted  by  clause  (b)  or  (c)  which,  taken  as a  whole,  are  not  more
restrictive, (e) this Indenture, (f) any restrictions or encumbrances arising in
connection with  Refinancing  Indebtedness,  provided that any  restrictions and
encumbrances  of the type  described  in this  Section 4.8 that arise under such
Refinancing  Indebtedness are not, taken as a whole, more restrictive than those
under the agreement  creating or evidencing the  Indebtedness  being refunded or
refinanced,  (g) any  restrictions  with respect to a Subsidiary  of the Company
imposed  pursuant to an  agreement  that has been  entered  into for the sale or
other  disposition of all or substantially all of the Capital Stock or assets of
such Subsidiary,  (h) any agreement restricting the sale or other disposition of
property securing Indebtedness if such agreement does not expressly restrict the
ability  of a  Subsidiary  of the  Company  to pay  dividends  or make  loans or
advances  and (i)  customary  restrictions  in  purchase  money  debt or  leases
relating to the property covered thereby.

SECTION 4.9 LIMITATIONS ON ADDITIONAL INDEBTEDNESS

             (a) After the date  hereof,  the Company  shall not,  and shall not
permit any of its Subsidiaries to, directly or indirectly, create, incur, issue,
assume,  guarantee,  extend the  maturity of, or  otherwise  become  liable with
respect  to  (collectively,   "incur"),  any  Indebtedness  (including,  without
limitation,  Acquired  Indebtedness),  unless after giving effect  thereto,  the
Company's Consolidated Coverage Ratio on the date thereof would be at least:

             (i)    2.00 to 1, if such date is on or prior to December 31, 1998,

             (ii)   2.25 to 1, if such date is after December 31, 1998 and on or
                    prior to December 31, 1999, and

             (iii)  2.50 to 1, if such date is after December 31, 1999,

in each  case  determined  on a pro  forma  basis as if the  incurrence  of such
additional  Indebtedness and the application of the net proceeds therefrom,  had
occurred at the  beginning  of the  four-quarter  period used to  calculate  the
Company's Consolidated Coverage Ratio.

             (b)  Notwithstanding  the  foregoing:   (a)  the  Company  and  its
Subsidiaries may (i) incur  Indebtedness under one or more Credit Facilities not
to exceed $700.0  million at any one time  outstanding;  (ii) incur  Refinancing
Indebtedness;  (iii) incur any  Indebtedness  of the Company to any Wholly Owned
Subsidiary  or of  any  Subsidiary  to  the  Company  or  to  any  Wholly  Owned
Subsidiary; (iv) incur any Indebtedness evidenced by letters of credit which are
used in the ordinary  course of business of the Company and its  Subsidiaries to
secure  workers'  compensation  and  other  insurance  coverages;  and (v) incur
Capitalized  Lease Obligations of the Company and its Subsidiaries such that the
aggregate  principal amount of Capitalized  Lease Obligations of the Company and
its  Subsidiaries  then  outstanding,   when  added  to  the  Capitalized  Lease
Obligations to be incurred,  does not exceed 5% of Consolidated Tangible Assets;
and (b) the  Company  and its  Subsidiaries  may incur  additional  Indebtedness
(including additional  Indebtedness under any Credit Facility that is designated
in such Credit  Facility as incurred  under this clause (b)),  provided that the
aggregate principal amount of any such additional Indebtedness outstanding under
this clause (b) at any time,  together with the aggregate  liquidation  value of
any outstanding  Preferred Stock issued by a Subsidiary of the Company, does not
exceed $75.0 million.


                                       28
<PAGE>

             No Subsidiary of the Company shall  Guarantee any  Indebtedness  of
the Company  (including  by way of a pledge of assets)  that is  subordinate  in
right  of  payment  to any  Senior  Indebtedness  unless  such  Subsidiary  also
guarantees the  Securities and waives,  and will not claim or take advantage of,
any rights of reimbursement,  indemnity or subrogation  against the Company as a
result of any payment by such Subsidiary  under its Guarantee of the Securities.
If such other Indebtedness of the Company is (1) pari passu with the Securities,
such  Guarantee  of such pari  passu  Indebtedness  shall be pari  passu with or
expressly subordinated to such Guarantee of the Securities,  or (2) subordinated
in right of payment  to the  Securities,  such  Guarantee  of such  subordinated
Indebtedness   shall  be  expressly   subordinated  to  such  Guarantee  of  the
Securities,  at least to the  extent  that  such  subordinated  Indebtedness  is
subordinated or junior to the  Securities.  Notwithstanding  the foregoing,  any
Guarantee of the  Securities  by a Subsidiary  of the Company may provide by its
terms that it shall be automatically and unconditionally released and discharged
upon the release or discharge of the Guarantee which resulted in the creation of
such  Guarantee  of the  Securities,  except a  discharge  or release by or as a
result of payment  under such  Guarantee  of such other  Indebtedness  or if any
other Guarantee of other Indebtedness is outstanding.

SECTION 4.10 CHANGE IN CONTROL

             (a) Following the occurrence of any Change in Control,  each Holder
will have the  right,  at such  Holder's  option,  to require  that the  Company
purchase  (a "Change  in Control  Repurchase"),  and upon the  exercise  of such
right,  the Company  shall,  subject to the  provisions  of Section 10.3 hereof,
purchase, all or any part of such Holder's Securities on a date (the "Repurchase
Date") that is no earlier  than 30 days nor later than 60 days after the date on
which the Company  gives  notice of a Change in Control as provided in (b) below
at a  purchase  price  equal to 101% of the  aggregate  principal  amount of the
Securities,  plus accrued and unpaid interest thereon, if any, to the Repurchase
Date.

             (b) Within 30 days after any Change in Control,  the Company  (with
notice to the  Trustee)  will mail or cause to be mailed to all  Holders  on the
date of the  Change  in  Control a notice of the  occurrence  of such  Change in
Control and of the Holders'  rights  arising as a result  thereof.  Such notice,
which shall govern the terms of the Change in Control  Repurchase,  shall state:


       1.     that a Change in Control has occurred and that such Holder has the
              right  to  require  the  Company  to   repurchase   such  Holder's
              Securities in cash;

       2.     the  Repurchase  Date (which  will be no earlier  than 30 days nor
              later than 60 days from the date such notice is mailed);

       3.     the purchase price for the repurchase;

       4.     the date by which the repurchase right must be exercised; and

       5.     the instructions  determined by the Company,  consistent with this
              Section  4.10,  that a  Holder  must  follow  in order to have its
              Securities repurchased.

             At the Company's request, the Trustee shall give such notice in the
Company's  name and at its expense;  provided,  however,  that the Company shall
deliver to the Trustee no later than the fifth Business Day preceding the Change
in Control an Officer's Certificate requesting that the Trustee give such notice
and  setting  forth the  information  to be stated in such notice as provided in
this Section 4.10 (b).

             (c) To exercise a repurchase  right,  a Holder shall deliver to the
Company (or a  depositary  or Paying  Agent  designated  by the Company for such
purpose  in the  notice  referred  to in (b)  above),  on or before the close of
business on the  Repurchase  Date,  the Security or  Securities  with respect to
which the repurchase right is being exercised, duly endorsed for transfer to the
Company,  with the form  entitled  "Option of Holder to Elect  Purchase"  on the
reverse of each  Security so delivered  completed.  Holders shall be entitled to
withdraw  their  election  if the  Company (or the  depositary  or Paying  Agent
designated by the Company for the purpose of receiving such election)  receives,
not later than five  Business  Days prior to the  Repurchase  Date,  a telegram,
telex,  facsimile  transmission  or letter setting forth the name of the Holder,
the  principal  amount of the Security or  Securities  the Holder  delivered for
purchase  and a statement  that such Holder is  withdrawing  its election to the
have the Security or Securities purchased.


                                       29
<PAGE>

             (d)  In  the  event  a  repurchase  right  shall  be  exercised  in
accordance with the terms hereof, subject to Article 10, the Company shall on or
promptly  following the  Repurchase  Date pay or cause to be paid in cash to the
Holder  thereof the  repurchase  price of the Security or Securities as to which
the repurchase right has been exercised.  In the event that the repurchase right
is  exercised  with  respect  to less  than the  entire  principal  amount  of a
surrendered  Security,  the Company shall execute and deliver to the Trustee and
the Trustee, upon written order of the Company,  shall authenticate for issuance
in the  name  of the  Holder  a new  Security  or  Securities  in the  aggregate
principal amount of the unrepurchased portion of such surrendered security.

             (e) If the Repurchase Date is on or before an Interest Payment Date
and on or after the related record date, any interest  accrued and unpaid to the
Repurchase  Date  will be paid to the  Person  in  whose  name the  Security  is
registered  at the close of  business  on such record  date,  and no  additional
interest will be payable to Holders who exercise their repurchase right pursuant
to this Section 4.10.

             (f)  Any  Change  in  Control  Repurchase  shall  be  conducted  in
compliance with applicable  tender offer rules,  including  Section 14(e) of the
Exchange Act and Rule 14(e)(1) thereunder.  The Change in Control Repurchase may
not be modified or  conditioned  by the  Company in any manner.

SECTION 4.11 LIMITATIONS  ON ASSET SALES

             The Company shall not, and shall not permit any of its Subsidiaries
to, consummate any Asset Sale unless (i) the Company or its Subsidiaries receive
consideration  at the time of such Asset Sale at least  equal to the fair market
value of the assets or Capital Stock  included in such Asset Sale (as determined
in good faith by the Board of Directors, whose determination shall be conclusive
and  evidenced  by a board  resolution)  and  (ii)  not  less  than  50% of such
consideration  is in the form of cash or Cash  Equivalents  (provided,  however,
that this clause (ii) shall not be applicable to a transaction  involving assets
acquired and  designated as held for sale,  which assets  represent in aggregate
since the date of the Indenture 5% or less of the net tangible assets previously
acquired by the Company or a Subsidiary  pursuant to acquisitions since the date
of the  Indenture  and  which  assets  are  disposed  of no later  than one year
following  their  initial  acquisition).  The Net Proceeds of Asset Sales shall,
within 360 days of receipt  thereof,  (a) be reinvested in the lines of business
of the Company or any of its Subsidiaries  immediately prior to such investment;
(b) be applied to the  payment of the  principal  of, and  interest  on,  Senior
Indebtedness;  (c) be  utilized  to make  any  Investment  in any  other  Person
permitted  under this  Indenture;  or (d) be applied to an offer (an "Asset Sale
Offer") to purchase  outstanding  Securities.  In any such Asset Sale Offer, the
Company  shall offer to purchase  Securities  on a pro rata basis  (unless  such
method is otherwise  prohibited,  in which case the  Securities  to be purchased
shall be selected by lot, with such adjustments as may be deemed  appropriate by
the  Company so that only  Securities  in  denominations  of $1,000 or  integral
multiples  thereof  shall be  purchased,  or in such other manner as the Trustee
shall  deem  fair  and  equitable),  at a  purchase  price  equal to 100% of the
aggregate  principal amount of the Securities,  plus accrued and unpaid interest
to the date of purchase,  in the manner set forth in this  Indenture.  Any Asset
Sale Offer will be conducted in compliance with  applicable  tender offer rules,
including Section 14(e) of the Exchange Act and Rule 14e-1  thereunder.  Any Net
Proceeds remaining  immediately after the completion of any Asset Sale Offer may
be used by the Company or its Subsidiaries for any purpose not inconsistent with
the other provisions of this Indenture.

             Notwithstanding   the  provisions  of  the  immediately   preceding
paragraph,  the Company and its  Subsidiaries  may,  in the  ordinary  course of
business (or, if otherwise than in the ordinary course of business, upon receipt
of a favorable written opinion from an independent financial advisor of national
reputation as to the fairness  from a financial  point of view to the Company or
such Subsidiary of the proposed  transaction),  exchange all or a portion of its
property,  businesses  or assets for  property,  businesses  or assets that,  or
Capital Stock of a Person all or  substantially  all of whose  assets,  are of a
type  used in a  healthcare  related  business,  or a  combination  of any  such
property,  businesses  or assets,  or Capital Stock of such a Person and cash or
Cash  Equivalents;  provided that (i) there shall not exist immediately prior or
subsequent  thereto a Default or an Event of  Default,  (ii) a  majority  of the
disinterested  members  of the Board of  Directors  of the  Company  shall  have
approved a resolution  of the Board of Directors  that such  exchange is fair to
the Company or such  Subsidiary,  as the case may be, and (iii) any cash or Cash
Equivalents received pursuant to any such exchange


                                       30
<PAGE>

shall be applied in the manner  applicable to Net Proceeds of Asset Sales as set
forth pursuant to the provisions of the  immediately  preceding  paragraph;  and
provided,  further,  that any  Capital  Stock of a  Person  received  in such an
exchange  pursuant to this paragraph shall be owned directly by the Company or a
Subsidiary  of the Company and,  when  combined  with the Capital  Stock of such
person already owned by the Company and its  Subsidiaries,  shall result in such
Person becoming a Wholly Owned Subsidiary of the Company.

SECTION 4.12 LIMITATIONS ON TRANSACTIONS WITH AFFILIATES

             Neither  the  Company  nor any of its  Subsidiaries  shall make any
loan, advance,  guarantee or capital  contribution to, or for the benefit of, or
sell,  lease,  transfer or otherwise  dispose of any of its properties or assets
to, or for the benefit of, or purchase or lease any property or assets from,  or
enter into or amend any contract,  agreement or  understanding  with, or for the
benefit  of, any  Affiliate  of the  Company or any of its  Subsidiaries  or any
Person  (or any  Affiliate  of such  Person)  holding  10% or more of the Common
Equity  of  the  Company  or  any  of  its  Subsidiaries   (each  an  "Affiliate
Transaction")  unless (i) such Affiliate  Transactions  are between or among the
Company  and its  Subsidiaries;  (ii)  such  Affiliate  Transactions  are in the
ordinary  course of business and  consistent  with past  practice;  or (iii) the
terms of such Affiliate  Transactions  are fair and reasonable to the Company or
such Subsidiary,  as the case may be, and are at least as favorable as the terms
which could be obtained by the Company or such  Subsidiary,  as the case may be,
in a comparable  transaction made on an arm's-length basis between  unaffiliated
parties.  In the event of any  transaction or series of  transactions  occurring
subsequent to the date of this  Indenture with an Affiliate of the Company which
is not permitted  under clauses (i) or (ii) above and involves in excess of $5.0
million, the terms of such transaction shall be in writing and a majority of the
disinterested  members of the Board of Directors  shall by resolution  determine
that such business or  transaction  meets the criteria set forth in clause (iii)
above.

SECTION 4.13 LIMITATIONS ON LIENS

             The  Company  shall not,  and shall not permit any  Subsidiary  to,
directly or  indirectly,  create,  incur or affirm any Lien of any kind securing
any  Indebtedness  which is pari passu or subordinate in right of payment to the
Securities (including any assumption,  guarantee or other liability with respect
thereto  by  any  Subsidiary)  upon  any  property  or  assets   (including  any
intercompany notes) of the Company or any Subsidiary owned on the date hereof or
hereafter  acquired,  or any income or profits therefrom,  unless the Securities
are directly  secured  equally and ratably with (or, in the case of subordinated
Indebtedness,  prior or senior thereto,  with the same relative  priority as the
Securities  shall  have with  respect  to such  subordinated  Indebtedness)  the
obligation  or liability  secured by such Lien except for Liens (A) securing any
Indebtedness which became Indebtedness pursuant to a transaction permitted under
Section 5.1 hereof or securing Acquired  Indebtedness  which, in each case, were
created prior to (and not created in connection  with, or in  contemplation  of)
the incurrence of such pari passu  Indebtedness or subordinated  Indebtedness by
the Company or any  Subsidiary  and which  Indebtedness  is permitted  under the
provisions  of Section 5.1 hereof,  (B)  securing any  Indebtedness  incurred in
connection with any refinancing,  renewal,  substitutions or replacements of any
such  Indebtedness  described  in  clause  (A) or (C)  created  in  favor of the
Company;  provided,  however,  that in the case of clauses (A) and (B), any such
Lien only  extends to the assets that were  subject to such Lien  securing  such
Indebtedness   prior  to  the  related   acquisition   by  the  Company  or  its
Subsidiaries.

SECTION 4.14. LIMITATIONS ON SUBSIDIARY PREFERRED STOCK
             The Company shall not permit any of its  Subsidiaries  to issue any
Preferred  Stock  (other than to the Company or a Wholly  Owned  Subsidiary)  or
permit any Person (other than the Company or a Wholly Owned  Subsidiary)  to own
or hold any interest in any Preferred Stock of any such  Subsidiary  (other than
Preferred  Stock  issued  prior  to the  date of  this  Indenture),  unless  the
Subsidiary would be permitted to incur  Indebtedness  pursuant to the provisions
of Section 4.9 hereof in the aggregate  principal  amount equal to the aggregate
liquidation value of such Preferred Stock.


                                       31
<PAGE>

SECTION 4.15 LIMITATIONS ON CERTAIN OTHER SUBORDINATED INDEBTEDNESS

             The Company shall not create,  incur, assume or suffer to exist any
Indebtedness that is subordinate in right of payment to any Senior  Indebtedness
unless such Indebtedness by its terms or the terms of the instrument creating or
evidencing  such  Indebtedness  is  subordinate in right of payment to, or ranks
pari passu with, the Securities.

SECTION 4.16 LIMITATIONS ON SUBSIDIARIES AND UNRESTRICTED SUBSIDIARIES

             The Company may, by written  notice to the Trustee,  designate  any
Subsidiary  (including a newly  acquired or a newly formed  Subsidiary) to be an
Unrestricted  Subsidiary;  provided,  however,  that (i) no  Default or Event of
Default shall have occurred and be  continuing  or would arise  therefrom,  (ii)
such  designation,  when  considered  as an  Investment as described in the next
sentence,  is at that time permitted under the covenant  described under Section
4.7 hereof and (iii) immediately  after giving effect to such  designation,  the
Company could incur $1.00 of additional  Indebtedness  pursuant to clause (a) of
Section 4.9 hereof.  For  purposes  of Section 4.7 hereof,  (i) an  "Investment"
shall be deemed to have been made at the time any Subsidiary is designated as an
Unrestricted  Subsidiary in an amount (proportionate to the Company's percentage
Equity Interest in such Subsidiary) equal to the net worth of such Subsidiary at
the time that such Subsidiary is designated as an Unrestricted Subsidiary;  (ii)
at any date the aggregate amount of all Restricted  Payments made as Investments
since May 15, 1996 shall exclude and be reduced by an amount  (proportionate  to
the Company's  percentage  Equity Interest in such Subsidiary)  equal to the net
worth  of any  Unrestricted  Subsidiary  from  and  after  the  date  that  such
Unrestricted  Subsidiary is designated a Subsidiary,  not to exceed, in the case
of any such  redesignation  of an Unrestricted  Subsidiary as a Subsidiary,  the
amount of Investments  previously  made by the Company and its  Subsidiaries  in
such  Unrestricted  Subsidiary (in the case of either clauses (i) or (ii) above,
"net worth" to be  calculated  based upon the fair market value of the assets of
such  Subsidiary  as of any such date of  designation);  and (iii) any  property
transferred to or from an  Unrestricted  Subsidiary  shall be valued at its fair
market  value  at the  time of such  transfer.  As of the  date of the  original
issuance of the Securities, there shall exist no Unrestricted Subsidiaries.

             Notwithstanding  the  foregoing,  the  Board  of  Directors  of the
Company may not  designate any  Subsidiary of the Company to be an  Unrestricted
Subsidiary if, after such designation,  (a) the Company or any Subsidiary of the
Company  provides  credit  support for, or a guarantee of, any  Indebtedness  or
other  obligation  (contingent or otherwise) of such  Subsidiary  (including any
undertaking, agreement or instrument evidencing such Indebtedness or obligation)
or is otherwise subject to recourse or obligated  thereunder or therefor,  (b) a
default with respect to any Indebtedness of such Subsidiary (including any right
which the  holders  thereof may have to take  enforcement  action  against  such
Subsidiary) would permit (upon notice,  lapse of time or both) any holder of any
other  Indebtedness of the Company or any Subsidiary of the Company to declare a
default  on  such  other  Indebtedness  or  cause  the  payment  thereof  to  be
accelerated or payable prior to its final scheduled maturity (whether or not any
such default had occurred or was continuing as of the time of such designation),
(c) such Subsidiary  owns any Equity  Interests in, or owns or holds any Lien on
any property of, any  Subsidiary  which is not a Subsidiary of the Subsidiary to
be so designated, (d) such Subsidiary has any contract,  arrangement,  agreement
or  understanding  with the Company,  or any Subsidiary of the Company,  whether
written or oral, other than a transaction  having terms no less favorable to the
Company or such  Subsidiary of the Company than those which might be obtained at
the time from persons who are not Affiliates of the Company,  or (e) the Company
or any  Subsidiary of the Company has any obligation to subscribe for any Equity
Interest  in such  Subsidiary  or to  maintain  or  preserve  such  Subsidiary's
financial  condition or to cause such Subsidiary to achieve  specified levels of
operating results.


                                       32
<PAGE>

                                   ARTICLE 5.

                                   SUCCESSORS

SECTION 5.1 LIMITATIONS ON MERGERS AND CONSOLIDATIONS

             The Company shall not  consolidate  or merge with or into, or sell,
lease, convey or otherwise dispose of all or substantially all of its assets, or
assign any of its obligations  hereunder or under the Securities,  to any Person
unless:

             (i)    the Person  formed by or  surviving  such  consolidation  or
                    merger (if other than the Company), or to which sale, lease,
                    conveyance or other  disposition or assignment shall be made
                    (collectively,  the "Successor"), is a corporation organized
                    and  existing  under  the laws of the  United  States or any
                    State thereof or the District of Columbia, and the Successor
                    assumes by supplemental  indenture in a form satisfactory to
                    the Trustee all of the obligations of the Company  hereunder
                    and under the Securities;

             (ii)   immediately  after  giving  effect to such  transaction,  no
                    Default  or Event of  Default  shall  have  occurred  and be
                    continuing;

             (iii)  immediately  after giving effect to such transaction and the
                    use of any net proceeds  therefrom on a pro forma basis, the
                    Consolidated  Net Worth of the Company or the Successor,  as
                    the case may be, would be at least equal to the Consolidated
                    Net  Worth  of  the  Company   immediately   prior  to  such
                    transaction; and

             (iv)   the  Consolidate  Coverage  Ratio  of  the  Company  or  the
                    Successor,  as the case  may be,  immediately  after  giving
                    effect to such  transaction,  would on a pro forma  basis be
                    such that the Company or the Successor,  as the case may be,
                    would  be  entitled  to  incur  at  least  $1 of  additional
                    Indebtedness  under the Consolidated  Coverage Ratio test in
                    Section 4.9(a).

             The Company shall deliver to the Trustee prior to the  consummation
of the proposed transaction an Officers' Certificate to the foregoing effect and
an  Opinion  of  Counsel   stating  that  the  proposed   transaction  and  such
supplemental indenture comply with this Indenture.

SECTION 5.2 SUCCESSOR CORPORATION SUBSTITUTED

             Upon any consolidation or merger, or any sale, lease, conveyance or
other  disposition of all or  substantially  all of the assets of the Company or
any  assignment of its  obligations  under this  Indenture or the  Securities in
accordance with Section 5.1, the Successor formed by such  consolidation or into
or with which the Company is merged or to which such sale, lease,  conveyance or
other  disposition  or assignment  is made shall succeed to, and be  substituted
for, and may exercise every right and power of, the Company under this Indenture
with the same effect as if such  Successor has been named as the Company  herein
and the predecessor  Company, in the case of a sale, lease,  conveyance or other
disposition or  assignment,  shall be released from all  obligations  under this
Indenture and the Securities.

                                   ARTICLE 6.

                              DEFAULTS AND REMEDIES

SECTION 6.1 EVENTS OF DEFAULT

             An "Event of Default" occurs if:


                                       33
<PAGE>

             (i)    the Company  defaults in the payment of the principal of, or
                    any premium on, any  Security  when the same becomes due and
                    payable,  whether at Stated Maturity, upon redemption,  upon
                    acceleration or otherwise;

             (ii)   the  Company  defaults  in the  payment of  interest  on any
                    Security  when  the same  becomes  due and  payable  and the
                    Default  continues  for a  period  of 30 days  (even if such
                    payment is prohibited by Article 10 hereof);

            (iii)   the Company  fails to comply with any of its  agreements  or
                    covenants  in, or  provisions  of,  the  Securities  or this
                    Indenture (other than a default in the performance or breach
                    of a covenant or agreement  specifically addressed in clause
                    (1) or (2) of this  Section) and such failure  continues for
                    the period and after the notice specified below;

             (iv)   any  acceleration  of the  maturity of  Indebtedness  of the
                    Company  or its  Subsidiaries  having  in the  aggregate  an
                    outstanding  principal amount of at least $10.0 million or a
                    failure to pay such  Indebtedness  at its  Stated  Maturity;
                    provided  that such  acceleration  or  failure to pay is not
                    cured within 10 days after such  acceleration  or failure to
                    pay;

             (v)    the Company or any of its Significant  Subsidiaries pursuant
                    to  or  within  the  meaning  of  any  Bankruptcy  Law:  (A)
                    commences a voluntary case,

                 (B) consents to the entry of an order for relief  against it in
                 an involuntary case,

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

                 (D) makes   a  general   assignment  for  the  benefit  of  its
                 creditors;

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

                 (A) is for relief against the Company or any of its Significant
                 Subsidiaries as debtor in an involuntary case,

                 (B) appoints   a  Custodian  of  the  Company  or  any  of  its
                 Significant   Subsidiaries   or  a   Custodian   for   all   or
                 substantially  all of the property of the Company or any of its
                 Significant Subsidiaries,  or

                 (C) orders   the  liquidation  of  the  Company  or  any of its
                 Significant  Subsidiaries,  and the  order  or  decree  remains
                 unstayed and in effect for 60 days.

             The  term  "Custodian"  means  any  receiver,   trustee,  assignee,
liquidator or similar official under any Bankruptcy Law.

             The  Trustee  shall not be deemed to know of a Default  unless  the
corporate trust officer having  responsibility  for the  administration  of this
Indenture  on behalf of the  Trustee  has actual  knowledge  of such  Default or
receives written notice of such Default with specific reference to such Default.

             A Default  under clause (iii) is not an Event of Default  until the
Trustee  notifies  the  Company,  or the  Holders  of at least 25% in  aggregate
principal amount of the then outstanding  Securities  notify the Company and the
Trustee, of the Default and the Company does not cure the Default within 45 days
after



                                       34
<PAGE>

receipt of the notice.  The notice must specify the  Default,  demand that it be
remedied and state that the notice is a "Notice of Default."

SECTION 6.2 ACCELERATION

             If an Event of Default (other than an Event of Default with respect
to the Company  specified  in clause (vi) or (vi) of Section  6.1) occurs and is
continuing,  the Trustee by written notice to the Company,  or the Holders of at
least 25% in aggregate  principal amount of the then  outstanding  Securities by
written notice to the Company and the Trustee,  may declare all Securities to be
due and payable  immediately.  Upon such declaration the amounts due and payable
on the Securities, as determined in the next succeeding paragraph,  shall be due
and  payable  immediately.  If an Event of Default  with  respect to the Company
specified  in clause (vi) or (vi) of Section 6.1  occurs,  such an amount  shall
ipso facto become and be immediately  due and payable  without any  declaration,
notice or other act on the part of the Trustee or any  Holder.  The Holders of a
majority in aggregate  principal  amount of the then  outstanding  Securities by
written notice to the Trustee may rescind an acceleration  and its  consequences
if the  rescission  would not  conflict  with any  judgment or decree and if all
existing  Events of Default (except  nonpayment of principal of, or premium,  if
any, or interest on the  Securities  or that  resulted  from a failure to comply
with Section 4.10 in which case a rescission  may be effected only by Holders of
an aggregate  principal  amount of Securities then  outstanding  greater than or
equal to that aggregate  principal amount of Securities which would be necessary
to waive the Default or Event of Default resulting in such acceleration pursuant
to Section 6.4) have been cured or waived.

             In the event that the  maturity of the  Securities  is  accelerated
pursuant to this Section 6.2, 100% of the principal  amount thereof and premium,
if any,  shall  become due and  payable  plus  accrued  interest  to the date of
payment plus interest on defaulted interest to the extent provided herein.

SECTION 6.3 OTHER REMEDIES

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

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

SECTION 6.5 WAIVER OF PAST DEFAULTS

             The Holders of a majority in aggregate principal amount of the then
outstanding  Securities  by written  notice to the Trustee may waive an existing
Default or Event of Default and its consequences, except a continuing Default or
Event of Default in the  payment of the  principal  of, or  premium,  if any, or
interest on any Security or in respect of a provision under this Indenture which
cannot be modified or amended without the consent of the Holder of each Security
then  outstanding or the Holders of at least 66 2/3% of the aggregate  principal
amount of Securities  outstanding,  as applicable  (in which case the consent of
the Holder of each Security then  outstanding or the Holders of at least 66 2/3%
of the aggregate principal amount of Securities outstanding, as the case may be,
shall be  required  to  consent  to a waiver of such  provision).  Upon any such
waiver,  such  Default  shall cease to exist,  and any Event of Default  arising
therefrom  shall  be  deemed  to have  been  cured  for  every  purpose  of this
Indenture; but no such waiver shall extend to any subsequent or other Default or
Event of Default or impair any right or remedy consequent thereon.

SECTION 6.5 CONTROL BY MAJORITY

         The Holders of a majority  in  aggregate  principal  amount of the then
outstanding  Securities may direct the time,  method and place of conducting any
proceeding for any remedy available to the Trustee or exercising


                                       35
<PAGE>

any trust or power  conferred on it.  However,  the Trustee may refuse to follow
any  direction  that  conflicts  with law or this  Indenture,  that the  Trustee
determines may be unduly prejudicial to the rights of other Holders, or that may
involve the Trustee in personal  liability,  in each case as  determined  by the
Trustee.

SECTION 6.6 LIMITATIONS ON SUITS

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

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

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

             (3)  such  Holder  or  Holders  offer  to  the  Trustee   indemnity
satisfactory to the Trustee in its sole discretion  against any loss,  liability
or expense;

             (4) the Trustee  does not comply  with the  request  within 60 days
after receipt of the request and the offer of indemnity; and

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

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

SECTION 6.7 RIGHTS OF HOLDERS TO RECEIVE PAYMENT

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

SECTION 6.8 COLLECTION SUIT BY TRUSTEE

             If an Event of Default  specified in Section  6.1(i) or (ii) occurs
and is continuing, the Trustee is authorized to recover judgment in its own name
and as  trustee  of an  express  trust  against  the  Company  for the amount of
principal of, premium,  if any, and interest remaining unpaid on the Securities,
determined in accordance with Section 6.2, and interest on overdue principal and
premium, if any, and, to the extent lawful,  interest on overdue installments of
interest,  and such further amount as shall be sufficient to cover the costs and
expenses  of  collection,  including  the  reasonable  compensation,   expenses,
disbursements and advances of the Trustee, its agents and counsel.

SECTION 6.9 TRUSTEE MAY FILE PROOFS OF CLAIM

             The  Trustee is  authorized  to file such proofs of claim and other
papers or documents as may be necessary or advisable in order to have the claims
of the Trustee (including any claim for the reasonable  compensation,  expenses,
disbursements  and  advances of the  Trustee,  its agents and  counsel)  and the
Holders  allowed  in any  judicial  proceedings  relative  to the  Company,  its
creditors  or its  property  and shall be  entitled  and  empowered  to collect,
receive and distribute any money or other property payable or deliverable on any
such  claims  and any  Custodian  in any  such  judicial  proceeding  is  hereby
authorized by each Holder to make such payments to the Trustee, and in the event
that the Trustee shall  consent to the making of such  payments  directly to the
Holders,  to  pay to the  Trustee  any  amount  due  to it  for  the  reasonable
compensation,  expenses,  disbursements and advances of the Trustee,  its agents
and counsel, and any other amounts due the Trustee


                                       36
<PAGE>

under  Section  7.6. To the extent  that the  payment of any such  compensation,
expenses, disbursements and advances of the Trustee, its agents and counsel, and
any other  amounts  due the Trustee  under  Section 7.6 out of the estate in any
such  proceeding,  shall be denied for any reason,  payment of the same shall be
secured  by a Lien on,  and  shall be paid  out of,  any and all  distributions,
dividends,  money,  securities  and other  properties  which the  Holders of the
Securities may be entitled to receive in such proceeding  whether in liquidation
or under any plan of reorganization or arrangement or otherwise.  Nothing herein
contained shall be deemed to authorize the Trustee to authorize or consent to or
accept or adopt on behalf of any Holder any plan of reorganization, arrangement,
adjustment or  composition  affecting the Securities or the rights of any Holder
thereof,  or to  authorize  the  Trustee  to vote in respect of the claim of any
Holder in any such  proceeding;  provided,  however,  that the  Trustee  may, on
behalf of the Holders,  vote for the election of a trustee (or similar official)
in bankruptcy and may be a member of the creditors' committee.

