COLUMBIA HCA HEALTHCARE CORP/
10-Q, 1998-08-13
GENERAL MEDICAL & SURGICAL HOSPITALS, NEC
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<PAGE>
 
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               UNITED STATES SECURITIES AND EXCHANGE COMMISSION
 
                            WASHINGTON, D.C. 20549
 
                                   FORM 10-Q
 
   [X]   QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15 (d) OF THE SECURITIES
                             EXCHANGE ACT OF 1934
 
                 FOR THE QUARTERLY PERIOD ENDED JUNE 30, 1998
 
                                      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 1-11239
 
                      COLUMBIA/HCA HEALTHCARE CORPORATION
            (EXACT NAME OF REGISTRANT AS SPECIFIED IN ITS CHARTER)
 
              DELAWARE                                 75-2497104
    (STATE OR OTHER JURISDICTION                    (I.R.S. EMPLOYER
  OF INCORPORATION OR ORGANIZATION)                IDENTIFICATION NO.)
 
           ONE PARK PLAZA                                 37203
        NASHVILLE, TENNESSEE                           (ZIP CODE)
   (ADDRESS OF PRINCIPAL EXECUTIVE
              OFFICES)
 
                                (615) 344-9551
             (REGISTRANT'S TELEPHONE NUMBER, INCLUDING AREA CODE)
 
                                NOT APPLICABLE
             (FORMER NAME, FORMER ADDRESS AND FORMER FISCAL YEAR,
                         IF CHANGED SINCE LAST REPORT)
 
  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, and (2) has been subject to such filing
requirements for the past 90 days.
 
                               YES  X     NO
 
  Indicate the number of shares outstanding of each of the issuer's classes of
common stock of the latest practical date.
 
<TABLE>
<CAPTION>
               CLASS OF COMMON STOCK           OUTSTANDING AT JULY 31, 1998
               ---------------------           ----------------------------
       <S>                                     <C>
       Voting common stock, $.01 par value          624,335,900 shares
       Nonvoting common stock, $.01 par value        21,000,000 shares
</TABLE>
 
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                                    1 of 38
<PAGE>
 
                      COLUMBIA/HCA HEALTHCARE CORPORATION
                                   FORM 10-Q
                                 JUNE 30, 1998
<TABLE>
<CAPTION>
                                                                         
                                                                          PAGE OF   
PART I: FINANCIAL INFORMATION                                            FORM 10-Q    
- -----------------------------                                            ---------
<S>                                                                      <C>
Item 1. Financial Statements
    Condensed Consolidated Statements of Income--for the quarters and six
     months ended June 30, 1998 and 1997.................................     3
    Condensed Consolidated Balance Sheets--June 30, 1998 and December 31,   
     1997................................................................     4
    Condensed Consolidated Statements of Cash Flows--for the six months     
     ended                                                                  
     June 30, 1998 and 1997..............................................     5
    Notes to Condensed Consolidated Financial Statements.................     6
Item 2. Management's Discussion and Analysis of Financial Condition and     
 Results of Operations...................................................     12
<CAPTION>                                                                   
PART II: OTHER INFORMATION                                                  
- --------------------------                                                  
<S>                                                                       <C>
Items 1 to 6.............................................................     27
</TABLE>
 
                                       2
<PAGE>
 
                      COLUMBIA/HCA HEALTHCARE CORPORATION
                  CONDENSED CONSOLIDATED STATEMENTS OF INCOME
          FOR THE QUARTERS AND SIX MONTHS ENDED JUNE 30, 1998 AND 1997
                                   UNAUDITED
                (DOLLARS IN MILLIONS, EXCEPT PER SHARE AMOUNTS)
 
<TABLE>
<CAPTION>
                                                    QUARTER       SIX MONTHS
                                                 --------------  --------------
                                                  1998    1997    1998    1997
                                                 ------  ------  ------  ------
<S>                                              <C>     <C>     <C>     <C>
Revenues.......................................  $4,781  $4,845  $9,682  $9,833
Salaries and benefits..........................   1,998   1,850   4,011   3,726
Supplies.......................................     719     658   1,465   1,357
Other operating expenses.......................     961     943   1,901   1,905
Provision for doubtful accounts................     340     310     683     607
Depreciation and amortization..................     311     308     620     604
Interest expense...............................     145     123     298     236
Equity in earnings of affiliates...............     (33)    (35)    (75)    (97)
Restructuring of operations and investigation
 related costs.................................      31       -      69       -
                                                 ------  ------  ------  ------
                                                  4,472   4,157   8,972   8,338
                                                 ------  ------  ------  ------
Income from continuing operations before
 minority interests and income taxes...........     309     688     710   1,495
Minority interests in earnings of consolidated
 entities......................................      18      45      38      92
                                                 ------  ------  ------  ------
Income from continuing operations before income
 taxes.........................................     291     643     672   1,403
Provision for income taxes.....................     118     258     280     563
                                                 ------  ------  ------  ------
Income from continuing operations..............     173     385     392     840
Discontinued operations:
  Income (loss) from operations of discontinued
   businesses, net of income taxes (benefits)
   of $2 and $18 for the quarters ended June
   30, 1998 and 1997, respectively, and ($14)
   and $34 for the six months ended June 30,
   1998 and 1997, respectively.................     (22)     27     (44)     51
  Loss on disposal of certain discontinued
   businesses..................................     (73)      -     (73)      -
Cumulative effect of accounting change, net of
 income tax benefit of $36.....................       -       -       -     (56)
                                                 ------  ------  ------  ------
  Net income...................................  $   78  $  412  $  275  $  835
                                                 ======  ======  ======  ======
Basic earnings per share:
  Income from continuing operations............  $  .27  $  .58  $  .61  $ 1.25
  Discontinued operations:
   Income (loss) from operations of
    discontinued businesses....................    (.04)    .04    (.07)    .08
   Loss on disposal of certain discontinued
    businesses.................................    (.11)      -    (.11)      -
  Cumulative effect of accounting change.......       -       -       -    (.08)
                                                 ------  ------  ------  ------
    Net income.................................  $  .12  $  .62  $  .43  $ 1.25
                                                 ======  ======  ======  ======
Diluted earnings per share:
  Income from continuing operations............  $  .27  $  .58  $  .61  $ 1.24
  Discontinued operations:
   Income (loss) from operations of
    discontinued businesses....................    (.04)    .04    (.07)    .08
   Loss on disposal of certain discontinued
    businesses.................................    (.11)      -    (.11)      -
  Cumulative effect of accounting change.......       -       -       -    (.08)
                                                 ------  ------  ------  ------
    Net income.................................  $  .12  $  .62  $  .43  $ 1.24
                                                 ======  ======  ======  ======
Cash dividends per share.......................  $  .02  $  .02  $  .04  $  .04
                                                 ======  ======  ======  ======
</TABLE>
 
                            See accompanying notes.
 
                                       3
<PAGE>
 
                      COLUMBIA/HCA HEALTHCARE CORPORATION
                     CONDENSED CONSOLIDATED BALANCE SHEETS
                                   UNAUDITED
                (DOLLARS IN MILLIONS, EXCEPT PER SHARE AMOUNTS)
 
<TABLE>
<CAPTION>
                                                          JUNE 30,  DECEMBER 31,
                                                            1998        1997
                                                          --------  ------------
<S>                                                       <C>       <C>
ASSETS
Current assets:
  Cash and cash equivalents.............................. $    25     $   110
  Accounts receivable, less allowances for doubtful
   accounts of $1,659 in 1998 and $1,661 in 1997.........   2,427       2,522
  Inventories............................................     462         452
  Income taxes receivable................................     227         532
  Other..................................................     905         807
                                                          -------     -------
                                                            4,046       4,423
Property and equipment, at cost..........................  16,814      16,254
Accumulated depreciation.................................  (6,442)     (6,024)
                                                          -------     -------
                                                           10,372      10,230
Investments of insurance subsidiary......................   1,508       1,422
Investments in and advances to affiliates................   1,371       1,329
Intangible assets, net...................................   3,405       3,521
Net assets of discontinued operations....................     141         841
Other....................................................     205         236
                                                          -------     -------
                                                          $21,048     $22,002
                                                          =======     =======
LIABILITIES AND STOCKHOLDERS' EQUITY
Current liabilities:
  Accounts payable....................................... $   727     $   929
  Accrued salaries.......................................     449         475
  Other accrued expenses.................................   1,174       1,237
  Long-term debt due within one year.....................   2,669         132
                                                          -------     -------
                                                            5,019       2,773
Long-term debt...........................................   5,693       9,276
Professional liability risks, deferred taxes and other
 liabilities.............................................   1,926       1,867
Minority interests in equity of consolidated entities....     830         836
Stockholders' equity:
  Common stock, $.01 par; authorized 1,600,000,000 voting
   shares and 50,000,000 nonvoting shares; outstanding
   623,961,300 voting shares and 21,000,000 nonvoting
   shares--June 30, 1998 and 620,452,200 voting shares
   and 21,000,000 nonvoting shares--December 31, 1997....       6           6
  Capital in excess of par value.........................   3,564       3,480
  Other..................................................      12          13
  Accumulated other comprehensive income.................      90          92
  Retained earnings......................................   3,908       3,659
                                                          -------     -------
                                                            7,580       7,250
                                                          -------     -------
                                                          $21,048     $22,002
                                                          =======     =======
</TABLE>
 
                            See accompanying notes.
 
                                       4
<PAGE>
 
                      COLUMBIA/HCA HEALTHCARE CORPORATION
                CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
                FOR THE SIX MONTHS ENDED JUNE 30, 1998 AND 1997
                                   UNAUDITED
                             (DOLLARS IN MILLIONS)
 
<TABLE>
<CAPTION>
                                                                   1998   1997
                                                                  ------  ----
<S>                                                               <C>     <C>
Cash flows from continuing operating activities:
  Net income.....................................................   $275  $835
  Adjustments to reconcile net income to net cash provided by
   continuing operating activities:
    Provision for doubtful accounts..............................    683   607
    Increase in accounts receivable..............................   (607) (819)
    Depreciation and amortization................................    620   604
    Income taxes.................................................    296  (116)
    Loss (income) from discontinued operations...................    117   (51)
    Cumulative effect of accounting change.......................      -    56
    Changes in other operating assets and liabilities............   (367) (341)
    Other........................................................    (10)   35
                                                                  ------  ----
      Net cash provided by continuing operating activities.......  1,007   810
                                                                  ------  ----
Cash flows from investing activities:
  Purchase of property and equipment.............................   (666) (696)
  Acquisition of hospitals and health care entities..............   (116) (133)
  Investments in and advances to affiliates......................      -   (29)
  Disposition of hospitals and health care entities..............     66   184
  Change in other investments....................................   (107) (124)
  Change in investment in discontinued operations, net...........     43    19
  Sale of certain discontinued operations........................    619     -
  Other..........................................................     72    61
                                                                  ------  ----
      Net cash used in investing activities......................    (89) (718)
                                                                  ------  ----
Cash flows from financing activities:
  Issuance of long-term debt.....................................      -   209
  Net change in commercial paper and bank borrowings.............   (916)  622
  Repayment of long-term debt....................................   (140) (187)
  Payment of cash dividends......................................    (26)  (27)
  Issuances (repurchases) of common stock, net...................     78  (718)
  Other..........................................................      1     5
                                                                  ------  ----
      Net cash used in financing activities...................... (1,003)  (96)
                                                                  ------  ----
Change in cash and cash equivalents..............................    (85)   (4)
Cash and cash equivalents at beginning of period.................    110   113
                                                                  ------  ----
Cash and cash equivalents at end of period....................... $   25  $109
                                                                  ======  ====
Interest payments................................................ $  294  $240
Income tax payments (refunds), net............................... $  (13) $709
</TABLE>
 
                            See accompanying notes.
 
                                       5
<PAGE>
 
                      COLUMBIA/HCA HEALTHCARE CORPORATION
             NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
                                   UNAUDITED
 
NOTE 1--BASIS OF PRESENTATION
 
  The accompanying unaudited condensed consolidated financial statements have
been prepared in accordance with generally accepted accounting principles for
interim financial information and with the instructions to Form 10-Q and
Article 10 of Regulation S-X. Accordingly, they do not include all of the
information and footnotes required by generally accepted accounting principles
for complete financial statements. In the opinion of management, all
adjustments considered necessary for a fair presentation have been included.
Operating results for the quarter and six months ended June 30, 1998, are not
necessarily indicative of the results that may be expected for the year ending
December 31, 1998. For further information, refer to the consolidated
financial statements and footnotes thereto included in the Company's annual
report on Form 10-K for the year ended December 31, 1997.
 
  Certain prior year amounts have been reclassified to conform to the current
year presentation.
 
NOTE 2--INVESTIGATIONS
 
  The Company is currently the subject of several federal investigations into
its business practices, as well as governmental investigations by various
states. The Company is cooperating in these investigations and understands,
through written notice and other means, that it is a target in these
investigations. Given the scope of the ongoing investigations, the Company
expects additional subpoenas and other investigative and prosecutorial
activity to occur in these and other jurisdictions in the future.
 
  The Company is the subject of a formal order of investigation by the
Securities and Exchange Commission. The Company understands that the
investigation includes the anti-fraud, periodic reporting and internal
accounting control provisions of the federal securities laws.
 
  Management believes the ongoing investigations and related media coverage
are having a negative effect on the Company's results of operations. It is too
early to predict the outcome or effect that the ongoing investigations, the
initiation of additional investigations, if any, and the related media
coverage will have on the Company's financial condition or results of
operations in future periods. Were the Company to be found in violation of
federal or state laws relating to Medicare, Medicaid or similar programs, the
Company could be subject to substantial monetary fines, civil and criminal
penalties and exclusion from participation in the Medicare and Medicaid
programs. Any such sanctions could have a material adverse effect on the
Company's financial position and results of operations. (See Note 9--
Contingencies and Part II, Item 1: Legal Proceedings.)
 
NOTE 3--RESTRUCTURING OF OPERATIONS
 
  The Company is currently in the process of restructuring its operations in
an effort to create a smaller and more focused company. The restructuring
includes divestitures of certain businesses as described in Note 5--
Discontinued Operations, divestitures of certain hospitals and surgery centers
to third parties and spin-offs of certain other assets to the Company's
stockholders.
 
 Divestiture of Certain Hospitals and Surgery Centers
 
  In May 1998, the Company announced agreements to sell 22 hospitals and
certain related facilities to a consortium of not-for-profit entities for an
aggregate sales price of approximately $1.2 billion. The agreements are
subject to customary conditions, including state regulatory, antitrust and
certain other approvals. The sales of 21 of these hospitals are expected to be
completed in the third quarter of 1998 and result in an after-tax gain of
approximately $300 million. Proceeds from the sales are expected to be used to
repay bank borrowings.
 
                                       6
<PAGE>
 
                      COLUMBIA/HCA HEALTHCARE CORPORATION
       NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS--(CONTINUED)
                                   UNAUDITED
 
NOTE 3--RESTRUCTURING OF OPERATIONS (CONTINUED)
 
 Divestiture of Certain Hospitals and Surgery Centers (Continued)
 
  In addition, during the first six months of 1998 the Company has completed
the sales of four hospitals and reached agreements to sell 11 more hospitals
to various entities for gross proceeds of approximately $300 million.These
transactions are not expected to have a material effect on results of
operations. Proceeds from the sales are expected to be used to repay bank
borrowings.
 
  In April 1998, the Company announced an agreement to sell 34 of its
ambulatory surgery centers located in "non-core" markets. The sale of these
ambulatory surgery centers was completed during July 1998 (See Note 11--
Subsequent Events).
 
 Spin-Offs
 
  The Company is continuing with its previously announced plan of filing a
ruling request with the Internal Revenue Service (the "IRS") to create two
tax-free spin-off companies. In July 1998, the Company's board of directors
authorized the submission of the ruling request to the IRS. (See Note 11--
Subsequent Events). The two proposed spin-off companies currently represent
the Pacific and America operating groups.
 
  The Pacific group is currently comprised of 42 consolidating hospitals with
approximately $460 million and $950 million in revenues for the quarter and
six months ended June 30, 1998, respectively. The Pacific group also has an
equity interest in one non-consolidated hospital.
 
  The America group is currently comprised of 22 consolidating hospitals with
approximately $125 million and $260 million in revenues for the quarter and
six months ended June 30, 1998, respectively.
 
NOTE 4--CHARGES RELATED TO INVESTIGATIONS AND RESTRUCTURING OF OPERATIONS
 
  During 1998, the Company recorded the following pretax charges related to
the investigations and restructuring of operations as discussed in Notes 2 and
3 (in millions):
 
<TABLE>
<CAPTION>
                                                              QUARTER SIX MONTHS
                                                              ------- ----------
      <S>                                                     <C>     <C>
      Professional fees related to investigations............   $24      $52
      Severance costs........................................     -        4
      Other..................................................     7       13
                                                                ---      ---
                                                                $31      $69
                                                                ===      ===
</TABLE>
 
NOTE 5--DISCONTINUED OPERATIONS
 
  Included in discontinued operations are three of the four business units
acquired in the August 1997 merger with Value Health, Inc. ("Value Health")
and the Company's home health care businesses. The Company implemented a plan
to dispose of these businesses during 1997.
 
  Revenues of the home health care and Value Health businesses to be disposed
of totaled $181 million and $342 million for the quarter ended June 30, 1998
and 1997, respectively, and $822 million and $682 million for the six months
ended June 30, 1998 and 1997, respectively.
 
  During the second quarter of 1998, the Company completed the sale of all
three Value Health units for proceeds totaling approximately $619 million. The
proceeds were used to repay bank borrowings. The Company recorded a $73
million loss upon completion of these disposals in 1998 which reflects changes
to the estimated loss on disposal of discontinued operations of $443 million
recorded in the fourth quarter of 1997.
 
                                       7
<PAGE>
 
                      COLUMBIA/HCA HEALTHCARE CORPORATION
       NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS--(CONTINUED)
                                   UNAUDITED
 
NOTE 5--DISCONTINUED OPERATIONS (CONTINUED)
 
  In June 1998, the Company announced four separate agreements to sell the
majority of its home health care operations (except operations in the state of
Florida) for approximately $60 million. Subsequent to the second quarter of
1998, the Company announced the signing of an agreement to sell its home
health operations in Florida for approximately $30 million. All of these sales
are expected to be completed by the end of the year, subject to various
regulatory approvals, and are not expected to have a material effect on
results of operations. The proceeds from the sales are expected to be used to
repay bank borrowings.
 
NOTE 6--INCOME TAXES
 
  The Company is currently contesting before the United States Tax Court (the
"Tax Court") and the United States Court of Federal Claims certain claimed
deficiencies and adjustments proposed by the Internal Revenue Service (the
"IRS") in conjunction with its examination of the Company's 1994 federal
income tax return, Columbia Healthcare Corporation's ("CHC") 1993 and 1994
federal income tax returns, HCA-Hospital Corporation of America's ("HCA") 1981
through 1988 and 1991 through 1993 federal income tax returns and Healthtrust,
Inc.-The Hospital Company's ("Healthtrust") 1990 through 1994 federal income
tax returns. The disputed items include: the disallowance of certain
acquisition-related costs, executive compensation, system conversion costs and
insurance premiums which were deducted in calculating taxable income and the
methods of accounting used by certain subsidiaries for calculating taxable
income related to vendor rebates and governmental receivables. The IRS is
claiming an additional $332 million in income taxes and interest through June
30, 1998.
 
  Tax Court decisions received in 1996 and 1997 related to HCA's 1981 through
1988 federal income tax returns may be appealed by the IRS or the Company to
the United States Court of Appeals, Sixth Circuit. The Company expects any
decisions regarding the appeal of these rulings will be made during 1998.
 
  Management believes that adequate provisions have been recorded to satisfy
final resolution of the disputed issues. Management believes that the Company,
CHC, HCA and Healthtrust properly reported taxable income and paid taxes in
accordance with applicable laws and agreements established with IRS during
previous examinations and that final resolution of these disputes will not
have a material adverse effect on the results of operations or financial
position of the Company.
 
                                       8
<PAGE>
 
                      COLUMBIA/HCA HEALTHCARE CORPORATION
       NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS--(CONTINUED)
                                   UNAUDITED
 
NOTE 7--EARNINGS PER SHARE
 
  The following table sets forth the computation of basic and diluted earnings
per share from continuing operations for the quarters and six months ended
June 30, 1998 and 1997 (dollars in millions, except per share amounts):
 
<TABLE>
<CAPTION>
                                                 QUARTER         SIX MONTHS
                                            ----------------- -----------------
                                              1998     1997     1998     1997
                                            -------- -------- -------- --------
<S>                                         <C>      <C>      <C>      <C>
Numerator(a):
  Income from continuing operations........ $    173 $    385 $    392 $    840
Denominator:
  Share reconciliation (in thousands):
    Shares used for basic earnings per
     share.................................  643,440  661,723  642,749  667,094
    Effect of dilutive securities:
      Stock options........................    3,956    4,587    3,067    5,526
      Warrants and other...................      597      796      651      756
                                            -------- -------- -------- --------
  Shares used for dilutive earnings per
   share...................................  647,993  667,106  646,467  673,376
                                            ======== ======== ======== ========
Earnings per share:
  Basic earnings per share from continuing
   operations.............................. $    .27 $    .58 $    .61 $   1.25
  Diluted earnings per share from
   continuing operations................... $    .27 $    .58 $    .61 $   1.24
</TABLE>
- --------
(a) Amount is used for both basic and diluted earnings per share computations
    since there is no earnings effect related to the dilutive securities.
 
NOTE 8--LONG-TERM DEBT
 
  Current portion of long-term debt at June 30, 1998 includes approximately
$2.4 billion outstanding under the Company's former 364-day revolving credit
facility which was converted to a one-year term loan (the "one- year term
loan").
 
  On July 10, 1998, the Company amended its one-year term loan and $2.0
billion five-year revolving credit agreement (the "Revolving Credit
Facility"). The amendments were primarily made to allow the Company to
repurchase up to $1.0 billion of its common stock (see Note 11--Subsequent
Events).
 
  On July 10, 1998, the Company entered into a $1.0 billion term loan
agreement with several banks which matures February 2002. Proceeds from the
$1.0 billion term loan were used to reduce borrowings under the Company's
Revolving Credit Facility, which the Company anticipates using to finance the
$1.0 billion stock repurchase program.
 
                                       9
<PAGE>
 
                      COLUMBIA/HCA HEALTHCARE CORPORATION
       NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS--(CONTINUED)
                                   UNAUDITED
 
NOTE 9--CONTINGENCIES
 
 Significant Legal Proceedings
 
  Various lawsuits, claims and legal proceedings (see Note 2--Investigations,
for a description of the ongoing government investigations) have been and are
expected to be instituted or asserted against the Company, including those
relating to shareholder derivative and class action complaints; purported
class action lawsuits filed by patients and payers alleging, in general,
improper and fraudulent billing, coding and physician referrals, as well as
other violations of law; certain qui tam or "whistleblower" actions alleging,
in general, unlawful claims for reimbursement or unlawful payments to
physicians for the referral of patients, as well as other violations and
litigation matters. While the amounts claimed may be substantial, the ultimate
liability cannot be determined or reasonably estimated at this time due to the
considerable uncertainties that exist. Therefore, it is possible that results
of operations, financial position and liquidity in a particular period could
be materially, adversely affected upon the resolution of certain of these
contingencies.
 
 General Liability Claims
 
  The Company is subject to claims and suits arising in the ordinary course of
business, including claims for personal injuries or wrongful restriction of,
or interference with, physicians' staff privileges. In certain of these
actions the claimants have asked for punitive damages against the Company,
which are usually not covered by insurance. It is management's opinion that
the ultimate resolution of these pending claims and legal proceedings will not
have a material adverse effect on the Company's results of operations or
financial position (see Part II, Item 1: Legal Proceedings).
 
NOTE 10--COMPREHENSIVE INCOME
 
  The components of comprehensive income, net of related tax, for the quarters
and six months ended June 30, 1998 and 1997 are as follows (in millions):
 
<TABLE>
<CAPTION>
                                                                        SIX
                                                           QUARTER    MONTHS
                                                          ---------- ----------
                                                          1998  1997 1998  1997
                                                          ----  ---- ----  ----
<S>                                                       <C>   <C>  <C>   <C>
Net income............................................... $78   $412 $275  $835
Unrealized gains (losses) on securities.................. (24)    28    -    14
Foreign currency translation adjustments.................   -      2   (2)    3
                                                          ---   ---- ----  ----
Comprehensive income..................................... $54   $442 $273  $852
                                                          ===   ==== ====  ====
</TABLE>
 
  The components of accumulated other comprehensive income, net of related
tax, at June 30, 1998 and December 31, 1997 are as follows:
 
<TABLE>
<CAPTION>
                                                                       1998 1997
                                                                       ---- ----
      <S>                                                              <C>  <C>
      Unrealized gains on securities.................................. $90  $90
      Foreign currency translation adjustments........................   -    2
                                                                       ---  ---
      Accumulated other comprehensive income.......................... $90  $92
                                                                       ===  ===
</TABLE>
 
                                      10
<PAGE>
 
                      COLUMBIA/HCA HEALTHCARE CORPORATION
       NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS--(CONTINUED)
                                   UNAUDITED
 
NOTE 11--SUBSEQUENT EVENTS
 
  In July 1998, the Company completed the sale of 34 of its ambulatory surgery
centers for proceeds of approximately $550 million. The sale resulted in an
after-tax gain of approximately $100 million. Proceeds from the sale were used
to repay bank borrowings.
 
  On July 16, 1998, the Company's board of directors authorized the submission
of a request for a ruling from the IRS for two tax-free spin-off Companies,
comprising the Pacific and America operating groups. The request is expected
to be filed in August 1998.
 
  On July 29, 1998, the Company announced a stock repurchase program under
which up to $1 billion of the Company's common stock may be purchased. In
August 1998, the Company commenced the repurchase program by entering into a
series of forward purchase contracts. The number of shares to be purchased and
the timing of purchases will be based upon several factors, including the
price of the Company's common stock, general market conditions, the status of
the ongoing federal and state governmental investigations of the Company's
business practices and other factors. In light of the ongoing investigations,
prior to the completion of the stock repurchase program, the Company will
address any government concerns related to the program.
 
NOTE 12--DERIVATIVES
 
  In June 1998, the Financial Accounting Standards Board issued Statement No.
133, Accounting for Derivative Instruments and Hedging Activities, which is
required to be adopted in years beginning after June 15, 1999. Because of the
Company's minimal use of derivatives, management does not anticipate that the
adoption of the new Statement will have a significant effect on earnings or
the financial position of the Company.
 
                                      11
<PAGE>
 
                ITEM 2. MANAGEMENT'S DISCUSSION AND ANALYSIS OF
                 FINANCIAL CONDITION AND RESULTS OF OPERATIONS
 
INVESTIGATIONS
 
  The Company is currently the subject of several federal investigations into
its business practices, as well as governmental investigations by various
states. The Company is cooperating in these investigations and understands,
through written notice and other means, that it is a target in these
investigations. Given the breadth of the ongoing investigations, the Company
expects additional subpoenas and other investigative and prosecutorial
activity to occur in these and other jurisdictions in the future.
 
  The Company is the subject of a formal order of investigation by the
Securities and Exchange Commission. The Company understands that the
investigation includes the anti-fraud, periodic reporting and internal
accounting control provisions of the federal securities laws.
 
  Management believes the ongoing investigations and related media coverage
are having a negative effect on the Company's results of operations. It is too
early to predict the outcome or effect that the ongoing investigations, the
initiation of additional investigations, if any, and the related media
coverage will have on the Company's financial condition or results of
operations in future periods. Were the Company to be found in violation of
federal or state laws relating to Medicare, Medicaid or similar programs, the
Company could be subject to substantial monetary fines, civil and criminal
penalties and exclusion from participation in the Medicare and Medicaid
programs. Any such sanctions could have a material adverse effect on the
Company's financial position and results of operations. (See Note 9--
Contingencies of the Notes to the Condensed Consolidated Financial Statements
and Part II, Item 1: Legal Proceedings.)
 
RESTRUCTURING OF OPERATIONS & DISCONTINUED OPERATIONS
 
  The Company is currently in the process of restructuring its operations in
an effort to create a smaller and more focused company. The restructuring
includes divestitures of certain hospitals and surgery centers to third
parties and spin-offs of certain other assets to the Company's stockholders
(See in Note 3--Restructuring Operations of the Notes to the Condensed
Consolidated Financial Statements) and the divestitures of certain
discontinued business (See Note 5--Discontinued Operations of the Notes to the
Condensed Consolidated Financial Statements).
 
BUSINESS STRATEGY
 
  The Company's strategy is to be a comprehensive provider of quality health
care services in select markets. The Company maintains and replaces equipment,
renovates and constructs replacement facilities and adds new services to
increase the attractiveness of its hospitals and other facilities to patients
and physicians. By developing a comprehensive health care network with a broad
range of health care services located throughout a community service area, the
Company is better able to attract and serve patients and physicians. The
Company is also able to reduce operating costs by sharing certain services
among several facilities in the same market and is better positioned to work
with health maintenance organizations ("HMOs"), preferred provider
organizations ("PPOs") and employers.
 
  The Company generally seeks to operate each of its facilities as part of a
network with other health care facilities that it owns or operates within the
same region. In instances where acquisitions of additional facilities in the
area are not possible or practical, the Company may seek joint ventures or
partnership arrangements with other local facilities.
 
                                      12
<PAGE>
 
                ITEM 2. MANAGEMENT'S DISCUSSION AND ANALYSIS OF
          FINANCIAL CONDITION AND RESULTS OF OPERATIONS--(CONTINUED)
 
 
RESULTS OF OPERATIONS
 
 Revenue/Volume Trends
 
   The Company has experienced a decline in volumes and revenues as well as
operational deficiencies. Management believes that the impact of the ongoing
government investigations and related media coverage, and the announced sale
of several hospitals as part of the Company's restructuring of operations has
created uncertainty in the respective communities.
 
  The Company's revenues also continue to be adversely affected by the trend
toward certain services being performed more frequently on an outpatient basis
and an increasing proportion of revenue being derived from fixed payment,
higher discount sources, including Medicare, Medicaid and managed care plans.
Admissions related to Medicare, Medicaid and managed care plan patients were
90% and 87% of total admissions for the six months ended June 30, 1998 and
1997, respectively.
 
  Insurance companies, government programs (other than Medicare) and employers
purchasing health care services for their employees are negotiating discounted
amounts that they will pay health care providers rather than paying standard
prices. These purchasers then become discounted payers, similar to HMOs and
PPOs, in virtually all markets and make it increasingly difficult for
providers, including the Company, to maintain their historical revenue growth
trends. Revenues from capitation arrangements (prepaid health service
agreements) are less than 1% of consolidated revenues.
 
  The growth in outpatient services is expected to continue in the health care
industry as procedures performed on an inpatient basis are converted to
outpatient procedures through continuing advances in pharmaceutical and
medical technologies. The redirection of certain procedures to an outpatient
basis is also influenced by pressures from payers to direct certain procedures
from inpatient care to outpatient care. Outpatient revenues grew to 37% of net
patient revenues for the six months ended June 30, 1998 from 36% during the
same period last year.
 
  The Company expects patient volumes from Medicare and Medicaid to continue
to increase due to the general aging of the population and the expansion of
state Medicaid programs. However, under the Balanced Budget Act of 1997 (the
"BBA-97"), the Company's reimbursement from the Medicare and Medicaid programs
were reduced and will be further reduced as some reductions will be phased in
over the next few years.
 
  Reductions in Medicare and Medicaid reimbursement, increasing percentages of
the patient volume being related to patients participating in managed care
plans and continuing trends toward more services being performed on an
outpatient basis are expected to present an ongoing challenge to the Company.
To achieve and maintain a reasonable operating margin in future periods, the
Company must increase patient volumes while controlling the costs of providing
services.
 
  Management believes that the proper response to this challenge includes the
delivery of a broad range of quality health care services to patients through
comprehensive health care networks with operating decisions being made by the
local management teams and local physicians.
 
                                      13
<PAGE>
 
                ITEM 2. MANAGEMENT'S DISCUSSION AND ANALYSIS OF
          FINANCIAL CONDITION AND RESULTS OF OPERATIONS--(CONTINUED)
 
RESULTS OF OPERATIONS (CONTINUED)
 
 Operating Results Summary
 
  The following is a summary of results from continuing operations for the
quarters and six months ended June 30, 1998 and 1997 (dollars in millions,
except per share amounts):
 
<TABLE>
<CAPTION>
                                                          QUARTER
                                                 -----------------------------
                                                     1998            1997
                                                 --------------  -------------
                                                 AMOUNT   RATIO  AMOUNT  RATIO
                                                 ------   -----  ------  -----
<S>                                              <C>      <C>    <C>     <C>
Revenues........................................ $4,781   100.0  $4,845  100.0
Salaries and benefits...........................  1,998    41.8   1,850   38.2
Supplies........................................    719    15.0     658   13.6
Other operating expenses........................    961    20.2     943   19.4
Provision for doubtful accounts.................    340     7.1     310    6.4
Depreciation and amortization...................    311     6.4     308    6.4
Interest expense................................    145     3.0     123    2.5
Equity in earnings of affiliates................    (33)   (0.7)    (35)  (0.7)
Restructuring of operations and investigation
 related costs..................................     31     0.7       -      -
                                                 ------   -----  ------  -----
                                                  4,472    93.5   4,157   85.8
                                                 ------   -----  ------  -----
Income from continuing operations before
 minority interests and income taxes............    309     6.5     688   14.2
Minority interests in earnings of consolidated
 entities.......................................     18     0.4      45    0.9
                                                 ------   -----  ------  -----
Income from continuing operations before income
 taxes..........................................    291     6.1     643   13.3
Provision for income taxes......................    118     2.5     258    5.4
                                                 ------   -----  ------  -----
Income from continuing operations............... $  173     3.6  $  385    7.9
                                                 ======   =====  ======  =====
Diluted earnings per share from continuing
 operations..................................... $  .27          $  .58
% changes from prior year:
  Revenues......................................   (1.3%)           3.7%
  Income from continuing operations before
   income taxes.................................  (54.7)            6.5
  Income from continuing operations.............  (55.0)            6.6
  Diluted earnings per share from continuing
   operations...................................  (53.4)            7.4
  Admissions (a)................................   (0.6)
  Equivalent admissions (b).....................    0.3
  Revenues per equivalent admission.............   (1.6)
Same-facility % changes from prior year (c):
  Revenues......................................   (3.0%)
  Admissions (a)................................   (0.5)
  Equivalent admissions (b).....................    0.6
  Revenues per equivalent admission.............   (3.7)
</TABLE>
 
                                      14
<PAGE>
 
                ITEM 2. MANAGEMENT'S DISCUSSION AND ANALYSIS OF
          FINANCIAL CONDITION AND RESULTS OF OPERATIONS--(CONTINUED)
 
RESULTS OF OPERATIONS (CONTINUED)
<TABLE>
<CAPTION>
                                                        SIX MONTHS
                                                 -----------------------------
                                                     1998            1997
                                                 --------------  -------------
                                                 AMOUNT   RATIO  AMOUNT  RATIO
                                                 ------   -----  ------  -----
<S>                                              <C>      <C>    <C>     <C>
Revenues........................................ $9,682   100.0% $9,833  100.0%
Salaries and benefits...........................  4,011    41.4   3,726   37.9
Supplies........................................  1,465    15.1   1,357   13.8
Other operating expenses........................  1,901    19.7   1,905   19.4
Provision for doubtful accounts.................    683     7.1     607    6.2
Depreciation and amortization...................    620     6.4     604    6.1
Interest expense................................    298     3.1     236    2.4
Equity in earnings of affiliates................    (75)   (0.8)    (97)  (1.0)
Restructuring of operations and investigation
 related costs..................................     69     0.7       -      -
                                                 ------   -----  ------  -----
                                                  8,972    92.7   8,338   84.8
                                                 ------   -----  ------  -----
Income from continuing operations before
 minority interests and income taxes............    710     7.3   1,495   15.2
Minority interests in earnings of consolidated
 entities.......................................     38     0.4      92    0.9
                                                 ------   -----  ------  -----
Income from continuing operations before income
 taxes..........................................    672     6.9   1,403   14.3
Provision for income taxes......................    280     2.8     563    5.7
                                                 ------   -----  ------  -----
Income from continuing operations............... $  392     4.1  $  840    8.6
                                                 ======   =====  ======  =====
Diluted earnings per share from continuing
 operations..................................... $  .61          $ 1.24
% changes from prior year:
  Revenues......................................   (1.5%)           5.0
  Income from continuing operations before
   income taxes.................................  (52.1)            9.9
  Income from continuing operations.............  (53.3)            9.9
  Diluted earnings per share from continuing
   operations...................................  (50.8)            9.7
  Admissions (a)................................    0.8
  Equivalent admissions (b).....................    1.8
  Revenues per equivalent admission.............   (3.3)
Same-facility % changes from prior year (c):
  Revenues......................................   (2.8)
  Admissions(a).................................    0.3
  Equivalent admissions (b).....................    1.5
  Revenues per equivalent admission.............   (4.2)
</TABLE>
- --------
(a) Admissions represent the total number of patients admitted (in the
    facility for a period in excess of 23 hours) to the Company's hospitals.
(b) Equivalent admissions is used by management and certain investors as a
    general measure of combined inpatient and outpatient volume. Equivalent
    admissions are computed by multiplying admissions (inpatient volume) by
    the sum of gross inpatient revenue and gross outpatient revenue and then
    dividing the resulting amount by gross inpatient revenue. The equivalent
    admissions computation "equates" outpatient revenue to the volume measure
    (admissions) used to measure inpatient volume resulting in a general
    measure of combined inpatient and outpatient volume.
(c) "Same facility" information excludes the operations of hospitals and their
    related facilities which were either acquired or divested during the
    current and prior year. The facilities to be sold as part of the Company's
    restructuring of operations efforts will continue to be included in "same
    facility" until the date they are divested.
 
                                      15
<PAGE>
 
                ITEM 2. MANAGEMENT'S DISCUSSION AND ANALYSIS OF
          FINANCIAL CONDITION AND RESULTS OF OPERATIONS--(CONTINUED)
 
RESULTS OF OPERATIONS (CONTINUED)
 
 Quarters Ended June 30, 1998 and 1997
 
  Income from continuing operations before income taxes declined 54.7% to $291
million in 1998 from $643 million in 1997, and pretax margins decreased to
6.1% in 1998 from 13.3% in 1997. The decrease in pretax income was primarily
attributable to the decline in revenues, a decrease in the operating margins
and costs associated with the restructuring of the Company's operations and
investigation related costs. The announced sale of several hospitals as part
of the Company's restructuring of operations also contributed to the declines
in revenues and admissions as well as operating margins.
 
  Revenues decreased 1.3% to $4,781 million in 1998 compared to $4,845 million
in 1997. Inpatient admissions decreased 0.6% from a year ago and equivalent
admissions (adjusted to reflect combined inpatient and outpatient volume)
increased 0.3%. On a same-facility basis, revenues decreased 3.0%, admissions
decreased 0.5% and equivalent admissions increased 0.6% from a year ago. The
decline in both reported and same-facility revenues compared to increases in
equivalent admissions resulted from declines in revenue per equivalent
admissions of 1.6% on a reported basis and 3.7% on a same-facility basis. As
previously discussed, the increase in outpatient volume activity is primarily
a result of the continuing trend of certain services, previously provided in
an inpatient setting, being converted to an outpatient setting.
 
  The decline in revenues was due to several factors including decreases in
Medicare reimbursement rates mandated by the BBA-97 which became effective
October 1, 1997 (lowered 1998 revenues by approximately $55 million for the
quarter), continued increases in discounts from the growing number of managed
care payers (managed care as a percentage of total admissions increased to 39%
in 1998 compared to 35% during 1997) and delays experienced in obtaining
Medicare cost report settlements (cost report filings and settlements resulted
in favorable revenue adjustments of $18 million in 1998 compared to $72
million in 1997).
 
  Operating expenses increased as a percentage of revenues in almost every
expense category, except depreciation and amortization, which remained
unchanged, and minority interests, which declined 0.5% from 1997 due to
decreased income from joint ventures that included minority partners. The
primary reason for the increases as a percentage of revenues in all other
expense categories, as described below, was the Company's inability to adjust
expenses in line with the decreases experienced in volumes and reimbursement
trends. Management attention to the investigations, reactions by certain
physicians and patients to the negative media coverage and management changes
at several levels and locations throughout the Company continue to contribute
to the Company's inability to implement changes to reduce operating expenses
in response to the volume and revenue declines.
 
  Salaries and benefits, as a percentage of revenues, increased to 41.8% in
1998 from 38.2% in 1997. The decline in revenues per equivalent admission was
a primary factor in the increase. In addition, the Company was unable to
adjust staffing levels corresponding with the declining equivalent admission
growth (man hours per equivalent admission increased slightly compared to last
year).
 
  Supply costs increased as a percentage of revenues to 15.0% in 1998 from
13.6% in 1997 due to a decline in net revenue per equivalent admission while
the cost of supplies per equivalent admission increased.
 
  Other operating expenses (primarily consisting of contract services,
professional fees, repairs and maintenance, rents and leases, utilities,
insurance and non-income taxes) increased as a percentage of revenues to 20.2%
in 1998 from 19.4% in 1997. The increase was due to small increases in several
of these areas as a percentage of revenues.
 
                                      16
<PAGE>
 
                ITEM 2. MANAGEMENT'S DISCUSSION AND ANALYSIS OF
          FINANCIAL CONDITION AND RESULTS OF OPERATIONS--(CONTINUED)
 
RESULTS OF OPERATIONS (CONTINUED)
 
 Quarters Ended June 30, 1998 and 1997 (Continued)
 
  Provision for doubtful accounts, as a percentage of revenues, increased to
7.1% in 1998 from 6.4% in 1997 due to internal factors such as continued
computer information system conversions (including patient accounting systems)
at various facilities and external factors such as payer mix shifts to managed
care plans (resulting in increased amounts of patient co-payments and
deductibles) and payer remittance slowdowns. The information system
conversions hampered the business office billing functions and collection
efforts in those facilities as some resources are directed to installing and
converting systems and building new data files, rather than devoting full
effort to billing and collecting receivables. The Company continues to
experience increased occurrences of charge audits from certain payers due to
the negative publicity surrounding the government investigations which have
resulted in delays in the collection of receivables. The delays in collections
result in an increase in receivables reserved under the Company's bad debt
allowance policy. Management is unable at this time to predict when or if,
these delays in collecting accounts receivable will improve or the effect
these delays will have on the ultimate amounts collected.
 
  Interest expense increased to $145 million in 1998 compared to $123 million
in 1997 primarily as a result of an increase in average outstanding debt
during 1998 compared to last year. This was due, in part, to the additional
debt incurred during the third and fourth quarters of 1997 related to the
Company's $1.0 billion common stock repurchase program which was completed in
the fourth quarter of 1997. Interest expense associated with the increase in
debt related to the funding of the 1997 merger with Value Health has been
allocated to "Discontinued operations" for the periods prior to the sales of
the respective Value Health businesses and is therefore excluded from interest
expense from continuing operations for certain periods.
 
  Equity in earnings of affiliates remained unchanged at 0.7% of revenues as
compared to last year.
 
  During 1998, the Company incurred $31 million ($18 million after-tax or $.03
per diluted share) of costs in connection with the restructuring of operations
and investigations. These costs included $24 million in professional fees
related to the investigations and $7 million in various other costs.
 
  The Company incurred a $22 million net loss from operations of its
discontinued businesses in 1998 compared to net income of $27 million during
the prior year. The majority of the loss, which is primarily related to the
Company's home health care business, is due to revenue reductions related to
Medicare rates of reimbursement for home health visits under the BBA-97, and a
decline in home health visits from 4.3 million last year to 2.1 million in
1998. The Company also incurred a $73 million loss on disposal of three Value
Health business units acquired in 1997. The loss reflects adjustments to the
Company's 1997 estimated loss on disposal for these businesses.
 
 Six Months Ended June 30, 1998 and 1997
 
  Income from continuing operations before income taxes declined 52.1% to $672
million in 1998 from $1,403 million in 1997, and pretax margins decreased to
6.9% in 1998 from 14.3% in 1997. The decrease in pretax income was primarily
attributable to the decline in revenues, decreases in the operating margin and
costs associated with the restructuring of operations and investigation
related costs. The announced sale of several hospitals as part of the
Company's restructuring of operations also contributed to the declines in both
revenues and operating margins.
 
  Revenues decreased 1.5% to $9.7 billion in 1998 compared to $9.8 billion in
1997. Inpatient admissions increased 0.8% from a year ago and equivalent
admissions (adjusted to reflect combined inpatient and outpatient volume)
increased 1.8%. On a same-facility basis, revenues decreased 2.8%, admissions
increased 0.3% and equivalent admissions increased 1.5% from a year ago. The
decline in both reported and same-facility revenues compared to increases in
equivalent admissions resulted from declines in revenue per equivalent
admission of
 
                                      17
<PAGE>
 
                ITEM 2. MANAGEMENT'S DISCUSSION AND ANALYSIS OF
          FINANCIAL CONDITION AND RESULTS OF OPERATIONS--(CONTINUED)
 
RESULTS OF OPERATIONS (CONTINUED)
 Six Months Ended June 30, 1998 and 1997 (Continued)
 
3.3% on a reported basis and 4.2% on a same-facility basis. As previously
discussed, the increase in outpatient volume activity is primarily a result of
the continuing trend of certain services, previously provided in an inpatient
setting, being converted to an outpatient setting.
 
  The decline in revenues was due to several factors including decreases in
Medicare reimbursement rates mandated by the BBA-97 which became effective
October 1, 1997 (lowered 1998 revenues by approximately $100 million),
continued increases in discounts from the growing number of managed care
payers (managed care as a percentage of total admissions increased to 38% in
1998 compared to 33% during 1997) and delays experienced in obtaining Medicare
cost report settlements (cost report filings and settlements resulted in
favorable revenue adjustments of $39 million in 1998 compared to $101 million
in 1997).
 
  Operating expenses increased as a percentage of revenues in almost every
expense category except minority interests which declined 0.5% from 1997 due
to decreased income from joint ventures that included minority partners. The
primary reason for the increases as a percentage of revenues in all other
expense categories, as described below, was the Company's inability to adjust
expenses in line with the decreases experienced in volumes and reimbursement
trends. Management attention to the investigations, reactions by certain
physicians and patients to the negative media coverage and management changes
at several levels and locations throughout the Company continue to contribute
to the Company's inability to implement changes to reduce operating expenses
in response to the volume and revenue declines.
 
  Salaries and benefits, as a percentage of revenues, increased to 41.4% in
1998 from 37.9% in 1997. The decline in revenues per equivalent admission was
a primary factor in the increase. In addition, the Company was unable to
adjust staffing levels corresponding with the declining equivalent admission
growth (man hours per equivalent admission increased slightly compared to last
year).
 
  Supply costs increased as a percentage of revenues to 15.1% in 1998 from
13.8% in 1997 due to a decline in net revenue per equivalent admission while
the cost of supplies per equivalent admission increased.
 
  Other operating expenses (which includes various expense categories)
increased as a percentage of revenues to 19.7% in 1998 from 19.4% in 1997.
 
  Provision for doubtful accounts, as a percentage of revenues, increased to
7.1% in 1998 from 6.2% in 1997 due to internal factors such as continued
computer information system conversions (including patient accounting systems)
at various facilities and external factors such as payer mix shifts to managed
care plans (resulting in increased amounts of patient co-payments and
deductibles) and payer remittance slowdowns. The information system
conversions hampered the business office billing functions and collection
efforts in those facilities as some resources are directed to installing and
converting systems and building new data files, rather than devoting full
effort to billing and collecting receivables. The Company experienced an
increased occurrence of charge audits from certain payers due to the negative
publicity surrounding the government investigations which have resulted in
delays in the collection of receivables. The delays in collections resulted in
an increase in receivables reserved under the Company's bad debt allowance
policy. Management is unable at this time to predict when or if, these delays
in collecting accounts receivable will improve or the effect these delays will
have on the ultimate amounts collected.
 
  Depreciation and amortization increased as a percentage of revenues to 6.4%
in 1998 from 6.1% in 1997, primarily due to the slowdown in revenue growth and
increased capital expenditures related to ancillary services (such as
outpatient services) and information systems. Capital expenditures in these
areas generally result in shorter depreciation and amortization lives for the
assets acquired than typical hospital acquisitions.
 
                                      18
<PAGE>
 
                ITEM 2. MANAGEMENT'S DISCUSSION AND ANALYSIS OF
          FINANCIAL CONDITION AND RESULTS OF OPERATIONS--(CONTINUED)
 
RESULTS OF OPERATIONS (CONTINUED)
 Six Months Ended June 30, 1998 and 1997 (Continued)
 
  Interest expense increased to $298 million in 1998 compared to $236 million
in 1997, primarily as a result of an increase in average outstanding debt
during 1998 compared to last year. This was due, in part, to the additional
debt incurred during the third and fourth quarters of 1997 related to the
Company's $1.0 billion common stock repurchase program which was completed in
the fourth quarter of 1997. Interest expense associated with the increase in
debt related to the funding of the 1997 merger with Value Health has been
allocated to "Discontinued operations" for periods prior to the sales of the
respective Value Health businesses and is therefore excluded from interest
expense from continuing operations for certain periods.
 
  Equity in earnings of affiliates decreased as a percentage of revenues to
0.8% in 1998 from 1.0% in 1997 primarily due to decreased profitability at
certain non-consolidated joint venture facilities.
 
