MID ATLANTIC MEDICAL SERVICES INC
10-Q/A, 1997-01-27
HOSPITAL & MEDICAL SERVICE PLANS
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<PAGE>


     <PAGE>  1

                         SECURITIES AND EXCHANGE COMMISSION
                               WASHINGTON, D.C. 20549
                                --------------------

                                     FORM 10-Q/A
                          AMENDMENT NUMBER 1 TO FORM 10-Q
                    FOR THE NINE MONTHS ENDED SEPTEMBER 30, 1996

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

         For the quarterly period ended SEPTEMBER 30, 1996, or

     [  ] Transition report pursuant to Section  13 OR 15(d) of the Securities
     Exchange Act of 1934

         For the transition period from          to         

                             ------------------------------
                             COMMISSION FILE NUMBER 1-13340
                             ------------------------------

                           MID ATLANTIC MEDICAL SERVICES, INC.
                 (Exact name of registrant as specified in its charter)

                                        DELAWARE
                            (State or other jurisdiction of
                             incorporation or organization)

                                      52-1481661
                         (IRS Employer Identification Number)

                           4 TAFT COURT, ROCKVILLE, MARYLAND
                       (Address of principal executive offices)

                                         20850
                                      (Zip code)

                                   (301) 294-5140
                (Registrant's telephone number, 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.

                Yes  X                        No 

     The  number of  shares outstanding  of each  of the  issuer's classes  of
     common  stock  was 54,677,862  shares of  common  stock, par  value $.01,
     outstanding as of September 30, 1996.




      -----------------------------------------------------------------------
      -----------------------------------------------------------------------<PAGE>


      -----------------------------------------------------------------------
      -----------------------------------------------------------------------<PAGE>


     <PAGE>  2
     PART I.  FINANCIAL INFORMATION
     ITEM 1.  FINANCIAL STATEMENTS
                           MID ATLANTIC MEDICAL SERVICES, INC.
                     CONSOLIDATED CONDENSED BALANCE SHEETS (Note 1)
                           (in thousands except share amounts)
     <TABLE>
     <CAPTION>
                                                                                     (Unaudited)        (Note)
                                                                                    September 30,     December 31,
                                                                                         1996             1995
                                                                                     ------------     ------------
     <S>                                                                             <C>              <C>
     ASSETS
     Current assets:
      Cash and cash equivalents                                                      $      2,523     $     10,874 
      Short-term investments                                                              161,588          204,734
      Accounts receivable, net of allowance of $4,564 and $3,638                           77,330           61,263
      Prepaid expenses, advances and other                                                 27,129            8,974
      Deferred income taxes                                                                 3,894            4,379
                                                                                      -----------      -----------
        Total current assets                                                              272,464          290,224
      Property and equipment, net of accumulated
       depreciation of $19,901 and $15,091                                                 44,592           38,704
      Statutory deposits                                                                    9,129           10,543
      Other assets                                                                         11,385           11,373
      Deferred income taxes                                                                 2,494            3,338  
                                                                                       ----------      -----------
        Total assets                                                                 $    340,064     $    354,182
                                                                                      ===========      ===========
     LIABILITIES AND STOCKHOLDERS' EQUITY
     Current liabilities:
      Notes payable                                                                  $         60     $        210
      Short-term borrowings                                                                 1,752            1,651
      Accounts payable                                                                     20,332           15,075
      Medical claims payable                                                              123,314          108,490
      Deferred premium revenue                                                              6,159           10,125
      Deferred income taxes                                                                   114            1,005  
                                                                                      -----------      -----------
        Total current liabilities                                                         151,731          136,556
      Notes payable                                                                           149              194
      Deferred income taxes                                                                   216              216
                                                                                      -----------      -----------
        Total liabilities                                                                 152,096          136,966
                                                                                      -----------      -----------           
     Stockholders' equity (Notes 2, 3 and 4)
      Common stock, $.01 par, 100,000,000 shares authorized; 56,772,502 issued
       and 54,677,862 outstanding at September 30, 1996; 46,631,327 issued and
       46,585,387 outstanding at December 31, 1995                                            568              466
      Additional paid-in capital                                                          168,018           40,374
      Stock compensation trust (common stock held in trust)                              (115,863) 
      Treasury stock, 2,094,640 shares at September 30, 1996; 45,940 shares at
       December 31, 1995                                                                  (41,211)             (33)
     Unrealized gains on investments, net of tax of $628 and $1,004                           961            1,535
      Retained earnings                                                                   175,495          174,874
                                                                                      -----------      -----------
        Total stockholders' equity                                                        187,968          217,216
                                                                                      -----------      -----------
        Total liabilities and stockholders' equity                                   $    340,064     $    354,182
                                                                                      ===========      ===========<PAGE>


     </TABLE>
     Note: The balance sheet at December  31, 1995 has been extracted from the
     audited financial statements at that date.
                 See accompanying notes to these financial statements.<PAGE>


     <PAGE>  3
                           MID ATLANTIC MEDICAL SERVICES, INC.
                       CONSOLIDATED CONDENSED STATEMENTS OF INCOME
                           (in thousands except share amounts)
                                       (Unaudited)
     <TABLE>
     <CAPTION>
                                                                                          Three Months Ended
                                                                                    September 30,     September 30,
                                                                                         1996              1995    
                                                                                     ------------      ------------
     <S>                                                                             <C>               <C>
     Revenue
       Health premium                                                                $    275,147      $    231,006
       Fee and other                                                                        4,159             3,916
       Life and disability premium                                                          1,217               619
       Home health services                                                                 5,539             4,162
       Investment                                                                           2,167             3,577
                                                                                      -----------       -----------
         Total revenue                                                                    288,229           243,280
                                                                                      -----------       -----------
     Expense
       Medical                                                                            259,811           191,317
       Life and disability claims                                                             810               351
       Home health patient services                                                         4,940             2,671
       Administrative (including interest expense of $167 and $368)                        29,878            25,749
                                                                                      -----------       -----------
         Total expense                                                                    295,439           220,088
                                                                                      -----------       -----------
     Income (loss) before income taxes                                                     (7,210)           23,192

     Benefit (provision) for income taxes                                                   2,499            (8,793)
                                                                                      -----------       -----------

     Net income (loss)                                                               $     (4,711)     $     14,399
                                                                                      ===========       ===========
     Income (loss) per common and common equivalent share:
       Net income (loss)                                                             $       (.10)     $        .30
                                                                                      ===========       ===========

     Weighted average common and common equivalent shares outstanding                  46,394,158        47,955,851
                                                                                      ===========       ===========
     /TABLE
<PAGE>


                 See accompanying notes to these financial statements.<PAGE>


     <PAGE>  4
                           MID ATLANTIC MEDICAL SERVICES, INC.
                       CONSOLIDATED CONDENSED STATEMENTS OF INCOME
                           (in thousands except share amounts)
                                       (Unaudited)
     <TABLE>
     <CAPTION>
                                                                                            Nine Months Ended
                                                                                    September 30,     September 30,
                                                                                         1996              1995    
                                                                                     ------------      ------------
     <S>                                                                             <C>               <C>
     Revenue
       Health premium                                                                $    801,427      $    665,963
       Fee and other                                                                       12,285            11,616
       Life and disability premium                                                          2,870               863
       Home health services                                                                15,546            13,628
       Investment                                                                           9,612             7,714
                                                                                      -----------       -----------
         Total revenue                                                                    841,740           699,784
                                                                                      -----------       -----------
     Expense
       Medical                                                                            736,814           543,804
       Life and disability claims                                                           1,681               453
       Home health patient services                                                        11,901             9,447
       Administrative (including interest expense of $592 and $910)                        90,273            73,584
                                                                                      -----------       -----------
         Total expense                                                                    840,669           627,288
                                                                                      -----------       -----------
     Income before income taxes                                                             1,071            72,496

     Provision for income taxes                                                              (450)          (27,354)
                                                                                      -----------       -----------

     Net income                                                                      $        621      $     45,142
                                                                                      ===========       ===========
     Income per common and common equivalent share:
       Net income                                                                    $        .01      $        .95
                                                                                      ===========       ===========

     Weighted average common and common equivalent shares outstanding                  47,176,616        47,731,721
                                                                                      ===========       ===========
     /TABLE
<PAGE>


                 See accompanying notes to these financial statements.<PAGE>


     <PAGE>  5
                           MID ATLANTIC MEDICAL SERVICES, INC.
                           CONSOLIDATED STATEMENT OF CASH FLOWS
                                     (in thousands)
                                      (Unaudited)
     <TABLE>
     <CAPTION>
                                                                                                       Nine Months
                                                                                                          Ending
                                                                                                    September 30, 1996
                                                                                                       ------------
     <S>                                                                             <C>               <C>
     Cash flows used in operating activities:
       Net income                                                                                      $        621
     Adjustments to reconcile net income to net cash used in
       operating activities:
         Depreciation and amortization                                               $      5,630
         Provision for bad debts                                                              926
         Provision for deferred income taxes                                                   27
         Loss on sale and disposal of assets                                                    8
         Increase in accounts receivable                                                  (16,993)
         Increase in prepaid expenses, advances, and other                                (18,155)
         Increase in accounts payable                                                       5,257
         Increase in medical claims payable                                                14,824
         Decrease in deferred premium revenue                                              (3,966)
                                                                                      -----------
           Total adjustments                                                                                (12,442)
                                                                                                        -----------
           Net cash used in operating activities                                                            (11,821)

     Cash flows provided by investing activities:
       Purchases of short-term investments                                               (291,978)
       Sales of short-term investments                                                    336,175
       Purchases of property and equipment                                                (10,836)
       Purchases of statutory deposits                                                     (2,407)
       Maturities of statutory deposits                                                     1,820
       Purchases of other assets                                                             (234)
       Proceeds from sale of assets                                                           319
                                                                                      -----------
             Net cash provided by investing activities                                                       32,859

     Cash flows used in financing activities:
       Principal payments on notes payable                                                   (195)
       Increase in short-term borrowings                                                      101
       Exercise of stock options                                                            5,866
       Stock option tax benefit                                                             6,017
       Purchase of treasury stock                                                         (41,178)
                                                                                      -----------
             Net cash used in financing activities                                                          (29,389)
                                                                                                        -----------
     Net decrease in cash and cash equivalents                                                               (8,351)

     Cash and cash equivalents at beginning of period                                                        10,874
                                                                                                        -----------
     Cash and cash equivalents at end of period                                                        $      2,523
                                                                                                        ===========
     /TABLE
<PAGE>


                 See accompanying notes to these financial statements.<PAGE>


     <PAGE>  6
                           MID ATLANTIC MEDICAL SERVICES, INC.
                           CONSOLIDATED STATEMENT OF CASH FLOWS
                                     (in thousands)
                                      (Unaudited)
     <TABLE>
     <CAPTION>
                                                                                                        Nine Months
                                                                                                          Ending
                                                                                                    September 30, 1995
                                                                                                       ------------
     <S>                                                                             <C>               <C>
     Cash flows provided by operating activities:
       Net income                                                                                      $     45,142
     Adjustments to reconcile net income to net cash provided by
       operating activities:
         Depreciation and amortization                                               $      4,326
         Provision for bad debts                                                               16
         Provision for deferred income taxes                                                3,081
         Loss on sale and disposal of assets                                                   78
         Increase in accounts receivable                                                  (19,086)
         Increase in prepaid expenses, advances, and other                                 (1,581)
         Decrease in accounts payable                                                        (206)
         Increase in medical claims payable                                                13,157
         Decrease in deferred premium revenue                                              (3,778)
         Increase in income taxes payable                                                   2,115
                                                                                      -----------
             Total adjustments                                                                               (1,878)
                                                                                                        -----------
             Net cash provided by operating activities                                                       43,264

