VIVRA INC
SC 14D9/A, 1997-06-09
MISC HEALTH & ALLIED SERVICES, NEC
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                       SECURITIES AND EXCHANGE COMMISSION
 
                             WASHINGTON, D.C. 20549
 
                            ------------------------
 
                                 SCHEDULE 14D-9
 
                                 (RULE 14D-101)
 
               SOLICITATION/RECOMMENDATION STATEMENT PURSUANT TO
 
            SECTION 14(D)(4) OF THE SECURITIES EXCHANGE ACT OF 1934

                               (Amendment No. 3)
                            ------------------------
    
                               VIVRA INCORPORATED
 
                           (NAME OF SUBJECT COMPANY)
 
                               VIVRA INCORPORATED
 
                       (NAME OF PERSON FILING STATEMENT)
 
                           --------------------------
 
                     COMMON STOCK, PAR VALUE $.01 PER SHARE
 
                         (TITLE OF CLASS OF SECURITIES)
 
                           --------------------------
 
                                   92855M104
 
                     (CUSIP NUMBER OF CLASS OF SECURITIES)
 
                           --------------------------
 
                                 KENT J. THIRY
 
                     PRESIDENT AND CHIEF EXECUTIVE OFFICER
 
                               VIVRA INCORPORATED
 
                         1850 GATEWAY DRIVE, SUITE 500
 
                          SAN MATEO, CALIFORNIA 94404
 
                                 (415) 577-5700
 
      (NAME, ADDRESS AND TELEPHONE NUMBER OF PERSON AUTHORIZED TO RECEIVE
 
   NOTICES AND COMMUNICATIONS ON BEHALF OF THE PERSON FILING THIS STATEMENT)
 
                           --------------------------
 
                                   COPIES TO:
 
                              JOHN W. LARSON, ESQ.
 
                            ALEXANDER D. LYNCH, ESQ.
 
                        BROBECK, PHLEGER & HARRISON LLP
 
                             TWO EMBARCADERO PLACE
 
                                 2200 GENG ROAD
 
                          PALO ALTO, CALIFORNIA 94303

                                 (415) 421-0160

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                                  INTRODUCTION

    This Amendment No. 3 Solicitation/Recommendation Statement on Schedule 
14D-9 (as amended or supplemented, this "Schedule 14D-9") relates to an offer 
by Gambro Healthcare Acquisition Corp., a Delaware corporation and an 
indirect wholly owned subsidiary of Incentive AB, a corporation organized 
under the laws of Sweden, to purchase all of the issued and outstanding 
Shares (as hereinafter defined) of Vivra Incorporated, a Delaware 
corporation. Capitalized terms used herein and not otherwise defined herein 
shall have the meaning assigned to them in the Offer to Purchase dated May 9, 
1997, a copy of which is filed as Exhibit (a)(1) to this Schedule 14D-9, is 
incorporated herein by reference in its entirety, and is attached hereto (the 
"Offer to Purchase").

   
ITEM 8. ADDITIONAL INFORMATION

     On June 6, 1997, the VSP Purchasers, Specialty Partners and the Company 
executed an Amendment to the Specialty Merger Agreement (the "Specialty 
Amendment") and consummated the Speciality Merger Transaction. A copy of the 
Specialty Amendment is attached hereto as Exhibit (c)(11) and is incorporated 
hereby reference in its entirety.

     Pursuant to the Speciality Amendment and the consummation of the 
Specialty Merger Transaction, the Company received sale proceeds of 
$75,288,540.67. Assuming both a pre-tax gain to the Company of approximately 
$1,289,000 and an income tax rate of 41%, the Company will incur a tax 
liability of approximately $528,500. The net after-tax sale proceeds, 
together with the expected savings in connection with the surrender 
of certain Options as contemplated by the Specialty Amendment, 
represents a net benefit to the Company of approximately $1.72 per 
Share on a fully diluted basis.