  During 1998, the Company incurred $69 million ($40 million after-tax or $.06
per diluted share) of costs in connection with the restructuring of operations
and investigations. These costs included $52 million in professional fees
related to the investigations and $17 million in various other costs.
 
  The Company incurred a $44 million net loss from operations of it's
discontinued businesses in 1998 compared to net income of $51 million during
the prior year. The majority of the loss, which is primarily related to the
Company's home health care business, is due to revenue reductions related to
Medicare rates of reimbursement for home health visits under the BBA-97 and a
decline in home health visits from 8.5 million last year to 4.7 million in
1998.
 
 Liquidity
 
  Cash provided by continuing operating activities totaled approximately $1.0
billion during the first six months of 1998 compared to $810 million in 1997.
The increase was primarily due to a $350 million federal income tax refund
received during 1998 related to excess estimated payment amounts made during
1997. The refund was partially offset by a decline in net income from 1997 to
1998.
 
  Cash used in investing activities declined to $89 million during the first
six months of 1998 from $718 million for the same period of 1997. The decline
was primarily due to $619 million in proceeds from the sale of certain
discontinued businesses offsetting capital expenditures of $666 million, which
were comparable to $696 million of capital expenditures in 1997.
 
  Cash flows used in financing activities totaled approximately $1.0 billion
during the first six months of 1998 compared to $96 million in 1997. The
excess of cash flows from continuing operations over cash used in investing
activities was primarily used to pay down debt during the first six months of
1998. During 1997, the excess cash flow from continuing operations over cash
used in investing activities along with net additional borrowings of $644
million were used to repurchase $718 million of the Company's common stock
under its share repurchase program.
 
  At June 30, 1998, current liabilities exceeded current assets by $973
million. Included in current liabilities is approximately $2.4 billion
outstanding under the Company's former 364-day revolving credit facility which
was converted to a one-year term loan (the "one-year term loan"). The Company
expects to repay the one-year term loan primarily through proceeds from
facility sales. Working capital balances totaled $1.7 billion at December 31,
1997. Management believes that proceeds from expected asset sales, cash flows
from operations and amounts available under the Company's $2.0 billion five-
year revolving credit facility due February 2002 (the "Revolving Credit
Facility") will be sufficient to meet expected liquidity needs during the next
twelve months.
 
  Investments of the Company's professional liability insurance subsidiary to
maintain statutory equity and pay claims totaled $1.7 billion at June 30, 1998
and $1.5 billion at December 31, 1997.
 
                                      19
<PAGE>
 
                ITEM 2. MANAGEMENT'S DISCUSSION AND ANALYSIS OF
          FINANCIAL CONDITION AND RESULTS OF OPERATIONS--(CONTINUED)
 
RESULTS OF OPERATIONS (CONTINUED)
 Liquidity (Continued)
 
  The Company has various agreements with joint venture partners whereby the
partners have an option to sell or "put" their interests in the joint venture
back to the Company within specific periods at fixed prices or prices based on
certain formulas. The combined put price under all such agreements was
approximately $1.0 billion at June 30, 1998. During April 1998, the partner in
the Memorial Healthcare Group, Inc. joint venture exercised their put option
whereby the Company purchased their remaining interest in the joint venture
for approximately $40 million. The Company cannot predict if, or when, other
joint venture partners will exercise such options.
 
  During the first quarter of 1998, the Internal Revenue Service (the "IRS")
issued guidance regarding the tax consequences of joint ventures between for-
profit and not-for-profit hospitals. The Company has not determined the impact
of the tax ruling on its existing joint ventures and is consulting with its
joint venture partners and tax advisers to develop an appropriate course of
action. The tax ruling could require the restructuring of certain joint
ventures with not-for-profits or influence the exercise of the put agreements
by certain joint venture partners.
 
  The settlement of the government investigations and the various lawsuits and
legal proceedings that have been asserted could result in substantial
liabilities to the Company. The ultimate liabilities cannot be reasonably
estimated, as to the timing or amounts, at this time; however, it is possible
that results of operations, financial position and liquidity could be
materially, adversely affected upon the resolution of certain of these
contingencies.
 
 Capital Resources
 
  Excluding acquisitions, capital expenditures were $666 million during the
first six months of 1998 compared to $696 million for the same period in 1997.
Planned capital expenditures (including construction projects) in 1998 are
expected to approximate $1.4 billion. Management believes that its capital
expenditure program is adequate to expand, improve and equip the Company's
existing health care facilities.
 
  Acquisition of hospitals and health care entities and investments in and
advances to affiliates (generally 50% interests in joint ventures that are
accounted for using the equity method) totaled $116 million during the first
six months of 1998 and $162 million in 1997.
 
  The Company expects to finance all capital expenditures with internally
generated and borrowed funds. Available sources of capital include public or
private debt, amounts available under the Company's Revolving Credit Facility
(approximately $1.8 billion as of July 31,1998) and equity. At June 30, 1998,
there were projects under construction which had an estimated additional cost
to complete and equip over the next few years of approximately $1.3 billion.
 
  During July 1998, the Company amended the one-year term loan and the
Revolving Credit Facility primarily to allow for a $1.0 billion share
repurchase of its common stock. Also during July 1998, the Company entered
into a $1.0 billion term loan agreement with several banks which matures
February 2002. Proceeds from $1.0 billion term loan were used to reduce
borrowings under the Company's Revolving Credit Facility which the Company
anticipates using to finance the $1.0 billion stock repurchase program.
 
  The one-year term loan, the Revolving Credit Facility and the new $1.0
billion term loan contain customary covenants which include (i) limitations on
additional debt, (ii) limitations on sales of assets, mergers and changes of
ownership, (iii) limitations on repurchases of the Company's common stock,
(iv) maintenance of certain interest coverage ratios and (v) attaining certain
minimum levels of consolidated earnings before interest, taxes,
 
                                      20
<PAGE>
 
                ITEM 2. MANAGEMENT'S DISCUSSION AND ANALYSIS OF
          FINANCIAL CONDITION AND RESULTS OF OPERATIONS--(CONTINUED)
 
RESULTS OF OPERATIONS (CONTINUED)
 Capital Resources (Continued)
 
depreciation and amortization. The Revolving Credit Facility and one-year term
loan also provide for the mandatory prepayment of loans thereunder, and a
corresponding reduction of commitments in the case of certain asset sales and
certain debt or equity issuances. The Company is currently in compliance with
all such covenants.
 
  During the third quarter of 1997, the Company began replacing amounts
outstanding under its commercial paper programs with borrowings under its bank
credit facilities. This was due to the limited access of commercial paper as a
funding source caused by downgrades of the Company's senior debt and
commercial paper credit ratings by Moody's Investor Service ("Moody's") and
Standard and Poor's. In February 1998, Moody's further downgraded the
Company's senior debt credit rating to Ba2 from Baa2 and the commercial paper
rating to NP (not prime) from P-3.
 
  As part of the Company's restructuring of operations discussed earlier, the
Company announced it is pursuing various restructuring alternatives which
include divestitures of certain assets to third parties and spin-offs of
certain assets to the Company's stockholders. These restructuring alternatives
could have the effect of materially changing the capital structure of the
Company. At this time, management has not determined the future capital
structure of the Company.
 
YEAR 2000 ISSUES
 
  The Year 2000 problem is the result of two potential malfunctions that could
have an impact on the Company's systems and equipment. The first problem
arises due to computers being programmed to use two rather than four digits to
define the applicable year. The second problem arises in embedded chips, where
microchips and microcontrollers have been designed using two rather than four
digits to define the applicable year. Certain of the Company's computer
programs, building infrastructure components (e.g. alarm systems and HVAC
systems) and medical devices that are date sensitive, may recognize a date
using "00" as the year 1900 rather than the year 2000. If uncorrected, the
problem could result in computer system and program failures or equipment and
medical device malfunctions that could result in a disruption of business
operations or that could affect patient diagnosis and treatment.
 
  With respect to the information technology ("IT") portions of the Company's
Year 2000 project, which address the inventory, assessment, remediation,
testing and implementation of internally developed software, the Company has
identified various software applications that are being addressed on separate
time lines. The Company has begun remediating for all these software
applications and is testing the software applications where remediation has
been completed. The Company has also completed the assessment of mission
critical third party software (i.e., that software which is essential for day
to day operations) and has developed testing and implementation plans with
separate time lines. The Company anticipates completing, in all material
respects, remediation, testing and implementation for internally developed and
mission critical third party software by June 1999. The Company's efforts are
currently on schedule.
 
  With respect to the IT infrastructure portion of the Company's Year 2000
project, the Company has undertaken a program to inventory, assess and
correct, replace or otherwise address impacted vendor products (hardware,
systems software, business software, and telecommunication equipment). The
Company has implemented a program to contact vendors, analyze information
provided, and to remediate, replace or otherwise address IT products that pose
a material Year 2000 Impact. The Company anticipates completion, in all
material respects, of the IT infrastructure portion of its program by June
1999. The IT infrastructure portion of the Company's Year 2000 project is
currently on schedule.
 
                                      21
<PAGE>
 
                ITEM 2. MANAGEMENT'S DISCUSSION AND ANALYSIS OF
          FINANCIAL CONDITION AND RESULTS OF OPERATIONS--(CONTINUED)
 
YEAR 2000 ISSUES (CONTINUED)
 
 
 
  The Company presently believes that with modifications to existing software
or the installation of upgraded software under the IT infrastructure portion,
the Year 2000 will not pose material operational problems for its computer
systems. However, if such modifications or upgrades are not accomplished in a
timely manner, Year 2000 related failures may present a material adverse
impact on the operations of the Company. Contingency planning will be
established and implemented in an effort to minimize any impact from Year 2000
related failures.
 
  With respect to the non-IT infrastructure portion of the Company's Year 2000
project, the Company has undertaken a program to inventory, assess and
correct, replace or otherwise address impacted vendor products, medical
equipment and other related equipment with embedded chips. The Company has
implemented a program to contact vendors, analyze information provided, and to
remediate, replace or otherwise address devices or equipment that pose a
material Year 2000 impact. The Company anticipates completion, in all material
respects, of the non-IT infrastructure portion of its program by June 1999.
The non-IT infrastructure portion of the Company's Year 2000 project is
currently on schedule.
 
  The Company is prioritizing its non-IT infrastructure efforts by focusing on
equipment and medical devices that will have a direct impact on patient safety
and health. The Company is directing the majority of its efforts to repair,
replace, upgrade or otherwise address this equipment and these medical devices
in order to minimize risk to patient safety and health. The Company is relying
on information that is being provided to it by equipment and medical device
manufacturers regarding the Year 2000 status of their products. While the
Company is attempting to evaluate information provided by its present vendors,
there can be no assurance that in all instances accurate information is being
provided. The Company also cannot in all instances guarantee that the repair,
replacement or upgrade of all non-IT infrastructure systems will occur on a
timely basis. Contingency planning will be established and implemented in an
effort to minimize any impact from Year 2000 related failures.
 
  The Company has initiated communications with its major third party payers
and intermediaries, including government payers and intermediaries. The
Company relies on these entities for accurate and timely reimbursement of
claims, often through the use of electronic data interfaces. The Company has
not received assurances that these interfaces will be timely converted.
Failure of these third party systems could have a material adverse affect on
the Company's results of operations. The Company also has initiated
communications with its mission critical suppliers and vendors (i.e. those
suppliers and vendors whose products and services are essential for day to day
operations) to assure their continued operation through the Year 2000. The
Company is continuing its efforts to obtain such assurances from all mission
critical suppliers and vendors. Failure of these third parties could have a
material impact on operations and/or the ability to provide health care
services. Contingency planning will be established and implemented in an
effort to minimize any impact from Year 2000 related failures.
 
  The Company is utilizing both internal and external resources to manage and
implement its Year 2000 program. With the assistance of such resources, the
Company has recently undertaken the development of contingency plans in the
event that its Year 2000 efforts, or the failures of third parties upon which
the Company relies, are not accurately or timely completed. This development
phase will continue through the end of 1998 with the implementation of
contingency plans occuring in 1999.
 
  The Year 2000 project is currently estimated to have a minimum total cost of
$75 million, of which the Company has incurred $18 million through the first
six months of 1998. Cumulatively, the Company has incurred $33 million of
costs related to the Year 2000 project. The increase to the estimated minimum
total cost is related to estimates for repair or replacement of non-IT
systems. The Company recognizes that the total cost is likely to increase as
it completes its assessment of non-IT systems and as it continues its
remediation and testing of IT systems. The Company is not currently able to
reasonably estimate the ultimate cost to be incurred for the
 
                                      22
<PAGE>
 
                ITEM 2. MANAGEMENT'S DISCUSSION AND ANALYSIS OF
          FINANCIAL CONDITION AND RESULTS OF OPERATIONS--(CONTINUED)
 
YEAR 2000 ISSUES (CONTINUED)
 
 
assessment, remediation, upgrade, replacement and testing of its impacted non-
IT systems. The majority of the costs related to the Year 2000 project will be
expensed as incurred and are expected to be funded through operating cash
flows.
 
  The costs of the project and estimated completion dates for the Year 2000
modifications are based on management's best estimates, which were derived
utilizing numerous assumptions of future events, including the continued
availability of certain resources, third party modification plans and other
factors. However, there can be no guarantees that these estimates will be
achieved and actual results could differ materially from those anticipated.
Specific factors that might cause such material differences include, but are
not limited to, the availability and cost of personnel trained in this area,
the ability to locate and correct all relevant computer codes and all medical
equipment.
 
HEALTH CARE REFORM
 
  In recent years, an increasing number of legislative proposals have been
introduced or proposed in Congress and in some state legislatures that would
significantly affect health care systems in the Company's markets. The cost of
certain proposals would be funded in significant part by reduction in payments
by government programs, including Medicare and Medicaid, to health care
providers (similar to the reductions incurred as part of BBA-97 as previously
discussed). While the Company is unable to predict which, if any, proposals
for health care reform will be adopted, there can be no assurance that
proposals adverse to the business of the Company will not be adopted.
 
PENDING IRS DISPUTES
 
  The Company is contesting income taxes and related interest proposed by the
IRS for prior years aggregating approximately $332 million as of June 30,
1998. Management believes that final resolution of these disputes will not
have a material adverse effect on the results of operations or financial
position of the Company. (See Note 6--Income Taxes of the Notes to Condensed
Consolidated Financial Statements for a description of the pending IRS
disputes).
 
                                      23
<PAGE>
 
                ITEM 2. MANAGEMENT'S DISCUSSION AND ANALYSIS OF
          FINANCIAL CONDITION AND RESULTS OF OPERATIONS--(CONTINUED)
 
 
SUBSEQUENT EVENTS
 
  In July 1998, the Company completed the sale of 34 of its ambulatory surgery
centers for proceeds of approximately $550 million. The sale resulted in an
after-tax gain of approximately $100 million. Proceeds from the sale were used
to repay bank borrowings.
 
  On July 16, 1998, the Company's board of directors authorized the submission
of a request for a ruling from the IRS for two tax-free spin-off Companies,
comprising the Pacific and America operating groups. The request is expected
to be filed in August 1998.
 
  On July 29, 1998, the Company announced a stock repurchase program under
which up to $1 billion of the Company's common stock may be purchased. In
August 1998, the Company commenced the repurchase program by entering into a
series of forward purchase contracts. The number of shares to be purchased and
the timing of purchases will be based upon several factors, including the
price of the Company's common stock, general market conditions, the status of
the ongoing federal and state governmental investigations of the Company's
business practices and other factors. In light of the ongoing investigations,
prior to the completion of the stock repurchase program, the Company will
address any government concerns related to the program.
 
FORWARD-LOOKING STATEMENTS
 
  Certain statements contained in this Quarterly Report on Form 10-Q,
including, without limitation, statements containing the words "believes,"
"anticipates," "expects," "estimates" and words of similar import, constitute
"forward-looking" statements within the meaning of the Private Securities
Litigation Reform Act of 1995. Such forward-looking statements involve known
and unknown risks, uncertainties and other factors that may cause the actual
results, performance or achievements of the Company or industry results to be
materially different from any future results, performance or achievements
expressed or implied by such forward-looking statements. Such factors include,
among others, the following: (i) general economic and business conditions,
(ii) competition; (iii) existing laws and governmental regulations and changes
in, or the failure to comply with laws on governmental regulations; (iv) the
outcome of the known and unknown governmental investigations of the Company's
business practices; (v) the recently enacted changes in the Medicare and
Medicaid programs affecting reimbursement to healthcare providers and
insurers; (vi) legislative proposals for healthcare reform; (vii) the ability
to enter into managed care provider arrangements on acceptable terms; (viii)
liability and other claims asserted against the Company; (ix) changes in
business strategy or development plans; (x) the ability to attract and retain
qualified management and personnel, including physicians; (xi) the
availability and terms of capital to fund the expansion of the Company's
business, including the acquisition of additional facilities; (xii) Year 2000
issues. Given these uncertainties, prospective investors are cautioned not to
place undue reliance on such forward-looking statements. The Company disclaims
any obligation to update any such factors or to publicly announce the results
of any revisions to any of the forward-looking statements contained herein to
reflect future events or developments.
 
                                      24
<PAGE>
 
                ITEM 2. MANAGEMENT'S DISCUSSION AND ANALYSIS OF
           FINANCIAL CONDITION AND RESULTS OF OPERATIONS--(CONTINUED)
                                 OPERATING DATA
 
<TABLE>
<CAPTION>
CONSOLIDATED                                                  1998     1997
- ------------                                                 ------- ---------
<S>                                                          <C>     <C>
Number of hospitals in operation at:
  March 31..................................................     310       314
  June 30...................................................     309       315
  September 30..............................................               314
  December 31...............................................               309
Number of freestanding outpatient surgical centers in
 operation at:
  March 31..................................................     142       143
  June 30 (a)...............................................     139       145
  September 30..............................................               143
  December 31...............................................               140
Licensed hospital beds at (b):
  March 31..................................................  60,739    60,993
  June 30...................................................  60,418    61,275
  September 30..............................................            61,071
  December 31...............................................            60,643
Weighted average licensed beds (c):
 Quarter:
  First.....................................................  60,765    61,222
  Second....................................................  60,712    61,203
  Third.....................................................            60,981
  Fourth....................................................            60,983
 Year.......................................................            61,096
Average daily census (d):
 Quarter:
  First.....................................................  28,758    28,401
  Second....................................................  25,515    25,921
  Third.....................................................            24,343
  Fourth....................................................            25,411
 Year.......................................................            26,006
Admissions (e):
 Quarter:
  First..................................................... 507,600   497,200
  Second.................................................... 474,400   477,200
  Third.....................................................           461,700
  Fourth....................................................           479,000
 Year.......................................................         1,915,100
Equivalent Admissions (f):
 Quarter:
  First..................................................... 755,800   731,900
  Second.................................................... 731,900   729,600
  Third.....................................................           711,300
  Fourth....................................................           728,600
 Year.......................................................         2,901,400
Average length of stay (days) (g):
 Quarter:
  First.....................................................     5.1       5.1
  Second....................................................     4.9       4.9
  Third.....................................................               4.9
  Fourth....................................................               4.9
 Year.......................................................               5.0
</TABLE>
 
                                       25
<PAGE>
 
                ITEM 2. MANAGEMENT'S DISCUSSION AND ANALYSIS OF
          FINANCIAL CONDITION AND RESULTS OF OPERATIONS--(CONTINUED)
                          OPERATING DATA (CONTINUED)
 
<TABLE>
<CAPTION>
NON-CONSOLIDATED (h)        1998  1997
- --------------------        ----- -----
<S>                         <C>   <C>
Number of hospitals in
 operation at:
  March 31................     26    27
  June 30.................     26    27
  September 30............           27
  December 31.............           27
Number of freestanding
 outpatient surgical
 centers in operation at:
  March 31................      5     5
  June 30.................      5     5
  September 30............            5
  December 31.............            5
Licensed hospital beds at:
  March 31................  6,357 6,537
  June 30.................  6,317 6,641
  September 30............        6,455
  December 31.............        6,455
</TABLE>
- --------
(a) Amounts include 34 surgery centers which were sold by the Company in July
    1998.
(b) Licensed beds are those beds for which a facility has been granted
    approval to operate from the applicable state licensing agency.
(c) Weighted average licensed beds represents the average number of licensed
    beds weighted based on periods owned.
(d) Average daily census represents the average number of patients in hospital
    beds each day.
(e) Admissions represent the total number of patients admitted (in the
    facility for a period in excess of 23 hours) to the Company's hospitals.
(f) Equivalent admissions are computed by multiplying admission (inpatient
    volume) by the sum of gross inpatient revenue and gross outpatient revenue
    and then dividing the resulting amount by gross inpatient revenue. The
    equivalent admissions computation "equates" outpatient revenue to the
    volume measure (admissions) used to measure inpatient volume resulting in
    a general measure of combined inpatient and outpatient volume.
(g) Average length of stay represents the average number of days admitted
    patients stay in the Company's hospitals.
(h) The non-consolidated facilities include facilities operated through 50/50
    joint ventures which are not controlled by Columbia. They are accounted
    for using the equity method of accounting and therefore, are not included
    on a fully consolidated basis in the condensed consolidated financial
    statements.
 
                                      26
<PAGE>
 
                          PART II: OTHER INFORMATION
 
ITEM 1: LEGAL PROCEEDINGS.
 
FEDERAL AND STATE INVESTIGATIONS
 
  In March 1997, various facilities of the Company's El Paso, Texas operations
were searched by federal authorities pursuant to search warrants, and the
government removed various records and documents. In February 1998, an
additional warrant was executed and a single computer was seized.
 
  In July 1997, various Company affiliated facilities and offices were
searched pursuant to search warrants issued by the United States District
Court in several states. During July, September and November 1997, the Company
was also served with subpoenas requesting records and documents related to
laboratory billing and diagnosis related group ("DRG") coding in various
states and home health operations in various jurisdictions, including, but not
limited to, Florida. In January 1998, the Company received a subpoena which
requested records and documents relating to physician relationships.
 
  Also, in July 1997, the United States District Court for the Middle District
of Florida, in Fort Myers, issued an indictment against three employees of a
subsidiary of the Company. The indictment relates to the alleged false
characterization of interest payments on certain debt resulting in Medicare
and CHAMPUS overpayments since 1986 to Columbia Fawcett Memorial Hospital, a
Port Charlotte, Florida hospital that was acquired by the Company in 1992. The
Company has been served with subpoenas for various records and documents. A
fourth employee of a subsidiary of the Company was indicted on July 22, 1998
by a superseding indictment.
 
  In addition, several hospital facilities affiliated with the Company in
various states have received individual federal and/or state government
inquiries, both informal and formal, requesting information related to
reimbursement from government programs.
 
  The Company is cooperating in these investigations and understands, through
written notice and other means, that it is a target in these investigations.
 
  Given the scope of the ongoing investigations, the Company expects
additional subpoenas and other investigative and prosecutorial activity to
occur in these and other jurisdictions in the future.
 
  The Company is also the subject of a formal order of investigation by the
Securities and Exchange Commission. The Company understands that the
investigation relates to the anti-fraud, periodic reporting and internal
accounting control provisions of the federal securities laws.
 
  While it is too early to predict the outcome of any of the ongoing
investigations or the initiation of any additional investigations, were the
Company to be found in violation of federal or state laws relating to
Medicare, Medicaid or similar programs, the Company could be subject to
substantial monetary fines, civil and criminal penalties and exclusion from
participation in the Medicare and Medicaid programs. Any such sanctions could
have a material adverse effect on the Company's financial position and results
of operations. (See NOTE 2 and NOTE 9 of the Notes to Condensed Consolidated
Financial Statements.)
 
LAWSUITS
 
 Qui Tam Actions
 
  Several qui tam actions have been brought by private parties ("relators") on
behalf of the United States of America and have been unsealed and served on
the Company. The government has declined to intervene in the qui tam actions
unsealed to date. To the best of the Company's knowledge, the actions allege,
in general, that the Company and certain subsidiaries and/or affiliated
partnerships violated the False Claims Act, 31 U.S.C. (S)3729 et seq., for
improper claims submitted to the government for reimbursement. The lawsuits
seek damages of three times the amount of all Medicare or Medicaid claims
(involving false claims) presented by the defendants to the federal
government, civil penalties of not less than $5,000 nor more than $10,000 for
each such Medicare or Medicaid claim, attorneys' fees and costs. The Company
is aware of additional qui tam actions that remain under seal and believes
that there are other sealed qui tam cases that it is unaware of.
 
                                      27
<PAGE>
 
  The matter of United States of America, ex rel. Scott Pogue v. Diabetes
Treatment Centers of America, Inc., et al., Civil Action No. 3-94-0515 was
filed under seal on June 23, 1994 in the United States District Court for the
Middle District of Tennessee. On February 6, 1995, the United States filed its
Notice of Non-Intervention and on that same date, the District Court ordered
the complaint unsealed. In general, the relator contends that sums paid to
physicians by the Diabetes Treatment Centers of America, who served as Medical
Directors at a hospital affiliated with the Company, were unlawful payments
for the referrals of their patients. Plaintiffs have filed a motion for
partial summary judgment which is pending.
 
  A lawsuit captioned United States of America ex rel. James Thompson v.
Columbia/HCA Healthcare Corporation, et al., was filed on March 10, 1995 in
the United States District Court for the Southern District of Texas, Corpus
Christi Division (Civil Action No. C-95-110). In general, the relator claims
that the defendants (the Company and certain subsidiaries and affiliated
partnerships) engaged in a widespread strategy to pay physicians money for
referrals and engaged in other conduct to induce referrals, such as: (i)
offering physicians equity interests in hospitals; (ii) offering loans to
physicians; (iii) paying money under the guise of "consultation fees" to
physicians to guarantee their capital investment; (iv) paying consultation
fees, rent or other monies to physicians; (v) providing free or reduced rate
rents for office space; (vi) providing free or reduced rate vacations and
trips; (vii) providing free or reduced rate opportunities for additional
medical training; (viii) providing income guarantees; and (ix) granting
physicians exclusive rights to perform procedures in particular fields of
practice. The defendants filed a Motion to Dismiss the Second Amended
Complaint in November 1995 which was granted by the Court in July 1996. In
August 1996, the relator appealed to the United States Court of Appeals for
the Fifth Circuit, and in October 1997, the Fifth Circuit affirmed in part and
vacated and remanded in part the Trial Court's rulings. Defendants filed a
Second Amended Motion to Dismiss which is currently pending and has not yet
been ruled on.
 
  On December 21, 1995, a matter entitled United States of America ex rel.,
Roy Meidinger vs. Lee Memorial Health System, et al., Case No. 95-423-FTM-99D,
was filed in the United States District Court for the Middle District Court of
Florida, Fort Myers Division. This case was brought against approximately
2,500 health care providers and insurance companies, including Columbia
Southwest Regional Medical Center, and generally concerns misrepresentation of
customary charges to HCFA. In December 1996, the United States declined to
intervene. In June 1997, the District Court entered an order directing relator
to serve the defendants. In late November and early December 1997, each of the
six defendants moved to dismiss the Complaint. In January 1998, relator filed
his opposition to the defendants' motion to dismiss. The Court has not yet
ruled on the defendants' motions.
 
  The matter of United States of America ex rel. Sandra Russell; and Sandra
Russell, in her own right v. EPIC Healthcare Management Group, et al., No. H-
95-99151, was filed on January 18, 1995 in the United States District Court
for the Southern District of Texas, Houston Division. The complaint alleges
that the defendants submitted claims, records and/or statements for Medicare
reimbursement in connection with home health services which were false. The
defendants moved to dismiss in May 1997. The Court granted defendants' motion
giving relator the right to replead. Relator filed an amended complaint.
Defendants filed a second motion to dismiss which was granted on June 25,
1998. To date, no Notice of Appeal has been filed.
 
  The matter of Mary Ann Wisz, Individually, and ex rel. United States of
America v. C/HCA Development, Inc. d/b/a Columbia-Olympia Fields Osteopathic
Hospital and Medical Center, Inc., et al., Case No. 97-C-2646, was filed on
April 16, 1998 in the United States District Court for the Northern District
of Illinois, Eastern Division. An amended complaint was filed on February 17,
1998 and on May 15, 1998, plaintiff was permitted leave to file its Second
Amended Complaint. In addition to adding Midwestern University as a party
defendant, the Second Amended Complaint contained allegations that Olympia
Fields Osteopathic Hospital and Medical Center and/or the Chicago Osteopathic
Hospital changed dates on out-patient surgical procedures. That portion of the
Second Amended Complaint has been answered and discovery is ongoing. The
Second Amended Complaint also alleges that one or both hospitals directed
surgical nurses to misdesignate the severity of surgeries. That portion of the
Second Amended Complaint is subject to a partial motion to dismiss, which
motion has been fully briefed and is currently pending.
 
                                      28
<PAGE>
 
  The Company intends to pursue the defense of the qui tam actions vigorously.
 
 Shareholder Derivative and Class Action Complaints Filed in the U.S. District
Courts
 
  Since April 1997, numerous securities class action and derivative lawsuits
have been filed in the United States District Court for the Middle District of
Tennessee against the Company and a number of its current and former
directors, officers and/or employees.
 
  On October 10, 1997, the Court entered an order consolidating all of the
securities class action claims into a single-captioned case, Morse, Sidney, et
al. v. R. Clayton McWhorter, et al., Case No. 3-97-0370. All of the other
individual securities class action lawsuits were administratively closed by
the Court. The consolidated Morse lawsuit is a purported class action seeking
the certification of a class of persons or entities who acquired the Company's
common stock from April 9, 1994 to September 9, 1997. The consolidated lawsuit
was brought against the Company, Richard Scott, David Vandewater, Thomas
Frist, Jr., R. Clayton McWhorter, Carl E. Reichardt, Magdalena Averhoff, M.D.,
T. Michael Long, and Donald S. MacNaughton. The lawsuit alleges, among other
things, that the defendants committed violations of the federal securities
laws by materially inflating the Company's revenues and earnings through a
number of practices, including upcoding, maintaining reserve cost reports,
disseminating false and misleading statements, cost shifting, illegal
reimbursements, improper billing, unbundling and violating various Medicare
laws. The lawsuit seeks damages, costs and expenses. Plaintiffs filed their
Motion for Class Certification in February 1998, and defendants filed
responsive briefs. No ruling has been made on class certification.
 
  On October 10, 1997, the Court entered an order consolidating all of the
derivative law claims into a single-captioned case, McCall, H. Carl, as
Comptroller of the State of New York and as Trustee of the New York State
Common Retirement Fund, derivatively on behalf of Columbia/HCA Healthcare
Corporation v. Richard L. Scott, et al., No. 3-97-0838. All of the other
derivative lawsuits were administratively closed by the Court. The
consolidated McCall lawsuit was brought against the Company, Thomas Frist,
Jr., Richard L. Scott, David T. Vandewater, R. Clayton McWhorter, Magdalena
Averhoff, M.D., Frank S. Royal, M.D., T. Michael Long, William T. Young and
Donald S. MacNaughton. The lawsuit alleges, among other things, derivative
claims against the individual defendants that they intentionally or
negligently breached their fiduciary duties to the Company by authorizing,
permitting, or failing to prevent the Company from engaging in various schemes
to improperly increase revenue, upcoding, improper cost reporting, improper
referrals, improper acquisition practices and overbilling. In addition, the
lawsuit asserts a derivative claim against some of the individual defendants
for breaching their fiduciary duties by engaging in insider trading. The
lawsuit seeks restitution, damages, recoupment of fines or penalties paid by
the Company, restitution and pre-judgment interest against the alleged insider
trading defendants, and costs and disbursements. In addition, the lawsuit
seeks orders: (i) prohibiting the Company from paying individual defendants
employment benefits; (ii) terminating all improper business relationships with
individual defendants; and (iii) requiring the Company to implement effective
corporate governance and internal control mechanisms designed to monitor
compliance with federal and state laws and ensure reports to the board of
material violations.
 
  The defendants filed motions to dismiss in both the Morse and McCall
lawsuits. These motions were referred to the Magistrate Judge for
consideration. In June 1998, the Magistrate Judge recommended that the Court
grant the motions to dismiss in both cases. Plaintiffs in both cases have
filed objections to the Magistrate's recommendations with the District Court,
and defendants will be filing responsive pleadings.
 
 Shareholder Derivative Actions Filed in State Courts
 
  Several derivative actions have been filed in state court by certain
purported stockholders of the Company against certain of the Company's current
and former officers and directors alleging breach of fiduciary duty, and
failure to take reasonable steps to ensure that the Company did not engage in
illegal practices thereby exposing the Company to significant damages.
 
                                      29
<PAGE>
 
  Two purported derivative actions entitled Barron, Evelyn, et al. v.
Magdelena Averhoff, et al., Civil Action No. 15822NC, filed on July 22, 1997,
and Kovalchick, John E. v. Magdelena Averhoff, et al. Civil Action No.
15829NC, filed on July 29, 1997, have been filed in the Court of Chancery of
the State of Delaware in and for New Castle County. The actions were brought
on behalf of the Company by certain purported shareholders of the Company
against certain of the Company's current and former officers and directors.
The suits seek damages, attorneys' fees and costs. In the Barron lawsuit,
plaintiffs also seek an Order (i) requiring individual defendants to return to
the Company all salaries or remunerations paid them by the Company, together
with proceeds of the sale of Columbia stock made in breach of their fiduciary
duties; (ii) prohibiting the Company from paying any individual defendant any
benefits pursuant to the terms of employment, consulting or partnership
agreements; and (iii) terminating all improper business relationships between
the Company and any individual defendant. In the Kovalchick lawsuit,
plaintiffs also seek an Order (i) requiring individual defendants to return to
the Company all salaries or remunerations paid to them by the Company and all
proceeds from the sale of Columbia stock made in breach of their fiduciary
duties; (ii) requiring that an impartial Compliance Committee be appointed to
meet regularly; and (iii) requiring that the Company be prohibited from paying
any director/defendant any benefits pursuant to terms of employment,
consulting or partnership agreements. On August 14, 1997, a similar purported
derivative action entitled State Board of Administration of Florida, the
public pension fund of the State of Florida in behalf of itself and in behalf
of all other stockholders of Columbia/HCA Healthcare Corporation derivatively
in behalf of Columbia/HCA Healthcare Corporation vs. Magdalena Averhoff, et
al., No. 97-2729, was filed in the Circuit Court in Davidson County, Tennessee
on behalf of the Company by certain purported shareholders of the Company
against certain of the Company's current and former directors and officers.
These lawsuits seek damages and costs as well as orders (i) enjoining the
Company from paying benefits to individual defendants; (ii) requiring
termination of all improper business relationships with individual defendants;
(iii) requiring the Company to provide for "independent public directors"; and
(iv) requiring the Company to put in place proper mechanisms of corporate
governance.
 
  The matter of Louisiana State Employees Retirement System, a public pension
fund of the State of Louisiana, in behalf of itself and in behalf of all other
stockholders of Columbia/HCA Healthcare Corporation derivatively in behalf of
Columbia/HCA Healthcare Corporation v. Magdalena Averhoff, et al., another
derivative action, was filed on March 19, 1998 in the Circuit Court of the
Eleventh Judicial Circuit, Dade County, Florida, General Jurisdiction Division
(Case No. 98-6050 CA04) and the defendants removed it to the United States
District Court, Southern District of Florida (Case No. 98-814-CIV). The
Louisiana State Employees Retirement System is the public pension fund of the
State of Louisiana. The suit alleges, among other things, breach of fiduciary
duties resulting in damage to the Company. The lawsuit seeks damages from the
individual defendants to be paid to the Company and attorneys' fees, costs and
expenses. In addition, the lawsuit seeks orders (i) requiring the individual
defendants to pay to the Company all benefits received by them from the
Company; (ii) enjoining the Company from paying any benefits to individual
defendants; (iii) requiring that defendants terminate all improper business
relationships with the Company and any individual defendants; (iv) requiring
that the Company provide for appointment of a majority of "independent public
directors"; and (v) requiring that the Company put in place proper mechanisms
of corporate governance. On August 10, 1998, the Court transferred this case
to the Middle District of Tennessee.
 
  The Company intends to pursue the defense of these federal and state
Shareholder Derivative and Class Action Complaints vigorously.
 
 Patient/Payer Actions and Other Class Actions
 
  The Company has from time to time received several purported class action
lawsuits which have been filed by patients and/or payers against the Company
and/or certain of its current and/or former officers and/or directors
alleging, in general, improper and fraudulent billing, overcharging, coding
and physician referrals, as well as other violations of law. Certain of the
lawsuits have been conditionally certified as class actions.
 
  The matter of Boyson, Cordula, on behalf of herself and all others similarly
situated v. Columbia/HCA Healthcare Corporation was filed on September 8, 1997
in the United States District Court for the Middle
 
                                      30
<PAGE>
 
District of Tennessee, Nashville Division (Civil Action No. 3-97-0936). The
lawsuit, which seeks certification of a national class comprised of all
persons or entities who have paid for medical services provided by the
Company, alleges, among other things, that the Company has engaged in a
pattern and practice of (i) inflating diagnosis and medical treatments of its
patients to receive larger payments from the purported class members; (ii)
providing unnecessary medical care; and (iii) billing for services never
rendered. This lawsuit seeks injunctive relief requiring the Company to
perform an accounting to identify and disgorge medical bill overcharges. It
also seeks damages, attorneys' fees, interest and costs. The defendant filed
its Answer in November 1997. Plaintiff filed a Motion for Class Certification,
and the defendant's opposition to this motion was filed in March 1998. A first
case management conference is scheduled to take place on August 21, 1998 in
the lawsuits against the Company, including the Boyson suit, that have been
consolidated by the Judicial Panel on Multi-District Litigation (the "MDL
Panel") in the Middle District of Tennessee. (See below) At the conference,
the Court is expected to set a schedule for pre-certification discovery and
class certification motion practice.
 
  The matter of Brown, Nancy, individually and on behalf of all others
similarly situated v. Columbia/HCA Healthcare Corporation was filed on
November 16, 1995, in the Circuit Court of Palm Beach County, Florida, Case
No. 95-9102 AD. This suit alleges that the hospital has charged excessive
amounts for items such as pharmaceuticals, medical supplies, laboratory tests,
medical equipment and related medical services. The suit seeks certification
of a nationwide class and damages for patients who have paid bills containing
allegedly excessive amounts for the allegedly unreasonable portion of the
charges as well as interest, attorneys' fees and costs. Plaintiff amended the
Complaint and the defendant filed an Answer and defenses in June 1996. In
October 1997, Harald Jackson moved to intervene in the lawsuit. The Court
denied Jackson's Motion in December 1997, and he filed a separate lawsuit
referenced below. No class has been certified.
 
  In October 1997, Colville, Douglas, et al. v. Columbia/Palm Drive Hospital,
et al., inclusive was filed in the Sonoma County Superior Court, California,
Case No. 217646. The suit seeks certification of a class comprised of
uninsured patients treated at the Company's hospitals and entities in
California who have been treated and charged different fees than any other
patient. The suit alleges, among other things, that the Company fraudulently
overcharged the plaintiffs and that it unlawfully charged uninsured patients
at a higher rate for the same services, compared to patients with insurance or
Medicare. This lawsuit seeks damages, attorneys' fees and costs, restitution,
and injunctive relief. In March 1998, the Company filed a Demurrer Motion. The
Demurrer was granted in part and denied in part. Plaintiff filed an Amended
Complaint and the defendants filed a Second Demurrer Motion in June 1998. The
Court has not yet ruled on the Motion.
 
  Jane Doe and her husband, John Doe, on their own behalf, and on behalf of
all other persons similarly situated vs. HCA Health Services of Tennessee,
Inc. dba HCA Donelson Hospital nka Summit Medical Center is a class action
suit filed on August 17, 1992 in the First Circuit Court for Davidson County,
Tennessee, Case No. 92C-2041. The suit principally alleges that Summit Medical
Center's charges for hospital services and supplies for medical services (a
hysterectomy in the plaintiff's case) exceeded the reasonable costs of its
goods and services, that the overcharges constitute a breach of contract and
an unfair or deceptive trade practice as well as a breach of the duty of good
faith and fair dealing. This suit seeks damages, costs and attorneys' fees. In
addition, the suit seeks a declaratory judgment recognizing plaintiffs' rights
to be free from predatory billing and collection practices and an Order (i)
requiring defendants to notify plaintiff class members of entry of declaratory
judgment and (ii) enjoining defendants from further efforts to collect charges
from the plaintiffs. In 1997, this case was certified as a class action
consisting of all past, present and future patients at Summit Medical Center.
Defendant filed a Motion for Summary Judgment relying upon the favorable
decision of another Nashville Circuit Judge in a factually similar case. In
March 1997, the Court denied the Motion for Summary Judgment and ordered the
parties into mediation. In June 1998, the Court of Appeals denied defendant's
application for permission to appeal the trial court's denial of the summary
judgment motion. At this time, the defendant is working on an application for
permission to appeal to the Supreme Court of Tennessee. In addition, the trial
court withdrew the order for mediation pending defendant's appeal of the
summary judgment denial.
 
 
                                      31
<PAGE>
 
  Ferguson, Charles, on behalf of himself and all other similarly situated v.
Columbia/HCA Healthcare Corporation, et al., was filed on September 16, 1997
in the Circuit Court for Washington County, Tennessee, Civil Action No. 18679.
This lawsuit seeks certification of a national class comprised of all those
who paid or were responsible for payment of any portion of a bill for medical
care or treatment provided by the Company and alleges, among other things,
that the Company engaged in billing fraud by excessively billing patients for
services rendered, billing patients for services not rendered or not medically
necessary, uniformly using improper codes to report patient diagnosis, and
improperly and illegally recruiting doctors to refer patients to the Company's
hospitals. The suit seeks damages, interest, attorneys' fees, costs and
expenses. In addition, the suit seeks an Order (i) requiring defendants to
provide an accounting of plaintiffs and class members who overpaid or were
obligated to overpay; and (ii) requiring defendants to disgorge all monies
illegally collected from plaintiffs and the class. Plaintiff filed a Motion
for Class Certification in September 1997 which has not been ruled on. In
December 1997, the Company filed a Motion for Summary Judgment which was
denied. In January 1998, plaintiff filed a Motion for Leave to File a Second
Amended Class Action Complaint to Add an Additional Class Representative which
was granted but the Court dismissed the claims asserted by the additional
plaintiff.
 
  The matter of Douglas, Cheryl, individually, and on behalf of all others
similarly situated v. Columbia/HCA Healthcare Corporation, et al., is a
purported class action filed on March 5, 1998 in the Circuit Court of Cook
County, Illinois, County Department, Chancery Division, Case No. 98 CH 2942.
The suit is very similar to the Ferguson case and generally alleges that
defendants were involved in fraudulent and deceptive acts including wrongful
billing, unnecessary treatment and wrongful diagnosis of patients with
illnesses that necessitate higher medical fees for financial gain. The suit
seeks damages, costs and expenses. Various defendants have filed a motion to
dismiss, which has now been fully briefed, and the parties await the court's
ruling.
 
  The matter of Hoop, Kemp, et al. v. Columbia/HCA Healthcare Corporation, et
al. was filed on August 18, 1997 in the District Court of Johnson County,
Texas, Civil Action No. 249-171-97. This suit seeks certification of a Texas
class comprised of persons who paid for any portion of an improper or
fraudulent bill for medical services rendered by any Texas facility owned or
operated by the Company. The suit seeks damages, attorneys' fees, costs and
expenses, as well as restitution to plaintiffs and the class in the amount by
which defendants have been unjustly enriched and equitable and injunctive
relief. The lawsuit principally alleges that the Company perpetrated a
fraudulent scheme that consisted of systematic and routine overbilling through
false and inaccurate bills, including padding, billing for services never
provided, and exaggerating the seriousness of patients' illnesses. The lawsuit
also alleges that the Company systematically entered into illegal kickback
schemes with doctors for patient referrals. The Company filed its answer in
November 1997.
 
  The matter of Jackson, Harald F., individually and on behalf of all others
similarly situated v. Columbia/HCA Healthcare Corporation was filed on
December 23, 1997 in the Circuit Court, Palm Beach County, Florida, Civil
Action No. 97-011419. The suit seeks certification of a national class of
persons or entities that have paid for medical services, alleging, among other
things, that the Company systematically and unlawfully inflated prices,
concealed its practice of inflating prices and engaged in and concealed a
uniform practice of overbilling and damages. The lawsuit seeks damages.
Defendant has filed a motion to dismiss which is pending.
 
  The matter of Johnson, Bruce A., et al. v. Plantation General Hospital,
Limited Partnership was filed on March 9, 1992 in the Circuit Court for the
Seventeenth Judicial Circuit, State of Florida, Broward County, Case No. 92-
06823 Division 2. In general, the suit alleges that the hospital charged
excessive amounts for pharmaceuticals, medical supplies and laboratory tests.
The suit sought certification of a class. Count I sought a price reduction on
all outstanding bills in the amount of the allegedly excessive portion of the
charges. Counts II and III sought damages for patients who have paid bills
containing allegedly excessive amounts for the alleged unreasonable portion of
the charges. Plaintiffs also included a claim for attorneys' fees. On
September 18, 1995, the trial court certified a class and the Fourth District
Court of Appeals affirmed. In October 1996, the hospital filed a Motion for
Summary Judgment on Counts II and III on the basis of the voluntary payment
defense. The Court granted the motion in November 1997. In April 1998,
following the hospital's statement that it would deem
 
                                      32
<PAGE>
 
the six to eleven year old outstanding debt of class members to be fully
satisfied, summary judgment was granted to the class on Count I. No monetary
judgment was recovered. In July 1998, the Court orally denied plaintiffs'
motion for attorneys' fees. Time to appeal that decision has not expired.
 
  The matter of Operating Engineers Local No. 312 Health & Welfare Fund, on
behalf of itself and as representative of a class of those similarly situated
v. Columbia/HCA Healthcare Corporation was filed on August 6, 1997 in the
United States District Court for the Eastern District of Texas, Civil Action
No. 597CV203. The original complaint alleged violations of the Racketeering
Influenced and Corrupt Organization Act ("RICO") based on allegations that the
defendant has employed one or more schemes or artifices to defraud the
plaintiff and purported class members through fraudulent billing for services
not performed, fraudulent overcharging in excess of correct rates and
fraudulent concealment and misrepresentation. In October 1997, the Company
filed a motion to transfer venue and to dismiss the lawsuit on jurisdiction
and venue grounds because the RICO claims are deficient. The motion to
transfer was denied on January 23, 1998. The motion to dismiss was also
denied. In February 1998, defendant filed a petition with the MDL Panel to
consolidate this case with Boyson for pretrial proceedings in the Middle
District of Tennessee. During the pendency of the motion to consolidate,
plaintiff amended its complaint to add allegations under the Employee
Retirement Income Security Act of 1974 ("ERISA"), as well as state law claims.
The amended complaint seeks damages, attorneys' fees and costs, as well as
disgorgement and injunctive relief. The MDL Panel granted defendant's motion
to consolidate on June 11, 1998, and this action was transferred to the Middle
District of Tennessee.
 
  On April 24, 1998, two matters, Board of Trustees of the Carpenters &
Millwrights of Houston & Vicinity Welfare Trust Fund v. Columbia/HCA
Healthcare Corporation, No. 598CV157, and Board of Trustees of the Texas
Ironworkers' Health Benefit Plan v. Columbia/HCA Healthcare Corporation, Case
No. 598CV158, were filed in the United States District Court for the Eastern
District of Texas. The original complaint in these suits alleged violations of
RICO only. Plaintiffs in both cases principally alleged that in order to
inflate its revenues and profits, defendant engaged in fraudulent billing for
services not performed, fraudulent overcharging in excess of correct rates and
fraudulent concealment and misrepresentation. These suits seek damages,
attorneys' fees and costs, as well as disgorgement and injunctive relief.
Plaintiffs subsequently amended their complaint to add allegations under ERISA
as well as state law claims. These suits have been consolidated by the MDL
Panel with Boyson and transferred to the Middle District of Tennessee for
pretrial proceedings.
 
  The matter of Tennessee Laborers Health and Welfare Fund, on behalf of
itself and all others similarly situated vs. Columbia/HCA Healthcare
Corporation, No. 3-98-0437, was filed in the United States District Court of
the Middle District of Tennessee, Nashville Division, on May 14, 1998. The
lawsuit seeks certification of a national class comprised of all employee
welfare benefit plans that have paid for medical services provided by the
Company. This case involves allegations under ERISA, as well as state law
claims which are similar to those alleged in Boyson. Plaintiff, an Employee
Welfare Benefit Plan, alleges that defendant violated the terms of the Plan
documents by overbilling the Plans, including but not limited to, exaggerating
the severity of illnesses, providing unnecessary treatment, billing for
services not rendered and other methods of overbilling and further violated
the terms of the Plan documents by taking Plan assets in payment of such
improper bills. Plaintiff further alleges that defendant intentionally
concealed or suppressed the true nature of its patients' illnesses, and the
actual treatment provided to those patients, and its improper billing. The
suit seeks injunctive relief in the form of an accounting, damages, attorneys'
fees, interest, and costs.
 
  The matter of Landgraff, Anne M. and Gina Magarian, on behalf of the
Columbia/HCA Stock Bonus Plan v. Columbia/HCA Healthcare Corporation of
America, et al., was filed on November 7, 1997 in the United States District
Court for the Northern District of Georgia, Atlanta Division, Civil Action No.
97-CV-3381. The suit seeks certification of a class of all participants in the
Columbia/HCA Stock Bonus Plan, alleging violations of ERISA. The suit
generally alleges that the Company breached its fiduciary duty to plan
participants, fraudulently concealed information from the public and
fraudulently inflated the Company's stock price through billing fraud and
illegal kickbacks for physician referrals. The suit seeks damages, interest,
attorneys' fees and costs, as well as an Order requiring defendants to
transfer management of Plan to a third-party. In January 1998, the parties
 
                                      33
<PAGE>
 
stipulated to transfer venue of the case to the United States District Court
for the Middle District of Tennessee. Defendants filed a Motion to Dismiss in
March 1998 which was denied. A scheduling order has been entered and a trial
date of June 8, 1999 has been set.
 