     Cash flows used in investing activities:
       Purchases of short-term investments                                               (313,267)
       Sales of short-term investments                                                    269,655
       Purchases of property and equipment                                                 (7,078)
       Purchases of statutory deposits                                                       (807)
       Maturities of statutory deposits                                                       135
       Purchases of other assets                                                             (690)
       Proceeds from sale of assets                                                           682
                                                                                      -----------
             Net cash used in investing activities                                                          (51,370)

     Cash flows provided by financing activities:
       Proceeds from notes payable                                                            300
       Principal payments on notes payable                                                 (5,786)
       Increase in short-term borrowings                                                      169
       Exercise of stock options                                                            4,065
       Stock option tax benefit                                                             5,683
                                                                                      -----------
             Net cash provided by financing activities                                                        4,431
                                                                                                        -----------
     Net decrease in cash and cash equivalents                                                               (3,675)

     Cash and cash equivalents at beginning of period                                                        17,054
                                                                                                        -----------
     Cash and cash equivalents at end of period                                                        $     13,379
                                                                                                        ===========
     /TABLE
<PAGE>



                 See accompanying notes to these financial statements.<PAGE>


     <PAGE>  7
                           MID ATLANTIC MEDICAL SERVICES, INC.
                   NOTES TO CONSOLIDATED CONDENSED FINANCIAL STATEMENTS

     INTRODUCTION

     Mid  Atlantic Medical Services, Inc. ("MAMSI") is a holding company whose
     subsidiaries are active in managed health care  and other life and health
     insurance  related  activities.    MAMSI's  principal  markets  currently
     include all or parts of the states of Maryland, Virginia, Delaware,  West
     Virginia,   North Carolina,  Pennsylvania and  the District  of Columbia.
     MAMSI  and its subsidiaries  (collectively referred to  as the "Company")
     have developed a  broad range  of managed health  care, health  insurance
     and related  ancillary products and deliver these services through health
     maintenance  organizations  ("HMOs"),  preferred  provider  organizations
     ("PPOs"),  a  life  and  health  insurance   company,  home  health  care
     companies and an outpatient surgery center.

     MAMSI  delivers managed  health care  services principally  through HMOs.
     In  general, the  HMOs, MD-Individual  Practice Association,  Inc. ("M.D.
     IPA"),  Optimum Choice, Inc.  ("OCI"), Optimum  Choice of  the Carolinas,
     Inc. ("OCCI") and Optimum Choice, Inc. of Pennsylvania ("OCIPA")  arrange
     for  health  care  services to  be  provided  to  a voluntarily  enrolled
     population  for a predetermined, prepaid fee, regardless of the extent or
     nature  of services  provided to the  enrollees.   The HMOs  offer a full
     complement  of   health  benefits,  including   physician,  hospital  and
     prescription drug services.

     Other MAMSI  subsidiaries include  Alliance PPO,  Inc., which  provides a
     PPO delivery  network  to  employers and  insurance  companies,  and  Mid
     Atlantic Psychiatric Services, Inc., which provides  specialized non-risk
     mental  health  services.    MAMSI  Life  and  Health  Insurance  Company
     develops  and markets indemnity health  products in addition  to life and
     short-term disability  insurance.   HomeCall, Inc., FirstCall,  Inc., and
     HomeCall Pharmaceutical  Services,  Inc.  provide  in-home  medical  care
     including  skilled nursing, infusion and therapy, and mail order pharmacy
     services to both MAMSI's HMO and indemnity members and other payors.

     NOTE 1 - FINANCIAL STATEMENTS

     The consolidated balance sheet of  the Company as of September  30, 1996,
     the consolidated statements of  operations for the three and  nine months
     ended September 30,  1996 and  1995, and the  consolidated statements  of
     cash flows  for the nine  months ended September  30, 1996 and  1995 have
     been prepared  by MAMSI without audit.  In the opinion of management, all
     adjustments   (consisting  of   normal  recurring   accruals)  considered
     necessary for a fair presentation have been included.

     Certain  information  and  disclosures  normally  included  in  financial
     statements  prepared  in accordance  with  generally  accepted accounting
     principles have  been condensed or  omitted.  These  financial statements
     should be read  in conjunction  with the financial  statements and  notes
     thereto included in the Company's December 31, 1995  audited consolidated
     financial statements.   The results of operations for the  three and nine
     month  periods ended September 30  are not necessarily  indicative of the
     operating results for the full year.

     Certain balances in the 1995 financial statements have been  reclassified
     to conform to the 1996 presentation.<PAGE>


     NOTE 2 - STOCK OPTION PLANS

     In  1996, the stockholders of MAMSI ratified the 1996 Non-Qualified Stock
     Option Plan whereby  options for the purchase  of up to 3,000,000  shares
     may be granted to  officers, employees and non-employee directors  of the
     Company.   Options under  this plan are  exercisable at 100%  of the fair
     market value per share on the date the options are granted.<PAGE>


     <PAGE>  8

     NOTE 3 - COMMON STOCK

     The  Company has implemented a  stock repurchase program  under which the
     Company may expend up to  $60.0 million (including brokerage commissions)
     to repurchase shares of its common  stock over a twelve month period.  As
     of  September  30, 1996,  the Company  has repurchased  approximately 2.1
     million shares  for an  aggregate purchase price  of approximately  $41.2
     million.

     NOTE 4 - STOCK COMPENSATION TRUST

     Effective  August  26,  1996,  the Company  established  the  MAMSI Stock
     Compensation  Trust ("SCT")  to  fund its  obligations  arising from  its
     various  stock compensation plans.   MAMSI funded the  SCT with 9,130,000
     shares of newly  issued MAMSI stock.  In exchange,  the SCT has delivered
     a  promissory note  to  MAMSI  for  approximately  $129.9  million  which
     represents the purchase price of the shares.  Amounts owed by the SCT  to
     MAMSI will be repaid  by cash received by the SCT or  will be forgiven by
     MAMSI, which  will result in  the SCT releasing  shares to satisfy  MAMSI
     obligations for stock compensation.

     For financial  reporting purposes,  the SCT  is consolidated  with MAMSI.
     The fair  market value  of  the shares  held by  the SCT  is shown  as  a
     reduction to  stockholders' equity in the  Company's consolidated balance
     sheet.  All transactions between  the SCT and MAMSI are eliminated.   The
     difference between  the cost and fair  value of common stock  held in the
     SCT  is  included  in  consolidated   additional  paid-in  capital.    At
     September 30,  1996, the SCT held  9,087,300 shares of common  stock at a
     fair market value of approximately $115.9 million.

     Shares  held by  the  SCT  are  excluded  from  weighted  average  shares
     outstanding used  in the  computation of  income or  loss per  common and
     common equivalent share.

     NOTE 5 - SHORT-TERM BORROWINGS

     During  the third quarter of 1996, the Company renegotiated its revolving
     credit  facilities to provide total revolving credit of $24.0 million. At
     September 30,  1996, approximately $1.8  million was drawn  against these
     facilities.<PAGE>


     <PAGE>  9



                                 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
     undersigned thereto duly authorized.


                      MID ATLANTIC MEDICAL SERVICES, INC.
                      --------------------------------------------
                      (Registrant)






     Date:  January 27, 1997        Robert E. Foss
                                  -------------------------------------------
     -
                                     Robert E. Foss
                                     Executive Vice President and
                                     Chief Financial Officer<PAGE>


     <PAGE>  10


     6(a) List of Exhibits.

                                  EXHIBIT INDEX
                                                       Location of Exhibit
     Exhibit                                               in Sequential
     Number      Description of Document                 Numbering System
     -------     -----------------------               -------------------

     10          Amended and Restated Stock 
                 Compensation Trust Agreement
                 dated December 20, 1996. . . . . . . . . . . . .

     10.1        Amended and Restated Common Stock 
                 Purchase Agreement dated
                 December 20, 1996. . . . . . . . . . . . . . . .

     10.2        Replacement Promissory Note dated 
                 December 20, 1996. . . . .

     27          Financial Data Schedule for the Nine
                 Months Ended September 30, 1996. . . . . . . .<PAGE>

<PAGE>


                  AMENDED AND RESTATED MID ATLANTIC MEDICAL SERVICES, INC.
                        STOCK COMPENSATION TRUST AGREEMENT

              THIS AMENDED AND RESTATED STOCK COMPENSATION TRUST AGREEMENT
     made and entered into as of the 20th day of December, 1996, effective as
     of August 26, 1996, by and between Mid Atlantic Medical Services, Inc.,
     a corporation organized under the laws of the State of Delaware
     (hereinafter referred to as the "Company") and THE BANK OF NEW YORK, a
     New York banking corporation (hereinafter referred to as the "Trustee").

              WHEREAS, the Company (as defined below) desires to establish a
     trust (the "Trust") in accordance with the laws of the State of New York
     and for the purposes stated in this Agreement;

              WHEREAS, the Trustee desires to act as trustee of the Trust,
     and to hold legal title to the assets of the Trusts, in trust, for the
     purposes hereinafter stated and in accordance with the terms hereof;

              WHEREAS, the Company or its subsidiaries have previously
     adopted the Plans (as defined below);

              WHEREAS, the Company desires to provide assurance of the
     availability of the shares of its common stock necessary to satisfy
     certain of its obligations or those of its subsidiaries under the Plans
     (as defined below);

              WHEREAS, the Trustee has accepted such appointment as of August
     26, 1996;

              WHEREAS, the Company intends, that the assets of the Trust Fund
     shall be and remain subject to the claims of the Company's creditors as
     herein provided and that the Plans not be deemed funded by virtue of the
     existence of this Trust; and

              WHEREAS, the Trust is intended to be a "grantor trust" with the
     result that the corpus and income of the Trust are treated as assets and
     income of the Company pursuant to Sections 671 through 679 of the Code;
     and

              NOW, THEREFORE, in consideration of the mutual covenants herein
     contained, the Company and the Trustee declare and agree as follows:

     1.       DEFINITIONS; ESTABLISHMENT OF TRUST

              1.1.    DEFINITIONS.  Whenever used in this Trust Agreement,
     unless otherwise provided or the context otherwise requires:

                      AUTHORIZED OFFICER.  "Authorized Officer" means the
     Chairman, President, any Vice President, the Secretary or the Treasurer
     of the Company or any other person or persons as may be designated by
     the Company.

                      BOARD OF DIRECTORS.  "Board of Directors" means the
     board of directors of the Company.