ITEM 9. MATERIALS TO BE FILED AS EXHIBITS
 
<TABLE>
<S>        <C>
(a)(1)     Offer to Purchase, dated May 9, 1997.*
(a)(2)     Letter of Transmittal.*
(a)(3)     Press release issued by the Company on May 5, 1997.*
(a)(4)     Opinion of Goldman, Sachs & Co., dated May 5, 1997.*
(a)(5)     Letter to Stockholders, dated May 9, 1997, from Kent J .Thiry, President and Chief
           Executive Officer of the Company.*
(c)(1)     Agreement and Plan of Merger, dated as of May 5, 1997, among Parent, Purchaser and
           the Company.*
(c)(2)     Relevant Portions of the Company's Information Statement filed with the Securities
           and Exchange Commission on May 9, 1997 pursuant to Section 14(f) of the Securities
           Exchange Act of 1934, as amended.*
(c)(3)     Sections 1 and 2 of the Services Agreement, dated May 5, 1997, by and between the
           Company and VSP.*
(c)(4)     Agreement and Plan of Reorganization, dated as of May 5, 1997, by and between VSP
           Holdings, Inc., VSP Holdings II, Inc., VSP Acquisition, Inc., Vivra Specialty
           Partners, Inc. and Vivra Incorporated.*
(c)(5)     Vivra Incorporated Retention Arrangement.*
(c)(6)     Vivra Specialty Partners, Inc. Retention Arrangement.*
(c)(7)     Article 8 of the Company's Certificate of Incorporation, as amended to date.*
(c)(8)     Revised and Restated Employment Contract, dated December 15, 1996, between the
           Company and Mr. Thiry.*
(c)(9)     Employment Contract dated October 31, 1995, between the Company and Ms. Zumwalt.*
(c)(10)    Complaint, GOODMAN EPSTEIN AND FLORENCE EPSTEIN v. VIVRA INC., ET 
           AL., Case No. 400617, filed in the Superior Court of the State of 
           California for the County of San Mateo.*
(c)(11)    Amendment No. 1 to the Agreement and Plan of Reorganization, dated 
           as of June 6, 1997, by and between VSP Holdings, Inc., VSP 
           Holdings II, Inc., VSP Acquisition, Inc., Vivra Specialty 
           Partners, Inc. and Vivra Incorporated.
</TABLE>

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*   Previously Filed.


                                       12
    
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                                   SIGNATURE
 
    After reasonable inquiry and to the best of my knowledge and belief, I
certify that the information set forth in this statement is true, complete, and
correct.
 
                                VIVRA INCORPORATED
 
                                By:              /s/ KENT J. THIRY
                                     -----------------------------------------
                                                   Kent J. Thiry
                                       PRESIDENT AND CHIEF EXECUTIVE OFFICER
   
Dated: June 9, 1997
    

                                       13

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                                                                 Exhibit(c)(11)

         AMENDMENT NO. 1 TO THE AGREEMENT AND PLAN OF REORGANIZATION
    
         This Amendment No. 1, dated as of June 6, 1997 (this "Amendment"), is
hereby entered into by and among VSP Holdings, Inc., a Delaware corporation (the
"Acquiror"), VSP Acquisition, Inc., a Delaware corporation and a wholly owned
subsidiary of Acquiror (the "Merger Sub"), VSP Holdings II, Inc., a Delaware
corporation ("Acquiror II"), Vivra Specialty Partners, Inc., a Nevada
corporation (the "Company"), and Vivra Incorporated, a Delaware corporation (the
"Parent"), to amend certain terms and conditions of the Agreement and Plan of
Reorganization, dated as of May 5, 1997 (the "Agreement"), by and among
Acquiror, Merger Sub, Acquiror II, the Company, and Parent.  Capitalized terms
used but not defined herein shall have the meanings ascribed to such terms in
the Agreement.

         WHEREAS, the parties to the Agreement desire to amend certain terms
and conditions of the Agreement; and

         WHEREAS, pursuant to Section 10.2 of the Agreement, the parties may
amend the Agreement pursuant to an instrument in writing signed by all of the
parties to the Agreement.