SECTION 6.10 PRIORITIES

             If the Trustee  collects  any money  pursuant to this Article 6, it
shall pay out the money in the following order:

             First: to the Trustee for amounts due under Section 7.6;

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

             Third: to the Company.

             The Trustee may fix a record date and payment  date for any payment
to Holders pursuant to this Article.

SECTION 6.11 UNDERTAKING FOR COSTS

             In any suit for the  enforcement  of any right or remedy under this
Indenture  or in any suit against the Trustee for any action taken or omitted by
it as a Trustee,  a court in its  discretion may require the filing by any party
litigant  in the suit of an  undertaking  to pay the costs of the suit,  and the
court in its  discretion  may  assess  reasonable  costs,  including  reasonable
attorneys'  fees,  against any party litigant in the suit,  having due regard to
the merits and good faith of the claims or defenses made by the party  litigant.
This Section  6.11 does not apply to a suit by the  Trustee,  a suit by a Holder
pursuant  to  Section  6.7 or a suit by  Holders  of more than 10% in  principal
amount of the then outstanding Securities.

                                   ARTICLE 7.
                                     TRUSTEE

SECTION 7.1 DUTIES OF TRUSTEE

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

             (2) Except during the continuance of an Event of Default:

             (a)  the  Trustee   need   perform   only  those  duties  that  are
specifically set forth in this Indenture and no others, and no implied covenants
or obligations shall be read into this Indenture against the Trustee; and

             (b) the Trustee shall have no duty to inquire as to the performance
of the Company's  covenants  herein and in the absence of bad faith on its part,
the Trustee may  conclusively  rely, as to the truth of the  statements  and the
correctness of the opinions  expressed  therein,  upon  certificates or opinions
furnished to the Trustee and conforming to the  requirements  of this Indenture;
however,  the Trustee shall


                                       37
<PAGE>

examine the  certificates  and  opinions to  determine  whether or not, on their
face, they appear to conform to the requirements of this Indenture.

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

             (i)    this paragraph does not limit the effect of paragraph (2) of
                    this Section;

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

             (iii)  the Trustee  shall not be liable with  respect to any action
                    it takes or omits to take in good faith in accordance with a
                    direction received by it pursuant to Section 6.5.

             (3) Whether or not therein  expressly so provided,  every provision
of  this  Indenture  that  in any way  relates  to the  Trustee  is  subject  to
paragraphs (1), (2), (3) and (5) of this Section 7.1.

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

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

SECTION 7.2 RIGHTS OF TRUSTEE

             (1) Subject to Section  7.1,  the Trustee may rely on any  document
believed by it to be genuine and to have been signed or  presented by the proper
Person,  and the Trustee need not  investigate  any fact or matter stated in the
document.

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

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

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

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

SECTION 7.3 INDIVIDUAL RIGHTS OF TRUSTEE

             The Trustee in its  individual or any other capacity may become the
owner or pledgee of Securities and may otherwise deal with the Company or any of
its  Affiliates  with the same rights it would have if it were not Trustee.  Any
Agent may do the same with like rights.


                                       38
<PAGE>

SECTION 7.4 TRUSTEE'S DISCLAIMER

             The Trustee makes no  representation as to the validity or adequacy
of this  Indenture or the  Securities or as to the Company's  ability to pay the
Securities when and as due or perform its other obligations hereunder.  It shall
not be accountable  for the Company's use of the proceeds from the Securities or
any  money  paid to the  Company  or upon  the  Company's  direction  under  any
provision  hereof. It shall not be responsible for the use or application of any
money  received  by any Paying  Agent  other than the  Trustee.  It shall not be
responsible  for  any  statement  or  recital  herein  or any  statement  in the
Securities other than its certificate of authentication.

SECTION 7.5 NOTICE OF DEFAULTS

             If a Default or Event of Default occurs and is continuing and if it
is  known  to  the  corporate  trust  officer  having   responsibility  for  the
administration  of this  Indenture on behalf of the Trustee,  the Trustee  shall
mail to Holders a notice of the Default or Event of Default within 90 days after
it occurs. Except in the case of a Default or Event of Default in payment of the
principal  of, or premium,  if any, or interest on any Security or that resulted
from a failure by the  Company to comply  with  Section  4.10,  the  Trustee may
withhold the notice if it in good faith  determines that  withholding the notice
is in the interests of Holders.

SECTION 7.6 COMPENSATION AND INDEMNITY

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

             The Company shall indemnify the Trustee,  its employees,  officers,
directors and agents and any predecessor  Trustee  hereunder  against any claim,
demand,  loss,  liability  or  expense  incurred  by  it  arising  out  of or in
connection  with the  acceptance  or  administration  of its  duties  under this
Indenture or in connection with enforcing this  indemnification  provision,  the
offering and sale of the  Securities,  any act of negligence or bad faith of the
Company or of any of its officers, employees, agents or licensees, except as set
forth in the next  paragraph.  The Trustee  promptly shall notify the Company of
any claim for which it may seek  indemnity.  The Company  shall defend the claim
and the Trustee  shall  cooperate in the defense.  The Trustee may have separate
counsel  and the  Company  shall pay the  reasonable  fees and  expenses of such
counsel.  The Company need not pay for any settlement  made without its consent,
which consent shall not be unreasonably withheld.

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

             To secure the Company's  payment  obligations  in this Section 7.6,
the Trustee  shall have a Lien prior to the  Securities on all money or property
held or collected by the Trustee, except that held in trust to pay principal of,
premium, if any, and interest on particular Securities.  Such Lien shall survive
the satisfaction and discharge of this Indenture.

             When the Trustee incurs expenses or renders services after an Event
of Default  specified  in Section  6.1(v) or (vi)  occurs,  the expenses and the
compensation   for  the  services  are  intended  to   constitute   expenses  of
administration under any Bankruptcy Law.

             The provisions of this Section 7.6 shall survive the resignation or
removal of the Trustee and the termination of this Indenture.


                                       39
<PAGE>

SECTION 7.7 REPLACEMENT OF TRUSTEE

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

             The  Trustee  may resign and be  discharged  from the trust  hereby
created by so  notifying  the  Company.  The Holders of a majority in  principal
amount of the then outstanding Securities may remove the Trustee by so notifying
the Trustee and the Company. The Company may remove the Trustee if:

             (1)  the Trustee fails to comply with Section 310(b) of the TIA;

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

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

             (4)  the Trustee becomes incapable of acting.

             If the Trustee  resigns or is removed or if a vacancy exists in the
office of Trustee for any reason, the Company shall promptly appoint a successor
Trustee.

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

             If the  Trustee  fails to comply with  Section 310 of the TIA,  any
Holder may petition any court of competent  jurisdiction  for the removal of the
Trustee and the appointment of a successor Trustee.

             A  successor  Trustee  shall  deliver a written  acceptance  of its
appointment  to  the  retiring  Trustee  and  to  the  Company.   Thereupon  the
resignation or removal of the retiring Trustee shall become  effective,  and the
successor  Trustee  shall have all the rights,  powers and duties of the Trustee
under  this  Indenture.  The  successor  Trustee  shall  mail  a  notice  of its
succession to Holders. The retiring Trustee shall promptly transfer all property
held by it as Trustee to the successor Trustee, subject to the Lien provided for
in Section  7.6.  Notwithstanding  replacement  of the Trustee  pursuant to this
Section 7.7, the Company's  obligations under Section 7.6 shall continue for the
benefit of the retiring Trustee.

SECTION 7.8 SUCCESSOR TRUSTEE BY MERGER, ETC.

             Subject to Section  7.9,  if the  Trustee  consolidates,  merges or
converts  into, or transfers  all or  substantially  all of its corporate  trust
business to, another corporation,  the successor corporation without any further
act shall be the successor Trustee.

SECTION 7.9 ELIGIBILITY; DISQUALIFICATION

             There  shall at all times be a Trustee  hereunder  which shall be a
bank or  corporation  organized and doing  business under the laws of the United
States of America,  any state  thereof or the  District  of Columbia  authorized
under  such laws to  exercise  corporate  trustee  power,  shall be  subject  to
supervision  or  examination  by Federal or state (or the  District of Columbia)
authority and shall have a combined  capital and surplus of at least $50 million
as set forth in its most recent published annual report of condition.

             This  Indenture  shall  always  have a Trustee  who  satisfies  the
requirements of TIA ss.  310(a)(1) and 310(a)(2).  The Trustee is subject to TIA
ss. 310(b).  If at any time the Trustee shall cease to be eligible in accordance
with the provisions of this Section,  it shall resign  immediately in the manner
and with the effect specified in Section 7.7.


                                       40
<PAGE>

                                   ARTICLE 8.

                             DISCHARGE OF INDENTURE

SECTION 8.1 TERMINATION OF COMPANY'S OBLIGATIONS

             (a) This Indenture shall cease to be of further effect (except that
the Company's obligations under Section 7.6 and the Trustee's and Paying Agent's
obligations  under Section 8.3 shall  survive) when all  outstanding  Securities
theretofore  authenticated and issued have been delivered (other than destroyed,
lost or stolen  Securities  that have been  replaced or paid) to the Trustee for
cancellation and the Company has paid all sums payable  hereunder.  In addition,
the Company may elect to have either  paragraph  (b) or  paragraph  (c) below be
applied to the  outstanding  Securities  upon compliance with the conditions set
forth in paragraph (d).

             (b) Upon the Company's  exercise under  paragraph (a) of the option
applicable  to this  paragraph  (b),  the  Company  shall be deemed to have been
released and discharged  from its  obligations  with respect to the  outstanding
Securities   on  the  date  the   conditions   set  forth  below  are  satisfied
(hereinafter, "legal defeasance"). For this purpose, such legal defeasance means
that the  Company  shall  be  deemed  to have  paid and  discharged  the  entire
indebtedness  represented by the outstanding Securities,  which shall thereafter
be deemed to be  "outstanding"  only for the  purposes  of the  Sections  of and
matters  under this  Indenture  referred to in (i) and (ii)  below,  and to have
satisfied all its other  obligations  under such  Securities  and this Indenture
insofar as such Securities are concerned (and the Trustee, at the expense of the
Company,  shall execute proper instruments  acknowledging the same),  except for
the  following  which shall  survive  until  otherwise  terminated or discharged
hereunder: (i) the rights of Holders of outstanding Securities to receive solely
from the trust fund described in paragraph (d) below and as more fully set forth
in such paragraph, payments in respect of the principal of, premium, if any, and
interest on such  Securities  when such  payments  are due,  (ii) the  Company's
obligations  with respect to such  Securities  under  Sections 2.5, 2.6 and 4.2,
and, with respect to the Trustee,  under Section 7.6, (iii) the rights,  powers,
trusts,  duties and  immunities  of the Trustee  hereunder and (iv) this Section
8.1.  Subject to compliance  with this Section 8.1, the Company may exercise its
option under this paragraph (b) notwithstanding the prior exercise of its option
under paragraph (c) below with respect to the Securities.

             (c) Upon the Company's  exercise under  paragraph (a) of the option
applicable to this  paragraph  (c), the Company shall be released and discharged
from its obligations  under any covenant  contained in Article 5 and in Sections
4.3, 4.4 and 4.6 through 4.16 with respect to the outstanding  Securities on and
after the date the  conditions  set  forth  below  are  satisfied  (hereinafter,
"covenant defeasance"),  and the Securities shall thereafter be deemed to be not
"outstanding" for the purpose of any direction,  waiver,  consent or declaration
or act of Holders (and the  consequences of any thereof) in connection with such
covenants,  but shall continue to be deemed "outstanding" for all other purposes
hereunder.  For this purpose,  such covenant defeasance means that, with respect
to the  outstanding  Securities,  the  Company may omit to comply with and shall
have no liability in respect of any term,  condition or limitation  set forth in
any such covenant,  whether  directly or indirectly,  by reason of any reference
elsewhere  herein to any such covenant or by reason of any reference in any such
covenant  to any  other  provision  herein  or in any  other  document  and such
omission to comply shall not  constitute a Default or an Event of Default  under
Section 6.1, but, except as specified above, the remainder of this Indenture and
such  Securities  shall be unaffected  thereby.

             (d) The following  shall be the  conditions to the  application  of
either paragraph (b) or (c) above to the outstanding Securities:

         (1) the Company has irrevocably deposited in trust with the Trustee or,
at the option of the Trustee, with a trustee satisfactory to the Trustee and the
Company under the terms of an irrevocable  trust agreement in form and substance
satisfactory  to the Trustee in its sole  discretion,  money or U.S.  Government
Obligations sufficient to pay principal of, premium, if any, and interest on the
Securities to maturity or redemption (in the opinion of a nationally  recognized
accounting  firm of  independent  certified  public  accountants  expressed in a
written certificate  delivered to the Trustee) and to pay all other sums payable
by it



                                       41
<PAGE>

hereunder;  provided  that (i) the trustee of the  irrevocable  trust shall have
been  irrevocably  instructed  to pay such  money or the  proceeds  of such U.S.
Government  Obligations  to the  Trustee  and (ii) the  Trustee  shall have been
irrevocably  instructed  to  apply  such  money  or the  proceeds  of such  U.S.
Government  Obligations to the payment of said principal,  premium,  if any, and
interest with respect to the Securities;

             (2)  the  Company  has   delivered  to  the  Trustee  an  Officer's
Certificate  stating that (a) all conditions  precedent provided for relating to
either the legal defeasance under paragraph (b) above or the covenant defeasance
under  paragraph (c) above,  as the case may be, have been complied with and (b)
if any other Indebtedness of the Company shall then be outstanding or committed,
such legal defeasance or covenant  defeasance will not violate the provisions of
the agreements or instruments evidencing such Indebtedness;

             (3) no  Default  or Event of Default  shall  have  occurred  and be
continuing on the date of such deposit;

             (4) the Trustee shall not have  received  notice from any holder of
Bank Debt or any holder of Senior  Indebtedness in an aggregate principal amount
in excess of $20 million that such legal defeasance or covenant defeasance would
violate the provisions of the agreements or instruments  evidencing  such Senior
Indebtedness;

             (5) such legal  defeasance or covenant  defeasance shall not result
in a breach or violation of, or constitute a default or event of default  under,
this  Indenture  or any other  material  agreement  or  instrument  to which the
Company is a party or by which it is bound;

             (6) in the case of an  election  under  paragraph  (b)  above,  the
Company  shall  have  delivered  to the  Trustee  an  Opinion  of  Counsel  from
nationally  recognized  counsel  acceptable to the Trustee  stating that (x) the
Company has received from, or there has been published by, the Internal  Revenue
Service a ruling, (y) there exists controlling precedent,  or (z) since the date
of this Indenture,  there has been a change in the applicable Federal income tax
law, in any case to the effect that the  Holders of the  outstanding  Securities
will not  recognize  income,  gain or loss for Federal  income tax purposes as a
result of such legal defeasance and will be subject to federal income tax on the
same  amount and in the same  manner and at the same time as would have been the
case if such legal defeasance had not occurred; and

             (7) in the case of an  election  under  paragraph  (c)  above,  the
Company  shall  have  delivered  to the  Trustee  an  Opinion  of  Counsel  from
nationally  recognized  counsel acceptable to the Trustee (i) to the effect that
the Holders of the  outstanding  Securities will not recognize  income,  gain or
loss for Federal income tax purposes as a result of such covenant defeasance and
will be subject to Federal  income tax on the same amount and in the same manner
and at the same time as would have been the case if such covenant defeasance had
not  occurred  or (ii) that the  Company has  received  from,  or there has been
published by, the Internal Revenue Service a ruling to the foregoing effect.

             After such  irrevocable  deposit made  pursuant to this Section 8.1
and  satisfaction  of the other  conditions  set forth herein,  the Trustee upon
request shall acknowledge in writing the discharge of the Company's  obligations
under this Indenture except for those surviving obligations specified above.

             The  Company  may  make an  irrevocable  deposit  pursuant  to this
Section  8.1 only if at such time it is not  prohibited  from doing so under the
provisions of Article 10 and the Company shall have delivered to the Trustee and
any Paying Agent an Officers' Certificate to that effect.

             In order  to have  money  available  on a  payment  date to pay the
principal  of,  premium,  if  any,  or  interest  on the  Securities,  the  U.S.
Government  Obligations  shall be payable as to principal,  premium,  if any, or
interest  on or before such  payment  date in such  amounts as will  provide the
necessary money to effect the applicable defeasance. U.S. Government Obligations
shall not be callable at the issuer's option.


                                       42
<PAGE>

SECTION 8.2 APPLICATION OF TRUST MONEY

             The  Trustee  or a  trustee  satisfactory  to the  Trustee  and the
Company shall hold in trust money or U.S. Government  Obligations deposited with
it pursuant to Section  8.1.  It shall apply the  deposited  money and the money
from U.S. Government Obligations through the Paying Agent and in accordance with
this Indenture to the payment of principal of, premium,  if any, and interest on
the Securities.

SECTION 8.3 REPAYMENT TO THE COMPANY

             The Trustee and the Paying Agent shall  promptly pay to the Company
upon written request any excess money or securities held by them at any time.

             The Trustee and the Paying  Agent shall pay to the Company at their
option  or upon  written  request  any  money  held by them for the  payment  of
principal,  premium,  if any, or interest  that remains  unclaimed for two years
after the date upon which such payment shall have become due; provided, however,
that the Company shall have either caused notice of such payment to be mailed to
each Holder  entitled  thereto no less than 30 days prior to such  repayment  or
within such period shall have published such notice in a financial  newspaper of
widespread  circulation  published in The City of New York. After payment to the
Company,  Holders  entitled to the money must look to the Company for payment as
general creditors unless an applicable abandoned property law designates another
Person,  and all  liability of the Trustee and such Paying Agent with respect to
such money shall cease.

SECTION 8.4 REINSTATEMENT

             If the Trustee or Paying Agent is unable to apply any money or U.S.
Government  Obligations  in  accordance  with Section 8.1 by reason of any legal
proceeding  or by reason of any order or judgment  of any court or  governmental
authority enjoining,  restraining or otherwise prohibiting such application, the
Company's  obligations  under this Indenture and the Securities shall be revived
and  reinstated as though no deposit had occurred  pursuant to Section 8.1 until
such time as the Trustee or Paying Agent is permitted to apply all such money or
U.S. Government  Obligations in accordance with Section 8.1; provided,  however,
that if the Company  has made any payment of premium,  if any, or interest on or
principal of any Securities because of the reinstatement of its obligations, the
Company shall be  subrogated to the rights of the Holders of such  Securities to
receive such payment from the money or U.S.  Government  Obligations held by the
Trustee or Paying Agent.

                                   ARTICLE 9.

                                   AMENDMENTS

SECTION 9.1 WITHOUT CONSENT OF HOLDERS

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

             (1)  to comply with Section 5.1;

             (2) to  evidence  and  provide for the  acceptance  of  appointment
hereunder by a successor Trustee with respect to the Securities;

             (3) to comply with a provision or provisions of the TIA  applicable
to this Indenture;

             (4) to add to the  covenants  of the Company for the benefit of the
Holders or an additional Event of Default or to provide for the surrender by the
Company of any right or power conferred upon it hereunder;

             (5) to secure the  Securities  or provide  for any  Guarantee  by a
Subsidiary;


                                       43
<PAGE>

             (6) to provide for the  issuance  of  securities  identical  in all
material respects to the Rule 144A Notes pursuant to the Exchange Offer; or

             (7) to cure any  ambiguity,  correct or  supplement  any  provision
which may be defective or  inconsistent  with any other  provision  contained in
this  Indenture,  or make any  provisions  with  respect to matters or questions
arising under this Indenture which shall not be inconsistent with the provisions
of this  Indenture,  provided  that  such  modification  or  amendment  does not
adversely affect the interests of the Holders.

             Upon the request of the Company, accompanied by a resolution of the
Board of Directors authorizing the execution of any such supplemental indenture,
and upon receipt by the Trustee of the  documents  described in Section 9.6, the
Trustee  shall  join  with the  Company  in the  execution  of any  supplemental
indenture  authorized  or permitted by the terms of this  Indenture and make any
further  appropriate  agreements and stipulations that may be therein contained,
but the Trustee shall not be obligated to enter into any supplemental  indenture
that  affects its own  rights,  duties or  immunities  under this  Indenture  or
otherwise.  After an amendment or waiver under this Section  becomes  effective,
the Company shall mail to the Holders of each Security affected thereby a notice
briefly  describing the amendment or waiver.  Any failure of the Company to mail
such notice,  or any defect therein,  shall not,  however,  in any way impair or
affect the validity of any such supplemental indenture.

SECTION 9.2 WITH CONSENT OF HOLDERS

             Except as provided in this Section 9.2, the Company and the Trustee
may amend this  Indenture  or the  Securities  with the  written  consent of the
Holders  of at least a  majority  in  principal  amount of the then  outstanding
Securities.

             Upon the request of the Company, accompanied by a resolution of the
Board of Directors authorizing the execution of any such supplemental indenture,
and upon the filing  with the  Trustee of evidence of the consent of the Holders
as  aforesaid,  and upon  receipt by the Trustee of the  documents  described in
Section  9.6, the Trustee  shall join with the Company in the  execution of such
supplemental  indenture unless such supplemental indenture affects the Trustee's
own rights,  duties or immunities  under this  Indenture or otherwise,  in which
case the Trustee may in its  discretion,  but shall not be  obligated  to, enter
into such supplemental indenture.

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

             The Holders of a majority  in  principal  amount of the  Securities
then  outstanding may waive  compliance in a particular  instance by the Company
with any provision of this Indenture or the Securities. However, (a) without the
consent of each Holder  affected,  an amendment or waiver under this Section may
not:

             (1)  change  the  Stated  Maturity  of  the  principal  of,  or any
installment of interest on, any Security;

             (2) reduce the principal amount of, or premium, if any, or interest
on, any Security;

             (3) change the place of payment  where,  or the coin or currency in
which, any Security or any premium or interest thereon is payable;

             (4)  impair  the  right  of  Holders  to  institute  suit  for  the
enforcement of payment of the principal of and premium,  if any, and interest on
Securities  on or  after  the  Stated  Maturity  thereof  (or  in  the  case  of
redemption, on or after the redemption date);


                                       44
<PAGE>

             (5) reduce the percentage in principal  amount of  Securities,  the
consent of whose  Holders is required for any  modification  or amendment of the
Indenture,  or the  consent  of whose  Holders  is  required  for any  waiver of
compliance  with certain  provisions  of this  Indenture or certain  Defaults or
Events  of  Default  hereunder  and  their  consequences  provided  for in  this
Indenture; or

             (6) modify any of the  provisions  of Section  6.4 or clause (a) of
this sentence of this Section 9.2, and (b) without the consent of the Holders of
at  least  66  2/3%  of  the  aggregate  principal  amount  of  the  outstanding
Securities, an amendment or waiver may not:

             (1)  amend,  change or  modify  the  provisions  of  Article  Three
                  relating  to the  optional  redemption  of  Securities  by the
                  Company in accordance with Section 3.7 hereof;

             (2)  amend,  change or modify the  obligations  of the Company with
                  respect to a Change in Control Repurchase  pursuant to Section
                  4.10  hereof or modify any of the  provisions  or  definitions
                  relating thereto; or

             (3)  modify or  change  any  provision  of  Article  10 in a manner
                  adverse to Holders of the Securities; or

             (4)  modify any of the provisions of clause (b) of this sentence of
                  this Section 9.2.

             The right of any Holder to participate  in any consent  required or
sought  pursuant to any provision of this  Indenture  (and the obligation of the
Company to obtain any such consent  otherwise  required from such Holder) may be
subject to the requirement that such Holder shall have been the Holder of record
of any Securities with respect to which such consent is required or sought as of
a date identified by the Trustee in a notice  furnished to Holders in accordance
with the terms of this Indenture.

SECTION 9.3 COMPLIANCE WITH TRUST INDENTURE ACT

             Every amendment to this Indenture or the Securities shall comply in
form and substance with the TIA as then in effect.

SECTION 9.4 REVOCATION AND EFFECT OF CONSENTS

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

             The Company may,  but shall not be obligated  to, fix a record date
for the purpose of determining the Holders  entitled to consent to any amendment
or waiver.  If the  Company  elects to fix a record date for such  purpose,  the
record  date  shall  be fixed at (i) the  later  of 30 days  prior to the  first
solicitation  of such  consent  or the date of the most  recent  list of Holders
furnished to the Trustee prior to such solicitation,  or (ii) such other date as
the Company shall designate. If a record date is fixed, then notwithstanding the
provisions  of the  immediately  preceding  paragraph,  those  Persons  who were
Holders at such record date (or their duly designated  proxies),  and only those
Persons,  shall be entitled to consent to such  amendment or waiver or to revoke
any consent previously given, whether or not such Persons continue to be Holders
after such record date.  No consent shall be valid or effective for more than 90
days after such record date unless consents from Holders of the principal amount
of Securities  required  hereunder for such  amendment or waiver to be effective
shall have also been given and not revoked within such 90-day period.


                                       45
<PAGE>

SECTION 9.5 NOTATION ON OR EXCHANGE OF SECURITIES

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

SECTION 9.6 TRUSTEE TO SIGN AMENDMENTS, ETC.

             The Trustee  shall sign any  amendment  or  supplemental  indenture
authorized pursuant to this Article 9 if the amendment does not adversely affect
the rights,  duties,  liabilities or immunities of the Trustee.  If it does, the
Trustee  may,  but need  not,  sign it.  In  signing  or  refusing  to sign such
amendment or  supplemental  indenture,  the Trustee shall be entitled to receive
and, subject to Section 7.1 and 7.2 shall be fully protected in relying upon, an
Officers' Certificate and an Opinion of Counsel as conclusive evidence that such
amendment  or  supplemental   indenture  is  authorized  or  permitted  by  this
Indenture,  that it is not inconsistent  herewith, and that it will be valid and
binding upon the Company in accordance with its terms.

                                  ARTICLE 10.

                                  SUBORDINATION

SECTION 10.1 SECURITIES SUBORDINATED TO SENIOR INDEBTEDNESS

             The Company covenants and agrees, and each Holder of a Security, by
his acceptance thereof,  likewise covenants and agrees,  that, to the extent and
in the  manner  hereinafter  set  forth in this  Article  10,  the  indebtedness
represented by the Securities  and all Payments or  Distributions  in Respect of
the Securities are hereby  expressly  made  subordinate  and subject in right of
payment  to the  prior  payment  in full  of all  Senior  Indebtedness,  whether
outstanding on the date of this Indenture or thereafter incurred.

             If at any time  following  the payment of any amount to a holder of
Senior  Indebtedness with respect to such Senior  Indebtedness,  such payment is
rescinded  or must  otherwise  be returned  by such holder upon the  insolvency,
bankruptcy,  reorganization,  dissolution  or  liquidation of the Company or any
other  Person or  otherwise,  and is so  rescinded  or  returned to the party or
parties making such payment, such Senior Indebtedness shall be reinstated to the
extent of such payment and the provisions of this Article 10 shall be applicable
as if such payment were never made.

             The  provisions  of this  Article  10 are for  the  benefit  of the
holders  of  Senior  Indebtedness,  and each  Holder of the  Securities,  by his
purchase or other  acquisition of the Securities,  hereby agrees for the benefit
of each holder of Senior  Indebtedness  that his  Securities  are subject to the
provisions of this Article 10.

SECTION 10.2 PAYMENT OVER OF PROCEEDS UPON DISSOLUTION, ETC.

             In  the  event  of  (a)  any  insolvency  or  bankruptcy   case  or
proceeding,  or any receivership,  liquidation,  reorganization or other similar
case or proceeding,  relative to the Company or to its creditors, as such, or to
a substantial  part of its assets,  or (b) any proceeding  for the  liquidation,
dissolution or other winding up of the Company, whether voluntary or involuntary
and whether or not involving insolvency or bankruptcy, or (c) any assignment for
the benefit of creditors or any other  marshalling of assets and  liabilities of
the Company, then and in any such event the holders of Senior Indebtedness shall
be entitled to receive payment in full of all amounts due or to become due on or
in  respect of all  Senior  Indebtedness  (including,  without  limitation,  all
Allowed and Disallowed  Post-Commencement  Interest and Expenses),  or provision
shall be made for such payment in cash or in a manner otherwise  satisfactory to
the holders of Senior  Indebtedness,  before the Holders of the  Securities  are
entitled  to receive any Payment or  Distribution  in Respect of the  Securities
(other than payments of amounts  deposited  prior to any such case,  proceeding,
dissolution  or other  winding  up or event in  accordance  with the  defeasance
provisions  of  Article  8  hereof),  and to that  end  the  holders  of  Senior
Indebtedness  shall be  entitled  to  receive,  for  application  to the payment


                                       46
<PAGE>

thereof, any payment or distribution of any kind or character,  whether in cash,
property or securities,  including any such payment or distribution which may be
payable or deliverable by reason of the payment of any other indebtedness of the
Company  being  subordinated  to the  payment  of the  Securities,  which may be
payable  or  deliverable  in  respect  of  the  Securities  in  any  such  case,
proceeding, dissolution, liquidation or other winding up or event.

             In the event that, notwithstanding the foregoing provisions of this
Section,  the  Trustee or the Holder of any  Security  shall have  received  any
Payment  or  Distribution  in  Respect  of  the  Securities  in any  such  case,
proceeding,  dissolution,  liquidation  or other winding up or event (other than
payments of amounts deposited prior to any such case, proceeding, dissolution or
other  winding  up or event in  accordance  with the  defeasance  provisions  of
Article 8  hereof),  including  any such  payment or  distribution  which may be
payable or deliverable by reason of the payment of any other indebtedness of the
Company being  subordinated to the payment of the Securities,  before all Senior
Indebtedness  (including,   without  limitation,   all  Allowed  and  Disallowed
Post-Commencement  Interest  and  Expenses)  is paid in full or payment  thereof
provided for, and, if (i) subject to Section 10.8,  such fact shall, at or prior
to the  time of such  payment  or  distribution,  have  been  made  known to the
Trustee,  then and in such event such payment or distribution shall be paid over
or  delivered   forthwith  to  the  holders  of  Senior  Indebtedness  or  to  a
representative   duly  appointed  by  any  such  holder  or  holders  of  Senior
Indebtedness  unless otherwise  required by law or court order or (ii) such fact
shall  have been made  known to such  Holder  at any time  before or after  such
payment, then and in such event such Holder shall forthwith pay over and deliver
such payment to the holders of Senior  Indebtedness or to a representative  duly
appointed  by any such  holder or holders  of such  Senior  Indebtedness  unless
otherwise required by law or court order, in either such case for application to
the payment of all Senior Indebtedness remaining unpaid, to the extent necessary
to pay all Senior Indebtedness (including,  without limitation,  all Allowed and
Disallowed Post-Commencement Interest and Expenses) in full, after giving effect
to any  concurrent  payment  or  distribution  to or for the  holders  of Senior
Indebtedness.

             The consolidation of the Company with, or the merger of the Company
into,  another Person or the liquidation or dissolution of the Company following
the  conveyance or transfer of its  properties  and assets  substantially  as an
entirety to another  Person upon the terms and conditions set forth in Article 5
shall not be deemed a  dissolution,  winding  up,  liquidation,  reorganization,
assignment for the benefit of creditors or marshalling of assets and liabilities
of the Company for the  purposes  of this  Section if the Person  formed by such
consolidation  or into  which  the  Company  is  merged  or  which  acquires  by
conveyance or transfer such properties and assets  substantially as an entirety,
as the case may be, shall, as a part of such consolidation,  merger,  conveyance
or transfer, comply with the conditions set forth in Article 5.

SECTION  10.3  PRIOR  PAYMENT  TO  SENIOR   INDEBTEDNESS  UPON  ACCELERATION  OF
SECURITIES

             In the event  that any  Securities  are  declared  due and  payable
before  their  Stated  Maturity,  then and in such  event the  holders of Senior
Indebtedness  outstanding at the time such  Securities so become due and payable
shall be entitled to receive  payment in full in cash, or in a manner  otherwise
satisfactory to the holders of Senior Indebtedness,  of all amounts due on or in
respect of such Senior Indebtedness (including,  without limitation, all Allowed
and Disallowed  Post-Commencement  Interest and Expenses)  before the Holders of
the Securities are entitled to receive any Payment or Distribution in Respect of
the  Securities  (including  any  payment  which may be payable by reason of the
payment of any other  indebtedness  of the  Company  being  subordinated  to the
payment of the Securities),  other than payment of amounts previously  deposited
in accordance with the defeasance  provisions of Article 8 hereof, by or for the
account of the Company.