                      CHANGE OF CONTROL.  "Change of Control" means any of
     the following events:

                      (a)    an acquisition by any individual, entity or
     group (within the meaning of Section 13(d)(3) or 14(d)(2) of the<PAGE>


     Securities Exchange Act of 1934, as amended (the "Exchange Act")) of
     beneficial ownership (within the meaning of Rule 13d-3 promulgated under
     the Exchange Act) of 50% or more of the combined voting power of the
     then outstanding voting securities of the Company; provided, however,
     that the following acquisitions shall not constitute a Change of
     Control:  (i) an acquisition by or directly from the Company, (ii) an
     acquisition by any employee benefit plan or trust sponsored or
     maintained by the Company; and (iii) any acquisition described in
     subclauses (A) or (B) of subsection (b) below; or<PAGE>


                      (b)  approval by the stockholders of the Company of (i)
     a complete dissolution or liquidation of the Company, (ii) a sale or
     other disposition of all or substantially all of the Company's assets or
     (iii) a reorganization, merger, or consolidation ("Business
     Combination") unless either (A) all or substantially all of the
     stockholders of the Company immediately prior to the Business
     Combination own more than 50% of the voting securities of the entity
     surviving the Business Combination, or the entity which directly or
     indirectly controls such surviving entity, in substantially the same
     proportion as they owned the voting securities of the Company
     immediately prior thereto, or (B) the consideration (other than cash
     paid in lieu of fractional shares or payment upon perfection of
     appraisal rights) issued to stockholders of the Company in the Business
     Combination is solely common stock which is publicly traded on an
     established securities exchange in the United States.

                      CODE.  "Code" means the Internal Revenue Code of 1986,
     as amended.

                      COMMITTEE.  "Committee" means a committee of officers
     selected by the Board of Directors, except as provided in Section 9.2,
     or by an individual or individuals authorized by the Board of Directors
     to make such selection which is charged with administration of the
     Trust.

                      COMPANY.  "Company" means Mid Atlantic Medical
     Services, Inc., a Delaware corporation, or any successor thereto. 
     References to the Company shall include its subsidiaries where
     appropriate.

                      COMPANY STOCK.  "Company Stock" means shares of common
     stock, par value $0.01 per share, issued by the Company or any successor
     securities.

                      EXTRAORDINARY DIVIDEND.  "Extraordinary Dividend" means
     any dividend or other distribution of cash or other property (other than
     Company Stock) made with respect to Company Stock, which the Board of
     Directors declares generally to be other than an ordinary dividend.

                      FAIR MARKET VALUE.  "Fair Market Value" means as of any
     date the closing price quotation, or, if none, the average of the bid
     and asked prices, as reported with respect to the Company Stock on the
     most recently available date, on any national exchange on which the
     Company Stock is then listed, or if not so listed, on the NASDAQ
     National Market, or other consolidated reporting system reporting trades
     of the Company Stock.  If the Company Stock is not so listed, "Fair
     Market Value" shall mean the average of the bid and asked prices as
     quoted by all market makers in the Company Stock.  In the event that a
     market for the Company Stock does not exist, the Committee may
     determine, in any case or cases, that "Fair Market Value" shall be
     determined on the basis of the opinion of one or more independent and
     reputable appraisers qualified to value companies in the Company's line
     of business.

                      INSOLVENCY.  "Insolvency" means (i) the inability of
     the Company to pay its debts as they become due, or (ii) the Company
     being subject to a pending proceeding as a debtor under the provisions
     of Title 11 of the United States Code (Bankruptcy Code).

                      LOAN.  "Loan" means the loan and extension of credit to<PAGE>


     the Trust evidenced by a  promissory note dated as of the Closing (as
     defined in the Amended and Restated Common Stock Purchase Agreement
     dated December 20, 1996, effective as of August 26, 1996, between the
     Trust and the Company (the Common Stock Purchase Agreement )) and,
     following cancellation of such promissory note, by the replacement
     promissory note dated as of the Rescission Closing (as defined in the
     Common Stock Purchase Agreement), with which the Trustee will purchase
     Company Stock.

                      OPTION GRANT.  "Option Grant" means an option granted
     under one of the Plans to a Plan Participant to acquire shares of
     Company Stock.<PAGE>



                      PLAN COMMITTEE CERTIFICATION.  "Plan Committee
     Certifications" means a certification to be provided to the Trustee by
     the Committee from time to time which (i) sets forth the number of
     shares of Company Stock transferred to a Plan Participant, and (ii)
     certifies that the determination of such number is in accordance with
     the terms of each Plan.

                      PLANS.  "Plans" means the employee plans listed on
     Schedule A hereto and any other employee benefit plan of the Company
     designated as such by the Board of Directors.

                      PLAN PARTICIPANT.  "Plan Participant" means an
     individual who has an Option Grant under any of the Plans.

                      RELIABLE SOURCE.  "Reliable Source" means (i) a report
     filed with the Securities and Exchange Commission, (ii) a public
     statement issued by the Company, or a periodical of general circulation,
     including, but not limited to, The NEW YORK TIMES or THE WALL STREET
     JOURNAL, or (iii) a certificate of the Company signed by the Chief
     Executive Officer or by the Chairman of the Board of Directors.

                      SUSPENSE ACCOUNT.  "Suspense Account" means the account
     in which shares of Company Stock acquired with the Loan are held until
     they are released pursuant to Section 3.1.

                      TRUST.  "Trust" means the trust established pursuant to
     this Trust Agreement.

                      TRUSTEE.  "Trustee" means Bank of New York or any
     successor trustee.

                      TRUST YEAR.  "Trust Year" means the period beginning on
     the date of the Closing (the "Closing Date") and ending on the next
     following December 31st and on each December 31st thereafter.

              1.2.    ESTABLISHMENT OF TRUST.

                      TRUST.  This Agreement and the Trust shall be known as
     the Mid Atlantic Medical Services, Inc. Stock Compensation Trust.  The
     parties intend that the Trust will be an independent legal entity with
     title to and power to convey all of its assets.  The parties hereto
     further intend that the Trust not be subject to the Employee Retirement
     Income Security Act of 1974, as amended.  The Trust is not a part of any
     of the Plans and does not provide retirement or other benefits to any
     Plan Participant.  The assets of the Trust will be held, invested and
     disposed of by the Trustee, in accordance with the terms of the Trust. 
     The Company covenants and agrees to at all times make available
     sufficient shares of Company Stock for purposes of the Plans to the
     extent that there are not sufficient shares in the Trust to meet the
     requirements of the Plans; provided, however, that the Trustee shall not
     be responsible for enforcing such obligation of the Company.

                      TRUSTEE.  The trustee named above, and its successor or
     successors, is hereby designated as the trustee hereunder, to receive,
     hold, invest, administer and distribute the Trust Fund in accordance
     with this Agreement, the provisions of which shall govern the power,
     duties and responsibilities of the Trustee.

                      TRUST FUND.  The assets held at any time and from time<PAGE>


     to time under the Trust collectively are herein referred to as the
     "Trust Fund" and shall consist of contributions received by the Trustee,
     proceeds of any loans, investments and reinvestment thereof, the
     earnings and income thereon, less disbursements therefrom.  Except as
     herein otherwise provided, title to the assets of the Trust Fund shall
     at all times be vested in the Trustee and securities that are part of
     the Trust Fund shall be held in such manner that the Trustee's name and
     the fiduciary capacity in which the securities are held are fully
     disclosed, subject to the right of the Trustee to hold title in bearer
     form or in the name of a nominee, and the interests of others in the
     Trust Fund shall be only the right to have such assets received, held,
     invested, administered and distributed in accordance with the provisions
     of the Trust.<PAGE>



                      IRREVOCABILITY.  The Trust Fund shall be used for the
     exclusive purpose of aiding the Company in delivering the benefits
     provided by the Plans and defraying the expenses of the Trust in
     accordance with this Trust Agreement.  The Trustee, however, is under no
     obligation to enforce the requirements set forth in the foregoing
     sentence.  No part of the income or corpus of the Trust Fund shall be
     recoverable by the Company except as provided in Sections 2.1, 2.2 and
     7.2 and except as provided in Article II of the Common Stock Purchase
     Agreement, with respect to the Rescission (as defined in such
     Agreement).

                      TRUST FUND SUBJECT TO CLAIMS.  Notwithstanding any
     provision of this Agreement to the contrary, the Trust Fund shall at all
     times remain subject to the claims of the Company's general creditors
     under federal and state law as set forth herein.

     2.       CONTRIBUTIONS AND DIVIDENDS

              2.1.    CONTRIBUTIONS.  For each Trust Year the Company shall
     contribute to the Trust in cash such amount, which together with
     dividends, as provided in Section 2.2, and any other earnings of the
     Trust Fund, shall enable the Trustee to make all scheduled payments of
     principal and interest due under the Loan on a timely basis.  Unless
     otherwise expressly provided herein, the Trustee shall apply all such
     contributions, dividends and earnings to the payment of principal and
     interest due under the Loan.  The Company may from time to time, in its
     sole discretion, make additional contributions to the Trust for the
     purpose of enabling the Trust to make prepayments of principal with
     respect to the Loan (a "Prepayment Contribution").  The Trustee shall
     immediately use any Prepayment Contribution to make a prepayment of
     principal with respect to the Loan.  All contributions made under the
     Trust shall be delivered to the Trustee.  The Trustee shall be
     accountable for all contributions received by it, but shall have no duty
     to require any contributions to be made to it.

              2.2.    DIVIDENDS.  Except as otherwise provided herein,
     dividends paid in cash on Company Stock held by the Trust, including
     Company Stock held in the Suspense Account, shall be applied to pay
     interest and repay scheduled principal due under the Loan.  In the event
     that cash dividends paid on Company Stock held in the Trust, other than
     Extraordinary Dividends, exceed the amount of scheduled principal and
     interest due in any Trust Year, such excess shall be used to purchase
     additional shares of Company Stock and/or shall be distributed to a
     broad cross-section of individuals employed by the Company, as
     determined in good faith by the Committee.  Dividends which are not in
     cash or in Company Stock (including Extraordinary Dividends, or portions
     thereof) shall be reduced to cash by the Trustee and reinvested in
     Company Stock as soon as practicable.  For purposes of this Agreement,
     Company Stock purchased with the proceeds of an Extraordinary Dividend,
     any excess dividend or with the proceeds of a non-cash dividend and any
     dividend paid in the form of Company Stock shall, for purposes of this
     Agreement (including without limitation Section 3.1 hereof), be deemed
     to have been acquired with the proceeds of the Loan.  In the Trustee's
     discretion, investments in Company Stock may be made through open-market
     purchases, private transactions or (with the Company's consent)
     purchases from the Company.  In carrying out the duties as set forth in
     this Section, the Trustee shall act solely pursuant to the directions of
     the Committee.<PAGE>


     3.      RELEASE AND ALLOCATION OF COMPANY STOCK

              3.1.    RELEASE OF SHARES.  Upon any payment (including a
     prepayment) or forgiveness in any Trust Year of any principal on the
     Loan (a "Principal Payment"), the following number of shares of Company
     Stock acquired with the proceeds of the Loan shall be available for
     allocation ("Available Shares") as provided in this Article 3:  the
     number of shares so acquired and held in the Suspense Account
     immediately before such payment or forgiveness, multiplied by a fraction
     the numerator of which is the amount of the Principal Payment and the
     denominator of which is the sum of such Principal Payment and the
     remaining principal of the Loan outstanding after such Principal
     Payment.