         NOW, THEREFORE, in consideration of the foregoing and the mutual
covenants and agreements set forth herein and other good and valuable
consideration, the receipt and sufficiency of which is hereby acknowledged by
the parties hereto, the parties hereby agree as follows:

              Capitalization of Acquiror.  Acquiror has amended its certificate
of incorporation to consolidate Acquiror Class A Common Stock and Acquiror Class
B Common Stock into a single class of common stock, par value $.01 per share, of
Acquiror (the "Acquiror Common Stock").  The parties hereto hereby agree that,
for all purposes in the Agreement, all references to shares of Acquiror Class A
Common Stock and Acquiror Class B Common Stock shall be deemed to refer to
shares of Acquiror Common Stock.

              Amendment to Section 1.02 of the Agreement.  Section 1.02 of the
Agreement is hereby amended and restated to read in its entirety as follows:

         "Section 1.02  VHI Acquisition.  Immediately prior to the consummation
         of the Merger, the Company will sell and transfer to Acquiror II all
         of the outstanding capital stock of Vivra Heart Imaging, Inc., a
         Nevada corporation ("VHI"), owned by the Company in exchange for a
         payment in cash by Acquiror II to the Company of an aggregate amount
         equal to $488,435.00 (the "VHI Consideration").  The foregoing
         transaction shall hereinafter be referred to as the "VHI Acquisition"
         and, together with the Merger, the "Transactions.""

              Amendment to Section 1.03 of the Agreement.  Section 1.03 of the
Agreement is hereby amended and restated to read in its entirety as follows:

         "Section 1.03  Closing.  Subject to the satisfaction or waiver of the
         conditions set forth herein, the closing of the Transactions (the
         "Closing"), shall take place on June 6, 1997 at 9:00 a.m. (San
         Francisco time) at the offices of 


<PAGE>

         Brobeck, Phleger & Harrison LLP, Spear Street Tower, One Market, San
         Francisco, California  94105, or at such other time and place as the
         parties shall designate in writing (the "Closing Date")."


              Amendment to Section 1.06 of the Agreement.  Section 1.06 of the
Agreement is hereby amended and restated to read in its entirety as follows:

         "Section 1.06  Certificate of Incorporation; Bylaws.  At the Effective
         Time, the Articles of Incorporation and Bylaws of the Surviving
         Corporation, each as in effect immediately prior to the Effective
         Time, shall be the Articles of Incorporation and Bylaws of the
         Surviving Corporation until thereafter amended as provided by Nevada
         Law, the Articles of Incorporation and the Bylaws."

              Amendment to Section 1.08 of the Agreement.  Section 1.08 of the
Agreement is hereby amended and restated to read in its entirety as follows:

         "Section 1.08  Conversion of Shares.  Subject to any adjustment to
         such terms pursuant to Section 1.12, at the Effective Time, (a) each
         share of Common Stock outstanding immediately prior to the Effective
         Time (other than any Dissenting Shares (as hereinafter defined), any
         shares of Common Stock held by Acquiror, and shares of Common Stock
         which are exchanged for Acquiror Common Stock pursuant to Section
         5.09(a) herein) shall automatically and without any action on the part
         of the holder thereof, upon surrender of the certificate that formally
         evidenced such Common Stock in the manner provided herein, be
         cancelled and shall be converted automatically into the right to
         receive an amount payable in cash, without interest, equal to
         $1.08880483 per share of Common Stock (such amount payable per share
         of Common Stock in the Merger being referred to herein as the "Merger
         Consideration"), (b) each share of Common Stock outstanding
         immediately prior to the Effective Time held by Acquiror shall be
         cancelled for no consideration, and (c) each share of common stock,
         $0.01 par value per share, of Merger Sub shall be converted into one
         share of common stock of the Surviving Corporation.  Notwithstanding
         the foregoing, in the event that options (the "Vivra Options") to
         acquire Parent common stock, par value $0.01 per share (the "Vivra
         Common Stock"), are cancelled pursuant to the last sentence of Section
         5.09(a) in connection with the Vivra Option Exchange (as defined in
         Section 5.09(a)), the Merger Consideration shall be decreased by an
         amount equal to the quotient obtained by dividing (i) the Gross Spread
         (as defined below) by (ii) the actual number of shares of Common Stock
         outstanding immediately prior to the Merger (after giving effect to
         the exchanges contemplated by Section 5.09(a)) (the "Post-Adjustment
         Merger Consideration").  For the purposes of the preceding sentence,
         (i) the Gross Spread for the Vivra Options cancelled in the Vivra
         Option Exchange shall be equal to the product of (x) the difference
         between $35.62 and the weighted-average per share exercise price of
         such Vivra Options and (y) the number of shares of Vivra Common Stock
         covered by such cancelled Vivra Options, and (ii) the aggregate Gross
         Spread for all Vivra Options cancelled in the Vivra Option Exchange
         shall not exceed $4,837,382.00."