             In the event that, notwithstanding the foregoing, the Company shall
make any Payment or  Distribution in Respect of the Securities to the Trustee or
the  Holder of any  Security  prohibited  by the  foregoing  provisions  of this
Section, then if (i) subject to Section 10.8, such fact shall, prior to the time
of such payment, have been made known to the Trustee, then and in such event the
Trustee shall forthwith pay over


                                       47
<PAGE>

and deliver  such  payment to the holders of such  Senior  Indebtedness  or to a
representative  duly  appointed  by any such  holder or holders  of such  Senior
Indebtedness  or (ii) such fact shall have been made known to such Holder at any
time  before or after such  payment,  then and in such event such  Holder  shall
forthwith   pay  over  and  deliver  such  payment  to  the  holders  of  Senior
Indebtedness or to a representative duly appointed by any such holder or holders
of such Senior Indebtedness,  in either such case for application to the payment
of all Senior Indebtedness then remaining unpaid (including, without limitation,
all Allowed and  Disallowed  Post-Commencement  Interest  and  Expenses),  after
giving effect to any concurrent payment or distribution to or for the benefit of
holders of Senior Indebtedness.

             The  provisions of this Section shall not apply to any payment with
respect to which Section 10.2 is applicable.

SECTION  10.3  NO  PAYMENT  UPON  CERTAIN   DEFAULTS   WITH  RESPECT  TO  SENIOR
INDEBTEDNESS

             (a) No Payment or Distribution in Respect of the Securities  (other
than payments of amounts previously  deposited in accordance with the defeasance
provisions  of  Article 8  hereof)  shall be made by or for the  account  of the
Company or any other Person upon its behalf upon the  occurrence  of any default
in the payment of principal,  premium,  if any,  interest on or any other amount
due under or with  respect  to any Bank Debt or any Senior  Indebtedness  (other
than Bank Debt) in excess of $20 million  beyond any  applicable  grace  period,
unless  and  until  such  default  is cured or waived or ceases to exist or such
Senior  Indebtedness has been paid in full or provision for such payment in cash
or in a manner otherwise satisfactory to holders of Senior Indebtedness has been
made.

             (b) Upon any default with respect to the financial  covenants under
the Credit Agreement as specified therein,  or if any payment or distribution by
the Company with respect to any Security would,  immediately after giving effect
thereto,  result in such default,  no Payment or  Distribution in Respect of the
Securities  (other than payments of amounts  previously  deposited in accordance
with the defeasance provisions of Article 8 hereof), including any payment which
may be  payable  by  reason  of the  payment  of any  other  indebtedness  being
subordinated  to the  payment  of the  Securities,  shall  be made by or for the
account of the  Company  on  account of  principal  of or  premium,  if any,  or
interest on the  Securities or on account of the  purchase,  redemption or other
acquisition  of the  Securities  for the period  specified  below (the  "Payment
Blockage  Period").  The Payment Blockage Period shall commence upon the receipt
of notice by the Company or the Trustee from the Bank Agent and shall end on the
earlier of (i) 179 days  thereafter,  (ii) the date on which such  default  with
respect to the financial covenants under the Credit Agreement is cured or waived
or ceases to exist or on which such Bank Debt is paid in full or  provision  for
such  payment in money or money's  worth has been made,  (iii) the date on which
the maturity of any  Indebtedness  (other than Senior  Indebtedness)  shall have
been accelerated by virtue of such event, or (iv) the date on which such Payment
Blockage  Period shall have been  terminated by written notice to the Company or
the Trustee from the Bank Agent,  after which any and all  required  payments in
respect of the Securities,  including any missed payments,  may resume. Only one
Payment  Blockage  Period may be commenced  during any period of 365 consecutive
days.  No default  with  respect  to the  financial  covenants  under the Credit
Agreement that existed or was continuing on the date of the  commencement of any
Payment  Blockage Period will be, or can be, made the basis for the commencement
of a second  Payment  Blockage  Period  whether  or not  within a period  of 365
consecutive  days,  unless such default has been cured or waived for a period of
not less than 90 consecutive  days. In no event will a Payment  Blockage  Period
extend beyond 179 days from the receipt by the Trustee of notice initiating such
Payment  Blockage  Period and there must be a 186  consecutive day period in any
365 day period during which no Payment Blockage Period is in effect.

             (c) In the event that,  notwithstanding the foregoing,  the Company
shall make any payment to the Trustee or the Holder of any  Security  prohibited
by the foregoing  provisions of this Section,  then (i) subject to Section 10.8,
if such  fact  shall,  at or prior to the time of such  payment,  have been made
known to the Trustee,  then and in such event the Trustee  shall  forthwith  pay
over and  deliver  such  payment to the holders of Senior  Indebtedness  or to a
representative  duly  appointed  by any such  holder or holders  of such  Senior
Indebtedness  or (ii) such fact shall have been made known to such Holder at any
time  before or after such  payment,  then and in such event such  Holder  shall
forthwith   pay  over  and  deliver  such  payment  to  the  holders  of  Senior
Indebtedness or to a representative duly appointed by any such holder or holders
of such Senior  Indebtedness.

                                       48
<PAGE>

The  provisions  of this Section  shall not apply to any payment with respect to
which Section 10.2 is applicable.

SECTION 10.5 PAYMENT PERMITTED IF NO DEFAULT

             Nothing contained in this Article or elsewhere in this Indenture or
in any of the  Securities  shall  prevent  (a) the  Company,  at any time except
during the pendency of any case, proceeding,  dissolution,  liquidation or other
winding up,  assignment  for the benefit of  creditors or other  marshalling  of
assets and  liabilities of the Company  referred to in Section 10.2 or under the
conditions described in Section 10.3 or Section 10.4, from making any Payment or
Distribution in Respect of the Securities, or (b) the application by the Trustee
of any  money  deposited  with it  hereunder  with  respect  to any  Payment  or
Distribution  in Respect of the  Securities  or the retention of such Payment or
Distribution  in Respect of the  Securities  by the Holders,  if, at the time of
such  application  by the Trustee,  it had not been notified in accordance  with
Section 10.8 that such payment was  prohibited by the provisions of this Article
10.

SECTION 10.6 SUBROGATION TO RIGHTS OF HOLDERS OF SENIOR INDEBTEDNESS

             Subject to the  payment in full in cash of all amounts due on or in
respect of Senior Indebtedness (including,  without limitation,  all Allowed and
Disallowed  Post-Commencement  Interest  and  Expenses,  except  to  the  extent
provided below), the Holders of the Securities shall be subrogated to the extent
of the payments or distributions made to the holders of such Senior Indebtedness
pursuant to the  provisions  of this  Article 10 (equally  and ratably  with the
holders  of all  indebtedness  of the  Company  which  by its  express  terms is
subordinated  to other  indebtedness  of the Company to  substantially  the same
extent as the  Securities  are  subordinated  and are entitled to like rights of
subrogation) to the rights of the holders of such Senior Indebtedness to receive
payments and  distributions of cash,  property and securities  applicable to the
Senior  Indebtedness until the principal of and premium, if any, and interest on
the  Securities  shall be paid in full.  For  purposes of such  subrogation,  no
payments or distributions to the holders of the Senior Indebtedness of any cash,
property or  securities  to which the Holders of the  Securities  or the Trustee
would be entitled  except for the provisions of this Article 10, and no payments
over  pursuant  to the  provisions  of this  Article  to the  holders  of Senior
Indebtedness  by Holders of the Securities or the Trustee,  shall,  as among the
Company, its creditors other than holders of Senior Indebtedness and the Holders
of the  Securities,  be deemed to be a payment or distribution by the Company to
or on account of the Senior Indebtedness.

             Notwithstanding  anything to the contrary in this Section 10.6, the
Holders  of the  Securities  hereby  agree  that  they  shall  have no rights of
subrogation  with respect to amounts paid to the holders of Senior  Indebtedness
in payment of any interest, reimbursements,  costs, expenses or indemnities that
are not allowed claims  enforceable  against the Company in a case or proceeding
under Bankruptcy Law.

SECTION 10.7 PROVISIONS SOLELY TO DEFINE RELATIVE RIGHTS

             The  provisions of this Article 10 are and are intended  solely for
the purpose of defining the relative  rights of the Holders of the Securities on
the one hand and the holders of Senior  Indebtedness on the other hand.  Nothing
contained in this Article or elsewhere in this Indenture or in the Securities is
intended to or shall (a) impair, as among the Company,  its creditors other than
holders of Senior Indebtedness and the Holders of the Securities, the obligation
of the Company,  which is absolute and  unconditional,  to pay to the Holders of
the  Securities  the  principal  of and  premium,  if any,  and  interest on the
Securities as and when the same shall become due and payable in accordance  with
their  terms;  or (b) affect the  relative  rights  against  the  Company of the
Holders of the Securities and creditors of the Company other than the holders of
Senior  Indebtedness;  or (c) prevent the Trustee or the Holder of any  Security
from exercising all remedies otherwise  permitted by applicable law upon default
under this  Indenture,  subject to the rights,  if any, under this Article 10 of
the holders of Senior  Indebtedness  to receive  cash,  property and  securities
otherwise  payable or deliverable to the Trustee or such Holder.  The failure to
make a payment on account of principal of,  premium,  if any, or interest on, or
any other amounts then payable with respect to, the  Securities by any reason of
this Article 10 shall not be construed as preventing  the occurrence of an Event
of Default under Section 6.1.


                                       49
<PAGE>

SECTION 10.8 APPLICATION BY TRUSTEE OF MONIES DEPOSITED WITH IT

             Money and U.S. Government  Obligations  deposited in trust with the
Trustee  pursuant to Section 8.2 and in compliance with Section 8.1 shall be for
the sole benefit of the Holders and, to the extent  allocated for the payment of
Securities, shall not be subject to the subordination provisions of this Article
10.  Otherwise,  any  deposit of monies by the  Company  with the Trustee or any
Paying Agent  (whether or not in trust) for payment on account of principal  of,
premium, if any, and interest on the Securities or that otherwise  constitutes a
Payment or  Distribution  in Respect of the  Securities  shall be subject to the
provisions of Sections 10.1,  10.2, 10.3 and 10.4 except that, if at least three
Business Days prior to the date on which by the terms of this Indenture any such
monies may become payable for any purpose (including,  without  limitation,  the
payment of the principal of,  premium,  if any, or the interest on any Security)
the  Trustee  shall not have  received  with  respect to such  monies the notice
provided for in Section 10.4(b) or 10.11, then the Trustee shall have full power
and  authority  to receive  such monies and to apply the same to the purpose for
which  they  were  received,  and  shall not be  affected  by any  notice to the
contrary  which may be received by it within three  Business  Days of such date.
This Section shall be construed solely for the benefit of the Trustee and Paying
Agent  and  shall  not  otherwise   affect  the  rights  of  holders  of  Senior
Indebtedness.

SECTION 10.9 TRUSTEE TO EFFECTUATE SUBORDINATION

             Each holder of a Security by his acceptance  thereof authorizes and
directs  the Trustee on his behalf to take such  action as may be  necessary  or
appropriate  to  effectuate  the  subordination  provided  in this  Article  and
appoints the Trustee his attorney-in-fact for any and all such purposes.

SECTION 10.10 NO WAIVER OF SUBORDINATION PROVISIONS

             No right of any present or future holder of any Senior Indebtedness
to  enforce  subordination  as herein  provided  shall at any time in any way be
prejudiced  or  impaired by any act or failure to act on the part of the Company
or by any act or failure to act, in good faith,  by any such  holder,  or by any
noncompliance  by the Company with the terms,  provisions  and covenants of this
Indenture,  regardless of any  knowledge  thereof any such holder may have or be
otherwise charged with.

             Without  in any  way  limiting  the  generality  of  the  foregoing
paragraph,  the holders of Senior Indebtedness may, at any time and from time to
time,  without  the  consent of or notice to the  Trustee or the  Holders of the
Securities,  without  incurring  responsibility to the Holders of the Securities
and without impairing or releasing the subordination provided in this Article or
the  obligations  hereunder of the Holders of the  Securities  to the holders of
Senior Indebtedness, do any one or more of the following: (i) change the manner,
place or terms of payment  or extend the time of payment  of, or renew or alter,
compromise,  accelerate,  extend or refinance Senior Indebtedness,  or otherwise
amend  or  supplement  in any  manner  Senior  Indebtedness  or  any  instrument
evidencing  the  same  or any  agreement  under  which  Senior  Indebtedness  is
outstanding; (ii) sell, exchange, release, foreclose upon or otherwise deal with
any property pledged, mortgaged or otherwise securing Senior Indebtedness; (iii)
release any Person  liable in any manner for the payment or collection of Senior
Indebtedness;  (iv) exercise or refrain from  exercising  any rights against the
Company  and any other  Person;  (v)  increase or reduce the rate of interest or
amount  of  principal  payable  on any  Senior  Indebtedness;  (vi)  release  or
discharge  the  Company,  by  acceptance  of a deed  or  assignment  in  lieu of
foreclosure or otherwise,  as to all or any portion of the Senior  Indebtedness;
or (vii)  release,  substitute  or add any one or more  guarantors or endorsers,
accept  additional or  substituted  security for payment or  performance  of the
Senior  Indebtedness,  or release  or  subordinate  any  security  therefor.  No
exercise,  delay in  exercise or failure to exercise by any holder of any Senior
Indebtedness  of any right  hereby  given it, no  dealing  by any  holder of any
Senior  Indebtedness with the Company or any other guarantor,  endorser or other
person, no change, impairment or suspension of any right or remedy of any holder
of any Senior  Indebtedness,  and no act or thing  which but for this  provision
could  act as a  release  or  exoneration  of  the  Holders  of  the  Securities
hereunder,  shall in any way  affect,  decrease,  diminish  or impair any of the
obligations  of the  Holders of the  Securities  and the  Trustee or give to the
Holders  of the  Securities,  the  Trustee  or any other  person  or entity  any
recourse or defense against any holder of any Senior Indebtedness.


                                       50
<PAGE>

SECTION 10.11 NOTICE TO TRUSTEE

             The Company shall give prompt  written notice to the Trustee of any
fact known to the Company  which would  prohibit the making of any payment to or
by the Trustee in respect of the Securities.  Notwithstanding  the provisions of
this Article or any other provision of this Indenture,  the Trustee shall not be
charged with  knowledge of the  existence of any facts which would  prohibit the
making of any payment to or by the Trustee in respect of the Securities,  unless
and until the  Trustee  shall have  received  written  notice  thereof  from the
Company  or a  holder  of  Senior  Indebtedness  or from  any  trustee  or other
representative  therefor;  and, prior to the receipt of any such written notice,
the  Trustee,  subject  to the  provisions  of  Sections  7.1 and 7.2,  shall be
entitled in all respects to assume that no such facts exist.

             Subject to the  provisions  of  Sections  7.1 and 7.2,  the Trustee
shall be entitled to rely on the delivery to it of a written  notice by a Person
representing  himself  to be a  holder  of  Senior  Indebtedness  (or a  trustee
therefor)  to  establish  that such  notice has been given by a holder of Senior
Indebtedness (or a trustee  therefor).  In the event that the Trustee determines
in good faith that further evidence is required with respect to the right of any
Person as a holder of Senior  Indebtedness  to  participate  in any  payment  or
distribution pursuant to this Article 10, the Trustee may request such Person to
furnish evidence to the reasonable  satisfaction of the Trustee as to the amount
of Senior  Indebtedness held by such Person,  the extent to which such Person is
entitled to  participate  in such  payment or  distribution  and any other facts
pertinent  to the  rights of such  Person  under  this  Article  10, and if such
evidence  is not  furnished,  the  Trustee  may defer any payment to such Person
pending  judicial  determination  as to the right of such Person to receive such
payment.

SECTION 10.12 RELIANCE ON JUDICIAL ORDER OR CERTIFICATE OF LIQUIDATING AGENT

             Upon any payment or distribution of assets of the Company  referred
to in this Article 10, the Trustee,  subject to the  provisions  of Sections 7.1
and 7.2,  and the Holders of the  Securities  shall be entitled to rely upon any
order or decree  entered by any court of  competent  jurisdiction  in which such
insolvency, bankruptcy, receivership, liquidation, reorganization,  dissolution,
winding up or similar case or  proceeding is pending,  or a  certificate  of the
trustee in bankruptcy,  receiver,  liquidating trustee, custodian,  assignee for
the  benefit  of  creditors,  agent or  other  person  making  such  payment  or
distribution,  delivered to the Trustee or to the Holders of Securities, for the
purpose of ascertaining  the Persons  entitled to participate in such payment or
distribution,  the holders of the Senior  Indebtedness and other indebtedness of
the Company,  the amount thereof or payable thereon,  the amount or amounts paid
or distributed  thereon and all other facts pertinent thereto or to this Article
10.

SECTION 10.13 TRUSTEE NOT FIDUCIARY FOR HOLDERS OF SENIOR INDEBTEDNESS

             The Trustee  shall not be deemed to owe any  fiduciary  duty to the
holders of Senior Indebtedness and shall not be liable to any such holders if it
shall in good faith  mistakenly  pay over or distribute to Holders of Securities
or to the Company or to any other Person cash,  property or  securities to which
holders of Senior Indebtedness shall be entitled by virtue of this Article 10 or
otherwise.

SECTION 10.14 RIGHTS OF TRUSTEE AS HOLDER OF SENIOR  INDEBTEDNESS;  PRESERVATION
OF TRUSTEE'S RIGHTS

             The Trustee in its individual capacity shall be entitled to all the
rights set forth in this Article with respect to any Senior  Indebtedness  which
may at any time be held by it, to the same extent as any other  holder of Senior
Indebtedness,  and nothing in this Indenture shall deprive the Trustee of any of
its rights as such holder.

             Nothing in this  Article  shall apply to claims of, or payments to,
the Trustee under or pursuant to Section 7.6.


                                       51
<PAGE>

                                  ARTICLE 11.

                                  MISCELLANEOUS

SECTION 11.1 TRUST INDENTURE ACT CONTROLS

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

SECTION 11.2 NOTICES

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

             If to the Company:

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

             If to the Trustee:

             First Union National Bank
             901 East Cary Street Second Floor
             Richmond, Virginia 23219
             Attn:  Corporate Trust

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

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

             Any  notice  or  communication  to a  Holder  shall  be  mailed  by
first-class  mail to the  Holder's  address  shown on the  register  kept by the
Registrar.  Failure to mail a notice or  communication to a Holder or any defect
in it shall not affect its sufficiency with respect to other Holders.

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

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

SECTION 11.3 CERTIFICATE AND OPINION AS TO CONDITIONS PRECEDENT

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

             (1) an Officers'  Certificate  (which shall include the  statements
set forth in Section  11.4)  stating  that,  in the opinion of the signers,  all
conditions  precedent  and  covenants,  if any,  provided for in this  Indenture
relating to the proposed action have been complied with; and


                                       52
<PAGE>

             (2) an Opinion of Counsel  (which shall include the  statements set
forth in Section 11.4)  stating  that, in the opinion of such counsel,  all such
conditions precedent and covenants have been complied with.

SECTION 11.4 STATEMENTS REQUIRED IN CERTIFICATE OR OPINION

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

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

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

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

             (4) a  statement  as to  whether  or not,  in the  opinion  of such
Person, such condition or covenant has been complied with.

SECTION 11.5 RULES BY TRUSTEE AND AGENTS

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

SECTION 11.6 LEGAL HOLIDAYS

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

SECTION 11.7 NO RECOURSE AGAINST OTHERS

             A director,  officer, employee or stockholder of the Company or the
Trustee,  as such,  shall  not have any  liability  for any  obligations  of the
Company  under the  Securities  or this  Indenture or for any claim based on, in
respect of or by reason of such  obligations or their  creation.  Each Holder by
accepting a Security waives and releases all such liability.

SECTION 11.8 GOVERNING LAW

THIS  INDENTURE  AND THE  SECURITIES  SHALL  BE  GOVERNED  BY AND  CONSTRUED  IN
ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK,  WITHOUT REGARD TO PRINCIPLES
OF CONFLICTS OF LAW.

SECTION 11.9 NO ADVERSE INTERPRETATION OF OTHER AGREEMENTS

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

                                       53
<PAGE>

SECTION 11.10 SUCCESSORS

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

SECTION 11.11 SEVERABILITY

             In case any provision in this Indenture or in the Securities  shall
be invalid, illegal or unenforceable,  the validity, legality and enforceability
of the  remaining  provisions  shall  not in any  way be  affected  or  impaired
thereby.

SECTION 11.12 COUNTERPART ORIGINALS

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

SECTION 11.13 TRUSTEE AS PAYING AGENT AND REGISTRAR

             The Company  initially  appoints  the  Trustee as Paying  Agent and
Registrar.

SECTION 11.14 TABLE OF CONTENTS, HEADINGS, ETC.

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

                            [Signatures on Next Page]



                                       54
<PAGE>



                                    





Dated as of September 11, 1997

                                                INTEGRATED HEALTH SERVICES, INC.



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

/s/ 
- ------------------------------------------


Dated as of September 11, 1997

                                                FIRST UNION NATIONAL BANK,
                                                as Trustee

                                                By:/s/
                                                   -----------------------------
                                                Name:
                                                Title:
Attest:
/s/
- ------------------------------------------





                                       55
<PAGE>




                                    EXHIBIT A

LEGENDS FOR GLOBAL SECURITY:

UNLESS  AND  UNTIL  IT IS  EXCHANGED  IN  WHOLE  OR IN PART  FOR  SECURITIES  IN
DEFINITIVE  FORM, THIS SECURITY MAY NOT BE TRANSFERRED  EXCEPT AS A WHOLE BY THE
DEPOSITARY TO A NOMINEE OF THE  DEPOSITARY OR BY A NOMINEE OF THE  DEPOSITARY TO
THE DEPOSITARY OR ANOTHER  NOMINEE OF THE DEPOSITARY OR BY THE DEPOSITARY OR ANY
SUCH  NOMINEE  TO  A  SUCCESSOR  DEPOSITARY  OR  A  NOMINEE  OF  SUCH  SUCCESSOR
DEPOSITARY. UNLESS THIS SECURITY IS PRESENTED BY AN AUTHORIZED REPRESENTATIVE OF
THE DEPOSITORY TRUST COMPANY (55 WATER STREET,  NEW YORK, NEW YORK) ("DTC"),  TO
THE ISSUER OR ITS AGENT FOR REGISTRATION OF TRANSFER,  EXCHANGE OR PAYMENT,  AND
ANY SECURITY  ISSUED IS  REGISTERED IN THE NAME OF CEDE & CO. OR SUCH OTHER NAME
AS REQUESTED BY AN AUTHORIZED  REPRESENTATIVE OF DTC (AND ANY PAYMENT IS MADE TO
CEDE & CO. OR SUCH OTHER ENTITY AS IS REQUESTED BY AN AUTHORIZED  REPRESENTATIVE
OF DTC),  ANY TRANSFER,  PLEDGE OR OTHER USE HEREOF FOR VALUE OR OTHERWISE BY OR
TO ANY PERSON IS WRONGFUL  INASMUCH AS THE REGISTERED OWNER HEREOF,  CEDE & CO.,
HAS AN INTEREST HEREIN.

THIS  SECURITY HAS NOT BEEN  REGISTERED  UNDER THE  SECURITIES  ACT OF 1933,  AS
AMENDED (THE  "SECURITIES  ACT"),  OR ANY STATE  SECURITIES  LAWS.  NEITHER THIS
SECURITY  NOR ANY  INTEREST  OR  PARTICIPATION  HEREIN MAY BE  REOFFERED,  SOLD,
ASSIGNED,  TRANSFERRED,  PLEDGED,  ENCUMBERED  OR  OTHERWISE  DISPOSED OF IN THE
ABSENCE OF SUCH  REGISTRATION OR UNLESS SUCH  TRANSACTION IS EXEMPT FROM, OR NOT
SUBJECT TO, REGISTRATION UNDER SUCH LAWS.

THE HOLDER OF THIS SECURITY BY ITS ACCEPTANCE  HEREOF AGREES NOT TO OFFER,  SELL
OR OTHERWISE  TRANSFER SUCH SECURITY PRIOR TO THE DATE (THE "RESALE  RESTRICTION
TERMINATION DATE") WHICH IS TWO YEARS AFTER THE LATER OF THE ORIGINAL ISSUE DATE
HEREOF AND THE LAST DATE ON WHICH THE  COMPANY OR ANY  AFFILIATED  PERSON OF THE
COMPANY WAS THE OWNER OF THIS SECURITY UNLESS SUCH OFFER, SALE OR OTHER TRANSFER
IS (A) TO THE COMPANY,  (B) PURSUANT TO A REGISTRATION  STATEMENT WHICH HAS BEEN
DECLARED  EFFECTIVE  UNDER THE SECURITIES ACT, (C) FOR SO LONG AS THE SECURITIES
ARE ELIGIBLE FOR RESALE PURSUANT TO RULE 144A, TO A PERSON THE HOLDER REASONABLY
BELIEVES IS A "QUALIFIED  INSTITUTIONAL BUYER" AS DEFINED IN RULE 144A UNDER THE
SECURITIES  ACT THAT  PURCHASES  FOR ITS OWN  ACCOUNT  OR FOR THE  ACCOUNT  OF A
QUALIFIED INSTITUTIONAL BUYER TO WHOM NOTICE IS GIVEN THAT THE TRANSFER IS BEING
MADE IN RELIANCE ON RULE 144A,  (D) TO AN  INSTITUTIONAL  "ACCREDITED  INVESTOR"
WITHIN THE MEANING OF SUBPARAGRAPH (A)(1),  (A)(2), (A)(3) OR (A)(7) OF RULE 501
UNDER THE SECURITIES ACT THAT IS ACQUIRING THE SECURITY FOR ITS OWN ACCOUNT,  OR
FOR THE ACCOUNT OF SUCH AN INSTITUTIONAL  "ACCREDITED  INVESTOR," FOR INVESTMENT
PURPOSES AND NOT WITH A VIEW TO, OR FOR OFFER OR SALE IN  CONNECTION  WITH,  ANY
DISTRIBUTION  IN  VIOLATION  OF THE  SECURITIES  ACT, OR (E) PURSUANT TO ANOTHER
AVAILABLE EXEMPTION FROM THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT AND
IN EACH  OF THE  FOREGOING  CASES  SUCH  OFFER,  SALE OR  OTHER  TRANSFER  IS IN
COMPLIANCE WITH ANY APPLICABLE STATE  SECURITIES LAWS,  SUBJECT TO THE COMPANY'S
AND THE TRUSTEE'S  RIGHT PRIOR TO ANY SUCH OFFER,  SALE OR TRANSFER  PURSUANT TO
CLAUSES  (D)  OR  (E)  TO  REQUIRE  THE  DELIVERY  OF  AN  OPINION  OF  COUNSEL,
CERTIFICATION AND/OR OTHER INFORMATION SATISFACTORY TO EACH OF THEM, AND IN EACH
OF THE FOREGOING  CASES,  A CERTIFICATE  OF TRANSFER IN THE FORM PROVIDED FOR IN
THE  INDENTURE  (A COPY OF WHICH MAY BE OBTAINED  FROM THE TRUSTEE) IS COMPLETED
AND DELIVERED BY THE TRANSFEROR TO THE TRUSTEE. THIS LEGEND WILL BE REMOVED UPON
THE REQUEST OF THE THEN  HOLDER OF THIS  SECURITY  AFTER THE RESALE  RESTRICTION
TERMINATION  DATE.  ANY  TRANSFEREE  OF THIS  SECURITY  SHALL BE  DEEMED TO HAVE
REPRESENTED  EITHER (A) THAT IT IS NOT USING THE ASSETS OF AN  EMPLOYEE  BENEFIT
PLAN SUBJECT TO THE EMPLOYEE  RETIREMENT  INCOME  SECURITY ACT  ("ERISA") OR THE
INTERNAL  REVENUE  CODE (THE "CODE") TO PURCHASE  THIS  SECURITY OR (B) THAT ITS
PURCHASE  AND  CONTINUED  HOLDING  OF THE  SECURITY  WILL BE  COVERED  BY A U.S.
DEPARTMENT OF LABOR CLASS  EXEMPTION  (WITH  RESPECT TO PROHIBITED  TRANSACTIONS
UNDER SECTION 406(A) OF ERISA).

<PAGE>

LEGENDS FOR DEFINITIVE SECURITY:

THIS  SECURITY HAS NOT BEEN  REGISTERED  UNDER THE  SECURITIES  ACT OF 1933,  AS
AMENDED (THE  "SECURITIES  ACT"),  OR ANY STATE  SECURITIES  LAWS.  NEITHER THIS
SECURITY  NOR ANY  INTEREST  OR  PARTICIPATION  HEREIN MAY BE  REOFFERED,  SOLD,
ASSIGNED,  TRANSFERRED,  PLEDGED,  ENCUMBERED  OR  OTHERWISE  DISPOSED OF IN THE
ABSENCE OF SUCH  REGISTRATION OR UNLESS SUCH  TRANSACTION IS EXEMPT FROM, OR NOT
SUBJECT TO, REGISTRATION UNDER SUCH LAWS.

THE HOLDER OF THIS SECURITY BY ITS ACCEPTANCE  HEREOF AGREES NOT TO OFFER,  SELL
OR OTHERWISE TRANSFER SUCH SECURITY,  PRIOR TO THE DATE (THE "RESALE RESTRICTION
TERMINATION DATE") WHICH IS TWO YEARS AFTER THE LATER OF THE ORIGINAL ISSUE DATE
HEREOF AND THE LAST DATE ON WHICH THE  COMPANY OR ANY  AFFILIATED  PERSON OF THE
COMPANY WAS THE OWNER OF THIS SECURITY UNLESS SUCH OFFER, SALE OR OTHER TRANSFER
IS (A) TO THE COMPANY,  (B) PURSUANT TO A REGISTRATION  STATEMENT WHICH HAS BEEN
DECLARED  EFFECTIVE  UNDER THE SECURITIES ACT, (C) FOR SO LONG AS THE SECURITIES
ARE ELIGIBLE FOR RESALE PURSUANT TO RULE 144A, TO A PERSON THE HOLDER REASONABLY
BELIEVES IS A "QUALIFIED  INSTITUTIONAL BUYER" AS DEFINED IN RULE 144A UNDER THE
SECURITIES  ACT THAT  PURCHASES  FOR ITS OWN  ACCOUNT  OR FOR THE  ACCOUNT  OF A
QUALIFIED INSTITUTIONAL BUYER TO WHOM NOTICE IS GIVEN THAT THE TRANSFER IS BEING
MADE IN RELIANCE ON RULE 144A,  (D) TO AN  INSTITUTIONAL  "ACCREDITED  INVESTOR"
WITHIN THE MEANING OF SUBPARAGRAPH (A)(1),  (A)(2), (A)(3) OR (A)(7) OF RULE 501
UNDER THE SECURITIES ACT THAT IS ACQUIRING THE SECURITY FOR ITS OWN ACCOUNT,  OR
FOR THE ACCOUNT OF SUCH AN INSTITUTIONAL  "ACCREDITED  INVESTOR," FOR INVESTMENT
PURPOSES AND NOT WITH A VIEW TO, OR FOR OFFER OR SALE IN  CONNECTION  WITH,  ANY
DISTRIBUTION  IN  VIOLATION  OF THE  SECURITIES  ACT, OR (E) PURSUANT TO ANOTHER
AVAILABLE EXEMPTION FROM THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT AND
IN EACH  OF THE  FOREGOING  CASES  SUCH  OFFER,  SALE OR  OTHER  TRANSFER  IS IN
COMPLIANCE WITH ANY APPLICABLE STATE  SECURITIES LAWS,  SUBJECT TO THE COMPANY'S
AND THE TRUSTEE'S  RIGHT PRIOR TO ANY SUCH OFFER,  SALE OR TRANSFER  PURSUANT TO
CLAUSES  (D)  OR  (E)  TO  REQUIRE  THE  DELIVERY  OF  AN  OPINION  OF  COUNSEL,
CERTIFICATION AND/OR OTHER INFORMATION SATISFACTORY TO EACH OF THEM, AND IN EACH
OF THE FOREGOING  CASES,  A CERTIFICATE  OF TRANSFER IN THE FORM PROVIDED FOR IN
THE  INDENTURE  (A COPY OF WHICH MAY BE OBTAINED  FROM THE TRUSTEE) IS COMPLETED
AND DELIVERED BY THE TRANSFEROR TO THE TRUSTEE. THIS LEGEND WILL BE REMOVED UPON
THE REQUEST OF THE THEN  HOLDER OF THIS  SECURITY  AFTER THE RESALE  RESTRICTION
TERMINATION  DATE.  ANY  TRANSFEREE  OF THIS  SECURITY  SHALL BE  DEEMED TO HAVE
REPRESENTED  EITHER (A) THAT IT IS NOT USING THE ASSETS OF AN  EMPLOYEE  BENEFIT
PLAN SUBJECT TO THE EMPLOYEE  RETIREMENT  INCOME  SECURITY ACT  ("ERISA") OR THE
INTERNAL  REVENUE  CODE (THE "CODE") TO PURCHASE  THIS  SECURITY OR (B) THAT ITS
PURCHASE  AND  CONTINUED  HOLDING  OF THE  SECURITY  WILL BE  COVERED  BY A U.S.
DEPARTMENT OF LABOR CLASS  EXEMPTION  (WITH  RESPECT TO PROHIBITED  TRANSACTIONS
UNDER SECTION 406(A) OF ERISA).