              3.2.    PAYMENT OF BENEFITS.  Available Shares shall be
     distributed, as directed by the Committee, to the Plan Participants at
     such times as may be required to provide shares in accordance with the
     Plans.  Any payments required by the Plan Participants shall be made in
     accordance with the Plans.<PAGE>


     4.       TAX WITHHOLDING

              4.1.    WITHOLDING OF TAXES.  The Trustee shall, as directed by
     the Committee, withhold, require withholding, or otherwise satisfy any
     withholding obligation, on any distribution which it is directed to
     make, such amount as the Committee shall reasonably estimate to be
     necessary to comply with applicable federal, state and local withholding
     requirements.  Upon settlement of such tax liability, the Trustee shall
     distribute the balance of such amount.  Prior to making any distribution
     hereunder, the Trustee may require such release of documents from any
     taxing authority, or may require such indemnity, as the Trustee shall
     reasonably deem necessary for its protection.

     5.       ADMINISTRATION OF TRUST FUND

              5.1.    MANAGEMENT AND CONTROL OF TRUST FUND.  Subject to the
     terms of this Agreement, the Trustee shall have exclusive authority and
     responsibility to manage and control the assets of the Trust Fund;
     provided, however, that the Trustee shall have no authority or
     responsibility to manage and control shares of Company Stock returned to
     the Company in connection with the Rescission from and after the date of
     the Rescission Closing (as such terms are defined in the Amended and
     Restated Common Stock Purchase Agreement, dated as of December 20, 1996,
     by and between the Company and the Trust).

              5.2.    INVESTMENT OF FUNDS.  Except as otherwise provided in
     Section 2.2 and in this Section 5.2, the Trustee shall invest and
     reinvest the Trust Fund exclusively in Company Stock, including any
     accretions thereto resulting from the proceeds of a tender offer,
     recapitalization or similar transaction which, if not in Company Stock,
     shall be reduced to cash as soon as practicable.  The Trustee may invest
     any portion of the Trust Fund temporarily pending investment in Company
     Stock, distribution or payment of expenses in (i) investments in United
     States Government obligations with maturities of less than one year,
     (ii) interest-bearing accounts including but not limited to certificates
     of deposit, time deposits, saving accounts and money market accounts
     with maturities of less than one year in any bank, including the
     Trustee's, with aggregate capital in excess of $1,000,000,000 and a
     Moody's Investor Services rating of at least P1, or an equivalent rating
     from a nationally recognized ratings agency, which accounts are insured
     by the Federal Deposit Insurance Corporation or other similar federal
     agency, (iii) obligations issued or guaranteed by any agency or
     instrumentality of the United States of America with maturities of less
     than one year or (iv) short-term discount obligations of the Federal
     National Mortgage Association.

              5.3.    TRUSTEE'S ADMINISTRATIVE POWERS.  Except as otherwise
     provided herein, and subject to the Trustee's duties hereunder, the
     Trustee shall have the following powers and rights, in addition to those
     provided elsewhere in this Agreement or by law:

                      (a)     to retain any asset of the Trust Fund;

                      (b)     subject to Section 5.4 and Article 3, to sell,
     transfer, mortgage, pledge, lease or otherwise dispose of, or grant
     options with respect to, any Trust Fund assets at public or private
     sale;

                      (c)     upon direction from the Committee and with the
     Trustee's consent, to borrow from any lender (including the Company<PAGE>


     pursuant to the Loan), to acquire Company Stock as authorized by this
     Agreement, to enter into lending agreements upon such terms (including
     reasonable interest and security for the loan and rights to renegotiate
     and prepay such loan) as may be determined by the Committee; provided,
     however, that any collateral given by the Trustee for the Loan shall be
     limited to cash and property contributed by the Company to the Trust and
     dividends paid on Company Stock held in the Trust and shall not include
     Company Stock acquired with the proceeds of Loan;

                      (d)     with the consent of the Committee, to settle,
     submit to arbitration, compromise, contest, prosecute or abandon claims
     and demands in favor of or against the Trust Fund initiated by a party
     other than the Trustee;

                      (e)     to vote or to give any consent with respect to
     any securities, including any Company Stock, held by the Trust either in
     person or by proxy for any purpose, provided that the Trustee shall
     vote, tender or exchange all shares of Company Stock as provided in
     Section 5.4;<PAGE>



                      (f)     to exercise any of the powers and rights of an
     individual owner with respect to any asset of the Trust Fund and to
     perform any and all other acts that in its judgment are necessary or
     appropriate for the proper administration of the Trust Fund, even though
     such powers, rights and acts are not specifically enumerated in this
     Agreement;

                      (g)     to employ such accountants, actuaries,
     investment bankers, appraisers, other advisors and agents as may be
     reasonably necessary in collecting, managing, administering, investing,
     valuing, distributing and protecting the Trust Fund or the assets
     thereof or any borrowings of the Trustee made in accordance with Section
     5.3(c); and to pay their reasonable fees and out-of-pocket expenses,
     which shall be deemed to be expenses of the Trust and for which the
     Trustee shall be reimbursed in accordance with Section 4.1;

                      (h)     to cause any asset of the Trust Fund to be
     issued, held or registered in the Trustee's name or in the name of its
     nominee, or in such form that title will pass by delivery, provided that
     the records of the Trustee shall indicate the true ownership of such
     asset;

                      (i)     to utilize another entity as custodian to hold,
     but not invest or otherwise manage or control, some or all of the assets
     of the Trust Fund; and

                      (j)     to consult with legal counsel (who may also be
     counsel for the Trustee generally) with respect to any of its duties or
     obligations hereunder; and to pay the reasonable fees and out-of-pocket
     expenses of such counsel, which shall be deemed to be expenses of the
     Trust and for which the Trustee shall be reimbursed in accordance with
     Section 4.1.

     Notwithstanding the foregoing, neither the Trust nor the Trustee shall
     have any power to, and shall not, engage in any trade or business.  Any
     loan obtained by the Trustee pursuant to Section 5.3(c) shall be in its
     capacity as Trustee and not in its individual corporate capacity.

              5.4.    VOTING AND TENDERING OF COMPANY STOCK.

              (a)     Voting of Company Stock.  The Trustee shall follow the
     directions of each Plan Participant, as to the manner in which shares of
     Company Stock held by the Trust are to be voted on each matter brought
     before an annual or special stockholders' meeting of the Company or the
     manner in which any consent is to be executed, in each case as provided
     below.  Before each such meeting of stockholders, the Trustee shall
     cause to be furnished to each Plan Participant, a copy of the proxy
     solicitation material received by the Trustee, together with a form
     requesting confidential instructions as to how to vote the shares of
     Company Stock held by the Trustee.  Upon timely receipt of directions
     from the Plan Participants, the Trustee shall on each such matter vote
     the number of shares (including fractional shares) of Company Stock held
     by the Trust as follows:

                      The Company Stock shall be voted by the Trustee with
     each Plan Participant directing a number of shares of Company Stock (the
     "Participant Directed Amount") equal to the quotient of (x) the total
     number of shares of Company Stock held by the Trust and (y) the number
     of Plan Participants on the relevant date.  Any Participant Shares for<PAGE>


     which the Trustee does not receive a signed voting-direction instrument
     shall be voted for, against or to abstain in the same proportions as
     those shares of Company Stock for which the Trustee did receive
     instructions.

                      Similar provisions shall apply in the case of any
     action by shareholder consent without a meeting.

                      (b)     TENDER OR EXCHANGE OF COMPANY STOCK.  The
     Trustee shall use its best efforts timely to distribute or cause to be
     distributed to each Plan Participant any written materials distributed
     to stockholders of the Company generally in connection with any tender
     offer or exchange offer, together with a form requesting confidential
     instructions as to whether or not to tender or exchange shares of
     Company Stock held in the Trust.  Upon timely receipt of instructions
     from a Plan Participant, the Trustee shall tender such Participant's
     Participant Directed Amount if such Plan Participant has directed the
     Trustee to tender.  


                      (c)     The Company shall maintain appropriate
     procedures to ensure that all instructions by Participants in the Plans
     are collected, tabulated, and transmitted to the Trustee without being
     divulged or released to any person affiliated with the Company or its
     affiliates.  All actions taken by Plan Participants shall be held
     confidential by the Trustee and shall not be divulged or released to any
     person, other than (i) agents of the Trustee who are not affiliated with
     the Company or its affiliates or (ii) by virtue of the execution by the
     Trustee of any proxy, consent or letter of transmittal for the shares of
     Company Stock held in the Trust.


     6.       CONCERNING THE TRUSTEE

              6.1.    Notices to the Trustee.
                      The Trustee may rely on the authenticity, truth and ac-
     curacy of, and will be fully protected in acting upon:  

                      (a)  any notice, direction, certification, approval or
     other writing of the Company, if evidenced by an instrument signed in
     the name of the Company by an Authorized Officer; and

                      (b)  any copy of a resolution of the Board of Directors
     of the Company, if certified by the Secretary or an Assistant Secretary
     of the Company under its corporate seal; or

                      (c)  any notice, direction, certification, approval or
     other writing, oral or other transmitted form of instruction received by
     the Trustee and believed by it to be genuine and to be sent by or on
     behalf of the Committee.

              6.2.    EXPENSES OF THE TRUST FUND.
                   
                      The Trustee is authorized to pay out of the Trust Fund: 


     (a) all brokerage fees and transfer tax expenses and other expenses
     incurred in connection with the sale or purchase of investments; (b) all
     real and personal property taxes, income taxes and other taxes of any
     kind at any time levied or assessed under any present or future law<PAGE>


     upon, or with respect to, the Trust Fund or any property included in the
     Trust Fund; (c) the Trustee's compensation and expenses as provided in
     Section 6.3 hereof; and (d) all other expenses of administering the
     Trust, including, without limitation, the expenses incurred by the
     Trustee pursuant to Section 6.11 of this Agreement, if any, unless
     promptly paid to the Trustee by the Company.  

              6.3.    COMPENSATION OF THE TRUSTEE.
                      
                      The Company will pay to the Trustee such compensation
     for its services as set forth on Exhibit A as from time to time amended
     by the Company and the Trustee and will reimburse the Trustee for all
     expenses (including reasonable attorney's fees) incurred by the Trustee
     in the administration of the Trust.  If not promptly paid on request,
     the Trustee may charge such fees and expenses to and pay the same from
     the Trust Fund.  The compensation and expenses of the Trustee shall
     constitute a lien on the Trust Fund.