              Amendment to Section 1.09 of the Agreement.  Section 1.09 of the 

<PAGE>

Agreement is hereby amended and restated to read in its entirety as follows:

         "Section 1.09  Stock Options.  

              (a)  Each stock option (and any related rights) to purchase
              capital stock of any of the VSP Reorganization Entities (as
              hereinafter defined) granted under stock option plans of the VSP
              Reorganization Entities outstanding prior to the consummation of
              the Reorganization (as hereinafter defined) (each, a "VSP
              Reorganization Entity Option") shall be converted into a stock
              option to purchase shares of Class A Common Stock under the
              Company's Stock Option Plans (the "Company Stock Option Plan")
              prior to the Closing Date on the terms and conditions described
              in Schedule 2.05(b) pursuant to the Reorganization (as
              hereinafter defined).

              (b)  Each stock option (and any related alternative rights) to
              purchase one share of Common Stock (the "Stock Options") granted
              under the Company's Stock Option Plan (including those granted to
              current or former employees, consultants and directors of the
              Company or the VSP Reorganization Entities and including those
              stock options granted pursuant to Section 1.09(a) above), which
              Stock Options are outstanding at the Effective Time (whether or
              not then presently exercisable), other than those that will
              expire by their terms in connection with or as a result of the
              Merger and those that are cancelled pursuant to Section 5.09(a)
              in exchange for newly issued options to purchase shares of
              Acquiror Common Stock pursuant to separate option exchange
              agreements (as defined in Section 5.09(a)) entered into between
              Acquiror and the holders of Stock Options, will be converted at
              the Effective Time into an option to purchase an equal  number of
              shares of Acquiror Common Stock at a price per share equal to the
              price per share of Class B Common Stock under each Stock Option
              (the "Option Consideration").  The Company Stock Option Plan
              shall terminate as of the Effective Time and thereafter the only
              rights of participants therein shall be the right to receive the
              consideration set forth in this Section 1.09.  Prior to the
              Effective Time, the Company shall use its reasonable efforts to
              cause each holder of outstanding Stock Options to execute an
              Option Exchange Agreement in form and substance acceptable to
              Acquiror, and shall take such other action as may be necessary to
              carry out the terms of this Section 1.09."

              Amendment to Section 1.11(b) of the Agreement.  Section 1.11(b)
of the Agreement is hereby amended and restated to read in its entirety:

         "Section 1.11  Surrender of Common Stock and Stock Options.
    
              (b)  At the Closing, each holder of Stock Options other than
              those cancelled pursuant to Section 5.09(a) shall deliver to
              Merger Sub a stock option agreement or other agreement evidencing
              the grant of Stock Options to the holder thereof (each an "Option
              Agreement") which, at the Effective Time, represented all of such
              holder's Stock Options, for 


<PAGE>

              conversion and exchange into the Option Consideration pursuant to
              this Section 1.11.  At the Closing, Acquiror shall deliver, and
              Acquiror and each holder of a Stock Option other than holders of
              Stock Options cancelled pursuant to Section 5.09(a) shall enter
              into, a stock option agreement, in form acceptable to Acquiror,
              providing for the Option Consideration to be received by each
              such optionholder (a "Replacement Option Agreement").  Following
              the Effective Time and until the holder shall have executed and
              delivered a Replacement Option Agreement and surrendered his or
              her Stock Options as contemplated by this Section 1.11, each
              holder of a Stock Option shall cease to possess any rights with
              respect to such Stock Option, except the right to receive upon
              such surrender and execution the Option Consideration as provided
              herein and the provisions of Nevada Law."