  The Company intends to pursue the defense of these class actions vigorously.
 
  While it is premature to predict the outcome of the qui tam, shareholder
derivative and class action lawsuits, the amounts claimed may be substantial.
It is possible that an adverse resolution, individually or in the aggregate,
could have a materially adverse impact on the Company's liquidity, financial
position and results of operations. See NOTES 2 and 9 of the Notes to
Consolidated Financial Statements.
 
  The Company believes the ongoing investigations, qui tam, shareholder cases,
class action cases and related media coverage are having a negative effect on
the Company's financial position and results of operations.
However, the Company is unable to measure the effect or predict the magnitude
that these matters and the related media coverage could have on the Company's
future results of operations and financial position.
 
 General Liability Claims
 
  A class action styled Mary Forsyth, et al. vs. Humana, Inc., et al., Case
No. CV-S-89-249-DWH, was filed on March 29, 1989, in the United States
District Court for the District of Nevada. Plaintiffs are two classes of
individuals who paid for, or received coverage under, group insurance policies
sold in the State of Nevada by Humana Insurance. They allege violations of
antitrust laws, ERISA and RICO which arise from the sale of the policies and
from incentives provided under the policies for insureds to use Humana Sunrise
Hospital in Las Vegas. The suit seeks attorneys' fees and costs, as well as
injunctive relief and insurance benefits for plaintiffs. In 1993, the United
States District Court granted summary judgment dismissing most of plaintiff's
claims but granted plaintiffs judgment on one claim that is assessed as having
a maximum exposure of under $4 million, plus attorneys' fees. Plaintiffs
appealed to the United States Court of Appeals for the Ninth Circuit which, in
May 1997, affirmed the judgment on the ERISA claims; reversed as to the
antitrust claims; and reversed in part as to the RICO claims, but affirmed the
District Court's grant of summary judgment limiting RICO damages to three
times the ERISA damages, with exposure assessed at under $12 million. In their
current complaint, plaintiffs claim approximately $133 million in antitrust
damages that is subject to statutory trebling. However, in their most recent
expert report, plaintiff's expert claims antitrust damages of approximately
$13-$21 million. Humana has petitioned the Supreme Court for a Writ of
Certiorari on the RICO claims which was granted. The antitrust claims have
been remanded to the United States District Court in Nevada. The District
Court has indicated that it is unlikely to set a trial date until the United
States Supreme Court rules on the merits of the claims presented in the
Petition for Writ of Certiorari. Humana filed a Motion for Summary Judgment on
all remaining antitrust claims raising issues that were not reached by the
District Court.
 
  On December 4, 1997, a lawsuit captioned Florida Software Systems, Inc., a
Florida corporation v. Columbia/HCA Healthcare Corporation, a Delaware
corporation was filed in the United States District Court for the Middle
District of Florida (Civil Action No. 97-2866-C.V.-T-17b). The lawsuit alleges
that the defendant breached an agreement under which Florida Software Systems,
Inc. was allegedly granted the exclusive right to provide medical claims
management for certain claims made by the Company for payment to any third
party payors in connection with the rendition of medical care or services. The
lawsuit alleges claims for fraud, breach of implied contract and breach of
contract. The lawsuit seeks damages, attorneys' fees and costs, as well as
injunctive relief.
 
  The Company intends to pursue the defense of these actions vigorously.
 
  The Company is also subject to claims and suits arising in the ordinary
course of business, including claims for personal injuries or for wrongful
restriction of, or interference with, physicians' staff privileges. In certain
of
 
                                      34
<PAGE>
 
these actions the claimants have asked for punitive damages against the
Company, which are usually not covered by insurance. In the opinion of
management, the ultimate resolution of these pending claims and legal
proceedings will not have a material adverse effect on the Company's results
of operations or financial position.
 
  The above information updates the Legal Proceedings section of the Company's
annual report on Form 10-K for the year ended December 31, 1997 and the
Company's quarterly report Form 10-Q for the period ended March 31, 1998.
 
                                      35
<PAGE>
 
ITEM 4: SUBMISSION OF MATTERS TO A VOTE OF SECURITY HOLDERS
 
  The Company's annual meeting of stockholders was held on May 14, 1998. The
following matters were voted upon at the meeting:
 

  1. Election of directors:
<TABLE>
<CAPTION>
                                             VOTES IN      VOTES
                                               FAVOR     WITHHELD
                                            ----------- -----------
     <S>                                    <C>         <C>         <C>
     Frederick W. Gluck..................   540,122,876   6,665,545
     T. Michael Long.....................   533,818,901  12,969,520
     Carl E. Reichardt...................   533,710,020  13,078,401
<CAPTION>
                                             VOTES IN      VOTES
                                               FAVOR      AGAINST   ABSTENTIONS
                                            ----------- ----------- -----------
 <C> <S>                                    <C>         <C>         <C>
  2. Amendment to the Company's Restated
     Certificate of Incorporation to
     provide for the annual election of
     directors...........................   492,615,837   3,552,188    907,056
  3. Amendments to the Columbia Hospital
     Corporation Outside Directors
     Nonqualified Stock Option Plan......   470,705,843  74,934,716  1,147,854
  4. Ratification of Ernst & Young LLP as
     the Company's auditors..............   545,464,624     848,985    474,809
  5. Stockholder proposal relating to
     tobacco investments.................    21,610,438 468,877,914  6,586,420
  6. Stockholder proposal related to
     equal access to proxy statement.....    32,215,038 462,652,399  2,207,633
</TABLE>
 
ITEM 6: EXHIBITS AND REPORTS ON FORM 8-K.
 
  (a) List of Exhibits:
 
<TABLE>
 <C>           <S>
 Exhibit 3(a)  --Amendment to the Restated Certificate of Incorporation.*
 Exhibit 3(b)  --Amendment to the By-laws of the Company.*
 Exhibit 10(a) --Third Amendment to the 364 Day Agreement, dated as of July 10,
                1998.*
 Exhibit 10(b) --Fourth Amendment to the Five-Year Agreement and Amendment,
                dated as of July 10, 1998.*
 Exhibit 10(c) --$1,000,000,000 Agreement dated as of July 10, 1998 among the
                Company, The Several Banks and Other Financial Institutions and
                NationsBank, N.A. as Documentation Agent, The Bank of Nova
                Scotia and Deutsche Bank Securities, as Co-Syndication Agents
                and The Chase Manhattan Bank, as Agent.*
 Exhibit 12    --Statement re Computation of Ratio of Earnings to Fixed
                Charges.
 Exhibit 27    --Financial Data Schedule*
</TABLE>
- --------
* Included only in filings under the Electronic Data, Gathering, Analysis, and
  Retrieval system.
 
  (b) Reports on Form 8-K filed during the quarter ended June 30, 1998:
 
  On May 19, 1998, the Company filed a report on Form 8-K announcing it had
reached an agreement to sell 22 hospitals to a consortium of not-for-profit
entities.
 
                                      36
<PAGE>
 
                                  SIGNATURES
 
  PURSUANT TO THE REQUIREMENTS OF THE SECURITIES EXCHANGE ACT OF 1934, THE
REGISTRANT HAS DULY CAUSED THIS REPORT TO BE SIGNED ON ITS BEHALF BY THE
UNDERSIGNED THEREUNTO DULY AUTHORIZED.
 
                                          Columbia/HCA Healthcare Corporation
 
                                                /s/ Kenneth C. Donahey
                                          -------------------------------------
                                                    KENNETH C. DONAHEY
Date: August 13, 1998                           SENIOR VICE PRESIDENT AND
                                                CONTROLLER
                                                  (PRINCIPAL ACCOUNTING
                                                  OFFICER)
 
                                      37

<PAGE>
                                                                    EXHIBIT 3(a)
 
                     RESTATED CERTIFICATE OF INCORPORATION
                                      OF
                        COLUMBIA HEALTHCARE CORPORATION

     Columbia Healthcare Corporation, a corporation organized and existing under
the laws of the State of Delaware, hereby certifies as follows:

     1.   The name of the corporation is Columbia Healthcare Corporation.
Columbia Healthcare Corporation was originally incorporated under the same name
and the original Certificate of Incorporation of the corporation was filed with
the Secretary of State of Delaware on July 7, 1993. A Restated Certificate of
Incorporation of the Corporation was filed with the Secretary of State of
Delaware on August 26, 1993.

     2.   Pursuant to Sections 242 and 245 of the General Corporation Law of the
State of Delaware, this Restated Certificate of Incorporation restates and
amends the provisions of the Restated Certificate of Incorporation of the
Corporation.

     3.   The text of the Restated Certificate of Incorporation is hereby
restated and amended to read in its entirety as follows:

     FIRST: The name of the Corporation is

     COLUMBIA/HCA HEALTHCARE CORPORATION

     SECOND: The address of the Corporation's registered office in the State of
Delaware is 1209 Orange Street, in the City of Wilmington, County of New Castle,
Delaware 19801. The name of its registered agent at such address is The
Corporation Trust Company.

     THIRD: The purpose of the Corporation is to engage in any lawful act or
activity for which corporations may be organized under the General Corporation
Law of Delaware.

     FOURTH: The total number of shares of all classes of capital stock which
the Corporation shall have the authority to issue is Eight Hundred and Fifty
Million (850,000,000) shares, divided into three classes of which Twenty Five
Million (25,000,000) shares, par value $.01 per share, shall be designated
Preferred Stock, Eight Hundred Million (800,000,000) shares, par value $.01 per
share, shall be designated Common Stock and Twenty Five Million (25,000,000)
shares, par value $.01 per share, shall be designated Nonvoting Common Stock.

 A.  Preferred Stock

  1.  Issuance.  The Board of Directors is authorized, subject to limitations
prescribed by law, to provide for the issuance of shares of Preferred Stock in
one or more series, to establish the number of shares to be included in each
such series, and to fix the designations, powers, preferences, and rights of the
shares of each such series, and any qualifications, limitations or restrictions
thereof.

 2.  Series A Preferred Stock and Series B Preferred Stock.

  Section 1.  Designation and Amount.  Eight million (8,000,000) shares of the
Preferred Stock of the Corporation shall be designated as "Series A
Participating Preferred Stock," par value $.01 per share (the "Series A
Preferred Stock") and two hundred fifty thousand (250,000) shares of the
Preferred Stock of the Corporation shall be designated as "Series B
Participating Preferred Stock," par value $.01 per share (the "Series B
Preferred Stock"). The number of shares of each such series of Preferred Stock
may be increased or decreased by resolution of the Board of Directors; provided
that no decrease shall reduce the number of shares of either of such series of
Preferred Stock to a number less than that of the shares of such series then
outstanding plus the number of shares issuable upon exercise of outstanding
rights, options or warrants or upon conversion of outstanding securities issued
by the Corporation.
<PAGE>
 
 Section 2.  Dividends and Distributions.

     (A) Subject to the prior and superior rights of the holders of any shares
of stock of the Corporation ranking prior and superior to the shares of Series A
Preferred Stock and Series B Preferred Stock with respect to dividends, the
holders of shares of Series A Preferred Stock and Series B Preferred Stock shall
be entitled to receive, when, as and if declared by the Board of Directors out
of assets legally available for the purpose, quarterly dividends payable in cash
on the first business day of January, April, July and October in each year (each
such date being referred to herein as a "Quarterly Dividend Payment Date"),
commencing on the first Quarterly Dividend Payment Date after the first issuance
of a share or fraction of a share of Series A Preferred Stock or Series B
Preferred Stock, in an amount per share (rounded to the nearest cent) equal to
the greater of (a) $1.00 or (b) subject to the provision for adjustment
hereinafter set forth, 100 times the aggregate per share amount of all cash
dividends, and 100 times the aggregate per share amount (payable in kind) of all
non-cash dividends or other distributions other than a dividend payable in
shares of Common Stock or a subdivision of the outstanding shares of Common
Stock (by reclassification or otherwise), declared on the Common Stock since the
immediately preceding Quarterly Dividend Payment Date, or, with respect to the
first Quarterly Dividend Payment Date, since the first issuance of any share or
fraction of a share of Series A Preferred Stock or Series B Preferred Stock;
provided that no dividend shall be declared on the shares of Series A Preferred
Stock or Series B Preferred Stock unless at the same time a dividend is declared
on the outstanding shares of the other series in the same amount and having the
same record and payment dates. In the event the Corporation shall at any time
after September 1, 1993 (i) declare any dividend on Common Stock payable in
shares of Common Stock, (ii) subdivide the outstanding Common Stock, (iii)
combine the outstanding Common Stock into a smaller number of shares, or (iv)
issue any shares of Common Stock in a reclassification or change of the
outstanding shares of Common Stock (including any such reclassification or
change in connection with a merger in which the Corporation is the continuing or
surviving Corporation), then in each such case the amount to which holders of
shares of Series A Preferred Stock and Series B Preferred Stock were entitled
immediately prior to such event under clause (b) of the preceding sentence shall
be adjusted by multiplying such amount by a fraction, the numerator of which is
the number of shares of Common Stock outstanding immediately after such event
and the denominator of which is the number of shares of Common Stock that were
outstanding immediately prior to such event.

     (B) The Corporation shall declare a dividend or distribution on the Series
A Preferred Stock and Series B Preferred Stock as provided in paragraph (A)
above immediately after it declares a dividend or distribution on the Common
Stock (other than a dividend payable in shares of Common Stock); provided that,
in the event no dividend or distribution shall have been declared on the Common
Stock during the period between any Quarterly Dividend Payment Date and the next
subsequent Quarterly Dividend Payment Date, a dividend of $1.00 per share on the
Series A Preferred Stock and Series B Preferred Stock shall nevertheless be
payable on such subsequent Quarterly Dividend Payment Date.

     (C) Dividends shall begin to accrue and be cumulative on outstanding shares
of Series A Preferred Stock and Series B Preferred Stock from the Quarterly
Dividend Payment Date next preceding the date of issue of such shares of Series
A Preferred Stock or Series B Preferred Stock, as the case may be, unless the
date of issue of such shares is prior to the record date for the first Quarterly
Dividend Payment Date for such shares, in which case dividends on such shares
shall begin to accrue from the date of issue of such shares, or unless the date
of issue is a Quarterly Dividend Payment Date or is a date after the record date
for the determination of holders of shares of Series A Preferred Stock or Series
B Preferred Stock entitled to receive a quarterly dividend and before such
Quarterly Dividend Payment Date, in either of which events such dividends shall
begin to accrue and be cumulative from such Quarterly Dividend Payment Date.
Accrued but unpaid dividends shall not bear interest. Dividends paid on the
shares of Series A Preferred Stock and Series B Preferred Stock in an amount
less than the total amount of such dividends at the time accrued and payable on
such shares shall be allocated pro rata on a share-by-share basis among all
shares of Series A Preferred Stock and Series B Preferred Stock at the time
outstanding. The Board of Directors may fix a record date for the determination
of holders of shares of Series A Preferred Stock and Series B Preferred Stock
entitled to receive



                                       2
<PAGE>
 
payment of a dividend or distribution declared thereon, which record date shall
be not more than 30 days prior to the date fixed for the payment thereof.

  Section 3.  Voting Rights.  The holders of shares of Series A Preferred Stock
and Series B Preferred Stock shall have the following voting rights:

     (A) (i)   Except as provided in paragraph C of this Section 3 and subject
to the provision for adjustment hereinafter set forth, each share of Series A
Preferred Stock shall entitle the holder thereof to 100 votes on all matters
submitted to a vote of the stockholders of the Corporation.

         (ii)  Except as otherwise provided herein or by law, the holders of
shares of Series A Preferred Stock and the holders of shares of Common Stock
shall vote together as one class on all matters submitted to a vote of
stockholders of the Corporation.

     (B) (i)   Except as otherwise required by applicable law, each outstanding
share of Series B Preferred Stock shall not be entitled to vote on any matter on
which the stockholders of the Corporation shall be entitled to vote, and shares
of Series B Preferred Stock shall not be included in determining the number of
shares voting or entitled to vote on any such matters.

        (ii)  On any matter on which the holders of shares of Common Stock are
entitled to vote and on which the holders of shares of Series B Preferred Stock
are also entitled to vote, except as otherwise required by law, the Series B
Preferred Stock shall vote together with the Common Stock (and each other class
or series of capital stock then entitled to vote with the Common Stock);
provided that each share of Series B Preferred Stock shall entitle the holder
thereof to 100 votes on any matter on which the Series B Preferred Stock shall
vote together with the Common Stock.

     (C) (i)   If, on the date used to determine stockholders of record for any
meeting of stockholders for the election of directors, a default in preference
dividends (as defined in subparagraph (v) below) on the Series A Preferred Stock
shall exist, the holders of the Series A Preferred Stock shall have the right,
voting as a class as described in subparagraph (ii) below, to elect two
directors (in addition to the directors elected by holders of Common Stock of
the Corporation). Such right may be exercised (a) at any meeting of stockholders
for the election of directors or (b) at a meeting of the holders of shares of
Voting Preferred Stock (as hereinafter defined), called for the purpose in
accordance with the Bylaws of the Corporation, until all such cumulative
dividends (referred to above) shall have been paid in full or until non-
cumulative dividends have been paid regularly for at least one year.

         (ii)  The right of the holders of Series A Preferred Stock to elect two
directors, as described above, shall be exercised as a class concurrently with
the rights of holders of any other series of any class of preferred stock of the
Corporation upon which voting rights to elect such directors have been conferred
and are then exercisable. The Series A Preferred Stock and any additional series
of such preferred stock which the Corporation may issue and which may provide
for the right to vote with the Series A Preferred Stock are collectively
referred to herein as "Voting Preferred Stock."

         (iii) Each director elected by the holders of shares of Voting
Preferred Stock shall be referred to herein as a "Preferred Director." A
Preferred Director so elected shall continue to serve as such director for a
term of one year, except that upon any termination of the right of all of such
holders to vote as a class for Preferred Directors, the term of office of such
directors shall terminate. Any Preferred Director may be removed by, and shall
not be removed except by, the vote of the holders of record of a majority of the
outstanding shares of Voting Preferred Stock then entitled to vote for the
election of directors, present (in person or by proxy) and voting together as a
single class (a) at a meeting of the stockholders, or (b) at a meeting of the
holders of shares of such Voting Preferred Stock, called for that purpose in
accordance with the Bylaws of the Corporation.



                                       3
<PAGE>
 
         (iv)  So long as a default in any preference dividends on the Series A
Preferred Stock shall exist or the holders of any other series of Voting
Preferred Stock shall be entitled to elect Preferred Directors, (a) any vacancy
in the office of a Preferred Director may be filled (except as provided in the
following clause (b)) by an instrument in writing signed by the remaining
Preferred Director and filed with the Corporation and (b) in the case of the
removal of any Preferred Director, the vacancy may be filled by the vote of the
holders of a majority of the outstanding shares of Voting Preferred Stock then
entitled to vote for the election of directors, present (in person or by proxy)
and voting together as a single class, at such time as the removal shall be
effected. Each director appointed as aforesaid by the remaining Preferred
Director shall be deemed, for all purposes hereof, to be a Preferred Director.

         (v)   For purposes hereof, a "default in preference dividends" on the
Series A Preferred Stock shall be deemed to have occurred whenever the amount of
cumulative and unpaid dividends on the Series A Preferred Stock shall be
equivalent to six full quarterly dividends or more (whether or not consecutive),
and, having so occurred, such default shall be deemed to exist thereafter until,
but only until, all cumulative dividends on all shares of the Series A Preferred
Stock then outstanding shall have been paid through the last Quarterly Dividend
Payment Date or until, but only until, non-cumulative dividends have been paid
regularly for at least one year.

     (D) Except as set forth herein (or as otherwise required by applicable
law), holders of Series A Preferred Stock and Series B Preferred Stock shall
have no general or special voting rights and their consent shall not be required
for taking any corporate action.

 Section 4.  Certain Restrictions.

     (A) Whenever quarterly dividends or other dividends or distributions
payable on the Series A Preferred Stock and/or Series B Preferred Stock as
provided in Section 2 are in arrears, thereafter and until all accrued and
unpaid dividends and distributions, whether or not declared, on such shares of
Preferred Stock outstanding shall have been paid in full, the Corporation shall
not:

         (i)  declare or pay dividends, or make any other distributions, on any
shares of stock ranking junior (either as to dividends or upon liquidation,
dissolution or winding up) to the Series A Preferred Stock and Series B
Preferred Stock;

         (ii)  declare or pay dividends, or make any other distributions, on any
shares of stock ranking on a parity (either as to dividends or upon liquidation,
dissolution or winding up) with the Series A Preferred Stock and Series B
Preferred Stock, except dividends paid ratably on the Series A Preferred Stock
and Series B Preferred Stock and all such parity stock on which dividends are
payable or in arrears in proportion to the total amounts to which the holders of
all such shares are then entitled (based upon their respective liquidation
values);

         (iii) redeem or purchase or otherwise acquire for consideration (except
as provided in (iv) below) shares of any stock ranking junior (either as to
dividends or upon liquidation, dissolution or winding up) to the Series A
Preferred Stock and Series B Preferred Stock, provided that the Corporation may
at any time redeem, purchase or otherwise acquire shares of any such junior
stock in exchange for shares of any stock of the Corporation ranking junior
(both as to dividends and upon dissolution, liquidation or winding up) to the
Series A Preferred Stock and Series B Preferred Stock;

         (iv) redeem or purchase or otherwise acquire for consideration any
shares of Series A Preferred Stock or Series B Preferred Stock, or any shares of
stock ranking on a parity (either as to dividends or upon liquidation,
dissolution or winding up) with the Series A Preferred Stock and Series B
Preferred Stock, except in accordance with a purchase offer made in writing or
by publication (as determined by the Board of Directors) to all holders of such
shares upon such terms as the Board of Directors, after consideration of the



                                       4
<PAGE>
 
respective annual dividend rates and other relative rights and preferences of
the respective series and classes, shall determine in good faith will result in
fair and equitable treatment among the respective series or classes.

     (B) The Corporation shall not permit any subsidiary of the Corporation to
purchase or otherwise acquire for consideration any shares of stock of the
Corporation unless the Corporation could, under paragraph (A) of this Section 4,
purchase or otherwise acquire such shares at such time and in such manner.

  Section 5.  Reacquired Shares.  Any shares of Series A Preferred Stock or
Series B Preferred Stock purchased or otherwise acquired by the Corporation in
any manner whatsoever shall be retired and canceled promptly after the
acquisition thereof. All such shares shall upon their cancellation become
authorized but unissued shares of Preferred Stock and may be reissued as part of
a new series of Preferred Stock subject to the conditions and restrictions on
issuance set forth in this  Restated Certificate of Incorporation, in any
Certificate of Amendment creating a series of Preferred Stock or as otherwise
required by law.

  Section 6.  Liquidation, Dissolution or Winding Up.

     (A) Subject to the prior and superior rights of holders of any shares of
stock of the Corporation ranking prior and superior to the shares of Series A
Preferred Stock and Series B Preferred Stock with respect to rights upon
liquidation, dissolution or winding up (voluntary or otherwise), no distribution
shall be made to the holders of shares of stock ranking junior (either as to
dividends or upon liquidation, dissolution or winding up) to the Series A
Preferred Stock and Series B Preferred Stock unless, prior thereto, the holders
of shares of Series A Preferred Stock and Series B Preferred Stock shall have
received $100.00 per share, plus an amount equal to accrued and unpaid dividends
and distributions thereon, whether or not declared, to the date of such payment
(the "Series Liquidation Preference"). Following the payment of the full amount
of the Series Liquidation Preference, no additional distributions shall be made
to the holders of shares of Series A Preferred Stock and Series B Preferred
Stock unless, prior thereto, the holders of shares of Common Stock and Nonvoting
Common Stock shall have received an amount per share (the "Capital Adjustment")
equal to the quotient obtained by dividing (i) the Series Liquidation Preference
by (ii) 100 (subject to the provision for adjustment hereinafter set forth in
subparagraph (C) below) (such number in clause (ii), the "Adjustment Number").
Following the payment of the full amount of the Series Liquidation Preference
and the Capital Adjustment in respect of all outstanding shares of Series A
Preferred Stock and Series B Preferred Stock, and Common Stock and Nonvoting
Common Stock, respectively, holders of Series A Preferred Stock and Series B
Preferred Stock, and holders of Common Stock and Nonvoting Common Stock shall
receive their ratable and proportionate share of the remaining assets to be
distributed in the ratio of the Adjustment Number to 1 with respect to such
Series A Preferred Stock and Series B Preferred Stock, and Common Stock and
Nonvoting Common Stock, on a per share basis, respectively.

     (B) In the event, however, that there are not sufficient assets available
to permit payment in full of the Series Liquidation Preference and the
liquidation preferences of all other series of stock of the Corporation, if any,
which rank on a parity with the Series A Preferred Stock and Series B Preferred
Stock, then such remaining assets shall be distributed ratably to the holders of
Series A Preferred Stock and Series B Preferred Stock and the holders of such
parity stock in proportion to their respective liquidation preferences. In the
event, however, that there are not sufficient assets available to permit payment
in full of the Capital Adjustment, then such remaining assets shall be
distributed ratably to the holders of Common Stock and Nonvoting Common Stock.

     (C) In the event the Corporation shall at any time after September 1, 1993
(i) declare any dividend on Common Stock payable in shares of Common Stock, (ii)
subdivide the outstanding Common Stock, (iii) combine or consolidate the
outstanding Common Stock into a smaller number of shares, or (iv) issue any
shares of Common Stock in a reclassification or exchange of the outstanding
shares of Common Stock (including any such reclassification or exchange in
connection with a merger in which the Corporation is the continuing or surviving
corporation), then in each such case the Adjustment Number in effect immediately
prior to such event shall be adjusted by multiplying such Adjustment Number by a
fraction the numerator of



                                       5
<PAGE>
 
which is the number of shares of Common Stock outstanding immediately after such
event and the denominator of which is the number of shares of Common Stock that
were outstanding immediately prior to such event.

 Section 7.  Conversion.

  (a)  Conversion of Series A Preferred Stock.  Subject to and upon compliance
with the provisions of Section 4 of Paragraph B of this Article FOURTH, any
Regulated Stockholder (as defined in Section 5 of Paragraph B of this Article
FOURTH) shall be entitled to convert, at any time and from time to time, any or
all of the shares of Series A Preferred Stock held by such stockholder into the
same number of shares of Series B Preferred Stock.

  (b)  Conversion of Series B Preferred Stock.  Subject to and upon compliance
with the provisions of Section 4 of Paragraph B of this Article FOURTH, each
record holder of Series B Preferred Stock shall be entitled to convert, at any
time and from time to time, any or all of the shares of Series B Preferred Stock
held by such stockholder into the same number of shares of Series A Preferred
Stock; provided however, that no holder of shares of Series B Preferred Stock
shall be entitled to convert any such shares to the extent that, as a result of
such conversion, such holder and its Affiliates (as defined in Section 5 of
Paragraph B of this Article FOURTH), directly or indirectly, would own, control
or have the power to vote a greater number of shares of Series A Preferred Stock
or other securities of any kind issued by the Corporation than such holder and
its Affiliates shall be permitted to own, control or have power to vote under
any law, regulation, rule or other requirement of any governmental authority at
the time applicable to such holder or its Affiliates.

  (c)  Stock Splits; Adjustments.  If the Corporation shall in any manner
subdivide (by stock split, stock dividend or otherwise) or combine (by reverse
stock split or otherwise) the outstanding shares of Series A Preferred Stock or
Series B Preferred Stock, then the outstanding shares of Series B Preferred
Stock or Series A Preferred Stock, as the case may be, shall be subdivided or
combined, as the case may be, to the same extent, share and share alike, and
effective provision shall be made for the protection of the conversion rights
hereunder.

     In the case of any reorganization, reclassification or change of shares of
Series A Preferred Stock or Series B Preferred Stock (other than a change in par
value or from par to no par value as a result of a subdivision or combination),
or in case of any consolidation of the Corporation with one or more corporations
or a merger of the Corporation with another corporation (other than a
consolidation or merger in which the Corporation is the resulting or surviving
corporation and which does not result in any reclassification or change of
outstanding shares of Series A Preferred Stock or Series B Preferred Stock),
each holder of a share of Series A Preferred Stock or Series B Preferred Stock
shall have the right at any time thereafter, so long as the conversion right
hereunder with respect to such share would exist had such event not occurred, to
convert such share into the kind and amount of shares of stock and other
securities and properties (including cash) receivable upon such reorganization,
reclassification, change, consolidation or merger by a holder of the number of
shares of Series A Preferred Stock or Series B Preferred Stock into which such
shares of Series A Preferred Stock or Series B Preferred Stock, as the case may
be, might have been converted immediately prior to such reorganization,
reclassification, change, consolidation or merger. In the event of such a
reorganization, reclassification, change, consolidation or merger, effective
provision shall be made in the certificate of incorporation of the resulting or
surviving corporation or otherwise for the protection of the conversion rights
of the shares of Series A Preferred Stock and Series B Preferred Stock that
shall be applicable, as nearly as reasonably may be, to any such other shares of
stock and other securities and property deliverable upon conversion of the
shares of Series A Preferred Stock or Series B Preferred Stock into which such
Series B Preferred Stock or Series A Preferred Stock, as the case may be, might
have been converted immediately prior to such event.

  (d)  Reservation of Shares.  The Corporation shall at all times reserve and
keep available out of its authorized but unissued shares of Preferred Stock or
its treasury shares, solely for the purpose of issuance upon the conversion of
shares of Series A Preferred Stock and Series B Preferred Stock, such number of
shares of such



                                       6
<PAGE>
 
class as are then issuable upon the conversion of all outstanding shares of
Series A Preferred Stock and Series B Preferred Stock.

     Shares of Series A Preferred Stock and Series B Preferred Stock that are
converted into shares of another class shall not be reissued, except for
reissuances in connection with the conversion of shares of Series A Preferred
Stock held by Regulated Stockholders into shares of Series B Preferred Stock and
the conversion of shares of Series B Preferred Stock into shares of Series A
Preferred Stock.

  Section 8.  Consolidation, Merger, etc.  In case the Corporation shall enter
into any consolidation, merger, combination or other transaction in which the
shares of Common Stock are exchanged for or changed into other stock or
securities, cash or any other property, then, in any such case, (i) the shares
of Series A Preferred Stock shall at the same time be similarly exchanged or
changed in an amount per share (subject to adjustment as set forth herein) equal
to 100 times the aggregate amount of stock, securities, cash or any other
property (payable in kind), as the case may be, into which or for which each
share of Common Stock is changed or exchanged and (ii) the shares of Series B
Preferred Stock shall at the same time be similarly exchanged or changed in an
amount per share (subject to adjustment as set forth herein) equal to 100 times
the aggregate amount of stock, securities, cash or other property (payable in
kind), as the case may be, into which or for which each share of Common Stock is
changed or exchanged (or, if any shares of Nonvoting Common Stock are then
outstanding and are being exchanged or changed, 100 times the aggregate amount
of stock, securities, cash or other property into which or for which each share
of Nonvoting Common Stock is changed or exchanged).

  Section 9.  No Redemption.  The shares of Series A Preferred Stock and Series
B Preferred Stock shall not be redeemable.

  Section 10.  Ranking.  The Series A Preferred Stock and Series B Preferred
Stock shall rank junior to all other series of stock of the Corporation (other
than the Common Stock) as to the payment of dividends and the distribution of
assets, unless the terms of any such series shall provide otherwise.

  Section 11.  Amendment.  The  Restated Certificate of Incorporation of the
Corporation shall not be amended in any manner which would materially alter or
change the powers, preferences or special rights of any series of Preferred
Stock so as to affect them adversely without the affirmative vote of the holders
of a majority or more of the outstanding shares of all series of Preferred Stock
so affected, voting together as a separate class.

 B.  Common Stock and Nonvoting Common Stock

     Shares of Common Stock and Nonvoting Common Stock will be identical and
will entitle the holders thereof to the same rights and privileges, except as
otherwise provided herein.

  Section 1.  Dividends.  Subject to the preferential rights, if any, of the
Preferred Stock, the holders of shares of Common Stock shall be entitled to
receive, when and if declared by the Board of Directors, out of the assets of
the Corporation which are by law available therefor, dividends payable either in
cash, in property or in shares of Common Stock or other securities of the
Corporation. The holders of shares of Nonvoting Common Stock shall be entitled
to receive, at the same time that any dividend is declared by the Board of
Directors on the shares of Common Stock, the same dividend per share on the
shares of Nonvoting Common Stock, payable on the same date as such dividend on
the Common Stock; provided that if any dividend is payable on the shares of
Common Stock in shares of Common Stock, or options, warrants or rights to
acquire shares of Common Stock, or securities convertible into or exchangeable
for shares of Common Stock, the shares, options, warrants, rights or securities
payable in the case of the dividend on the shares of Nonvoting Common Stock
shall be shares of, or options, warrants or rights to acquire, or securities
convertible into or exchangeable for, Nonvoting Common Stock.

 Section 2.  Voting Rights.


                                       7

<PAGE>
 
  (a)  Common Stock.  At every annual or special meeting of stockholders of the
Corporation, every holder of Common Stock shall be entitled to one vote, in
person or by proxy, for each share of Common Stock standing in such holder's
name on the books of the Corporation.

  (b)  Nonvoting Common Stock.  Except as set forth herein or as otherwise
required by law, each outstanding share of Nonvoting Common Stock shall not be
entitled to vote on any matter on which the stockholders of the Corporation
shall be entitled to vote, and shares of Nonvoting Common Stock shall not be
included in determining the number of shares voting or entitled to vote on any
such matters. On any matter on which the holders of shares of Common Stock and
the holders of shares of Nonvoting Common Stock are entitled to vote, except as
otherwise required by law, the Common Stock and Nonvoting Common Stock shall
vote together as a single class, and each holder of shares of Nonvoting Common
Stock entitled to vote shall be entitled to one vote for each share of such
stock held by such holder; provided, however, that notwithstanding the
foregoing, holders of shares of Nonvoting Common Stock shall be entitled to vote
as a separate class on any amendment to this Section 2(b) and on any amendment,
repeal or modification of any provision of this  Restated Certificate of
Incorporation that adversely affects the powers, preferences or special rights
of holders of the Nonvoting Common Stock.

  Section 3.  Liquidation, Dissolution or Winding Up.  In the event of any
voluntary or involuntary liquidation, dissolution or winding up of the affairs
of the Corporation, after payment or provision for payment of the debts and
other liabilities of the Corporation and of the preferential amounts, if any, to
which the holders of Preferred Stock shall be entitled, the holders of all
outstanding shares of Common Stock and Nonvoting Common Stock shall be entitled
to share ratably in the remaining net assets of the Corporation.

 Section 4.  Conversion

  (a)  Conversion of Common Stock.  Subject to and upon compliance with the
provisions of this Section 4, any Regulated Stockholder (defined below) shall be
entitled to convert, at any time and from time to time, any or all of the shares
of Common Stock held by such stockholder into the same number of shares of
Nonvoting Common Stock.

  (b)  Conversion of Nonvoting Common Stock.  Subject to and upon compliance
with the provisions of this Section 4, each record holder of Nonvoting Common
Stock shall be entitled to convert, at any time and from time to time, any or
all of the shares of Nonvoting Common Stock held by such stockholder into the
same number of shares of Common Stock; provided however, that no holder of
shares of Nonvoting Common Stock shall be entitled to convert any such shares to
the extent that, as a result of such conversion, such holder and its Affiliates
(defined below), directly or indirectly, would own, control or have the power to
vote a greater number of shares of Common Stock or other securities of any kind
issued by the Corporation than such holder and its Affiliates shall be permitted
to own, control or have power to vote under any law, regulation, rule or other
requirement of any governmental authority at the time applicable to such holder
or its Affiliates.

  (c)  Conversion Procedure.  Each conversion of shares of a class or series of
the capital stock of the Corporation into shares of another class or series of
capital stock of the Corporation shall be effected by the surrender of the
certificate or certificates representing the shares to be converted (the
"Converting Shares") at the principal office of the Corporation (or such other
office or agency of the Corporation as the Corporation may designate by written
notice to the holders of shares of capital stock of the Corporation) at any time
during its usual business hours, together with written notice by the holder of
such Converting Shares, stating that such holder desires to convert the
Converting Shares, or a stated number of the shares represented by such
certificate or certificates, into an equal number of shares of the class or
series into which such shares may be converted (the "Converted Shares"). Such
notice shall also state the name or names (with addresses) and denominations in
which the certificate or certificates for Converted Shares are to be issued and
shall include instructions for the delivery thereof. The Corporation shall
promptly notify each Regulated Stockholder of its receipt of such notice.
Promptly after such surrender and the receipt of such written notice, the
Corporation will issue and deliver in accordance with the surrendering holder's
instructions the certificate or certificates



                                       8
<PAGE>
 
evidencing the Converted Shares issuable upon such conversion, and the
Corporation will deliver to the converting holder a certificate (which shall
contain such legends as were set forth on the surrendered certificate or
certificates) representing any shares which were represented by the certificate
or certificates that were delivered to the Corporation in connection with such
conversion, but which were not converted; provided, however, that if such
conversion is subject to subparagraph (d) of this Section 4 below, the
Corporation shall not issue such certificate or certificates until the
expiration of the Deferral Period referred to therein. Such conversion, to the
extent permitted by law, shall be deemed to have been effected as of the close
of business on the date on which such certificate or certificates shall have
been surrendered and such notice shall have been received by the Corporation,
and at such time the rights of the holder of the Converting Shares as such
holder shall cease (except that, in the case of a conversion subject to
subparagraph (d) of this Section 4 below, the conversion shall be deemed to be
effective upon the expiration of the Deferral Period referred to therein), and
the person or persons in whose name or names the certificate or certificates for
the Converted Shares are to be issued upon such conversion shall be deemed to
have become the holder or holders of record of the Converted Shares. Upon
issuance of shares in accordance with this Section 4, such Converted Shares
shall be deemed to be duly authorized, validly issued, fully paid and non-
assessable.

     Notwithstanding any provision of this Section 4 to the contrary, the
Corporation shall not be required to record the conversion of, and no holder of
shares shall be entitled to convert, shares of nonvoting capital stock of the
Corporation into shares of voting capital stock of the Corporation unless such
conversion is permitted under applicable law; provided, however, that the
Corporation shall be entitled to rely without independent verification upon the
representation of any holder that the conversion of shares by such holder is
permitted under applicable law, and in no event shall the Corporation be liable
to any such holder or any third party arising from any such conversion whether
or not permitted by applicable law.

  (d)  Notice of Conversion to Other Regulated Stockholders; Deferral.  The
Corporation shall not convert or directly or indirectly redeem, purchase or
otherwise acquire any shares of Common Stock or any other class of capital stock
of the Corporation or take any other action affecting the voting rights of such
shares, if such action will increase the percentage of any class of outstanding
voting securities owned or controlled by any Regulated Stockholder (other than
any such stockholder which requested that the Corporation take such action, or
which otherwise waives in writing its rights under this subparagraph (d)),
unless the Corporation gives written notice (the "Deferral Notice") of such
action to each Regulated Stockholder. The Corporation will defer making any such
conversion, redemption, purchase or other acquisition, or taking any such other
action for a period of 20 days (the "Deferral Period") after giving the Deferral
Notice in order to allow each Regulated Stockholder to determine whether it
wishes to convert or take any other action with respect to the voting capital
stock it owns, controls or has the power to vote, and if any such Regulated
Stockholder then elects to convert any shares of voting capital stock, it shall
notify the Corporation in writing within 10 days of the issuance of the Deferral
Notice, in which case the Corporation shall (i) promptly notify from time to
time prior to the end of such 20-day period each other Regulated Stockholder
holding shares of each proposed conversion and the proposed transactions, and
(ii) effect the conversions requested by all Regulated Stockholders in response
to the notices issued pursuant to this subparagraph (d) at the end of the
Deferral Period. The Corporation will not directly or indirectly redeem,
purchase, acquire or take any other action affecting outstanding shares of
capital stock of the Corporation if such action will increase the percentage of
the outstanding shares of capital stock owned or controlled by any Regulated
Stockholder and its Affiliates (other than a stockholder which waives in writing
its rights under this Section 4) to more than 24.9% of the aggregate number of
outstanding shares of capital stock of the Corporation (it being understood that
for the purposes of the foregoing calculation each one one-hundredth of a share
of Series A Preferred Stock or Series B Preferred Stock shall be treated as the
equivalent of one share of Common Stock or Nonvoting Common Stock).

  (e)  Stock Splits; Adjustments.  If the Corporation shall in any manner
subdivide (by stock split, stock dividend or otherwise) or combine (by reverse
stock split or otherwise) the outstanding shares of Common Stock or Nonvoting
Common Stock, then the outstanding shares of Nonvoting Common Stock or Common
Stock, as


                                       9

<PAGE>
 
the case may be, shall be subdivided or combined, as the case may be, to the
same extent, share and share alike, and effective provision shall be made for
the protection of the conversion rights hereunder.

     In the case of any reorganization, reclassification or change of shares of
Common Stock or Nonvoting Common Stock (other than a change in par value or from
par to no par value as a result of a subdivision or combination), or in case of
any consolidation of the Corporation with one or more corporations or a merger
of the Corporation with another corporation (other than a consolidation or
merger in which the Corporation is the resulting or surviving corporation and
which does not result in any reclassification or change of outstanding shares of
Common Stock or Nonvoting Common Stock), each holder of a share of Common Stock
or Nonvoting Common Stock shall have the right at any time thereafter, so long
as the conversion right hereunder with respect to such share would exist had
such event not occurred, to convert such share into the kind and amount of
shares of stock and other securities and properties (including cash) receivable
upon such reorganization, reclassification, change, consolidation or merger by a
holder of the number of shares of Common Stock or Nonvoting Common Stock into
which such shares of Common Stock or Nonvoting Common Stock, as the case may be,
might have been converted immediately prior to such reorganization,
reclassification, change, consolidation or merger. In the event of such a
reorganization, reclassification, change, consolidation or merger, effective
provision shall be made in the certificate of incorporation of the resulting or
surviving corporation or otherwise for the protection of the conversion rights
of the shares of Common Stock and Nonvoting Common Stock that shall be
applicable, as nearly as reasonably may be, to any such other shares of stock
and other securities and property deliverable upon conversion of the shares of
Common Stock or Nonvoting Common Stock into which such Common Stock or Nonvoting
Common Stock, as the case may be, might have been converted immediately prior to
such event.

     The Corporation shall not be a party to any merger, consolidation or
recapitalization pursuant to which any Regulated Stockholder would be required
to take (i) any voting securities which would cause such holder to violate any
law, regulation or other requirement of any governmental body applicable to such
holder, or (ii) any securities convertible into voting securities which, if such
conversion took place, would cause such holder to violate any law, regulation or
other requirement of any governmental body applicable to such holder other than
securities which are specifically provided to be convertible only in the event
that such conversion may occur without any such violation.

  (f)  Reservation of Shares.  The Corporation shall at all times reserve and
keep available out of its authorized but unissued shares of Common Stock and
Nonvoting Common Stock or its treasury shares, solely for the purpose of
issuance upon the conversion of shares of Common Stock and Nonvoting Common
Stock, such number of shares of such class as are then issuable upon the
conversion of all outstanding shares of Common Stock and Nonvoting Common Stock.

     Shares of Common Stock and Nonvoting Common Stock that are converted into
shares of another class shall not be reissued, except for reissuances in
connection with the conversion of shares of Common Stock held by Regulated
Stockholders into shares of Nonvoting Common Stock and the conversion of shares
of Nonvoting Common Stock into shares of Common Stock.

  (g)  No Charge.  The issuance of certificates for shares of any class or
series of capital stock of the Corporation upon conversion of shares of another
class or series of capital stock of the Corporation shall be made without charge
to the holders of such shares for any issuance tax in respect thereof or other
cost incurred by the Corporation in connection with such conversion and the
related issuance of shares of capital stock of the Corporation; provided,
however, that the Corporation shall not be required to pay any tax which may be
payable in respect of any transfer involved in the issuance and delivery of any
certificate in a name other than that of the holder of the capital stock of the
Corporation converted.

  Section 5.  Definitions.  As used in this Paragraph B, the following terms
shall have the meanings shown below:



                                      10
<PAGE>
 
     "Affiliate" shall mean with respect to any Person, any other Person,
directly or indirectly controlling, controlled by or under common control with
such Person. For the purpose of the above definition, the term "control"
(including with correlative meaning, the terms "controlling," "controlled by"
and "under common control with"), as used with respect to any Person, shall mean
the possession, directly or indirectly, of the power to direct or cause the
direction of the management and policies of such Person, whether through the
ownership of voting securities or by contract or otherwise.

     "Person" shall mean an individual, a partnership, a corporation, a trust, a
joint venture, an unincorporated organization or a government or any department
or agency thereof.

     "Regulated Stockholder" shall mean (a) any stockholder that is subject to
the provisions of Regulation Y of the Board of Governors of the Federal Reserve
System, 12 C.F.R. Part 225 (or any successor to such Regulation) ("Regulation
Y") which was a "Regulated Stockholder" of HCA-Hospital Corporation of America
(as such term was defined in the certificate of incorporation of such
corporation) immediately prior to the merger (the "Merger") of HCA-Hospital
Corporation of America with CHOS Acquisition Corporation, a wholly owned
subsidiary of the Corporation, so long as such stockholder shall hold, and only
with respect to, the shares of Common Stock or Nonvoting Common Stock received
by such stockholder in connection with the Merger and shares of Series A
Preferred Stock and Series B Preferred Stock received by such stockholder upon
the exercise of preferred stock purchase rights received by such stockholder in
connection with the Merger, or shares issued upon conversion(s) of or in respect
of any of the foregoing shares or upon exercise of preferred stock purchase
rights received upon conversion(s) of any of the foregoing shares, (b) any
Affiliate of any such Regulated Stockholder that is a transferee of any of the
foregoing shares or rights or shares issued upon conversion(s) of or in respect
of any of the foregoing shares or upon exercise of preferred stock purchase
rights received upon conversion(s) of any of the foregoing shares and (c) any
Person to which such Regulated Stockholder or any of its Affiliates has
transferred such shares or rights, so long as such transferee shall hold, and
only with respect to, any of the foregoing shares or rights or any shares issued
upon conversion(s) of or in respect of any of the foregoing shares or upon
exercise of preferred stock purchase rights received upon conversion(s) of any
of the foregoing shares but only if such Person (or any Affiliate of such
Person) is subject to the provisions of Regulation Y.

 Section 6.  Certain Amendments Affecting Nonvoting Common Stock.

    (a)  In addition to any other action required by law or by this  Restated
Certificate of Incorporation, any change in the authorized number of shares of
any class of capital stock of the Corporation shall require the affirmative vote
of a majority of the directors then in office and the affirmative vote of the
holders of not less than a majority of the then outstanding shares of Common
Stock and Nonvoting Common Stock, voting together as a single class. The
provisions of this Section 6(a) may be amended by, in addition to any other
action required by law or by this  Restated Certificate of Incorporation, the
affirmative vote of the holders of not less than a majority of the then
outstanding shares of Common Stock and Nonvoting Common Stock, voting together
as a single class.

    (b)  In addition to any other action required by law or by this  Restated
Certificate of Incorporation, any change in the powers, preferences or special
rights of the shares of Nonvoting Common Stock so as to affect the holders
thereof adversely shall require the affirmative vote of a majority of the
directors then in office and the affirmative vote of the holders of not less
than 66 2/3% of the shares of Nonvoting Common Stock.

     FIFTH: The business and affairs of the Corporation shall be managed by or
under the direction of the Board of Directors. The Board of Directors may
exercise all such authority and powers of the Corporation and do all such lawful
acts and things as are not by statute or this  Restated Certificate of
Incorporation directed or required to be exercised or done by the stockholders.

  A.  Number of Directors.  The number of directors of the Corporation
(exclusive of directors to be elected by the holders of one or more series of
the Preferred Stock of the Corporation which may be outstanding,



                                      11
<PAGE>
 
voting separately as a series or class) shall be fixed from time to time by
action of not less than a majority of the members of the Board of Directors then
in office, but in no event shall be less than three nor more than fifteen.

  B.  Classes.  The directors shall be divided into three classes, as nearly
equal in number as reasonably possible, with the term of office of the first
class to expire at the 1994 annual meeting of stockholders, the term of office
of the second class to expire at the 1995 annual meeting of stockholders and the
term of office of the third class to expire at the 1996 annual meeting of
stockholders. At each annual meeting of stockholders following adoption of this
Restated Certificate of Incorporation, directors shall be elected to succeed
those directors whose terms expire for a term of office to expire at the third
succeeding annual meeting of stockholders after their election. Directors need
not be stockholders. All directors shall hold office until the expiration of the
term for which elected and until their successors are elected, except in the
case of the death, resignation, disqualification or removal of any director.

  C.  Vacancies.  Subject to the rights, if any, of the holders of any series of
Preferred Stock then outstanding, newly created directorships resulting from any
increase in the authorized number of directors or any vacancies in the Board of
Directors resulting from death, resignation, disqualification or removal may be
filled only by a majority vote of the directors then in office, though less than
a quorum, and directors so chosen shall hold office for a term expiring at the
annual meeting of stockholders at which the term of office of the class to which
they have been elected expires or, in the case of newly created directorships,
shall hold office until such time as determined by the directors electing such
new director (in a manner consistent with paragraph B above). No decrease in the
number of directors constituting the Board of Directors shall shorten the term
of any incumbent director.