              6.4.    PROTECTION OF THE TRUSTEE.
                     
                      The Company shall pay and shall protect, indemnify and
     save harmless the Trustee and its officers, employees and agents from
     and against any and all losses, liabilities (including liabilities for
     penalties), actions, suits, judgments, demands, damages, costs and
     expenses (including, without limitation, attorneys' fees and expenses)
     of any nature arising from or relating to any action or any failure to
     act by the Trustee, its officers, employees and agents or the
     transactions contemplated by this Trust Agreement, including, but not
     limited to, any claim with respect to the Rescission (as such term is
     defined in the Common Stock Purchase Agreement), any claim by a 
     shareholder of the Company of any kind or nature, any claim made by a
     Plan Participant or his or her beneficiary with respect to payments made
     or to be made by the Trustee and any claim made by the Company or its
     successor, whether pursuant to a sale of assets, merger, consolidation,
     liquidation or otherwise, that this Trust Agreement is invalid or ultra
     vires, except to the extent that any such loss, liability, action, suit,
     judgment, demand, damage, cost or expense has been determined by a final
     judgment of a court of competent jurisdiction to be solely the result of
     the gross negligence or 
     willful misconduct of the Trustee, its officers, employees or agents. 
     To the extent that the Company has not fulfilled its obligations under
     the foregoing provisions of this Section, the Trustee shall be
     reimbursed out of the assets of the Trust Fund or may set up reasonable
     reserves for the payment of such obligations.  The Trustee assumes no
     obligation or responsibility with respect to any action required by this
     Trust Agreement on the part of the Company or the Committee.  With
     respect to all action or inaction taken or not taken by the Trustee
     prior to the Rescission Closing, the rights of the Trustee shall 
     be determined in accordance with the terms and provisions of the Common
     Stock Purchase Agreement.

              6.5.    DUTIES OF THE TRUSTEE.
           
                      The Trustee will be under no duties whatsoever, except
     such duties as are specifically set forth as such in this Trust
     Agreement, and no implied covenant or obligation will be read into this
     Trust Agreement against the Trustee.  The Trustee will not be liable for
     any action or failure to act except if such action or failure to act
     constitutes gross negligence or willful misconduct.  The Trustee will
     not be compelled to take any action toward the execution or enforcement<PAGE>


     of the Trust or to prosecute or defend any suit in respect thereof,
     unless indemnified to its satisfaction against loss, cost, liability and
     expense; and the Trustee will be under no liability or 
     obligation to anyone with respect to any failure on the part of the
     Company, the Committee or a Plan Participant.  Nothing in this Trust
     Agreement shall be construed as requiring the Trustee to make any
     payment in excess of the amounts held in the Trust Fund at the time of
     such payment or otherwise to risk its own funds.  The Trustee has no
     duty to maintain records with respect to Option Grants or with respect
     to the shares in the Suspense Account.

              6.6.    SETTLEMENT OF ACCOUNTS OF THE TRUSTEE.
                      
                      The Trustee shall keep or cause to be kept accurate and
     detailed accounts of all investments, receipts, disbursements and other
     transactions hereunder.  Such accounts shall be open to inspection and
     audit at all reasonable times during normal business hours by any person
     designated by the Company or the Committee.  At least annually after the
     end of each Plan Year, the Trustee shall file with the Company and the
     Committee a written account, listing the investments of the Trust Fund
     and any uninvested cash balance thereof, and setting forth all receipts,
     disbursements, payments, and other transactions respecting the Trust
     Fund not included in any such previous account.  Any account, when
     approved by the Company and the Committee, will be binding and
     conclusive on the Company, the Committee and all Plan Participants, and
     the Trustee will thereby be released and discharged from any liability
     or accountability to the Company, the Committee and all Plan
     Participants with respect to all matters set forth therein.  Omission by
     the Company or the Committee to object in writing to any specific items
     in any such account within sixty (60) days after its delivery will
     constitute approval of the account by the Company and the Committee.  No
     other accounts or reports shall be required to be given to the Company,
     the Committee or a Plan Participant except as stated herein or except as
     otherwise agreed to in 
     writing by the Trustee.  The Trustee shall not be required to file, and
     no Plan Participant or beneficiary shall have right to compel, an
     accounting, judicial or otherwise, by the Trustee.

              6.7.    RIGHT TO JUDICIAL SETTLEMENT.
                 
                      Nothing contained in this Trust Agreement shall be
     construed as depriving the Trustee of the right to have a judicial
     settlement of its accounts, and upon any proceeding for a judicial
     settlement of the Trustee's accounts or for instructions the only
     necessary parties thereto in addition to the Trustee shall be the
     Company and the Committee.

              6.8.    RESIGNATION OR REMOVAL OF THE TRUSTEE.
                      
                      The Trustee may at any time resign and may at any time
     be removed by the Company upon thirty (30) days' notice in writing.

              6.9.    APPOINTMENT OF SUCCESSOR TRUSTEE.
               
                     In the event of the resignation or removal of the
     Trustee, or in any other event in which the Trustee ceases to act, a
     successor trustee may be appointed by the Company by instrument in
     writing delivered to and accepted by the successor trustee. Notice of
     such appointment and approval, if applicable, will be given by the
     Company to the retiring trustee, and the successor trustee will deliver<PAGE>


     to the retiring trustee an instrument in writing accepting such
     appointment.  Notwithstanding the foregoing, if no appointment and
     approval, if applicable, of a successor trustee is made by the 
     Company within a reasonable time after such a resignation, removal or
     other event, any court of competent jurisdiction may appoint a successor
     trustee after such notice, if any, solely to the Company and the
     retiring trustee, as such court may deem suitable and proper.

              In the event of such resignation, removal or other event, the 
     retiring trustee or its successors and assigns shall file with the
     Company a final account to which the provisions of Section 6.6 hereof
     relating to annual accounts shall apply.

              In the event of the appointment of a successor trustee, such 
     successor trustee will succeed to all the right, title and estate of,
     and will be, the Trustee; and the retiring trustee will after the
     settlement of its final account and the receipt of any compensation or
     expenses due it, deliver the Trust Fund to the successor trustee
     together with all such instruments of transfer, conveyance, assignment
     and further assurance as the successor trustee may reasonably require. 
     The retiring trustee will retain a lien upon the Trust Fund to secure
     all amounts due the retiring trustee pursuant to the provisions of this
     Trust Agreement.

              6.10.   MERGER OR CONSOLIDATION OF THE TRUSTEE.
                      
                      Any corporation continuing as the result of any merger
     or resulting from any consolidation to which merger or consolidation the
     Trustee is a party, or any corporation to which substantially all the
     business and assets of the Trustee may be transferred, will be deemed
     automatically to be continuing as the Trustee.

              6.11.   DECLARATORY JUDGMENT.  Effective on and after December
     20, 1996, the Trustee may, prior to taking any action pursuant to this
     Agreement with respect to which the Trustee determines in good faith
     that the legality or permissibility of such action under this Agreement
     or otherwise is questionable, seek a declaratory judgment from a court
     of competent jurisdiction as to such legality or permissibility.

     7.       ENFORCEMENT; INSOLVENCY OF THE COMPANY
              
              7.1.    ENFORCEMENT OF TRUST AGREEMENT AND LEGAL PROCEEDINGS.
                      
                      The Company shall have the right to enforce any provi-
     sion of this Trust Agreement.  In any action or proceeding affecting the
     Trust, the only necessary parties shall be the Company, the Trustee and
     the Committee and, except as otherwise required by applicable law, no
     other person shall be entitled to any notice or service of process.  Any
     judgment entered in such an action or proceeding shall, to the maximum
     extent permitted by applicable law, be binding and conclusive on all
     persons having or claiming to have any interest in the Trust.

              7.2.    INSOLVENCY OF THE COMPANY.

                      (a) If at any time (i) the Company or a person claiming
     to be a creditor of the Company alleges in writing to the Trustee that
     the Company has become Insolvent, (ii) the Trustee is served with any
     order, process or paper from which it appears that an allegation to the
     effect that the Company is Insolvent has been made in a judicial
     proceeding or (iii) the Trustee has actual knowledge of a current report<PAGE>


     or statement from a nationally recognized credit reporting agency or
     from a Reliable Source to the effect that the 
     Company is Insolvent, the Trustee shall discontinue allocations under
     Section 3 under this Trust Agreement, shall hold the Trust Fund for the
     benefit of the Company's creditors, and shall resume allocations under
     Section 3 under this Trust Agreement, only upon receipt of an order of a
     court of competent jurisdiction requiring such payment or if the Trustee
     has actual knowledge of a current report or statement from a nationally
     recognized credit reporting agency or other Reliable Source (other than
     a Reliable Source described in clause (iii) of the definition thereof)
     to the effect that the Company is not Insolvent; provided, however, that
     in the event that allocations under Section 
     3 were discontinued by reason of a court order or injunction, the
     Trustee shall resume allocations only upon receipt of an order of a
     court of competent jurisdiction requiring such allocation.  The Company
     and its Chief Executive Officer shall be obligated to give the Trustee
     prompt written notice in the event that the Company becomes Insolvent. 
     The Trustee shall not be liable to anyone in the event benefit payments
     are discontinued pursuant to this Section 7.2.  For purposes of this
     Section 7.2, the term Company shall include any and all of the Company's
     subsidiaries. The Company hereby specifically represents 
     and warrants to the Trustee that, as of December 20, 1996, neither the
     Company nor any subsidiary of the Company with one or more employees
     benefiting under the Plans is Insolvent.

     8.  AMENDMENT, REVOCATION AND TERMINATION

                      8.1.  AMENDMENTS.  Except as otherwise provided herein,
     the company may amend the Trust at any time and from time to time in any
     manner which it deems desirable, provided that no amendment which would
     adversely affect the rights, duties, interests, fees or obligations of
     the Trustee shall be made without the Trustee's written consent, which
     consent shall not be unreasonably withheld.  Notwithstanding the
     foregoing, the Company shall retain the power under all circumstances to
     amend the Trust to correct any errors or clarify any ambiguities or
     similar issues of interpretation in this Agreement.

                      8.2.  TERMINATION.  Subject to the terms of this
     Section 8.2, the Trust shall terminate on the later of (i) the date all
     Available Shares are distributed and (ii) the date on which the Loan is
     paid in full (the "Termination Date").  The Company may terminate the
     Trust at any time prior to the Termination Date.  The Trust shall also
     terminate automatically upon the Company giving the Trustee written
     notice of a Change of Control (The Trustee shall have no duty to
     authenticate the occurrence of a Change of Control).  

     Immediately upon a termination of the Trust, the Company shall be deemed
     to have forgiven all amounts then outstanding under the Loan.  As soon
     as practicable after receiving notice from the Company of a Change of
     Control or upon any other termination of the Trust, the Trustee shall
     sell all of the Company Stock and other non-cash assets (if any) then
     held in the Trust Fund as directed by the Committee in good faith taking
     into account the interests of a broad cross-section of individuals em-
     ployed by the Company.  The proceeds of such sale shall first be
     returned to the Company up to an amount equal to 
     the principal amount, plus any accrued interest, of the Loan that was
     forgiven upon such termination.  Any funds remaining in the Trust after
     such payment to the Company (the "Excess Funds") shall be allocated and
     distributed with reasonable promptness to Plan Participants among a
     broad cross-section of the Company's employees as determined by the<PAGE>


     Committee.

                      8.3.  FORM OF AMENDMENT OR TERMINATION.  Any amendment
     or termination of the Trust shall be evidenced by an instrument in
     writing signed by an Authorized Officer of the Company, certifying that
     said amendment or termination has been authorized and directed by the
     Company or the Board of Directors, as applicable, and, in the case of
     any amendment, shall be consented to by signature of an authorized
     officer of the Trustee, if required by Section 8.1.