              Amendment to Section 1.13 of the Agreement.  Section 1.13 of the
Agreement is hereby deleted.

              Amendment to Section 2.05 of the Agreement.  Section 2.05 of the
Agreement is hereby amended and restated to read in its entirety as follows:

         "Section 2.05  Capitalization.  

              (a)  The authorized capital stock of the Company consists of
              80,000,000 shares of Preferred Stock, $0.01 per share (the
              "Preferred Stock"), 100,000,000 shares of Class B Common Stock
              and 20,000,000 shares of Class A Common Stock.  The issued and
              outstanding shares of Preferred Stock, Class A Common Stock and
              Class B Common Stock (such issued shares are collectively
              referred to herein as the "Capital Stock"), as of the date hereof
              and as adjusted to give effect to the Reorganization (as
              hereinafter defined), are as set forth on Schedule 2.05(a).  All
              of the shares of Capital Stock have been duly authorized and
              validly issued and are fully paid and nonassessable.  Except as
              set forth in Schedule 2.05(b) hereto or as contemplated herein,
              there are no subscriptions, options, warrants, conversion rights,
              rights of exchange, or other rights, plans, agreements or
              commitments of any nature whatsoever (including, without
              limitation, conversion or preemptive rights) providing for the
              purchase, issuance, transaction, registration or sale of any
              shares of the Company's Capital Stock or any securities
              convertible into or exchangeable for any shares of the Company's
              Capital Stock (collectively, the "Company Derivative
              Securities").  Without taking into account any effect of the
              exchange of options pursuant to Section 5.09(a), none of the
              Company Derivative Securities are entitled to be accelerated as a
              result of the Merger.  All of the Company Derivative Securities
              have been issued, and all of the Company Derivative Securities to
              be issued in the Reorganization will be issued, pursuant to valid
              exemptions from registration under all Federal and state
              securities laws, except where the failure to have such exemptions
              would not have a Company Material Adverse Affect, and there are
              no outstanding obligations of the Company to repurchase, redeem
              or otherwise acquire 


<PAGE>

              any of the Company Derivative Securities.

              (b)  The authorized and outstanding capital stock of each VSP
              Entity, as of the date hereof and as adjusted to give effect to
              the Reorganization (as hereinafter defined), is as set forth on
              Schedule 2.05(c) hereto (such issued shares are collectively
              referred to as the "VSP Entities' Capital Stock").  All such
              shares of VSP Entities' Capital Stock have been duly authorized
              and validly issued and are fully paid and nonassessable.  Except
              as set forth on Schedules 2.05(b) or 2.05(d) hereto or as
              contemplated herein, there are no subscriptions, options,
              warrants, concession rights, rights of exchange, or other rights,
              plans, agreements or commitments of any nature whatsoever
              (including, without limitation, conversion or preemptive rights)
              providing for the purchase, issuance, transaction, registration
              or sale of any shares of VSP Entities' Capital Stock or any
              securities convertible into, or exchangeable for, any shares of
              VSP Entities' Capital Stock (the "VSP Entity Derivative
              Securities").  None of the VSP Entity Derivative Securities are
              entitled to be accelerated as a result of the Merger.  All of the
              VSP Derivative Securities have been issued, and all of the VSP
              Derivative Securities, if any, to be issued in the Reorganization
              will be issued, pursuant to valid exemptions from registration
              under all Federal and State securities laws, except where the
              failure to have such exemption would not have a Company Material
              Adverse Effect, and there are no outstanding obligations of any
              of the VSP Entities or the Company to repurchase, redeem or
              otherwise acquire any of the VSP Derivative Securities."