                                      A-2

<PAGE>


                    9 1/4% SENIOR SUBORDINATED NOTES DUE 2008


Cusip No.                                                                     $


INTEGRATED HEALTH SERVICES, INC.

promises to pay to



or registered assigns,

the principal sum of



Dollars  [or such  greater or lesser  amount as  indicated  on the  Schedule  of
Exchanges of Definitive Securities on the reverse hereof]1 on January 15, 2008.

Interest Payment Dates:         January 15 and July 15

Record Dates:                   December 31 and June 30



Authentication:                              Dated:                     , 1997

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

FIRST UNION NATIONAL BANK,
as Trustee                                      INTEGRATED HEALTH SERVICES, INC.



By:                                             By:
   ---------------------                           -----------------------------
    Authorized Officer

                                                By:
                                                   -----------------------------
                                                                          (SEAL)


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

     1 This phrase  should be included  only if the Security is issued in global
form.


                                      A-3

<PAGE>



                    9 1/4% SENIOR SUBORDINATED NOTES DUE 2008


             1.  INTEREST.   INTEGRATED   HEALTH  SERVICES,   INC.,  a  Delaware
corporation (the "Company"), promises to pay interest on the principal amount of
this  Security at 9 1/4% per annum from the date this  Security is issued  until
maturity.  The Company will pay interest  semiannually on January 15 and July 15
of each year, or if any such day is not a Business  Day, on the next  succeeding
Business Day (each an "Interest  Payment Date") and any Penalty Interest payable
pursuant to Section 6 of the  Registration  Rights  Agreement  on such  Interest
Payment Date.  Interest on the Securities  will accrue from the most recent date
on which interest has been paid or, if no interest has been paid,  from the date
of issuance;  provided,  that if there is no existing  Default in the payment of
interest,  and if this Security is authenticated  between a record date referred
to on the face hereof and the next succeeding  Interest  Payment Date,  interest
shall accrue from such next succeeding Interest Payment Date; provided, further,
that the first Interest Payment Date shall be January 15, 1998. Interest will be
computed on the basis of a 360-day year of twelve 30-day months.

             2.  METHOD  OF  PAYMENT.  The  Company  will  pay  interest  on the
Securities (except defaulted interest) to the Persons who are registered Holders
of  Securities  at the close of business on the record date next  preceding  the
Interest  Payment Date,  even if such  Securities are canceled after such record
date and on or before such  Interest  Payment Date. In the case of a Security to
be repurchased by the Company in connection with a Change in Control  Repurchase
pursuant to paragraph 6, on or after an interest  payment  record date and prior
to the next Interest Payment Date, the registered  holder of such Security as of
such  record  date shall be  entitled  to accrued  and  unpaid  interest  to the
repurchase  date,  as provided in paragraph 6 below.  The Holder must  surrender
this Security to a Paying Agent to collect principal payments.  The Company will
pay the principal of,  premium,  if any, and interest on the Securities in money
of the United  States of America that at the time of payment is legal tender for
payment of public and private debts. Such amounts will be payable (i) in respect
of Securities in book-entry form held of record by the Depository  Trust Company
("DTC") or its nominee,  in same day funds on or prior to the payment dates with
respect to such amounts and (ii) in respect of Securities issued in certificated
form,  at the office of the Trustee,  and the  Securities  may be presented  for
registration  of  transfer  or  exchange,  at the  offices of the  Trustee.  The
Company,  however,  may pay such amounts in respect of the Securities  issued in
certificated form by check payable in such money mailed to a Holder's registered
address.

             3. PAYING  AGENT AND  REGISTRAR.  Initially,  FIRST UNION  NATIONAL
BANK, the Trustee under the  Indenture,  will act as Paying Agent and Registrar.
The Company  may change any Paying  Agent,  Registrar  or  co-registrar  without
notice to any Holder. The Company or any of its Subsidiaries may act in any such
capacity.

             4. INDENTURE.  The Company issued the Securities under an Indenture
dated as of  September  11,  1997  ("Indenture")  between  the  Company  and the
Trustee.  The terms of the Securities  include those stated in the Indenture and
those made part of the  Indenture  by reference  to the Trust  Indenture  Act of
1939, as amended (15 U.S. Code ss.ss. 77aaa-77bbbb), as in effect on the date of
execution of the Indenture.  The  Securities are subject to all such terms,  and
Holders are  referred  to the  Indenture  and such Act for a  statement  of such
terms. The Securities are unsecured  general  obligations of the Company limited
to $500,000,000 in aggregate  principal amount, plus amounts, if any, sufficient
to pay interest on  outstanding  Securities  as set forth in Paragraph 2 hereof.
The  Securities  will rank pari passu with the  Exchange  Notes,  the  Company's
10-1/4%  Senior  Subordinated  Notes  due  2006,  the  Company's  9-5/8%  Senior
Subordinated Notes due 2002, Series A, the Company's 10-3/4% Senior Subordinated
Notes due 2004 and the Company's 9-1/2% Senior Subordinated Notes due 2007.

             5.  OPTIONAL  REDEMPTION.  The Company may redeem all or any of the
Securities at any time on or after January 15, 2003 at the following  redemption
prices (expressed as percentages of principal  amount),  plus accrued and unpaid
interest to the redemption date:


                                      A-4

<PAGE>


                    IF REDEEMED DURING
              THE 12-MONTH PERIOD COMMENCING                REDEMPTION PRICE
              ------------------------------                ----------------
                     January 15, 2003                            104.625%
                     January 15, 2004                            103.083%
                     January 15, 2005                            101.542%
             January 15, 2006 and thereafter                       100%

             Notwithstanding  the  foregoing,  the  Company  may  redeem  in the
aggregate up to $166,667,000 principal amount of Securities at any time and from
time to time prior to January 15, 2001 at a redemption price equal to 109.25% of
the  aggregate  principal  amount so  redeemed,  plus  accrued  interest  to the
redemption  date,  out of the net cash  proceeds  of one or more  Public  Equity
Offerings;  provided that at least  $333,333,000  aggregate  principal amount of
Securities  originally  issued remains  outstanding  after the occurrence of any
such redemption and that any such redemption occurs within 60 days following the
closing of any such Public Equity Offering.

             6. RIGHT TO REQUIRE  REPURCHASE.  Following  the  occurrence of any
Change in Control,  each Holder will have the right to require  that the Company
repurchase  (a "Change in Control  Repurchase")  such  Holder's  Securities at a
purchase  price  equal  to  101%  of  the  aggregate  principal  amount  of  the
Securities,  plus accrued and unpaid  interest  thereon,  if any, to the date of
repurchase.  Within 30 days after any Change in Control,  the Company or, at the
Company's request, the Trustee, shall cause to be mailed a notice to all Holders
notifying such Holders of the occurrence of such Change in Control, the Holder's
rights  arising as a result thereof and the procedures to be followed by Holders
wishing to exercise such rights.

             A Holder of  Securities  may exercise the right to require a Change
in Control  Repurchase after receipt of notice of the existence of such right by
completing the form entitled  "OPTION OF HOLDER TO ELECT PURCHASE"  appearing on
this  Security  and by  complying  with the other  procedures  set forth in such
notice.  Any portion of  Securities  with respect to which the Holder  wishes to
exercise such right must be in integral multiples of $1,000.

             7.  MANDATORY  OFFER TO REPURCHASE.  If the Company  consummates an
Asset Sale (as such term is defined in the  Indenture),  the Company may,  under
certain  circumstances,  be  required  to utilize a portion of the net  proceeds
received  from such Asset  Sale to offer to  purchase  Securities  at a purchase
price equal to 100% of the aggregate  principal  amount of the Securities,  plus
accrued  interest to the date fixed for  redemption  (the  "Asset Sale  Offer").
Holders of Securities  that are the subject of an offer to purchase will receive
an Asset Sale Offer from the Company or the Trustee.  The Asset Sale Offer shall
remain  open for a period  of 30 days  after  its  commencement  unless a longer
offering period is required by law (the "Asset Sale Offer Period").  On or prior
to the fifth  Business Day  following  the  termination  of the Asset Sale Offer
Period (the "Asset Sale Payment Date"), the Company shall purchase, or cause the
Trustee to purchase,  and mail or deliver  payment for the amount of  Securities
required to be  purchased  pursuant to the Asset Sale Offer or, if less than the
amount of Securities  required to be purchased  pursuant to the Asset Sale Offer
has been tendered, all Securities tendered in response to the Asset Sale Offer.

             A Holder of Securities  may tender or refrain from tendering all or
any portion of his  Securities at his discretion by completing the form entitled
"OPTION OF HOLDER TO ELECT PURCHASE" appearing on this Security.  Any portion of
Securities tendered must be in integral multiples of $1,000.

             8. NOTICE OF  REDEMPTION.  Notice of  Redemption  will be mailed at
least 30 days but not  more  than 60 days  before  the  redemption  date to each
Holder of Securities  to be redeemed at his  registered  address.  Securities in
denominations  larger  than  $1,000  may be  redeemed  in part but only in whole
multiples  of $1,000,  unless all of the  Securities  held by a Holder are to be
redeemed.  On and after the  redemption  date  interest  will cease to accrue on
Securities  or  portions  thereof  called for  redemption  (unless  the  Company
defaults on its obligation to repurchase Securities).


                                      A-5

<PAGE>

             9. SUBORDINATION.  The indebtedness  evidenced by this Security is,
to the extent  provided in the  Indenture,  subordinate  and subject in right of
payment to the prior payment in full of all Senior  Indebtedness  (as defined in
the  Indenture),  and this Security is issued  subject to the  provisions of the
Indenture with respect thereto.  Each Holder of this Security,  by accepting the
same,  (a) agrees to and shall be bound by such  provisions,  (b) authorizes and
directs  the Trustee on his behalf to take such  action as may be  necessary  or
appropriate to effectuate the  subordination  so provided,  and (c) appoints the
Trustee his attorney-in-fact for any and all such purposes.

             10.  DENOMINATIONS,  TRANSFER,  EXCHANGE.  The  Securities  are  in
registered  form  without  coupons  in  denominations  of  $1,000  and  integral
multiples of $1,000. The transfer of Securities may be registered and Securities
may be exchanged as provided in the Indenture. The Registrar and the Trustee may
require a Holder,  among other things, to furnish  appropriate  endorsements and
transfer documents and to pay any taxes and fees required by law or permitted by
the Indenture.

             11. PERSONS DEEMED OWNERS.  The registered Holder of a Security may
be treated as its owner for all purposes.

             12.  AMENDMENTS  AND WAIVERS.  Subject to certain  exceptions,  the
Indenture or the Securities may be amended or  supplemented  with the consent of
the Holders of at least a majority in principal  amount of the  Securities  then
outstanding,  and any existing  default under,  or compliance with any provision
of, the Indenture may be waived (other than any  continuing  Default or Event of
Default in the payment of interest or premium,  if any, on or the  principal  of
the Securities or in respect of a provision  under the Indenture which cannot be
modified  or amended  without the  consent of the Holder of each  Security  then
outstanding or the Holders of at least 66 2/3% of the aggregate principal amount
of  Securities  outstanding,  as  applicable  (in which case the  consent of the
Holder of each Security then  outstanding  or the Holders of at least 66 2/3% of
the aggregate  principal amount of Securities  outstanding,  as the case may be,
shall be required to consent to a waiver of such provision)) with the consent of
the  Holders  of  a  majority  in  principal   amount  of  the  Securities  then
outstanding.  Without the consent of any Holder, the Company and the Trustee may
amend  or  supplement  the  Indenture  or the  Securities  to  provide  for  the
assumption  of the Company's  obligations  to Holders in the case of a merger or
acquisition;  to evidence and provide for the  acceptance of  appointment of any
successor  Trustee under the Indenture;  to comply with the  requirements of the
Trust Indenture Act of 1939, as amended;  to add to the covenants of the Company
for the benefit of the Holders or an  additional  Event of Default or to provide
for the surrender by the Company of any right or power  conferred  upon it under
the  Indenture;  secure  the  Securities  or  provide  for  any  Guarantee  by a
Subsidiary;  to provide for the issuance of securities identical in all material
respects  to the  Securities  pursuant  to the  Exchange  Offer;  or to cure any
ambiguity,  correct  or  supplement  any  provision  which may be  defective  or
inconsistent  with any other provision in the Indenture,  or make any provisions
with respect to matters or questions arising under the Indenture which shall not
be  inconsistent  with the  provisions  of the  Indenture,  provided  that  such
modification  or  amendment  does not  adversely  affect  the  interests  of the
holders.

             The right of any Holder to participate  in any consent  required or
sought  pursuant to any  provision of the Indenture  (and the  obligation of the
Company to obtain any such consent  otherwise  required from such Holder) may be
subject to the requirement that such Holder shall have been the Holder of record
of any Securities with respect to which such consent is required or sought as of
a date identified by the Trustee in a notice  furnished to Holders in accordance
with the terms of the Indenture.

             Without the consent of each Holder  affected,  the Company may not,
among other things,  (i) change the Stated  Maturity of the principal of, or any
installment of interest on, any Security,  (ii) reduce the principal  amount of,
or premium,  if any, or interest  on, any  Security,  (iii)  change the place of
payment where, or the coin or currency in which,  any Security or any premium or
interest thereon is payable, (iv) impair the right of a Holder to institute suit
for the  enforcement  of payment of the  principal of and  premium,  if any, and
interest on any Security on or after the Stated Maturity thereof (or in the case
of a redemption,  on or after the redemption  date) or (v) reduce the percentage
in principal  amount of Securities  the consent of whose Holders is required for
any modification or amendment of the Indenture,  or the consent of whose Holders
is  required  for any  waiver  of  compliance  with  certain  provisions  of the
Indenture or certain Defaults or Events of Default thereunder.


                                      A-6

<PAGE>

             Without the consent of at least 66 2/3% of the aggregate  principal
amount of  outstanding  Securities,  the  Company  may not (i) amend,  change or
modify the provisions of Article Three of the Indenture relating to the optional
redemption  of the  Securities  by the Company in  accordance  with  Section 3.7
thereof,  (ii)  amend,  change or modify the  obligations  of the  Company  with
respect  to a Change in  Control  Repurchase  pursuant  to  Section  4.10 of the
Indenture or modify any of the  provisions or  definitions  relating  thereto or
(iii)  modify  or  change  any   provision  of  the   Indenture   affecting  the
subordination or ranking of the Securities in a manner adverse to Holders of the
Securities.

             13. DEFAULTS AND REMEDIES.  Events of Default include:  (i) default
in payment of principal or premium on the Securities; (ii) default in payment of
interest on the Securities for 30 days; (iii) failure by the Company for 45 days
after notice to it to comply with any of its other  agreements  in the Indenture
or the Securities;  (iv) any  acceleration of Indebtedness of the Company or its
Subsidiaries  having  an  outstanding  principal  amount of $10  million  in the
aggregate or a failure to pay such  Indebtedness  at its stated maturity if such
acceleration or failure to pay is not cured within 10 days of such  acceleration
or failure to pay; and (v) certain  events of  bankruptcy or  insolvency.  If an
Event of Default  occurs and is  continuing,  the  Trustee or the  Holders of at
least 25% in aggregate  principal amount of the then outstanding  Securities may
declare all the Securities to be immediately due and payable for an amount equal
to 100% of the principal  amount of the  Securities,  and premium,  if any, plus
accrued interest to the date of payment,  except that in the case of an Event of
Default arising from certain events of bankruptcy or insolvency, all outstanding
Securities become due and payable  immediately without further action or notice.
Holders may not enforce the  Indenture or the  Securities  except as provided in
the Indenture.  The Trustee may require  indemnity  satisfactory to it before it
enforces  the  Indenture  or the  Securities.  Subject to  certain  limitations,
Holders of a majority in principal amount of the then outstanding Securities may
direct the  Trustee  in its  exercise  of any trust or power.  The  Trustee  may
withhold  from Holders  notice of any  continuing  default  (except a default in
payment of  principal  or  interest  or that  resulted  from the  failure of the
Company  to comply  with its  obligations  with  respect to  Holders'  rights to
require repurchase of Securities upon a Change in Control) if it determines that
withholding  notice is in their  interests.  The Company  must furnish an annual
compliance certificate to the Trustee.

             14. TRUSTEE DEALINGS WITH COMPANY.  The Trustee,  in its individual
or any other  capacity,  may make loans to, accept  deposits  from,  and perform
services  for the Company or its  Affiliates,  and may  otherwise  deal with the
Company or its Affiliates, as if it were not Trustee.

             15. NO RECOURSE  AGAINST OTHERS. A director,  officer,  employee or
stockholder,  as such,  of the  Company  shall  not have any  liability  for any
obligations  of the Company  under the  Securities  or the  Indenture or for any
claim  based  on,  in  respect  of or by  reason  of such  obligations  or their
creation.  Each Holder by  accepting  a Security  waives and  releases  all such
liability. The waiver and release are part of the consideration for the issuance
of the Securities.

             16. ERISA  MATTERS.  Each Holder of  Securities,  by its acceptance
thereof,  will be deemed to  certify  that (i) no part of the funds used by such
Holder to purchase the Securities constitutes assets of an employee benefit plan
or (ii) the acquisition and continued  holding of the Securities will be covered
by a U.S.  Department  of Labor  class  exemption  (with  respect to  prohibited
transactions set forth under Section 406(a) of ERISA).

             17.  AUTHENTICATION.   This  Security  shall  not  be  valid  until
authenticated by the manual signature of the Trustee or an authenticating agent.

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

                                      A-7

<PAGE>

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

                             Integrated Health Services, Inc.
                             10065 Red Run Boulevard
                             Owings Mills, Maryland 21117
                             Attention:  Secretary




                                      A-8

<PAGE>


                                 ASSIGNMENT FORM

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


- ----------------------------------------------------------------
(Insert assignee's Soc. Sec. or Tax I.D. no.)


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


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


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


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

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


Date: 
     ---------------------

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



Signature Guarantee:
                    ----------------------------


                                      A-9

<PAGE>



                       OPTION OF HOLDER TO ELECT PURCHASE

             If you want to elect to have this Security purchased by the Company
pursuant to Section 3.8 or 4.10 of the Indenture, check the appropriate box:

      [ ] Section 3.8           [ ] Section 4.10

             If you want to elect to have only part of the Security purchased by
the Company  pursuant to Section 3.8 or 4.10 of the Indenture,  state the amount
you elect to have purchased:

$
 -----------------------------------

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



Signature Guarantee:
                    --------------------


                                      A-10

<PAGE>


            [FORM OF SCHEDULE OF EXCHANGES OF DEFINITIVE SECURITIES2]

      The following  exchanges of a part of this Global  Security for Definitive
Securities have been made.
<TABLE>
<CAPTION>

                            Amount of decrease   Amount of increase    Principal Amount of    
                               in Principal         in Principal       this Global Security         Signature of
                  Date of     Amount of this       Amount of this         following such         authorized officer
                 Exchange    Global Security      Global Security    decrease (or increase)          of Trustee
               ----------   ------------------    -----------------    ----------------------    ------------------
<S>     <C>
        1.

        2.

        3.

        4.

        5.

        6.

        7.

        8.

        9.

        10.
</TABLE>


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


 2 This schedule should be included only if the Security is issued in global
   form.

                                      A-11
<PAGE>

                                    EXHIBIT B


LEGEND FOR GLOBAL SECURITY:

UNLESS  AND  UNTIL  IT IS  EXCHANGED  IN  WHOLE  OR IN PART  FOR  SECURITIES  IN
DEFINITIVE  FORM, THIS SECURITY MAY NOT BE TRANSFERRED  EXCEPT AS A WHOLE BY THE
DEPOSITARY TO A NOMINEE OF THE  DEPOSITARY OR BY A NOMINEE OF THE  DEPOSITARY TO
THE DEPOSITARY OR ANOTHER  NOMINEE OF THE DEPOSITARY OR BY THE DEPOSITARY OR ANY
SUCH  NOMINEE  TO  A  SUCCESSOR  DEPOSITARY  OR  A  NOMINEE  OF  SUCH  SUCCESSOR
DEPOSITARY. UNLESS THIS SECURITY IS PRESENTED BY AN AUTHORIZED REPRESENTATIVE OF
THE DEPOSITORY TRUST COMPANY (55 WATER STREET,  NEW YORK, NEW YORK) ("DTC"),  TO
THE ISSUER OR ITS AGENT FOR REGISTRATION OF TRANSFER,  EXCHANGE OR PAYMENT,  AND
ANY SECURITY  ISSUED IS  REGISTERED IN THE NAME OF CEDE & CO. OR SUCH OTHER NAME
AS REQUESTED BY AN AUTHORIZED  REPRESENTATIVE OF DTC (AND ANY PAYMENT IS MADE TO
CEDE & CO. OR SUCH OTHER ENTITY AS IS REQUESTED BY AN AUTHORIZED  REPRESENTATIVE
OF DTC),  ANY TRANSFER,  PLEDGE OR OTHER USE HEREOF FOR VALUE OR OTHERWISE BY OR
TO ANY PERSON IS WRONGFUL  INASMUCH AS THE REGISTERED OWNER HEREOF,  CEDE & CO.,
HAS AN INTEREST HEREIN.


<PAGE>



               9 1/4% SENIOR SUBORDINATED NOTES DUE 2008, SERIES A


Cusip No.                                                                     $


INTEGRATED HEALTH SERVICES, INC.

promises to pay to



or registered assigns,

the principal sum of



Dollars  [or such  greater or lesser  amount as  indicated  on the  Schedule  of
Exchanges of Definitive Securities on the reverse hereof]* on January 15, 2008

Interest Payment Dates:    January 15 and July 15

Record Dates:              December 31 and June 30



Authentication:                              Dated:                       , 1997

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

FIRST UNION NATIONAL BANK,
as Trustee                                  INTEGRATED HEALTH SERVICES, INC.



By:                                         By:
   -------------------------                   ---------------------------------
    Authorized Officer


                                            By:
                                               ---------------------------------

                                                                         (SEAL)
- ------------------------

* This phrase  should be included  only if the Security is issued in global
  form.

                                      B-2

<PAGE>

               9 1/4% SENIOR SUBORDINATED NOTES DUE 2008, SERIES A


             1.  INTEREST.   INTEGRATED   HEALTH  SERVICES,   INC.,  a  Delaware
corporation (the "Company"), promises to pay interest on the principal amount of
this Security  (which has been  exchanged for one of the Company's 9 1/4% Senior
Subordinated Notes due 2008 (the "Rule 144A Notes") at 9 1/4% per annum from the
date this  Security is issued  until  maturity.  The Company  will pay  interest
semiannually on January 15 and July 15 of each year, or if any such day is not a
Business  Day, on the next  succeeding  Business Day (each an "Interest  Payment
Date").  Interest  on the  Securities  will  accrue from the most recent date on
which  interest  has been paid or, if no interest  has been paid,  from the most
recent date on which interest was paid on the Rule 144A Notes or, if no interest
was paid on the Rule 144A Notes,  from the date of original issuance of the Rule
144A Notes;  provided,  that if there is no  existing  Default in the payment of
interest,  and if this Security is authenticated  between a record date referred
to on the face hereof and the next succeeding  Interest  Payment Date,  interest
shall accrue from such next succeeding Interest Payment Date; provided, further,
that the first Interest Payment Date shall be January 15, 1998. Interest will be
computed on the basis of a 360-day year of twelve 30-day months.

             2.  METHOD  OF  PAYMENT.  The  Company  will  pay  interest  on the
Securities (except defaulted interest) to the Persons who are registered Holders
of  Securities  at the close of business on the record date next  preceding  the
Interest  Payment Date,  even if such  Securities are canceled after such record
date and on or before such  Interest  Payment Date. In the case of a Security to
be repurchased by the Company in connection with a Change in Control  Repurchase
pursuant to paragraph 6, on or after an interest  payment  record date and prior
to the next Interest Payment Date, the registered  holder of such Security as of
such  record  date shall be  entitled  to accrued  and  unpaid  interest  to the
repurchase  date,  as provided in paragraph 6 below.  The Holder must  surrender
this Security to a Paying Agent to collect principal payments.  The Company will
pay the principal of,  premium,  if any, and interest on the Securities in money
of the United  States of America that at the time of payment is legal tender for
payment of public and private debts. Such amounts will be payable (i) in respect
of Securities in book-entry form held of record by the Depository  Trust Company
("DTC") or its nominee,  in same day funds on or prior to the payment dates with
respect to such amounts and (ii) in respect of Securities issued in certificated
form,  at the office of the Trustee,  and the  Securities  may be presented  for
registration  of  transfer  or  exchange,  at the  offices of the  Trustee.  The
Company,  however,  may pay such amounts in respect of the Securities  issued in
certificated form by check payable in such money mailed to a Holder's registered
address.

             3. PAYING  AGENT AND  REGISTRAR.  Initially,  FIRST UNION  NATIONAL
BANK, the Trustee under the  Indenture,  will act as Paying Agent and Registrar.
The Company  may change any Paying  Agent,  Registrar  or  co-registrar  without
notice to any Holder. The Company or any of its Subsidiaries may act in any such
capacity.

             4. INDENTURE.  The Company issued the Securities under an Indenture
dated as of  September  11,  1997  ("Indenture")  between  the  Company  and the
Trustee.  The terms of the Securities  include those stated in the Indenture and
those made part of the  Indenture  by reference  to the Trust  Indenture  Act of
1939, as amended (15 U.S. Code ss.ss. 77aaa-77bbbb), as in effect on the date of
execution of the Indenture.  The  Securities are subject to all such terms,  and
Holders are  referred  to the  Indenture  and such Act for a  statement  of such
terms. The Securities are unsecured  general  obligations of the Company limited
to $500,000,000 in aggregate  principal amount, plus amounts, if any, sufficient
to pay interest on  outstanding  Securities  as set forth in Paragraph 2 hereof.
The  Securities  will rank pari passu with the Rule 144A  Notes,  the  Company's
10-1/4%  Senior  Subordinated  Notes  due  2006,  the  Company's  9-5/8%  Senior
Subordinated Notes due 2002, Series A, the Company's 10-1/4% Senior Subordinated
Notes due 2004 and the Company's 9-1/2% Senior Subordinated Notes due 2007.

             5.  OPTIONAL  REDEMPTION.  The Company may redeem all or any of the
Securities at any time on or after January 15, 2003 at the following  redemption
prices (expressed as percentages of principal  amount),  plus accrued and unpaid
interest to the redemption date:


                                      B-3

<PAGE>


                    IF REDEEMED DURING
              THE 12-MONTH PERIOD COMMENCING                   REDEMPTION PRICE
              ------------------------------                   ----------------
                     January 15, 2003                              104.625%
                     January 15, 2004                              103.083%
                     January 15, 2005                              101.542%
             January 15, 2006 and thereafter                         100%

             Notwithstanding  the  foregoing,  the  Company  may  redeem  in the
aggregate up to $166,667,000 principal amount of Securities at any time and from
time to time prior to January 15, 2001 at a redemption price equal to 109.25% of
the  aggregate  principal  amount so  redeemed,  plus  accrued  interest  to the
redemption  date,  out of the net cash  proceeds  of one or more  Public  Equity
Offerings;  provided that at least  $333,333,000  aggregate  principal amount of
Securities  originally  issued remains  outstanding  after the occurrence of any
such redemption and that any such redemption occurs within 60 days following the
closing of any such Public Equity Offering.


             6. RIGHT TO REQUIRE  REPURCHASE.  Following  the  occurrence of any
Change in Control,  each Holder will have the right to require  that the Company
repurchase  (a "Change in Control  Repurchase")  such  Holder's  Securities at a
purchase  price  equal  to  101%  of  the  aggregate  principal  amount  of  the
Securities,  plus accrued and unpaid  interest  thereon,  if any, to the date of
repurchase.  Within 30 days after any Change in Control,  the Company or, at the
Company's request, the Trustee, shall cause to be mailed a notice to all Holders
notifying such Holders of the occurrence of such Change in Control, the Holder's
rights  arising as a result thereof and the procedures to be followed by Holders
wishing to exercise such rights.

             A Holder of  Securities  may exercise the right to require a Change
in Control  Repurchase after receipt of notice of the existence of such right by
completing the form entitled  "OPTION OF HOLDER TO ELECT PURCHASE"  appearing on
this  Security  and by  complying  with the other  procedures  set forth in such
notice.  Any portion of  Securities  with respect to which the Holder  wishes to
exercise such right must be in integral multiples of $1,000.

             7.  MANDATORY  OFFER TO REPURCHASE.  If the Company  consummates an
Asset Sale (as such term is defined in the  Indenture),  the Company may,  under
certain  circumstances,  be  required  to utilize a portion of the net  proceeds
received  from such Asset  Sale to offer to  purchase  Securities  at a purchase
price equal to 100% of the aggregate  principal  amount of the Securities,  plus
accrued  interest to the date fixed for  redemption  (the  "Asset Sale  Offer").
Holders of Securities  that are the subject of an offer to purchase will receive
an Asset Sale Offer from the Company or the Trustee.  The Asset Sale Offer shall
remain  open for a period  of 30 days  after  its  commencement  unless a longer
offering period is required by law (the "Asset Sale Offer Period").  On or prior
to the fifth  Business Day  following  the  termination  of the Asset Sale Offer
Period (the "Asset Sale Payment Date"), the Company shall purchase, or cause the
Trustee to purchase,  and mail or deliver  payment for the amount of  Securities
required to be  purchased  pursuant to the Asset Sale Offer or, if less than the
amount of Securities  required to be purchased  pursuant to the Asset Sale Offer
has been tendered, all Securities tendered in response to the Asset Sale Offer.

             A Holder of Securities  may tender or refrain from tendering all or
any portion of his  Securities at his discretion by completing the form entitled
"OPTION OF HOLDER TO ELECT PURCHASE" appearing on this Security.  Any portion of
Securities tendered must be in integral multiples of $1,000.

             8. NOTICE OF  REDEMPTION.  Notice of  Redemption  will be mailed at
least 30 days but not  more  than 60 days  before  the  redemption  date to each
Holder of Securities  to be redeemed at his  registered  address.  Securities in
denominations  larger  than  $1,000  may be  redeemed  in part but only in whole
multiples  of $1,000,  unless all of the  Securities  held by a Holder are to be
redeemed.  On and after the  redemption  date  interest  will cease to accrue on
Securities  or  portions  thereof  called for  redemption  (unless  the  Company
defaults on its obligation to repurchase Securities).


                                      B-4

<PAGE>

             9. SUBORDINATION.  The indebtedness  evidenced by this Security is,
to the extent  provided in the  Indenture,  subordinate  and subject in right of
payment to the prior payment in full of all Senior  Indebtedness  (as defined in
the  Indenture),  and this Security is issued  subject to the  provisions of the
Indenture with respect thereto.  Each Holder of this Security,  by accepting the
same,  (a) agrees to and shall be bound by such  provisions,  (b) authorizes and
directs  the Trustee on his behalf to take such  action as may be  necessary  or
appropriate to effectuate the  subordination  so provided,  and (c) appoints the
Trustee his attorney-in-fact for any and all such purposes.

             10.  DENOMINATIONS,  TRANSFER,  EXCHANGE.  The  Securities  are  in
registered  form  without  coupons  in  denominations  of  $1,000  and  integral
multiples of $1,000. The transfer of Securities may be registered and Securities
may be exchanged as provided in the Indenture. The Registrar and the Trustee may
require a Holder,  among other things, to furnish  appropriate  endorsements and
transfer documents and to pay any taxes and fees required by law or permitted by
the Indenture.

             11. PERSONS DEEMED OWNERS.  The registered Holder of a Security may
be treated as its owner for all purposes.

             12.  AMENDMENTS  AND WAIVERS.  Subject to certain  exceptions,  the
Indenture or the Securities may be amended or  supplemented  with the consent of
the Holders of at least a majority in principal  amount of the  Securities  then
outstanding,  and any existing  default under,  or compliance with any provision
of, the Indenture may be waived (other than any  continuing  Default or Event of
Default in the payment of interest or premium,  if any, on or the  principal  of
the Securities or in respect of a provision  under the Indenture which cannot be
modified  or amended  without the  consent of the Holder of each  Security  then
outstanding or the Holders of at least 66 2/3% of the aggregate principal amount
of  Securities  outstanding,  as  applicable  (in which case the  consent of the
Holder of each Security then  outstanding  or the Holders of at least 66 2/3% of
the aggregate  principal amount of Securities  outstanding,  as the case may be,
shall be required to consent to a waiver of such provision)) with the consent of
the  Holders  of  a  majority  in  principal   amount  of  the  Securities  then
outstanding.  Without the consent of any Holder, the Company and the Trustee may
amend  or  supplement  the  Indenture  or the  Securities  to  provide  for  the
assumption  of the Company's  obligations  to Holders in the case of a merger or
acquisition;  to evidence and provide for the  acceptance of  appointment of any
successor  Trustee under the Indenture;  to comply with the  requirements of the
Trust Indenture Act of 1939, as amended;  to add to the covenants of the Company
for the benefit of the Holders or an  additional  Event of Default or to provide
for the surrender by the Company of any right or power  conferred  upon it under
the  Indenture;  secure  the  Securities  or  provide  for  any  Guarantee  by a
Subsidiary;  to provide for the issuance of securities identical in all material
respects  to the  Securities  pursuant  to the  Exchange  Offer;  or to cure any
ambiguity,  correct  or  supplement  any  provision  which may be  defective  or
inconsistent  with any other provision in the Indenture,  or make any provisions
with respect to matters or questions arising under the Indenture which shall not
be  inconsistent  with the  provisions  of the  Indenture,  provided  that  such
modification  or  amendment  does not  adversely  affect  the  interests  of the
holders.