     9.       MISCELLANEOUS PROVISIONS

              9.1.    SUCCESSORS.
                      
                      This Trust Agreement shall be binding upon and inure to
     the benefit of the Company and the Trustee and their respective
     successors and assigns.

              9.2. COMMITTEE ACTION.

                      Any action required or permitted to be taken by the
     Committee may be taken on behalf of the Committee by any individual so
     authorized.  The Company (or the Committee after a Change of Control)
     shall furnish to the Trustee the name and specimen signature of each
     member of the Committee upon whose statement of a decision or direction
     the Trustee is authorized to rely. Until notified of a change in the
     identity of such person or persons, the Trustee shall act upon the
     assumption that there has been no change.  After the Company has given
     the Trustee notice that a Change of Control has occurred, the Board of
     Directors shall no longer have the authority to remove or appoint
     members of the Committee and the members of the Committee in place 
     immediately preceding such a Change of Control shall continue as such
     members and shall appoint new members to replace any members who resign
     or otherwise cease to be members after the Change of Control. 


              9.3.    NONALIENATION.
                      
                      Except insofar as applicable law may otherwise require,
     (a) no amount payable to or in respect of any Plan Participant at any
     time under the Trust shall be subject in any manner to alienation by
     anticipation, sale, transfer, assignment, bankruptcy, pledge,
     attachment, charge or encumbrance of any kind, and any attempt to so
     alienate, sell, transfer, assign, pledge, attach, charge or otherwise
     encumber any such amount, whether presently or thereafter payable, shall
     be void; and (b) the Trust Fund shall in no manner 
     be liable for or subject to the debts or liabilities of any Plan
     Participant.

              9.4.    COMMUNICATIONS.

                      (a)  Communications to the Company shall be addressed
     to the Company at 4 Taft Court, Rockville, MD  20850 Attn:  Joseph L.
     Guarriello, provided, however, that upon the Company's written request,
     such communications shall be sent to such other address as the Company
     may specify.

                      (b)  Communications to the Trustee shall be addressed
     to it at One Wall Street, New York, New York 10286, Attn:  Division
     Head, Master Trust/Custody Division; provided, however, that upon the<PAGE>


     Trustee's written request, such communications shall be sent to such
     other address as the Trustee may specify.

                      (c)  No communication shall be binding on the Trustee
     until it is received by officer the Trustee having primary responsi-
     bility for this Trust, and no communication shall be binding on the
     Company until it is received by the Company.

              9.5.    HEADINGS.
                      
                      Titles to the Sections of this Trust Agreement are
     included for convenience only and shall not control the meaning or
     interpretation of any provision of this Trust Agreement.

              9.6.    THIRD PARTIES.
                      
                      A third party dealing with the Trustee shall not be
     required to make inquiry as to the authority of the Trustee to take any
     action nor be under any obligation to follow the proper application by
     the Trustee of the proceeds of sale of any property sold by the Trustee
     or to inquire into the validity or propriety of any act of the Trustee.

              9.7.    GOVERNING LAW.

                      This Trust Agreement and the Trust established
     hereunder shall be governed by and construed, enforced, and administered
     in accordance with the internal laws of the State of New York without
     regard to principles of conflicts of laws and the Trustee shall be
     liable to account only in the courts of that state.

              9.8.    COUNTERPARTS.
                      
                      This Trust Agreement may be executed in any number of 
     counterparts, each of which shall be deemed to be the original although
     the others shall not be produced.<PAGE>


              IN WITNESS WHEREOF, this Trust Agreement has been duly executed
     by the parties hereto as of the day and year first above written.



                                        MID ATLANTIC MEDICAL SERVICES, INC.


                                        By:  /S/ JOSEPH L. GUARRIELLO
                                            --------------------------        
                 
     Attest



      /S/ ALISA CHESTLER
     --------------------
       
                                                 THE BANK OF NEW YORK, as 
                                                 TRUSTEE



                                                 By:  /S/  EUGENE J. FORAN    
                                                    ---------------------- 
                                               


     Attest



     /S/ KATARINA ANTENS-MILLER
     ---------------------------<PAGE>



                                       SCHEDULE A
                                       ----------


                                  MAMSI 1990 Non-Qualified Stock Option Plan
                                  MAMSI 1991 Non-Qualified Stock Option Plan
                                  MAMSI 1992 Non-Qualified Stock Option Plan
                                  MAMSI 1993 Non-Qualified Stock Option Plan
                                  MAMSI 1994 Non-Qualified Stock Option Plan
                                  MAMSI 1995 Non-Qualified Stock Option Plan
                                  MAMSI 1996 Non-Qualified Stock Option Plan<PAGE>


                                      The Bank of New York
                                        Schedule of Fees
                                               for
                                      Grantor Trust Services
                                               for
                                 MID ATLANTIC MEDICAL SERVICES, INC.


     The following schedule of fees would apply to the subject trust.  Fees
     are rendered quarterly.


     Administration Fees:                       $15,000 annually

     Special Asset Fee:

     $10,000 per annum for the first company stock account held as an asset
     per issuer.

     $3,000 per annum for each additional account.

     Transaction Fees:

     Security Transaction                       $15.00 per security
                                                 transaction
     Lump Sum/Expense Payments                  $12.50 per check plus postage
     Periodic Payments                          $2.00 per check plus postage
     Wire Transfers (outgoing)                  $15.00 per transfer

     Special Transaction Fees

     Change of Control                          $10,000 per event
     Insolvency                                 $10,000 per event
     Termination of the Trust                   $3,000 per event
     Tax Form Preparation                       $150 per hour as incurred
     Convert to Pay Status                      $100 per participant
     Proxy Services                             $150/hour
     Corporate Action Administrative Services   $150/hour
     Legal Fees/Out-of-Pocket Expenses          As Incurred

     Special Reporting Fees - Sub Plan Accounting

     $1,500 annually per investment pool
     $250 per plan within each pool

     Fees as quoted above do not include any direct out-of-pocket or legal
     expenses which would become payable in accordance with the grantor trust
     agreement.  There are no initial set-up fees, except legal fees,
     incurred with the establishment/conversion of the trust to The Bank of
     New York.
                                            Exhibit A<PAGE>

<PAGE>




                  AMENDED AND RESTATED COMMON STOCK PURCHASE AGREEMENT


                    THIS AMENDED AND RESTATED COMMON STOCK PURCHASE AGREEMENT
     (this "Agreement"), made this 20th day of December, 1996, effective as
     of August 26, 1996, between Mid Atlantic Medical Services, Inc., a
     Delaware corporation (the "Seller") and The Bank of New York, not in its
     individual or corporate capacity, but solely in its capacity as trustee
     (the "Trustee") of the Stock Compensation Trust (the "Trust") (the Trust
     is hereinafter sometimes referred to as the "Purchaser") under an
     amended and restated trust agreement between the Seller and the Trustee
     dated December 20, 1996 effective as of August 26, 1996 (the "Trust
     Agreement").

                              W I T N E S S E T H:


                    WHEREAS, this Agreement was originally effective as of
     August 26, 1996; and

                    WHEREAS, pursuant to this Agreement, as contemplated by
     the Trust Agreement, the Purchaser purchased from the Seller, and the
     Seller sold to the Purchaser, 20,000,000 shares of the Seller s common
     stock, $0.01 par value (the  Common Stock ) on August 26, 1996, all as
     more specifically described herein (the  Original Transaction ); and

                    WHEREAS, as payment for such Common Stock, the Purchaser
     paid to the Seller $200,000 and issued a promissory note, in favor of
     the Seller, in the principal amount of $284,800,000; and

                    WHEREAS, following the consummation of such transaction,
     it was determined that, pursuant to the listing rules of the New York
     Stock Exchange (the  NYSE Listing Rules ), the number of shares of
     Common Stock sold by the Seller to the Purchaser exceeded the maximum
     number of shares that may be issued without the approval of the
     shareholders of  the Seller; and

                    WHEREAS, in order in order to comply with such NYSE
     Listing Rules, the Seller and the Purchaser have agreed to amend and
     restate this Agreement to provide that (i) the Purchaser will return to
     the Seller 10,870,000 shares of Common Stock, (ii) the promissory note
     issued by the Purchaser in favor of the Seller in connection with the
     Original Transaction will be canceled, and (iii) a replacement
     promissory note will be issued by the Purchaser in favor of the Seller,
     in the principal amount of $129,902,500.

                    NOW, THEREFORE, in consideration of the mutual covenants
     and undertakings contained herein, and subject to and on the terms and
     conditions herein set forth, the parties hereto agree as follows:<PAGE>


                                    ARTICLE I

                           PURCHASE AND SALE OF SHARES

             1.1    PURCHASE AND SALE.  Subject to the terms and conditions
     set forth herein, the Seller will sell to the Purchaser, and the
     Purchaser will purchase from the Seller, at the Closing (as hereinafter
     defined), twenty million (20,000,000) shares of Common Stock at $14.25
     per share which is the Fair Market Value (as defined in the Trust) of
     the Common Stock on the last full trading day prior to the Closing.  The
     shares of Common Stock to be purchased by the Purchaser and sold by the
     Seller at the Closing are referred to in this Agreement as the "Common
     Shares."  In consideration for the Common Shares, the Purchaser will
     deliver to the Seller cash in the amount of $200,000, representing the
     par value of the Common Stock and a note in the form of Schedule 1.1 to
     this Agreement in the principal amount of $284,800,000 (the "Original
     Note").

             1.2    CLOSING.  The closing of the sale and purchase of the 
     Common Shares hereunder (the "Closing"), will be held at the offices of
     the Seller on August 26, 1996 or at such other time, date and place as
     agreed to by the parties.

             1.3    DELIVERY AND PAYMENT.  At the Closing, the Seller 
     will deliver to the Purchaser a certificate representing the Common
     Shares, which certificate shall be registered in the name of the
     Trustee, or the name of its nominee, against payment by the Purchaser to
     the Seller of the aggregate purchase price therefor.  Notwithstanding
     the foregoing, the Seller may accomplish the transfer of shares to the
     Trustee by book entry, in which event a cross receipt shall be executed
     by the parties.  The Seller will pay all stamp and other transfer taxes,
     if any, which may be payable in respect of the sale and delivery of the
     Common Shares.

                                    ARTICLE II

                                 RETURN OF SHARES

                    2.1    RETURN OF SHARES.  Subject to terms and
     conditions set forth herein, the Purchaser shall deliver to the Seller,
     at the Rescission Closing (as hereinafter defined) 10,870,000 shares of
     Common Stock (the  Returned Common Shares ).  In order to accomplish
     such delivery, the Seller shall reflect the transfer of 10,870,000
     shares of Common Stock from the Purchaser to the Seller by book entry
     and the Seller and the Purchaser shall execute a cross-receipt in the
     form of Schedule 2.1 to this Agreement. The Seller will pay all stamp
     and other transfer taxes, if any, which may be payable in respect of the
     transfer of the Returned Common Shares.  The actions described in this
     Section 2.1 are referred to in this Agreement, collectively, as the
      Rescission. 