  D.  Removal.  Subject to the rights, if any, of any series of Preferred Stock
then outstanding, any director, or the entire Board of Directors, may be removed
from office at any time, but only for cause and only by the affirmative vote of
the holders of at least 66 2/3% of the voting power of all of the then
outstanding shares of capital stock of the Corporation entitled to vote
generally in the election of directors, voting together as a single class.
Directors so chosen shall hold office for a term expiring at the annual meeting
of stockholders at which the term of office of the class to which they have been
elected expires.

     SIXTH: Subject to the rights of the holders of any class or series of
Preferred Stock, any action required or permitted to be taken at any annual or
special meeting of stockholders may be taken only upon the vote of the
stockholders at an annual or special meeting duly called and may not be taken by
written consent of the stockholders.

     SEVENTH: Subject to the rights of the holders of any class or series of
Preferred Stock, special meetings of the stockholders, unless otherwise
prescribed by statute, may be called at any time only by the Board of Directors,
the Chairman of the Board or the Chief Executive Officer.

     EIGHTH: At an annual meeting of stockholders, only such business shall be
conducted, and only such proposals shall be acted upon, as shall have been
properly brought before the annual meeting of stockholders (a) by, or at the
direction of, the Board of Directors or (b) by a stockholder of the Corporation
who complies with the procedures set forth in this Article EIGHTH. For business
or a proposal to be properly brought before an annual meeting of stockholders by
a stockholder, the stockholder must have given timely notice thereof in writing
to the Secretary of the Corporation. To be timely, a stockholder's notice must
be delivered to or mailed and received at the principal executive offices of the
Corporation not less than 60 days nor more than 90 days prior to the scheduled
date of the annual meeting, regardless of any postponement, deferral or
adjournment of that meeting to a later date; provided, however, that if less
than 70 days' notice or prior public disclosure of the date of the annual
meeting is given or made to stockholders, notice by the stockholder to be timely
must be so delivered or received not later than the close of business on the
10th day following the earlier of (i) the day on which such notice of the date
of the meeting was mailed or (ii) the day on which such public disclosure was
made.



                                      12
<PAGE>
 
     A stockholder's notice to the Secretary shall set forth as to each matter
the stockholder proposes to bring before an annual meeting of stockholders (i) a
description, in 500 words or less, of the business desired to be brought before
the annual meeting and the reasons for conducting such business at the annual
meeting, (ii) the name and address, as they appear on the Corporation's books,
of the stockholder proposing such business and any other stockholders known by
such stockholder to be supporting such proposal, (iii) the class and number of
shares of the Corporation which are beneficially owned by such stockholder on
the date of such stockholder's notice and by any other stockholders known by
such stockholder to be supporting such  proposal on the date of such
stockholder's notice, (iv) a description, in 500 words or less, of any interest
of the stockholder in such proposal and (v) a representation that the
stockholder is a holder of record of stock of the Corporation and intends to
appear in person or by proxy at the meeting to present the proposal specified in
the notice. Notwithstanding anything in this  Restated Certificate of
Incorporation to the contrary, no business shall be conducted at a meeting of
stockholders except in accordance with the procedures set forth in this Article
EIGHTH.

     The chairman of the meeting shall, if the facts warrant, determine and
declare to the meeting that the business was not properly brought before the
meeting in accordance with the procedures prescribed by this Article EIGHTH, and
if he should so determine, he shall so declare to the meeting and any such
business not properly brought before the meeting shall not be transacted.
Notwithstanding the foregoing, nothing in this Article EIGHTH shall  be
interpreted or construed to require the inclusion of information about any such
proposal in any proxy statement distributed by, at the direction of, or on
behalf of, the Board of Directors.

  NINTH:  Subject to the rights, if any, of the holders of any series of
Preferred Stock then outstanding, only persons nominated in accordance with the
procedures set forth in this Article NINTH shall be eligible for election as
directors. Nominations of persons for election to the Board may be made at an
annual meeting of stockholders or special meeting of stockholders called by the
Board of Directors for the purpose of electing directors (i) by or at the
direction of the Board or (ii) by any stockholder of the Corporation entitled to
vote for the election of directors at such meeting who complies with the notice
procedures set forth in this Article NINTH. Such nominations, other than those
made by or at the direction of the Board, shall be made pursuant to timely
notice in writing to the Secretary of the Corporation. To be timely, a
stockholder's notice must be delivered to or mailed and received at the
principal executive offices of the Corporation not less than 60 days nor more
than 90 days prior to the scheduled date of the meeting, regardless of any
postponement, deferral or adjournment of that meeting to a later date; provided,
however, that if less than 70 days' notice or prior public disclosure of the
date of the meeting is given or made to stockholders, notice by the stockholder
to be timely must be so delivered or received not later than the close of
business on the 10th day following the earlier of (i) the day on which such
notice of the date of the meeting was mailed or (ii) the day on which such
public disclosure was made.

     A stockholder's notice to the Secretary shall set forth (i) as to each
person whom the stockholder proposes to nominate for election or reelection as a
director (a) the name, age, business address and residence address of such
person, (b) the principal occupation or employment of such person, (c) the class
and number of shares of the Corporation which are beneficially owned by such
person on the date of such stockholder's notice and (d) any other information
relating to such person that is required to be disclosed in solicitations of
proxies for election of directors, or is otherwise required, in each case
pursuant to Regulation 14A under the Securities Exchange Act of 1934, as
amended, or any successor statute thereto (the "Exchange Act") (including
without limitation such person's written consent to being named in the proxy
statement as a nominee and to serving as a director if elected); (ii) as to the
stockholder giving the notice (a) the name and address, as they appear on the
Corporation's books, of such stockholder and any other stockholders known by
such stockholder to be supporting such nominee(s), (b) the class and number of
shares of the Corporation which are beneficially owned by such stockholder on
the date of such stockholder's notice and by any other stockholders known by
such stockholder to be supporting such nominee(s) on the date of such
stockholder's notice, (c) a representation that the stockholder is a holder of
record of stock of the Corporation entitled to vote at such meeting and intends
to appear in person or by proxy at the meeting to nominate the person or persons
specified in the notice; and (iii) a description of all arrangements or
understandings between the stockholder and each nominee



                                      13
<PAGE>
 
and other person or persons (naming such person or persons) pursuant to which
the nomination or nominations are to be made by the stockholder.

     No person shall be eligible for election as a director of the Corporation
unless nominated in accordance with the procedures set forth in this Article
NINTH. The chairman of the meeting shall, if the facts warrant, determine and
declare to the meeting that a nomination was not made in accordance with the
procedures prescribed by this Article NINTH, and if he should so determine, he
shall so declare to the meeting and the defective nomination shall be
disregarded.

  TENTH:  The Board of Directors is expressly authorized to adopt, amend or
repeal the Bylaws of the Corporation. Any Bylaws made by the directors under the
powers conferred hereby may be amended or repealed by the directors or by the
stockholders. Notwithstanding the foregoing and anything contained in this
Restated Certificate of Incorporation to the contrary, the Bylaws shall not be
amended or repealed by the stockholders, and no provision inconsistent therewith
shall be adopted by the stockholders, without the affirmative vote of the
holders of at least 75% of the voting power of all shares of the Corporation
entitled to vote generally in the election of directors, voting together as a
single class.

  ELEVENTH:  Elections of directors need not be by written ballot unless the
Bylaws of the Corporation shall otherwise provide.

  TWELFTH:  A director of the Corporation shall not be personally liable to the
Corporation or its stockholders for monetary damages for breach of fiduciary
duty as a director; provided, however, that the foregoing shall not eliminate or
limit the liability of a director (i) for any breach of the director's duty of
loyalty to the Corporation or its stockholders, (ii) for acts or omissions not
in good faith or which involve intentional misconduct or a knowing violation of
law, (iii) under Section 174 of the General Corporation Law of Delaware, or (iv)
for any transaction from which the director derived an improper personal
benefit. If the General Corporation Law of Delaware is hereafter amended to
permit further elimination or limitation of the personal liability of directors,
then the liability of a director of the Corporation shall be eliminated or
limited to the fullest extent permitted by the General Corporation Law of
Delaware as so amended. Any repeal  or modification of this Article TWELFTH
shall not adversely affect any right or protection of a director of the
Corporation existing at the time of such repeal or modification.

  THIRTEENTH:  Whenever a compromise or arrangement is proposed between this
Corporation and its creditors or any class of them or between this Corporation
and its stockholders or any class of them, any court of equitable jurisdiction
within the State of Delaware may, on the application in a summary way of this
Corporation or of any creditor or stockholder thereof or on the application of
any receiver or receivers appointed for this Corporation under the provisions of
Section 291 of the General Corporation Law of Delaware or on the application of
trustees in dissolution or of any receiver or receivers appointed for this
Corporation under the provisions of Section 279 of the General Corporation Law
of Delaware, order a meeting of the creditors or class of creditors, or of the
stockholders or class of stockholders of this Corporation, as the case may be,
to be summoned in such manner as the said court directs. If a majority in number
representing three-fourths in value of the creditors or class of creditors, or
of the stockholders or class of stockholders of this Corporation, as the case
may be, agree to any compromise or arrangement and to any reorganization of this
Corporation as a consequence of such compromise or arrangement, the said
compromise or arrangement and the said reorganization shall, if sanctioned by
the court to which said application has been made, be binding on all the
creditors or class of creditors, or on all of the stockholders or class of
stockholders, of this Corporation, as the case may be, and also on this
Corporation.

     FOURTEENTH:

     A.   For purposes of this Article FOURTEENTH, the following terms shall be
defined as follows:



                                      14
<PAGE>
 
     (1) The term "Business Combination" shall mean (a) any merger or
consolidation of the Corporation or a Subsidiary with a Related Person, (b) any
sale, lease, exchange, mortgage, pledge, transfer or other disposition other
than in the ordinary course of business to or with a Related Person of any
assets of the Corporation or a Subsidiary having an aggregate fair market value
of $25,000,000 or more, (c) the issuance or transfer by the Corporation of any
shares of Voting Stock or securities convertible into or exercisable for such
shares (other than by way of pro rata distribution to all stockholders) to a
Related Person, (d) any recapitalization, merger or consolidation that would
have the effect of increasing the voting power of a Related Person, (e) the
adoption of any plan or proposal for the liquidation or dissolution of the
Corporation or a Subsidiary proposed, directly or indirectly, by or on behalf of
a Related Person, (f) any merger or consolidation of the Corporation with
another Person proposed, directly or indirectly, by or on behalf of a Related
Person unless the entity surviving or resulting from such merger or
consolidation has a provision in its certificate or articles of incorporation,
charter or similar governing instrument which is substantially identical to this
Article FOURTEENTH or (g) any agreement, contract or other arrangement or
understanding providing, directly or indirectly, for any of the transactions
described in this Paragraph A(1).

     (2) The term "Related Person" shall mean any individual, partnership,
corporation, trust or other Person which, together with its "affiliates" and
"associates", as defined in Rule 12b-2 under the Exchange Act as in effect on
September 1, 1993, and together with any other individual, partnership,
corporation, trust or other Person with which it or they have any agreement,
contract or other arrangement or understanding with respect to acquiring,
holding, voting or disposing of Voting Stock, "beneficially owns" (within the
meaning of Rule 13d-3 under the Exchange Act on said date) an aggregate of 10%
or more of the outstanding Voting Stock. A Related Person, its affiliates and
associates and all such other individuals, partnerships, corporations and other
Persons with whom it or they have any such agreement, contract or other
arrangement or understanding, shall be deemed a single Related Person for
purposes of this Article FOURTEENTH; provided, however, that the members of the
Board of Directors of the Corporation shall not be deemed to be associates or
otherwise to constitute a Related Person solely by reason of their board
membership. A person who is a Related Person as of (i) the time any definitive
agreement relating to a Business Combination is entered into, (ii) the record
date for the determination of stockholders entitled to notice of and to vote on
a Business Combination or (iii) immediately prior to the consummation of a
Business Combination, shall be deemed a Related Person for purposes of this
Article FOURTEENTH.

     (3) The term "Continuing Director" shall mean any member of the Board of
Directors of the Corporation who is not an "affiliate" or "associate" of the
Related Person referred to in Paragraph A(2) of this Article FOURTEENTH and was
a member of the Board of Directors prior to the time that such Related Person
became a Related Person, and any successor of a Continuing Director who is
unaffiliated with such Related Person and is recommended to succeed a Continuing
Director by a majority of the Continuing Directors.

     (4) The term "Person" shall mean any individual, firm, corporation or other
entity.

     (5) The term "Subsidiary" shall mean any corporation or other entity of
which the Person in question owns, directly or indirectly, not less than 50% of
any class of equity securities or not less than 50% of the voting power of all
securities of the Corporation entitled to vote generally in the election of
directors.

     (6) The term "Voting Stock" shall mean any shares of the Corporation
entitled to vote generally in the election of directors.

     (7) The term "Entire Board of Directors" shall mean the total number of
directors which the Corporation would have if there were no vacancies.

     (8) The term "Market Value" shall mean the average of the high-and low-
quoted sales price on the date in question (or, if there is no reported sale on
such date, on the last preceding date on which any reported sale occurred) of a
share on the Composite Tape for the New York Stock Exchange - Listed Stocks,



                                      15
<PAGE>
 
or, if the shares are not listed or admitted to trading on such exchange, on the
principal United States securities exchange registered under the Exchange Act on
which the shares are listed or admitted to trading, or, if the shares are not
listed or admitted to trading on any such exchange, the mean between the closing
high bid and low-asked quotations with respect to a share on such date as quoted
on the National Association of Securities Dealers Automated Quotations System,
or any similar system then in use, or, if no such quotations are available, the
fair market value on such date of a share as at least 66 2/3% of the Continuing
Directors shall determine.

     B.   In addition to any other vote required by this  Restated Certificate
of Incorporation or the General Corporation Law of Delaware, the affirmative
vote of the holders of not less than 85% of the outstanding Voting Stock held by
stockholders other than a Related Person by or with whom or on whose behalf,
directly or indirectly, a Business Combination is proposed, voting as a single
class, shall be required for the approval or authorization of such Business
Combination; provided, however, that the 85% voting requirement shall not be
applicable and such Business Combination may be approved by the vote required by
law or by any other provision of this  Restated Certificate of Incorporation if
either:

     (1) The Business Combination is approved by the Board of Directors of the
Corporation by the affirmative vote of at least 66 2/3% of the Continuing
Directors, or

     (2) All of the following conditions are satisfied:

     (a) The aggregate amount of cash and the fair market value of the property,
securities or other consideration to be received per share of capital stock of
the Corporation in the Business Combination by the holders of  capital stock  of
the  Corporation, other  than  the Related Person involved in the Business
Combination, shall not be less than the highest of (i) the highest per share
price (including brokerage commissions,  soliciting  dealers'  fees,  and
dealer-management compensation, and with appropriate adjustments for
recapitalizations, stock splits, stock dividends and like transactions and
distributions) paid by such Related Person in acquiring any of its holdings of
such class or series of capital stock, (ii) the highest per share Market Value
of such class or series of capital stock within the twelve-month period
immediately preceding the date the proposal for such Business Combination was
first publicly announced or (iii) the book value per share of such class or
series of capital stock, determined in accordance with generally accepted
accounting principles, as of the last day of the month immediately preceding the
date the proposal for such Business Combination was first publicly announced;

     (b) The consideration to be received in such Business Combination by
holders of capital stock other than the Related Person involved shall, except to
the extent that a stockholder agrees otherwise as to all or part of the shares
which he or she owns, be in the same form and of the same kind as the
consideration paid by the Related Person in acquiring capital stock already
owned by it, provided, however, that if the Related Person has paid for capital
stock with varying forms of consideration, the form of consideration for shares
of capital stock acquired in the Business Combination by the Related Person
shall either be cash or the form used to acquire the largest number of shares of
capital stock previously acquired by it; and

     (c) A proxy statement responsive to the requirements of the Exchange Act
and regulations promulgated thereunder, whether  or not  the Corporation is then
subject to such requirements, shall be mailed to the stockholders of the
Corporation for the purpose of soliciting stockholder approval of such Business
Combination and shall contain at the front thereof, in a prominent place, (i)
any recommendations as to the advisability (or inadvisability) of the Business
Combination which the Continuing Directors may choose to state and (ii) the
opinion of a reputable investment banking firm selected by the Continuing
Directors as to the fairness of the terms of such Business Combination, from a
financial point of view, to the public stockholders (other than the Related
Person) of the Corporation.

     C.   A Related Person shall be deemed for purposes of this Article
FOURTEENTH to have acquired a share of the Corporation at the time when such
Related Person became the beneficial owner thereof



                                      16
<PAGE>
 
(as such term is defined in Paragraph A(2) of this Article FOURTEENTH). With
respect to shares owned by affiliates, associates and other Persons whose
ownership is attributed to a Related Person, if the price paid by such Related
Person for such shares is not determinable, the price so paid shall be deemed to
be the higher of (i) the price paid upon acquisition thereof by the affiliate,
associate or other Person or (ii) the Market Value of the shares in question at
the time when the Related Person became the beneficial owner thereof.

     For purposes of this Article FOURTEENTH, in the event of a Business
Combination upon consummation of which the Corporation would be the surviving
corporation or would continue to exist (unless it is provided, contemplated or
intended that as part of such Business Combination a plan of liquidation or
dissolution of the Corporation will be effected), the term "other consideration
to be received" in Paragraph B(2)(a) shall include (without limitation) common
stock or other capital stock of the Corporation retained by stockholders of the
Corporation (other than Related Persons who are parties to such Business
Combination).

     Nothing contained in this Article shall be construed to relieve any Related
Person from any fiduciary obligation imposed by law.

     D.   Notwithstanding any other provision of this  Restated Certificate of
Incorporation or the Bylaws of the Corporation (and notwithstanding the fact
that a lesser percentage may be permitted by law), any amendment, addition,
alteration, change or repeal of this Article FOURTEENTH, or any other amendment
of this  Restated Certificate of Incorporation or the Bylaws of the Corporation
inconsistent with or modifying or permitting circumvention of this Article
FOURTEENTH, must first be proposed by the Board of Directors of the Corporation,
upon the affirmative vote of at least two-thirds of the directors then in office
at a duly constituted meeting of the Board of Directors called for such purpose,
and thereafter approved by the affirmative vote of the holders of not less than
85% of the then outstanding Voting Stock held by stockholders other than a
Related Person by or with whom or on whose behalf, directly or indirectly, a
Business Combination is proposed, voting as a single class; provided, however,
that this Paragraph D shall not apply to, and such 85% vote shall not be
required for, any such amendment, addition,  alteration, change or  repeal
recommended to stockholders of the Corporation by the affirmative vote of not
less than 66 2/3% of the Continuing Directors. For the purposes of this
Paragraph D only, if at the time when any such amendment, addition, alteration,
change or repeal is under consideration there is no proposed Business
Combination, the term "Continuing Directors" shall be deemed to mean the Entire
Board of Directors.

  FIFTEENTH:  The Board of Directors, each committee of the Board of Directors
and each individual director, in discharging their respective duties under
applicable law and this  Restated Certificate of Incorporation and in
determining what they each believe to be in the best interests of the
Corporation and its stockholders, may consider the effects, both short-term and
long-term, of any action or proposed action taken or to be taken by the
Corporation, the Board of Directors or any committee of the Board on the
interests of (i) the employees, associates, associated physicians, distributors,
patients or other customers, suppliers or creditors of the Corporation and its
subsidiaries and (ii) the communities in which the Corporation and its
subsidiaries own or lease property or conduct business, all to the extent that
the Board of Directors, any committee of the Board of Directors or any
individual director deems pertinent under the circumstances (including the
possibility that the interests of the Corporation may best be  served by the
continued independence of  the Corporation); provided, however, that the
provisions of this Article FIFTEENTH shall not limit in any way the right of the
Board of Directors to consider any other lawful factors  in making its
determinations, including, without limitation, the effects, both short-term and
long-term, of any action or proposed action on the Corporation or its
stockholders directly; and provided further that this Article FIFTEENTH shall be
deemed solely to  grant discretionary authority to the Board of Directors, each
committee of the Board of Directors and each individual director and shall not
be deemed to provide to any specific constituency any right to be considered.

  SIXTEENTH:  Each person who was or is made a party or is threatened to be made
a party to or is involved (including, without limitation, as a witness) in any
actual or threatened action, suit or proceeding, whether



                                      17
<PAGE>
 
civil, criminal, administrative or investigative (hereinafter a "proceeding"),
by reason of the fact that he is or was a director, officer, employee or agent
of the corporation or is or was serving at the request of the Corporation as a
director, officer, employee or agent of another corporation or of a partnership,
joint venture, trust or other enterprise, including service with respect to an
employee benefit plan (hereinafter an "indemnitee"), whether the basis of such
proceeding is alleged action in an official capacity as a director, officer,
employee or agent or in any other capacity while serving as such a director,
officer, employee or agent, shall be indemnified and held harmless by the
Corporation to the full extent authorized by the General Corporation Law of
Delaware, as the same exists or may hereafter be amended (but, in the case of
any such amendment, only to the extent that such amendment permits the
Corporation to provide broader indemnification rights than said law permitted
the Corporation to provide prior to such amendment), or by other applicable law
as then in effect, against all expense, liability and loss (including attorneys'
fees, judgments, fines, excise taxes under the Employee Retirement Income
Security Act of 1974, as amended from time to time ("ERISA"), penalties and
amounts to be paid in settlement) actually and reasonably incurred or suffered
by such indemnitee in connection therewith.

  A.  Procedure.  Any indemnification under this Article SIXTEENTH (unless
ordered by a court) shall be made by the Corporation only as authorized in the
specific case upon a determination that indemnification of the director,
officer, employee or agent is proper in the circumstances because he or she has
met the applicable standard of conduct set forth in the General Corporation Law
of Delaware, as the same exists or hereafter may be amended (but, in the case of
any such amendment, only to the extent that such amendment permits the
Corporation to provide broader indemnification rights than said law permitted
the Corporation to provide prior to such amendment). Such determination shall be
made (a) by the Board of Directors by a majority vote of a quorum consisting of
directors who were not parties to such action, suit or proceeding (the
"Disinterested Directors"), or (b) if such a quorum of Disinterested Directors
is not obtainable, or, even if obtainable a quorum of Disinterested Directors so
directs, by independent legal counsel in a written opinion, or (c) by the
stockholders.

  B.  Advances For Expenses.  Costs, charges and expenses (including attorneys'
fees) incurred by a director or officer of the Corporation in defending a civil
or criminal action, suit or proceeding shall be paid by the Corporation in
advance of the final disposition of such action, suit or proceeding upon receipt
of an undertaking by or on behalf of the director or officer to repay all
amounts so advanced in the event that it shall ultimately be determined that
such director or officer is not entitled to be indemnified by the Corporation as
authorized in this Article SIXTEENTH. Such costs, charges and expenses incurred
by other employees and agents may be so paid upon such terms and conditions, if
any, as the majority of the Disinterested Directors deems appropriate. The
majority of the Disinterested Directors may, in the manner set forth above, and
upon approval of such director, officer, employer, employee or agent of the
Corporation, authorize the Corporation's counsel to represent such person, in
any action, suit or proceeding, whether or not the Corporation is a party to
such action, suit or proceeding.

  C.  Procedure for Indemnification.  Any indemnification or advance of costs,
charges and expenses under this Article SIXTEENTH, shall be made promptly, and
in any event within 60 days upon the written request of the director, officer,
employee or agent. The right to indemnification or advances as granted by this
Article SIXTEENTH, shall be enforceable by the director, officer, employee or
agent in any court of competent jurisdiction, if the Corporation denies such
request, in whole or in part, or if no disposition thereof is made within 60
days. Such person's costs and expenses incurred in connection with successfully
establishing his or her right to indemnification, in whole or in part, in any
such action shall also be indemnified by the Corporation. It shall be a defense
to any such action (other than an action brought to enforce a claim for the
advance of costs, charges and expenses under this Article SIXTEENTH, where the
required undertaking, if any, has been received by the Corporation) that the
claimant has not met the standard of conduct set forth in the General
Corporation Law of Delaware, as the same exists or hereafter may be amended
(but, in the case of any such amendment, only to the extent that such amendment
permits the Corporation to provide broader indemnification rights than said law
permitted the Corporation to provide prior to such amendment), but the burden of
proving such defense shall be on the Corporation. Neither the failure of the
Corporation (including



                                      18
<PAGE>
 
its Board of Directors, its independent legal counsel and its stockholders) to
have made a determination prior to the commencement of such action that
indemnification of the claimant is proper in the circumstances because he or she
has met the applicable standard of conduct set forth in the General Corporation
Law of Delaware, as the same exists or hereafter may be amended (but, in the
case of any such amendment, only to the extent that such amendment permits the
Corporation to provide broader indemnification rights that said law permitted
the Corporation to provide prior to such amendment), nor the fact that there has
been an actual determination by the Corporation (including its Board of
Directors, its independent legal counsel and its stockholders) that the claimant
has not met such applicable standard of conduct, shall be a defense to the
action or create a presumption that the claimant has not met the applicable
standard of conduct.

  D.  Other Rights; Continuation of Right to Indemnification.  The
indemnification and advancement of expenses provided by this Article SIXTEENTH
shall not be deemed exclusive of any other rights to which a person seeking
indemnification or advancement of expenses may be entitled under any law (common
or statutory), bylaw, agreement, vote of stockholders or disinterested directors
or otherwise, both as to action in his or her official capacity and as to action
in another capacity while holding office or while employed by or acting as agent
for the Corporation, and shall continue as to a person who has ceased to be a
director, officer, employee or agent, and shall inure to the benefit of the
estate, heirs, executors and administrators of such person. All rights to
indemnification under this Article SIXTEENTH, shall be deemed to be a contract
between the Corporation and each director, officer, employee or agent of the
Corporation who serves or served in such capacity at any time while this Article
SIXTEENTH, is in effect. Any repeal or modification of this Article SIXTEENTH,
or any repeal or modification of relevant provisions of the General Corporation
Law of Delaware or any other applicable laws shall not in any way diminish any
rights to indemnification of such director, officer, employee or agent or the
obligations of the Corporation arising hereunder with respect to any action,
suit or proceeding arising out of, or relating to, any actions, transactions or
facts occurring prior to the final adoption of such modification or repeal. For
the purposes of this Article SIXTEENTH, references to "the Corporation" include
all constituent corporations absorbed in a consolidation or merger as well as
the resulting or surviving corporation, so that any person who is or was a
director, officer, employee or agent of such a constituent corporation or is or
was serving at the request of such constituent corporation as a director,
officer, employee or agent of another corporation, partnership, joint venture,
trust or other enterprise shall stand in the same position under the provisions
of this Article SIXTEENTH, with respect to the resulting or surviving
corporation, as he would if he or she had served the resulting or surviving
corporation in the same capacity.

  E.  Insurance.  The Corporation shall have power to purchase and maintain
insurance on behalf of any person who is or was or has agreed to become a
director, officer, employee or agent of the Corporation, or is or was serving at
the request of the Corporation as a director, officer, employee or agent of
another corporation, partnership, joint venture, trust or other enterprise
against any liability asserted against him or her and incurred by him or her or
on his or her behalf in any such capacity, or arising out of his or her status
as such, whether or not the Corporation would have the power to indemnify him or
her against such liability under the provisions of this Article SIXTEENTH;
provided, however, that such insurance is available on acceptable terms, which
determination shall be made by a vote of a majority of the Board of Directors.

  F.  Savings Clause.  If this Article SIXTEENTH, or any portion hereof shall be
invalidated on any ground by any court of competent jurisdiction, then the
Corporation shall nevertheless indemnify each person entitled to indemnification
under the first paragraph of this Article SIXTEENTH, as to all expense,
liability and loss (including attorneys' fees, judgments, fines, ERISA excise
taxes, penalties and amounts to be paid in settlement) actually and reasonably
incurred or suffered by such person and for which indemnification is available
to such person pursuant to this Article SIXTEENTH, to the full extent permitted
by any applicable  portion of this Article SIXTEENTH, that shall not have been
invalidated and to the full extent permitted by applicable law.

  SEVENTEENTH:  In furtherance and not in limitation of the powers conferred by
law or in this  Restated Certificate of Incorporation, the Board of Directors
(and any committee of the Board of Directors) is expressly



                                      19
<PAGE>
 
authorized, to the extent permitted by law, to take such action or actions as
the Board or such committee may determine to be reasonably necessary or
desirable to (A) encourage any person to enter into negotiations with the Board
of Directors and management of the Corporation with respect to any transaction
which may result in a change in control of the Corporation which is proposed or
initiated by such person or (B) contest or oppose any such transaction which the
Board of Directors or such committee determines to be unfair, abusive or
otherwise undesirable with respect to the Corporation and its business, assets
or properties or the stockholders of the Corporation, including, without
limitation, the adoption of such plans or the issuance of such rights, options,
capital stock, notes, debentures or other evidences of indebtedness or other
securities of the Corporation, which rights, options, capital stock, notes,
evidences of indebtedness and other securities (i) may be exchangeable for or
convertible into cash or other securities on such terms and conditions as may be
determined by the Board or such committee and (ii) may provide for the treatment
of any holder or class of holders thereof designated by the Board of Directors
or any such committee in respect of the terms, conditions, provisions and rights
of such securities which is different from, and unequal to, the terms,
conditions, provisions and rights applicable to all other holders thereof.

  EIGHTEENTH:  The Corporation reserves the right to amend, add, alter, change,
repeal or adopt any provision contained in this  Restated Certificate of
Incorporation, in the manner now or hereafter prescribed by statute, and all
rights conferred upon stockholders herein are granted subject to this
reservation. In addition to any affirmative vote required by applicable law or
any other provision of this Restated Certificate of Incorporation or specified
in any agreement, and in addition to any voting rights granted to or held by the
holders of any series of Preferred Stock, the affirmative vote of the holders of
not less than 75% of the voting power of all securities of the Corporation
entitled to vote generally in the election of directors shall be required to
amend, add, alter, change, repeal or adopt any provisions inconsistent with
Articles FIFTH, SIXTH, SEVENTH, EIGHTH, NINTH, TENTH, TWELFTH, THIRTEENTH,
FIFTEENTH, SIXTEENTH, SEVENTEENTH and EIGHTEENTH of this Restated Certificate of
Incorporation.

     IN WITNESS WHEREOF, this Restated Certificate of Incorporation has been
signed by authorized representatives of the Corporation this 10th day of
February, 1994.

                              COLUMBIA HEALTHCARE CORPORATION


                              BY: /s/ STEPHEN T. BRAUN
                                 ------------------------------------
                                    STEPHEN T. BRAUN
                                    SENIOR VICE PRESIDENT,
                                    GENERAL COUNSEL AND
                                    ASSISTANT SECRETARY


ATTEST:


BY:  /s/ JOAN O. KROGER
     ----------------------
     JOAN O. KROGER
     SECRETARY




                                      20
<PAGE>
 
                           CERTIFICATE OF AMENDMENT
                                      OF
                     RESTATED CERTIFICATE OF INCORPORATION
                                      OF
                      COLUMBIA/HCA HEALTHCARE CORPORATION


     Columbia/HCA Healthcare Corporation, a corporation organized and existing
under the laws of the State of Delaware (the "Corporation"), hereby certifies as
follows:

     FIRST:         That the Board of Directors of the Corporation, at a duly
called meeting thereof, and subject to the approval of the stockholders of the
Corporation, adopted a resolution to amend the Fifth Article, Section A of the
Restated Certificate of Incorporation of the Corporation to increase the size of
the Board of Directors to eighteen members, so that as amended such Fifth
Article, Section A shall read and be substituted in its entirety as follows:

          "A.  Number of Directors.  The number of directors of the Corporation
          (exclusive of directors to be elected by the holders of one or more
          series of the Preferred Stock of the Corporation which may be
          outstanding, voting separately as a series or class) shall be fixed
          from time to time by action of not less than a majority of the members
          of the Board of Directors then in office, but in no event shall be
          less than three nor more than eighteen."

     SECOND:        That the above amendment was adopted at a duly called
Special Meeting of Stockholders and in accordance with the provisions of Section
242 of the General Corporation Law of the State of Delaware and the
Corporation's Restated Certificate of Incorporation by the affirmative vote of
the holders of not less than seventy-five percent of the voting power of all the
securities of the Corporation entitled to vote.

     THIRD:         All other provisions of the Corporation's Restated
Certificate of Incorporation shall remain unchanged.

     IN WITNESS WHEREOF, this Certificate of Amendment of Restated Certificate
of Incorporation has been signed by an authorized representative of the
Corporation this 21st day of April, 1995.

                                       COLUMBIA/HCA HEALTHCARE CORPORATION

                                       By:  /s/ STEPHEN T. BRAUN
                                          ------------------------------------- 
                                                Stephen T. Braun
                                                Senior Vice President
                                                and Secretary
<PAGE>
 
                           CERTIFICATE OF AMENDMENT
                                      OF
                     RESTATED CERTIFICATE OF INCORPORATION
                                      OF
                      COLUMBIA/HCA HEALTHCARE CORPORATION

                ------------------------------------------------
   
                        PURSUANT TO SECTION 242 OF THE
               GENERAL CORPORATION LAW OF THE STATE OF DELAWARE

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

     Columbia/HCA Healthcare Corporation, a corporation organized and existing
under the laws of the State of Delaware (the "Corporation"), hereby certifies as
follows:

     FIRST:   That the Board of Directors of the Corporation, at a duly called
meeting thereof, and subject to the approval of the stockholders of the
Corporation, adopted certain resolutions to amend the Fourth Article of the
Restated Certificate of Incorporation of the Corporation to increase the
authorized number of shares of the Corporation's Common Stock and Nonvoting
Common Stock, so that the first paragraph of such Fourth Article shall be
amended to read in its entirety as follows:

     FOURTH:  The total number of shares of all classes of capital stock which
     the Corporation shall have the authority to issue is One Billion Six
     Hundred Seventy-Five Million (1,675,000,000) shares, divided into three
     classes of which Twenty-Five Million (25,000,000) shares, par value $.01
     per share, shall be designated Preferred Stock, One Billion Six Hundred
     Million (1,600,000,000) shares, par value $.01 per share, shall be
     designated Common Stock and Fifty Million (50,000,000) shares, par value
     $.01 per share, shall be designated Nonvoting Common Stock.

     SECOND:     That the above amendment was adopted at the duly called 1997
Annual Meeting of Stockholders of the Corporation in accordance with the
provisions of Section 242 of the General Corporation Law of the State of
Delaware and the Corporation's Restated Certificate of Incorporation by the
affirmative vote of the holders of a majority of the outstanding shares of
Common Stock and Nonvoting Common Stock, voting together as a single class.

     THIRD:      All other provisions of the Corporation's Restated Certificate
of Incorporation shall remain unchanged.

     IN WITNESS WHEREOF, the Corporation has caused its corporate seal to be
affixed and this Certificate of Amendment of Restated Certificate of
Incorporation to be signed and attested by authorized representatives of the
Corporation this 26th day of June, 1997.

                                    COLUMBIA/HCA HEALTHCARE CORPORATION
 

Attest:                             By:         /s/ STEPHEN T. BRAUN
                                       ----------------------------------------
                                                    Stephen T. Braun
                                       Senior Vice President and General Counsel
By:/s/ JOHN M. FRANCK II
   -------------------------------
       John M. Franck II
      Corporate Secretary
<PAGE>
 
                           CERTIFICATE OF AMENDMENT
                                      OF
                     RESTATED CERTIFICATE OF INCORPORATION
                                      OF
                      COLUMBIA/HCA HEALTHCARE CORPORATION
                ______________________________________________

                        PURSUANT TO SECTION 242 OF THE
               GENERAL CORPORATION LAW OF THE STATE OF DELAWARE
               ________________________________________________

     Columbia/HCA Healthcare Corporation, a corporation organized and existing
under the laws of the State of Delaware (the "Corporation"), hereby certifies as
follows:

     FIRST: That the Board of Directors of the Corporation, at a duly called
meeting thereof, and subject to the approval of the stockholders of the
Corporation, adopted certain resolutions to amend the Fifth Article of the
Restated Certificate of Incorporation of the Corporation to read in its entirety
as follows:

          FIFTH: The business and affairs of the Corporation shall be managed by
     or under the direction of the Board of Directors. The Board of Directors
     may exercise all such authority and powers of the Corporation and do all
     such lawful acts and things as are not by statute or this Restated
     Certificate of Incorporation directed or required to be exercised or done
     by the stockholders.

     A.  Number of Directors.  The number of directors of the Corporation
     (exclusive of directors to be elected by the holders of one or more series
     of the Preferred Stock of the Corporation which may be outstanding, voting
     separately as a series or class) shall be fixed from time to time by action
     of not less than a majority of the members of the Board of Directors then
     in office, but in no event shall be less than three nor more than eighteen.

     B.  Terms.  Until the annual meeting of stockholders in 2001, the
     directors shall be divided into three classes designated Class I, Class II
     and Class III, respectively.  Each director elected prior to the
     effectiveness of this Article FIFTH shall serve for the full term for which
     he or she was elected, such that the term of each director elected at the
     1996 annual meeting (Class III) or appointed to fill a vacancy as a Class
     III director prior to the 1999 annual meeting shall end at the annual
     meeting in 1999, the term of each director elected at the 1997 annual
     meeting (Class I) or appointed to fill a vacancy as a Class I director
     prior to the 2000 annual meeting shall end at the annual meeting in 2000,
     and the term of each director elected at the 1998 annual meeting (Class II)
     or appointed to fill a vacancy as a Class II director prior the 2001 annual
     meeting shall end at the annual meeting in 2001.  Following the expiration
     of the term of Class III directors in 1999, Class I directors in 2000, and
     Class II directors in 2001, the directors in each such Class shall hold
     office for a term expiring at the next annual meeting of stockholders or
     until their successors are elected and qualified or until their earlier
     resignation or removal.  Commencing with the Annual Meeting of Stockholders
     in 2001, the foregoing classification of the Board of Directors shall
     cease, and all directors shall be of one class and shall hold office for a
     term expiring at the next annual meeting of stockholders or until their
     successors are elected and qualified or until their earlier resignation or
     removal. In no case shall a decrease in the number of directors shorten the
     term of any incumbent director.
<PAGE>
 
     C.  Vacancies.  Subject to the rights, if any, of the holders of any
     series of Preferred Stock then outstanding, newly created directorships
     resulting from any increase in the authorized number of directors or any
     vacancies in the Board of Directors resulting from death, resignation,
     disqualification or removal may be filled only by a majority vote of the
     directors then in office, though less than a quorum, and directors so
     chosen shall hold office for a term expiring at the annual meeting of
     stockholders at which the term of office of the class to which they have
     been elected expires; provided that, after the Annual Meeting of
     Stockholders in 2001, directors so chosen shall hold office for a term
     expiring at the next annual meeting of stockholders or until their
     successors are elected and qualified or until their earlier resignation or
     removal.  No decrease in the number of directors constituting the Board of
     Directors shall shorten the term of any incumbent director.

     D.  Removal.  Until and including the Annual Meeting of Stockholders in
     2001, and subject to the rights, if any, of any series of Preferred Stock
     then outstanding, any director, or the entire Board of Directors, may be
     removed from office at any time, but only for cause and only by the
     affirmative vote of the holders of at least 66 2/3% of the voting power of
     all of the then outstanding shares of capital stock of the Corporation
     entitled to vote generally in the election of directors, voting together as
     a single class. Directors so chosen shall hold office for a term expiring
     at the annual meeting of stockholders at which the term of office of the
     class to which they have been elected expires. Following the Annual Meeting
     of Stockholders in 2001, subject to the rights, if any, of any series of
     Preferred Stock then outstanding, any director, or the entire Board of
     Directors, may be removed from office at any time by the affirmative vote
     of the holders of the majority of the voting power of all of the then
     outstanding shares of capital stock of the Corporation entitled to vote
     generally in the election of directors, voting together as a single class
     at a duly held meeting.

     SECOND: That the above amendment was adopted at the duly called 1998 Annual
Meeting of Stockholders of the Corporation in accordance with the provisions of
Section 242 of the General Corporation Law of the State of Delaware and the
Corporation's Restated Certificate of Incorporation.

     IN WITNESS WHEREOF, the Corporation has caused this Certificate of
Amendment of Restated Certificate of Incorporation to be signed by its
authorized officer this 11th day of August, 1998.

                              COLUMBIA/HCA HEALTHCARE CORPORATION


                              BY: /s/ JOHN M. FRANCK II
                                 -----------------------------------------------
                                      JOHN M. FRANCK II
                                      CORPORATE SECRETARY

                                       2

<PAGE>
 
                                                                    EXHIBIT 3(b)


                                                   ADOPTED JULY 7, 1993
                                                   AMENDED FEBRUARY 10, 1994

                                   BYLAWS OF
                      COLUMBIA/HCA HEALTHCARE CORPORATION


                                   ARTICLE I
                                    OFFICES


  SECTION 1.  Registered Office.  The registered office of the Corporation shall
be within the State of Delaware in the City of Wilmington, County of New Castle.

  SECTION 2.  Other Offices.  The Corporation may also have an office or offices
other than said registered office at such place or places, either within or
without the State of Delaware, as the Board of Directors shall from time to time
determine or the business of the Corporation may require.


                                   ARTICLE II
                            MEETINGS OF STOCKHOLDERS


  SECTION 1.  Place of Meetings.  All meetings of the stockholders for the
election of directors or for any other purpose shall be held at any such place,
either within or without the State of Delaware, as shall be designated from time
to time by the Board of Directors and stated in the notice of meeting or in a
duly executed waiver thereof.

  SECTION 2.  Annual Meeting.  The annual meeting of stockholders shall be held
at such date and time as shall be designated from time to time by the Board of
Directors and stated in the notice of meeting or in a duly executed waiver
thereof.  At such annual meeting, the stockholders shall elect, by a plurality
vote, a class of the Board of Directors in the manner provided in the
Corporation's Certificate of Incorporation and transact such other business as
may properly be brought before the meeting.

  SECTION 3.  Special Meetings.  Special meetings of stockholders, unless
otherwise prescribed by statute, may be called at any time only by the Board of
Directors, the Chairman of the Board or the Chief Executive Officer.

  SECTION 4.  Notice of Meetings. Except as otherwise expressly required by
statute, written notice of each annual and special meeting of stockholders
stating the date, place and hour of the meeting, and, in the case of a special
meeting, the purpose or purposes for which the meeting is called, shall be given
to each stockholder of record entitled to vote thereat not less than ten nor
more than sixty days before the date of the meeting. Business transacted at any
special meeting of stockholders shall be limited to the purposes stated in the
notice. Notice shall be given personally or by mail and, if by mail, shall be
sent in a postage prepaid envelope, addressed to the stockholder at the address
appearing on the records of the Corporation. Notice by mail shall be deemed
given at the time when the same shall be deposited in the United States mail,
postage prepaid. Notice of any meeting shall not be required to be given to any
person who attends such meeting, except when such person attends the meeting in
person or by proxy for the express purpose of objecting, at the beginning of the
meeting, to the transaction of any business because the meeting is not lawfully
called or convened, or who, either before or after the meeting, shall submit a
signed written waiver
<PAGE>
 
of notice, in person or by proxy. Neither the business to be transacted at, nor
the purpose of, an annual or special meeting of stockholders need be specified
in any written waiver of notice.

  SECTION 5.  List of Stockholders.  The officer who has charge of the stock
ledger of the Corporation shall prepare and make, at least ten days before each
meeting of stockholders, a complete list of the stockholders entitled to vote at
the meeting, arranged in alphabetical order, showing the address of and the
number of shares registered in the name of each stockholder.  Such list shall be
open to the examination of any stockholder, for any purpose germane to the
meeting, during ordinary business hours, for a period of at least ten days prior
to the meeting, either at a place within the city, town or village where the
meeting is to be held, which place shall be specified in the notice of meeting,
or, if not specified, at the place where the meeting is to be held.  The list
shall be produced and kept at the time and place of the meeting during the whole
time thereof, and may be inspected by any stockholder who is present.

  SECTION 6.  Quorum, Adjournments.  The holders of a majority of the voting
power of the issued and outstanding stock of the Corporation entitled to vote
thereat, present in person or represented by proxy, shall constitute a quorum
for the transaction of business at all meetings of stockholders, except as
otherwise provided by statute or by the Certificate of Incorporation.  If,
however, such quorum shall not be present or represented by proxy at any meeting
of stockholders, the stockholders entitled to vote thereat, present in person or
represented by proxy, shall have the power to adjourn the meeting from time to
time, without notice other than announcement at the meeting, until a quorum
shall be present or represented by proxy. At such adjourned meeting at which a
quorum shall be present or represented by proxy, any business may be transacted
which might have been transacted at the meeting as originally called.  If the
adjournment is for more than thirty days, or, if after adjournment a new record
date is set, a notice of the adjourned meeting shall be given to each
stockholder of record entitled to vote at the meeting.

  SECTION 7.  Organization.  At each meeting of stockholders, the Chairman of
the Board, if one shall have been elected, or, in his absence or if one shall
not have been elected, the Chief Executive Officer, shall act as chairman of the
meeting.  The Secretary or, in his absence or inability to act, the person whom
the chairman of the meeting shall appoint secretary of the meeting, shall act as
secretary of the meeting and keep the minutes thereof.

  SECTION 8.  Order of Business.  The order of business at all meetings of the
stockholders shall be as determined by the chairman of the meeting.

  SECTION 9.  Voting.  Except as otherwise provided by statute or the
Certificate of Incorporation, each stockholder of the Corporation shall be
entitled at each meeting of stockholders to one vote for each share of capital
stock of the Corporation standing in his name on the record of stockholders of
the Corporation:

  (a) on the date fixed pursuant to the provisions of Section 7 of Article V of
these Bylaws as the record date for the determination of the stockholders who
shall be entitled to notice of and to vote at such meeting; or

  (b) if no such record date shall have been so fixed, then at the close of
business on the day next preceding the day on which notice thereof shall be
given, or, if notice is waived, at the close of business on the date next
preceding the day on which the meeting is held.

     Each stockholder entitled to vote at any meeting of stockholders may
authorize another person or persons to act for him by a proxy signed by such
stockholder or his attorney-in-fact, but no proxy shall be voted after three
years from its date, unless the proxy provides for a longer period.  Any such
proxy shall

                                       2
<PAGE>
 
be delivered to the secretary of the meeting at or prior to the time designated
in the order of business for so delivering such proxies. When a quorum is
present at any meeting, the vote of the holders of a majority of the voting
power of the issued and outstanding stock of the Corporation entitled to vote
thereon, present in person or represented by proxy, shall decide any question
brought before such meeting, unless the question is one upon which by express
provision of statute or of the Certificate of Incorporation or of these Bylaws,
a different vote is required, in which case such express provision shall govern
and control the decision of such question. Unless required by statute, or
determined by the chairman of the meeting to be advisable, the vote on any
question need not be by ballot. On a vote by ballot, each ballot shall be signed
by the stockholder voting, or by his proxy, and shall state the number of shares
voted.

  SECTION 10.  Inspectors.  The Board of Directors shall, in advance of any
meeting of stockholders, appoint one or more inspectors to act at such meeting
or any adjournment thereof and make a written report thereof.  If any of the
inspectors so appointed shall fail to appear or shall be unable to act, the
chairman of the meeting shall appoint one or more inspectors.  Each inspector,
before entering upon the discharge of his or her duties, shall take and sign an
oath faithfully to execute the duties of inspector at such meeting with strict
impartiality and according to the best of his or her ability.  The inspectors
shall ascertain the number of shares of capital stock of the Corporation
outstanding and the voting power of each, determine the number of shares
represented at the meeting and the validity of proxies and ballots, count all
votes and ballots, determine and retain for a reasonable period a record of the
disposition of any challenges made to any determination by the inspectors and
certify their determination of the number of shares represented at the meeting
and their count of all votes and ballots.  The inspectors may appoint or retain
other persons or entities to assist the inspectors in the performance of the
duties of the inspectors. No director or candidate for the office of director
shall act as an inspector of an election of directors. Inspectors need not be
stockholders.


                                  ARTICLE III
                              BOARD OF DIRECTORS


  SECTION 1.  Place of Meetings.  Meetings of the Board of Directors shall be
held at such place or places, within or without the State of Delaware, as the
Board of Directors may from time to time determine or as shall be specified in
the notice of any such meeting.

  SECTION 2.  Annual Meeting.  The Board of Directors shall meet for the purpose
of organization, the election of officers and the transaction of other business,
as soon as practicable after each annual meeting of stockholders, on the same
day and at the same place where such annual meeting shall be held.  Notice of
such meeting need not be given.  In the event such annual meeting is not so
held, the annual meeting of the Board of Directors may be held at such other
time or place (within or without the State of Delaware) as shall be specified in
a notice thereof given as hereinafter provided in Section 5 of this Article III.

  SECTION 3.  Regular Meetings.  Regular meetings of the Board of Directors
shall be held at such time and place as the Board of Directors may fix.  If any
day fixed for a regular meeting shall be a legal holiday at the place where the
meeting is to be held, then the meeting which would otherwise be held on that
day shall be held at the same hour on the next succeeding business day (unless
the Chairman of the Board determines otherwise).  Notice of regular meetings of
the Board of Directors need not be given except as otherwise required by statute
or these Bylaws.