              Amendment to Section 5.08 of the Agreement.  Section 5.08 of the
Agreement is hereby amended and restated to read in its entirety as follows:

         "Section 5.08  Reorganization.  Prior to the Closing, Parent and the
         Company will consummate, or cause to be consummated, the following
         transactions:

              (a)  Each of Vivra Asthma Allergy Careamerica, Inc., Vivra ENT,
              Inc., Vivra Health Advantage, Inc., Vivra Orthopaedics, Inc., and
              Vivra OB-GYN Services, Inc. (collectively, the "VSP
              Reorganization Entities") will be merged with and into the
              Company, and, in connection therewith, each VSP Reorganization
              Entity Option shall be converted into an option to purchase
              shares of Common Stock under the Company Stock Option Plan as
              reflected on Schedule 2.05(b) (the "VSP Reorganization Merger"). 
              In connection therewith, the Company will use reasonable efforts
              (without the requirement of paying any money or making any
              financial concession) to cause each holder of VSP Reorganization
              Entity Options to execute and deliver an option exchange
              agreement, in form and substance satisfactory to the Company and
              Acquiror, pursuant to which each holder of VSP Reorganization
              Entity Options will agree, among other things, to the conversion
              of his or her VSP Reorganization Entity Options into options to
              acquire Common Stock pursuant to the Reorganization and, (i) to
              cancel his or her options to acquire Common Stock in exchange for 


<PAGE>

              newly issued options to acquire Acquiror Common Stock, (ii) to
              enter into a stockholders' agreement, in form and substance
              satisfactory to the Company and Acquiror, upon the exercise of
              any options to acquire Acquiror Common Stock following the
              Closing, and (iii) to terminate the existing stockholders
              agreement relating to the shares of capital stock of the VSP
              Reorganization Entity issuable upon the exercise of such holder's
              VSP Reorganization Entity Options.

              (b)  Immediately prior to the Closing, Parent will convey,
              transfer and assign to the Company all of the assets of Parent
              listed on Schedule 5.08(b) and the Company will assume and agree
              to perform all of the liabilities and obligations of Parent
              listed on Schedule 5.08(b) hereto; provided, however, that with
              respect to any leases listed on Schedule 5.08(b) hereto, the
              Company will use reasonable efforts to obtain the consent of any
              lessor to such leases prior to the Closing (the "Assignment" and
              collectively with the VSP Reorganization Merger and the
              conversion contemplated by Section 5.10, the "Reorganization")."

              Amendment to Section 5.09 of the Agreement.  Section 5.09 of the
Agreement is hereby amended and restated to read in its entirety as follows:

         "Section 5.09  Certain Exchange Transactions.

              (a)  Prior to the Closing, Parent and the Company will use
              reasonable efforts (without the requirement of paying any money
              or making any financial concession) to cause each holder of
              capital stock of the Company other than Parent and each holder of
              Stock Options to enter into an agreement (each, an "Exchange
              Agreement" or "Option Exchange Agreement," as applicable) with
              Acquiror, (i) to exchange such shares of capital stock held by
              such holder immediately prior to the Closing for an equal number
              of shares of Acquiror Common Stock or to cancel such Stock
              Options in exchange for options to purchase an equal number of
              shares of Acquiror Common Stock, as applicable (such options to
              have such exercise prices and voting terms as are agreed upon
              between the Company and Acquiror), (ii) to terminate the
              stockholders agreements, dated as of May 1, 1996, by and between
              the Company and certain of its stockholders and optionholders,
              and (iii) to enter into a new stockholders' agreement, in form
              and substance satisfactory to Acquiror and the Company, relating
              to such holder's shares of Acquiror Common Stock or the shares of
              Acquiror Common Stock issuable upon such holder's exercise of
              options, as applicable.  The parties hereto agree and acknowledge
              that Acquiror, the Company and Vivra may enter into separate
              Option Exchange Agreements with certain members of management of
              the Company pursuant to which (a) a portion of such persons'
              existing Stock Options and Vivra Options may be cancelled in
              advance of the Merger in exchange for new options to acquire
              Company Common Stock (the "New Company Options") and (b) such New
              Company Options will be cancelled simultaneously with the Merger
              in exchange for options to acquire an equal number of shares of
              Acquiror 


<PAGE>

              Common Stock, in each case, on the terms and conditions agreed
              upon between such members of management, the Company, Vivra and
              Acquiror (the "Vivra Option Exchange").