                 2.2    CANCELLATION OF NOTE; ISSUANCE OF REPLACEMENT NOTE. 
     At the Rescission Closing, the Seller shall deliver the Note to the
     Purchaser, and the Note shall be marked canceled.  Simultaneous
     therewith, the Purchaser shall deliver to the Seller a replacement note
     in the form of  Schedule 2.2 to this Agreement in the principal amount
     of $129,902,500 (the  Replacement Note ).

                    2.3    RESCISSION CLOSING.  The closing of the  
     Rescission hereunder (the  Rescission Closing ) will be held at the<PAGE>


     offices of the Seller on December 20, 1996 or at such other time, date
     and place as agreed to by the parties.

                    2.4    REPRESENTATIONS.  The Seller hereby represents 
     and warrants to the Purchaser that (i) the Committee (as such term is
     defined in the Trust Agreement) has approved the Rescission, (ii) the
     Rescission has no federal income or other tax consequences to the
     Seller, the Trustee or otherwise, and (iii) the Purchaser has properly
     performed all of its duties under this Agreement with respect to the
     Returned Shares from the Closing Date through the date of the Rescission
     Closing.

                    2.5    RETIREMENT OF SHARES.  As of the date of the  
     Rescission Closing, the Seller shall cause the Returned Shares to be
     retired so that the total number of issued and outstanding shares of the
     Seller is reduced by the number of Returned Shares.<PAGE>



                                    ARTICLE III

                   REPRESENTATIONS AND WARRANTIES OF THE SELLER
                   

                    The Seller represents and warrants to the Purchaser as
     follows:

                    3.1    CORPORATE EXISTENCE AND AUTHORITY.  The Seller
     (i) is a corporation duly organized, validly existing and in good
     standing under the laws of the State of Delaware; (ii) has all requisite
     corporate power to execute, deliver and perform this Agreement; and
     (iii) has taken all necessary corporation action to authorize the
     execution, delivery and performance of this Agreement.

                    3.2    NO CONFLICT.  The execution and delivery of 
     this Agreement does not, and the consummation of the transactions
     contemplated hereby will not, conflict with or constitute a default
     under (i) the Seller's certificate of incorporation or by-laws, (ii) any
     agreement, indenture or other instrument to which the Seller is a party
     or by which the Seller or its assets may be bound or (iii) any law,
     regulation, order, arbitration, award, judgment or decree applicable to
     the Seller.

                    3.3    VALIDITY.  This Agreement has been duly  
     executed and delivered by the Seller and is a valid and binding
     agreement of the Seller enforceable against the Seller in accordance
     with its terms, except as the enforceability thereof may be limited by
     any applicable bankruptcy, insolvency, reorganization, moratorium,
     fraudulent conveyance or other laws affecting the enforcement of
     creditors' rights generally, and by general principles of equity.

                    3.4    THE COMMON SHARES.  The Common Shares have been   
     duly authorized and are (or when issued as contemplated hereby will be)
     validly issued and constitute fully-paid and non-assessable shares of
     Common Stock, $0.01 par value, of the Seller.  No stockholder of the
     Seller has any preemptive or other subscription right to acquire any
     shares of Common Stock.  The Seller will convey to the Purchaser, on the
     date of Closing, good and valid title to the Common Shares free and
     clear of any liens, claims, security interests and encumbrances.

                    3.5    LITIGATION.  There are no actions, suits, 
     proceedings or arbitrations or investigations pending, or to the
     Seller's best knowledge, threatened in any court or before any
     governmental agency or instrumentality or arbitration panel or otherwise
     against or by the Seller which seek to or could restrain, prohibit,
     rescind or declare unlawful, or result in substantial damages in respect
     of this Agreement or the performance hereof by the Seller (including,
     without limitation, the delivery of the Common Shares).

                    3.6    RESCISSION.  Neither the Rescission nor any 
     transaction related to the Rescission, including the holding of
     9,130,000 shares of Common Stock by the Purchaser immediately following
     such Rescission, violates any federal or state law or any rule of the
     New York Stock Exchange.  After giving effect to the Rescission, the
     purchase and sale of the Common Shares will not violate any rule of the
     New York Stock Exchange applicable to companies whose stock is listed
     thereon.<PAGE>



                                    ARTICLE IV

                  REPRESENTATIONS AND WARRANTIES OF THE PURCHASER
                    
                    The Purchaser hereby represents and warrants to the
     Seller as follows:

                    4.1    AUTHORITY; VALIDITY.  The Purchaser has full 
     power and authority to execute and deliver this Agreement and the
     Replacement Note as Trustee and to consummate the transactions
     contemplated hereby.  The Replacement Note has been duly executed by the
     Trustee on behalf of the Trust and, upon the execution and delivery by
     the Trustee on behalf of the Trust, the Replacement Note will be a valid
     and binding agreement of the Purchaser enforceable in accordance with
     its terms, except as the enforceability thereof may be limited by any
     applicable bankruptcy, insolvency, reorganization, moratorium,
     fraudulent conveyance or other laws affecting the enforcement of
     creditors' rights generally, and by general principles of equity.


                                    ARTICLE V

                 RESTRICTIONS ON DISPOSITION OF THE COMMON SHARES


                    5.1     RESTRICTED SECURITIES.  The Purchaser 
     acknowledges that the Purchaser is acquiring the Common Shares pursuant
     to a transaction exempt from registration under the 1933 Act.  The
     Purchaser represents, warrants and agrees that all Common Shares
     acquired by the Purchaser pursuant to this Agreement are being acquired
     for investment without any intention of making a distribution thereof,
     or of making any sale or other disposition thereof which would be in
     violation of the 1933 Act or any applicable state securities law, and
     that the Purchaser will not dispose of any of the Common Shares (other
     than in the Rescission) except that the Trustee will, from time to time,
     convey a portion of the Common Shares to the participants in the Plans
     (as such term is defined in the Trust Agreement) to satisfy the
     obligations of the Seller thereunder, and except upon termination of the
     Trust to the extent that the Trust then holds any Common Shares.

                    5.2    LEGEND.  Until such time as the Common Shares 
     are registered pursuant to the provisions of the 1933 Act, any
     certificate or certificates representing the Common Shares delivered
     pursuant to Section 1.3 or 2.1, will bear a legend in substantially the
     following form:

                   "The shares represented by this certificate have not been  
                  registered under the Securities Act of 1933, as amended,    
                 and may not be sold, transferred or otherwise disposed of    
                unless they have first been registered under such Act or      
               unless an exemption from registration is available."

     The Seller may place stop transfer orders against the registration or
     transfer of any shares evidenced by such a certificate or certificates
     until such time as the requirements of the foregoing are satisfied.


                                    ARTICLE VI<PAGE>


                              CONDITIONS TO CLOSING

                    6.1      Conditions to Obligations of the Purchaser.  The
     obligation of the Purchaser to purchase the Common Shares is subject to
     the satisfaction of the following conditions on the date of Closing:

                             (a)      The representations and warranties of   
                   the Seller set forth in Article III hereof shall be true   
                  and correct; and if the Closing shall occur on a date       
                 other than the date of this Agreement, the Purchaser         
                shall have been furnished with a certificate, dated the       
               date of Closing, to such effect, signed by an authorized       
              officer of the Seller; and<PAGE>



                             (b)      All permits, approvals, authorizations  
                   and consents of third parties necessary for the            
                  consummation of the transactions herein shall have been     
                 obtained, and no order of any court or administrative        
                agency shall be in effect which restrains or prohibits        
               the transactions contemplated by this Agreement, and no        
              suit, action or other proceeding by any governmental            
             body or other person shall have been instituted which            
            questions the validity or legality of the transactions            
           contemplated by this Agreement.

                    6.2     Conditions to Obligations of the Seller.  The 
     obligation of the Seller to issue, sell and deliver the Common Shares to
     the Purchaser is subject to the satisfaction of the following conditions
     on the date of Closing:

                             (a)      The representations and warranties of   
                   the Purchaser set forth in Article IV hereof shall be      
                  true and correct; and if the Closing shall occur on a       
                 date other than the date of this Agreement, the Seller       
                shall have been furnished with a certificate dated the        
               date of Closing, to such effect, signed by an authorized       
              office of the Trustee; and

                             (b)      No order of any court or                
                   administrative agency shall be in effect which restrains   
                  or prohibits the transactions contemplated by this          
                 Agreement, and no suit, action or other proceeding by        
                any governmental body or other person shall  have been        
               instituted which questions the validity or legality of         
              the transactions contemplated by this Agreement.


                                    ARTICLE VII

                                  MISCELLANEOUS
      

                             7.1      EXPENSES.  The Seller shall pay all of 
     its expenses, and it shall pay the Purchaser's expenses, in connection
     with the authorization, preparation, execution and performance of this
     Agreement, including without limitation the reasonable fees and expenses
     of the Trustee, its agents, representatives, counsel, financial advisors
     and consultants.

                             7.2      SURVIVAL OF SELLER'S REPRESENTATIONS 
     AND WARRANTIES.  All representations and warranties made by the Seller 
     to the Purchaser in this Agreement shall survive the Closing and the
     Rescission Closing.

                             7.3      NOTICES.  All notices, requests or 
     other communications required or permitted to be delivered hereunder
     shall be in writing, delivered by registered or certified mail, return
     receipt requested, as follows:

                             (a)      To the Seller:

                                      Joseph L. Guarriello, Executive Vice
                                       President and General Counsel<PAGE>


                                      Mid Atlantic Medical Services, Inc.
                                      4 Taft Court
                                      Rockville, MD  20850


                             (b)      To the Purchaser:

                                      Katarina Antens-Miller, AVP
                                      Relationship Manager
                                      The Bank of New York
                                      One Wall Street
                                      New York, NY  10286


     Any party hereto may from time to time, by written notice given as
     aforesaid, designate any other address to which notices, requests or
     other communications addressed to it shall be sent.<PAGE>



                    7.4      SPECIFIC PERFORMANCE.  The parties
     hereto acknowledge that damages would be an inadequate remedy for any
     breach of the provisions of this Agreement and agree that the
     obligations of the parties hereunder shall be specifically enforceable,
     and neither party will take any action to impede the other from seeking
     to enforce such rights of specific performance.


                    7.5     SUCCESSORS AND ASSIGNS; INTEGRATION; 
     ASSIGNABILITY.  This Agreement shall be binding upon and inure to the 
     benefit of and be enforceable by the parties hereto, and their
     respective legal representatives, successors and assigns.  This
     Agreement (a) constitutes, together with the Note, the Trust Agreement,
     and any other written agreements between the Purchaser and the Seller
     executed and delivered on the date hereof, the entire agreement between
     the parties hereto and supersedes all other prior agreements and
     understandings, both written and oral, among the parties, with respect
     to the subject matter hereof; (b) shall not confer upon any person other
     than the parties hereto any rights or remedies hereunder; and (c) shall
     not be assignable by operation of law or otherwise, except that the
     Trustee may assign all its rights hereunder to any corporation or other
     institution exercising trust powers in connection with any such
     institution assuming the duties of a trustee under the Trust.

                    7.6      GOVERNING LAW.  This Agreement shall be 
     governed by and construed in accordance with the laws of the state of
     New York.

                    7.7      FURTHER ASSURANCES.  Subject to the terms and 
     conditions herein provided, each of the parties hereto agrees to use all
     reasonable efforts to take, or cause to be taken, all action and to do,
     or cause to be done, all things necessary, proper or advisable to
     consummate and make effective the transactions contemplated by this
     Agreement.