             The right of any Holder to participate  in any consent  required or
sought  pursuant to any  provision of the Indenture  (and the  obligation of the
Company to obtain any such consent  otherwise  required from such Holder) may be
subject to the requirement that such Holder shall have been the Holder of record
of any Securities with respect to which such consent is required or sought as of
a date identified by the Trustee in a notice  furnished to Holders in accordance
with the terms of the Indenture.

             Without the consent of each Holder  affected,  the Company may not,
among other things,  (i) change the Stated  Maturity of the principal of, or any
installment of interest on, any Security,  (ii) reduce the principal  amount of,
or premium,  if any, or interest  on, any  Security,  (iii)  change the place of
payment where, or the coin or currency in which,  any Security or any premium or
interest thereon is payable, (iv) impair the right of a Holder to institute suit
for the  enforcement  of payment of the  principal of and  premium,  if any, and
interest on any Security on or after the Stated Maturity thereof (or in the case
of a redemption,  on or after the redemption  date) or (v) reduce the percentage
in principal  amount of Securities  the consent of whose Holders is required for
any modification or amendment of the Indenture,  or the consent of whose Holders
is  required  for any  waiver  of  compliance  with  certain  provisions  of the
Indenture or certain Defaults or Events of Default thereunder.


                                      B-5

<PAGE>

             Without the consent of at least 66 2/3% of the aggregate  principal
amount of  outstanding  Securities,  the  Company  may not (i) amend,  change or
modify the provisions of Article Three of the Indenture relating to the optional
redemption  of the  Securities  by the Company in  accordance  with  Section 3.7
thereof,  (ii)  amend,  change or modify the  obligations  of the  Company  with
respect  to a Change in  Control  Repurchase  pursuant  to  Section  4.10 of the
Indenture or modify any of the  provisions or  definitions  relating  thereto or
(iii)  modify  or  change  any   provision  of  the   Indenture   affecting  the
subordination or ranking of the Securities in a manner adverse to Holders of the
Securities.

             13. DEFAULTS AND REMEDIES.  Events of Default include:  (i) default
in payment of principal or premium on the Securities; (ii) default in payment of
interest on the Securities for 30 days; (iii) failure by the Company for 45 days
after notice to it to comply with any of its other  agreements  in the Indenture
or the Securities;  (iv) any  acceleration of Indebtedness of the Company or its
Subsidiaries  having  an  outstanding  principal  amount of $10  million  in the
aggregate or a failure to pay such  Indebtedness  at its stated maturity if such
acceleration or failure to pay is not cured within 10 days of such  acceleration
or failure to pay; and (v) certain  events of  bankruptcy or  insolvency.  If an
Event of Default  occurs and is  continuing,  the  Trustee or the  Holders of at
least 25% in aggregate  principal amount of the then outstanding  Securities may
declare all the Securities to be immediately due and payable for an amount equal
to 100% of the principal  amount of the  Securities,  and premium,  if any, plus
accrued interest to the date of payment,  except that in the case of an Event of
Default arising from certain events of bankruptcy or insolvency, all outstanding
Securities become due and payable  immediately without further action or notice.
Holders may not enforce the  Indenture or the  Securities  except as provided in
the Indenture.  The Trustee may require  indemnity  satisfactory to it before it
enforces  the  Indenture  or the  Securities.  Subject to  certain  limitations,
Holders of a majority in principal amount of the then outstanding Securities may
direct the  Trustee  in its  exercise  of any trust or power.  The  Trustee  may
withhold  from Holders  notice of any  continuing  default  (except a default in
payment of  principal  or  interest  or that  resulted  from the  failure of the
Company  to comply  with its  obligations  with  respect to  Holders'  rights to
require repurchase of Securities upon a Change in Control) if it determines that
withholding  notice is in their  interests.  The Company  must furnish an annual
compliance certificate to the Trustee.

             14. TRUSTEE DEALINGS WITH COMPANY.  The Trustee,  in its individual
or any other  capacity,  may make loans to, accept  deposits  from,  and perform
services  for the Company or its  Affiliates,  and may  otherwise  deal with the
Company or its Affiliates, as if it were not Trustee.

             15. NO RECOURSE  AGAINST OTHERS. A director,  officer,  employee or
stockholder,  as such,  of the  Company  shall  not have any  liability  for any
obligations  of the Company  under the  Securities  or the  Indenture or for any
claim  based  on,  in  respect  of or by  reason  of such  obligations  or their
creation.  Each Holder by  accepting  a Security  waives and  releases  all such
liability. The waiver and release are part of the consideration for the issuance
of the Securities.

             16. ERISA  MATTERS.  Each Holder of  Securities,  by its acceptance
thereof,  will be deemed to  certify  that (i) no part of the funds used by such
Holder to purchase the Securities constitutes assets of an employee benefit plan
or (ii) the acquisition and continued  holding of the Securities will be covered
by a U.S.  Department  of Labor  class  exemption  (with  respect to  prohibited
transactions set forth under Section 406(a) of ERISA).

             17.  AUTHENTICATION.   This  Security  shall  not  be  valid  until
authenticated by the manual signature of the Trustee or an authenticating agent.

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


                                      B-6

<PAGE>

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

                           Integrated Health Services, Inc.
                           10065 Red Run Boulevard
                           Owings Mills, Maryland  21117
                           Attention:  Secretary



                                      B-7

<PAGE>

                                 ASSIGNMENT FORM


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


- ---------------------------------------------------------------
(Insert assignee's Soc. Sec. or Tax I.D. no.)


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


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


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


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

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

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


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






Signature Guarantee:
                    ----------------------------


                                      B-8

<PAGE>



                       OPTION OF HOLDER TO ELECT PURCHASE

             If you want to elect to have this Security purchased by the Company
pursuant to Section 3.8 or 4.10 of the Indenture, check the appropriate box:

             [ ] Section 3.8                [ ] Section 4.10

             If you want to elect to have only part of the Security purchased by
the Company  pursuant to Section 3.8 or 4.10 of the Indenture,  state the amount
you elect to have purchased:


$-------------------------

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




Signature Guarantee:
                    --------------------


                                      B-9

<PAGE>



            [FORM OF SCHEDULE OF EXCHANGES OF DEFINITIVE SECURITIES*]

The  following  exchanges  of a part  of this  Global  Security  for  Definitive
Securities have been made.
<TABLE>
<CAPTION>



                             Amount of          Amount of       Principal Amount of  
                            decrease in        increase in      this Global Security 
                          Principal Amount   Principal Amount     following such          Signature of    
                          of this Global      of this Global       decrease (or         authorized officer
   Date of Exchange          Security           Security            increase)              of Trustee     
   ----------------       ---------------    ----------------   --------------------    ------------------

<S> <C>
1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

</TABLE>

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

* This schedule should be included only if the Security is issued in global
  form.


                                      B-10

<PAGE>

                                    EXHIBIT C

             [FORM OF CERTIFICATE TO BE DELIVERED UPON EXCHANGE OR  REGISTRATION
OF TRANSFER OF RULE 144A NOTES]


                      CERTIFICATE FOR EXCHANGE OR TRANSFER

             Re: 9 1/4% Senior Subordinated Notes due 2008 ("Rule 144A Notes")

             This  Certificate   relates  to  $_________   Principal  amount  of
Securities  held in  *__________  book-entry or *__________  definitive  form by
_________________ (the "Transferor").


The Transferor*:

             [ ] has  requested  the  Trustee  by  written  order to  deliver in
exchange  for  its  beneficial  interest  in the  Global  Security  held  by the
Depositary a Security or Securities in definitive, registered form of authorized
denominations and an aggregate principal amount equal to its beneficial interest
in such Global Security (or the portion thereof indicated above); or

             [ ] has  requested  the  Trustee by written  order to  exchange  or
register the transfer of a Security or Securities.

             In  connection  with  such  request  and in  respect  of each  such
security,  the Transferor  does hereby certify that  Transferor is familiar with
the Indenture relating to the  above-captioned  Notes and as provided in Section
2.5  of  such  Indenture,  the  transfer  of  this  Security  does  not  require
registration under the Securities Act (as defined below) because:

             [ ]  Such  Security  is being  acquired  for the  Transferor's  own
account,  without transfer (in satisfaction of Section  2.5(a)(ii)(A) or Section
2.5(d)(i)(A) of the Indenture).

             [ ]  Such   Security   is  being   transferred   to  a   "qualified
institutional  buyer" (as defined in rule 144A under the Securities Act of 1933,
as amended (the  "Securities  Act") in reliance on Rule 144A (in satisfaction of
Section  2.5(a)(ii)(B),   section  2.5(b)(i)  or  Section  2.5(d)(i)(B)  of  the
Indenture).

             [ ] Such Security is being  transferred in accordance with Rule 144
under the  Securities  Act, or pursuant to an effective  registration  statement
under the Securities Act.

             [ ]  Such  Security  is  being   transferred  in  reliance  and  in
compliance  with  an  exemption  from  the  registration   requirements  of  the
Securities  Act, other than Rule 144A or Rule 144 under the  Securities  Act. An
opinion  of  counsel  to  the  effect  that  such   transfer  does  not  require
registration under the Securities Act accompanies this Certificate.


- ------------------------------------------------------
[INSERT NAME OF TRANSFEROR]

By:
   ---------------------------------------------------

Date:
     ------------------------

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

- -----------------------------
*  Check applicable box.

<PAGE>


                           FORM OF PURCHASE LETTER FOR
                       INSTITUTIONAL ACCREDITED INVESTORS

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

Dear Sirs:

In  connection with our purchase of $      principal  amount  of 9  1/4%  Senior
Subordinated  Notes due 2008 (the "Notes") of Integrated  Health Services,  Inc.
(the "Company"),  we represent,  warrant and agree as follows:

1.    The notes have not been registered under the U.S.  Securities Act of 1933,
as amended (the "Securities  Act"), or any state securities laws, and may not be
offered or sold except  pursuant to an exemption  from, or in a transaction  not
subject  to  the  registration  requirements  of  the  Securities  Act  and  any
applicable state securities laws.

2.    We are  an  institutional  investor  that  is an "accredited investor" (as
defined in Rule 501(a)(1),  (a)(2),  (a)(3) or (a)(7) under the Securities Act).
We have such knowledge and experience in financial and business matters as to be
capable of evaluating the merits and risks of an investment in the Notes, and we
and each account for which we are acting are each able to bear the economic risk
of our or its investments.

3.    We are acquiring the Notes  purchased by us for our own account or for one
or more accounts (each of which is an institutional  "accredited investor"),  as
to each of which we exercise sole investment discretion and for each of which we
are acquiring not less than $250,000 total principal amount of Notes.

4.    We have received adequate information concerning the Company and the Notes
to make an informed  investment  decision  with  respect to our  purchase of the
Notes.

5.    We   understand  that  the  Notes  are  being  sold  to  us pursuant to an
exemption from, or in a transaction not subject to the registration requirements
of the Securities Act. Subject to paragraph 6 hereof,  we are not purchasing the
Notes with a view to the resale, distribution or other disposition thereof.

6.    If,  within two years  after  the  original  issuance  of  the  Notes,  we
should  decide to  dispose  of any Notes  bearing  the  legend  set forth in the
Offering  Memorandum  dated  September  8, 1997,  under the  caption  "Notice to
Investors," we shall not offer, sell, transfer, pledge, hypothecate or otherwise
dispose of any Notes except:

     (a) to the Company;
     (b) inside  the  United  States to a  "qualified  institutional  buyer" (as
defined in Rule 144A under the Securities Act) in compliance with Rule 144A;
     (c)  to an  institutional  "accredited  investor"  within  the  meaning  of
subparagraph (a)(1),  (a)(2),  (a)(3) or (a)(7) of Rule 501 under the Securities
Act  that is  purchasing  for  its own  account  or for the  account  of such an
institutional "accredited investor";
     (d)  pursuant  to any  other  available  exemption  from  the  registration
requirements of the Securities Act; or

     (e) pursuant to an effective  registration  statement  under the Securities
Act.  We shall  provide  to any  person  purchasing  any Notes  from us a notice
advising such  purchaser that transfers of the Notes are restricted as set forth
herein.

7.    We  understand  that,  prior  to any  proposed  transfer  of any  Notes to
an  institutional  "accredited  investor"  within two years  after the  original
issuance of the Notes,  we shall be required to furnish to First Union  National
Bank, as Trustee, and the Company such  certifications,  legal opinions or other
information as they may reasonably require to confirm that the proposed transfer
is being made pursuant to an exemption from, or in a transaction not subject to,
the  registration  requirements  of the Securities Act and any applicable  state
securities laws.

8.    We understand that the  certificates  representing  the Notes will, until
the second  anniversary  of the  original  issuance of the Notes,  bear a legend
substantially to the effect set forth in paragraphs (1), (6) and (7) hereof.

9.   We  shall  preserve  copies  of  this  letter  and  all   related  letters,
certifications,  legal opinions,  notices and other documents,  and upon request
shall furnish you with the copies thereof. You are


                                      C-2

<PAGE>

entitled to rely on such documents and we  irrevocably  authorize you to produce
such  documents in  connection  with an  administrative  or legal  proceeding or
official inquiry with respect to the matters covered hereby.


                                              Very truly yours,


                                              ----------------------------------
                                                    (Name of Purchaser)

                                              By:
                                                 -------------------------------


                                              Date:
                                                   -----------------------------

Upon transfer the Notes would be  registered  in the name of the new  beneficial
owner as follows:

Name:
     ----------------------------------------

Address:
        --------------------------------------

Taxpayer ID Number:
                  ---------------------------


                                      C-3




                                  $500,000,000

                        INTEGRATED HEALTH SERVICES, INC.

                    9 1/4% SENIOR SUBORDINATED NOTES DUE 2008

                               PURCHASE AGREEMENT
                               ------------------

                                                              September 8, 1997
SMITH BARNEY INC.
MORGAN STANLEY & CO. INCORPORATED
DONALDSON, LUFKIN & JENRETTE
  SECURITIES CORPORATION
CITICORP SECURITIES, INC.

c/o SMITH BARNEY INC.
388 Greenwich Street
New York, New York 10013

Dear Sirs:

                  Integrated Health Services,  Inc., a Delaware corporation (the
"Company"),  proposes,  upon the terms and conditions set forth herein, to issue
and  sell  to  you,  as  the  initial  purchasers  (the  "Initial  Purchasers"),
$500,000,000  aggregate principal amount of its 9 1/4% Senior Subordinated Notes
due 2008 (the "Notes").  The Notes will be issued  pursuant to the provisions of
an Indenture,  to be dated as of September 11, 1997 (the  "Indenture"),  between
the Company and First Union National Bank, as Trustee (the "Trustee").

                  The Company  wishes to confirm as follows its  agreement  with
the Initial Purchasers in connection with the purchase and resale of the Notes.

                  1. Preliminary  Offering  Memorandum and Offering  Memorandum.
The  Notes  will  be  offered  and  sold  to  the  Initial   Purchasers  without
registration  under the  Securities  Act of 1933,  as amended  (the  "Act"),  in
reliance on an exemption pursuant to Section 4(2) under the Act. The Company has
prepared  a  preliminary  offering  memorandum,   dated  August  26,  1997  (the
"Preliminary Offering Memorandum"),  and an offering memorandum, dated September
8, 1997 (the "Offering  Memorandum"),  setting forth  information  regarding the
Company  and the  Notes.  Any  references  herein  to the  Preliminary  Offering
Memorandum and the Offering Memorandum shall be deemed to include all amendments
and supplements  thereto and any documents  filed under the Securities  Exchange
Act of 1934, as amended,  and the rules and  regulations  of the  Securities and
Exchange Commission (the "Commission") thereunder  (collectively,  the "Exchange
Act") which are  incorporated  by reference  therein.  As used herein,  the term
"Incorporated  Documents" means the documents which at the time are incorporated
by reference in the Preliminary Offering Memorandum,  the Offering Memorandum

<PAGE>

or any amendment or supplement thereto.  The Company hereby confirms that it has
authorized  the use of the  Preliminary  Offering  Memorandum  and the  Offering
Memorandum  in  connection  with the  offering  and  resale  of the Notes by the
Initial Purchasers.

                  The Company understands that the Initial Purchasers propose to
make  offers and sales (the  "Exempt  Resales")  of the Notes  purchased  by the
Initial  Purchasers  hereunder  only on the terms and in the manner set forth in
the Offering  Memorandum and Section 2 hereof, as soon as the Initial Purchasers
deem  advisable  after this Agreement has been executed and delivered to persons
whom the Initial  Purchasers  reasonably  believe to be qualified  institutional
buyers ("Qualified Institutional Buyers") as defined in Rule 144A under the Act,
as such rule may be amended  from time to time ("Rule  144A"),  in  transactions
under  Rule 144A  (such  persons  being  referred  to  herein  as the  "Eligible
Purchasers").

                  It is understood and acknowledged  that upon original issuance
thereof,  and  until  such  time as the same is no  longer  required  under  the
applicable  requirements  of the Act,  the Notes (and all  securities  issued in
exchange therefor or in substitution thereof) shall bear the following legend:

         THIS SECURITY HAS NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933,
         AS  AMENDED  (THE  "SECURITIES  ACT"),  OR ANY STATE  SECURITIES  LAWS.
         NEITHER THIS SECURITY NOR ANY INTEREST OR  PARTICIPATION  HEREIN MAY BE
         REOFFERED,  SOLD,  ASSIGNED,   TRANSFERRED,   PLEDGED,   ENCUMBERED  OR
         OTHERWISE  DISPOSED  OF IN THE ABSENCE OF SUCH  REGISTRATION  OR UNLESS
         SUCH TRANSACTION IS EXEMPT FROM, OR NOT SUBJECT TO,  REGISTRATION UNDER
         SUCH LAWS.

         THE HOLDER OF THIS  SECURITY  BY ITS  ACCEPTANCE  HEREOF  AGREES NOT TO
         OFFER, SELL OR OTHERWISE TRANSFER SUCH SECURITY, PRIOR TO THE DATE (THE
         "RESALE  RESTRICTION  TERMINATION  DATE")  WHICH IS TWO YEARS AFTER THE
         LATER OF THE ORIGINAL  ISSUE DATE HEREOF AND THE LAST DATE ON WHICH THE
         COMPANY OR ANY  AFFILIATED  PERSON OF THE COMPANY WAS THE OWNER OF THIS
         SECURITY (OR ANY PREDECESSOR OF SUCH SECURITY) UNLESS SUCH OFFER,  SALE
         OR OTHER TRANSFER IS (A) TO THE COMPANY, (B) PURSUANT TO A REGISTRATION
         STATEMENT  WHICH HAS BEEN DECLARED  EFFECTIVE UNDER THE SECURITIES ACT,
         (C) FOR SO LONG AS THE SECURITIES  ARE ELIGIBLE FOR RESALE  PURSUANT TO
         RULE 144A, TO A PERSON THE HOLDER  REASONABLY  BELIEVES IS A "QUALIFIED
         INSTITUTIONAL  BUYER" AS DEFINED IN RULE 144A UNDER THE  SECURITIES ACT
         THAT  PURCHASES  FOR ITS OWN  ACCOUNT OR FOR THE ACCOUNT OF A QUALIFIED
         INSTITUTIONAL  BUYER TO WHOM NOTICE IS GIVEN THAT THE TRANSFER IS BEING
         MADE IN  RELIANCE  ON RULE 144A,  (D) TO AN  INSTITUTIONAL  "ACCREDITED
         INVESTOR" WITHIN THE MEANING OF SUBPARAGRAPH (a)(1),  (a)(2), (a)(3) OR
         (a)(7) OF RULE 501  UNDER  THE  SECURITIES  ACT THAT IS  ACQUIRING  THE
         SECURITY  FOR  ITS  OWN  ACCOUNT,   OR  FOR  THE  ACCOUNT  OF  SUCH  AN
         INSTITUTIONAL  "ACCREDITED  INVESTOR," FOR INVESTMENT  PURPOSES AND NOT
         WITH A  VIEW  TO,  OR  FOR  OFFER  OR  SALE  IN  CONNECTION  WITH,  ANY
         DISTRIBUTION  IN  VIOLATION OF THE  SECURITIES  ACT, OR (E) PURSUANT TO
         ANOTHER AVAILABLE  EXEMPTION FROM THE REGISTRATION


                                       2
<PAGE>

         REQUIREMENTS  OF THE SECURITIES ACT, AND IN EACH OF THE FOREGOING CASES
         SUCH OFFER, SALE OR OTHER TRANSFER IS IN COMPLIANCE WITH ANY APPLICABLE
         STATE SECURITIES LAWS, SUBJECT TO THE COMPANY'S AND THE TRUSTEE'S RIGHT
         PRIOR TO ANY SUCH OFFER,  SALE OR  TRANSFER  PURSUANT TO CLAUSES (D) OR
         (E) TO REQUIRE THE  DELIVERY  OF AN OPINION OF  COUNSEL,  CERTIFICATION
         AND/OR OTHER  INFORMATION  SATISFACTORY TO EACH OF THEM, AND IN EACH OF
         THE FOREGOING CASES, A CERTIFICATE OF TRANSFER IN THE FORM PROVIDED FOR
         IN THE  INDENTURE (A COPY OF WHICH MAY BE OBTAINED FROM THE TRUSTEE) IS
         COMPLETED AND DELIVERED BY THE  TRANSFEROR TO THE TRUSTEE.  THIS LEGEND
         WILL BE REMOVED  UPON THE REQUEST OF THE THEN  HOLDER OF THIS  SECURITY
         AFTER THE RESALE  RESTRICTION  TERMINATION DATE. ANY TRANSFEREE OF THIS
         SECURITY SHALL BE DEEMED TO HAVE REPRESENTED  EITHER (A) THAT IT IS NOT
         USING THE ASSETS OF AN EMPLOYEE  BENEFIT  PLAN  SUBJECT TO THE EMPLOYEE
         RETIREMENT  INCOME SECURITY ACT ("ERISA") OR THE INTERNAL  REVENUE CODE
         (THE  "CODE") TO PURCHASE  THIS  SECURITY OR (B) THAT ITS  PURCHASE AND
         CONTINUED HOLDING OF THE SECURITY WILL BE COVERED BY A U.S.  DEPARTMENT
         OF LABOR CLASS EXEMPTION WITH RESPECT TO PROHIBITED  TRANSACTIONS UNDER
         SECTION 406(a) OF ERISA.

                  It is also understood and acknowledged that holders (including
subsequent transferees) of the Notes will have the registration rights set forth
in the registration rights agreement (the "Registration  Rights Agreement"),  to
be dated  the date  hereof,  in  substantially  the form of  Exhibit  A  hereto.
Pursuant to the  Registration  Rights  Agreement,  the Company will agree (i) to
file  with  the  Commission,  under  the  circumstances  set  forth  therein,  a
registration  statement  on the  appropriate  form under the Act  relating  to a
proposed exchange offer (the "Registered  Exchange Offer") to the holders of the
Notes to issue and deliver to such  holders,  in exchange for the Notes,  a like
principal  amount of debt  securities  of the Company  identical in all material
respects  to the Notes (the "New  Notes")  and (ii) to use its  reasonable  best
efforts to cause such registration  statement to be declared  effective.  If (a)
the Company is not permitted to effect the Registered Exchange Offer because the
Registered  Exchange  Offer would violate any  applicable  law or the applicable
interpretations  of the Commission's staff or because of any change in currently
prevailing  interpretations  of the  Commission's  staff  or (b) the  Registered
Exchange  Offer has not been  consummated  for any other reason  within 240 days
after the Closing Date (as defined herein),  then the Company shall file and use
its  reasonable  best efforts to cause to be declared  effective a  registration
statement on an appropriate form under the Act relating to the offer and sale of
the  Notes by the  holders  thereof  from  time to time in  accordance  with the
methods of distribution  set forth in such  registration  statement and Rule 415
under the Act. The registration  statement to be filed under the Act pursuant to
the   Registration   Rights   Agreement  is  hereinafter   referred  to  as  the
"Registration  Statement."  This Agreement,  the Indenture and the  Registration
Rights  Agreement are  hereinafter  referred to  collectively  as the "Operative
Documents".

                  Capitalized  terms used  herein  without  definition  have the
respective  meanings  specified  therefor  in  the  Indenture  or  the  Offering
Memorandum.

                  2.  Agreements to Sell,  Purchase and Resell.  (a) The Company
hereby  agrees,  subject to all the terms and  conditions  set forth herein,  to
issue  and  sell  to  each  Initial   Purchaser  and,  upon  the  basis  of  the
representations, warranties and agreements of the



                                       3
<PAGE>

Company  herein  contained and subject to all the terms and conditions set forth
herein,  each Initial Purchaser agrees,  severally and not jointly,  to purchase
from the  Company,  at a  purchase  price of  97.375%  of the  principal  amount
thereof,  the  principal  amount of Notes set  forth  opposite  the name of such
Initial Purchaser in Schedule I hereto.

                  (b) The Initial  Purchasers have advised the Company that they
propose to offer the Notes for sale upon the terms and  conditions  set forth in
this Agreement and in the Offering  Memorandum.  Each Initial  Purchaser  hereby
represents  and  warrants  to, and agrees  with,  the Company  that such Initial
Purchaser  (i) is  purchasing  the Notes  pursuant to a private sale exempt from
registration  under the Act, (ii) will not solicit offers for, or offer or sell,
the Notes by means of any form of general solicitation or general advertising or
in any manner  involving a public offering within the meaning of Section 4(2) of
the Act, and (iii) will solicit  offers for the Notes only from, and will offer,
sell or deliver the Notes as part of its initial offering,  only to persons whom
the Initial Purchasers reasonably believe to be Qualified  Institutional Buyers,
or if any such person is buying for one or more institutional accounts for which
such  person is acting  as  fiduciary  or  agent,  only  when  such  person  has
represented  to the  Initial  Purchasers  that each such  account is a Qualified
Institutional Buyer, to whom notice has been given that such sale or delivery is
being made in reliance on Rule 144A and in each case, in transactions under Rule
144A. The Initial  Purchasers  have advised the Company that they will offer the
Notes to Eligible Purchasers at a price initially equal to 100% of the principal
amount thereof,  plus accrued interest, if any, from the date of issuance of the
Notes.  Such  price  may  be  changed  by the  Initial  Purchasers  at any  time
thereafter without notice.

                  The Initial  Purchasers  understand  that the Company and, for
purposes of the opinions to be delivered to the Initial  Purchasers  pursuant to
Sections  7(c)(xiii) and 7(e) hereof,  counsel to the Company and counsel to the
Initial  Purchasers,  will rely  upon the  accuracy  and truth of the  foregoing
representations and agreements and the Initial Purchasers hereby consent to such
reliance.

                  3. Delivery of the Notes and Payment Therefor. Delivery to the
Initial  Purchasers  of and payment for the Notes shall be made at the office of
Smith Barney Inc., 388 Greenwich Street,  New York, NY 10013, at 10:00 A.M., New
York City time, on September 11, 1997 (the "Closing Date"). The place of closing
for the  Notes and the  Closing  Date may be varied  by  agreement  between  the
Initial Purchasers and the Company.

                  The Notes will be delivered to the Initial  Purchasers against
payment of the purchase price therefor by wire transfer of federal or other same
day funds to an account or accounts designated by the Company. The Notes will be
evidenced  by one or more global  securities  in  definitive  form (the  "Global
Note")  and will be  registered  in the  name of Cede & Co.  as  nominee  of The
Depository  Trust  Company  ("DTC").  The Notes to be  delivered  to the Initial
Purchasers  shall be made  available to the Initial  Purchasers in New York City
for inspection not later than 9:30 a.m., New York City time, on the business day
next preceding the Closing Date.

                  4.  Agreements  of the  Company.  The Company  agrees with the
Initial Purchasers as follows:

                  (a) The Company  will advise the Initial  Purchasers  promptly
and, if  requested  by them,  will  confirm  such advice in writing,  within the
period  of time  referred  to in  paragraph  (e)  below,  of any  change  in the
Company's condition (financial or other), business,  prospects,  properties, net
worth or results of operations, or of the happening of any event,


                                       4
<PAGE>

which makes any statement  made in the Offering  Memorandum  (as then amended or
supplemented) untrue or which requires the making of any additions to or changes
in the Offering  Memorandum (as then amended or  supplemented)  in order to make
the  statements  therein  not  misleading,  or of  the  necessity  to  amend  or
supplement the Offering  Memorandum (as then amended or  supplemented) to comply
with any law.

                  (b)  The  Company  will  furnish  to the  Initial  Purchasers,
without charge, as of the date of the Offering Memorandum, such number of copies
of the Offering  Memorandum as may then be amended or  supplemented  as they may
reasonably request.

                  (c) The Company will not make any  amendment or  supplement to
the Preliminary  Offering  Memorandum or to the Offering Memorandum of which the
Initial Purchasers shall not previously have been advised or to which they shall
reasonably  object after being so advised or file any document which upon filing
becomes an Incorporated Document,  without delivering a copy of such document to
the Initial Purchasers, prior to or concurrently with such filing.

                  (d) Prior to the execution and delivery of this Agreement, the
Company has delivered or will deliver to the Initial Purchasers, without charge,
in such  quantities  as the  Initial  Purchasers  shall  have  requested  or may
hereafter reasonably request, copies of the Preliminary Offering Memorandum. The
Company  consents to the use, in accordance with the securities or Blue Sky laws
of the  jurisdictions  in which the Notes are offered by the Initial  Purchasers
and by  dealers,  prior  to  the  date  of  the  Offering  Memorandum,  of  each
Preliminary  Offering  Memorandum  so  furnished  by the  Company.  The  Company
consents  to  the  use of the  Offering  Memorandum  (and  of any  amendment  or
supplement  thereto) in accordance  with the  securities or Blue Sky laws of the
jurisdictions  in which the Notes are offered by the Initial  Purchasers  and by
all dealers to whom Notes may be sold, in connection  with the offering and sale
of the Notes.

                  (e) If, at any time prior to completion of the distribution of
the Notes by the  Initial  Purchasers  to Eligible  Purchasers,  any event shall
occur that in the  judgment  of the Company or in the opinion of counsel for the
Initial  Purchasers  should be set  forth in the  Offering  Memorandum  (as then
amended or supplemented) in order to make the statements  therein,  in the light
of the  circumstances  under which they were made, not  misleading,  or if it is
necessary to supplement or amend the Offering  Memorandum,  or to file under the
Exchange Act any document which upon filing becomes an Incorporated Document, to
comply  with  any  law,  the  Company  will  forthwith  prepare  an  appropriate
supplement or amendment thereto or such document, and will expeditiously furnish
to the Initial Purchasers and dealers a reasonable number of copies thereof.  In
the event that the Company and the Initial  Purchasers  agree that the  Offering
Memorandum should be amended or supplemented, or that a document should be filed
under the Exchange Act which upon filing becomes an Incorporated  Document,  the
Company,  if requested by the Initial  Purchasers,  will promptly  issue a press
release  announcing  or  disclosing  the  matters to be covered by the  proposed
amendment or supplement or such document.

                  (f) The Company will cooperate with the Initial Purchasers and
with  their  counsel  in  connection  with the  qualification  of the  Notes for
offering and sale by the Initial  Purchasers and by dealers under the securities
or Blue Sky laws of such  jurisdictions as the Initial  Purchasers may designate
and will file such consents to service of process or other  documents  necessary
or appropriate in order to effect such qualification;  provided that in no event
shall the Company be  obligated  to qualify to do  business in any  jurisdiction
where it is


                                       5
<PAGE>

not now so qualified or to take any action which would  subject it to service of
process in suits,  other than those  arising out of the  offering or sale of the
Notes, in any jurisdiction where it is not now so subject.

                  (g) So long as any of the Notes are  outstanding,  the Company
will furnish to the Initial Purchasers (i) as soon as available,  a copy of each
report of the Company mailed to stockholders  or filed with the Commission,  and
(ii) from time to time such  other  information  concerning  the  Company as the
Initial Purchasers may request.

                  (h) If this Agreement  shall  terminate or shall be terminated
after execution and delivery  pursuant to any provisions  hereof (otherwise than
pursuant  to  Section  10 hereof or by notice  given by the  Initial  Purchasers
terminating  this  Agreement  pursuant  to Section 9 or Section 11 hereof) or if
this  Agreement  shall be  terminated by the Initial  Purchasers  because of any
failure  or  refusal  on the part of the  Company  to  comply  with the terms or
fulfill any of the conditions of this Agreement, the Company agrees to reimburse
the  Initial  Purchasers  for all  out-of-pocket  expenses  (including  fees and
expenses of its counsel) reasonably incurred by it in connection  herewith,  but
without any further obligation on the part of the Company for loss of profits or
otherwise.