              (b)  Prior to the Closing, Parent and the Company will use
              reasonable efforts (without the requirement of paying any money
              or making any financial concession) to cause each holder of
              capital stock of Vivra Heart Services, Inc. ("VHS") other than
              the Company and each holder of options to acquire VHS capital
              stock ("VHS Options") to enter into an agreement with Acquiror,
              (i) to exchange such shares of capital stock of VHS held by such
              holders immediately prior to the Closing for a number of shares
              of Acquiror Common Stock equal to the product of .405 multiplied
              by the number of shares of capital stock of VHS held by each such
              holder or to cancel such VHS Options in exchange for options to
              purchase a number of shares of Acquiror Common Stock equal to the
              product of .405 multiplied by the number of shares of capital
              stock of VHS which could be purchased by such holder pursuant to
              such holder's option, as applicable (such options to have such
              exercise prices and voting terms as are agreed upon between the
              Company and Acquiror), (ii) to terminate the stockholders
              agreements, dated as of May 1, 1996, by and between VHS and
              certain of its stockholders and optionholders, and (iii) to enter
              into a new stockholders' agreement, in form and substance
              satisfactory to Acquiror and the Company, relating to such
              holder's shares of Acquiror Common Stock or the shares of
              Acquiror Common Stock issuable upon such holder's exercise of
              options, as applicable.

              (c)  Prior to the Closing, Parent and the Company will use
              reasonable efforts (without the requirement of paying any money
              or making any financial concession) to cause each holder of
              capital stock of VHI other than the Company to enter into an
              agreement with Acquiror II (i) to exchange such shares of capital
              stock for an equal number of shares of capital stock of
              Acquiror II, (ii) to cancel and terminate any stockholder
              agreement to which such holder is a party relating to such shares
              of VHI capital stock, and (iii) to enter into a new stockholders'
              agreement, in form and substance satisfactory to Acquiror II and
              the Company, relating to such holder's shares of capital stock of
              Acquiror II."

              Amendment to Section 5.13 of the Agreement.  Section 5.13 of the
Agreement is hereby amended and restated to read in its entirety as follows:

         "Section 5.13  Intercompany Transactions.  Between the date hereof and
         the Closing Date, Parent, on the one hand, and the Company and the VSP
         Entities on the other hand, shall not engage in any transactions or
         make any payments or advances to one another or enter into any
         commitments to provide services or to transfer assets or liabilities
         to or from one another, (i) except as contemplated by the
         Reorganization, and (iii) except as provided for in the Services
         Agreement, dated as of the date hereof, between the Company and Parent
         (the "Services Agreement"), a copy of which is attached hereto as
         Exhibit 5.13 and (iii) except that, immediately prior to the Closing,
         Parent shall 


<PAGE>

         transfer to the Company $2,500,000.00 in cash."

              Amendment to Section 8.08 of the Agreement.  Section 8.08 of the
Agreement is hereby amended and restated to read in its entirety as follows:

         "Section 8.08  The Offer.  Purchaser shall have advised Parent that,
subject to the satisfaction of the conditions to the Offer set forth in Annex A
to the Vivra Agreement, it will purchase the Parent Shares in the Offer or the
Purchaser or any other person or entity shall have acquired either (i) greater
than fifty percent (50%) of the outstanding capital stock of Parent or (ii) all
or substantially all of the assets of Parent, in either case by way of merger,
purchase of stock, purchase of assets or otherwise."

              Addition of Section 8.09 to the Agreement.  Section 8.09 of the
Agreement is hereby added to read as follows:

         "Section 8.09  Non-Competition Agreement.  The Company and the Parent
         shall have entered into a non-competition agreement containing the
         provisions set forth in Exhibit 7.06 hereto."