                    7.8      AMENDMENT AND WAIVER.  No amendment or waiver 
     of any provision of this Agreement or consent to departure therefrom
     shall be effective unless in writing and signed by the Purchaser and the
     Seller.

                    7.9      COUNTERPARTS.  This Agreement may be executed 
     in any number of counterparts with the same effect as if the signatures
     thereto were upon one instrument.

                    7.10     CERTAIN LIMITATIONS.  The execution and 
     delivery of this Agreement and the performance by the Trustee of this
     Agreement and under the terms of the Trust have been or will be,
     effected by the Trustee in its capacity as Trustee.  Nothing in this
     Agreement shall be interpreted to increase, decrease or modify in any
     manner any liability of the Trustee to the Seller or to any trustee,
     representative or other claimant by right of the Seller resulting from
     the Trustee's performance of its duties under the constituent
     instruments of the Trust, and no personal liability shall be asserted or
     enforceable against the Trustee by reason of any of the covenants,
     statements or representations contained in this Agreement.  With respect
     to all action or inaction taken or not taken by the Trustee prior to the
     Rescission Closing, the rights of the Trustee shall be determined in
     accordance with the terms and provisions of this amended and restated
     Agreement.<PAGE>


                    7.11     INCORPORATION.   The terms and conditions of 
     the Trust Agreement relating to the nature of the responsibilities of
     the Trustee and the indemnification of the Trustee by the Seller are
     incorporated herein by reference and made applicable to this Agreement.<PAGE>


                    IN WITNESS WHEREOF, the undersigned have duly executed
     this Agreement on the date and year first above written.
                                 
                                        Mid Atlantic Medical Services, Inc.



                                        By:  /s/ Joseph L. Guarriello
                                            -------------------------------
                                        Title:    Executive VP, General     
                                                ---------------------------
                                                   Counsel & Secretary 


                                        Attest: /s/ Alisa Chestler
                                                ---------------------------

                                        Title:  Asst. Secretary
                                               ----------------------------



                                        The Bank of New York in its capacity  
                                       as trustee of the Mid Atlantic         
                                      Medical Services, Inc. Stock            
                                     Compensation Trust



                                        By: /s/ Eugene J. Foran  
                                   --------------------------------   
                                                                    
                                        Title:  Vice President   
                                                ---------------------------- 


                                        Attest:  By: Katarina Antens-Miller 
                                                -----------------------------

                                        Title:   Asst. Vice President
                                                -----------------------------<PAGE>

<PAGE>






                               REPLACEMENT PROMISSORY NOTE
                               ---------------------------

     $129,902,500                                          December 20, 1996



     FOR VALUE RECEIVED, the undersigned, The Bank of New York, not in its
     individual or corporate capacity but solely in its capacity as Trustee
     of the Mid Atlantic Medical Services, Inc. Stock Compensation Trust (the
     "Trust") hereby promises on behalf of the Trust to pay to the order of
     Mid Atlantic Medical Services, Inc., a Delaware corporation (the
     "Company"), at the principal offices of the Company, the aggregate
     principal amount of $129,902,500 as shown on Schedule A attached hereto
     as such may be amended from time to time, with interest in arrears
     thereon, as hereinafter provided.

     Principal shall be paid in installments in the amounts and on the dates
     set forth on the Maturity Schedule attached hereto as Schedule A, the
     last such installment due on August 26, 2011 (the fifteenth anniversary
     of the Closing); PROVIDED, HOWEVER, that this Note may be prepaid in
     whole or in part at any time without penalty; and PROVIDED FURTHER that
     the principal amount of this note shall be forgiven in the event that
     the Trust shall have been terminated in accordance with Section 8.2
     thereof and the Trustee shall have complied with the requirements of
     such Section.  Interest on the unpaid principal balance, at an annual
     interest rate (the "Interest Rate") equal to 8%, shall be paid
     quarterly, in arrears, on each January 15th, April 15th, July 15th and
     October 15th commencing October 15, 1996 and shall be calculated on the
     basis of a 360-day year of 30-day months, as set forth on Schedule B. 
     Whenever any payment falls due on a Saturday, Sunday or public holiday,
     such payment shall be made on the next succeeding business day.  Certain
     provisions of the Trust Agreement made effective as of August 26, 1996
     between the Company and the Trustee as amended and restated on December
     20, 1996 relating to the Trust affect the Company's obligations to make
     payments of principal and interest on the Note.

     This Note shall be construed under the laws of the State of New York.

     The undersigned represents and warrants that the indebtedness
     represented by this Note was incurred for the purpose of purchasing
     shares of Common Stock of the Company.

     This Note may not be assigned by the Company, other than by operation of
     law, without the prior express written consent of the undersigned.

     The Company shall have no recourse whatsoever to any assets of the
     Trustee for repayment.  The Trustee is entering into this Agreement not
     in its individual or corporate capacity but solely as Trustee, and no
     personal or corporate liability or personal or corporate
     responsibilities are assumed by, or shall at any time be asserted or
     enforceable against, the Trustee in its individual or corporate capacity
     under, or with respect to, this Agreement.<PAGE>



                                          The Bank of New York not in
                                          its individual or corporate
                                          capacity but solely in its
                                          capacity as Trustee of the
                                          Mid Atlantic Medical
                                          Services, Inc. Stock
                                          Compensation Trust

      
                                                                              
                                          By:/s/ Eugene J. Foran
                                          -------------------------           
                                          Title:  Vice President
                                          -------------------------

                                          ATTEST: /s/ Katarina Antens-Miller
                                          ----------------------------------
                                          Title: Asst. Vice President
                                          ---------------------------
                                                  <PAGE>




                                       SCHEDULE A
                                       ----------


                 Trust Year                                Principal Payment
                 ----------                                -----------------

                     1997                                      $ 4,330,084
                     1998                                      $ 8,660,167
                     1999                                      $ 8,660,167
                     2000                                      $ 8,660,167
                     2001                                      $ 8,660,167
                     2002                                      $ 8,660,167
                     2003                                      $ 8,660,167
                     2004                                      $ 8,660,167
                     2005                                      $ 8,660,167
                     2006                                      $ 8,660,167
                     2007                                      $ 8,660,167
                     2008                                      $ 8,660,167
                     2009                                      $ 8,660,167
                     2010                                      $ 8,660,167
                     2011                                      $12,990,245<PAGE>




                                       SCHEDULE B


             Payment Date                              Interest Payment
             ------------                              ----------------

               10/15/96                                 $1,423,589.04
               01/15/97                                 $2,619,403.84
               04/15/97                                 $2,562,460.27
               07/15/97                                 $2,590,932.05
               10/15/97                                 $2,571,950.86
               01/15/98                                 $2,532,090.36
               04/15/98                                 $2,477,044.92
               07/15/98                                 $2,504,567.64
               10/15/98                                 $2,437,184.42
               01/15/99                                 $2,357,463.43
               04/15/99                                 $2,306,214.23
               07/15/99                                 $2,331,838.83
               10/15/99                                 $2,262,557.49
              01/15/2000                                $2,182,836.50
              04/15/2000                                $2,159,110.02
              07/15/2000                                $2,159,110.02
              10/15/2000                                $2,087,930.56
              01/15/2001                                $2,008,209.57
              04/15/2001                                $1,964,552.84
              07/15/2001                                $1,986,381.21
              10/15/2001                                $1,913,303.63
              01/15/2002                                $1,833,582.64
              04/15/2002                                $1,793,722.15
              07/15/2002                                $1,813,652.40
              10/15/2002                                $1,738,676.70
              01/15/2003                                $1,658,955.72
              04/15/2003                                $1,622,891.46
              07/15/2003                                $1,640,923.59
              10/15/2003                                $1,564,049.78
              01/15/2004                                $1,484,328.79
              04/15/2004                                $1,468,194.78
              07/15/2004                                $1,468,194.78
              10/15/2004                                $1,389,422.85
              01/15/2005                                $1,309,701.86
              04/15/2005                                $1,281,230.08
              07/15/2005                                $1,295,465.97
              10/15/2005                                $1,214,795.92
              01/15/2006                                $1,135,074.93
              04/15/2006                                $1,110,399.39
              07/15/2006                                $1,122,737.16
              10/15/2006                                $1,040,168.99
              01/15/2007                                $  960,448.00
              04/15/2007                                $  939,568.69
              07/15/2007                                $  950,008.35
              10/15/2007                                $  865,542.06
              01/15/2008                                $  785,821.07
              04/15/2008                                $  777,279.54
              07/15/2008                                $  777,279.54
              10/15/2008                                $  690,915.13
              01/15/2009                                $  611,194.14
              04/15/2009                                $  597,907.31
              07/15/2009                                $  604,550.73<PAGE>


              10/15/2009                                $  516,288,20
              01/15/2010                                $  436,567.21
              04/15/2010                                $  427,076.62
              07/15/2010                                $  431,821.92
              10/15/2010                                $  341,661.27
              01/15/2011                                $  261,940.28
              04/15/2011                                $  256,245.93
              07/15/2011                                $  259,093.11<PAGE>

<TABLE> <S> <C>

<ARTICLE> 5
<LEGEND>
THIS SCHEDULE CONTAINS SUMMARY FINANCIAL INFORMATION EXTRACTED FROM THE
COMPANY'S QUARTERLY REPORT ON FORM 10-Q FOR THE QUARTERLY PERIOD ENDED SEPTEMBER
30, 1996 AND IS QUALIFIED IN ITS ENTIRETY BY REFERENCE TO SUCH FINANCIAL
STATEMENTS.
</LEGEND>
<MULTIPLIER> 1,000
       
<S>                             <C>
<PERIOD-TYPE>                   9-MOS
<FISCAL-YEAR-END>                          DEC-31-1996
<PERIOD-START>                             JAN-01-1996
<PERIOD-END>                               SEP-30-1996
<CASH>                                          $2,523
<SECURITIES>                                   161,588
<RECEIVABLES>                                   77,330
<ALLOWANCES>                                     4,564
<INVENTORY>                                          0
<CURRENT-ASSETS>                               272,464
<PP&E>                                          44,592
<DEPRECIATION>                                  19,901
<TOTAL-ASSETS>                                $340,064
<CURRENT-LIABILITIES>                         $151,731
<BONDS>                                            149
                                0
                                          0
<COMMON>                                           568
<OTHER-SE>                                     187,400
<TOTAL-LIABILITY-AND-EQUITY>                  $340,064
<SALES>                                             $0
<TOTAL-REVENUES>                               841,740
<CGS>                                                0
<TOTAL-COSTS>                                  750,396
<OTHER-EXPENSES>                                     0
<LOSS-PROVISION>                                   926
<INTEREST-EXPENSE>                                 592
<INCOME-PRETAX>                                  1,071
<INCOME-TAX>                                       450
<INCOME-CONTINUING>                                621
<DISCONTINUED>                                       0
<EXTRAORDINARY>                                      0
<CHANGES>                                            0
<NET-INCOME>                                      $621
<EPS-PRIMARY>                                     $.01
<EPS-DILUTED>                                     $.01
        

</TABLE>


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