                  (i) The Company will apply the net  proceeds  from the sale of
the  Notes  to be sold by it  hereunder  substantially  in  accordance  with the
description set forth in the Offering Memorandum.

                  (j) Except as stated in this Agreement and in the  Preliminary
Offering Memorandum and Offering Memorandum, the Company has not taken, nor will
it take, directly or indirectly, any action designed to or that might reasonably
be expected to cause or result in  stabilization or manipulation of the price of
the Notes to facilitate the sale or resale of the Notes.  Except as permitted by
the Act, the Company will not  distribute  any offering  material in  connection
with the Exempt Resales.

                  (k) The Company  will use its best  efforts to cause the Notes
to be eligible for trading on The PORTAL Market.

                  (l) From and after  the  Closing  Date,  so long as any of the
Notes are outstanding and are "Restricted  Securities" within the meaning of the
Rule 144(a)(3)  under the Act or, if earlier,  until two years after the Closing
Date, and during any period in which the Company is not subject to Section 13 or
15(d) of the Exchange  Act, the Company will furnish to holders of the Notes and
prospective purchasers of Notes designated by such holders, upon request of such
holders or such prospective purchasers, the information required to be delivered
pursuant to Rule 144A(d)(4) under the Act to permit compliance with Rule 144A in
connection with resale of the Notes.

                  (m) The Company agrees not to sell,  offer for sale or solicit
offers to buy or  otherwise  negotiate in respect of any security (as defined in
the Act) that would be  integrated  with the sale of the Notes in a manner  that
would  require  the  registration  under  the  Act of the  sale  to the  Initial
Purchasers or the Eligible Purchasers of the Notes.

                  (n) The  Company  agrees to  comply  with all of the terms and
conditions of the Registration Rights Agreement, and all agreements set forth in
representation  letters of the Company to DTC  relating  to the  approval of the
Notes by DTC for "book entry" transfer.


                                       6
<PAGE>

                  (o) The Company agrees that prior to any  registration  of the
Notes pursuant to the Registration Rights Agreement,  or at such earlier time as
may be so required,  the Indenture  shall be qualified under the Trust Indenture
Act of 1939 (the "1939  Act") and will cause to be  entered  into any  necessary
supplemental indentures in connection therewith.

                  5.  Representations and Warranties of the Company. The Company
represents and warrants to the Initial Purchasers that:

                  (a)  The   Preliminary   Offering   Memorandum   and  Offering
Memorandum  with respect to the Notes have been  prepared by the Company for use
by the Initial  Purchasers in connection  with the Exempt  Resales.  No order or
decree preventing the use of the Preliminary Offering Memorandum or the Offering
Memorandum or any amendment or supplement  thereto,  or any order asserting that
the transactions  contemplated by this Agreement are subject to the registration
requirements  of the Act, has been issued and no proceeding for that purpose has
commenced or is pending or, to the knowledge of the Company, is contemplated.

                  (b) The  Preliminary  Offering  Memorandum  and  the  Offering
Memorandum as of their  respective  dates and the Offering  Memorandum as of the
Closing Date,  did not or will not at any time contain an untrue  statement of a
material fact or omit to state a material fact required to be stated  therein or
necessary  to make the  statements  therein  not  misleading,  except  that this
representation  and warranty does not apply to  statements in or omissions  from
the  Preliminary  Offering  Memorandum and Offering  Memorandum made in reliance
upon and in  conformity  with  information  relating to the  Initial  Purchasers
furnished  to the Company in writing by or on behalf of the  Initial  Purchasers
expressly for use therein.

                  (c) The Incorporated  Documents heretofore filed were filed in
a timely manner and, when they were filed (or, if any amendment  with respect to
any such  document was filed,  when such  document was filed),  conformed in all
material respects to the requirements of the Exchange Act and did not contain an
untrue statement of a material fact or omit to state a material fact required to
be stated  therein or necessary to make the statements  therein not  misleading;
and any further Incorporated Documents will, when so filed, be filed in a timely
manner and conform in all material  respects to the requirements of the Exchange
Act and will not contain an untrue statement of a material fact or omit to state
a  material  fact  required  to be  stated  therein  or  necessary  to make  the
statements therein not misleading.

                  (d) The Indenture has been duly and validly  authorized by the
Company and, upon its  execution,  delivery and  performance  by the Company and
assuming due authorization,  execution, delivery and performance by the Trustee,
will be a valid and binding agreement of the Company,  enforceable in accordance
with its terms,  except as  enforcement  thereof  may be limited by  bankruptcy,
insolvency or other similar laws  affecting  creditors'  rights  generally,  and
conforms in all  material  respects to the  description  thereof in the Offering
Memorandum; and no qualification of the Indenture under the 1939 Act is required
in  connection  with the offer and sale of the Notes  contemplated  hereby or in
connection with the Exempt Resales.

                  (e) The Notes have been duly  authorized  by the Company  and,
when executed by the Company and authenticated by the Trustee in accordance with
the Indenture and delivered to the Initial  Purchasers  against payment therefor
in  accordance  with the  terms  hereof,  will  have  been  validly  issued  and
delivered,  and will  constitute  valid and binding  obligations  of the Company
entitled to the benefits of the Indenture  and  enforceable  in accordance  with
their  terms,  except as  enforcement  thereof  may be  limited  by  bankruptcy,
insolvency or other similar laws affecting the enforcement of creditors'  rights
generally, and the


                                       7
<PAGE>

Notes will conform in all material  respects to the  description  thereof in the
Offering Memorandum.

                  (f) All the outstanding shares of capital stock of the Company
have been duly authorized and validly issued,  are fully paid and  nonassessable
and  are  free  of any  preemptive  or,  except  as set  forth  in the  Offering
Memorandum,  similar  rights  and were  issued and sold in  compliance  with all
applicable  Federal and state securities laws; and the authorized  capital stock
of the Company conforms to the description thereof in the Offering Memorandum.

                  (g) The  Company  is a  corporation  duly  organized,  validly
existing and in good standing  under the laws of the State of Delaware with full
corporate  power and authority to own,  lease and operate its  properties and to
conduct its  business  as  described  in the  Offering  Memorandum,  and is duly
registered and qualified to conduct its business and is in good standing in each
jurisdiction  or place where the nature of its  properties or the conduct of its
business requires such  registration or qualification,  except where the failure
so to  register  or  qualify  does not have a  material  adverse  effect  on the
condition (financial or other), business,  prospects,  properties,  net worth or
results of  operations  of the  Company  and the  Subsidiaries  (as  hereinafter
defined) taken as a whole (a "Material Adverse Effect").

                  (h) All the  Company's  subsidiaries  (as  defined in the Act)
included in Exhibit 21 to the Company's  Annual Report on Form 10-K for the year
ended  December  31,  1996,  together  with those  subsidiaries  of the  Company
identified in Schedule II to this Agreement, are referred to herein individually
as a "Subsidiary" and collectively as the  "Subsidiaries."  Each Subsidiary is a
corporation or limited partnership duly organized,  validly existing and in good
standing  in the  jurisdiction  of its  organization,  with  full  corporate  or
partnership  power and authority to own, lease and operate its properties and to
conduct its  business  as  described  in the  Offering  Memorandum,  and is duly
registered and qualified to conduct its business and is in good standing in each
jurisdiction  or place where the nature of its  properties or the conduct of its
business requires such  registration or qualification,  except where the failure
so to  register  or  qualify  or be in good  standing  does not have a  Material
Adverse  Effect.  None  of  the  subsidiaries  of the  Company  other  than  the
Subsidiaries  is engaged in any business  activities  or  operations  or has any
material assets or liabilities.  All the outstanding  shares of capital stock of
each of the  Subsidiaries  which is a corporation  have been duly authorized and
validly issued,  are fully paid and  nonassessable,  and are wholly owned by the
Company directly or indirectly through one of the other  Subsidiaries,  free and
clear  of  any  lien,  adverse  claim,   security  interest,   equity  or  other
encumbrance,  except as described in the Offering  Memorandum and except for the
shares of capital stock of certain  Subsidiaries  pledged to Citibank,  N.A., as
administrative  agent  ("Citibank"),  in connection with the Company's Revolving
Credit  Agreement  dated as of May 15, 1996 with  Citibank  and the lenders from
time to time party thereto (the "Credit Agreement") and/or to Meditrust Mortgage
Investments, Inc. and/or any of its affiliates (collectively, "Meditrust"). Each
limited  partnership  agreement  pursuant to which the  Company or a  Subsidiary
holds a  general  partnership  interest  in a  limited  partnership  which  is a
Subsidiary  is in full  force and effect and  constitutes  the legal,  valid and
binding  agreement of the parties thereto,  enforceable  against such parties in
accordance with the terms thereof,  except as enforcement thereof may be limited
by  bankruptcy,  insolvency or other similar laws  affecting the  enforcement of
creditors' rights generally and by general equitable  principles;  and there has
been no material  breach of or default under,  and no event which with notice or
lapse of time would  constitute  a material  breach of or  default  under,  such
agreements by the Company or any Subsidiary or, to the Company's best knowledge,
any other party to such agreements.


                                       8
<PAGE>

                  (i) There are no legal or governmental proceedings pending or,
to the knowledge of the Company,  threatened,  against the Company or any of the
Subsidiaries,  or to which the Company or any of the  Subsidiaries,  or to which
any of their respective  properties,  is subject,  that are not disclosed in the
Offering  Memorandum and which, if adversely  decided,  are reasonably likely to
cause a Material  Adverse Effect or materially  affect the issuance of the Notes
or the consummation of the transactions contemplated by the Operative Documents.
There  are no  material  agreements,  contracts,  indentures,  leases  or  other
instruments  that  are not  described  in the  Offering  Memorandum  or that are
required to be filed as an exhibit to any Incorporated  Document that are not so
filed.  Neither the Company nor any  Subsidiary  is involved in any strike,  job
action or labor  dispute  with any group of  employees,  and,  to the  Company's
knowledge,  no such action or dispute is threatened,  which is reasonably likely
to have a Material Adverse Effect.

                  (j) Neither the Company nor any of the  Subsidiaries is (i) in
violation of its  certificate or articles of  incorporation  or by-laws or other
organizational   documents,   or  of  any  law,  ordinance,   administrative  or
governmental  rule  or  regulation  applicable  to  the  Company  or  any of the
Subsidiaries or of any decree of any court or governmental agency or body having
jurisdiction over the Company or any of the Subsidiaries,  except where any such
violation  or  violations  in the  aggregate  would not have a Material  Adverse
Effect or (ii) in default in any  material  respect  in the  performance  of any
obligation, agreement or condition contained in any bond, debenture, note or any
other evidence of indebtedness or in any material agreement, indenture, lease or
other  instrument to which the Company or any of the  Subsidiaries is a party or
by which any of them or any of their respective  properties may be bound, except
as may be disclosed in the Offering Memorandum.

                  (k)  Neither  the  issuance,  offer,  sale or  delivery of the
Notes, the execution,  delivery or performance of this Agreement,  the Indenture
or the Registration  Rights Agreement by the Company nor the consummation by the
Company of the  transactions  contemplated  hereby or thereby (i)  requires  any
consent,  approval,  authorization  or other order of, or registration or filing
with, any court,  regulatory body,  administrative  agency or other governmental
body,  agency or official (except such as may be required in connection with the
registration  under the Act of the Notes and/or the New Notes in accordance with
the Registration Rights Agreement,  the qualification of the Indenture under the
1939 Act and  except  for  compliance  with the  securities  or Blue Sky laws of
various jurisdictions) or conflicts or will conflict with or constitutes or will
constitute  a breach of, or a default  under,  the  certificate  or  articles of
incorporation or bylaws, or other  organizational  documents,  of the Company or
any of the  Subsidiaries  or (ii) conflicts or will conflict with or constitutes
or will constitute a breach of, or a default under, in any material respect, any
material agreement, indenture, lease or other instrument to which the Company or
any of the  Subsidiaries  is a party  or by  which  any of them or any of  their
respective  properties may be bound, or violates or will violate in any material
respect any statute, law, regulation or filing or judgment, injunction, order or
decree  applicable  to the  Company or any of the  Subsidiaries  or any of their
respective properties, or will result in the creation or imposition of any lien,
charge or  encumbrance  upon any property or assets of the Company or any of the
Subsidiaries  pursuant to the terms of any  agreement or instrument to which any
of them is a party or by which  any of them may be bound or to which  any of the
property or assets of any of them is subject.

                  (l) The  accountants,  KPMG Peat  Marwick  LLP and  Deloitte &
Touche  LLP,  who have  certified  or shall  certify  the  financial  statements
included as part of the Offering  Memorandum  (or any  amendment  or  supplement
thereto), are independent certified public


                                       9
<PAGE>

accountants under Rule 101 of the AICPA's Code of Professional  Conduct, and its
interpretation and rulings.

                  (m) The  historical  financial  statements,  together with the
related  schedules  and notes forming part of the Offering  Memorandum  (and any
amendment or supplement thereto), comply as to form with the requirements of the
Exchange  Act and  present  fairly in all  material  respects  the  consolidated
financial  position,  results of operations and changes in stockholders'  equity
and cash  flows of each of the  Company  and its  Subsidiaries,  First  American
Health Care of Georgia,  Inc. ("First American") and RoTech Medical  Corporation
("RoTech")  on the basis stated in the  Offering  Memorandum  at the  respective
dates or for the  respective  periods to which they apply;  such  statements and
related  schedules  and notes have been prepared in  accordance  with  generally
accepted  accounting  principles  consistently  applied  throughout  the periods
involved,  except as disclosed therein;  and the other financial and statistical
information and data set forth in the Offering  Memorandum (and any amendment or
supplement thereto) is accurately  presented and, to the extent such information
and data is derived from the financial  books and records of the Company and its
Subsidiaries,  First  American  or RoTech,  as the case may be, is prepared on a
basis consistent with such financial  statements and the books and records.  The
pro  forma  financial  statements  and other  pro  forma  financial  information
included or  incorporated  by  reference in the  Offering  Memorandum  have been
prepared in accordance with the  Commission's  rules and guidelines with respect
to pro forma financial  information and have been properly compiled on the basis
described therein,  and the assumptions used in the preparation  thereof are, in
the Company's opinion, reasonable.

                  (n) The  Company  has all  requisite  power and  authority  to
execute,  deliver and  perform  its  obligations  under this  Agreement  and the
Registration   Rights  Agreement;   the  execution  and  delivery  of,  and  the
performance  by the Company of its  obligations  under,  this  Agreement and the
Registration  Rights  Agreement  have been duly and  validly  authorized  by the
Company, and this Agreement and the Registration Rights Agreement have been duly
executed  and  delivered  by the  Company and  constitute  the valid and legally
binding agreements of the Company, enforceable against the Company in accordance
with their terms, except as the enforcement hereof and thereof may be limited by
bankruptcy,  insolvency  or other  similar laws  affecting  the  enforcement  of
creditors'  rights  generally  and  subject  to  the  applicability  of  general
principles  of  equity,  and  except  as rights to  indemnity  and  contribution
hereunder and thereunder may be limited by Federal or state  securities  laws or
principles of public policy.

                  (o) Except as  disclosed in the  Offering  Memorandum  (or any
amendment  or  supplement  thereto),  subsequent  to the date as of  which  such
information is given in the Offering  Memorandum (or any amendment or supplement
thereto),  neither the  Company nor any of the  Subsidiaries  has  incurred  any
liability or obligation,  direct or contingent, or entered into any transaction,
not in the ordinary course of business,  that is material to the Company and the
Subsidiaries taken as a whole, and there has not been any material change in the
capital stock, or material  increase in the short-term or long-term debt, of the
Company or any of the  Subsidiaries,  or any  material  adverse  change,  or any
development  involving  or which  could  reasonably  be  expected  to  involve a
prospective  material  adverse  change,  in the condition  (financial or other),
business,  properties, net worth or results of operations of the Company and the
Subsidiaries taken as a whole.

                  (p)  Each of the  Company  and the  Subsidiaries  has good and
marketable  title to all property (real and personal)  described in the Offering
Memorandum as being owned by it, free and clear of all liens,  claims,  security
interests  or other  encumbrances  except such as are  described in the Offering
Memorandum  or in an  Incorporated  Document  or  exhibit  thereto,


                                       10
<PAGE>

and all the property  described in the Offering  Memorandum  as being held under
lease by each of the Company  and the  Subsidiaries  is held by it under  valid,
subsisting and enforceable leases, with only such exceptions as in the aggregate
are not materially  burdensome and do not interfere in any material respect with
the  conduct of the  business of the  Company  and the  Subsidiaries  taken as a
whole.

                  (q)  Except  as  permitted  by the Act,  the  Company  has not
distributed  and, prior to the later to occur of the Closing Date and completion
of the distribution of the Notes,  will not distribute any offering  material in
connection  with the offering  and sale of the Notes other than the  Preliminary
Offering Memorandum and Offering Memorandum.

                  (r)  Each of the  Company  and the  Subsidiaries  and,  to the
Company's  knowledge,  the owners of the facilities and other businesses managed
by the  Company  or any  Subsidiary  have such  permits,  licenses,  franchises,
certificates and other approvals or authorizations of governmental or regulatory
authorities  ("Permits")  as are  necessary  under  applicable  law to own their
respective  properties  and to conduct their  respective  business in the manner
described  in the  Offering  Memorandum  (including,  without  limitation,  such
Permits as are required  under such  federal,  state and other health care laws,
and  under  such HMO or  similar  licensure  laws and  such  insurance  laws and
regulations,  as are applicable  thereto),  and with respect to those facilities
and other businesses that  participate in Medicare and/or  Medicaid,  to receive
reimbursement  under  Medicare  and  Medicaid,  subject  in  each  case  to such
qualifications as may be set forth in the Offering  Memorandum and except to the
extent that the failure to have such Permits  would not have a Material  Adverse
Effect; the Company and each of the Subsidiaries have fulfilled and performed in
all material respects, all their respective material obligations with respect to
the Permits, and no event has occurred which allows, or after notice or lapse of
time would  allow,  revocation  or  termination  thereof or results in any other
material  impairment of the rights of the holder of any such Permit,  subject in
each case to such  qualification as may be set forth in the Offering  Memorandum
and except to the extent that any such revocation or termination  would not have
a Material Adverse Effect; and, except as described in the Offering  Memorandum,
none of the Permits  contains any restriction  that is materially  burdensome to
the Company or any of the Subsidiaries.

                  (s) The  business  practices  of the  Company  and each of its
Subsidiaries do not violate in any material respect any applicable provisions of
federal or state law governing Medicare or any state Medicaid program, including
without  limitation,  Sections  1320a-7a  and 1320a-7b of Title 42 of the United
States Code, and no individual with an ownership or control interest, as defined
in 42 U.S.C. ss.1320a-3(a)(3), in the Company or any of its Subsidiaries, or who
is an  officer,  director,  or  managing  employee,  as  defined  in  42  U.S.C.
ss.1320a-5(b),  of the Company or any of its  Subsidiaries is a person described
in  42  U.S.C.   ss.1320a-7(b)(8)(B),   and  the   Company's  and  each  of  its
Subsidiaries'  business  practices  do not violate in any  material  respect any
applicable  provisions of federal or state law regarding physician ownership of,
or financial  relationship  with, or referral to entities  providing health care
related goods or services,  or laws requiring  disclosure of financial interests
held by  physicians  in  entities  to which  they  may  refer  patients  for the
provision of health care related goods or services.

                  (t) The information presented in the Offering Memorandum under
the caption "Business of RoTech" fairly presents the information purported to be
shown and does not  contain an untrue  statement  of a material  fact or omit to
state a material  fact  required to be stated  therein or  necessary to make the
statements therein not misleading.


                                       11
<PAGE>

                  (u) The  Company  maintains  a system of  internal  accounting
controls  sufficient to provide reasonable  assurances that (i) transactions are
executed in accordance with management's general or specific authorization; (ii)
transactions  are  recorded as  necessary  to permit  preparation  of  financial
statements in conformity with generally  accepted  accounting  principles and to
maintain  accountability for assets; (iii) access to assets is permitted only in
accordance with  management's  general or specific  authorization;  and (iv) the
recorded   accountability  for  assets  is  compared  with  existing  assets  at
reasonable  intervals  and  appropriate  action  is taken  with  respect  to any
differences.

                  (v) Neither the  Company nor any of the  Subsidiaries  nor, to
the Company's knowledge,  any employee or agent of the Company or any Subsidiary
has made any  payment of funds of the Company or any  Subsidiary  or received or
retained any funds in violation of any law, rule or regulation,  which violation
would have a Material Adverse Effect.

                  (w)  Except  as  disclosed  in the  Offering  Memorandum,  the
Company and each of the  Subsidiaries  have filed all tax returns required to be
filed, which returns are true and correct in all material respects,  and neither
the Company nor any  Subsidiary  is in default in the payment of any taxes which
were payable  pursuant to said returns or any assessments  with respect thereto,
except where the failure to file such returns and make such  payments  would not
have a Material Adverse Effect.

                  (x)  The  Company  and the  Subsidiaries  own or  possess  all
patents,  trademarks,  trademark  registration,   service  marks,  service  mark
registrations,  trade names, copyrights, licenses, inventions, trade secrets and
rights  described  in the Offering  Memorandum  as being owned by any of them or
necessary for the conduct of their respective businesses, and the Company is not
aware of any claim to the  contrary or any  challenge by any other person to the
rights of the Company and the Subsidiaries with respect to the foregoing.

                  (y) The  Company  is not  and,  upon  sale of the  Notes to be
issued and sold thereby in accordance  herewith and the  application  of the net
proceeds to the Company of such sale as  described  in the  Offering  Memorandum
under the caption "Use of Proceeds," will not be an "investment  company" within
the meaning of the Investment Company Act of 1940, as amended.

                  (z) When the Notes are issued and  delivered  pursuant to this
Agreement,  such Notes will not be of the same class (within the meaning of Rule
144A(d)(3)  under the Act) as any  security of the  Company  that is listed on a
national  securities  exchange registered under Section 6 of the Exchange Act or
that is quoted in a United States automated interdealer quotation system.

                  (aa) Neither the Company nor any affiliate (as defined in Rule
501(b) of  Regulation  D  ("Regulation  D") under  the Act) of the  Company  has
directly,  or through any agent (provided that no  representation  is made as to
the Initial Purchasers or any person acting on their behalf),  (i) sold, offered
for sale,  solicited  offers to buy or otherwise  negotiated  in respect of, any
security  (as  defined  in the  Act)  which  is or will be  integrated  with the
offering and sale of the Notes in a manner that would  require the  registration
of the Notes under the Act or (ii)  engaged in any form of general  solicitation
or general  advertising  (within the meaning of Regulation D) in connection with
the offering of the Notes.

                  (ab) The Company is not  required  to deliver the  information
specified in Rule  144A(d)(4) in connection  with the offering and resale of the
Notes by the Initial Purchasers.


                                       12
<PAGE>

                  (ac) Assuming (i) that the  representations  and warranties in
Section 2 hereof are true, (ii) the Initial Purchasers comply with the covenants
set forth in  Section 2 hereof and (iii)  that each  person to whom the  Initial
Purchasers offer, sell or deliver the Notes is a Qualified  Institutional Buyer,
the  purchase  and sale of the Notes  pursuant  hereto  (including  the  Initial
Purchasers'  proposed  offering  of the Notes on the terms and in the manner set
forth in the  Offering  Memorandum  and  Section  2 hereof)  is exempt  from the
registration requirements of the Act.

                  (ad) The execution and delivery of this  Agreement,  the other
Operative  Documents  and the sale of the Notes to the Initial  Purchasers or by
the Initial  Purchasers to Eligible  Purchasers  will not involve any prohibited
transaction  within the meaning of Section  406 of ERISA or Section  4975 of the
Code. The  representation  made by the Company in the preceding sentence is made
in reliance  upon and  subject to the  accuracy  of, and  compliance  with,  the
representations  and covenants made or deemed made by the Eligible Purchasers as
set forth in the  Offering  Memorandum  under the  section  entitled  "Notice to
Investors."

                  6. Indemnification and Contribution. (a) The Company agrees to
indemnify and hold harmless each Initial  Purchaser and each person, if any, who
controls  any Initial  Purchaser  within the meaning of Section 15 of the Act or
Section 20 of the  Exchange  Act,  from and against any and all losses,  claims,
damages,  liabilities and expenses (including reasonable costs of investigation)
arising out of or based upon any untrue statement or alleged untrue statement of
a material fact  contained in the  Preliminary  Offering  Memorandum or Offering
Memorandum or in any amendment or supplement thereto, or arising out of or based
upon any omission or alleged  omission to state therein a material fact required
to be stated therein or necessary to make the statements therein not misleading,
except insofar as such losses,  claims,  damages,  liabilities or expenses arise
out of or are based upon any untrue  statement  or  omission  or alleged  untrue
statement  or  omission  which has been made  therein  or omitted  therefrom  in
reliance upon and in conformity  with the  information  relating to such Initial
Purchaser  furnished  in writing to the Company by or on behalf of such  Initial
Purchaser expressly for use in connection therewith; provided, however, that the
indemnification  contained in this paragraph (a) with respect to the Preliminary
Offering  Memorandum shall not inure to the benefit of any Initial Purchaser (or
to the benefit of any person  controlling  any Initial  Purchaser) on account of
any such loss, claim, damage,  liability or expense arising from the sale of the
Notes by such Initial Purchaser to any person if the untrue statement or alleged
untrue statement or omission or alleged omission of a material fact contained in
the Preliminary Offering Memorandum was corrected in the Offering Memorandum and
such Initial Purchaser sold Notes to that person without sending or giving at or
prior  to  the  written  confirmation  of  such  sale,  a copy  of the  Offering
Memorandum  (as then  amended or  supplemented)  if the Company  has  previously
furnished  sufficient  copies thereof to such Initial  Purchaser.  The foregoing
indemnity  agreement shall be in addition to any liability which the Company may
otherwise have.

                  (b) If any action, suit or proceeding shall be brought against
any Initial Purchaser or any person controlling any Initial Purchaser in respect
of which indemnity may be sought against the Company,  such Initial Purchaser or
such  controlling   person  shall  promptly  notify  the  parties  against  whom
indemnification  is  being  sought  (the  "indemnifying   parties"),   and  such
indemnifying parties shall assume the defense thereof,  including the employment
of counsel and payment of all fees and expenses.  Such Initial  Purchaser or any
such  controlling  person shall have the right to employ separate counsel in any
such action,  suit or proceeding and to participate in the defense thereof,  but
the fees and  expenses of such  counsel  shall be at the expense of such Initial
Purchaser or such controlling person unless (i) the indemnifying



                                       13
<PAGE>

parties  have  agreed  in  writing  to pay  such  fees  and  expenses,  (ii) the
indemnifying  parties have failed to assume the defense and employ  counsel,  or
(iii) the named parties to any such action,  suit or proceeding  (including  any
impleaded  parties)  include  both such Initial  Purchaser  or such  controlling
person  and  the  indemnifying  parties  and  such  Initial  Purchaser  or  such
controlling person shall have been advised by its counsel that representation of
such indemnified  party and any indemnifying  party by the same counsel would be
inappropriate under applicable standards of professional conduct (whether or not
such  representation  by the same  counsel has been  proposed)  due to actual or
potential differing interests between them (in which case the indemnifying party
shall  not  have  the  right to  assume  the  defense  of such  action,  suit or
proceeding on behalf of such Initial Purchaser or such controlling  person).  It
is understood,  however, that the indemnifying parties shall, in connection with
any one such action, suit or proceeding or separate but substantially similar or
related actions,  suits or proceedings in the same  jurisdiction  arising out of
the same general allegations or circumstances, be liable for the reasonable fees
and  expenses of only one separate  firm of attorneys  (in addition to any local
counsel) at any time for all such Initial Purchasers and controlling persons not
having actual or potential  differing  interests with the Initial  Purchasers or
among  themselves,  which firm shall be  designated  in writing by Smith  Barney
Inc.,  and that  all such  fees and  expenses  shall be  reimbursed  as they are
incurred. The indemnifying parties shall not be liable for any settlement of any
such action, suit or proceeding  effected without their written consent,  but if
settled  with such  written  consent,  or if there be a final  judgment  for the
plaintiff in any such action, suit or proceeding, the indemnifying parties agree
to indemnify and hold harmless any Initial Purchaser,  to the extent provided in
paragraph (a), and any such controlling person from and against any loss, claim,
damage, liability or expense by reason of such settlement or judgment.

                  (c) Each Initial Purchaser agrees,  severally and not jointly,
to indemnify and hold harmless the Company, and its directors and officers,  and
any person who controls the Company  within the meaning of Section 15 of the Act
or Section 20 of the Exchange Act to the same extent as the  indemnity  from the
Company to each Initial  Purchaser set forth in paragraph  (a) hereof,  but only
with  respect to  information  relating to such Initial  Purchaser  furnished in
writing  by or on  behalf of such  Initial  Purchaser  expressly  for use in the
Preliminary  Offering  Memorandum  or Offering  Memorandum  or any  amendment or
supplement  thereto.  If any action, suit or proceeding shall be brought against
the Company,  any of its directors or officers,  or any such controlling  person
based on the  Preliminary  Offering  Memorandum or Offering  Memorandum,  or any
amendment or supplement thereto, and in respect of which indemnity may be sought
against such Initial  Purchaser  pursuant to this  paragraph  (c),  such Initial
Purchaser shall have the rights and duties given to the Company by paragraph (b)
above  (except that if the Company  shall have assumed the defense  thereof such
Initial  Purchaser  shall not be  required  to do so,  but may  employ  separate
counsel  therein  and  participate  in the  defense  thereof,  but the  fees and
expenses of such counsel shall be at such Initial Purchaser's expense),  and the
Company, its directors and officers,  and any such controlling person shall have
the rights and duties given to the Initial  Purchasers  by paragraph  (b) above.
The foregoing  indemnity  agreement  shall be in addition to any liability which
the Initial Purchasers may otherwise have.

                  (d) If the  indemnification  provided for in this Section 6 is
unavailable  to an  indemnified  party  under  paragraphs  (a) or (c)  hereof in
respect of any losses,  claims,  damages,  liabilities  or expenses  referred to
therein,  then an indemnifying  party, in lieu of indemnifying  such indemnified
party,  shall contribute to the amount paid or payable by such indemnified party
as a result of such losses, claims, damages, liabilities or expenses (i) in such
proportion as is  appropriate to reflect the relative  benefits  received by the
Company on the one hand and the  Initial  Purchasers  on the other hand from the
offering of the Notes, or (ii) if the allocation


                                       14
<PAGE>

provided  by clause  (i)  above is not  permitted  by  applicable  law,  in such
proportion as is appropriate to reflect not only the relative  benefits referred
to in clause  (i) above but also the  relative  fault of the  Company on the one
hand and the Initial  Purchasers on the other in connection  with the statements
or omissions  that  resulted in such losses,  claims,  damages,  liabilities  or
expenses, as well as any other relevant equitable  considerations.  The relative
benefits  received by the Company on the one hand and the Initial  Purchasers on
the other shall be deemed to be in the same proportion as the total net proceeds
from the offering (before  deducting  expenses)  received by the Company bear to
the total discounts and commissions received by the Initial Purchasers,  in each
case as set forth in the table on the cover page of the Offering Memorandum. The
relative fault of the Company on the one hand and the Initial  Purchasers on the
other hand shall be determined by reference to, among other things,  whether the
untrue or alleged untrue statement of a material fact or the omission or alleged
omission to state a material fact relates to information supplied by the Company
on the one hand or by the Initial  Purchasers on the other hand and the parties'
relative intent, knowledge,  access to information and opportunity to correct or
prevent such statement or omission.

                  (e) The Company and the Initial Purchasers agree that it would
not be just and  equitable  if  contribution  pursuant  to this  Section  6 were
determined by a pro rata  allocation  or by any other method of allocation  that
does not take account of the equitable  considerations  referred to in paragraph
(d) above. The amount paid or payable by an indemnified party as a result of the
losses, claims,  damages,  liabilities and expenses referred to in paragraph (d)
above shall be deemed to include,  subject to the  limitations  set forth above,
any legal or other expenses  reasonably  incurred by such  indemnified  party in
connection with  investigating  any claim or defending any such action,  suit or
proceeding.  Notwithstanding  the  provisions  of this  Section  6,  no  Initial
Purchaser  shall be required to contribute any amount in excess of the amount by
which the total price of the Notes  purchased  and resold by it as  contemplated
hereby  exceeds  the amount of any  damages  which such  Initial  Purchaser  has
otherwise  been  required  to pay by reason of such  untrue  or  alleged  untrue
statement  or  omission  or alleged  omission.  No person  guilty of  fraudulent
misrepresentation  (within  the  meaning of  Section  11(f) of the Act) shall be
entitled to  contribution  from any person who was not guilty of such fraudulent
misrepresentation.

                  (f) No  indemnifying  party shall,  without the prior  written
consent of the  indemnified  party,  effect  any  settlement  of any  pending or
threatened action,  suit or proceeding in respect of which any indemnified party
is or could have been a party and indemnity could have been sought  hereunder by
such indemnified party, unless such settlement includes an unconditional release
of such  indemnified  party from all  liability  on claims  that are the subject
matter of such action, suit or proceeding.