                                       3
<PAGE>
 
  SECTION 4.  Special Meetings.  Special meetings of the Board of Directors may
be called by the Chairman of the Board, if one shall have been elected, by two
or more directors of the Corporation or by the Chief Executive Officer or the
President.

  SECTION 5.  Notice of Meetings.  Notice of each special meeting of the Board
of Directors (and of each regular meeting for which notice shall be required)
shall be given by the Secretary as hereinafter provided in this Section 5, in
which notice shall be stated the time and place of the meeting.  Except as
otherwise required by these Bylaws, such notice need not state the purposes of
such meeting.  Notice of each such meeting shall be sent to each director,
addressed to such director at his or her residence or usual place of business,
by telegraph, cable, telex, telecopier or other similar means, or be delivered
to him or her personally or be given to him or her by telephone or other similar
means, at least two hours before the time at which such meeting is to be held.
Notice of any such meeting need not be given to any director who shall, either
before or after the meeting, submit a signed waiver of notice or who shall
attend such meeting, except when he or she shall attend for the express purpose
of objecting, at the beginning of the meeting, to the transaction of any
business because the meeting is not lawfully called or convened.

  SECTION 6.  Quorum and Manner of Acting.  A majority of the entire Board of
Directors shall constitute a quorum for the transaction of business at any
meeting of the Board of Directors, and, except as otherwise expressly required
by statute, the Certificate of Incorporation or these Bylaws, the act of a
majority of the directors present at any meeting at which a quorum is present
shall be the act of the Board of Directors. In the absence of a quorum at any
meeting of the Board of Directors, a majority of the directors present thereat
may adjourn such meeting to another time and place.  Notice of the time and
place of any such adjourned meeting shall be given to all of the directors
unless such time and place were announced at the meeting at which the
adjournment was taken, in which case such notice shall only be given to the
directors who were not present thereat.  At any adjourned meeting at which a
quorum is present, any business may be transacted which might have been
transacted at the meeting as originally called.  The directors shall act only as
a Board and the individual directors shall have no power as such.

  SECTION 7.  Organization.  At each meeting of the Board of Directors, the
Chairman of the Board, if one shall have been elected, or, in the absence of the
Chairman of the Board or if one shall not have been elected, another director
chosen by a majority of the directors present, shall act as chairman of the
meeting and preside thereat.  The Secretary or, in his absence or if one shall
not have been elected, any person appointed by the chairman of the meeting,
shall act as secretary of the meeting and keep the minutes thereof.

  SECTION 8.  Resignations.  Any director of the Corporation may resign at any
time by giving written notice of his resignation to the Corporation.  Any such
resignation shall take effect at the time specified therein or, if the time when
it shall become effective shall not be specified therein, immediately upon its
receipt by the Corporation.  Unless otherwise specified therein, the acceptance
of such resignation shall not be necessary to make it effective.

  SECTION 9.  Compensation.  The Board of Directors shall have authority to fix
the compensation, including fees and reimbursement of expenses, of directors for
services to the Corporation in any capacity.

  SECTION 10.  Committees.  The Board of Directors may, by resolution passed by
a majority of the entire Board of Directors, designate one or more committees,
including an executive committee and a nominating committee, each committee to
consist of one or more of the directors of the Corporation.  Commencing with the
date of the adoption of these Bylaws and ending on the date which is three years
from such date, the nominating committee shall be composed of four directors and
such committee shall have the exclusive

                                       4
<PAGE>
 
power to nominate persons to serve as directors of the Corporation. The
composition of the nominating committee shall be determined in accordance with
Section 7.14(b) of that certain Merger Agreement, dated as of June 10, 1993, by
and between Columbia Hospital Corporation and Galen Health Care, Inc. Subject to
the foregoing, the Board of Directors may designate one or more directors as
alternate members of any committee, who may replace any absent or disqualified
member at any meeting of the committee. In addition, in the absence or
disqualification of a member of a committee, the member or members thereof
present at any meeting and not disqualified from voting, whether or not he or
she or they constitute a quorum, may unanimously appoint another member of the
Board of Directors to act at the meeting in the place of any such absent or
disqualified member.

     Except to the extent restricted by statute or the Certificate of
Incorporation, each such committee, to the extent provided in the resolution
creating it, shall have and may exercise all the powers and authority of the
Board of Directors.  Each such committee shall serve at the pleasure of the
Board of Directors and have such name as may be determined from time to time by
resolution adopted by the Board of Directors. Each committee shall keep regular
minutes of its meetings and report the same to the Board of Directors.

  SECTION 11.  Action by Consent.  Unless restricted by the Certificate of
Incorporation, any action required or permitted to be taken by the Board of
Directors or any committee thereof may be taken without a meeting if all members
of the Board of Directors or such committee, as the case may be, consent thereto
in writing, and the writing or writings are filed with the minutes of the
proceedings of the Board of Directors or such committee, as the case may be.

  SECTION 12.  Telephonic Meeting.  Unless restricted by the Certificate of
Incorporation, any one or more members of the Board of Directors or any
committee thereof may participate in a meeting of the Board of Directors or such
committee by means of a conference telephone or similar communications equipment
by means of which all persons participating in the meeting can hear each other.
Participation by such means shall constitute presence in person at a meeting.

  SECTION 13.  Mandatory Board Retirement Policy.  Effective July 1, 1994, no
person shall be nominated to a term of office on the Company's Board of
Directors who has attained the age of 70 or more before the first day of the
proposed term of office; provided, however, the foregoing policy shall be
inapplicable to current directors of the Company aged 70 or more whose current
term of office, on February 10, 1994, expires subsequent to the Company's 1994
Annual Meeting of Stockholders.


                                  ARTICLE IV
                                   OFFICERS


  SECTION 1.  Number and Qualifications.  The officers of the Corporation shall
be elected by the Board of Directors and shall include the Chairman of the
Board, the Chief Executive Officer, the President, one or more Vice Presidents
(including Senior, Executive Vice Presidents or other classifications of Vice
Presidents), the Secretary and the Treasurer.  If the Board of Directors wishes,
it may also elect other officers (including one or more Assistant Treasurers and
one or more Assistant Secretaries) as may be necessary or desirable for the
business of the Corporation.  Any two or more offices may be held by the same
person, and no officer except the Chairman of the Board need be a director.
Each officer shall hold office until his or her successor shall have been duly
elected and shall have qualified, or until his death, or until he or she shall
have resigned or have been removed or disqualified, as hereinafter provided in
these Bylaws.

                                       5
<PAGE>
 
  SECTION 2.  Resignations. Any officer of the Corporation may resign at any
time by giving written notice of his or her resignation to the Corporation. Any
such resignation shall take effect at the time specified therein or, if the time
when it shall become effective shall not be specified therein, immediately upon
receipt by the Corporation. Unless otherwise specified therein, the acceptance
of any such resignation shall not be necessary to make it effective.

  SECTION 3.  Removal.  Any officer of the Corporation may be removed, either
with or without cause, at any time, by the Board of Directors at any meeting
thereof.

  SECTION 4.  Chairman of the Board.  The Chairman of the Board shall be elected
from among the members of the Board.  If present, he or she shall preside at all
meetings of the Board of Directors and Stockholders.  He or she shall advise and
counsel with the Chief Executive Officer, and in his or her absence with other
executives of the Corporation, and shall perform such other duties as may from
time to time be assigned to him or her by the Board of Directors.

  SECTION 5.  Chief Executive Officer.  The Chief Executive Officer shall also
serve as the President and, subject to the Board of Directors, he or she shall
have general executive charge, management, and control of the properties and
operations of the Corporation in the ordinary course of its business, with all
such powers with respect to such properties and operations as may be reasonably
incident to such responsibilities.  If the Board of Directors has not elected a
Chairman or in the absence or inability to act of the Chairman of the Board, the
Chief Executive Officer shall exercise all of the powers and discharge all of
the duties of the Chairman of the Board.

  SECTION 6.  Vice President.  Each Vice President shall perform all such duties
as from time to time may be assigned to him or her by the Board of Directors,
the Chairman of the Board, the Chief Executive Officer or the President.  At the
request of the Chief Executive Officer or the President or in his or her absence
or in the event of his or her inability or refusal to act, the Vice President,
or if there shall be more than one, the Vice Presidents in the order determined
by the Board of Directors (or if there be no such determination, then the Vice
Presidents in the order of their election), shall perform the duties of the
Chief Executive Officer or the President, as applicable.

  SECTION 7.  Treasurer.  The Treasurer shall

     (a) have charge and custody of, and be responsible for, all the funds and
securities of the Corporation;

     (b)  keep full and accurate accounts of receipts and disbursements in books
belonging to the Corporation;

     (c) deposit all moneys and other valuables to the credit of the Corporation
in such depositaries as may be designated by the Board of Directors or pursuant
to its direction;

     (d) receive, and give receipts for, moneys due and payable to the
Corporation from any source whatsoever;

     (e) disburse the funds of the Corporation and supervise the investment of
its funds, taking proper vouchers therefor;

                                       6
<PAGE>
 
     (f) render to the Board of Directors, whenever the Board of Directors may
require, an account of the financial condition of the Corporation; and

     (g) in general, perform all duties incident to the office of Treasurer and
such other duties as from time to time may be assigned to him or her by the
Board of Directors, the Chairman of the Board or the Chief Executive Officer.

  SECTION 8.  Secretary.  The Secretary shall

  (a)  keep or cause to be kept in one or more books provided for the purpose,
the minutes of all meetings of the Board of Directors, the committees of the
Board of Directors and the stockholders;

  (b) see that all notices are duly given in accordance with the provisions of
these Bylaws and as required by law;

  (c) be custodian of the records and the seal of the Corporation and affix and
attest the seal to all certificates for shares of the Corporation (unless the
seal of the Corporation on such certificates shall be a facsimile, as
hereinafter provided) and affix and attest the seal to all other documents to be
executed on behalf of the Corporation under its seal;

  (d) see that the books, reports, statements, certificates and other documents
and records required by law to be kept and filed are properly kept and filed;
and

  (e) in general, perform all duties incident to the office of Secretary and
such other duties as from time to time may be assigned to him or her by the
Board of Directors, the Chairman of the Board or the Chief Executive Officer.

  SECTION 9.  The Assistant Treasurer.  The Assistant Treasurer, or if there
shall be more than one, the Assistant Treasurers in the order determined by the
Board of Directors (or if there be no such determination, then in the order of
their election), shall, in the absence of the Treasurer or in the event of his
or her inability or refusal to act, perform the duties and exercise the powers
of the Treasurer and shall perform such other duties as from time to time may be
assigned by the Board of Directors.

  SECTION 10.  The Assistant Secretary.  The Assistant Secretary, or if there
shall be more than one, the Assistant Secretaries in the order determined by the
Board of Directors (or if there be no such determination, then in the order of
their election), shall, in the absence of the Secretary or in the event of his
or her inability or refusal to act, perform the duties and exercise the powers
of the Secretary and shall perform such other duties as from time to time may be
assigned by the Board of Directors, the Chairman of the Board or the Chief
Executive Officer.

  SECTION 11.  Officers' Bonds or Other Security.  If required by the Board of
Directors, any officer of the Corporation shall give a bond or other security
for the faithful performance of his or her duties, in such amount and with such
surety as the Board of Directors may require.

  SECTION 12.  Compensation.  The compensation of the officers of the
Corporation for their services as such officers shall be fixed from time to time
by the Board of Directors.  An officer of the Corporation shall not be prevented
from receiving compensation by reason of the fact that he or she is also a
director of the Corporation.

                                       7
<PAGE>
 
                                   ARTICLE V
                     STOCK CERTIFICATES AND THEIR TRANSFER


  SECTION 1.  Stock Certificates.  Every holder of stock in the Corporation
shall be entitled to have a certificate signed by, or in the name of the
Corporation by, the Chairman of the Board, the Chief Executive Officer, the
President or a Vice President and by the Treasurer or an Assistant Treasurer or
the Secretary or an Assistant Secretary of the Corporation, certifying the
number of shares owned by him or her in the Corporation.  If the Corporation
shall be authorized to issue more than one class of stock or more than one
series of any class, the designations, preferences and relative, participating,
optional or other special rights of each class of stock or series thereof and
the qualifications, limitations or restrictions of such preferences or rights
shall be set forth in full or summarized on the face or back of the certificate
which the Corporation shall issue to represent such class or series of stock,
provided that, except as otherwise provided in Section 202 of the General
Corporation Law of the State of Delaware, in lieu of the foregoing requirements,
there may be set forth on the face or back of the certificate which the
Corporation shall issue to represent such class or series of stock, a statement
that the Corporation will furnish without charge to each stockholder who so
requests the designations, preferences and relative, participating, optional or
other special rights of each class of stock or series thereof and the
qualifications, limitations or restrictions of such preferences or rights.

  SECTION 2.  Facsimile Signatures.  Any or all of the signatures on a
certificate may be a facsimile.  In case any officer, transfer agent or
registrar who has signed or whose facsimile signature has been placed upon a
certificate shall have ceased to be such officer, transfer agent or registrar
before such certificate is issued, it may be issued by the Corporation with the
same effect as if he or she were such officer, transfer agent or registrar at
the date of issue.

  SECTION 3.  Lost Certificates.  The Board of Directors may direct a new
certificate or certificates to be issued in place of any certificate or
certificates theretofore issued by the Corporation alleged to have been lost,
stolen, or destroyed.  When authorizing such issue of a new certificate or
certificates, the Board of Directors may, in its discretion and as a condition
precedent to the issuance thereof, require the owner of such lost, stolen, or
destroyed certificate or certificates, or his legal representative, to give the
Corporation a bond in such sum as it may direct sufficient to indemnify it
against any claim that may be made against the Corporation on account of the
alleged loss, theft or destruction of any such certificate or the issuance of
such new certificate.

  SECTION 4.  Transfers of Stock.  Upon surrender to the Corporation or the
transfer agent of the Corporation of a certificate for shares duly endorsed or
accompanied by proper evidence of succession, assignment or authority to
transfer, it shall be the duty of the Corporation to issue a new certificate to
the person entitled thereto, cancel the old certificate and record the
transaction upon its records; provided, however, that the Corporation shall be
entitled to recognize and enforce any lawful restriction on transfer. Whenever
any transfer of stock shall be made for collateral security, and not absolutely,
it shall be so expressed in the entry of transfer if, when the certificates are
presented to the Corporation for transfer, both the transferor and the
transferee request the Corporation to do so.

  SECTION 5.  Transfer Agents and Registrars.  The Board of Directors may
appoint, or authorize any officer or officers to appoint, one or more transfer
agents and one or more registrars.

                                       8
<PAGE>
 
  SECTION 6.  Regulations.  The Board of Directors may make such additional
rules and regulations, not inconsistent with these Bylaws, as it may deem
expedient concerning the issue, transfer and registration of certificates for
shares of stock of the Corporation.

  SECTION 7.  Fixing the Record Date.  In order that the Corporation may
determine the stockholders entitled to notice of or to vote at any meeting of
stockholders or any adjournment thereof or entitled to receive payment of any
dividend or other distribution or allotment of any rights, or entitled to
exercise any rights in respect of any change, conversion or exchange of stock or
for the purpose of any other lawful action, the Board of Directors may fix, in
advance, a record date, which shall not be more than sixty nor less than ten
days before the date of such meeting, nor more than sixty days prior to any
other action.  A determination of stockholders of record entitled to notice of
or to vote at a meeting of stockholders shall apply to any adjournment of the
meeting; provided, however, that the Board of Directors may, in its discretion,
fix a new record date for the adjourned meeting.

  SECTION 8.  Registered Stockholders.  The Corporation shall be entitled to
recognize the exclusive right of a person registered on its records as the owner
of shares of stock to receive dividends and to vote as such owner, shall be
entitled to hold liable for calls and assessments a person registered on its
records as the owner of shares of stock, and shall not be bound to recognize any
equitable or other claim to or interest in such share or shares of stock on the
part of any other person, whether or not it shall have express or other notice
thereof, except as otherwise provided by the laws of Delaware.

  SECTION 9.  Legends.  The Board of Directors shall have the power and
authority to provide that certificates representing shares of stock bear such
legends as the Board of Directors deems appropriate to assure that the
Corporation does not become liable for violations of federal or state securities
laws or other applicable law.


                                  ARTICLE VI
                              GENERAL PROVISIONS


  SECTION 1.  Dividends.  Subject to the provisions of statute and the
Certificate of Incorporation, dividends upon the shares of capital stock of the
Corporation may be declared by the Board of Directors at any regular or special
meeting.  Dividends may be paid in cash, in property or in shares of stock of
the Corporation, unless otherwise provided by statute or the Certificate of
Incorporation.

  SECTION 2.  Reserves.  Before payment of any dividend, there may be set aside
out of any funds of the Corporation available for dividends such sum or sums as
the Board of Directors may, from time to time, in its absolute discretion, think
proper as a reserve or reserves to meet contingencies, or for equalizing
dividends, or for repairing or maintaining any property of the Corporation or
for such other purpose as the Board of Directors may think conducive to the
interests of the Corporation.  The Board of Directors may modify or abolish any
such reserve in the manner in which it was created.

  SECTION 3.  Seal.  The seal of the Corporation shall be in such form as shall
be approved by the Board of Directors.

  SECTION 4.  Fiscal Year.  The fiscal year of the Corporation shall end on
December 31 of each year and may thereafter be changed by resolution of the
Board of Directors.

                                       9
<PAGE>
 
  SECTION 5.  Checks, Notes, Drafts, Etc.  All checks, notes, drafts or other
orders for the payment of money of the Corporation shall be signed, endorsed or
accepted in the name of the Corporation by such officer, officers, person or
persons as from time to time may be designated by the Board of Directors or by
an officer or officers authorized by the Board of Directors to make such
designation.

  SECTION 6.  Execution of Contracts, Deeds, Etc.  The Board of Directors may
authorize any officer or officers, agent or agents, in the name and on behalf of
the Corporation to enter into or execute and deliver any and all deeds, bonds,
mortgages, contracts and other obligations or instruments, and such authority
may be general or confined to specific instances.  The attestation to such
execution by the Secretary of the Corporation shall not be necessary to
constitute such deed, bond, mortgage, contract or other instrument a valid and
binding obligation against the Corporation unless the resolutions, if any, of
the Board of Directors authorizing such execution expressly state that such
attestation is necessary.

  SECTION 7.  Voting of Stock in Other Corporations.  Unless otherwise provided
by resolution of the Board of Directors, the Chairman of the Board, the Chief
Executive Officer, the President or any Vice President, from time to time, may
(or may appoint one or more attorneys or agents to) cast the votes which the
Corporation may be entitled to cast as a shareholder or otherwise in any other
corporation, any of whose shares or securities may be held by the Corporation,
at meetings of the holders of the shares or other securities of such other
corporation.  In the event one or more attorneys or agents are appointed, the
Chairman of the Board, the Chief Executive Officer or the President may instruct
the person or persons so appointed as to the manner of casting such votes or
giving such consent.  The Chairman of the Board, the Chief Executive Officer or
the President may, or may instruct the attorneys or agents appointed to, execute
or cause to be executed in the name and on behalf of the Corporation and under
its seal or otherwise, such written proxies, consents, waivers or other
instruments as may be necessary or proper in the circumstances.


                                  ARTICLE VII
                                  AMENDMENTS


  These Bylaws may be amended or repealed or new bylaws adopted (a) by the
affirmative vote of the holders of at least 75% of the voting power of all
shares of the Corporation entitled to vote generally in the election of
directors, voting together as a single class or (b) if the Certificate of
Incorporation so provides, by action of the Board of Directors at a regular or
special meeting thereof.  Any bylaw made by the Board of Directors may be
amended or repealed by action of the stockholders at any annual or special
meeting of stockholders.


                                     /s/ JOAN KROGER    
                                    ----------------------------------
                                    Joan Kroger
                                    Secretary

                                       10
<PAGE>
 
                            AMENDMENT NO. 1 TO THE
                                   BYLAWS OF
                      COLUMBIA/HCA HEALTHCARE CORPORATION


     On June 8, 1995, the Board of Directors of Columbia/HCA Healthcare
Corporation (the "Company") approved an amendment to the Company's Bylaws by
adding a new Section 14 to Article III thereof in order to make certain
exceptions to Section 13 of Article III.  The new Section 14 shall hereby be
added and read as follows:

"SECTION 14.  Exceptions to Mandatory Retirement Policy.  The provisions of
              -----------------------------------------                    
Section 13 of this Article III shall not apply in respect of Donald S.
MacNaughton.  In addition, Charles J. Kane and John W. Landrum shall be entitled
to continue to serve on the Board of Directors (subsequent to June 30, 1995) so
long as they agree in writing to resign their directorships effective June 30,
1996.



Dated:  June 8, 1995                   COLUMBIA/HCA HEALTHCARE CORPORATION


                                       By:/s/ STEPHEN T. BRAUN
                                          -------------------------------
                                          Stephen T. Braun, Secretary
<PAGE>
 
                            AMENDMENT NO. 2 TO THE
                                   BYLAWS OF
                      COLUMBIA/HCA HEALTHCARE CORPORATION


     On May 14, 1998, the Board of Directors of Columbia/HCA Healthcare
Corporation (the "Company") approved an amendment to the Company's Bylaws by
amending Section 14 to Article III thereof in order to make certain exceptions
to Section 13 of Article III. Section 14 shall hereby be amended to read as
follows:

"SECTION 14.  Exceptions to Mandatory Retirement Policy.  The provisions of
              -----------------------------------------                    
Section 13 of this Article III shall not apply in respect of Thomas S. Murphy
who has agreed to serve as a member of the Board of Directors of the Company."



Dated: May 14, 1998                   COLUMBIA/HCA HEALTHCARE CORPORATION


                                      By:/s/ JOHN M. FRANCK II
                                         --------------------------------------
                                         John M. Franck II, Corporate Secretary




<PAGE>
 
                                                                   EXHIBIT 10(a)

                                THIRD AMENDMENT


          THIRD AMENDMENT, dated as of July 10, 1998 (this "Third Amendment"),
to the Agreement and Amendment dated as of June 17, 1997, as amended by the
First Amendment, dated as of February 3, 1998 and the Second Amendment, dated as
of March 26, 1998 (as the same may be amended, supplemented or modified from
time to time, the "June 1997 364-Day Agreement and Amendment") among
COLUMBIA/HCA HEALTHCARE CORPORATION, a Delaware corporation (the "Company"), the
several banks and other financial institutions from time to time parties hereto
(the "Banks"), BANK OF AMERICA NATIONAL TRUST & SAVINGS ASSOCIATION,  THE BANK
OF NEW YORK, CITIBANK, N.A., DEUTSCHE BANK AG, FLEET NATIONAL BANK, THE FUJI
BANK LIMITED, THE INDUSTRIAL BANK OF JAPAN, LIMITED, ATLANTA AGENCY, MORGAN
GUARANTY TRUST COMPANY OF NEW YORK, NATIONSBANK, N.A., PNC BANK NATIONAL
ASSOCIATION, UNION BANK OF SWITZERLAND, NEW YORK BRANCH AND WACHOVIA BANK OF
GEORGIA, N.A., as Co-Agents (collectively, the "Co-Agents"), THE SAKURA BANK,
LTD. NEW YORK BRANCH, THE SUMITOMO BANK LIMITED, SUNTRUST BANK, NASHVILLE, N.A.,
WELLS FARGO BANK, N.A., as Lead Managers (collectively, the "Lead Managers") and
THE CHASE MANHATTAN BANK, a New York banking corporation, as Agent for the Banks
hereunder (in such capacity, the "Agent") and as CAF Loan Agent (in such
capacity, the "CAF Loan Agent").

                             W I T N E S S E T H :
                             -------------------- 

          WHEREAS, for the convenience of the parties to the agreement and
amendment dated as of February 28, 1996 (the "February 1996 Agreement and
Amendment"), among the Company, the several banks and other financial
institutions from time to time parties thereto and Chase, as agent for the Banks
hereunder and as CAF Loan Agent, a composite conformed copy (the "364-Day
Composite Conformed Credit Agreement") of the Credit Agreement, dated as of
February 10, 1994 as incorporated by reference into and amended by the September
1994 Agreement and Amendment, the February 1995 Agreement and Amendment and the
February 1996 Agreement and Amendment was prepared and delivered to such
parties;

          WHEREAS, the Company, the several banks and other financial
institutions and Chase, as agent for the Banks hereunder and as CAF Loan Agent,
were parties to the Agreement and Amendment, dated as of February 26, 1997 (the
"February 1997 364-Day Agreement and Amendment") which adopted and incorporated
by reference all of the terms and provisions of the 364-Day Composite Conformed
Credit Agreement, subject to the amendment thereto provided for in the February
1997 364-Day Agreement and Amendment;

          WHEREAS, the February 1997 364-Day Agreement and Amendment was
replaced by the June 1997 364-Day Agreement and Amendment;

          WHEREAS, the June 1997 364-Day Agreement and Amendment adopts and
incorporates by reference all of the terms and provisions of the 364-Day
Composite
<PAGE>
 
                                                                               2


Conformed Credit Agreement, subject to the amendment thereto provided for in the
June 1997 364-Day Agreement and Amendment;

          WHEREAS, the parties hereto wish to amend certain provisions of the
June 1997 364-Day Agreement and Amendment on the terms set forth herein;

          NOW, THEREFORE, in consideration of the premises and of the mutual
agreements herein contained, the parties hereto agree as follows:

          1.   Definitions.  Unless otherwise defined herein, terms defined in
the June 1997 364-Day Agreement and Amendment shall be used as so defined.

          2.   Amendments to the June 1997 364-Day Agreement and Amendment.

     (a) Section 3 of the June 1997 364-Day Agreement and Amendment is hereby
amended as follows:

     (1)  by inserting in such section the following new defined terms in proper
     alphabetical order:

          "`Consolidated Net Worth':  as of the date of determination, all items
     which in conformity with GAAP would be included under shareholders' equity
     on a consolidated balance sheet of the Company and its Subsidiaries at such
     date.".

          "`Consolidated Total Capitalization':  for any period for which the
     amount thereof is to be determined, the sum of Consolidated Net Worth at
     such date and Consolidated Total Debt at such date.".

          "`July 1998 Term Loan Facility':  the senior term loan facility, dated
     as of July 8, 1998, among the Company, the several banks and financial
     institutions from time to time parties thereto, and The Chase Manhattan
     Bank, as agent, as the same may be amended, supplemented or otherwise
     modified from time to time.".

          "`Regulation X':  Regulation X of the Board of Governors of the
     Federal Reserve System.".

     (2)  by deleting the defined terms "Mandatory Prepayment Event" and
     "Subsidiary" in their entirety and substituting in lieu thereof the
     following new defined terms in proper alphabetical order:

          "`Mandatory Prepayment Event':  any of the following events:

               (a)  the receipt by the Company or any of its Subsidiaries of Net
          Cash Proceeds from any sale or other disposition by it of any
          business, hospital or other assets, including any capital stock or
          other ownership interest in any Subsidiary or any intercompany
          obligations (other than as a result of any
<PAGE>
 
                                                                               3

          casualty where such Net Cash Proceeds are to be used to replace or
          rebuild the related assets);

               (b)  the receipt by the Company or any of its Subsidiaries of Net
          Cash Proceeds from the issuance to Persons other than the Company and
          its Subsidiaries of any capital stock or other ownership interests of
          the Company or such Subsidiary, as the case may be; and

               (c)  the receipt by the Company or any of its Subsidiaries of Net
          Cash Proceeds from the incurrence from, or the issuance or sale to,
          persons other than the Company and its Subsidiaries of any
          Indebtedness of the Company or such Subsidiary, as the case may be
          (excluding Indebtedness under the February 1997 Five-Year Agreement
          and Amendment and the July 1998 Term Loan Facility), with a scheduled
          maturity date on the date of incurrence thereof which is, or which is
          extendable at the option of the Company or such Subsidiary to be, one
          year or more from such date of incurrence;

     In each case for (a), (b) and (c), excluding (i) any such event in which
     the Net Cash Proceeds so received (together with the Net Cash Proceeds
     received from any related series of events) are less than $10,000,000 and
     (ii) any such event to the extent that the Net Cash Proceeds from such
     event, together with the Net Cash Proceeds from all other events referred
     to in this definition from March 26, 1998 (excluding, in each case, any
     such event excluded by clause (i) above), is $500,000,000 or less.".

          "`Subsidiary':  as to any Person, a corporation, partnership or other
     entity of which shares of stock or other ownership interests having
     ordinary voting power (other than stock or such other ownership interests
     having such power only by reason of the happening of a contingency) to
     elect a majority of the board of directors or other managers of such
     corporation, partnership or other entity are at the time owned, or the
     management of which is otherwise controlled, directly or indirectly through
     one or more intermediaries, or both, by such Person.  Unless otherwise
     qualified, all references to a "Subsidiary" or to "Subsidiaries" in this
     Agreement shall refer to a Subsidiary or Subsidiaries of the Company.".

     (b)  Section 7 of the June 1997 364-Day Agreement and Amendment is hereby
amended by adding the following new paragraph after Section 7 reading as
follows:

     "SECTION 7B.  Subsections 3.1, 3.2 and 3.15 of the 364-Day Composite
     Conformed Credit Agreement as adopted and incorporated by the June 1997
     364-Day Agreement and Amendment are hereby amended by deleting such
     subsections in their entirety and inserting in lieu thereof the following
     new subsections 3.1, 3.2 and 3.15:

               `3.1  Corporate Organization and Existence.  Each of the Company
          and each Subsidiary is a corporation, partnership or other entity duly
          organized and validly existing and in good standing under the laws of
          the jurisdiction in which it is organized (except, in the case of
          Subsidiaries, where the failure to
<PAGE>
 
                                                                               4

          be in good standing would not be material to the Company and its
          Subsidiaries on a consolidated basis) and has all necessary power to
          carry on the business now conducted by it.  The Company has all
          necessary corporate power and has taken all corporate action required
          to make all the provisions of this Agreement and the Notes and all
          other agreements and instruments executed in connection herewith and
          therewith, the valid and enforceable obligations they purport to be.
          Each of the Company and each Subsidiary is duly qualified and in good
          standing in all jurisdictions other than that of its organization in
          which the physical properties owned, leased or operated by it are
          located (except, in the case of Subsidiaries, where the failure to be
          in good standing would not be material to the Company and its
          Subsidiaries on a consolidated basis), and is duly authorized,
          qualified and licensed under all laws, regulations, ordinances or
          orders of Governmental Authorities, or otherwise, to carry on its
          business in the places and in the manner presently conducted.

               3.2  Subsidiaries.  As of the date hereof, the Company has only
          the Subsidiaries set forth in Schedule II. Schedule II indicates all
          Subsidiaries of the Company which are not wholly-owned Subsidiaries as
          of the date hereof. As of the date hereof, the capital stock and
          securities owned by the Company and its Subsidiaries in each of the
          Company's Subsidiaries are owned free and clear of any mortgage,
          pledge, lien, encumbrance, charge or restriction on the transfer
          thereof other than restrictions on transfer imposed by applicable
          securities laws and restrictions, liens and encumbrances outstanding
          on the date hereof and listed in said Schedule II.

               3.15   Federal Regulations.  No part of the proceeds of any Loans
          will be used for "purchasing" or "carrying" any "margin stock" within
          the respective meanings of each of the quoted terms under Regulation U
          as now and from time to time hereafter in effect (except in a manner
          which is not in violation of Regulation U or X) or for any purpose
          which violates the provisions of the Regulations of the Board of
          Governors of the Federal Reserve System. If requested by any Bank or
          the Agent, the Company will furnish to the Agent and each Bank a
          statement to the foregoing effect in conformity with the requirements
          of FR Form U-1 referred to in said Regulation U.'"

     (c)  Section 9 of the June 1997 364-Day Agreement and Amendment is hereby
amended by deleting such section in its entirety and substituting in lieu
thereof the following:

          "SECTION 9.  Ratio of Consolidated Total Debt to Consolidated Total
     Capitalization.  Subsection 5.6 of the 364-Day Composite Conformed Credit
     Agreement as adopted and incorporated by reference into this June 1997 364-
     Day Agreement and Amendment is hereby amended by deleting such subsection
     in its entirety and substituting in lieu thereof the following:

               `Ratio of Consolidated Total Debt to Consolidated Total
          Capitalization.  The Company and its Subsidiaries will not at any time
          have outstanding
<PAGE>
 
                                                                               5

          Consolidated Total Debt in an amount in excess of 65% of Consolidated
          Total Capitalization.'".

     (d)  Section 9A of the June 1997 364-Day Agreement and Amendment is hereby
amended by deleting such section in its entirety and substituting in lieu
thereof the following:

          "SECTION 9A.  Company Officers' Certificate.  Subsection 4.3 of the
     364-Day Composite Conformed Credit Agreement as adopted and incorporated by
     reference into this June 1997 364-Day Agreement and Amendment is hereby
     amended by deleting such subsection in its entirety and substituting in
     lieu thereof the following:

               `4.3  Company Officers' Certificate.  The representations and
          warranties contained in Section 3 (as qualified by the disclosures in
          (i) the Company's Annual Report on Form 10-K for its fiscal year ended
          December 31, 1997, (ii) the Company's Quarterly Reports on Form 10-Q
          for its fiscal quarters ended June 30, 1997, September 30, 1997 and
          March 31, 1998 and (iii) the Company's Report on Form 8-K dated
          February 6, 1998, February 13, 1998, March 6, 1998 and May 27, 1998,
          in each case as filed with the Securities and Exchange Commission and
          previously distributed to the Banks) shall be true and correct in all
          material respects on the Closing Date and on and as of each Borrowing
          Date with the same force and effect as though made on and as of such
          date; no Default shall have occurred (except a Default which shall
          have been waived in writing or which shall have been cured) and no
          Default shall exist after giving effect to the Loan to be made;
          between December 31, 1994 and such Borrowing Date, neither the
          business nor assets, nor the condition, financial or otherwise, of the
          Company and its Subsidiaries on a consolidated basis shall have been
          adversely affected in any material manner as a result of any fire,
          flood, explosion, accident, drought, strike, lockout, riot, sabotage,
          confiscation, condemnation, or any purchase of any property by
          Governmental Authority, activities of armed forces, acts of God or the
          public enemy, new or amended legislation, regulatory order, judicial
          decision or any other event or development whether or not related to
          those enumerated above (all subject to the disclosures enumerated
          above); and the Agent shall have received a certificate containing a
          representation to these effects dated such Borrowing Date and signed
          by a Responsible Officer.'.

     (e)  Section 9C of the June 1997 364-Day Agreement and Amendment is hereby
amended by deleting such section in its entirety and substituting in lieu
thereof the following:

          "SECTION 9C.  Distributions.  Subsection 5.8 of the 364-Day Composite
     Conformed Credit Agreement as adopted and incorporated by reference into
     this June 1997 364-Day Agreement and Amendment as hereby amended by
     deleting such subsection in its entirety and substituting in lieu thereof
     the following:

               `5.8  Distributions.  The Company will not make any Distribution
          except that, so long as no Event of Default exists or would exist
          after giving
<PAGE>
 
                                                                               6

          effect thereto, the Company may make a Distribution; provided however,
          that at any time the Commitments under this Agreement plus the
          commitments under the February 1997 Five-Year Agreement and Amendment
          (or, if such commitments have expired or been terminated, the
          outstanding loans thereunder) shall exceed $2,000,000,000 in aggregate
          amount, the Company will not purchase, repurchase, redeem or otherwise
          acquire (including any "synthetic" acquisitions through equity
          derivatives) any shares of any class of capital stock of the Company
          directly or indirectly through a Subsidiary or otherwise, except for
          such acquisitions funded with the proceeds of loans made pursuant to
          the July 1998 Term Loan Facility or the February 1997 Five-Year
          Agreement and Amendment in an aggregate principal amount of up to
          $1,000,000,000.'.

     (f)  Section 9F of the June 1997 364-Day Agreement and Amendment is hereby
amended by deleting such section in its entirety and substituting in lieu
thereof the following:

          "SECTION 9F.  Limitation on Optional Payments and Modifications of
     Debt Instruments.  The 364-Day Composite Conformed Credit Agreement as
     adopted and incorporated by reference into this June 1997 364-Day Agreement
     and Amendment is hereby amended by adding the following new subsection
     immediately following subsection 5.15 therein as follows:

               `5.16  Limitation on Optional Payments and Modifications of Debt
          Instruments.  At any time the commitments under the February 1997
          Five-Year Agreement and Amendment plus the commitments under the June
          1997 364-Day Agreement and Amendment (or, if such commitments have
          expired or been terminated, the outstanding loans thereunder) exceed
          $2,000,000,000 in aggregate amount, the Company will not make, and
          will not permit any of its Subsidiaries to make, any optional payment
          or prepayment on or redemption, defeasance or purchase of any
          Indebtedness of the Company or any of its Subsidiaries (other than
          Indebtedness under the July 1998 Term Loan Facility, the February 1997
          Five-Year Agreement and Amendment, the June 1997 364-Day Agreement and
          Amendment or Indebtedness under Financing Leases in an aggregate
          amount not to exceed $50,000,000 in any fiscal year of the Company),
          or amend, modify or change, or consent or agree to any amendment,
          modification or change to any of the terms relating to the payment or
          prepayment or principal of or interest on, any such Indebtedness,
          other than any amendment, modification or change which would extend
          the maturity or reduce the amount of any payment of principal thereof
          or which would reduce the rate or extend the date for payment of
          interest there or which would not be adverse to the Banks.'"

     (g) The June 1997 364-Day Agreement and Amendment is hereby amended by
adding the following new paragraphs immediately after Section 9F reading as
follows:
<PAGE>
 
                                                                               7

          "SECTION 9G.  Indebtedness of Subsidiaries.  Paragraph (b) of
     subsection 5.1 of the 364-Day Composite Conformed Credit Agreement as
     adopted and incorporated by reference into this June 1997 364-Day Agreement
     and Amendment is hereby amended by deleting such paragraph in its entirety
     and substituting in lieu thereof the following:

          `(b)  Each of the Company and its Subsidiaries will promptly pay when
          due, or   in conformance with customary trade terms, all other
          Indebtedness and liabilities incident to its operations; provided,
          however, that any such Indebtedness or liability need not be paid if
          the validity or amount thereof shall currently be contested in good
          faith and if the Company or the Subsidiary in question shall have set
          aside on its books appropriate reserves with respect thereto.  The
          Subsidiaries will not create, incur, assume or suffer to exist any
          Indebtedness, except:  (i) Indebtedness outstanding on the date hereof
          and listed on Schedule III; (ii) Indebtedness that is owing to the
          Company or any other Subsidiary; (iii) Indebtedness incurred pursuant
          to an accounts receivable program and (iv) additional Indebtedness at
          any time outstanding in an aggregate principal amount not to exceed
          10% of Consolidated Assets.'.

          "SECTION 9H.  Sales of Assets.  Subsection 5.10 of the 364-Day
     Composite Conformed Credit Agreement as adopted and incorporated by
     reference into this June 1997 364-Day Agreement and Amendment is hereby
     amended by deleting such subsection in its entirety and substituting in
     lieu thereof the following:

               `5.10  Sales of Assets.  The Company and its Subsidiaries may
          from time to time sell or otherwise dispose of all or any part of
          their respective assets; provided, however, that in any fiscal year,
          the Company and its Subsidiaries will not (a) sell or dispose of
          (including, without limitation, any disposition resulting from any
          merger or consolidation involving a Subsidiary of the Company, and any
          Sale-and-Leaseback Transaction), outside of the ordinary course of
          business, to Persons other than the Company and its Subsidiaries,
          assets constituting in the aggregate more than 12% of Consolidated
          Assets of the Company and its Subsidiaries as at the end of the
          immediately preceding fiscal year (excluding an amount equal to the
          book value of those assets the Net Cash Proceeds from the disposition
          of which have been applied to prepay outstanding revolving credit
          loans under the June 1997 364-Day Agreement and Amendment in
          accordance with subsection 2.18) and (b) exchange with Persons other
          than the Company and its Subsidiaries any asset or group of assets for
          another asset or group of assets unless (i) such asset or group of
          assets are exchanged for an asset or group of assets of a
          substantially similar type or nature, (ii) on a pro forma basis both
          before and after giving effect to such exchange, no Default or Event
          of Default shall have occurred and be continuing, (iii) the aggregate
          fair market value (as determined in good faith by the Board of
          Directors of the Company) of the asset or group of assets being
          transferred by the Company or such Subsidiary and the asset or group
          of assets being acquired by the Company or such Subsidiary are
<PAGE>
 
                                                                               8

          substantially equal and (iv) the aggregate of (x) all assets of the
          Company and its Subsidiaries sold pursuant to subsection 5.10(a)
          (including, without limitation, any disposition resulting from any
          merger or consolidation involving a Subsidiary of the Company, and any
          Sale-and-Leaseback Transaction) (excluding an amount equal to the book
          value of those assets the Net Cash Proceeds from the disposition of
          which have been applied to prepay outstanding revolving credit loans
          under the June 1997 364-Day Agreement and Amendment in accordance with
          subsection 2.18) and (y) the aggregate fair market value (as
          determined in good faith by the Board of Directors of the Company) of
          all assets of the Company and its Subsidiaries exchanged pursuant to
          this subsection 5.10(b) does not exceed 20% of Consolidated Assets of
          the Company and its Subsidiaries as at the end of the immediately
          preceding fiscal year.'".


          "SECTION 9I.  Application of Proceeds of Loans.  Subsection 2.16 of
     the 364-Day Composite Conformed Credit Agreement as adopted and
     incorporated by reference into this June 1997 364-Day Agreement and
     Amendment is hereby amended by deleting such subsection in its entirety and
     substituting in lieu thereof the following:

               `2.16  Application of Proceeds of Loans.  Subject to the
          provisions of the following sentence, the Company may use the proceeds
          of the Loans for any lawful corporate purpose.  The Company will not,
          directly or indirectly, apply any part of the proceeds of any such
          Loan for the purpose of "purchasing" or "carrying" any "margin stock"
          within the respective meanings of each of the quoted terms under
          Regulation U, or to refund any indebtedness incurred for such purpose,
          except in a manner which is not in violation of Regulations U and X.'.


          3.   Effective Date; Conditions Precedent.  This Third Amendment will
become effective on July 10, 1998 (the "Effective Date") subject to the
compliance by the Company with its agreements herein contained and to the
satisfaction on or before the Effective Date of the following further
conditions:

               (a)  Loan Documents.  The Agent shall have received copies of
     this Third Amendment, executed and delivered by a duly authorized officer
     of the Company, with a counterpart for each Bank, and executed and
     delivered by the Required Banks.

               (b)  Company Officers' Certificate.  The representations and
     warranties contained in Section 3 of the 364-Day Composite Conformed Credit
     Agreement as adopted and incorporated by reference into, and as amended by,
     the June 1997 364-Day Agreement and Amendment (as qualified by the
     disclosures in (i) the Company's Annual Report on Form 10-K for its fiscal
     year ended December 31, 1997, (ii) the
<PAGE>
 
                                                                               9

     Company's Quarterly Reports on Form 10-Q for its fiscal quarters ended June
     30, 1997, September 30, 1997 and March 31, 1998 and (iii) the Company's
     Report on Form 8-K dated February 6, 1998, February 13, 1998, March 6, 1998
     and May 27, 1998, in each case as filed with the Securities and Exchange
     Commission and previously distributed to the Banks) shall be true and
     correct in all material respects on the Effective Date with the same force
     and effect as though made on and as of such date; on and as of the
     Effective Date and after giving effect to this Third Amendment, no Default
     shall have occurred (except a Default which shall have been waived in
     writing or which shall have been cured); and the Agent shall have received
     a certificate containing a representation to these effects dated the
     Effective Date and signed by a Responsible Officer.

               (c)  Term Loan Facility.  The Company shall have entered into a
     senior term loan facility, structured and arranged by Chase to be used for
     general corporate purposes, including for the repurchase of shares of
     common stock of the Company (including any "synthetic" acquisitions through
     equity derivatives), on terms and conditions satisfactory to Chase.

          4.   Legal Obligation.  The Company represents and warrants to each
Bank that this Third Amendment constitutes the legal, valid and binding
obligation of the Company, enforceable against it in accordance with its terms,
subject to the effects of bankruptcy, insolvency, fraudulent conveyances,
reorganization, moratorium and other similar laws relating to or affecting
creditors' rights generally, general equitable principles (whether considered in
a proceeding in equity or at law) and an implied covenant of good faith and fair
dealing.

          5.   Continuing Effect; Application.  Except as expressly amended
hereby, the June 1997 364-Day Agreement and Amendment shall continue to be and
shall remain in full force and effect in accordance with its terms.

          6.   Expenses.  The Company agrees to pay or reimburse the Agent for
all of its reasonable out-of-pocket costs and expenses incurred in connection
with the development, preparation and execution of, and any amendment,
supplement or modification to, this Third Amendment and any other documents
prepared in connection herewith, and the consummation of the transactions
contemplated hereby and thereby, including, without limitation, the reasonable
fees and disbursements of counsel to the Agent.

               7.   GOVERNING LAW.  THIS THIRD AMENDMENT AND THE RIGHTS AND
OBLIGATIONS OF THE PARTIES UNDER THIS THIRD AMENDMENT SHALL BE GOVERNED BY, AND
CONSTRUED AND INTERPRETED IN ACCORDANCE WITH, THE LAW OF THE STATE OF NEW YORK.

          8.   Counterparts.  This Third Amendment may be executed by one or
more of the parties to this Third Amendment on any number of separate
counterparts and all of said counterparts taken together shall be deemed to
constitute one and the same instrument.  A set
<PAGE>
 
                                                                              10

of the copies of this Third Amendment signed by all the parties shall be lodged
with the Company and the Agent.
<PAGE>
 
                                                                              11


          IN WITNESS WHEREOF, the parties hereto have caused this Third
Amendment to be duly executed and delivered by their proper and duly authorized
officers as of the day and year first above written.