              Amendment to Section 9.01.  Section 9.01 of the Agreement is
hereby amended and restated to read in its entirety as follows:

         "Section 9.01  Indemnification by Acquiror.  The Acquiror, Acquiror II
         and Merger Sub, shall, and, from and after the Effective Time, the
         Surviving Corporation shall, indemnify, defend and hold harmless the
         Parent and its successors, affiliates, stockholders, officers and
         employees from and against any and all claims, demands, actions,
         losses, damages, liabilities, costs and expenses (including reasonable
         attorneys' fees and expenses) which arise out of or in connection with
         the operation of the business of the Company and the VSP Entities,
         including, without limitation, any liabilities of Parent and its
         affiliates (other than the Company and the VSP Entities) arising out
         of the provision of specialty physician network and disease management
         services to managed care and provider organizations (other than such
         businesses included within the Dialysis Business (as hereinafter
         defined), including, without limitation all liabilities arising under
         the agreements set forth on Schedule 9.01, other than those
         liabilities and obligations that Parent has agreed to pay pursuant to
         the Services Agreement (collectively, the "VSP Liabilities")."

              Amendment to Section 9.02.  Section 9.02 of the Agreement is
hereby amended and restated to read in its entirety as follows:

         "Section 9.02  Indemnification by Parent.  The Parent and its
         successors shall indemnify, defend and hold harmless the Acquiror,
         Acquiror II and Merger Sub, and from and after the Effective Time, the
         Surviving Corporation, and their successors, affiliates, stockholders,
         officers and employees from and against any and all claims, demands,
         actions, losses, damages, liabilities, costs and expenses (including
         reasonable attorneys' fees and expenses) which arise out of or in
         connection with the operation of the business of the Parent (other
         than the VSP Liabilities) and Vivra Renal Care, Inc. ("VRC") and the
         Dialysis Subsidiaries (as 


<PAGE>

         defined in the Vivra Agreement), including without limitation, any
         liabilities of the Company and the VSP Entities arising out of the
         provision of dialysis, renal care, nephrology, disease management, or
         nephrologist practice management businesses or the business of
         contracting with payors on behalf of nephrologists (the "Dialysis
         Business")."

              Closing Conditions.  In consideration of the execution and
delivery of this Amendment and the certificates, opinions and other
documentation delivered by the parties to the Agreement concurrently herewith
pursuant to Articles VII and VIII of the Agreement, the parties hereto
acknowledge and agree that all conditions to their respective obligations to
close the Transactions have been satisfied. 

              Other Provisions Unchanged.  Except as specifically amended and
restated by this Amendment, all of the terms and conditions of the Agreement
will continue in full force and effect.

              Governing Law.  This Amendment shall be governed by the laws of
the state of California, without regard to principles of conflicts or choice of
law.

              Integration.  This Amendment, together with the Agreement, sets
forth the entire understanding between and among the parties relating to the
subject matter contained herein and supersedes all prior discussions and
understandings between them.

              Duplicate Originals.  This Amendment may be executed in as many
duplicate originals as may be deemed necessary and convenience, each of which,
when so executed, shall be deemed an original but all such duplicate originals
shall constitute but one and the same instrument.



[remainder of page intentionally left blank] 

<PAGE>

         IN WITNESS WHEREOF, the parties hereto have caused this Amendment to
be duly executed as of the date first above written.

                                  VSP HOLDINGS, INC.



                                  By:_________________________                  
                                  Name:_______________________                  
                                  Title:______________________                  
                 

                                  VSP HOLDINGS II, INC.



                                  By:_________________________                  
                                  Name:_______________________                  
                                  Title:______________________                  
                 


                                  VSP ACQUISITION, INC.


                                  By:_________________________                  
                                  Name:_______________________                  
                                  Title:______________________                  
                 


                                  VIVRA SPECIALTY PARTNERS, INC.


                                  By:_________________________                  
                                  Name:_______________________                  
                                  Title:______________________                  
                 



                                  VIVRA INCORPORATED


                                  By:_________________________                  
                                  Name:_______________________                  
                                  Title:______________________                  
                 


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