                  (g) Any losses, claims,  damages,  liabilities or expenses for
which an indemnified party is entitled to  indemnification or contribution under
this Section 6 shall be paid by the indemnifying  party to the indemnified party
as such losses,  claims,  damages,  liabilities  or expenses are  incurred.  The
indemnity  and  contribution  agreements  contained  in this  Section  6 and the
representations  and warranties of the Company set forth in this Agreement shall
remain  operative  and  in  full  force  and  effect,   regardless  of  (i)  any
investigation  made by or on  behalf  of any  Initial  Purchaser  or any  person
controlling any Initial Purchaser, the Company, its directors or officers or any
person  controlling  the  Company,  (ii)  acceptance  of any Notes  and  payment
therefor hereunder,  and (iii) any termination of this Agreement. A successor to
any Initial Purchaser or any person controlling any Initial Purchaser, or to the
Company, its directors or officers or any person controlling the Company,  shall
be entitled to the benefits of the  indemnity,  contribution  and  reimbursement
agreements contained in this Section 6.



                                       15
<PAGE>

                  7.  Conditions  of the Initial  Purchasers'  Obligations.  The
several  obligations of the Initial  Purchasers to purchase the Notes  hereunder
are subject to the following conditions:

                  (a) At the  time of  execution  of this  Agreement  and on the
Closing Date, no order or decree  preventing the use of the Offering  Memorandum
or any  amendment  or  supplement  thereto,  or any  order  asserting  that  the
transactions  contemplated  by this  Agreement  are subject to the  registration
requirements  of the Act shall  have been  issued  and no  proceedings  for that
purpose  shall have been  commenced or shall be pending or, to the  knowledge of
the Company, be contemplated.  No stop order suspending the sale of the Notes in
any jurisdiction designated by the Initial Purchasers shall have been issued and
no  proceedings  for that purpose shall have been  commenced or shall be pending
or, to the knowledge of the Company, shall be contemplated.

                  (b) Subsequent to the effective date of this Agreement,  there
shall  not  have  occurred  (i)  any  change,  or any  development  involving  a
prospective  change,  in  or  affecting  the  condition  (financial  or  other),
business,  properties, net worth, or results of operations of the Company or the
Subsidiaries not contemplated by the Offering  Memorandum,  which in the opinion
of the Initial Purchasers,  would materially adversely affect the market for the
Notes, or (ii) any event or development  relating to or involving the Company or
any officer or director of the  Company  which makes any  statement  made in the
Offering  Memorandum  untrue or which,  in the  opinion of the  Company  and its
counsel or the Initial Purchasers and their counsel,  requires the making of any
addition to or change in the  Offering  Memorandum  in order to state a material
fact required by any law to be stated  therein or necessary in order to make the
statements  therein not misleading,  if amending or  supplementing  the Offering
Memorandum  to reflect such event or  development  would,  in the opinion of the
Initial Purchasers, materially adversely affect the market for the Notes.

                  (c) The Initial  Purchasers shall have received on the Closing
Date an opinion of Fulbright & Jaworski L.L.P.,  counsel for the Company,  dated
the Closing Date and addressed to the Initial Purchasers, to the effect that:

                        (i) The Company is a corporation  duly  incorporated and
validly  existing in good standing  under the laws of the State of Delaware with
full corporate  power and authority to own, lease and operate its properties and
to conduct  its  business  as  described  in the  Offering  Memorandum  (and any
amendment or supplement thereto);

                        (ii) Each Significant  Subsidiary (as defined in Section
1.02(w) of Regulation S-X  promulgated  under the Act) is a corporation  validly
existing  and in  good  standing  under  the  laws  of the  jurisdiction  of its
organization, with full corporate power and authority to own, lease, and operate
its  properties  and to  conduct  its  business  as  described  in the  Offering
Memorandum  (and any amendment or supplement  thereto);  and all the outstanding
shares of capital stock of each of the Significant  Subsidiaries  have been duly
authorized  and validly  issued,  are fully paid and  nonassessable,  and to the
knowledge  of such  counsel,  are  wholly  owned  by the  Company  directly,  or
indirectly through one of the other Subsidiaries, free and clear of any security
interest, lien, adverse claim, equity or other encumbrance,  except as described
in the Offering Memorandum and except for the shares of capital stock of certain
Subsidiaries  pledged  to  Citibank  as agent  in  connection  with  the  Credit
Agreement and/or to Meditrust;

                                       16
<PAGE>


                        (iii) The authorized  capital stock of the Company is as
set forth under the caption "Capitalization" in the Offering Memorandum;

                        (iv) The Company has  corporate  power and  authority to
enter into this Agreement and the  Registration  Rights  Agreement and to issue,
sell  and  deliver  the  Notes  to be sold by it to the  Initial  Purchasers  as
provided herein,  and this Agreement and the Registration  Rights Agreement have
been duly authorized, executed and delivered by the Company and are valid, legal
and  binding  agreements  of the  Company,  enforceable  against  the Company in
accordance  with their terms,  except (A) as  enforcement of rights to indemnity
and  contribution  hereunder and  thereunder  may be limited by Federal or state
securities  laws  or  principles  of  public  policy  and  (B)  subject  to  the
qualification that the enforceability of the Company's obligations hereunder and
thereunder  may be limited by  bankruptcy,  fraudulent  conveyance,  insolvency,
reorganization,  moratorium,  and other laws relating to or affecting creditors'
rights generally and by general equitable principles;

                        (v) The Indenture has been duly and validly  authorized,
executed and delivered by the Company and, assuming due authorization, execution
and  delivery by the Trustee,  is a valid and binding  agreement of the Company,
enforceable in accordance with its terms,  subject to the qualification that the
enforceability  of  the  Company's  obligations  thereunder  may be  limited  by
bankruptcy, fraudulent conveyance, insolvency,  reorganization,  moratorium, and
other laws relating to or affecting  creditors'  rights generally and by general
equitable  principles;  and no qualification of the Indenture under the 1939 Act
is  required  in  connection  with the offer and sale of the Notes  contemplated
hereby or in connection with the Exempt Resales;

                        (vi) The Notes have been duly and validly  authorized by
the Company and when  executed by the Company in  accordance  with the Indenture
and, assuming due  authentication of the Notes by the Trustee,  upon delivery to
the Initial  Purchasers  against  payment  therefor in accordance with the terms
hereof,  will have been validly issued and delivered,  and will constitute valid
and  binding  obligations  of  the  Company  entitled  to  the  benefits  of the
Indenture, subject to the qualification that the enforceability of the Company's
obligations  thereunder  may be limited by  bankruptcy,  fraudulent  conveyance,
insolvency, reorganization,  moratorium, and other laws relating to or affecting
creditors' rights generally and by general equitable principles;

                        (vii) Neither the offer,  sale or delivery of the Notes,
the execution,  delivery or performance  by the Company of this  Agreement,  the
Registration  Rights Agreement or the Indenture,  compliance by the Company with
the  provisions  hereof  or  thereof  nor  consummation  by the  Company  of the
transactions  contemplated  hereby or thereby  constitutes or will  constitute a
breach or  violation  of, or a  default  under,  in any  material  respect,  the
certificate  or  articles  of  incorporation  or bylaws or other  organizational
documents of the Company or any of the Significant  Subsidiaries or any material
agreement,  indenture,  lease or other instrument to which the Company or any of
the Significant  Subsidiaries is a party or by which any of them or any of their
respective  properties is bound that is an exhibit to any Incorporated  Document
or is known to such counsel, or will result in the creation or imposition of any
lien, charge or encumbrance upon any property or assets of the Company or any of
the Significant  Subsidiaries pursuant to the terms of any material agreement or
instrument  to which any of them is a party or by which any of them may be bound
or to which any of the  property or assets of any of them is subject  that is an
exhibit to any Incorporated  Document or is known to such counsel,  nor will any
such action result in any violation in any material respect of any existing law,
or any  regulation,  ruling  (assuming  compliance  with  all  applicable  state
securities


                                       17
<PAGE>

and Blue Sky laws and, in the case of the Registration Rights Agreement, the Act
and the Exchange Act and the 1939 Act),  judgment,  injunction,  order or decree
known to such counsel, applicable to the Company or the Significant Subsidiaries
or any of their respective properties;

                        (viii)  No  consent,  approval,  authorization  or other
order  of,  or  registration  or  filing  with,  any  court,   regulatory  body,
administrative  agency  or other  governmental  body,  agency,  or  official  is
required  on the part of the  Company  (except as have been  obtained  under the
Exchange Act, or such as may be required under state securities or Blue Sky laws
governing the purchase and distribution of the Notes, or such as may be required
to qualify  the  Indenture  under the 1939 Act,  and such as may be  required in
connection  with the  performance  by the Company of its  obligations  under the
Registration  Rights  Agreement,  as to which such  counsel  need not express an
opinion) for the valid issuance and sale of the Notes to the Initial  Purchasers
as contemplated by this Agreement;

                        (ix)  The   Incorporated   Documents   (except  for  the
financial statements and the notes thereto and the schedules and other financial
and statistical data included therein, as to which such counsel need not express
any opinion), at the time they were filed, appear on their face to have complied
as to form in all material respects with the requirements of the Exchange Act;

                        (x) To the knowledge of such  counsel,  (A) there are no
legal or governmental  proceedings  pending or threatened against the Company or
any of the Subsidiaries,  or to which the Company or any of the Subsidiaries, or
any of their  property,  are  subject,  which are not  disclosed in the Offering
Memorandum and which,  if adversely  decided,  are reasonably  likely to cause a
Material  Adverse  Effect or materially  affect the issuance of the Notes or the
consummation of the transactions contemplated by the Operative Documents and (B)
there  are no  material  agreements,  contracts,  indentures,  leases  or  other
instruments, that are not described in the Offering Memorandum (or any amendment
or  supplement  thereto)  or that are  required to be filed as an exhibit to any
Incorporated Document that are not filed as required;

                        (xi) The statements in the Offering Memorandum,  insofar
as they are descriptions of contracts,  agreements or other legal documents,  or
refer to  statements of law or legal  conclusions,  are accurate in all material
respects and present fairly the information described therein;

                        (xii) When the Notes are issued and  delivered  pursuant
to this Agreement,  such Notes will not be of the same class (within the meaning
of Rule 144A(d)(3)  under the Act) as any security of the Company that is listed
on a national securities exchange registered under Section 6 of the Exchange Act
or that is quoted in a United States automated interdealer quotation system;

                        (xiii) No  registration  of the  Notes  under the Act is
required for the sale of the Notes to the Initial  Purchasers as contemplated in
this  Agreement  or for the  Exempt  Resales  (assuming  (A) that  any  Eligible
Purchaser who buys the Notes in the Exempt Resales is a Qualified  Institutional
Buyer and (B) the accuracy of the Initial Purchasers'  representations and those
of the Company in this Agreement  regarding the absence of general  solicitation
in  connection  with the Exempt  Resales);

                        (xiv)  The  Company  is  not  required  to  deliver  the
information  specified in Rule  144A(d)(4) in  connection  with the offering and
resale of the Notes by the Initial Purchasers; and


                                       18
<PAGE>

                        (xv) Although such counsel has not undertaken, except as
otherwise indicated in their opinion, to determine  independently,  and does not
assume any  responsibility  for, the accuracy,  completeness  or fairness of the
statements  in the Offering  Memorandum,  such counsel has  participated  in the
preparation of the Offering  Memorandum,  including review and discussion of the
contents thereof, and has reviewed the Incorporated  Documents,  and, relying as
to  materiality  to a large  extent  upon the  opinions  of  officers  and other
representatives  of the  Company,  nothing  has  come to the  attention  of such
counsel that has caused them to believe that the Offering Memorandum,  as of its
date and as of the Closing Date contained an untrue statement of a material fact
or omitted to state a material fact  required to be stated  therein or necessary
to make the statements  therein,  in light of the circumstances under which they
were made,  not  misleading  or that any amendment or supplement to the Offering
Memorandum,  as of its respective date, and as of the Closing Date contained any
untrue statement of a material fact or omitted to state a material fact required
to be stated  therein or necessary in order to make the statements  therein,  in
light of the circumstances  under which they were made, not misleading (it being
understood  that such  counsel  need  express  no  opinion  with  respect to the
financial statements and the notes thereto and the schedules and other financial
and  statistical  data  included or  incorporated  by  reference in the Offering
Memorandum and information furnished by or on behalf of the Initial Purchasers).

                  The  opinion of such  counsel  shall be limited to the laws of
the United States, the State of New York and the internal corporation law of the
State of Delaware.

                  (d) The Initial  Purchasers shall have received on the Closing
Date an opinion of Marshall A.  Elkins,  Esq.,  General  Counsel of the Company,
dated the Closing  Date and  addressed to the Initial  Purchasers  to the effect
that:

                        (i) The  Company is duly  registered  and  qualified  to
conduct its business and is in good  standing as a foreign  corporation  in each
jurisdiction  or place where the nature of its  properties or the conduct of its
business requires such  registration or qualification,  except where the failure
so to  register  or qualify or to be in good  standing  does not have a Material
Adverse Effect;

                        (ii) All the  shares  of  capital  stock of the  Company
outstanding  prior to the  issuance of the Notes have been duly  authorized  and
validly issued, are fully paid and nonassessable;

                        (iii) Each  Subsidiary is duly  registered and qualified
to conduct its  business  and is in good  standing as a foreign  corporation  or
limited  partnership  in each  jurisdiction  or place  where  the  nature of its
properties  or the  conduct  of  its  business  requires  such  registration  or
qualification,  except  where the  failure so to register or qualify or to be in
good standing does not have a Material Adverse Effect;

                        (iv) Neither the Company nor any of the  Subsidiaries is
in violation in any material  respect of its respective  certificate or articles
of incorporation or bylaws, or other  organizational  documents,  or to the best
knowledge  of such  counsel  after  reasonable  inquiry,  is in  default  in any
material  respect in the  performance of any material  obligation,  agreement or
condition  contained  in  any  bond,  debenture,   note  or  other  evidence  of
indebtedness or in any material agreement,  indenture, lease or other instrument
to which the  Company or any of the  Subsidiaries  is a party or by which any of
them or any of their respective  properties may be bound, except as disclosed in
the  Offering  Memorandum  and except to the extent that any such  violation  or
default would not have a Material Adverse Effect;


                                       19
<PAGE>

                        (v) Such  counsel  has no  reason  to  believe  that the
Company  and its  Subsidiaries  do not  have  all  Permits  (including,  without
limitation,  such Permits as are  necessary  under such federal and state health
care laws and under such HMO and similar  licensure laws and such insurance laws
and  regulations as are applicable to the Company and its  Subsidiaries)  as are
necessary to own,  lease and operate its  properties  and conduct its  business,
except to the  extent  that the  failure to have such  Permits  would not have a
Material  Adverse  Effect;  and to the  best  knowledge  of such  counsel  after
reasonable  inquiry there are no proceedings  pending or threatened  against the
Company  or any of its  Subsidiaries  that may  cause  any such  Permit  that is
material  to  the  conduct  of  the  business  of  the  Company  or  any  of its
Subsidiaries to be revoked, withdrawn, cancelled, suspended or not renewed;

                        (vi) Such  counsel has no reason to believe that (a) the
business  practices  of the  Company or any of its  Subsidiaries  violate in any
material  respect any  applicable  provisions  of federal or state law governing
Medicare or any state Medicaid program,  including without limitation,  Sections
1320a-7a  and  1320a-7b  of  Title 42 of the  United  States  Code,  or that any
individual  with an  ownership  or  control  interest,  as  defined in 42 U.S.C.
ss.1320a-3(a)(3),  in  the  Company  or any  of  its  Subsidiaries  or who is an
officer,  director, or managing employee as defined in 42 U.S.C.  ss.1320a-5(b),
of the Company or any of its  Subsidiaries  is a person  described  in 42 U.S.C.
ss.1320a-7(b)(8)(B),  or that (b) the  Company's  or any  Subsidiary's  business
practices  violate in any material respect any applicable  provisions of federal
or state law regarding physician  ownership of, or financial  relationship with,
or referral to entities providing health care related goods or services, or laws
requiring  disclosure of financial  interests  held by physicians in entities to
which they may refer  patients for the provision of health care related goods or
services;  and to the best knowledge of such counsel after  reasonable  inquiry,
neither the Company nor any of its  Subsidiaries  is in  violation  of any other
law, ordinance,  administrative or governmental rule or regulation applicable to
the  Company  or any of  its  Subsidiaries  or of any  decree  of any  court  or
governmental  agency or body having  jurisdiction over the Company or any of its
Subsidiaries,  except to the  extent  that any such  violation  would not have a
Material  Adverse  Effect;  and

                        (vii) Although such counsel has not  undertaken,  except
as otherwise  indicated in such counsel's opinion,  to determine  independently,
and does not  assume any  responsibility  for,  the  accuracy,  completeness  or
fairness  of the  statements  in  the  Offering  Memorandum,  such  counsel  has
participated in the preparation of the Offering  Memorandum and the Incorporated
Documents, and nothing has come to the attention of such counsel that has caused
such counsel to believe that the Offering  Memorandum,  as of its date and as of
the Closing Date,  contained an untrue  statement of material fact or omitted to
state a material  fact  required to be stated  therein or  necessary to make the
statements  therein,  in light of the circumstances  under which they were made,
not  misleading or that any amendment or supplement to the Offering  Memorandum,
as of its  respective  date,  and as of the Closing  Date  contained  any untrue
statement of a material  fact or omitted to state a material fact required to be
stated therein or necessary in order to make the statements therein, in light of
the  circumstances  under  which  they  were  made,  not  misleading  (it  being
understood  that such  counsel  need  express  no  opinion  with  respect to the
financial statements and the notes thereto and the schedules and other financial
and  statistical  data  included or  incorporated  by  reference in the Offering
Memorandum and information furnished by or on behalf of the Initial Purchasers).

                  (e) The Initial  Purchasers shall have received on the Closing
Date an opinion of Dewey Ballantine,  counsel for the Initial Purchasers,  dated
the Closing Date, and addressed to the Initial  Purchasers,  with respect to the
matters referred to in clauses (iv), (v), (vi), (xiii)


                                       20
<PAGE>

and (xv) of the foregoing  paragraph  (c) and such other related  matters as the
Initial Purchasers may request.

                  (f)  The  Initial   Purchasers  shall  have  received  letters
addressed to the Initial  Purchasers,  and dated the date hereof and the Closing
Date from KPMG Peat Marwick LLP and Deloitte & Touche LLP, independent certified
public  accountants,  substantially  in the  forms  heretofore  approved  by the
Initial Purchasers.

                  (g) (i) There shall not have been any  material  change in the
capital  stock of the Company nor any  material  increase in the  short-term  or
long-term  debt of the Company  (other than in the ordinary  course of business)
from that set forth or contemplated in the Offering Memorandum (or any amendment
or supplement  thereto);  (ii) there shall not have been,  since the  respective
dates  as of which  information  is given  in the  Offering  Memorandum  (or any
amendment  or  supplement  thereto),  except as may  otherwise  be stated in the
Offering  Memorandum  (or any  amendment or  supplement  thereto),  any material
adverse  change in the  condition  (financial  or other),  business,  prospects,
properties,  net  worth  or  results  of  operations  of  the  Company  and  the
Subsidiaries  taken as a whole; (iii) the Company and the Subsidiaries shall not
have any liabilities or obligations, direct or contingent (whether or not in the
ordinary  course  of  business),  that  are  material  to the  Company  and  the
Subsidiaries,  taken as a whole,  other than  those  reflected  in the  Offering
Memorandum  (or  any  amendment  or  supplement  thereto);   and  (iv)  all  the
representations  and warranties of the Company contained in this Agreement shall
be true and correct in all material respects on and as of the date hereof and on
and as of the  Closing  Date as if made on and as of the Closing  Date,  and the
Initial Purchasers shall have received a certificate, dated the Closing Date and
signed by the chief executive  officer and the chief  accounting  officer of the
Company (or such other officers as are acceptable to the Initial Purchasers), to
the effect set forth in this Section  7(g) and in Section  7(h) hereof.

                  (h) The  Company  shall  not  have  failed  at or prior to the
Closing Date to have  performed or complied  with any of its  agreements  herein
contained  and required to be  performed or complied  with by it hereunder at or
prior to the  Closing  Date.

                  (i) The Initial  Purchasers  shall have received  certificates
dated the date  hereof  and the  Closing  Date  signed  by the chief  accounting
officer of the Company  substantially  in the forms  heretofore  approved by the
Initial  Purchasers,  respecting  the  Company's  compliance  with the financial
covenants set forth in each of the Company's  indentures,  the Credit  Agreement
and certain other  agreements of the Company.

                  (j)  There  shall  not  have  been  any  announcement  by  any
"nationally recognized statistical rating organization," as defined for purposes
of Rule 436(g) under the Act, that (i) it is downgrading  its rating assigned to
any class of  securities  of the  Company,  or (ii) except as  disclosed  in the
Offering  Memorandum,  it is  reviewing  its  ratings  assigned  to any class of
securities of the Company with a view to possible downgrading,  or with negative
implications,  or  direction  not  determined.

                  (k) The Notes shall have been  approved for trading on PORTAL.

                  (l) Prior to the date of this  Agreement,  the  Company  shall
have received and shall have furnished to the Initial  Purchasers  copies of the
requisite  written  consent of the lenders party to the Credit  Agreement to the
consummation  by the Company of the  transactions  contemplated by the Operative
Documents and the Offering  Memorandum.


                                       21
<PAGE>

                  (m) The Company shall have furnished or caused to be furnished
to the Initial Purchasers such further certificates and documents as the Initial
Purchasers shall have requested.

                  All such opinions,  certificates,  letters and other documents
will be in compliance  with the  provisions  hereof only if they are  reasonably
satisfactory in form and substance to the Initial Purchasers and counsel for the
Initial Purchasers.

                  Any  certificate  or  document  signed by any  officer  of the
Company and delivered to the Initial  Purchasers,  or to counsel for the Initial
Purchasers,  shall be deemed a representation and warranty by the Company to the
Initial Purchasers as to the statements made therein.

                  8. Expenses. The Company agrees to pay the following costs and
expenses and all other costs and expenses  incident to the  performance by it of
its obligations hereunder: (i) the preparation,  printing or reproduction of the
Offering Memorandum (including financial statements thereto), and each amendment
or  supplement  thereto;  (ii)  the  printing  (or  reproduction)  and  delivery
(including postage,  air freight charges and charges for counting and packaging)
of such copies of the Offering Memorandum,  the Preliminary Offering Memorandum,
the Incorporated Documents,  and all amendments or supplements to any of them as
may be reasonably  requested for use in connection with the offering and sale of
the  Notes;  (iii)  the  preparation,  printing,  authentication,  issuance  and
delivery of certificates for the Notes,  including any stamp taxes in connection
with  the  original  issuance  and sale of the  Notes;  (iv)  the  printing  (or
reproduction)  and delivery of this Agreement,  the Indenture,  the Registration
Rights  Agreement,  the preliminary and supplemental  Blue Sky Memoranda and all
other  agreements  or  documents   printed  (or  reproduced)  and  delivered  in
connection with the offering of the Notes;  (v) the application for quotation of
the  Notes on  PORTAL;  (vi) the  qualification  of the Notes for offer and sale
under the  securities  or Blue Sky laws of the  several  states as  provided  in
Section 4(f) hereof  (including the reasonable fees,  expenses and disbursements
of counsel for the Initial Purchasers  relating to the preparation,  printing or
reproduction,  and  delivery  of  the  preliminary  and  supplemental  Blue  Sky
Memoranda and such  qualification);  (vii) the performance by the Company of its
obligations  under  the  Registration  Rights  Agreement;  (viii)  the  fees and
expenses  of the  Company's  accountants  and the fees and  expenses  of counsel
(including   local  and  special   counsel)  for  the  Company;   and  (ix)  the
transportation   and  other  expenses  incurred  by  or  on  behalf  of  Company
representatives  in connection with  presentations to prospective  purchasers of
the Notes.  The  Company  hereby  agrees that it will pay in full on the Closing
Date the fees and  expenses  referred  to in  clause  (vi) of this  Section 8 by
delivering to counsel for the Initial Purchasers on such date a check payable to
such counsel in the requisite amount.

                  9.  Effective Date of Agreement.  This Agreement  shall become
effective  upon the  execution  and delivery  hereof by all the parties  hereto.
Until  such  time as this  Agreement  shall  have  become  effective,  it may be
terminated  by the  Company,  by  notifying  the Initial  Purchasers,  or by the
Initial  Purchasers,  by notifying the Company.

                  Any  notice  under  this  Section 9 may be given by  telegram,
telecopy or telephone but shall be subsequently confirmed by letter.

                  10. Default by an Initial Purchaser.  If any Initial Purchaser
shall fail or refuse to purchase  the Notes which it is obligated to purchase on
the Closing Date, and arrangements  satisfactory to the  non-defaulting  Initial
Purchasers and the Company for the


                                       22
<PAGE>

purchase of such Notes by the  non-defaulting  Initial  Purchasers or by another
party or parties  satisfactory to the non-defaulting  Initial Purchasers and the
Company  are not made within  thirty-six  (36) hours  after such  default,  this
Agreement shall terminate  without  liability on the part of the  non-defaulting
Initial  Purchasers  or the  Company.  In any such case which does not result in
termination of this Agreement,  either the non-defaulting  Initial Purchasers or
the Company shall have the right to postpone the Closing  Date,  but in no event
for longer than seven (7) days, in order that the required  changes,  if any, in
the Offering  Memorandum or any other documents or arrangements may be effected.
Any action taken under this  paragraph  shall not relieve a  defaulting  Initial
Purchaser  from liability in respect of such default under this  Agreement.  The
term "Initial Purchaser" as used in this Agreement includes, for all purposes of
this  Agreement,  any party not identified in this Agreement who purchases Notes
which a defaulting  Initial  Purchaser is  obligated,  but fails or refuses,  to
purchase.

                  11. Termination of Agreement.  This Agreement shall be subject
to termination  in the absolute  discretion of the Initial  Purchasers,  without
liability on the part of the Initial Purchasers to the Company, by notice to the
Company, if prior to the Closing Date (i) trading in securities generally on the
New York Stock  Exchange,  American Stock Exchange or the Nasdaq National Market
shall have been suspended or materially  limited,  (ii) a general  moratorium on
commercial  banking  activities  in New York shall have been  declared by either
Federal or state authorities, or (iii) there shall have occurred any outbreak or
escalation of hostilities or other international or domestic calamity, crisis or
change in political,  financial or economic  conditions,  the effect of which on
the  financial  markets  of the  United  States  is such as to make  it,  in the
judgment of the Initial Purchasers,  impracticable or inadvisable to commence or
continue  the  offering of the Notes on the terms set forth on the cover page of
the Offering  Memorandum or to enforce  contracts for the resale of the Notes by
the Initial  Purchasers.  Notice of such termination may be given to the Company
by  telegram,  telecopy or  telephone  and shall be  subsequently  confirmed  by
letter.

                  12.  Information  Furnished  by the  Initial  Purchasers.  The
statements set forth in the stabilization  legend on the inside front cover, the
last paragraph on the cover page and in the third and seventh  paragraphs  under
the caption "Plan of  Distribution" in the Preliminary  Offering  Memorandum and
Offering Memorandum,  constitute the only information  furnished by or on behalf
of the Initial  Purchasers as such  information  is referred to in Sections 5(b)
and 6  hereof,  except  that  each of Smith  Barney  Inc.,  Donaldson,  Lufkin &
Jenrette Securities Corporation and Citicorp Securities,  Inc. has furnished the
information  relating to them  contained in the eighth  paragraph,  and Citicorp
Securities, Inc. has furnished the information contained in the ninth paragraph,
under the caption "Plan of Distribution"  contained in the Preliminary  Offering
Memorandum and the Offering Memorandum.

                  13. Miscellaneous. Except as otherwise provided in Sections 4,
9 and 11 hereof,  notice given pursuant to any provision of this Agreement shall
be in writing and shall be delivered (i) if to the Company, at the office of the
Company at 10065 Red Run Boulevard,  Owings Mills, MD 21117, Attention:  General
Counsel, with a copy to Fulbright & Jaworski L.L.P., 666 Fifth Avenue, New York,
NY 10103, Attention:  Roy L. Goldman, Esq. or (ii) if to the Initial Purchasers,
to Smith Barney Inc.,  388  Greenwich  Street,  New York,  NY 10013,  Attention:
Manager,  Investment  Banking Division,  with a copy to Dewey  Ballantine,  1301
Avenue of the Americas, New York, NY 10019, Attention: Frederick W. Kanner, Esq.

                  This  Agreement has been and is made solely for the benefit of
the Initial  Purchasers,  the  Company,  its  directors,  its  officers  and the
controlling  persons  referred  to in  Section  6 hereof  and  their  respective
successors and assigns, to the extent provided herein, and


                                       23
<PAGE>

no other  person  shall  acquire  or have any  right  under or by virtue of this
Agreement. Neither the term "successor" nor the term "successors and assigns" as
used in this Agreement shall include a purchaser from the Initial  Purchasers of
any of the Notes in his status as such purchaser.

                  14.  Applicable  Law;  Counterparts.  This Agreement  shall be
governed by and construed in  accordance  with the laws of the State of New York
applicable  to contracts  made and to be performed  within the State of New York
without  giving  effect to the  choice of laws or  conflict  of laws  principles
thereof.

                  This  Agreement  may be signed in various  counterparts  which
together constitute one and the same instrument. If signed in counterparts, this
Agreement  shall not become  effective  unless at least one  counterpart  hereof
shall have been executed and delivered on behalf of each party hereto.


                                       24

<PAGE>

                  Please  confirm that the  foregoing  correctly  sets forth the
agreement between the Company and the Initial Purchasers.



                                            Very truly yours,

                                            INTEGRATED HEALTH SERVICES, INC.


                                            By: /s/ Eleanor J. Harding
                                               ---------------------------------
                                            Name:  Eleanor J. Harding
                                            Title: Executive Vice President-
                                                   Finance


Accepted in New York, New York

September 8, 1997


Confirmed as of the date first above mentioned.

SMITH BARNEY INC.
MORGAN STANLEY & CO. INCORPORATED
DONALDSON, LUFKIN & JENRETTE
  SECURITIES CORPORATION
CITICORP SECURITIES, INC.

By:   SMITH BARNEY INC.



By:  /s/ Benjamin R. Lorello
     -------------------------------
     Name: Benjamin R. Lorello
     Title: Managing Director

                                      II


<PAGE>



                                   SCHEDULE I


                        INTEGRATED HEALTH SERVICES, INC.



                                                                Principal Amount
Initial Purchaser                                                   of Notes
- -----------------                                               ----------------

Smith Barney Inc.........................................         $250,000,000

Morgan Stanley & Co. Incorporated........................          100,000,000

Donaldson, Lufkin & Jenrette
  Securities Corporation.................................           75,000,000

Citicorp Securities, Inc.................................           75,000,000
                                                                  ------------
Total....................................................         $500,000,000
                                                                  ============


                                       
<PAGE>

                                   SCHEDULE II
                                   -----------
<TABLE>
<CAPTION>

========================================================================================================================
                                                   STATE OF                            STATE(S)
                     COMPANY                    INCORPORATION                 QUALIFIED TO DO BUSINESS
- ------------------------------------------------------------------------------------------------------------------------
<S>                                                <C>                               <C>
HEALTH CARE INDUSTRIES                             Florida
- ------------------------------------------------------------------------------------------------------------------------
IHS ACQUISITION XX, INC.                           California
- ------------------------------------------------------------------------------------------------------------------------
IHS NETWORK SERVICES, INC.                         Delaware                          Florida
- ------------------------------------------------------------------------------------------------------------------------
INTEGRATED HEALTH SERVICES OF           
KURT, INC.                                         Delaware                          Washington
- ------------------------------------------------------------------------------------------------------------------------
SYMPHONY RESPIRATORY SERVICES, INC.                Delaware                          Arkansas
                                                                                     Arizona
                                                                                     California
                                                                                     District of Columbia
                                                                                     Florida
                                                                                     Georgia
                                                                                     Idaho
                                                                                     Illinois
                                                                                     Indiana
                                                                                     Iowa
                                                                                     Kentucky
                                                                                     Louisiana
                                                                                     Maine
                                                                                     Maryland
                                                                                     Michigan
                                                                                     Minnesota
                                                                                     Missouri
                                                                                     Mississippi
                                                                                     North Carolina
                                                                                     Nebraska
                                                                                     New Hampshire
                                                                                     New Jersey
                                                                                     New York
                                                                                     Ohio
                                                                                     Oklahoma
                                                                                     Pennsylvania
                                                                                     South Carolina
                                                                                     Tennessee
                                                                                     Texas
                                                                                     Virginia
                                                                                     Wisconsin
                                                                                     West Virginia
                                                                                     Wyoming
- ------------------------------------------------------------------------------------------------------------------------
TEXAS LPC, INC.                                    Texas
- ------------------------------------------------------------------------------------------------------------------------
WEST COAST CAMBRIDGE, INC.                         California
- ------------------------------------------------------------------------------------------------------------------------
WOODRIDGE CONVALESCENT CENTER, INC.
CENTER, INC.                                       Texas
========================================================================================================================
</TABLE>



                                  $500,000,000

                        INTEGRATED HEALTH SERVICES, INC.