                                 COLUMBIA/HCA HEALTHCARE CORPORATION          
                                                                              
                                                                              
                                 By: /s/ DAVID G. ANDERSON
                                    ----------------------------------------- 
                                     Name:   David G. Anderson
                                     Title:  Vice President Finance and
                                             Treasurer
                                                                              
                                                                              
                                 THE CHASE MANHATTAN BANK, as Agent, as CAF   
                                 Loan Agent and as a Bank                     
                                                                              
                                                                              
                                 By: /s/ DAWN LEE LUM
                                    ----------------------------------------- 
                                     Name:   Dawn Lee Lum                     
                                     Title:  Vice President                   
                                                                              
                                                                              
                                 ABN AMRO BANK N.V., as a Bank                
                                                                              
                                                                              
                                 By: /s/ THOMAS B. THORNHILL
                                    ----------------------------------------- 
                                     Name:   Thomas Thornhill
                                     Title:  Group Vice President

                                                                              
                                 By: /s/ LARRY K. KELLEY
                                    ----------------------------------------- 
                                     Name:   Larry K. Kelley
                                     Title:  Group Vice President
                                                                              
                                                                              
                                 ARAB BANK PLC, GRAND CAYMAN BRANCH, as a Bank
                                                                              
                                                                              
                                 By: /s/ [Illegible]
                                    ----------------------------------------- 
                                     Name:                                    
                                     Title:                                   
<PAGE>
 

                                 BANCA MONTE DEI PASCHI DI SIENA SpA, as a Bank
                                                                              
                                                                              
                                 By: 
                                    -----------------------------------------
                                     Name:                                    
                                     Title:                    
                                 
                                             
                                 By: 
                                    -----------------------------------------
                                     Name:                                    
                                     Title:                                   
                                                                              
                                                                              
                                 BANK ONE TEXAS, N.A., as a Bank              
                                                                              
                                                                              
                                 By: /s/ JAMES B. LUKOWICZ                
                                    -----------------------------------------
                                     Name:   James B. Lukowicz                
                                     Title:  Vice President                   
                                                                              
                                                                              
                                 BANK OF AMERICA NATIONAL TRUST AND SAVINGS   
                                 ASSOCIATION, as a Co-Agent and as a Bank     
                                                                              
                                                                              
                                 By: 
                                    -----------------------------------------  
                                     Name:                                    
                                     Title:                                   
                                                                              
                                                                              
                                 THE BANK OF NEW YORK, as a Co-Agent and as a  
                                 Bank                                         
                                                                              
                                                                              
                                 By: /s/ ANN MARIE HUGHES                 
                                    -----------------------------------------
                                     Name:   Ann Marie Hughes
                                     Title:  Vice President                   
                                                                              
                                                                              
                                 THE BANK OF NOVA SCOTIA, as a Bank           
                                                                              
                                                                              
                                 By: /s/ W. J. BROWN                      
                                    -----------------------------------------
                                     Name:   W. J. Brown                      
                                     Title:  Vice President                    
                                             
<PAGE>
 

                                 BANK OF TOKYO-MITSUBISHI TRUST COMPANY,  
                                 as a Bank                                    
                                                                              
                                                                              
                                 By: /s/ DOUGLAS J. WEIR                   
                                    -----------------------------------------  
                                     Name:   Douglas J. Weir 
                                     Title:  Vice President
                                                                              
                                                                               
                                 BANQUE NATIONALE DE PARIS -Houston Agency,   
                                 as a Bank                                    
                                                                              
                                                                              
                                 By: /s/ HENRY F. SETINA                   
                                    -----------------------------------------  
                                     Name:   Henry F. Setina                  
                                     Title:  Vice President                   
                                                                              
                                                                              
                                 BARNETT BANK, N.A., as a Bank                
                                                                              
                                                                              
                                 By: /s/ KEVIN WAGLEY                      
                                    -----------------------------------------  
                                     Name:   Kevin Wagley                     
                                     Title:  Vice President                   
                                                                              
                                                                              
                                 CITIBANK, N.A., as a Bank                    
                                                                              
                                                                              
                                 By: /s/ MARGARET AU BROWN                 
                                    -----------------------------------------  
                                     Name:   Margaret Au Brown 
                                     Title:  Managing Director
                                                                              
                                                                              
                                 COMERICA BANK, as a Bank                     
                                                                              
                                                                              
                                 By: /s/ COLLEEN M. MURPHY                 
                                    -----------------------------------------  
                                     Name:   Colleen M. Murphy                
                                     Title:  Assistant Vice President         
<PAGE>
 

                                 CORESTATES BANK, N.A., as a Bank 
                                                                              
                                                                              
                                 By: 
                                    -----------------------------------------   
                                     Name:                                    
                                     Title:                                   
                                                                              
                                                                              
                                 CRESTAR BANK, as a Bank                      
                                                                              
                                                                              
                                 By: /s/ C. GRAY KEY                       
                                    -----------------------------------------  
                                     Name:   C. Gray Key 
                                     Title:  Vice President                   
                                                                              
                                                                              
                                 THE DAI-ICHI KANGYO BANK, LIMITED, as a Bank
                                                                              
                                                                              
                                 By: /s/TATSUJI NOGUCHI                   
                                    -----------------------------------------  
                                     Name:   Tatsuji Noguchi 
                                     Title:  Chief Representative
                                                                              
                                                                              
                                 DEUTSCHE BANK AG, NEW YORK AND/OR CAYMAN     
                                 ISLANDS BRANCH(ES), as a Co-Agent and as     
                                 a Bank                                       
                                                                              
                                                                              
                                 By: /s/ SUSAN L. PEARSON                  
                                    -----------------------------------------  
                                     Name:   Susan L. Pearson                 
                                     Title:  Director
                                     
                                         
                                 By: /s/ HANS-JOSEF THIELE                 
                                    -----------------------------------------  
                                     Name:   Hans-Josef Thiele                
                                     Title:  Director                         
                                                                              
                                                                              
                                 FIRST HAWAIIAN BANK, as a Bank               
                                                                              
                                                                              
                                 By: /s/ CHARLES L. JENKINS                
                                    -----------------------------------------  
                                     Name:   Charles L. Jenkins               
                                     Title:  Vice President and Manager       
<PAGE>
 

                                 FIRST AMERICAN NATIONAL BANK, as a Bank
                                                                               
                                                                              
                                 By: /s/SANDY HAMRICK                     
                                    -----------------------------------------  
                                     Name:   Sandy Hamrick                    
                                     Title:  Senior Vice President            


                                 By: /s/ L. RICHARD SCHILLER              
                                    ----------------------------------------- 
                                     Name:   L. Richard Schiller              
                                     Title:  Vice President            


                                 THE FIRST NATIONAL BANK OF CHICAGO,          
                                 as a Bank                                    
                                                                              
                                                                              
                                 By: 
                                    -----------------------------------------  
                                     Name:                                    
                                     Title:                                   
                                                                              
                                                                              
                                 FIRST UNION NATIONAL BANK, as a Bank         
                                                                              
                                                                              
                                 By: 
                                    -----------------------------------------  
                                     Name:                                    
                                     Title:                                   
                                                                              
                                                                              
                                 FLEET NATIONAL BANK, as a Co-Agent and as a  
                                 Bank                                         
                                                                               
                                                                              
                                 By: /s/ MARYANN S. SMITH                  
                                    -----------------------------------------  
                                     Name:   Maryann S. Smith
                                     Title:  Vice President                   
                                                                              
                                                                              
                                 THE FUJI BANK LIMITED, as a Co-Agent and as a 
                                 Bank                                         
                                                                              
                                                                              
                                 By: /s/ TOSHIHIRO MITSUI                    
                                    -----------------------------------------  
                                     Name:   Toshihiro Mitsui                   
                                     Title:  Senior Vice President and Joint
                                             General Manager
 
<PAGE>
 

                                 THE INDUSTRIAL BANK OF JAPAN, LIMITED, ATLANTA 
                                 AGENCY, as a Co-Agent and as a Bank           
                                                                              
                                                                              
                                 By: /s/ KOICHI HASEGAWA                   
                                    -----------------------------------------  
                                     Name:   Koichi Hasegawa 
                                     Title:  Senior Vice President and Deputy
                                             General Manager
                                                                              
                                                                              
                                 KEYBANK NATIONAL ASSOCIATION, as a Bank      
                                                                              
                                                                              
                                 By: /s/ THOMAS J. PURCELL                 
                                    -----------------------------------------  
                                     Name:   Thomas J. Purcell                
                                     Title:  Vice President                   
                                                                              
                                                                              
                                 THE MITSUBISHI TRUST AND BANKING CORPORATION, 
                                 as a Bank                                    
                                                                               
                                                                              
                                 By: /s/ BEATRICE E. KOSSODO               
                                    -----------------------------------------  
                                     Name:   Beatrice E. Kossodo 
                                     Title:  Senior Vice President            
                                                                              
                                                                              
                                 THE MITSUI TRUST AND BANKING COMPANY, LIMITED,
                                 NEW YORK BRANCH, as a Bank                   
                                                                               
                                                                              
                                 By: /s/ MARGARET HOLLOWAY                 
                                    -----------------------------------------  
                                     Name:   Margaret Holloway                 
                                     Title:  Vice President & Manager         
                                                                              
                                                                              
                                 MORGAN GUARANTY TRUST COMPANY OF NEW YORK, as 
                                 a Co-Agent and as a Bank                     

                                                                              
                                 By: 
                                    -----------------------------------------  
                                     Name:                                    
                                     Title:                                    
                                             
                                             
<PAGE>
 


                                 NATIONAL CITY BANK OF KENTUCKY, as a Bank    
                                                                               
                                                                               
                                 By: /s/ DENY SCOTT 
                                    -----------------------------------------  
                                     Name:   Deny Scott 
                                     Title:  Vice President
                                                                               
                                                                               
                                 NATIONSBANK, N.A. as a Co-Agent and as a Bank 
                                                                               
                                                                               
                                 By: /s/ KEVIN WAGLEY
                                    -----------------------------------------  
                                     Name:   Kevin Wagley
                                     Title:  Vice President
                                                                               
                                                                               
                                 THE NORINCHUKIN BANK, NEW YORK BRANCH, as a  
                                 Bank                                         
                                                                                
                                                                               
                                 By: 
                                    -----------------------------------------  
                                     Name:                                    
                                     Title:                                   
                                                                              
                                                                              
                                 THE NORTHERN TRUST COMPANY, as a Bank        
                                                                              
                                                                              
                                 By: /s/ CHRISTINA L. JAKUC 
                                    -----------------------------------------  
                                     Name:   Christina L. Jakuc 
                                     Title:  Second Vice President
                                                                              
                                                                               
                                 PNC BANK, N.A., as a Co-Agent and as a Bank  
                                                                              
                                                                              
                                 By: /s/ KATHRYN M. BOHR 
                                    -----------------------------------------  
                                     Name:   Kathryn M. Bohr 
                                     Title:  Vice President
                                             
                                             
<PAGE>
 

                                 THE SAKURA BANK, LTD. NEW YORK BRANCH, as a   
                                 Lead Manager and as a Bank                   
                                                                               
                                                                              
                                 By: /s/ GARY FRANKE
                                    -----------------------------------------  
                                     Name:   Gary Franke
                                     Title:  Vice President & Manager
                                                                              
                                                                              
                                 THE SUMITOMO BANK, LIMITED,  as a Lead Manager
                                 and as a Bank                                 
                                                                               
                                                                              
                                 By: 
                                    -----------------------------------------  
                                     Name:    
                                     Title:  
                                                                              
                                                                              
                                 THE SUMITOMO TRUST & BANKING CO., LTD., NEW  
                                 YORK BRANCH, as a Bank                       
                                                                               
                                                                              
                                 By: /s/ STEPHEN STRATICI 
                                    -----------------------------------------  
                                     Name:   Stephen Stratici
                                     Title:  Vice President
                                                                              
                                                                              
                                 SUNTRUST BANK, NASHVILLE, N.A., as a Lead    
                                 Manager and as a Bank                        
                                                                               
                                                                              
                                 By: /s/ MARK D. MATTSON 
                                    -----------------------------------------  
                                     Name:   Mark D. Mattson 
                                     Title:  Vice President
                                                                              
                                                                              
                                 THE TOKAI BANK, LIMITED, NEW YORK BRANCH, as  
                                 a Bank                                       
                                                                               
                                                                              
                                 By: /s/ SHINICHI NAKATANI 
                                    -----------------------------------------  
                                     Name:   Shinichi Nakatani 
                                     Title:  Assistant General Manager
                                             
                                             
<PAGE>
 


                                 TORONTO DOMINION (TEXAS), INC., as a Bank    
                                                                              
                                                                              
                                 By: /s/ JORGE A. GARCIA 
                                    -----------------------------------------  
                                     Name:   Jorge A. Garcia 
                                     Title:  Vice President
                                                                              
                                                                              
                                 THE TOYO TRUST & BANKING CO., LTD., as a Bank 
                                                                              
                                                                              
                                 By: /s/ T. MIKUMO 
                                    -----------------------------------------  
                                     Name:   T. Mikumo 
                                     Title:  Vice President
                                                                              
                                                                              
                                 UBS AG, NEW YORK BRANCH, as a Co-Agent and as 
                                 a Bank                                       
                                                                               
                                                                              
                                 By: /s/ LEO L. BALTZ 
                                    -----------------------------------------  
                                     Name:   Leo L. Baltz 
                                     Title:  Director

                                                                              
                                 By: /s/ EDUARDO SALAZAR
                                    -----------------------------------------  
                                     Name:   Eduardo Salazar
                                     Title:  Executive Director

                                                                              
                                 UNION PLANTERS BANK, N.A. 

                                                                              
                                 By: /s/ [ILLEGIBLE]
                                    -----------------------------------------  
                                     Name:    
                                     Title:   
                                                                              
                                                                              
                                 WACHOVIA BANK OF GEORGIA, N.A., as a Co-Agent 
                                 and as a Bank                                
                                                                               
                                                                              
                                 By: /s/ KENNETH WASHINGTON 
                                    -----------------------------------------  
                                     Name:   Kenneth Washington 
                                     Title:  Vice President
                                             
                                             
<PAGE>
 


                                 WELLS FARGO BANK, N.A., as a Lead Manager and
                                 as a Bank                                    
                                                                                
                                 By: /s/ DONALD A. HARTMANN 
                                    -----------------------------------------
                                     Name:   Donald A. Hartmann 
                                     Title:  Senior Vice President
                                                                                
                                 By: /s/ TIMOTHY A. MCDEVITT 
                                    -----------------------------------------
                                     Name:   Timothy A. McDevitt 
                                     Title:  Vice President
                                           
                                             

<PAGE>
 
                                                                   EXHIBIT 10(b)
 
                               FOURTH AMENDMENT


          FOURTH AMENDMENT, dated as of July 10, 1998 (this "Fourth Amendment"),
to the Agreement and Amendment dated as of February 26, 1997, as amended by the
First Amendment, dated as of June 17, 1997, the Second Amendment, dated as of
February 3, 1998 and the Third Amendment, dated as of March 26, 1998 (as the
same may be amended, supplemented or modified from time to time, the "February
1997 Five-Year Agreement and Amendment") among COLUMBIA/HCA HEALTHCARE
CORPORATION, a Delaware corporation (the "Company"), the several banks and other
financial institutions from time to time parties hereto (the "Banks"), BANK OF
AMERICA NATIONAL TRUST & SAVINGS ASSOCIATION, THE BANK OF NEW YORK, DEUTSCHE
BANK AG, FLEET NATIONAL BANK, THE FUJI BANK LIMITED, THE INDUSTRIAL BANK OF
JAPAN, LIMITED, ATLANTA AGENCY, MORGAN GUARANTY TRUST COMPANY OF NEW YORK,
NATIONSBANK, N.A., PNC BANK NATIONAL ASSOCIATION, TORONTO DOMINION (TEXAS),
INC., UNION BANK OF SWITZERLAND, NEW YORK BRANCH AND WACHOVIA BANK OF GEORGIA,
N.A., as Co-Agents (collectively, the "Co-Agents"), THE SAKURA BANK, LTD. NEW
YORK BRANCH, THE SUMITOMO BANK LIMITED, SUNTRUST BANK, NASHVILLE, N.A., WELLS
FARGO BANK, N.A., as Lead Managers (collectively, the "Lead Managers") and THE
CHASE MANHATTAN BANK, a New York banking corporation as Agent for the Banks
hereunder ("Chase", and in such capacity, the "Agent") and as CAF Loan Agent (in
such capacity, the "CAF Loan Agent").


                              W I T N E S E T H :
                              ------------------ 


          WHEREAS, for the convenience of the parties to the agreement and
amendment dated as of February 28, 1996 (the "February 1996 Agreement and
Amendment"), among the Company, the several banks and other financial
institutions from time to time parties thereto and Chase, as agent for the Banks
hereunder and as CAF Loan Agent, a composite conformed copy (the "Five-Year
Composite Conformed Credit Agreement") of the Credit Agreement, dated as of
February 10, 1994 as incorporated by reference into and amended by the September
1994 Agreement and Amendment, the February 1995 Agreement and Amendment and the
February 1996 Agreement and Amendment was prepared and delivered to such
parties;

          WHEREAS, the February 1997 Five-Year Agreement and Amendment adopts
and incorporates by reference all of the terms and provisions of the Five-Year
Composite Conformed Credit Agreement, subject to the amendment thereto provided
for in the February 1997 Five-Year Agreement and Amendment;

          WHEREAS, the parties hereto wish to amend certain provisions of the
February 1997 Five-Year Agreement and Amendment on the terms set forth herein;

          NOW, THEREFORE, in consideration of the premises and of the mutual
agreements herein contained, the parties hereto agree as follows:
<PAGE>
 
                                                                               2



          1.  Definitions.  Unless otherwise defined herein, terms defined in
the February 1997 Five-Year Agreement and Amendment shall be used as so defined.

          2.   Amendments to the February 1997 Five-Year Agreement and
Amendment.
     (a) Section 3 of the February 1997 Five-Year Agreement and Amendment is
hereby amended as follows:

     (1)  by inserting in such section the following new defined terms in proper
     alphabetical order:

          "`Consolidated Net Worth':  as of the date of determination, all items
     which in conformity with GAAP would be included under shareholders' equity
     on a consolidated balance sheet of the Company and its Subsidiaries at such
     date.".

          "`Consolidated Total Capitalization':  for any period for which the
     amount thereof is to be determined, the sum of Consolidated Net Worth at
     such date and Consolidated Total Debt at such date.".

          "`July 1998 Term Loan Facility':  the senior term loan facility, dated
     as of July 8, 1998, among the Company, the several banks and financial
     institutions from time to time parties thereto, and The Chase Manhattan
     Bank, as agent, as the same may be amended, supplemented or otherwise
     modified from time to time.".

          "`Regulation X':  Regulation X of the Board of Governors of the
     Federal Reserve System.".

     (2)  by deleting the defined terms "Mandatory Prepayment Event" and
     "Subsidiary" in their entirety and substituting in lieu thereof the
     following new defined terms in proper alphabetical order:

          "`Mandatory Prepayment Event':  any of the following events:

               (a)  the receipt by the Company or any of its Subsidiaries of Net
          Cash Proceeds from any sale or other disposition by it of any
          business, hospital or other assets, including any capital stock or
          other ownership interest in any Subsidiary or any intercompany
          obligations (other than as a result of any casualty where such Net
          Cash Proceeds are to be used to replace or rebuild the related
          assets);

               (b)  the receipt by the Company or any of its Subsidiaries of Net
          Cash Proceeds from the issuance to Persons other than the Company and
          its Subsidiaries of any capital stock or other ownership interests of
          the Company or such Subsidiary, as the case may be; and
<PAGE>
 
                                                                               3

               (c)  the receipt by the Company or any of its Subsidiaries of Net
          Cash Proceeds from the incurrence from, or the issuance or sale to,
          persons other than the Company and its Subsidiaries of any
          Indebtedness of the Company or such Subsidiary, as the case may be
          (excluding Indebtedness under the February 1997 Five-Year Agreement
          and Amendment and the July 1998 Term Loan Facility), with a scheduled
          maturity date on the date of incurrence thereof which is, or which is
          extendable at the option of the Company or such Subsidiary to be, one
          year or more from such date of incurrence;

     In each case for (a), (b) and (c), excluding (i) any such event in which
     the Net Cash Proceeds so received (together with the Net Cash Proceeds
     received from any related series of events) are less than $10,000,000 and
     (ii) any such event to the extent that the Net Cash Proceeds from such
     event, together with the Net Cash Proceeds from all other events referred
     to in this definition from March 26, 1998 (excluding, in each case, any
     such event excluded by clause (i) above), is $500,000,000 or less.".

          "`Subsidiary':  as to any Person, a corporation, partnership or other
     entity of which shares of stock or other ownership interests having
     ordinary voting power (other than stock or such other ownership interests
     having such power only by reason of the happening of a contingency) to
     elect a majority of the board of directors or other managers of such
     corporation, partnership or other entity are at the time owned, or the
     management of which is otherwise controlled, directly or indirectly through
     one or more intermediaries, or both, by such Person.  Unless otherwise
     qualified, all references to a "Subsidiary" or to "Subsidiaries" in this
     Agreement shall refer to a Subsidiary or Subsidiaries of the Company.".

     (b)  Section 6 of the February 1997 Five-Year Agreement and Amendment is
hereby amended by adding the following new paragraphs after Section 6 reading as
follows:

     "SECTION 6B.  Subsections 3.1, 3.2 and 3.15 of the Five-Year Composite
     Conformed Credit Agreement as adopted and incorporated by the February 1997
     Five-Year Agreement and Amendment are hereby amended by deleting such
     subsections in their entirety and inserting in lieu thereof the following
     new subsections 3.1, 3.2 and 3.15:

               '3.1 Corporate Organization and Existence. Each of the Company
          and each Subsidiary is a corporation, partnership or other entity duly
          organized and validly existing and in good standing under the laws of
          the jurisdiction in which it is organized (except, in the case of
          Subsidiaries, where the failure to be in good standing would not be
          material to the Company and its Subsidiaries on a consolidated basis)
          and has all necessary power to carry on the business now conducted by
          it. The Company has all necessary corporate power and has taken all
          corporate action required to make all the provisions of this Agreement
          and the Notes and all other agreements and instruments executed in
          connection herewith and therewith, the valid and enforceable
          obligations they purport to be. Each of the Company and each
          Subsidiary is duly qualified and in good standing in all jurisdictions
          other than that of its organization in which the
<PAGE>
 
                                                                               4

          physical properties owned, leased or operated by it are located
          (except, in the case of Subsidiaries, where the failure to be in good
          standing would not be material to the Company and its Subsidiaries on
          a consolidated basis), and is duly authorized, qualified and licensed
          under all laws, regulations, ordinances or orders of Governmental
          Authorities, or otherwise, to carry on its business in the places and
          in the manner presently conducted.

               3.2  Subsidiaries.  As of the date hereof, the Company has only
          the Subsidiaries set forth in Schedule II.  Schedule II indicates all
          Subsidiaries of the Company which are not wholly-owned Subsidiaries as
          of the date hereof.  As of the date hereof, the capital stock and
          securities owned by the Company and its Subsidiaries in each of the
          Company's Subsidiaries are owned free and clear of any mortgage,
          pledge, lien, encumbrance, charge or restriction on the transfer
          thereof other than restrictions on transfer imposed by applicable
          securities laws and restrictions, liens and encumbrances outstanding
          on the date hereof and listed in said Schedule II.

               3.15  Federal Regulations.  No part of the proceeds of any Loans
          will be used for "purchasing" or "carrying" any "margin stock" within
          the respective meanings of each of the quoted terms under Regulation U
          as now and from time to time hereafter in effect (except in a manner
          which is not in violation of Regulation U or X) or for any purpose
          which violates the provisions of the Regulations of the Board of
          Governors of the Federal Reserve System.  If requested by any Bank or
          the Agent, the Company will furnish to the Agent and each Bank a
          statement to the foregoing effect in conformity with the requirements
          of FR Form U-1 referred to in said Regulation U.'"
 
     (c) Section 8A of the February 1997 Five-Year Agreement and Amendment is
hereby amended by deleting such Section in its entirety and substituting in lieu
thereof the following:

          "SECTION 8A.  Ratio of Consolidated Total Debt to Consolidated Total
     Capitalization.  Subsection 5.6 of the Five-Year Composite Conformed Credit
     Agreement as adopted and incorporated by reference into this February 1997
     Five-Year Agreement and Amendment is hereby amended by deleting such
     subsection in its entirety and substituting in lieu thereof the following:

               `Ratio of Consolidated Total Debt to Consolidated Total
          Capitalization.  The Company and its Subsidiaries will not at any time
          have outstanding Consolidated Total Debt in an amount in excess of 65%
          of Consolidated Total Capitalization.'".

     (d) Section 8D of the February 1997 Five-Year Agreement and Amendment is
hereby amended by deleting such section in its entirety and substituting in lieu
thereof the following:
<PAGE>
 
                                                                               5

          "SECTION 8D.  Distributions.  Subsection 5.8 of the Five-Year
     Composite Conformed Credit Agreement as adopted and incorporated by
     reference into this February 1997 Five-Year Agreement and Amendment as
     hereby amended by deleting such subsection in its entirety and substituting
     in lieu thereof the following:

               `5.8  Distributions.  The Company will not make any Distribution
          except that, so long as no Event of Default exists or would exist
          after giving effect thereto, the Company may make a Distribution;
                                                                           
          provided however, that at any time the Commitments under this
          Agreement plus the commitments under the June 1997 364-Day Agreement
          and Amendment (or, if such commitments have expired or been
          terminated, the outstanding loans thereunder) shall exceed
          $2,000,000,000 in aggregate amount, the Company will not purchase,
          repurchase, redeem or otherwise acquire (including any "synthetic"
          acquisitions through equity derivatives) any shares of any class of
          capital stock of the Company directly or indirectly through a
          Subsidiary or otherwise, except for such acquisitions funded with the
          proceeds of loans made pursuant to the July 1998 Term Loan Facility or
          the February 1997 Five-Year Agreement and Amendment in an aggregate
          principal amount of up to $1,000,000,000.'.

     (e) Section 8F of the February 1997 Five-Year Agreement and Amendment is
hereby amended by deleting such section in its entirety and substituting in lieu
thereof the following:

          "SECTION 8F.  Limitation on Optional Payments and Modifications of
     Debt Instruments.  The Five-Year Composite Conformed Credit Agreement as
     adopted and incorporated by reference into this February 1997 Five-Year
     Agreement and Amendment is hereby amended by adding the following new
     subsection immediately following subsection 5.15 therein as follows:

               `5.16 Limitation on Optional Payments and Modifications of Debt
          Instruments. At any time the commitments under the February 1997 Five-
          Year Agreement and Amendment plus the commitments under the June 1997
          364-Day Agreement and Amendment (or, if such commitments have expired
          or been terminated, the outstanding loans thereunder) exceed
          $2,000,000,000 in aggregate amount, the Company will not make, and
          will not permit any of its Subsidiaries to make, any optional payment
          or prepayment on or redemption, defeasance or purchase of any
          Indebtedness of the Company or any of its Subsidiaries (other than
          Indebtedness under the July 1998 Term Loan Facility, the February 1997
          Five-Year Agreement and Amendment, the June 1997 364-Day Agreement and
          Amendment or Indebtedness under Financing Leases in an aggregate
          amount not to exceed $50,000,000 in any fiscal year of the Company),
          or amend, modify or change, or consent or agree to any amendment,
          modification or change to any of the terms relating to the payment or
          prepayment or principal of or interest on, any such Indebtedness,
          other than any amendment, modification or change which would extend
          the maturity or
<PAGE>
 
                                                                               6

          reduce the amount of any payment of principal thereof or which would
          reduce the rate or extend the date for payment of interest there or
          which would not be adverse to the Banks.


     (f) The February 1997 Five-Year Agreement and Amendment is hereby amended
by adding the following new paragraphs immediately after Section 8G reading as
follows:

          "SECTION 8H.  Indebtedness of Subsidiaries.  Paragraph (b) of
     subsection 5.1 of the Five-Year Composite Conformed Credit Agreement as
     adopted and incorporated by reference into this February 1997 Five-Year
     Agreement and Amendment is hereby amended by deleting such paragraph in its
     entirety and substituting in lieu thereof the following:

               `(b)  Each of the Company and its Subsidiaries will promptly pay
          when due, or in conformance with customary trade terms, all other
          Indebtedness and liabilities incident to its operations; provided,
          however, that any such Indebtedness or liability need not be paid if
          the validity or amount thereof shall currently be contested in good
          faith and if the Company or the Subsidiary in question shall have set
          aside on its books appropriate reserves with respect thereto.  The
          Subsidiaries will not create, incur, assume or suffer to exist any
          Indebtedness, except:  (i) Indebtedness outstanding on the date hereof
          and listed on Schedule III; (ii) Indebtedness that is owing to the
          Company or any other Subsidiary; (iii) Indebtedness incurred pursuant
          to an accounts receivable program and (iv) additional Indebtedness at
          any time outstanding in an aggregate principal amount not to exceed
          10% of Consolidated Assets.'.

          "SECTION 8I.  Sales of Assets.  Subsection 5.10 of the Five-Year
     Composite Conformed Credit Agreement as adopted and incorporated by
     reference into this February 1997 Five-Year Agreement and Amendment is
     hereby amended by deleting such subsection in its entirety and substituting
     in lieu thereof the following:

 
               `5.10 Sales of Assets. The Company and its Subsidiaries may from
          time to time sell or otherwise dispose of all or any part of their
          respective assets; provided, however, that in any fiscal year, the
          Company and its Subsidiaries will not (a) sell or dispose of
          (including, without limitation, any disposition resulting from any
          merger or consolidation involving a Subsidiary of the Company, and any
          Sale-and-Leaseback Transaction), outside of the ordinary course of
          business, to Persons other than the Company and its Subsidiaries,
          assets constituting in the aggregate more than 12% of Consolidated
          Assets of the Company and its Subsidiaries as at the end of the
          immediately preceding fiscal year (excluding an amount equal to the
          book value of those assets the Net Cash Proceeds from the disposition
          of which have been applied to prepay the outstanding revolving credit
          loans under the June 1997 364-Day Agreement and Amendment in
          accordance with subsection 2.18
<PAGE>
 
                                                                               7

          thereof) and (b) exchange with any Persons other than the Company and
          its Subsidiaries any asset or group of assets for another asset or
          group of assets unless (i) such asset or group of assets are exchanged
          for an asset or group of assets of a substantially similar type or
          nature, (ii) on a pro forma basis both before and after giving effect
          to such exchange, no Default or Event of Default shall have occurred
          and be continuing, (iii) the aggregate fair market value (as
          determined in good faith by the Board of Directors of the Company) of
          the asset or group of assets being transferred by the Company or such
          Subsidiary and the asset or group of assets being acquired by the
          Company or such Subsidiary are substantially equal and (iv) the
          aggregate of (x) all assets of the Company and its Subsidiaries sold
          pursuant to subsection 5.10(a) (including, without limitation, any
          disposition resulting from any merger or consolidation involving a
          Subsidiary of the Company, and any Sale-and-Leaseback Transaction)
          (excluding an amount equal to the book value of those assets the Net
          Cash Proceeds from the disposition of which have been applied to
          prepay the outstanding revolving credit loans under the June 1997 364-
          Day Agreement and Amendment in accordance with subsection 2.18
          thereof) and (y) the aggregate fair market value (as determined in
          good faith by the Board of Directors of the Company) of all assets of
          the Company and its Subsidiaries exchanged pursuant to this subsection
          5.10(b) does not exceed 20% of Consolidated Assets of the Company and
          its Subsidiaries as at the end of the immediately preceding fiscal
          year.'"

          "SECTION 8J.  Application of Proceeds of Loans.  Subsection 2.16 of
     the Five-Year Composite Conformed Credit Agreement as adopted and
     incorporated by reference into this February 1997 Five-Year Agreement and
     Amendment is hereby amended by deleting such subsection in its entirety and
     substituting in lieu thereof the following:

               `2.16  Application of Proceeds of Loans.  Subject to the
          provisions of the following sentence, the Company may use the proceeds
          of the Loans for any lawful corporate purpose.  the Company will not,
          directly or indirectly, apply any part of the proceeds of any such
          Loan for the purpose of "purchasing" or "carrying" any "margin stock"
          within the respective meanings of each of the quoted terms under
          Regulation U, or to refund any indebtedness incurred for such purpose,
          except in a manner which is not in violation of Regulations U and X.'.

          "SECTION 8K.  Company Officers' Certificate.  Subsection 4.3 of the
     Five-Year Composite Conformed Credit Agreement as adopted and incorporated
     by reference into this February 1997 Five-Year Agreement and Amendment is
     hereby amended by deleting such subsection in its entirety and substituting
     in lieu thereof the following:

               `4.3 Company Officers' Certificate. The representations and
          warranties contained in Section 3 (as qualified by the disclosures in
          (i) the Company's
<PAGE>
 
                                                                               8

          Annual Report on Form 10-K for its fiscal year ended December 31,
          1997, (ii) the Company's Quarterly Reports on Form 10-Q for its fiscal
          quarters ended June 30, 1997, September 30, 1997 and March 31, 1998
          and (iii) the Company's Report on Form 8-K dated February 6, 1998,
          February 13, 1998, March 6, 1998 and May 27, 1998, in each case as
          filed with the Securities and Exchange Commission and previously
          distributed to the Banks) shall be true and correct in all material
          respects on the Closing Date and on and as of each Borrowing Date with
          the same force and effect as though made on and as of such date; no
          Default shall have occurred (except a Default which shall have been
          waived in writing or which shall have been cured) and no Default shall
          exist after giving effect to the Loan to be made; between December 31,
          1994 and such Borrowing Date, neither the business nor assets, nor the
          condition, financial or otherwise, of the Company and its Subsidiaries
          on a consolidated basis shall have been adversely affected in any
          material manner as a result of any fire, flood, explosion, accident,
          drought, strike, lockout, riot, sabotage, confiscation, condemnation,
          or any purchase of any property by Governmental Authority, activities
          of armed forces, acts of God or the public enemy, new or amended
          legislation, regulatory order, judicial decision or any other event or
          development whether or not related to those enumerated above (all
          subject to the disclosures enumerated above); and the Agent shall have
          received a certificate containing a representation to these effects
          dated such Borrowing Date and signed by a Responsible Officer.'.

          3.   Effective Date; Conditions Precedent.  This Fourth Amendment will
become effective on July 10, 1998 (the "Effective Date") subject to the
compliance by the Company with its agreements herein contained and to the
satisfaction on or before the Effective Date of the following further
conditions:

               (a)  Loan Documents.  The Agent shall have received copies of
     this Fourth Amendment, executed and delivered by a duly authorized officer
     of the Company, with a counterpart for each Bank, and executed and
     delivered by the Required Banks.

               (b) Company Officers' Certificate. The representations and
     warranties contained in Section 3 of the Five-Year Composite Conformed
     Credit Agreement as adopted and incorporated by reference into, and as
     amended by, the February 1997 Five-Year Agreement and Amendment (as
     qualified by the disclosures in (i) the Company's Annual Report on Form 10-
     K for its fiscal year ended December 31, 1997, (ii) the Company's Quarterly
     Reports on Form 10-Q for its fiscal quarters ended June 30, 1997, September
     30, 1997 and March 31, 1998 and (iii) the Company's Report on Form 8-K
     dated February 6, 1998, February 13, 1998, March 6, 1998 and May 27, 1998,
     in each case as filed with the Securities and Exchange Commission and
     previously distributed to the Banks) shall be true and correct in all
     material respects on the Effective Date with the same force and effect as
     though made on and as of such date; on and as of the Effective Date and
     after giving effect to this Fourth Amendment, no Default shall have
     occurred (except a Default which shall have been
<PAGE>
 
                                                                               9

     waived in writing or which shall have been cured); and the Agent shall have
     received a certificate containing a representation to these effects dated
     the Effective Date and signed by a Responsible Officer.

               (c)  Term Loan Facility.  The Company shall have entered into a
     senior term loan facility, structured and arranged by Chase to be used for
     general corporate purposes, including for the repurchase of shares of
     common stock of the Company (including any "synthetic" acquisitions through
     equity derivatives), on terms and conditions satisfactory to Chase.

          4.   Legal Obligation.  The Company represents and warrants to each
Bank that this Fourth Amendment constitutes the legal, valid and binding
obligation of the Company, enforceable against it in accordance with its terms,
subject to the effects of bankruptcy, insolvency, fraudulent conveyances,
reorganization, moratorium and other similar laws relating to or affecting
creditors' rights generally, general equitable principles (whether considered in
a proceeding in equity or at law) and an implied covenant of good faith and fair
dealing.

          5.   Continuing Effect; Application.  Except as expressly amended
hereby, the February 1997 Five-Year Agreement and Amendment shall continue to be
and shall remain in full force and effect in accordance with its terms.

          6.   Expenses.  The Company agrees to pay or reimburse the Agent for
all of its reasonable out-of-pocket costs and expenses incurred in connection
with the development, preparation and execution of, and any amendment,
supplement or modification to, this Fourth Amendment and any other documents
prepared in connection herewith, and the consummation of the transactions
contemplated hereby and thereby, including, without limitation, the reasonable
fees and disbursements of counsel to the Agent.

          7. GOVERNING LAW. THIS FOURTH AMENDMENT AND THE RIGHTS AND OBLIGATIONS
OF THE PARTIES UNDER THIS FOURTH AMENDMENT SHALL BE GOVERNED BY, AND CONSTRUED
AND INTERPRETED IN ACCORDANCE WITH, THE LAW OF THE STATE OF NEW YORK.

          8.   Counterparts.  This Fourth Amendment may be executed by one or
more of the parties to this Fourth Amendment on any number of separate
counterparts and all of said counterparts taken together shall be deemed to
constitute one and the same instrument.  A set of the copies of this Fourth
Amendment signed by all the parties shall be lodged with the Company and the
Agent.
<PAGE>
 
          IN WITNESS WHEREOF, the parties hereto have caused this Fourth
Amendment to be duly executed and delivered by their proper and duly authorized
officers as of the day and year first above written.


                                   COLUMBIA/HCA HEALTHCARE CORPORATION


                                   By:  /s/ DAVID G. ANDERSON
                                       -----------------------------------------
                                        Name:  David G. Anderson
                                        Title: Vice President Finance and
                                               Treasurer


                                   THE CHASE MANHATTAN BANK, as Agent, as CAF
                                   Loan Agent and as a Bank


                                   By:  /s/ DAWN LEE LUM
                                       -----------------------------------------
                                        Name:  Dawn Lee Lum
                                        Title: Vice President


                                   ABN AMRO BANK N.V., as a Bank


                                   By:  /s/ THOMAS S. THORNHILL
                                       -----------------------------------------
                                        Name:  Thomas S. Thornhill
                                        Title: Group Vice President


                                   By:  /s/ STEVEN L. HIPSMAN
                                       -----------------------------------------
                                        Name:  Steven L. Hipsman
                                        Title: Vice President


                                   ARAB BANK PLC, GRAND CAYMAN BRANCH, as a Bank


                                   By:  /s/ [ILLEGIBLE]
                                       -----------------------------------------
                                        Name:
                                        Title:
<PAGE>
 
                                   BANCA MONTE DEI PASCHI DI SIENA SpA,
                                   as a Bank


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


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


                                   BANCA NAZIONALE del LAVORO, SpA, as a Bank


                                   By:  /s/ LEONARDO VALENTINI
                                       -----------------------------------------
                                        Name:  Leonardo Valentini
                                        Title: First Vice President

                                   By:  /s/ ROBERTO MANCONE
                                       -----------------------------------------
                                        Name:  Roberto Mancone
                                        Title: AVP Senior Loan Officer


                                   BANK ONE TEXAS, N.A., as a Bank


                                   By:  /s/ JAMES B. LUKOWICZ 
                                       -----------------------------------------
                                        Name:  James B. Lukowicz
                                        Title: Vice President


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


                                   By:  /s/ J. GREGORY SEIBLY
                                       -----------------------------------------
                                        Name:  J. Gregory Seibly
                                        Title: Vice President


                                   THE BANK OF NEW YORK, as a Co-Agent and as
                                   a Bank


                                   By:  /s/ ANN MARIE HUGHES
                                       -----------------------------------------
                                        Name:  Ann Marie Hughes
                                        Title: Vice President
<PAGE>
 
                                   THE BANK OF NOVA SCOTIA, as a Bank


                                   By:  /s/ W.J. BROWN
                                       -----------------------------------------
                                        Name:  W.J. Brown
                                        Title: Vice President


                                   BANK OF TOKYO-MITSUBISHI TRUST COMPANY, as
                                   a Bank


                                   By:  /s/ DOUGLAS J. WEIR
                                       -----------------------------------------
                                        Name:  Douglas J. Weir
                                        Title: Vice President


                                   BANK OF YOKOHAMA, as a Bank


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


                                   BANQUE NATIONALE DE PARIS -Houston Agency,
                                   as a Bank


                                   By:  /s/ HENRY F. SETINA
                                       -----------------------------------------
                                        Name:  Henry F. Setina
                                        Title: Vice President


                                   BARNETT BANK, N.A., as a Bank


                                   By:  /s/ KEVIN WAGLEY
                                       -----------------------------------------
                                        Name:  Kevin Wagley
                                        Title: Vice President
<PAGE>
 
                                   CITIBANK, N.A., as a Bank


                                   By:  /s/ MARGARET AU BROWN
                                       -----------------------------------------
                                        Name:  Margaret Au Brown
                                        Title: Managing Director


                                   COMERICA BANK, as a Bank

                                   By:  /s/ COLLEEN M. MURPHY
                                       -----------------------------------------
                                        Name:  Colleen M. Murphy
                                        Title: Assistant Vice President


                                   CORESTATES BANK, N.A., as a Bank


                                   By:  /s/ JAMES A. HOBENSACK
                                       -----------------------------------------
                                        Name:  James A. Hobensack
                                        Title: Senior Vice President


                                   CRESTAR BANK, as a Bank


                                   By:  /s/ C. GRAY KEY
                                       -----------------------------------------
                                        Name:  C. GRAY KEY
                                        Title: Vice President


                                   THE DAI-ICHI KANGYO BANK, LIMITED, as a Bank

 
                                   By:  /s/ TATSUJI NOGUCHI
                                       -----------------------------------------
                                        Name:  Tatsuji Noguchi
                                        Title: Chief Representative
<PAGE>
 
                                   DEN DANSKE BANK AKTIESELSKAB, as a Bank
                                   CAYMAN ISLANDS BRANCH c/o New York Branch


                                   By:  /s/ JOHN O'NEILL
                                       -----------------------------------------
                                        Name:  John O'Neill
                                        Title: Vice President


                                   By:  /s/ DENNIS T. SHUGRUE
                                       -----------------------------------------
                                        Name:  Dennis T. Shugrue
                                        Title: International Banking Officer


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


                                   By:  /s/ SUSAN L. PEARSON
                                       -----------------------------------------
                                        Name:  Susan L. Pearson
                                        Title: Director


                                   By:  /s/ HANS-JOSEF THIELE
                                       -----------------------------------------
                                        Name:  Hans-Josef Thiele
                                        Title: Director


                                   FIRST AMERICAN NATIONAL BANK, as a Bank


                                   By:  /s/ SANDY HAMRICK
                                       -----------------------------------------
                                        Name:  Sandy Hamrick
                                        Title: Senior Vice President


                                   FIRST HAWAIIAN BANK, as a Bank


                                   By:  /s/ CHARLES L. JENKINS
                                       -----------------------------------------
                                        Name:  Charles L. Jenkins
                                        Title: Vice President and Manager
<PAGE>
 
                                   THE FIRST NATIONAL BANK OF CHICAGO, as a Bank


                                   By:  /s/ L. RICHARD SCHILLER
                                       -----------------------------------------
                                        Name:  L. Richard Schiller
                                        Title: Vice President


                                   FIRST UNION NATIONAL BANK, as a Bank


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


                                   FLEET NATIONAL BANK, as a Co-Agent and as
                                   a Bank


                                   By:  /s/ MARYANN S. SMITH
                                       -----------------------------------------
                                        Name:  Maryann S. Smith
                                        Title: Vice President


                                   THE FUJI BANK LIMITED, as a Co-Agent and
                                   as a Bank


                                   By:  /s/ TOSHIHIRO MITSUI
                                       -----------------------------------------
                                        Name:  Toshihiro Mitsui
                                        Title: Senior Vice President and
                                               Joint General Manager


                                   THE INDUSTRIAL BANK OF JAPAN, LIMITED,
                                   ATLANTA AGENCY, as a Co-Agent and as a Bank


                                   By:  /s/ KOICHI HASEGAWA
                                       -----------------------------------------
                                        Name:  Koichi Hasegawa
                                        Title: Senior Vice President and
                                               Deputy General Manager
<PAGE>
 
                                   KEYBANK NATIONAL ASSOCIATION, as a Bank


                                   By:  /s/ THOMAS J. PURCELL
                                       -----------------------------------------
                                        Name:  Thomas J. Purcell
                                        Title: Vice President


                                   THE MITSUBISHI TRUST AND BANKING
                                   CORPORATION, as a Bank


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


                                   THE MITSUI TRUST AND BANKING COMPANY,
                                   LIMITED, NEW YORK BRANCH, as a Bank


                                   By:  /s/ MARGARET HOLLOWAY
                                       -----------------------------------------
                                        Name:  Margaret Holloway
                                        Title: Vice President & Manager


                                   MORGAN GUARANTY TRUST COMPANY OF NEW YORK,
                                   as a Co-Agent and as a Bank

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


                                   NATIONAL CITY BANK OF KENTUCKY, as a Bank


                                   By:  /s/ DENY SCOTT
                                       -----------------------------------------
                                        Name:  Deny Scott
                                        Title: Vice President
<PAGE>
 
                                   NATIONSBANK, N.A. as a Co-Agent and as a Bank


                                   By:  /s/ KEVIN WAGLEY
                                       -----------------------------------------
                                        Name:  Kevin Wagley
                                        Title: Vice President


                                   THE NORINCHUKIN BANK, NEW YORK BRANCH,
                                   as a Bank


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


                                   THE NORTHERN TRUST COMPANY, as a Bank


                                   By:  /s/ CHRISTINA L. JAKUC
                                       -----------------------------------------
                                        Name:  Christina L. Jakuc
                                        Title: Second Vice President


                                   PNC BANK, N.A., as a Co-Agent and as a Bank


                                   By:  /s/ KATHRYN M. BOHR
                                       -----------------------------------------
                                        Name:  Kathryn M. Bohr
                                        Title: Vice President


                                   THE SAKURA BANK, LTD. NEW YORK BRANCH,
                                   as a Lead Manager and as a Bank


                                   By:  /s/ YASUMASA KIKUCHI
                                       -----------------------------------------
                                        Name:  Yasumasa Kikuchi
                                        Title: Senior Vice President
<PAGE>
 
                                   THE SUMITOMO BANK, LIMITED,  as a
                                   Lead Manager and as a Bank


                                   By:  /s/ GARY FRANKE
                                       -----------------------------------------
                                        Name:  Gary Franke
                                        Title: Vice President & Manager


                                   THE SUMITOMO TRUST & BANKING CO., LTD.,
                                   NEW YORK BRANCH, as a Bank


                                   By:  /s/ STEPHEN STRATICI
                                       -----------------------------------------
                                        Name:  Stephen Stratici
                                        Title: Vice President


                                   SUNTRUST BANK, NASHVILLE, N.A., as a
                                   Lead Manager and as a Bank


                                   By:  /s/ MARK D. MATTSON
                                       -----------------------------------------
                                        Name:  Mark D. Mattson
                                        Title: Vice President


                                   THE TOKAI BANK, LIMITED, NEW YORK BRANCH,
                                   as a Bank


                                   By:  /s/ SHINICHI NAKATANI
                                       -----------------------------------------
                                        Name:  Shinichi Nakatani
                                        Title: Assistant General Manager


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


                                   By:  /s/ JORGE A. GARCIA
                                       -----------------------------------------
                                        Name:  Jorge A. Garcia
                                        Title: Vice President
<PAGE>
 
                                   THE TOYO TRUST & BANKING CO., LTD., as a Bank


                                   By:  /s/ T. MIKUMO
                                       -----------------------------------------
                                        Name:  T. MIKUMO
                                        Title: Vice President


                                   UBS AG, NEW YORK BRANCH, as a Co-Agent and
                                   as a Bank


                                   By:  /s/ LEO L. BALTZ
                                       -----------------------------------------
                                        Name:  Leo L. Baltz
                                        Title: Director


                                   By:  /s/ EDUARDO SALAZAR
                                       -----------------------------------------
                                        Name:  Eduardo Salazar
                                        Title: Executive Director


                                   UNION PLANTERS BANK, N.A.

                                   By:  /s/ [ILLEGIBLE]
                                       -----------------------------------------
                                        Name:
                                        Title:


                                   WACHOVIA BANK OF GEORGIA, N.A., as a
                                   Co-Agent and as a Bank


                                   By:  /s/ KENNETH WASHINGTON
                                       -----------------------------------------
                                        Name:  Kenneth Washington
                                        Title: Vice President


                                   WELLS FARGO BANK, N.A., as a Lead Manager
                                   and as a Bank


                                   By:  /s/ DONALD A. HARTMANN
                                       -----------------------------------------
                                        Name:  Donald A. Hartmann
                                        Title: Senior Vice President


                                   By:  /s/ TIMOTHY A. McDEVITT
                                       -----------------------------------------
                                        Name:  Timothy A. McDevitt
                                        Title: Vice President
<PAGE>
 
                                   YASUDA TRUST AND BANKING, as a Bank


                                   By:  /s/ JUNICHIRO KAWAMURA
                                       -----------------------------------------
                                        Name:  Junichiro Kawamura
                                        Title: Vice President

<PAGE>
 
                                                                   EXHIBIT 10(c)

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



                           $1,000,000,000 AGREEMENT


                                     AMONG


                     COLUMBIA/HCA HEALTHCARE CORPORATION,


              THE SEVERAL BANKS AND OTHER FINANCIAL INSTITUTIONS
                       FROM TIME TO TIME PARTIES HERETO,

                          THE CO-AGENTS NAMED HEREIN,

                              NATIONSBANK, N.A.,
                            AS DOCUMENTATION AGENT,

                            THE BANK OF NOVA SCOTIA
                                      AND
                           DEUTSCHE BANK SECURITIES,

                           AS CO-SYNDICATION AGENTS,

                                      AND

                           THE CHASE MANHATTAN BANK,
                                   AS AGENT


                           DATED AS OF JULY 10, 1998


================================================================================
<PAGE>
 
                               TABLE OF CONTENTS
                               -----------------

                                                                       Page
                                                                       ----

SECTION 1.  DEFINITIONS...............................................    1
      1.1   Defined Terms.............................................    1
      1.2   Other Definitional Provisions.............................   12

SECTION 2.  AMOUNT AND TERMS OF LOANS.................................   12
      2.1   Loans and Notes...........................................   12
      2.2   Fees......................................................   13
      2.3   Termination or Reduction of Commitments...................   13
      2.4   Optional Prepayments......................................   13
      2.5   Conversion Options; Minimum Amount of Loans...............   14
      2.6   Interest Rate and Payment Dates for Loans.................   14
      2.7   Computation of Interest and Fees..........................   15
      2.8   Inability to Determine Interest Rate......................   16
      2.9   Pro Rata Borrowings and Payments..........................   16
      2.10  Illegality................................................   17
      2.11  Requirements of Law.......................................   17
      2.12  Capital Adequacy..........................................   18
      2.13  Taxes.....................................................   18
      2.14  Indemnity.................................................   20
      2.15  Application of Proceeds of Loans..........................   20
      2.16  Notice of Certain Circumstances; Assignment of
              Commitments Under Certain Circumstances.................   20

SECTION 3.  REPRESENTATIONS AND WARRANTIES............................   21
      3.1   Corporate Organization and Existence......................   21
      3.2   Subsidiaries..............................................   21
      3.3   Financial Information.....................................   21
      3.4   Changes in Condition......................................   22
      3.5   Assets....................................................   22
      3.6   Litigation................................................   22
      3.7   Tax Returns...............................................   23
      3.8   Contracts, etc............................................   23
      3.9   No Legal Obstacle to Agreement............................   23
      3.10  Defaults..................................................   23
      3.11  Burdensome Obligations....................................   23
      3.12  Pension Plans.............................................   24
      3.13  Disclosure................................................   24
      3.14  Environmental and Public and Employee Health
              and Safety Matters......................................   24
      3.15  Federal Regulations.......................................   25
      3.16  Investment Company Act; Other Regulations.................   25
      3.17  Year 2000 Matters.........................................   25
<PAGE>
 
                                                                       Page
                                                                       ----

SECTION 4.  CONDITIONS................................................   25
      4.1   Loan Documents............................................   25
      4.2   Legal Opinions............................................   26
      4.3   Company Officers' Certificate.............................   26
      4.4   Legality, etc.............................................   26
      4.5   General...................................................   26
      4.6   Fees......................................................   26
      4.7   Amendments to Existing Agreements.........................   27

SECTION 5.  GENERAL COVENANTS.........................................   27
      5.1   Taxes, Indebtedness, etc..................................   27
      5.2   Maintenance of Properties; Compliance with Law............   27
      5.3   Transactions with Affiliates..............................   28
      5.4   Insurance.................................................   28
      5.5   Financial Statements......................................   28
      5.6   Ratio of Consolidated Total Debt to
              Consolidated Total Capitalization.......................   31
      5.7   Interest Coverage Ratio...................................   31
      5.8   Distributions.............................................   31
      5.9   Merger or Consolidation...................................   31
      5.10  Sales of Assets...........................................   31
      5.11  Compliance with ERISA.....................................   32
      5.12  Negative Pledge...........................................   32
      5.13  Sale-and-Lease-back Transactions..........................   34
      5.14  Maximum Consolidated Total Debt...........................   34
      5.15  Minimum Consolidated Earnings Before Interest,
              Taxes, Depreciation and Amortization....................   34
      5.16  Limitation on Optional Payments and
            Modifications of Debt Instruments.........................   34

SECTION 6.  DEFAULTS..................................................   35
      6.1   Events of Default.........................................   35
      6.2   Annulment of Defaults.....................................   37
      6.3   Waivers...................................................   37
      6.4   Course of Dealing.........................................   37

SECTION 7.  THE AGENT.................................................   37
      7.1   Appointment...............................................   37
      7.2   Delegation of Duties......................................   38
      7.3   Exculpatory Provisions....................................   38
      7.4   Reliance by Agent.........................................   38
      7.5   Notice of Default.........................................   39
      7.6   Non-Reliance on Agent and Other Banks.....................   39
      7.7   Indemnification...........................................   39


                                     -ii-
<PAGE>
 
                                                                       Page
                                                                       ----

      7.8   Agent in Its Individual Capacity..........................   40
      7.9   Successor Agent...........................................   40

SECTION 8.  MISCELLANEOUS.............................................   40
      8.1   Amendments and Waivers....................................   40
      8.2   Notices...................................................   41
      8.3   No Waiver; Cumulative Remedies............................   41
      8.4   Survival of Representations and Warranties................   41
      8.5   Payment of Expenses and Taxes; Indemnity..................   42
      8.6   Successors and Assigns; Participations;
              Purchasing Banks........................................   42
      8.7   Adjustments; Set-off......................................   45

                                     -iii-
<PAGE>
 
                                                                       Page
                                                                       ----
 
     8.8    Counterparts..............................................   45
     8.9    GOVERNING LAW.............................................   45
     8.10   WAIVERS OF JURY TRIAL.....................................   45
     8.11   Submission To Jurisdiction; Waivers.......................   45
 

SCHEDULES

SCHEDULE I    Commitment Amounts and Percentages; Lending
              Offices; Addresses for Notice
SCHEDULE II   Subsidiaries of the Company
SCHEDULE III  Indebtedness
SCHEDULE IV   Applicable Margins
SCHEDULE V    Significant Litigation


EXHIBITS

EXHIBIT A     Form of Note
EXHIBIT B     Form of Commitment Transfer Supplement


                                     -iv-
<PAGE>
 
     AGREEMENT, dated as of July 10, 1998 (this "Agreement"), among COLUMBIA/HCA
HEALTHCARE CORPORATION, a Delaware corporation (the "Company"), the several
banks and other financial institutions from time to time parties hereto (the
"Banks"), BANK OF AMERICA NATIONAL TRUST AND SAVINGS ASSOCIATION, THE BANK OF
NEW YORK, THE FIRST NATIONAL BANK OF CHICAGO, FLEET NATIONAL BANK, TORONTO
DOMINION (TEXAS), INC. AND WACHOVIA BANK OF GEORGIA, N.A. as Co-Agents
(collectively, the "Co-Agents"), NATIONSBANK, N.A., as documentation agent for
the Banks hereunder (the "Documentation Agent") and THE BANK OF NOVA SCOTIA and
DEUTSCHE BANK SECURITIES INC., as co-syndication agents for the Banks hereunder
(the "Co-Syndication Agents"); and THE CHASE MANHATTAN BANK, a New York banking
corporation, as agent for the Banks hereunder (in such capacity, the "Agent").