                    9 1/4% Senior Subordinated Notes due 2008

                          REGISTRATION RIGHTS AGREEMENT
                          -----------------------------

                                                               September 8, 1997

SMITH BARNEY INC.
MORGAN STANLEY & CO. INCORPORATED
DONALDSON, LUFKIN & JENRETTE
  SECURITIES CORPORATION
CITICORP SECURITIES, INC.
c/o      SMITH BARNEY INC.
         388 Greenwich Street
         New York, New York 10013

Dear Sirs:


                  Integrated Health Services,  Inc., a Delaware corporation (the
"Company"),  proposes to issue and sell to Smith Barney Inc.,  Morgan  Stanley &
Co.  Incorporated,  Donaldson,  Lufkin &  Jenrette  Securities  Corporation  and
Citicorp Securities,  Inc. (the "Initial Purchasers"),  upon the terms set forth
in a purchase  agreement of even date herewith (the  "Purchase  Agreement"),  an
aggregate of  $500,000,000  principal  amount of its 9 1/4% Senior  Subordinated
Notes due 2008 (the "Notes").  The Notes will be issued pursuant to an indenture
(the "Indenture")  dated as of September 11, 1997, between the Company and First
Union National Bank, as trustee (the "Trustee"). As an inducement to the Initial
Purchasers  to enter  into  the  Purchase  Agreement  and in  satisfaction  of a
condition to the obligations of the Initial Purchasers  thereunder,  the Company
agrees with the Initial Purchasers,  for the benefit of the holders of the Notes
(including, without limitation, the Initial Purchasers), as follows:

                  1. Registered  Exchange Offer.  The Company shall prepare and,
as  promptly  as  reasonably  practicable  after the date on which  the  Company
delivers the Notes to the Initial Purchasers (the "Closing Date"), file with the
Securities and Exchange  Commission (the "Commission") a registration  statement
on an  appropriate  form  under the  Securities  Act of 1933,  as  amended  (the
"Securities  Act"),  with respect to a proposed offer (the "Registered  Exchange
Offer") to the  holders of the Notes to issue and  deliver to such  holders,  in
exchange  for the  Notes,  a like  principal  amount of debt  securities  of the
Company identical in all material respects to, and entitled to substantially the
same benefits of, the Notes (the "New Notes"),  shall use all reasonable efforts
to cause such  registration  statement to become  effective under the Securities
Act and,  following the declaration of the  effectiveness  of that  registration
statement,  shall use all reasonable efforts to commence the Registered Exchange
Offer and shall  cause the same to remain open for a period of not less than the
period required under  applicable  Federal and state  securities laws, and to be
conducted  in  accordance  with  such  procedures  as  may  be  required  by the
applicable  provisions of the  Securities  Exchange Act of 1934, as amended (the
"Exchange  Act"),  it being the objective of such  Registered  Exchange Offer to
enable each holder of Notes electing to


                                        
<PAGE>

exchange  Notes for New Notes  (assuming that such holder is not an affiliate of
the Company within the meaning of the Securities Act,  acquires the New Notes in
the ordinary course of such holder's  business and has no arrangements  with any
person to  participate in the  distribution  of the New Notes) to trade such New
Notes from and after their receipt without any limitations or restrictions under
the Securities Act (subject to any applicable  requirement  that  broker-dealers
deliver  a  prospectus  meeting  the  requirements  of  the  Securities  Act  in
connection  with sales of New Notes received by them in the Registered  Exchange
Offer).  In connection  with such Registered  Exchange Offer,  the Company shall
take such other action, including, without limitation, appropriate filings under
state securities  laws, as may be necessary to realize the foregoing  objective.
The New  Notes  may be issued in the  Registered  Exchange  Offer  under (i) the
Indenture or (ii) an indenture substantially similar to the Indenture,  and will
not be subject to the transfer restrictions described in the Offering Memorandum
(subject to any applicable  requirement that broker-dealers deliver a prospectus
meeting the  requirements  of the Securities Act in connection with sales of New
Notes received by them in the Registered  Exchange Offer), and the New Notes and
the Notes will vote and consent together on all matters as one class and neither
the New Notes nor the Notes will have the right to vote or consent as a separate
class on any  matter.  The  Company  agrees  that for a period of 90 days  after
consummation  of  the  Registered  Exchange  Offer  it  will  make  available  a
prospectus  meeting the  requirements  of the  Securities  Act (which may be the
prospectus  used in  connection  with  the  Registered  Exchange  Offer)  to any
broker-dealer  for use in  connection  with any resale of New Notes  acquired by
such broker-dealer in the Registered Exchange Offer.

                  2. Shelf  Registration.  If, because the  Registered  Exchange
Offer would violate any applicable law or the applicable  interpretations of the
Commission's   staff  or  because  of  any   change  in   currently   prevailing
interpretations  of the  Commission's  staff,  the Company is not  permitted  to
effect the Registered  Exchange Offer as  contemplated by Section 1 hereof or in
the event the Registered  Exchange Offer is not for any other reason consummated
within 240 days after the Closing  Date,  the Company  shall take the  following
actions:


                  (a) The Company shall,  as promptly as reasonably  practicable
after (i) the Closing  Date, in the event the Company is not permitted to effect
the Registered  Exchange Offer as  contemplated  by Section 1 hereof because the
Registered  Exchange  Offer would  violate an  applicable  law or an  applicable
interpretation  of the Commission's  staff or because of a change in a currently
prevailing  interpretation of the Commission's  staff or (ii) 240 days after the
Closing  Date,  if the  Registered  Exchange  Offer is not for any other  reason
consummated by such date, file with the Commission and thereafter  shall use all
reasonable efforts to cause to be declared effective a registration statement on
an  appropriate  form under the Securities Act relating to the offer and sale of
the  Notes by the  holders  thereof  from  time to time in  accordance  with the
methods of distribution  set forth in such  registration  statement and Rule 415
under the Securities Act (hereafter, the "Shelf Registration").

                  (b) The Company shall use all  reasonable  efforts to keep the
registration statement relating to the Shelf Registration continuously effective
in order to permit the prospectus  included  therein to be usable by the holders
of the Notes for a period of two years from the date the registration  statement
is declared  effective or such shorter  period that will  terminate when all the
Notes  covered by the  registration  statement  have been sold  pursuant to such
registration  statement;  provided, that the Company shall be deemed not to have
used all reasonable efforts to keep the registration  statement effective during
the  requisite  period if it  voluntarily  takes any action that would result in
holders  of  Notes  covered  thereby  not  being  able to offer  and  sell  such
securities during that period, unless such action is required by applicable law,
including,   but  not  limited  to,  reasonable  periods  necessary  to  prepare
appropriate  disclosure.  The foregoing proviso shall not apply to actions taken
(or  contemplated  to be taken) by the  Company in good  faith and for  business
reasons (a "Suspension Event"), including, without limitation, the


                                       2
<PAGE>

acquisition or  divestiture of assets or the offering or sale of securities,  so
long as the  Company  promptly  thereafter  complies  with the  requirements  of
Section 3(h) hereof,  if  applicable.  Any such period  during which the Company
fails to keep the  registration  statement  effective  and usable for offers and
sales of Notes is  referred to as a  "Suspension  Period." A  Suspension  Period
shall  commence on and include the date that the Company  gives  notice that the
registration statement is no longer effective or the prospectus included therein
is no longer usable for offers and sales of Notes and shall end on the date when
each seller of Notes covered by such registration  statement either receives the
copies of the  supplemented or amended  prospectus  contemplated by Section 3(h)
hereof or is advised in writing by the Company that use of the prospectus may be
resumed.

                  (c)  Notwithstanding any other provisions of this Agreement to
the contrary, the Company shall cause the registration statement and the related
prospectus and any amendment or supplement  thereto, as of the effective date of
such  registration  statement,  amendment  or  supplement,  (i) to comply in all
material respects with the applicable requirements of the Securities Act and the
rules and  regulations  of the  Commission  and (ii) not to  contain  any untrue
statement  of a material  fact or omit to state a material  fact  required to be
stated therein or necessary to make the statements  therein not misleading other
than  statements  or  omissions  made in reliance  upon and in  conformity  with
information  furnished  to the  Company  in writing  by the  Initial  Purchasers
expressly for use in such registration  statement and the related prospectus and
any amendment or supplement thereto.

                  3.  Registration  Procedures.  In  connection  with any  Shelf
Registration contemplated by Section 2 hereof and, to the extent applicable, the
Registered  Exchange  Offer  contemplated  by  Section 1 hereof,  the  following
provisions shall apply:


                  (a) The Company shall furnish to the Initial Purchasers, prior
to the filing thereof with the Commission,  a copy of the registration statement
and each  amendment  thereof  and each  supplement,  if any,  to the  prospectus
included  therein and shall obtain the consent (which shall not be  unreasonably
withheld or delayed) of the Initial Purchasers to any such filing.

                  (b) The Company  shall advise the Initial  Purchasers  and the
holders of the Notes and the New Notes (to the extent applicable) in writing:

                         (i) when the  registration  statement and any amendment
         thereto has been filed with the  Commission  and when the  registration
         statement or any post-effective amendment thereto has become effective;

                         (ii) of any request by the Commission for amendments or
         supplements to the  registration  statement or the prospectus  included
         therein or for  additional  information;

                         (iii) of the  issuance  by the  Commission  of any stop
         order suspending the effectiveness of the registration statement or the
         initiation of any proceedings for that purpose;

                         (iv) of the receipt by the Company of any  notification
         with respect to the  suspension of the  qualification  of the Notes and
         New Notes for sale in any jurisdiction or the initiation or threatening
         of any proceeding for such purpose; and

                         (v)  of  the  happening  of  any  event  (other  than a
         Suspension  Event,  in which  case the  Company  need only  notify  the
         Initial Purchasers and the holders of the Notes that a Suspension Event
         exists) that  requires the Company to make changes in the  registration
         statement


                                       3
<PAGE>

         or  the  prospectus  in  order  to  make  the  statements  therein  not
         misleading  (which advice shall be accompanied  by an instruction  that
         such notice constitutes material nonpublic information,  and to suspend
         the use of the prospectus  until the requisite  changes have been made,
         and  which  instruction  shall  require  that  such  holders  shall not
         communicate such material nonpublic  information to any third party and
         shall  not  sell  or  purchase,  or  offer  to sell  or  purchase,  any
         securities of the Company after receipt of such advice and prior to the
         effectiveness  of any  action  required  to be  taken  by  the  Company
         pursuant to Section 3(h) hereof).

                  (c) The Company  shall use all  reasonable  efforts to prevent
the issuance or obtain the withdrawal of any order suspending the  effectiveness
of the registration statement at the earliest possible time.

                  (d) The Company shall furnish to each holder of Notes included
within the coverage of the Shelf Registration, without charge, at least one copy
of  the  registration  statement  and  any  post-effective   amendment  thereto,
including financial statements and schedules,  and, if the holder so requests in
writing,  all exhibits  (including  those  incorporated  by reference).

                  (e) The Company shall deliver to each holder of Notes included
within the coverage of the Shelf  Registration,  if any, without charge, as many
copies of the prospectus (including each preliminary prospectus) included in the
registration  statement with respect to the Shelf Registration and any amendment
or  supplement  thereto as such  persons  may  reasonably  request.  The Company
consents,  subject  to the  provisions  of  the  Agreement,  to  the  use of the
prospectus or any amendment or supplement thereto by each of the selling holders
of Notes in  connection  with the offering and sale of the Notes  covered by the
prospectus,   or  any  amendment  or  supplement   thereto,   included  in  such
registration  statement.

                  (f) Prior to any  public  offering  of Notes  pursuant  to the
Shelf Registration,  the Company shall register or qualify or cooperate with the
holders  of  securities   included  therein  and  their  respective  counsel  in
connection with the  registration or  qualification  of such Notes for offer and
sale under the securities or blue sky laws of such  jurisdictions  in the United
States as any holder of Notes reasonably  requests in writing and do any and all
other acts or things necessary or advisable to enable the offer and sale in such
jurisdictions of the securities covered by the Shelf Registration; provided that
the Company shall not be required to (i) qualify generally to do business in any
jurisdiction where it is not then so qualified,  (ii) take any action that would
subject it to the  service of  process  in suits,  other than as to matters  and
transactions relating to the Shelf Registration, in any jurisdiction where it is
not now  subject  or (iii)  take any action  which  would  subject it to general
service of process or to  taxation in any  jurisdiction  where it is not then so
subject.

                  (g) The Company shall  cooperate with the holders of the Notes
to facilitate the timely  preparation and delivery of certificates  representing
Notes to be sold in the Shelf  Registration free of any restrictive  legends and
in such  denominations and registered in such names as the holders may request a
reasonable  period  of time  prior  to  sales of  Notes  pursuant  to the  Shelf
Registration.

                  (h) Upon the occurrence of any event  contemplated  by Section
3(b)(v) above (including, without limitation, any Suspension Event), the Company
shall, as promptly as reasonably practicable, prepare a post-effective amendment
to the registration  statement or a supplement to the related prospectus or file
any other  required  document so that, as thereafter  delivered to purchasers of
the Notes,  the  prospectus  will not contain an untrue  statement of a material
fact or omit to state any material fact necessary to make the statements therein
not misleading.

                                       4
<PAGE>

                  (i) Not  later  than  the  effective  date  of the  applicable
registration  statement,  the Company  will  provide a CUSIP  number for the New
Notes and provide the applicable trustee with printed certificates for the Notes
or New  Notes,  as the case may be,  in a form  eligible  for  deposit  with The
Depository  Trust Company.

                  (j) The Company will use all reasonable efforts to comply with
all rules and  regulations  of the  Commission to the extent and so long as they
are applicable to the Registered  Exchange Offer or the Shelf  Registration  and
will make generally  available to its security holders (or otherwise  provide in
accordance  with  Section  11(a) of the  Securities  Act) an earnings  statement
satisfying the provisions of Section 11(a) of the Securities  Act, no later than
45 days after the end of a  12-month  period  (or 90 days,  if such  period is a
fiscal  year)  beginning  with the first  month of the  Company's  first  fiscal
quarter  commencing  after the effective date of the Shelf  Registration,  which
statement  shall cover such  12-month  period.

                  (k) The Company  shall cause the  Indenture  (or an  indenture
substantially  identical to the  Indenture in the case of a Registered  Exchange
Offer) to be qualified  under the Trust  Indenture Act of 1939, as amended.

                  (l) The Company  may  require  each holder of Notes to be sold
pursuant to the Shelf  Registration  to furnish to the Company such  information
regarding the holder and the  distribution of such Notes as the Company may from
time to time reasonably require for inclusion in the registration statement. The
Company may also require each holder of Notes  participating  in the  Registered
Exchange Offer to represent to the Company that at the time of the  consummation
of the  Registered  Exchange  Offer (i) such holder is not an  affiliate  of the
Company,  (ii) any New Notes  received  by such  holder  will be acquired in the
ordinary  course of its business and (iii) such holder will have no  arrangement
or understanding with any person to participate in the distribution of the Notes
or the New Notes within the meaning of the Securities Act. Each holder agrees by
acquisition  of Notes that,  upon  receipt of any notice from the Company of the
existence of any fact of the kind  described  in Section  3(b)(v)  hereof,  such
holder will  forthwith  discontinue  disposition  of Notes  until such  holder's
receipt of the copies of the supplemented or amended Prospectus  contemplated by
Section 3(h)  hereof,  or until it is advised in writing by the Company that the
use of the prospectus may be resumed,  and has received copies of any additional
or supplemental  filings with respect to the  Prospectus.  If so directed by the
Company,  each holder will deliver to the Company (at the Company's expense) all
copies,  other than permanent file copies then in such holder's  possession,  of
the  prospectus  covering  such  Notes  current  at the time of  receipt of such
notice.

                  4. Registration  Expenses. The Company shall bear all expenses
incurred in connection with the performance of its obligations  under Sections 1
through  3 hereof  and,  in the  event of a Shelf  Registration,  shall  bear or
reimburse the holders of the Notes for the reasonable fees and  disbursements of
one firm of counsel  designated by the holders of a majority in principal amount
of the  Notes to act as  counsel  for the  holders  of the  Notes in  connection
therewith.


                  5. Indemnification.
                     ---------------

                  (a) The Company agrees to indemnify and hold harmless (i) each
Initial  Purchaser,  (ii) each  holder  of Notes  and/or  New  Notes  (including
broker-dealers  receiving New Notes in the  Registered  Exchange  Offer) (each a
"Holder"),  (iii) each  person,  if any,  who  controls  (within  the meaning of
Section 15 of the Act or Section 20 of the Exchange  Act) any Initial  Purchaser
or any  Holder  (any of the  persons  referred  to in this  clause  (iii)  being
hereinafter  referred  to as a  "controlling  person")  and (iv) the


                                       5
<PAGE>

respective officers, directors, partners, employees,  representatives and agents
of any Initial  Purchaser  or any Holder or any  controlling  person (any person
referred to in clause (i), (ii), (iii) or (iv) may hereinafter be referred to as
a "Non-Company Indemnitee"),  to the fullest extent lawful, from and against any
and all losses, claims, damages,  liabilities and judgments caused by any untrue
statement  or alleged  untrue  statement  of a material  fact  contained  in any
registration  statement or prospectus (or any amendments or supplements thereto)
prepared in accordance with this Agreement,  including any document incorporated
by reference  therein,  or caused by any  omission or alleged  omission to state
therein a material fact  required to be stated  therein or necessary to make the
statements  therein not  misleading,  except,  with  respect to any  Non-Company
Indemnitee,  insofar as such losses, claims,  damages,  liabilities or judgments
(1) are caused by any such  untrue  statement  or  omission  or  alleged  untrue
statement or omission based upon information furnished in writing to the Company
by such Non-Company  Indemnitee expressly for use therein or (2) with respect to
any  preliminary  prospectus,   result  from  the  fact  that  such  Non-Company
Indemnitee  sold  Notes or New Notes to a person  to whom  there was not sent or
given, at or prior to the written confirmation of such sale, a copy of the final
prospectus, as amended or supplemented, if required under the Securities Act and
if  the  Company  shall  have  previously   furnished  copies  thereof  to  such
Non-Company   Indemnitee  in  accordance  with  this  Agreement  and  the  final
prospectus,  as  amended  or  supplemented,  would have  corrected  such  untrue
statement or omission.

                  (b)  In  case  any  action   shall  be  brought   against  any
Non-Company Indemnitee based upon any registration  statement or prospectus,  or
any amendment or supplement thereto,  and with respect to which indemnity may be
sought against the Company,  such  Non-Company  Indemnitee shall promptly notify
the  Company in writing  and the  Company  shall  assume  the  defense  thereof,
including the employment of counsel reasonably  satisfactory to such Non-Company
Indemnitee  and payment of all fees and expenses.  Such  Non-Company  Indemnitee
shall  have  the  right to  employ  separate  counsel  in any  such  action  and
participate in the defense  thereof,  but the fees and expenses of counsel shall
be  paid by such  Non-Company  Indemnitee,  unless  (i) the  employment  of such
counsel shall have been specifically  authorized in writing by the Company, (ii)
the Company shall have failed to assume the defense and employ  counsel or (iii)
the named parties to any such action  (including any impleaded  parties) include
both such Non-Company Indemnitee and the Company and such Non-Company Indemnitee
shall have been advised by counsel that it would be  inappropriate  for the same
counsel to represent such Non-Company  Indemnitee and the Company (in which case
the  Company  shall not have the right to assume the  defense of such  action on
behalf of such Non-Company  Indemnitee,  it being understood,  however, that the
Company  shall not,  in  connection  with any one such  action or  separate  but
substantially similar or related actions in the same jurisdiction arising out of
the same  general  allegations  or  circumstances,  be  liable  for the fees and
expenses of more than one separate  firm of attorneys  (in addition to any local
counsel) for the  Non-Company  Indemnitees,  which firm shall be  designated  in
writing by the Non-Company  Indemnitees  and whose fees and expenses  reasonably
incurred  shall be  reimbursed as they are  incurred).  The Company shall not be
liable for any  settlement  of any such  action  effected  without  the  written
consent of the Company,  but if settled with the written consent of the Company,
the Company  agrees to indemnify  and hold harmless any  Non-Company  Indemnitee
from and  against  any  amounts  payable  pursuant  to such  written  consent in
connection  with such  settlement.  Notwithstanding  the  immediately  preceding
sentence,  if in any case  where the fees and  expenses  of  counsel  are at the
expense of the Company and a  Non-Company  Indemnitee  shall have  requested the
Company to reimburse such  Non-Company  Indemnitee for such fees and expenses of
counsel  as  incurred,  the  Company  agrees  that it  shall be  liable  for any
settlement  of any  action  effected  without  its  written  consent if (i) such
settlement  is entered into more than 30 business  days after the receipt by the
Company of the  aforesaid  request  and (ii) the  Company  shall have  failed to
reimburse  such  Non-Company  Indemnitee  in  accordance  with such  request for
reimbursement  prior to the date of such  settlement.  The  Company  shall  not,
without the prior written  consent of such  Non-Company  Indemnitee,  effect any
settlement of any pending or threatened proceeding


                                       6
<PAGE>

in respect of which such  Non-Company  Indemnitee  is or could have been a party
and indemnity could have been sought hereunder by such  Non-Company  Indemnitee,
unless such settlement  includes an  unconditional  release of such  Non-Company
Indemnitee  from all  liability  on claims that are the  subject  matter of such
proceeding.

                  (c) Each Holder  agrees to indemnify and hold harmless (i) the
Company, (ii) each of the Initial Purchasers,  (iii) each other Holder, (iv) any
person controlling (within the meaning of Section 15 of the Act or Section 20 of
the Exchange Act) the Company,  any Initial  Purchaser and each other Holder and
(v) the respective officers, directors, partners, employees, representatives and
agents of each of the parties  referred to in clauses (i), (ii), (iii) and (iv),
to the same extent as the  foregoing  indemnity  from the Company to each of the
Non-Company  Indemnitees,  but only with respect to information relating to such
Holder that was  furnished  in writing by such Holder  expressly  for use in any
registration  statement  (or any amendment or  supplement  thereto)  prepared in
accordance  with this  Agreement.  In no event shall the liability of any Holder
hereunder be greater in amount than the dollar  amount of the proceeds  received
by such  Holder  upon the sales of the Notes or New  Notes  giving  rise to such
indemnification  obligation.

                  (d) If the  indemnification  provided for in this Section 5 is
unavailable to an indemnified party in respect of any losses,  claims,  damages,
liabilities or judgments  referred to herein,  then each indemnifying  party, in
lieu of indemnifying such indemnified party, shall contribute to the amount paid
or  payable  by such  indemnified  party as a  result  of such  losses,  claims,
damages,  liabilities  and  judgments in such  proportion as is  appropriate  to
reflect the relative fault of the  indemnifying  party, on the one hand, and the
indemnified  party,  on the other hand,  in  connection  with the  statements or
omissions  which  resulted  in such  losses,  claims,  damages,  liabilities  or
judgments, as well as any other relevant equitable considerations.  The relative
fault of the indemnifying  party, on the one hand, and the indemnified party, on
the other hand, shall be determined by reference to, among other things, whether
the untrue or alleged  untrue  statement  of a material  fact or the omission or
alleged omission to state a material fact relates to information supplied by the
indemnifying  party,  on the one hand, or the  indemnified  party,  on the other
hand, and the parties'  relative  intent,  knowledge,  access to information and
opportunity to correct or prevent such statement or omission.

                  The Company, each Initial Purchaser and each Holder agree that
it would not be just and equitable if contribution pursuant to this Section 5(d)
were  determined  by pro rata  allocation  or by any other method of  allocation
which does not take account of the equitable  considerations  referred to in the
immediately preceding paragraph.  The losses,  claims,  damages,  liabilities or
judgments  of an  indemnified  party  referred to in the  immediately  preceding
paragraph  shall be deemed to  include,  subject  to the  limitations  set forth
above, any legal or other expenses reasonably incurred by such indemnified party
in connection with  investigating or defending any such action or claim prior to
the indemnifying party's assumption of the defense thereof or subsequent thereto
to  the  extent  permitted  by the  second  sentence  of  Section  5(b)  hereof.
Notwithstanding  the  provisions of this Section 5, none of the Holders shall be
required to contribute,  in the aggregate, any amount in excess of the amount by
which the total amount received by such Holder with respect to the sale of Notes
or New Notes  exceeds the amount of any damages  which such Holder has otherwise
been  required to pay by reason of such untrue or alleged  untrue  statement  or
omission or alleged omission.  No person guilty of fraudulent  misrepresentation
(within the meaning of Section 11(f) of the Securities Act) shall be entitled to
contribution   from  any  person   who  was  not   guilty  of  such   fraudulent
misrepresentation.  The  obligations  of Holders to contribute  pursuant to this
Section 5(d) are several in proportion  to the  respective  principal  amount of
Notes and/or New Notes held by each of the Holders hereunder and not joint.


                                       7
<PAGE>


                  6. Additional Interest Under Certain Circumstances.
                     -----------------------------------------------

                  (a)  Additional  interest  (the "Penalty  Interest")  shall be
assessed as follows:


                         (i)  If a  registration  statement  with  respect  to a
         Registered Exchange Offer or a Shelf Registration is not filed with the
         Commission  within 90 days following the Closing Date,  then commencing
         on the 91st day after  the  Closing  Date,  Penalty  Interest  shall be
         accrued on the Notes over and above the  accrued  interest at a rate of
         .25% per annum for the first 90 days immediately following the 90th day
         after the Closing Date,  such Penalty  Interest  rate  increasing by an
         additional .25 % per annum at the beginning of each  subsequent  90-day
         period;

                         (ii) If a  registration  statement  with  respect  to a
         Registered   Exchange  Offer  or  a  Shelf  Registration  is  filed  as
         contemplated by subsection  6(a)(i) above and is not declared effective
         by the  Commission  within 180 days  following the Closing Date,  then,
         commencing  on the 181st day after the Closing Date,  Penalty  Interest
         shall be accrued on the Notes over and above the accrued  interest at a
         rate of .25% per annum for the first 90 days immediately  following the
         180th day after the Closing Date, such Penalty Interest rate increasing
         by an additional  .25 % per annum at the  beginning of each  subsequent
         90-day  period; and

                         (iii) If either (A) the Company has not  exchanged  New
         Notes for all Notes validly  tendered in  accordance  with the terms of
         the Registered  Exchange Offer on or prior to 40 days after the date on
         which  the  registration  statement  with  respect  to  the  Registered
         Exchange  Offer  was  declared  effective,  or  (B)  if  applicable,  a
         registration  statement with respect to a Shelf  Registration  has been
         declared  effective  and  such  registration  statement  ceases  to  be
         effective  prior to two years from its original  effective  date (other
         than by reason of the occurrence of a Suspension  Event),  then Penalty
         Interest  shall be  accrued  on the Notes  over and  above the  accrued
         interest at a rate of .25% per annum for the first 60 days  immediately
         following (x) the 40th day after such effective date in the case of (A)
         above,  or (y) the day such  registration  statement  with respect to a
         Shelf Registration  ceases to be effective (other than by reason of the
         occurrence  of a  Suspension  Event)  in the  case of (B)  above,  such
         Penalty Interest rate increasing by an additional .25% per annum at the
         beginning of each subsequent 60-day period;

provided,  however,  that the Penalty  Interest rate on the Notes may not exceed
1.0% per annum at any time; and provided,  further,  that (1) upon the filing of
the  registration  statement  with respect to a Registered  Exchange  Offer or a
Shelf Registration (in the case of (i) above), (2) upon the effectiveness of the
registration  statement  filed with respect to a Registered  Exchange Offer or a
Shelf  Registration (in the case of (ii) above), or (3) upon the exchange of New
Notes  for all  Notes  validly  tendered  in  accordance  with the  terms of the
Registered  Exchange  Offer,  or  upon  the  effectiveness  of the  registration
statement filed with respect to a Shelf  Registration which had ceased to remain
effective  prior to two years from its original  effective  date (in the case of
(iii)  above),  Penalty  Interest  on the Notes as a result of such  clause (i),
(ii), or (iii) shall immediately cease to accrue. The Penalty Interest specified
in this  Section 6(a) shall be payable by the Company to the holders of Notes at
the times,  in the manner and subject to the same terms and conditions set forth
in the  Indenture,  as nearly as may be, as though the rate set out in the Notes
had been increased,  which payments shall be calculated pursuant to Section 6(b)
below. The interest rate on the Notes,  inclusive of Penalty Interest,  shall in
no event exceed 10 1/4% per annum.

                  (b) Any  amounts of Penalty  Interest  due  pursuant to clause
(i),  (ii),  or (iii) of  Section  6(a)  above  will be  payable  in cash on the
interest payment dates of the Notes.


                                       8
<PAGE>

                  The  amount  of  Penalty   Interest   will  be  determined  by
multiplying the applicable  Penalty Interest rate by the principal amount of the
Notes,  multiplied  by a fraction,  the numerator of which is the number of days
such Penalty Interest rate was applicable during such period  (determined on the
basis of a 360-day year comprised of twelve 30-day months),  and the denominator
of which is 360.

(v) If the Company effects the Registered  Exchange  Offer,  the Company will be
entitled to close the  Registered  Exchange  Offer provided that it has accepted
all Notes  theretofore  validly  tendered  in  accordance  with the terms of the
Registered  Exchange Offer. Notes not tendered in the Registered  Exchange Offer
shall bear  interest  at the same rates in effect at the time of issuance of the
Notes.

                  7. Miscellaneous.
                     -------------


                  (a) Amendments  and Waivers.  The provisions of this Agreement
may not be  amended,  modified  or  supplemented,  and  waivers or  consents  to
departures from the provisions  hereof may not be given,  unless the Company has
obtained  the written  consent of holders of a majority in  aggregate  principal
amount of the Notes.

                  (b) Notices. All notices and other communications provided for
or permitted  hereunder shall be made in writing by  hand-delivery,  first-class
mail, telex, telecopier or air courier which guarantees overnight delivery:

                                (1) If to a holder of Notes or New Notes, at the
                  most  current  address  given by such holder to the Company in
                  accordance  with the  provisions of this Section  7(b),  which
                  address initially is, with respect to each holder, the address
                  of such holder to which  confirmation  of the sale of Notes or
                  New Notes to such holder was first  sent,  with a copy in like
                  manner to the Initial  Purchasers c/o Smith Barney Inc. at 388
                  Greenwich Street, New York, New York 10013.

                                (2) If to an Initial Purchaser,  to  the address
                  specified in 7(b)(1);

                                 (3)If to the Company, at the following address:

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

                  All such  notices and  communications  shall be deemed to have
been duly given: at the time delivered by hand, if personally  delivered;  three
business days after being  deposited in the mail,  postage  prepaid,  if mailed;
when  answered  back,  if telexed;  when  receipt  acknowledged  by  recipient's
telecopy operator, if telecopied; and on the day delivered, if sent by overnight
air courier guaranteeing next day delivery.

                  (c) Successors and Assigns.  This Agreement shall inure to the
benefit  of and be  binding  upon  the  successors  and  assigns  of each of the
parties,  including,  without  limitation,  and  without the need for an express
assignment, subsequent holders of the Notes and the New Notes.


                                       9
<PAGE>

                  (d) Counterparts. This Agreement may be executed in any number
of  counterparts  and by the parties  hereto in separate  counterparts,  each of
which when so executed  shall be deemed to be an original and all of which taken
together  shall  constitute  one and the  same  agreement.

                  (e)  Headings.   The  headings  in  this   Agreement  are  for
convenience  of  reference  only and  shall not limit or  otherwise  affect  the
meaning  hereof.

                  (f) Governing  Law. This  Agreement  shall be governed by and
construed in accordance  with the laws of the State of New York,  without regard
to its  conflicts of laws rules.

                  (g)  Severability.  If any  one  or  more  of the  provisions
contained  herein,  or the  application  thereof  in any  circumstance,  is held
invalid, illegal or unenforceable,  the validity, legality and enforceability of
any such  provision  in every  other  respect  and of the  remaining  provisions
contained herein shall not be affected or impaired thereby.



                                       10
<PAGE>


                  Please  confirm that the  foregoing  correctly  sets forth the
agreement between the Company and the Initial Purchasers.


                                          Very truly yours,

                                          INTEGRATED HEALTH SERVICES, INC.





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





Confirmed as of the date first
above mentioned.


SMITH BARNEY INC.
MORGAN STANLEY & CO. INCORPORATED
DONALDSON, LUFKIN & JENRETTE
  SECURITIES CORPORATION
CITICORP SECURITIES, INC.

By: SMITH BARNEY INC.

By: /s/ Benjamine R. Lorello
    ------------------------------
    Name: Benjamin R. Lorello
    Title: Managing Director


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