     In consideration of the promises and mutual agreements herein contained and
for other good and valuable consideration, the parties hereto hereby agree as
follows:

     SECTION 1.  DEFINITIONS

     1.1    Defined Terms.  As used in this Agreement, the following terms have
the following meanings:

            "Affiliate":  (a) any director or officer of any corporation or
     partner or joint venturer or Person holding a similar position in another
     Person or members of their families, whether or not living under the same
     roof, or any Person owning beneficially more than 5% of the outstanding
     common stock or other evidences of beneficial interest of the Person in
     question, (b) any Person of which any one or more of the Persons described
     in clause (a) above is an officer, director or beneficial owner of more
     than 5% of the shares or other beneficial interest and (c) any Person
     controlled by, controlling or under common control with the Person in
     question.
 
            "Alternate Base Rate":  for any day, a rate per annum (rounded
     upwards, if necessary, to the next 1/16 of 1%) equal to the greatest of (a)
     the Prime Rate in effect on such day, (b) the Base CD Rate in effect on
     such day plus 1% and (c) the Federal Funds Effective Rate in effect on such
     day plus 1/2 of 1%.  For purposes hereof:  "Prime Rate" shall mean the rate
     of interest per annum publicly announced from time to time by the Agent as
     its prime rate in effect at its principal office in New York City (each
     change in the Prime Rate to be effective on the date such change is
     publicly announced); "Base CD Rate" shall mean the sum of (a) the product
     of (i) the Three-Month Secondary CD Rate and (ii) a fraction, the numerator
     of which is one and the denominator of which is one minus the C/D Reserve
     Percentage and (b) the C/D Assessment Rate; "Three-Month Secondary CD Rate"
     shall mean, for any day, the secondary market rate for three-month
     certificates of deposit reported as being in effect on such day (or, if
     such day shall not be a Business Day, the next preceding Business Day) by
     the Board of Governors of the Federal Reserve System (the "Board") through
     the public information telephone line of the Federal Reserve Bank of New
     York (which rate will, under the current practices of the Board, be
     published in Federal Reserve Statistical Release H.15(519) during the week
     following such day), or, if such rate shall not be so reported on such day
     or such next preceding Business Day, the average of the secondary market
     quotations for three-month
<PAGE>
 
                                                                               2



     certificates of deposit of major money center banks in New York City
     received at approximately 10:00 A.M., New York City time, on such day (or,
     if such day shall not be a Business Day, on the next preceding Business
     Day) by the Agent from three New York City negotiable certificate of
     deposit dealers of recognized standing selected by it; "C/D Reserve
     Percentage" shall mean, for any day, that percentage (expressed as a
     decimal) which is in effect on such day, as prescribed by the Board (or any
     successor), for determining the maximum reserve requirement for a member
     bank of the Federal Reserve System in New York City with deposits exceeding
     one billion Dollars in respect of new non-personal three-month certificates
     of deposit in the secondary market in Dollars in New York City and in an
     amount of $100,000 or more; "C/D Assessment Rate" shall mean, for any day,
     the net annual assessment rate (rounded upward to the nearest 1/100 of 1%)
     determined by Chase to be payable on such day to the Federal Deposit
     Insurance Corporation or any successor (the "FDIC") for FDIC's insuring
     time deposits made in Dollars at offices of Chase in the United States; and
     "Federal Funds Effective Rate" shall mean, for any day, the weighted
     average of the rates on overnight federal funds transactions with members
     of the Federal Reserve System arranged by federal funds brokers, as
     published on the next succeeding Business Day by the Federal Reserve Bank
     of New York, or, if such rate is not so published for any day which is a
     Business Day, the average of the quotations for the day of such
     transactions received by the Agent from three federal funds brokers of
     recognized standing selected by it.  If for any reason the Agent shall have
     determined (which determination shall be conclusive absent manifest error)
     that it is unable to ascertain the Base CD Rate or the Federal Funds
     Effective Rate, or both, for any reason, including the inability or failure
     of the Agent to obtain sufficient quotations in accordance with the terms
     thereof, the Alternate Base Rate shall be determined without regard to
     clause (b) or (c), or both, of the first sentence of this definition, as
     appropriate, until the circumstances giving rise to such inability no
     longer exist.  Any change in the Alternate Base Rate due to a change in the
     Prime Rate, the Three-Month Secondary CD Rate or the Federal Funds
     Effective Rate shall be effective on the effective day of such change in
     the Prime Rate, the Three-Month Secondary CD Rate or the Federal Funds
     Effective Rate, respectively.

            "Alternate Base Rate Loans": Loans hereunder at such time as they
     are made and/or being maintained at a rate of interest based upon the
     Alternate Base Rate.

            "Applicable Margin":  for each Type of Loan during a Level I Period,
     Level II Period, Level III Period or Level IV Period, the rate per annum
     set forth under the relevant column heading in Schedule IV.  Increases or
     decreases in the Applicable Margin shall become effective on the first day
     of the Level I Period, Level II Period, Level III Period or Level IV
     Period, as the case may be, to which such Applicable Margin relates.

            "Attributable Debt":  means (i) as to any capitalized lease
     obligations, the Indebtedness carried on the balance sheet in respect
     thereof in accordance with GAAP and (ii) as to any operating leases, the
     total net amount of rent required to be paid under such leases during the
     remaining term thereof.
<PAGE>
 
                                                                               3


            "Auditor": any independent certified public accountant of nationally
     recognized standing and reputation selected by the Company.

            "Available Commitments": at a particular time, an amount equal to
     the difference between (a) the amount of the Commitments at such time and
     (b) the aggregate unpaid principal amount at such time of all Loans.

            "Bank Obligations":  as defined in subsection 6.1.

            "Benefitted Bank":  as defined in subsection 8.7.

            "Borrowing Date": any Business Day specified in a notice pursuant to
     subsection 2.1(c) as a date on which the Company requests the Banks to make
     Loans hereunder.

            "Business Day":  a day other than a Saturday, Sunday or other day on
     which commercial banks in New York City are authorized or required by law
     to close.

            "Change in Control":  of any corporation, (a) any Person or "group"
     (as defined in Section 13(d)(3) of the Securities Exchange Act of 1934, as
     amended), other than the Company, that shall acquire more than 50% of the
     Voting Stock of such corporation or (b) any Person or group (as defined in
     preceding clause (a)), other than the Company, that shall acquire more than
     20% of the Voting Stock of such corporation and, at any time following an
     acquisition described in this clause (b), the Continuing Directors shall
     not constitute a majority of the board of directors of such corporation.

            "Chase":  The Chase Manhattan Bank, a New York banking corporation.

            "Closing Date": the date on which all of the conditions precedent
     for the Closing Date set forth in Section 4 are satisfied.

            "Code":  the Internal Revenue Code of 1986, as amended from time to
     time.

            "Commitment":  as to any Bank, its obligation to make Loans to the
     Company pursuant to subsection 2.1(a) in an aggregate amount not to exceed
     at any one time outstanding the amount set forth opposite such Bank's name
     in Schedule I, as such amount may be reduced from time to time as provided
     herein.

            "Commitment Percentage":  as to any Bank, the percentage of the
     aggregate Commitments constituted by such Bank's Commitment.

            "Commitment Period":  the period from and including the Closing Date
     to but not including the Termination Date or such earlier date on which the
     Commitments shall terminate as provided herein.

            "Commitment Transfer Supplement":  a Commitment Transfer Supplement,
     substantially in the form of Exhibit B.
<PAGE>
 
                                                                               4

            "Consolidated Assets": the consolidated assets of the Company and
     its Subsidiaries, determined in accordance with GAAP.

            "Consolidated Earnings Before Interest and Taxes": for any period
     for which the amount thereof is to be determined, Consolidated Net Income
     for such period plus (i) all amounts deducted in computing such
     Consolidated Net Income in respect of interest expense on Indebtedness and
     income taxes and (ii) non-cash non-recurring charges (including charges as
     a result of changes in method of accounting) and adjustments for impairment
     of long-lived assets in accordance with original pronouncement number 121
     of the Financial Accounting Standards Board incurred or made as of or for
     the fiscal quarters ending September 30, 1997 and December 31, 1997 not
     exceeding in the aggregate $1,200,000,000 on a pre-tax basis, all
     determined in accordance with GAAP.

            "Consolidated Earnings Before Interest, Taxes, Depreciation and
     Amortization":  for any period for which the amount thereof is to be
     determined, consolidated net revenues for such period minus consolidated
     operating expenses plus or minus equity in earnings of affiliates of the
     Company and its Subsidiaries (excluding Value Health and home health
     operations included in discontinued operations) for such period (which
     consolidated operating expenses shall, in any event, include and be limited
     to salaries and benefits, supplies, other operating expenses and provision
     for doubtful accounts), all determined in accordance with GAAP and
     consistent with the Company's reporting on Forms 10-Q and 10-K.

            "Consolidated Interest Expense": for any period for which the amount
     thereof is to be determined, all amounts deducted in computing Consolidated
     Net Income for such period in respect of interest expense on Indebtedness
     determined in accordance with GAAP.

            "Consolidated Net Income":  for any period, the consolidated net
     income, if any, after taxes, of the Company and its Subsidiaries for such
     period determined in accordance with GAAP; provided, however, that
     Consolidated Net Income shall not include any gain or loss attributable to
     extraordinary items, any sale of assets not in the ordinary course of
     business or any taxes or tax savings as a result thereof.

            "Consolidated Net Tangible Assets": means the total amount of assets
     (less applicable reserves and other properly deductible items) after
     deducting therefrom (i) all current liabilities as disclosed on the
     consolidated balance sheet of the Company (excluding any thereof which are
     by their terms extendable or renewable at the option of the obligor thereon
     to a time more than 12 months after the time as of which the amount thereof
     is being computed and excluding any deferred income taxes that are included
     in current liabilities), and (ii) all goodwill, trade names, trademarks,
     patents, unamortized debt discount and expense and other like intangible
     assets, all as set forth on the most recent consolidated balance sheet of
     the Company and computed in accordance with GAAP.
<PAGE>
 
                                                                               5

            "Consolidated Net Worth": as of the date of determination, all items
     which in conformity with GAAP would be included under shareholders' equity
     on a consolidated balance sheet of the Company and its Subsidiaries at such
     date.

            "Consolidated Total Capitalization":  for any period for which the
     amount thereof is to be determined, the sum of Consolidated Net Worth at
     such date and Consolidated Total Debt at such date.

            "Consolidated Total Debt":  the aggregate of all Indebtedness
     (including the current portion thereof) of the Company and its Subsidiaries
     on a consolidated basis.

            "Continuing Director":  any member of the Board of Directors of the
     Company who is a member of such Board on the date of this Agreement, and
     any Person who is a member of such Board and whose nomination as a director
     was approved by a majority of the Continuing Directors then on such Board.

            "Contractual Obligation":  as to any Person, any provision of any
     security issued by such Person or of any agreement, instrument or
     undertaking to which such Person is a party or by which it or any of its
     property is bound.

            "Control Group Person":  any Person which is a member of the
     controlled group or is under common control with the Company within the
     meaning of Section 414(b) or 414(c) of the Code or Section 4001(b)(1) of
     ERISA.

            "Default": any of the events specified in subsection 6.1, whether or
     not any requirement for the giving of notice, the lapse of time, or both,
     or any other condition, has been satisfied.

            "Distribution": (a) the declaration or payment of any dividend on or
     in respect of any shares of any class of capital stock of the Company other
     than dividends payable solely in shares of common stock of the Company; (b)
     the purchase, redemption or other acquisition of any shares of any class of
     capital stock of the Company directly or indirectly through a Subsidiary or
     otherwise; and (c) any other distribution on or in respect of any shares of
     any class of capital stock of the Company.

            "Dollars" and "$": dollars in lawful currency of the United States
     of America.

            "Domestic Lending Office": the office of each Bank designated as
     such in Schedule I.

            "ERISA":  the Employee Retirement Income Security Act of 1974, as
     amended from time to time.

            "Eurocurrency Reserve Requirements":  for any day as applied to a
     Eurodollar Loan, the aggregate (without duplication) of the rates
     (expressed as a decimal fraction) of reserve requirements in effect on such
     day (including, without limitation, basic,
<PAGE>
 
                                                                               6

     supplemental, marginal and emergency reserves under any regulations of the
     Board of Governors of the Federal Reserve System or other Governmental
     Authority having jurisdiction with respect thereto), dealing with reserve
     requirements prescribed for eurocurrency funding (currently referred to as
     "Eurocurrency Liabilities" in Regulation D of such Board) maintained by a
     member bank of such System.

            "Eurodollar Lending Office":  the office of each Bank designated as
     such in Schedule I.

            "Eurodollar Loans":  Loans hereunder at such time as they are made
     and/or are being maintained at a rate of interest based upon the Eurodollar
     Rate.

            "Eurodollar Rate":  with respect to each day during each Interest
     Period pertaining to a Eurodollar Loan, the rate per annum equal to the
     average (rounded upwards to the nearest whole multiple of one sixteenth of
     one percent) of the respective rates notified to the Agent by the Reference
     Banks as the rate at which each of their Eurodollar Lending Offices is
     offered Dollar deposits two Business Days prior to the beginning of such
     Interest Period in the interbank eurodollar market where the eurodollar and
     foreign currency and exchange operations of such Eurodollar Lending Office
     are then being conducted at or about 10:00 A.M., New York City time, for
     delivery on the first day of such Interest Period for the number of days
     comprised therein and in an amount comparable to the amount of the
     Eurodollar Loan of such Reference Bank to be outstanding during such
     Interest Period.
 
            "Eurodollar Tranche":  the collective reference to Eurodollar Loans
     having the same Interest Period (whether or not originally made on the same
     day).

            "Event of Default":  any of the events specified in subsection 6.1,
     provided that any requirement for the giving of notice, the lapse of time,
     or both, or any other condition, event or act has been satisfied.

            "February 1997 Five-Year Agreement and Amendment": the Agreement and
     Amendment, dated as of February 26, 1997 (as amended, modified or
     supplemented), among the Company, the Co-Agents (as defined therein),
     Chase, as Agent and as CAF Loan Agent (as defined therein), and the several
     banks and other financial institutions parties thereto, which adopts and
     incorporates by reference to the extent provided therein the Five-Year
     Composite Credit Agreement dated as of February 28, 1996.

            "Financing Lease":  any lease of property, real or personal, if the
     then present value of the minimum rental commitment thereunder should, in
     accordance with GAAP, be capitalized on a balance sheet of the lessee.

            "GAAP":  (a) with respect to determining compliance by the Company
     with the provisions of subsections 5.6, 5.7 and 5.10, generally accepted
     accounting principles in the United States of America consistent with those
     utilized in preparing the audited financial statements referred to in
     subsection 3.3 and (b) with respect to the financial
<PAGE>
 
                                                                               7

     statements referred to in subsection 3.3 or the furnishing of financial
     statements pursuant to subsection 5.5 and otherwise, generally accepted
     accounting principles in the United States of America from time to time in
     effect.

            "Governmental Authority":  any nation or government, any state or
     other political subdivision thereof and any entity exercising executive,
     legislative, judicial, regulatory or administrative functions of or
     pertaining to government.

            "Guarantee Obligation": any arrangement whereby credit is extended
     to one party on the basis of any promise of another, whether that promise
     is expressed in terms of an obligation to pay the Indebtedness of another,
     or to purchase an obligation owed by that other, to purchase assets or to
     provide funds in the form of lease or other types of payments under
     circumstances that would enable that other to discharge one or more of its
     obligations, whether or not such arrangement is listed in the balance sheet
     of the obligor or referred to in a footnote thereto, but shall not include
     endorsements of items for collection in the ordinary course of business.

            "Indebtedness":  of a Person, at a particular date, the sum (without
     duplication) at such date of (a) all indebtedness of such Person for
     borrowed money or for the deferred purchase price of property or services
     or which is evidenced by a note, bond, debenture or similar instrument, (b)
     all obligations of such Person under Financing Leases, (c) all obligations
     of such Person in respect of letters of credit, acceptances, or similar
     obligations issued or created for the account of such Person in excess of
     $1,000,000, (d) all liabilities secured by any Lien on any property owned
     by the Company or any Subsidiary even though such Person has not assumed or
     otherwise become liable for the payment thereof and (e) all Guarantee
     Obligations relating to any of the foregoing in excess of $1,000,000.

            "Insolvency" or "Insolvent": at any particular time, a Multiemployer
     Plan which is insolvent within the meaning of Section 4245 of ERISA.

            "Interest Payment Date": (a) as to any Alternate Base Rate Loan, the
     last day of each March, June, September and December, commencing on the
     first of such days to occur after Alternate Base Rate Loans are made or
     Eurodollar Loans are converted to Alternate Base Rate Loans, (b) as to any
     Eurodollar Loan in respect of which the Company has selected an Interest
     Period of one, two or three months, the last day of such Interest Period
     and (c) as to any Eurodollar Loan in respect of which the Company has
     selected a longer Interest Period than the periods described in clause (b),
     the last day of each March, June, September and December falling within
     such Interest Period and the last day of such Interest Period.

            "Interest Period":  with respect to any Eurodollar Loans:

                 (i)     initially, the period commencing on the borrowing or
            conversion date, as the case may be, with respect to such Eurodollar
            Loans and ending one, two, three or six months thereafter (or, with
            the consent of all the Banks, nine or
<PAGE>
 
                                                                               8

            twelve months thereafter), as selected by the Company in its notice
            of borrowing as provided in subsection 2.1(c) or its notice of
            conversion as provided in subsection 2.5(a), as the case may be; and

                 (ii)    thereafter, each period commencing on the last day of
            the next preceding Interest Period applicable to such Eurodollar
            Loans and ending one, two, three or six months thereafter (or, with
            the consent of all the Banks, nine or twelve months thereafter), as
            selected by the Company by irrevocable notice to the Agent not less
            than three Business Days prior to the last day of the then current
            Interest Period with respect to such Eurodollar Loans;

     provided that, all of the foregoing provisions relating to Interest Periods
     are subject to the following:

                 (1)     if any Interest Period pertaining to a Eurodollar Loan
            would otherwise end on a day which is not a Business Day, such
            Interest Period shall be extended to the next succeeding Business
            Day unless the result of such extension would be to carry such
            Interest Period into another calendar month in which event such
            Interest Period shall end on the immediately preceding Business Day;

                 (2)     if the Company shall fail to give notice as provided
            above, the Company shall be deemed to have selected an Alternate
            Base Rate Loan to replace the affected Eurodollar Loan;

                 (3)     any Interest Period pertaining to a Eurodollar Loan
            that begins on the last Business Day of a calendar month (or on a
            day for which there is no numerically corresponding day in the
            calendar month at the end of such Interest Period) shall end on the
            last Business Day of a calendar month;

                 (4)     any Interest Period pertaining to a Eurodollar Loan
            that would otherwise end after the Termination Date shall end on the
            Termination Date; and

                 (5)     the Company shall select Interest Periods so as not to
            require a payment or prepayment of any Eurodollar Loan during an
            Interest Period for such Loan.

            "June 1997 364-Day Agreement and Amendment":  the $3,000,000,000
     Agreement and Amendment, dated as of June 17, 1997, among the Company, the
     several banks and other financial institutions from time to time parties
     thereto, the co-agents and lead managers named therein and The Chase
     Manhattan Bank, as Agent and as CAF Loan Agent therein, as the same has
     been and may be amended, supplemented or otherwise modified or replaced or
     extended from time to time.

            "Level I Period":  any period during which the lower of the publicly
     announced ratings by S&P and Moody's of the then current senior unsecured,
     non-credit enhanced,
<PAGE>
 
                                                                               9

     long-term Indebtedness of the Company that has been publicly issued are BBB
     - or better or Baa3 or better, respectively.

            "Level II Period": any period during which the lower of the publicly
     announced ratings by S&P and Moody's of the then current senior unsecured,
     non-credit enhanced, long-term Indebtedness of the Company that has been
     publicly issued are BB+ or Ba1, respectively.

            "Level III Period": any period during which the lower of the
     publicly announced ratings by S&P and Moody's of the then current senior
     unsecured, non-credit enhanced, long-term Indebtedness of the Company that
     has been publicly issued are BB or Ba2, respectively.

            "Level IV Period":  any period during which either of the publicly
     announced ratings by S&P or Moody's of the then current senior unsecured,
     non-credit enhanced, long-term Indebtedness of the Company that has been
     publicly issued is equal to or below BB- or unrated or equal to or below
     Ba3 or unrated, as the case may be.

            "Lien":  any mortgage, pledge, hypothecation, assignment, deposit
     arrangement, encumbrance, lien (statutory or other), or preference,
     priority or other security agreement or preferential arrangement of any
     kind or nature whatsoever (including, without limitation, any conditional
     sale or other title retention agreement, any financing lease having
     substantially the same economic effect as any of the foregoing).

            "Loan":  as defined in subsection 2.1(a).

            "Loan Documents":  this Agreement and the Notes.

            "Moody's": Moody's Investors Service, Inc., or any successor
     thereto.

            "Multiemployer Plan": a Plan which is a multiemployer plan as
     defined in Section 4001(a)(3) of ERISA.

            "Net Cash Proceeds":  means, with respect to any sale or disposition
     by the Company of assets, cash payments received by the Company or any of
     its Subsidiaries from such sale or disposition net of bona fide direct
     costs of sale including, without limitation, (i) income taxes reasonably
     estimated to be actually payable as a result of such sale or disposition
     within one year of the date of receipt of such cash payments, (ii)
     transfer, sales, use and other taxes payable in connection with such sale
     or disposition, (iii) payment of the outstanding principal amount of,
     premium or penalty, if any, and interest on any Indebtedness (other than on
     the revolving credit loans under the June 1997 364-Day Amendment and
     Agreement) that is secured by a Lien on the stock or assets in question and
     that is required to be repaid under the terms thereof as a result of such
     sale or disposition, and (iv) broker's commissions and reasonable fees and
     expenses of counsel, accountants and other professional advisors in
     connection with such sale or disposition.
<PAGE>
 
                                                                              10

            "Notes":  as defined in subsection 2.1(b).

            "Participants":  as defined in subsection 8.6(b).

            "PBGC": the Pension Benefit Guaranty Corporation established
     pursuant to Subtitle A of Title IV of ERISA.

            "Person":  an individual, partnership, corporation, business trust,
     joint stock company, trust, unincorporated association, joint venture,
     Governmental Authority or other entity of whatever nature.

            "Plan":  at a particular time, any employee benefit plan which is
     covered by ERISA and in respect of which the Company or a Control Group
     Person is (or, if such plan were terminated at such time, would under
     Section 4069 of ERISA be deemed to be) an "employer" as defined in Section
     3(5) of ERISA.

            "Principal Property":  means each acute care hospital providing
     general medical and surgical services (including real property but
     excluding equipment, personal property and hospitals which primarily
     provide specialty medical services, such as psychiatric and obstetrical and
     gynecological services) at least 50% of which is owned by the Company and
     its Subsidiaries on a consolidated basis and located in the United States
     of America.

            "Purchasing Banks":  as defined in subsection 8.6(c).

            "Reference Banks":  Chase and Citibank, N.A.

            "Register":  as defined in subsection 8.6(d).

            "Regulation U": Regulation U of the Board of Governors of the
     Federal Reserve System.

            "Regulation X": Regulation X of the Board of Governors of the
     Federal Reserve System.

            "Reorganization":  with respect to any Multiemployer Plan, the
     condition that such plan is in reorganization within the meaning of such
     term as used in Section 4241 of ERISA.

            "Reportable Event": any of the events set forth in Section 4043(b)
     of ERISA, other than those events as to which the thirty day notice period
     is waived under subsections .13,.14,.16,.18,.19 or .20 of PBGC Reg. (S)
     2615.

            "Required Banks":  (i) during the Commitment Period, Banks whose
     Commitment Percentages aggregate at least 51% and (ii) after the
     Commitments have expired or been terminated, Banks whose outstanding Loans
     represent in the aggregate 51% of all outstanding Loans.
<PAGE>
 
                                                                              11

            "Requirement of Law": as to any Person, the Certificate of
     Incorporation and By-Laws or other organizational or governing documents of
     such Person, and any law, treaty, rule or regulation or determination of an
     arbitrator or a court or other Governmental Authority, in each case
     applicable to or binding upon such Person or any of its property or to
     which such Person or any of its property is subject.

            "Responsible Officer":  the chief executive officer, the president,
     any executive or senior vice president or vice president of the Company,
     the chief financial officer, treasurer or controller of the Company.

            "S&P":  Standard & Poor's Ratings Service, or any successor thereto.

            "Sale-and-Leaseback Transaction": means any arrangement entered into
     by the Company or any Significant Subsidiary with any person (other than
     the Company or a Significant Subsidiary), or to which any such person is a
     party, providing for the leasing to the Company or any Significant
     Subsidiary for a period of more than three years of any Principal Property
     which has been or is to be held or transferred by the Company or such
     Significant Subsidiary to such Person or to any other Person (other than
     the Company or a Significant Subsidiary), to which funds have been or are
     to be advanced by such Person on the security of the leased property.

            "Significant Subsidiary":  means, at any particular time, any
     Subsidiary of the Company having total assets of $15,000,000 or more at
     that time.

            "Single Employer Plan":  any Plan which is covered by Title IV of
     ERISA, but which is not a Multiemployer Plan.

            "Subsidiary":  as to any Person, a corporation, partnership or other
     entity of which shares of stock or other ownership interests having
     ordinary voting power (other than stock or such other ownership interests
     having such power only by reason of the happening of a contingency) to
     elect a majority of the board of directors or other managers of such
     corporation, partnership or other entity are at the time owned, or the
     management of which is otherwise controlled, directly or indirectly through
     one or more intermediaries, or both, by such Person.  Unless otherwise
     qualified, all references to a "Subsidiary" or to "Subsidiaries" in this
     Agreement shall refer to a Subsidiary or Subsidiaries of the Company.

            "Taxes":  as defined in subsection 2.13.

            "Termination Date":  February 25, 2002.

            "Transfer Effective Date":  as defined in each Commitment Transfer
     Supplement.

            "Transferee":  as defined in subsection 8.6(f).
<PAGE>
 
                                                                              12

            "Type": as to any Loan, its nature as an Alternate Base Rate Loan or
     Eurodollar Loan.

            "Voting Stock": of any corporation, shares of capital stock or other
     securities of such corporation entitled to vote generally in the election
     of directors of such corporation.

            "Working Day":  any Business Day on which dealings in foreign
     currencies and exchange between banks may be carried on in London, England.

            1.2  Other Definitional Provisions.  (a)  Unless otherwise specified
therein, all terms defined in this Agreement shall have the defined meanings
when used in the Notes or any certificate or other document made or delivered
pursuant hereto.

            (b)  As used herein and in the other Loan Documents, and any
certificate or other document made or delivered pursuant hereto or thereto,
accounting terms relating to the Company and its Subsidiaries not defined in
subsection 1.1 and accounting terms partly defined in subsection 1.1, to the
extent not defined, shall have the respective meanings given to them under GAAP.

            (c)  The words "hereof", "herein" and "hereunder" and words of
similar import when used in this Agreement shall refer to this Agreement as a
whole and not to any particular provision of this Agreement, and Section,
subsection, Schedule and Exhibit references are to this Agreement unless
otherwise specified.

            (d)  The meanings given to terms defined herein shall be equally
applicable to both the singular and plural forms of such terms.


            SECTION 2.  AMOUNT AND TERMS OF LOANS

            2.1  Loans and Notes.  (a)  Subject to the terms and conditions
hereof, each Bank severally agrees to make loans ("Loans") to the Company on the
Closing Date in an aggregate principal amount not to exceed the Commitment of
such Bank.  The Loans may be (i) Eurodollar Loans, (ii) Alternate Base Rate
Loans or (iii) a combination thereof, as determined by the Company and notified
to the Agent in accordance with subsection 2.1(c).

            (b)  Upon the request by any Bank, the Loan made by such Bank shall
be evidenced by a promissory note of the Company, substantially in the form of
Exhibit A with appropriate insertions as to payee, date and principal amount (a
"Note"), payable to the order of such Bank and evidencing the obligation of the
Company to pay a principal amount equal to the amount of the initial Commitment
of such Bank or, if a lesser amount, the aggregate unpaid principal amount of
all Loans made by such Bank. Each Bank is hereby authorized to record the date,
Type and amount of each Loan made or converted by such Bank, and the date and
amount of each payment or prepayment of principal thereof, and, in the case of
Eurodollar Loans, the Interest Period with respect thereto, on the schedule
annexed to and constituting a part of such Note, and any such recordation shall
constitute prima facie evidence of the accuracy of the
<PAGE>
 
                                                                              13

information so recorded; provided, however, that the failure to make any such
recordation shall not affect the obligations of the Company hereunder or under
any Note.  Each such Note shall (x) be dated the Closing Date, (y) be stated to
mature on the Termination Date, and (z) bear interest on the unpaid principal
amount thereof from time to time outstanding at the applicable interest rate per
annum determined as provided in subsection 2.6.

            (c)  The Company may borrow under the Commitments on the Closing
Date; provided that the Company shall give the Agent irrevocable notice (which
notice must be received by the Agent (i) prior to 11:30 A.M., New York City time
three Business Days prior to the Closing Date, in the case of Eurodollar Loans,
and (ii) prior to 10:00 A.M., New York City time, on the Closing Date, in the
case of Alternate Base Rate Loans), specifying (A) the amount to be borrowed,
(B) whether the borrowing is to be of Eurodollar Loans, Alternate Base Rate
Loans, or a combination thereof, and (C) if the borrowing is to be entirely or
partly of Eurodollar Loans, the length of the Interest Period therefor. Upon
receipt of such notice from the Company, the Agent shall promptly notify each
Bank thereof. Each Bank will make the amount of its pro rata share of each
borrowing available to the Agent for the account of the Company at the office of
the Agent set forth in subsection 8.2 prior to 12:00 P.M., New York City time,
on the Closing Date in funds immediately available to the Agent. The proceeds of
all such Loans will then be made available to the Company by the Agent at such
office of the Agent by crediting the account of the Company on the books of such
office with the aggregate of the amounts made available to the Agent by the
Banks.

            2.2  Fees.  The Company agrees to pay to the Agent the other fees in
the amounts, and on the date, agreed to by the Company and the Agent in the fee
letter, dated June 4, 1998, between the Agent and the Company.

            2.3  Termination or Reduction of Commitments. The Company shall have
the right, upon not less than five Business Days' notice to the Agent, to
terminate the Commitments or, from time to time, to reduce ratably the amount of
the Commitments, provided that no such termination or reduction shall be
permitted if, after giving effect thereto and to any prepayments of the Loans
made on the effective date thereof, the then outstanding principal amount of the
Loans would exceed the amount of the Commitments then in effect. Any such
reduction shall be in an amount of $10,000,000 or a whole multiple of $1,000,000
in excess thereof, and shall reduce permanently the amount of the Commitments
then in effect.

            2.4  Optional Prepayments. The Company may on the last day of the
relevant Interest Period if the Loans to be prepaid are in whole or in part
Eurodollar Loans, or at any time and from time to time if the Loans to be
prepaid are Alternate Base Rate Loans, prepay the Loans, in whole or in part,
without premium or penalty, upon at least three Business Days' irrevocable
notice to the Agent, specifying the date and amount of prepayment and whether
the prepayment is of Eurodollar Loans or Alternate Base Rate Loans or a
combination thereof, and if of a combination thereof, the amount of prepayment
allocable to each. Upon receipt of such notice the Agent shall promptly notify
each Bank thereof. If such notice is given, the payment amount specified in such
notice shall be due and payable on the date specified therein, together with
accrued interest to such date on the amount prepaid. Partial prepayments shall
be in an aggregate principal amount of $5,000,000, or a whole multiple of
$1,000,000 in excess thereof,
<PAGE>
 
                                                                              14

and may only be made if, after giving effect thereto, subsection 2.5(c) shall
not have been contravened.  Partial prepayments under this subsection 2.4 shall
be applied ratably to scheduled installments of the Loans pursuant to subsection
2.6(e).

            2.5  Conversion Options; Minimum Amount of Loans.  (a)  The Company
may elect from time to time to convert Eurodollar Loans to Alternate Base Rate
Loans by giving the Agent at least two Business Days' prior irrevocable notice
of such election (given before 10:00 A.M., New York City time, on the date on
which such notice is required), provided that any such conversion of Eurodollar
Loans shall, subject to the fourth following sentence, only be made on the last
day of an Interest Period with respect thereto.  The Company may elect from time
to time to convert Alternate Base Rate Loans to Eurodollar Loans by giving the
Agent at least three Business Days' prior irrevocable notice of such election
(given before 11:30 A.M., New York City time, on the date on which such notice
is required).  Upon receipt of such notice, the Agent shall promptly notify each
Bank thereof.  Promptly following the date on which such conversion is being
made each Bank shall take such action as is necessary to transfer its portion of
such Loans to its Domestic Lending Office or its Eurodollar Lending Office, as
the case may be.  All or any part of outstanding Eurodollar Loans and Alternate
Base Rate Loans may be converted as provided herein, provided that, unless the
Required Banks otherwise agree, (i) no Loan may be converted into a Eurodollar
Loan when any Event of Default has occurred and is continuing, (ii) partial
conversions shall be in an aggregate principal amount of $5,000,000 or a whole
multiple thereof, and (iii) any such conversion may only be made if, after
giving effect thereto, subsection 2.5(c) shall not have been contravened.

            (b)  Any Eurodollar Loans may be continued as such upon the
expiration of an Interest Period with respect thereto by compliance by the
Company with the notice provisions contained in subsection 2.5(a); provided
that, unless the Required Banks otherwise agree, no Eurodollar Loan may be
continued as such when any Event of Default has occurred and is continuing, but
shall be automatically converted to an Alternate Base Rate Loan on the last day
of the then current Interest Period with respect thereto. The Agent shall notify
the Banks promptly that such automatic conversion contemplated by this
subsection 2.5(b) will occur.

            (c)  All borrowings, conversions, payments, prepayments and
selection of Interest Periods hereunder shall be in such amounts and be made
pursuant to such elections so that, after giving effect thereto, the aggregate
principal amount of the Loans comprising any Eurodollar Tranche shall not be
less than $10,000,000. At no time shall there be more than 10 Eurodollar
Tranches.

            2.6  Interest Rate and Payment Dates for Loans.  (a)  The Eurodollar
Loans comprising each Eurodollar Tranche shall bear interest for each day during
each Interest Period with respect thereto on the unpaid principal amount thereof
at a rate per annum equal to the Eurodollar Rate plus the Applicable Margin.

            (b)  Alternate Base Rate Loans shall bear interest for each day from
and including the date thereof on the unpaid principal amount thereof at a rate
per annum equal to the Alternate Base Rate plus the Applicable Margin.
<PAGE>
 
                                                                              15

            (c)  If all or a portion of the principal amount of any Loans shall
not be paid when due (whether at the stated maturity, by acceleration or
otherwise), each Eurodollar Loan shall, unless the Required Banks otherwise
agree, be converted to an Alternate Base Rate Loan at the end of the last
Interest Period with respect thereto.  Any such overdue principal amount shall
bear interest at a rate per annum which is 2% above the rate which would
otherwise be applicable pursuant to subsection 2.6(a) or (b), and any overdue
interest or other amount payable hereunder shall bear interest at a rate per
annum which is 2% above the Alternate Base Rate, in each case from the date of
such non-payment until paid in full (after as well as before judgment).

            (d)  Interest shall be payable in arrears on each Interest Payment
Date.

            (e)  The Company shall make principal payments on the Loans in
installments on the dates and in the amounts set forth below:

            Installment Date          Principal Amount
            ----------------          ----------------

            August 1, 1999            $100,000,000
            February 1, 2000          $100,000,000
            August 1, 2000            $150,000,000
            February 1, 2001          $150,000,000
            August 1, 2001            $250,000,000
            February 25, 2002         $250,000,000

            2.7  Computation of Interest and Fees.  (a)  Interest in respect of
Alternate Base Rate Loans shall be calculated on the basis of a (i) 365-day (or
366-day, as the case may be) year for the actual days elapsed when such
Alternate Base Rate Loans are based on the Prime Rate, and (ii) a 360-day year
for the actual days elapsed when based on the Base CD Rate or the Federal Funds
Effective Rate.  Interest in respect of Eurodollar Loans shall be calculated on
the basis of a 360-day year for the actual days elapsed.  The Agent shall as
soon as practicable notify the Company and the Banks of each determination of a
Eurodollar Rate.  Any change in the interest rate on a Loan resulting from a
change in the Alternate Base Rate or the Applicable Margin or the Eurocurrency
Reserve Requirements shall become effective as of the opening of business on the
day on which such change in the Alternate Base Rate is announced, such
Applicable Margin changes as provided herein or such change in or the
Eurocurrency Reserve Requirements shall become effective, as the case may be.
The Agent shall as soon as practicable notify the Company and the Banks of the
effective date and the amount of each such change.

            (b)  Each determination of an interest rate by the Agent pursuant to
any provision of this Agreement shall be conclusive and binding on the Company
and the Banks in the absence of manifest error.  The Agent shall, at the request
of the Company, deliver to the Company a statement showing the quotations used
by the Agent in determining any interest rate pursuant to subsection 2.6(a) or
(c).

            (c)  If any Reference Bank's Commitment shall terminate (otherwise
than on termination of all the commitments), or its Loan shall be assigned for
any reason whatsoever, such Reference Bank shall thereupon cease to be a
Reference Bank, and if, as a result of the
<PAGE>
 
                                                                              16

foregoing, there shall only be one Reference Bank remaining, then the Agent
(after consultation with the Company and the Banks) shall, by notice to the
Company and the Banks, designate another Bank as a Reference Bank so that there
shall at all times be at least two Reference Banks.

            (d)  Each Reference Bank shall use its best efforts to furnished
quotations of rates to the Agent as contemplated hereby.  If any of the
Reference Banks shall be unable or otherwise fails to supply such rates to the
Agent upon its request, the rate of interest shall be determined on the basis of
the quotations of the remaining Reference Banks or Reference Bank.

            2.8  Inability to Determine Interest Rate.  In the event that:

                 (i)     the Agent shall have determined (which determination
     shall be conclusive and binding upon the Company) that, by reason of
     circumstances affecting the interbank eurodollar market generally, adequate
     and reasonable means do not exist for ascertaining the Eurodollar Rate for
     any requested Interest Period;

                 (ii)    only one of the Reference Banks is able to obtain bids
     for its Dollar deposits for such Interest Period in the manner contemplated
     by the term "Eurodollar Rate"; or

                 (iii)   the Agent shall have received notice prior to the first
     day of such Interest Period from Banks constituting the Required Banks that
     the interest rate determined pursuant to subsection 2.6(a) for such
     Interest Period does not accurately reflect the cost to such Banks (as
     conclusively certified by such Banks) of making or maintaining their
     affected Loans during such Interest Period;

with respect to (A) proposed Loans that the Company has requested be made as
Eurodollar Loans, (B) Eurodollar Loans that will result from the requested
conversion of Alternate Base Rate Loans into Eurodollar Loans or (C) the
continuation of Eurodollar Loans beyond the expiration of the then current
Interest Period with respect thereto, the Agent shall forthwith give facsimile
or telephonic notice of such determination to the Company and the Banks at least
one day prior to, as the case may be, the requested Borrowing Date for such
Eurodollar Loans, the conversion date of such Loans or the last day of such
Interest Period.  If such notice is given (x) any requested Eurodollar Loans
shall be made as Alternate Base Rate Loans, (y) any Alternate Base Rate Loans
that were to have been converted to Eurodollar Loans shall be continued as
Alternate Base Rate Loans and (z) any outstanding Eurodollar Loans shall be
converted, on the last day of the then current Interest Period with respect
thereto, to Alternate Base Rate Loans.  Until such notice has been withdrawn by
the Agent, no further Eurodollar Loans shall be made, nor shall the Company have
the right to convert Alternate Base Rate Loans to Eurodollar Loans.

            2.9  Pro Rata Borrowings and Payments. (a) Borrowing by the Company
of Loans shall be made ratably from the Banks in accordance with their
Commitment Percentages.
<PAGE>
 
                                                                              17

            (b)  All payments (including prepayments) to be made by the Company
on account of principal, interest and fees shall be made without set-off or
counterclaim and shall be made to the Agent, for the account of the Banks, at
the Agent's office set forth in subsection 8.2, in lawful money of the United
States of America and in immediately available funds. The Agent shall distribute
such payments to the Banks promptly upon receipt in like funds as received. If
any payment hereunder (other than payments on the Eurodollar Loans) becomes due
and payable on a day other than a Business Day, such payment shall be extended
to the next succeeding Business Day, and, with respect to payments of principal,
interest thereon shall be payable at the then applicable rate during such
extension. If any payment on a Eurodollar Loan becomes due and payable on a day
other than a Business Day, the maturity thereof shall be extended to the next
succeeding Business Day unless the result of such extension would be to extend
such payment into another calendar month in which event such payment shall be
made on the immediately preceding Business Day.

            2.10  Illegality.  Notwithstanding any other provisions herein, if
after the date hereof the adoption of or any change in any Requirement of Law or
in the interpretation or application thereof shall make it unlawful for any Bank
to make or maintain Eurodollar Loans as contemplated by this Agreement, (a) the
Bank shall, within 30 Business Days after it becomes aware of such fact, notify
the Company, through the Agent, of such fact, (b) the commitment of such Bank
hereunder to make Eurodollar Loans or convert Alternate Base Rate Loans to
Eurodollar Loans shall forthwith be cancelled and (c) such Bank's Loans then
outstanding as Eurodollar Loans, if any, shall be converted automatically to
Alternate Base Rate Loans on the respective last days of the then current
Interest Periods for such Loans or within such earlier period as required by
law.  Each Bank shall take such action as may be reasonably available to it
without legal or financial disadvantage (including changing its Eurodollar
Lending Office) to prevent the adoption of or any change in any such Requirement
of Law from becoming applicable to it.

            2.11  Requirements of Law.  (a)  If after the date hereof the
adoption of or any change in any Requirement of Law or in the interpretation or
application thereof or compliance by any Bank with any request or directive
(whether or not having the force of law) after the date hereof from any central
bank or other Governmental Authority:

                 (i)     shall subject any Bank to any tax of any kind
     whatsoever with respect to this Agreement, any Note or any Eurodollar Loans
     made by it, or change the basis of taxation of payments to such Bank of
     principal, facility fee, interest or any other amount payable hereunder in
     respect of Loans (except for changes in the rate of tax on the overall net
     income of such Bank);

                 (ii)    shall impose, modify or hold applicable any reserve,
     special deposit, compulsory loan or similar requirement against assets held
     by, or deposits or other liabilities in or for the account of, advances or
     loans by, or other credit extended by, or any other acquisition of funds
     by, any office of such Bank which are not otherwise included in the
     determination of the Eurodollar Rate hereunder; or

                 (iii)   shall impose on such Bank any other condition;
<PAGE>
 
                                                                              18

and the result of any of the foregoing is to increase the cost to such Bank, by
any amount which such Bank deems to be material, of making, renewing or
maintaining advances or extensions of credit or to reduce any amount receivable
hereunder, in each case, in respect of its Eurodollar Loans, then, in any such
case, the Company shall promptly pay such Bank, upon its demand, any additional
amounts necessary to compensate such Bank for such additional cost or reduced
amount receivable.  If a Bank becomes entitled to claim any additional amounts
pursuant to this subsection 2.11(a), it shall, within 30 Business Days after it
becomes aware of such fact, notify the Company, through the Agent, of the event
by reason of which it has become so entitled.  A certificate as to any
additional amounts payable pursuant to the foregoing sentence submitted by such
Bank, through the Agent, to the Company shall be conclusive in the absence of
manifest error.  Each Bank shall take such action as may be reasonably available
to it without legal or financial disadvantage (including changing its Eurodollar
Lending Office) to prevent any such Requirement of Law or change from becoming
applicable to it.  This covenant shall survive the termination of this Agreement
and payment of the outstanding Indebtedness hereunder or pursuant to the Notes.

            (b)  In the event that after the date hereof a Bank is required to
maintain reserves of the type contemplated by the definition of "Eurocurrency
Reserve Requirements", such Bank may require the Company to pay, promptly after
receiving notice of the amount due, additional interest on the related
Eurodollar Loan of such Bank at a rate per annum determined by such Bank up to
but not exceeding the excess of (i) (A) the applicable Eurodollar Rate divided
by (B) one minus the Eurocurrency Reserve Requirements over (ii) the applicable
Eurodollar Rate.  Any Bank wishing to require payment of any such additional
interest on account of any of its Eurodollar Loans shall notify the Company no
more than 30 Business Days after each date on which interest is payable on such
Eurodollar Loan of the amount then due it under this subsection 2.11(b), in
which case such additional interest on such Eurodollar Loan shall be payable to
such Bank at the place indicated in such notice.  Each such notification shall
be accompanied by such information as the Company may reasonably request.

            2.12  Capital Adequacy.  If any Bank shall have determined that
after the date hereof the adoption of or any change in any Requirement of Law
regarding capital adequacy or in the interpretation or application thereof or
compliance by such Bank or any corporation controlling such Bank with any
request or directive after the date hereof regarding capital adequacy (whether
or not having the force of law) from any central bank or Governmental Authority,
does or shall have the effect of reducing the rate of return on such Bank's or
such corporation's capital as a consequence of its obligations hereunder to a
level below that which such Bank or such corporation could have achieved but for
such adoption, change or compliance (taking into consideration such Bank's or
such corporation's policies with respect to capital adequacy) by an amount which
is reasonably deemed by such Bank to be material, then from time to time,
promptly after submission by such Bank, through the Agent, to the Company of a
written request therefor (such request shall include details reasonably
sufficient to establish the basis for such additional amounts payable and shall
be submitted to the Company within 30 Business Days after it becomes aware of
such fact), the Company shall promptly pay to such Bank such additional amount
or amounts as will compensate such Bank for such reduction. The agreements in
this subsection 2.12 shall survive the termination of this Agreement and payment
of the Loans and the Notes and all other amounts payable hereunder.
<PAGE>
 
                                                                              19

            2.13  Taxes.  (a)  All payments made by the Company under this
Agreement shall be made free and clear of, and without reduction or withholding
for or on account of, any present or future income, stamp or other taxes,
levies, imposts, duties, charges, fees, deductions or withholdings, now or
hereafter imposed, levied, collected, withheld or assessed by any Governmental
Authority excluding, in the case of the Agent and each Bank, net income and
franchise taxes imposed on the Agent or such Bank by the jurisdiction under the
laws of which the Agent or such Bank is organized or any political subdivision
or taxing authority thereof or therein, or by any jurisdiction in which such
Bank's Domestic Lending Office or Eurodollar Lending Office, as the case may be,
is located or any political subdivision or taxing authority thereof or therein
(all such non-excluded taxes, levies, imposts, deductions, charges or
withholdings being hereinafter called "Taxes").  If any Taxes are required to be
withheld from any amounts payable to the Agent or any Bank hereunder or under
the Notes, the amounts so payable to the Agent or such Bank shall be increased
to the extent necessary to yield to the Agent or such Bank (after payment of all
Taxes) interest or any such other amounts payable hereunder at the rates or in
the amounts specified in this Agreement and the Notes.  Whenever any Taxes are
payable by the Company, as promptly as possible thereafter, the Company shall
send to the Agent for its own account or for the account of such Bank, as the
case may be, a certified copy of an original official receipt received by the
Company showing payment thereof.  If the Company fails to pay any Taxes when due
to the appropriate taxing authority or fails to remit to the Agent the required
receipts or other required documentary evidence, the Company shall indemnify the
Agent and the Banks for any incremental taxes, interest or penalties that may
become payable by the Agent or any Bank as a result of any such failure.

            (b)  Each Bank that is not incorporated under the laws of the United
States of America or a state thereof agrees that it will deliver to the Company
and the Agent (i) two duly completed copies of United States Internal Revenue
Service Form 1001 or 4224 or successor applicable form, as the case may be,
certifying in each case that such Bank is entitled to receive payments under
this Agreement and the Notes payable to it, without deduction or withholding of
any United States federal income taxes, and (ii) an Internal Revenue Service
Form W-8 or W-9 or successor applicable form, as the case may be, to establish
an exemption from United States backup withholding tax. Each Bank which delivers
to the Company and the Agent a Form 1001 or 4224 and Form W-8 or W-9 pursuant to
the next preceding sentence further undertakes to deliver to the Company and the
Agent two further copies of the said letter and Form 1001 or 4224 and Form W-8
or W-9, or successor applicable forms, or other manner of certification, as the
case may be, on or before the date that any such letter or form expires or
becomes obsolete or after the occurrence of any event requiring a change in the
most recent letter and form previously delivered by it to the Company, and such
extensions or renewals thereof as may reasonably be requested by the Company,
certifying in the case of a Form 1001 or 4224 that such Bank is entitled to
receive payments under this Agreement without deduction or withholding of any
United States federal income taxes, unless in any such cases an event (including
without limitation any change in treaty, law or regulation) has occurred prior
to the date on which any such delivery would otherwise be required which renders
all such forms inapplicable or which would prevent such Bank from duly
completing and delivering any such letter or form with respect to it and such
Bank advises the Company that it is not capable of receiving payments without
any deduction or withholding of United States federal income tax, and in the
case of a Form W-8 or W-9, establishing an exemption from United States backup
withholding tax.
<PAGE>
 
                                                                              20

            (c)  The agreements in subsection 2.13 shall survive the termination
of this Agreement and the payment of the Notes and all other amounts payable
hereunder.

            2.14 Indemnity.  The Company agrees to indemnify each Bank and to
hold each Bank harmless from any loss or expense (other than any loss of
anticipated margin or profit) which such Bank may sustain or incur as a
consequence of (a) default by the Company in payment when due of the principal
amount of or interest on any Eurodollar Loans of such Bank, (b) default by the
Company in making a borrowing or conversion after the Company has given a notice
of borrowing in accordance with subsection 2.1(c) or a notice of continuation or
conversion pursuant to subsection 2.5, (c) default by the Company in making any
prepayment after the Company has given a notice in accordance with subsection
2.4 or (d) the making of a prepayment of a Eurodollar Loan on a day which is not
the last day of an Interest Period with respect thereto, including, without
limitation, in each case, any such loss or expense arising from the reemployment
of funds obtained by it to maintain its Eurodollar Loans hereunder or from fees
payable to terminate the deposits from which such funds were obtained.  Any Bank
claiming any amount under this subsection 2.14 shall provide calculations, in
reasonable detail, of the amount of its loss or expense.  This covenant shall
survive termination of this Agreement and payment of the outstanding
Indebtedness hereunder or pursuant to the Notes.

            2.15 Application of Proceeds of Loans.  Subject to the provisions of
the following sentence, the Company may use the proceeds of the Loans for any
lawful corporate purpose, including for the repurchase of shares of common stock
of the Company and the repayment of loans under the February 1997 Five-Year
Agreement and Amendment.  The Company will not, directly or indirectly, apply
any part of the proceeds of any such Loan for the purpose of "purchasing" or
"carrying" any "margin stock" within the respective meanings of each of the
quoted terms under Regulation U, or to refund any indebtedness incurred for such
purpose, except in a manner which is not in violation of Regulations U and X.

            2.16 Notice of Certain Circumstances; Assignment of Commitments
Under Certain Circumstances. (a) Any Bank claiming any additional amounts
payable pursuant to subsections 2.11, 2.12 or 2.13 or exercising its rights
under subsection 2.10, shall, in accordance with the respective provisions
thereof, provide notice to the Company and the Agent. Such notice to the Company
and the Agent shall include details reasonably sufficient to establish the basis
for such additional amounts payable or the rights to be exercised by the Bank.

            (b)  Any Bank claiming any additional amounts payable pursuant to
subsections 2.11, 2.12 or 2.13 or exercising its rights under subsection 2.10,
shall use reasonable efforts (consistent with legal and regulatory restrictions)
to file any certificate or document requested by the Company or to change the
jurisdiction of its applicable lending office if the making of such filing or
change would avoid the need for or reduce the amount of any such additional
amounts which may thereafter accrue or avoid the circumstances giving rise to
such exercise and would not, in the sole determination of such Bank, be
otherwise disadvantageous to such Bank.

            (c)  In the event that the Company shall be required to make any
additional payments to any Bank pursuant to subsections 2.11, 2.12 or 2.13 or
any Bank shall exercise its rights under subsection 2.10, the Company shall have
the right at its own expense, upon notice
<PAGE>
 
                                                                              21

to such Bank and the Agent, to require such Bank to transfer and to assign
without recourse (in accordance with and subject to the terms of subsection 8.6)
all its interest, rights and obligations under this Agreement to another
financial institution (including any Bank) acceptable to the Agent (which
approval shall not be unreasonably withheld) which shall assume such
obligations; provided that (i) no such assignment shall conflict with any
Requirement of Law and (ii) such assuming financial institution shall pay to
such Bank in immediately available funds on the date of such assignment the
outstanding principal amount of such Bank's Loans hereunder together with
accrued interest thereon and all other amounts accrued for its account or owed
to it hereunder, including, but not limited to additional amounts payable under
subsections 2.2, 2.10, 2.11, 2.12, 2.13 and 2.14.


            SECTION 3.  REPRESENTATIONS AND WARRANTIES

            The Company hereby represents and warrants that:

            3.1  Corporate Organization and Existence.  Each of the Company and
each Subsidiary is a corporation, partnership or other entity duly organized and
validly existing and in good standing under the laws of the jurisdiction in
which it is organized (except, in the case of Subsidiaries, where the failure to
be in good standing would not be material to the Company and its Subsidiaries on
a consolidated basis) and has all necessary power to carry on the business now
conducted by it.  The Company has all necessary corporate power and has taken
all corporate action required to make all the provisions of this Agreement and
the Notes and all other agreements and instruments executed in connection
herewith and therewith, the valid and enforceable obligations they purport to
be.  Each of the Company and each Subsidiary is duly qualified and in good
standing in all jurisdictions other than that of its organization in which the
physical properties owned, leased or operated by it are located (except, in the
case of Subsidiaries, where the failure to be in good standing would not be
material to the Company and its Subsidiaries on a consolidated basis), and is
duly authorized, qualified and licensed under all laws, regulations, ordinances
or orders of Governmental Authorities, or otherwise, to carry on its business in
the places and in the manner presently conducted.

            3.2  Subsidiaries.  As of the date hereof, the Company has only the
Subsidiaries set forth in Schedule II.  Schedule II indicates all Subsidiaries
of the Company which are not wholly-owned Subsidiaries.  The capital stock and
securities owned by the Company and its Subsidiaries in each of the Company's
Subsidiaries are owned free and clear of any mortgage, pledge, lien,
encumbrance, charge or restriction on the transfer thereof other than
restrictions on transfer imposed by applicable securities laws and restrictions,
liens and encumbrances outstanding on the date hereof and listed in said
Schedule II.

            3.3  Financial Information.  The Company has furnished to the Agent
and each Bank copies of the following:

            (a)  the Annual Report of the Company for the fiscal year ended
     December 31, 1997, containing the consolidated balance sheet of the Company
     and its Subsidiaries as
<PAGE>
 
                                                                              22

     at said date and the related consolidated statements of income, common
     stockholders' equity and changes in financial position for the fiscal year
     then ended, accompanied by the opinion of Ernst-Young LLP;

            (b)  the Annual Report of the Company on Form 10-K for the fiscal
     year ended December 31, 1997;

            (c)  Quarterly Report of the Company on Form 10-Q for the fiscal
     quarter ended March 31, 1998; and

            (d)  Current Reports on Form 8-K filed with the Securities and
     Exchange Commission on February 6, 1998,  February 13, 1998, March 6, 1998
     and May 27, 1998, respectively.

     Such financial statements (including any notes thereto) have been prepared
     in accordance with GAAP and fairly present the financial conditions of the
     corporations covered thereby at the dates thereof and the results of their
     operations for the periods covered thereby, subject to normal year-end
     adjustments in the case of interim statements.  As of the date hereof and
     except as disclosed in the above-referenced reports, neither the Company
     nor any of its Subsidiaries has any known contingent liabilities of any
     significant amount which are not referred to in said financial statements
     or in the notes thereto which could reasonably be expected to have a
     material adverse effect on the business or assets or on the condition,
     financial or otherwise, of the Company and its Subsidiaries, on a
     consolidated basis.

            3.4  Changes in Condition.  Since December 31, 1997 there has been
no material adverse change in the business or assets or in the condition,
financial or otherwise, of the Company and its Subsidiaries, on a consolidated
basis.

            3.5  Assets.  The Company and each Subsidiary have good and
marketable title to all material assets carried on their books and reflected in
the most recent balance sheet referred to in subsection 3.3 or furnished
pursuant to subsection 5.5, except for assets held on Financing Leases or
purchased subject to security devices providing for retention of title in the
vendor, and except for assets disposed of as permitted by this Agreement.

            3.6  Litigation.  Except as disclosed in the Company's Annual Report
on Form 10-K for its fiscal year ended December 31, 1997 and its Quarterly
Report on Form 10-Q for its fiscal quarter ended March 31, 1998, in each case as
filed with the Securities and Exchange Commission and previously distributed to
the Banks, and except as set forth on Schedule V hereto, there is no litigation,
at law or in equity, or any proceeding before any federal, state, provincial or
municipal board or other governmental or administrative agency pending or to the
knowledge of the Company threatened which, after giving effect to any applicable
insurance, may involve any material risk of a material adverse effect on the
business or assets or on the condition, financial or otherwise, of the Company
and its Subsidiaries on a consolidated basis or which seeks to enjoin the
consummation of any of the transactions contemplated by this Agreement or any
other Loan Document and involves any
<PAGE>
 
                                                                              23

material risk that any such injunction will be issued, and no judgment, decree,
or order of any federal, state, provincial or municipal court, board or other
governmental or administrative agency has been issued against the Company or any
Subsidiary which has, or may involve, a material risk of a material adverse
effect on the business or assets or on the condition, financial or otherwise, of
the Company and its Subsidiaries on a consolidated basis.  With respect to the
matters disclosed in the Company's Annual Report on Form 10-K for the fiscal
year ended December 31, 1997 and its Quarterly Report on Form 10-Q for its
fiscal quarter ended March 31, 1998, in each case as filed with the Securities
and Exchange Commission and previously distributed to the Banks, and the matters
set forth on Schedule V hereto, since the date of such disclosures there has
been no development which is material and adverse to the business or assets or
to the condition, financial or otherwise, of the Company and its Subsidiaries on
a consolidated basis.

            3.7  Tax Returns.  The Company and each of its Subsidiaries have
filed all tax returns which are required to be filed and have paid, or made
adequate provision for the payment of, all taxes which have or may become due
pursuant to said returns or to assessments received. The Company knows of no
material additional assessments since said date for which adequate reserves
appearing in the said balance sheet have not been established.

            3.8  Contracts, etc.  Attached hereto as Schedule III is a statement
of outstanding Indebtedness of the Company and its Subsidiaries for borrowed
money as of the date set forth therein and a complete and correct list of all
agreements, contracts, indentures, instruments, documents and amendments thereto
to which the Company or any Subsidiary is a party or by which it is bound
pursuant to which any such Indebtedness of the Company and its Subsidiaries in
excess of $25,000,000 is outstanding on the date hereof.  Said Schedule III also
includes a complete and correct list of all such Indebtedness of the Company and
its Subsidiaries outstanding on the date indicated in respect of Guarantee
Obligations in excess of $1,000,000 and letters of credit in excess of
$1,000,000, and there have been no increases in such Indebtedness since said
date other than as permitted by this Agreement.

            3.9  No Legal Obstacle to Agreement.  Neither the execution and
delivery of this Agreement or of any Notes, nor the making by the Company of any
borrowings hereunder, nor the consummation of any transaction herein or therein
referred to or contemplated hereby or thereby nor the fulfillment of the terms
hereof or thereof or of any agreement or instrument referred to in this
Agreement, has constituted or resulted in or will constitute or result in a
breach of the provisions of any contract to which the Company or any of its
Subsidiaries is a party or by which it is bound or of the charter or by-laws of
the Company, or the violation of any law, judgment, decree or governmental
order, rule or regulation applicable to the Company or any of its Subsidiaries,
or result in the creation under any agreement or instrument of any security
interest, lien, charge or encumbrance upon any of the assets of the Company or
any of its Subsidiaries.  Other than those which have already been obtained, no
approval, authorization or other action by any governmental authority or any
other Person is required to be obtained by the Company or any of its
Subsidiaries in connection with the execution, delivery and performance of this
Agreement or the transactions contemplated hereby, or the making of any
borrowing by the Company hereunder.
<PAGE>
 
                                                                              24

            3.10  Defaults.  Neither the Company nor any Subsidiary is in
default under any provision of its charter or by-laws or, so as to affect
adversely in any material manner the business or assets or the condition,
financial or otherwise, of the Company and its Subsidiaries on a consolidated
basis, under any provision of any agreement, lease or other instrument to which
it is a party or by which it is bound or of any Requirement of Law.

            3.11  Burdensome Obligations.  Neither the Company nor any 
Subsidiary is a party to or bound by any agreement, deed, lease or other
instrument, or subject to any charter, by-law or other corporate restriction
which, in the opinion of the management thereof, is so unusual or burdensome as
to in the foreseeable future have a material adverse effect on the business or
assets or condition, financial or otherwise, of the Company and its Subsidiaries
on a consolidated basis. The Company does not presently anticipate that future
expenditures of the Company and its Subsidiaries needed to meet the provisions
of any federal or state statutes, orders, rules or regulations will be so
burdensome as to have a material adverse effect on the business or assets or
condition, financial or otherwise, of the Company and its Subsidiaries on a
consolidated basis.

            3.12  Pension Plans.  Each Plan maintained by the Company, any
Subsidiary or any Control Group Person or to which any of them makes or will
make contributions is in material compliance with the applicable provisions of
ERISA and the Code.  Neither the Company nor any Subsidiary nor any Control
Group Person maintains, contributes to or participates in any Plan that is a
"defined benefit plan" as defined in ERISA.  Neither the Company, any
Subsidiary, nor any Control Group Person has since June 30, 1993 maintained,
contributed to or participated in any Multiemployer Plan, with respect to which
a complete withdrawal would result in any withdrawal liability.  The Company and
its Subsidiaries have met all of the funding standards applicable to all Plans
that are not Multiemployer Plans, and there exists no event or condition which
would permit the institution of proceedings to terminate any Plan that is not a
Multiemployer Plan.  The current value of the benefits guaranteed under Title IV
of ERISA of each Plan that is not a Multiemployer Plan does not exceed the
current value of such Plan's assets allocable to such benefits.

            3.13  Disclosure.  Neither this Agreement nor any agreement,
document, certificate or statement furnished to the Banks by the Company in
connection herewith contains any untrue statement of material fact or omits to
state a material fact necessary in order to make the statements contained herein
or therein not misleading.

            3.14  Environmental and Public and Employee Health and Safety
Matters. The Company and each Subsidiary has complied with all applicable
Federal, state, and other laws, rules and regulations relating to environmental
pollution or to environmental regulation or control or to public or employee
health or safety, except to the extent that the failure to so comply would not
be reasonably likely to result in a material adverse effect on the business or
assets or on the condition, financial or otherwise, of the Company and its
Subsidiaries on a consolidated basis. The Company's and the Subsidiaries'
facilities do not contain, and have not previously contained, any hazardous
wastes, hazardous substances, hazardous materials, toxic substances or toxic
pollutants regulated under the Resource Conservation and Recovery Act, the
Comprehensive Environmental Response Compensation and Liability Act, the
<PAGE>
 
                                                                              25

Hazardous Materials Transportation Act, the Toxic Substance Control Act, the
Clean Air Act, the Clean Water Act or any other applicable law relating to
environmental pollution or public or employee health and safety, in violation of
any such law, or any rules or regulations promulgated pursuant thereto, except
for violations that would not be reasonably likely to result in a material
adverse effect on the business or assets or on the condition, financial or
otherwise, of the Company and its Subsidiaries on a consolidated basis.  The
Company is aware of no events, conditions or circumstances involving
environmental pollution or contamination or public or employee health or safety,
in each case applicable to it or its Subsidiaries, that would be reasonably
likely to result in a material adverse effect on the business or assets or on
the condition, financial or otherwise, of the Company and its Subsidiaries on a
consolidated basis.

            3.15  Federal Regulations.  No part of the proceeds of any Loans
will be used for "purchasing" or "carrying" any "margin stock" within the
respective meanings of each of the quoted terms under Regulation U as now and
from time to time hereafter in effect (except in a manner which is not in
violation of Regulation U or X) or for any purpose which violates the provisions
of the Regulations of the Board of Governors of the Federal Reserve System. If
requested by any Bank or the Agent, the Company will furnish to the Agent and
each Bank a statement to the foregoing effect in conformity with the
requirements of FR Form U-1 referred to in said Regulation U.

            3.16  Investment Company Act; Other Regulations.  The Company is not
an "investment company", or a company "controlled" by an "investment company",
within the meaning of the Investment Company Act of 1940, as amended.  The
Company is not subject to regulation under any Federal or State statute or
regulation which limits its ability to incur Indebtedness.

            3.17  Year 2000 Matters.  Any reprogramming required to permit the
proper functioning (but only to the extent that such proper functioning would
otherwise be materially impaired by the occurrence of the year 2000) in the year
2000 of computer systems and other equipment containing embedded microchips, in
either case owned or operated by the Company or any of its Subsidiaries or used
or relied upon in the conduct of their business (including any such systems and
other equipment supplied by others or with which the computer systems of the
Company or any of its Subsidiaries interface), and the testing of all material
systems and other equipment as so reprogrammed, will be completed by September
30, 1999.  The costs to the Company and its Subsidiaries that have not been
incurred as of the date hereof for such reprogramming and testing and for the
other reasonably foreseeable consequences to them of any improper functioning of
other computer systems and equipment containing embedded microchips due to the
occurrence of the year 2000 could not reasonably be expected to result in a
Default or Event of Default or to have a material adverse change in the business
or assets or in the condition, financial or otherwise, of the Company and its
Subsidiaries on a consolidated basis.
<PAGE>
 
                                                                              26

            SECTION 4.  CONDITIONS

            The obligations of each Bank to make the Loans contemplated by
subsection 2.1 shall be subject to the compliance by the Company with its
agreements herein contained and to the satisfaction on or before the Closing
Date and each Borrowing Date of such of the following further conditions as are
applicable on the Closing Date or such Borrowing Date, as the case may be:

            4.1  Loan Documents.  The Agent shall have received (i) this
Agreement, executed and delivered by a duly authorized officer of the Company,
with a counterpart for each Bank, and (ii) for the account of each Bank, if
requested by such Bank, a Note conforming to the requirements hereof and
executed by a duly authorized officer of the Company.

            4.2  Legal Opinions.  On the Closing Date and on any Borrowing Date
as the Agent shall request, each Bank shall have received from any general,
associate, or assistant general counsel to the Company, such opinions as the
Agent shall have reasonably requested with respect to the transactions
contemplated by this Agreement.

            4.3  Company Officers' Certificate.  The representations and
warranties contained in Section 3 (as qualified by the disclosures in (i) the
Company's Annual Report on Form 10-K for its fiscal year ended December 31,
1997, (ii) the Company's Quarterly Reports on Form 10-Q for its fiscal quarters
ended June 30, 1997, September 30, 1997 and March 31, 1998 and (iii) the
Company's Reports on Form 8-K dated February 6, 1998, February 13, 1998, March
6, 1998 and May 27, 1998, in each case as filed with the Securities and Exchange
Commission and previously distributed to the Banks) shall be true and correct in
all material respects on the Closing Date and on and as of each Borrowing Date
with the same force and effect as though made on and as of such date; no Default
shall have occurred (except a Default which shall have been waived in writing or
which shall have been cured) and no Default shall exist after giving effect to
the Loan to be made; between December 31, 1997 and such Borrowing Date, neither
the business nor assets, nor the condition, financial or otherwise, of the
Company and its Subsidiaries on a consolidated basis shall have been adversely
affected in any material manner as a result of any fire, flood, explosion,
accident, drought, strike, lockout, riot, sabotage, confiscation, condemnation,
or any purchase of any property by Governmental Authority, activities of armed
forces, acts of God or the public enemy, new or amended legislation, regulatory
order, judicial decision or any other event or development whether or not
related to those enumerated above (all subject to the disclosures referred to
above); and the Agent shall have received a certificate containing a
representation to these effects dated such Borrowing Date and signed by a
Responsible Officer.

            4.4  Legality, etc.  The making of the Loan to be made by such Bank
on each Borrowing Date shall not subject such Bank to any penalty or special
tax, shall not be prohibited by any Requirement of Law applicable to such Bank
or the Company, and all necessary consents, approvals and authorizations of any
Governmental Authority or any Person to or of any such Loan shall have been
obtained and shall be in full force and effect.
<PAGE>
 
                                                                              27

            4.5  General.  All instruments and legal and corporate proceedings
in connection with the Loans contemplated by this Agreement shall be
satisfactory in form and substance to the Agent, and the Agent shall have
received copies of all documents, and favorable legal opinions and records of
corporate proceedings, which the Agent may have reasonably requested in
connection with the Loans and other transactions contemplated by this Agreement.

            4.6  Fees.  The Agent shall have received the fees to be received on
the Closing Date referred to in subsection 2.2.

            4.7  Amendments to Existing Agreements.  The conditions to the
effectiveness of the Fourth Amendment to the February 1997 Five-year Agreement
and Amendment and the Third Amendment to the June 1997 364-Day Agreement and
Amendment shall have been satisfied.


            SECTION 5.  GENERAL COVENANTS

            On and after the date hereof, until all of the Notes and all other
amounts payable pursuant hereto shall have been paid in full and so long as the
Commitments shall remain in effect, the Company covenants that the Company will
comply, and will cause each of its Subsidiaries to comply, with such of the
provisions of this Section 5 and such other provisions of this Agreement as are
applicable to the Person in question.

            5.1  Taxes, Indebtedness, etc.  (a)  Each of the Company and its
Subsidiaries will duly pay and discharge, or cause to be paid and discharged,
before the same shall become in arrears, all taxes, assessments, levies and
other governmental charges imposed upon such corporation and its properties,
sales and activities, or any part thereof, or upon the income or profits
therefrom; provided, however, that any such tax, assessment, charge or levy need
not be paid if the validity or amount thereof shall currently be contested in
good faith by appropriate proceedings and if the Company or the Subsidiary in
question shall have set aside on its books appropriate reserves with respect
thereto.

            (b)  Each of the Company and its Subsidiaries will promptly pay when
due, or in conformance with customary trade terms, all other Indebtedness and
liabilities incident to its operations; provided, however, that any such
Indebtedness or liability need not be paid if the validity or amount thereof
shall currently be contested in good faith and if the Company or the Subsidiary
in question shall have set aside on its books appropriate reserves with respect
thereto.  The Subsidiaries will not create, incur, assume or suffer to exist any
Indebtedness, except:  (i) Indebtedness outstanding on the date hereof and
listed on Schedule III; (ii) Indebtedness that is owing to the Company or any
other Subsidiary; (iii) Indebtedness incurred pursuant to an accounts receivable
program; and (iv) additional Indebtedness at any time outstanding in an
aggregate principal amount not to exceed 10% of Consolidated Assets.

            5.2  Maintenance of Properties; Compliance with Law.  Each of the
Company and its Subsidiaries (a) will keep its material properties in good
repair, working order and
<PAGE>
 
                                                                              28

condition and will from time to time make all necessary and proper repairs,
renewals, replacements, additions and improvements thereto and will comply at
all times with the provisions of all material leases and other material
agreements to which it is a party so as to prevent any loss or forfeiture
thereof or thereunder unless compliance therewith is being currently contested
in good faith by appropriate proceedings and (b) in the case of the Company or
any Subsidiary of the Company while such Person remains a Subsidiary, will do
all things necessary to preserve, renew and keep in full force and effect and in
good standing its corporate existence and franchises necessary to continue such
businesses.  The Company and its Subsidiaries will comply in all material
respects with all valid and applicable Requirements of Law (including any such
laws, rules, regulations or governmental orders relating to the protection of
environmental or public or employee health or safety) of the United States, of
the States thereof and their counties, municipalities and other subdivisions and
of any other jurisdiction, applicable to the Company and its Subsidiaries,
except where compliance therewith shall be contested in good faith by
appropriate proceedings, the Company or the Subsidiary in question shall have
set aside on its books appropriate reserves in conformity with GAAP with respect
thereto, and the failure to comply therewith could not reasonably be expected
to, in the aggregate, have a material adverse effect on the business or assets
or on the condition, financial or otherwise, of the Company and its Subsidiaries
on a consolidated basis.

            5.3  Transactions with Affiliates.  Neither the Company nor any of
its Subsidiaries will enter into any transactions, including, without
limitation, the purchase, sale or exchange of property or the rendering of any
service, with any of their Affiliates (other than the Company and its
Subsidiaries) unless such transaction is otherwise permitted under this
Agreement, is in the ordinary course of the Company's or such Subsidiary's
business and is upon fair and reasonable terms no less favorable to the Company
or such Subsidiary, as the case may be, than it would obtain in an arm's-length
transaction.

            5.4  Insurance.  The Company will, and will cause each of its
Subsidiaries to, maintain or cause to be maintained, with financially sound and
reputable insurers including any Subsidiary which is engaged in the business of
providing insurance protection, insurance (including, without limitation,
professional liability insurance against claims for malpractice) with respect to
its properties and business and the properties and business of its Subsidiaries
against loss or damage of the kinds customarily insured against of such types
and such amounts as are customarily carried under similar circumstances by other
corporations.  Such insurance may be subject to co-insurance, deductibility or
similar clauses which, in effect, result in self-insurance of certain losses,
and the Company may self-insure against such loss or damage, provided that
adequate insurance reserves are maintained in connection with such self-
insurance.

            5.5  Financial Statements.  The Company will and will cause each of
its Subsidiaries to maintain a standard modern system of accounting in which
full, true and correct entries will be made of all dealings or transactions in
relation to its business and affairs in accordance with GAAP consistently
applied, and will furnish the following to each Bank (in duplicate if so
requested):
<PAGE>
 
                                                                              29

            (a)  Annual Statements.  As soon as available, and in any event
     within 120 days after the end of each fiscal year, the consolidated balance
     sheet as at the end of each fiscal year and consolidated statements of
     profit and loss and of retained earnings for such fiscal year of the
     Company and its Subsidiaries, together with comparative consolidated
     figures for the next preceding fiscal year, accompanied by reports or
     certificates of an Auditor, to the effect that such balance sheet and
     statements were prepared in accordance with GAAP consistently applied and
     fairly present the financial position of the Company and its Subsidiaries
     as at the end of such fiscal year and the results of their operations and
     changes in financial position for the year then ended and the statement of
     such Auditor and of a Responsible Officer of the Company that such Auditor
     and Responsible Officer have caused the provisions of this Agreement to be
     reviewed and that nothing has come to their attention to lead them to
     believe that any Default exists hereunder or, if such is not the case,
     specifying such Default or possible Default and the nature thereof. In
     addition, such financial statements shall be accompanied by a certificate
     of a Responsible Officer of the Company containing computations showing
     compliance with subsections 5.6 through 5.8, 5.10, 5.12, 5.14 and 5.15.

            (b)  Quarterly Statements.  As soon as available, and in any event
     within 60 days after the close of each of the first three fiscal quarters
     of the Company and its Subsidiaries in each year, consolidated balance
     sheets as at the end of such fiscal quarter and consolidated profit and
     loss and retained earnings statements for the portion of the fiscal year
     then ended, of the Company and its Subsidiaries, together with computations
     showing compliance with subsections 5.6 through 5.8, 5.10, 5.12, 5.14 and
     5.15, accompanied by a certificate of a Responsible Officer of the Company
     that such statements and computations have been properly prepared in
     accordance with GAAP, consistently applied, and fairly present the
     financial position of the Company and its Subsidiaries as at the end of
     such fiscal quarter and the results of their operations and changes in
     financial position for such quarter and for the portion of the fiscal year
     then ended, subject to normal audit and year-end adjustments, and to the
     further effect that he has caused the provisions of this Agreement and all
     other agreements to which the Company or any of its Subsidiaries is a party
     and which relate to Indebtedness to be reviewed, and has no knowledge that
     any Default has occurred under this Agreement or under any such other
     agreement, or, if said Responsible Officer has such knowledge, specifying
     such Default and the nature thereof.

            (c)  Notice of Material Litigation; Defaults.  The Company will
     promptly notify each Bank in writing, by delivery of the Company's Annual
     Report on Form 10-K, Quarterly Reports on Form 10-Q and Current Reports on
     Form 8-K filed with the Securities and Exchange Commission or otherwise, as
     to any litigation or administrative proceeding to which it or any of its
     Subsidiaries may hereafter be a party which, after giving effect to any
     applicable insurance, may involve any material risk of any material
     judgment or liability or which may otherwise result in any material adverse
     change in the business or assets or in the condition, financial or
     otherwise, of the Company and its Subsidiaries on a consolidated basis.
     Promptly
<PAGE>
 
                                                                              30

     upon acquiring knowledge thereof, the Company will notify each Bank of the
     existence of any Default, including, without limitation, any default in the
     payment of any Indebtedness for money borrowed of the Company or any
     Subsidiary or under the terms of any agreement relating to such
     Indebtedness, specifying the nature of such Default and what action the
     Company has taken or is taking or proposes to take with respect thereto.
     Promptly upon acquiring knowledge thereof, the Company will notify each
     Bank of a change in the publicly announced ratings by S&P and Moody's of
     the then current senior unsecured, non-credit enhanced, long-term
     Indebtedness of the Company.

            (d)  ERISA Reports.  The Company will furnish the Agent with copies
     of any request for waiver of the funding standards or extension of the
     amortization periods required by Sections 303 and 304 of ERISA or Section
     412 of the Code promptly after any such request is submitted by the Company
     to the Department of Labor or the Internal Revenue Service, as the case may
     be. Promptly after a Reportable Event occurs, or the Company or any of its
     Subsidiaries receives notice that the PBGC or any Control Group Person has
     instituted or intends to institute proceedings to terminate any pension or
     other Plan, or prior to the Plan administrator's terminating such Plan
     pursuant to Section 4041 of ERISA, the Company will notify the Agent and
     will furnish to the Agent a copy of any notice of such Reportable Event
     which is required to be filed with the PBGC, or any notice delivered by the
     PBGC evidencing its institution of such proceedings or its intent to
     institute such proceedings, or any notice to the PBGC that a Plan is to be
     terminated, as the case may be. The Company will promptly notify each Bank
     upon learning of the occurrence of any of the following events with respect
     to any Plan which is a Multiemployer Plan: a partial or complete withdrawal
     from any Plan which may result in the incurrence by the Company or any of
     is Subsidiaries of withdrawal liability in excess of $1,000,000 under
     Subtitle E of Title IV of ERISA, or of the termination, insolvency or
     reorganization status of any Plan under such Subtitle E which may result in
     liability to the Company or any of its Subsidiaries in excess of
     $1,000,000. In the event of such a withdrawal, upon the request of the
     Agent or any Bank, the Company will promptly provide information with
     respect to the scope and extent of such liability, to the best of the
     Company's knowledge.

            (e)  Reports to Stockholders, etc.  Promptly after the sending,
     making available or filing of the same, copies of all reports and financial
     statements which the Company shall send or make available to its
     stockholders including, without limitation, all reports on Form 8-K, 10-Q
     or 10-K or any similar form hereafter in use which the Company shall file
     with the Securities and Exchange Commission.

            (f)  Other Information.  From time to time upon request of the Agent
     or any Bank, the Company will furnish information regarding the business
     affairs and condition, financial or otherwise, of the Company and its
     Subsidiaries.  The Company agrees that any authorized officers and
     representatives of any Bank shall have the right during reasonable business
     hours to examine the books and records of the Company and its Subsidiaries,
     and to make notes and abstracts therefrom, to make an
<PAGE>
 
                                                                              31

     independent examination of its books and records for the purpose of
     verifying the accuracy of the reports delivered by the Company and its
     Subsidiaries pursuant to this Agreement or otherwise, and ascertaining
     compliance with this Agreement.

            (g)  Confidentiality of Information.  Each Bank acknowledges that
     some of the information furnished to such Bank pursuant to this subsection
     5.5 may be received by such Bank prior to the time it shall have been made
     public, and each Bank agrees that it will keep all information so furnished
     confidential and shall make no use of such information until it shall have
     become public, except (i) in connection with matters involving operations
     under or enforcement of this Agreement or the Notes, (ii) in accordance
     with each Bank's obligations under law or pursuant to subpoenas or other
     process to make information available to governmental agencies and
     examiners or to others, (iii) to each Bank's corporate Affiliates and
     Transferees and prospective Transferees so long as such Persons agree to be
     bound by this subsection 5.5(g) or (iv) with the prior consent of the
     Company.

            5.6  Ratio of Consolidated Total Debt to Consolidated Total
Capitalization.  The Company and its Subsidiaries will not at any time have
outstanding Consolidated Total Debt in an amount in excess of 65% of
Consolidated Total Capitalization.

            5.7  Interest Coverage Ratio.  On the last day of each fiscal
quarter of the Company, commencing with the fiscal quarter ending December 31,
1998, the Consolidated Earnings Before Interest and Taxes of the Company and its
Subsidiaries for the four consecutive fiscal quarters of the Company then ending
will be an amount which equals or exceeds 200% of the Consolidated Interest
Expense of the Company and its Subsidiaries for the same four consecutive fiscal
quarters.

            5.8  Distributions.  The Company will not make any Distribution
except that, so long as no Event of Default exists or would exist after giving
effect thereto, the Company may make a Distribution; provided however, that at
any time the Commitments under the February 1997 Five-Year Agreement and
Amendment plus the commitments under the June 1997 364-Day Agreement and
Amendment (or, if such commitments have expired or been terminated, the
outstanding loans thereunder) shall exceed $2,000,000,000 in aggregate amount,
the Company will not purchase, repurchase, redeem or otherwise acquire
(including any "synthetic" acquisitions through equity derivatives) any shares
of any class of capital stock of the Company directly or indirectly through a
Subsidiary or otherwise, except for such acquisitions funded with the proceeds
of Loans made pursuant to this Agreement or the February 1997 Five-Year
Agreement and Amendment in an aggregate principal amount not to exceed
$1,000,000,000.

            5.9  Merger or Consolidation.  The Company will not become a
constituent corporation in any merger or consolidation unless the Company shall
be the surviving or resulting corporation and immediately before and after
giving effect to such merger or consolidation there shall exist no Default;
provided that the Company may merge into another Subsidiary owned by the Company
for the purpose of causing the Company to be incorporated in a different
jurisdiction in the United States.
<PAGE>
 
                                                                              32

            5.10 Sales of Assets.  The Company and its Subsidiaries may from
time to time sell or otherwise dispose of all or any part of their respective
assets; provided, however, that in any fiscal year, the Company and its
Subsidiaries will not (a) sell or dispose of (including, without limitation, any
disposition resulting from any merger or consolidation involving a Subsidiary of
the Company, and any Sale-and-Leaseback Transaction), outside of the ordinary
course of business, to Persons other than the Company and its Subsidiaries,
assets constituting in the aggregate more than 12% of Consolidated Assets of the
Company and its Subsidiaries as at the end of the immediately preceding fiscal
year (excluding an amount equal to the book value of those assets the Net Cash
Proceeds from the disposition of which have been applied to prepay the
outstanding revolving credit loans under the June 1997 364-Day Agreement and
Amendment in accordance with subsection 2.18 thereof) and (b) exchange with any
Persons other than the Company and its Subsidiaries any asset or group of assets
for another asset or group of assets unless (i) such asset or group of assets
are exchanged for an asset or group of assets of a substantially similar type or
nature, (ii) on a pro forma basis both before and after giving effect to such
exchange, no Default or Event of Default shall have occurred and be continuing,
(iii) the aggregate fair market value (as determined in good faith by the Board
of Directors of the Company) of the asset or group of assets being transferred
by the Company or such Subsidiary and the asset or group of assets being
acquired by the Company or such Subsidiary are substantially equal and (iv) the
aggregate of (x) all assets of the Company and its Subsidiaries sold pursuant to
subsection 5.10(a) (including, without limitation, any disposition resulting
from any merger or consolidation involving a Subsidiary of the Company, and any
Sale-and-Leaseback Transaction) (excluding an amount equal to the book value of
those assets the Net Cash Proceeds from the disposition of which have been
applied to prepay the outstanding revolving credit loans under the June 1997 
364-Day Agreement and Amendment in accordance with subsection 2.18 thereof) and
(y) the aggregate fair market value (as determined in good faith by the Board of
Directors of the Company) of all assets of the Company and its Subsidiaries
exchanged pursuant to this subsection 5.10(b) does not exceed 20% of
Consolidated Assets of the Company and its Subsidiaries as at the end of the
immediately preceding fiscal year.

            5.11 Compliance with ERISA.  Each of the Company and its
Subsidiaries will meet, and will cause all Control Group Persons to meet, all
minimum funding requirements applicable to any Plan imposed by ERISA or the Code
(without giving effect to any waivers of such requirements or extensions of the
related amortization periods which may be granted), and will at all times
comply, and will cause all Control Group Persons to comply, in all material
respects with the provisions of ERISA and the Code which are applicable to the
Plans. At no time shall the aggregate actual and contingent liabilities of the
Company under Sections 4062, 4063, 4064 and other provisions of ERISA
(calculated as if the 30% of collective net worth amount referred to in Section
4062(b)(1)(A)(i)(II) of ERISA exceeded the actual total amount of unfunded
guaranteed benefits referred to in Section 4062(B)(1)(A)(i)(I) of ERISA) with
respect to all Plans (and all other pension plans to which the Company, any
Subsidiary, or any Control Group Person made contributions prior to such time)
exceed $7,500,000. Neither the Company nor its Subsidiaries will permit any
event or condition to exist which could permit any Plan which is not a
Multiemployer Plan to be terminated under circumstances which would cause the
lien provided for in Section 4068 of ERISA to attach to the assets of the
Company or any of its Subsidiaries.
<PAGE>
 
                                                                              33

            5.12  Negative Pledge.  The Company will not and will ensure that no
Subsidiary will create or have outstanding any security on or over any Principal
Property in respect of any Indebtedness and the Company will not create or have
outstanding any security on or over the capital stock of any of its Subsidiaries
that own a Principal Property and will ensure that no Subsidiary will create or
have outstanding any security on or over the capital stock of any of its
respective Subsidiaries that own a Principal Property except in either case for:

            (a)  any security for the purchase price or cost of construction of
     real property acquired by the Company or any of its Subsidiaries (or
     additions, substantial repairs, alterations or substantial improvements
     thereto) or equipment, provided that such Indebtedness and such security
     are incurred within 18 months of the acquisition or completion of
     construction (or alteration or repair) and full operation;

            (b)  any security existing on property or on capital stock, as the
     case may be, at the time of acquisition of such property or capital stock,
     as the case maybe, by the Company or a Subsidiary or on the property or
     capital stock, as the case may be, of a corporation at the time of the
     acquisition of such corporation by the Company or a Subsidiary (including
     acquisitions through merger or consolidation);

            (c)  any security created in favor of the Company or a Subsidiary;

            (d)  any security created by operation of law in favor of government
     agencies of the United States of America or any State thereof;

            (e)  any security created in connection with the borrowing of funds
     if within 120 days such funds are used to repay Indebtedness in at least
     the same principal amount as secured by other security of Principal
     Property or capital stock of a Subsidiary that owns a Principal Property,
     as the case may be, with an independent appraised fair market value at
     least equal to the appraised fair market value of the Principal Property or
     capital stock of a Subsidiary that owns a Principal Property, as the case
     may be, secured by the new security; and

            (f)  any extension, renewal or replacement of any security referred
     to in the foregoing clauses (a) through (e) provided that the amount
     thereby secured is not increased;

unless any Loans made and/or to be made to and all other sums payable by the
Company under this Agreement shall be secured equally and ratably with (or prior
to) such Indebtedness so long as such Indebtedness shall be so secured.
Notwithstanding the foregoing, the Company and any one or more Subsidiaries may,
without securing the Loans made and/or to be made to and all other sums payable
by the Company under this Agreement, create, issue or assume Indebtedness which
would otherwise be subject to the foregoing restrictions in an aggregate
principal amount which, together with all other such Indebtedness of the Company
and its Subsidiaries (not including Indebtedness permitted to be secured
pursuant to the foregoing clauses (a) through (f) and the aggregate Attributable
Debt),
<PAGE>
 
                                                                              34

including Indebtedness in respect of Sale-and-Lease-back Transactions (other
than those permitted by subsection 5.13(b)), does not exceed 10% of Consolidated
Net Tangible Assets of the Company and its Subsidiaries.
     
            5.13 Sale-and-Lease-back Transactions.  Neither the Company nor any
Significant Subsidiary will enter into any Sale-and-Lease-back Transaction with
respect to any Principal Property with any Person (other than the Company or a
Subsidiary) unless either (a) the Company or such Significant Subsidiary would
be entitled, pursuant to the provisions described in subsection 5.12(a) through
(f) to incur Indebtedness secured by a security on the property to be leased
without equally and ratably securing the Loans made and/or to be made to and all
other sums payable by the Company under this Agreement, or (b) the Company
during or immediately after the expiration of 120 days after the effective date
of such transaction applies to the voluntary retirement of its Indebtedness
and/or the acquisition or construction of Principal Property an amount equal to
the greater of the net proceeds of the sale of the property leased in such
transaction or the fair value in the opinion of the chief financial officer of
the Company of the leased property at the time such transaction was entered
into.

            5.14 Maximum Consolidated Total Debt.  The Company and its
Subsidiaries will not at any time to and including September 30, 1998 have
outstanding Consolidated Total Debt in an amount in excess of $10,000,000,000.

            5.15 Minimum Consolidated Earnings Before Interest, Taxes,
Depreciation and Amortization.  The Consolidated Earnings Before Interest,
Taxes, Depreciation and Amortization of the Company and its Subsidiaries will
be, for each period specified below, an amount which equals or exceeds the
amount set forth opposite such period:

               Period                                Amount
               ------                                ------

     Two fiscal quarters ending
      June 30, 1998                                $1,500,000,000

     Three fiscal quarters
      ending September 30, 1998                    $2,250,000,000

            5.16 Limitation on Optional Payments and Modifications of Debt
Instruments.  At any time the commitments under the February 1997 Five-Year
Agreement and Amendment plus the commitments under the June 1997 364-Day
Agreement and Amendment (or, if such commitments have expired or been
terminated, the outstanding loans thereunder) exceed $2,000,000,000 in aggregate
amount, the Company will not make, and will not permit any of its Subsidiaries
to make, any optional payment or prepayment on or redemption, defeasance or
purchase of any Indebtedness of the Company or any of its Subsidiaries (other
than Indebtedness under this Agreement, the February 1997 Five-Year Agreement
and Amendment or under the June 1997 364-Day Agreement and Amendment or under
Financing Leases in an aggregate amount not to exceed $50,000,000 in any fiscal
year of the Company), or amend, modify or change, or consent or agree to any
amendment, modification or change to any of
<PAGE>
 
                                                                              35

the terms relating to the payment or prepayment or principal of or interest on,
any such Indebtedness, other than any amendment, modification or change which
would extend the maturity or reduce the amount of any payment of principal
thereof or which would reduce the rate or extend the date for payment of
interest thereon or which would not be adverse to the Banks.


            SECTION 6.  DEFAULTS

            6.1  Events of Default.  Upon the occurrence of any of the following
events:

            (a)  any default shall be made by the Company in any payment in
     respect of: (i) interest payable hereunder as the same shall become due and
     such default shall continue for a period of five days; or (ii) principal of
     any of the Indebtedness hereunder or evidenced by the Notes as the same
     shall become due, whether at maturity, by prepayment, by acceleration or
     otherwise; or

            (b)  any default shall be made by either the Company or any
     Subsidiary of the Company in the performance or observance of any of the
     provisions of subsections 5.6 through 5.10 and 5.12 through 5.15; or

            (c)  any default shall be made in the due performance or observance
     of any other covenant, agreement or provision to be performed or observed
     by either the Company or any Subsidiary under this Agreement, and such
     default shall not be rectified or cured to the satisfaction of the Required
     Banks within a period expiring 30 days after written notice thereof by the
     Agent to the Company; or

            (d)  any representation or warranty of or with respect to the
     Company or any Subsidiary of the Company to the Banks in connection with
     this Agreement shall have been untrue in any material respect on or as of
     the date made and the facts or circumstances to which such representation
     or warranty relates shall not have been subsequently corrected to make such
     representation or warranty no longer incorrect; or

            (e)  any default shall be made in the payment of any item of
     Indebtedness of the Company or any Subsidiary or under the terms of any
     agreement relating to such Indebtedness and such default shall continue
     without having been duly cured, waived or consented to, beyond the period
     of grace, if any, therein specified; provided, however, that such default
     shall not constitute an Event of Default unless (i) the outstanding
     principal amount of such item of Indebtedness exceeds $10,000,000, or (ii)
     the aggregate outstanding principal amount of such item of Indebtedness and
     all other items of Indebtedness of the Company and its Subsidiaries as to
     which such defaults exist and have continued without being duly cured,
     waived or consented to beyond the respective periods of grace, if any,
     therein specified exceeds $25,000,000, or (iii) such default shall have
     continued without being rectified or cured to the satisfaction of the
<PAGE>
 
                                                                              36

     Required Banks for a period of 30 days after written notice thereof by the
     Agent to the Company; or

            (f)  either the Company or any Significant Subsidiary shall be
     involved in financial difficulties as evidenced:

                 (i)     by its commencement of a voluntary case under Title 11
            of the United States Code as from time to time in effect, or by its
            authorizing, by appropriate proceedings of its board of directors or
            other governing body, the commencement of such a voluntary case;

                 (ii)    by the filing against it of a petition commencing an
            involuntary case under said Title 11 which shall not have been
            dismissed within 60 days after the date on which said petition is
            filed or by its filing an answer or other pleading within said 60-
            day period admitting or failing to deny the material allegations of
            such a petition or seeking, consenting or acquiescing in the relief
            therein provided;

                 (iii)   by the entry of an order for relief in any involuntary
            case commenced under said Title 11;

                 (iv)    by its seeking relief as a debtor under any applicable
            law, other than said Title 11, of any jurisdiction relating to the
            liquidation or reorganization of debtors or to the modification or
            alteration of the rights of creditors, or by its consenting to or
            acquiescing in such relief;

                 (v)     by the entry of an order by a court of competent
            jurisdiction (i) finding it to be bankrupt or insolvent, (ii)
            ordering or approving its liquidation, reorganization or any
            modification or alteration of the rights of its creditors, or (iii)
            assuming custody of, or appointing a receiver or other custodian
            for, all or a substantial part of its property;

                 (vi)    by its making an assignment for the benefit of, or
            entering into a composition with, its creditors, or appointing or
            consenting to the appointment of a receiver or other custodian for
            all or a substantial part of its property; or

            (g)  a Change in Control of the Company shall occur;

then and in each and every such case, (x) the Agent may, with the consent of the
Required Banks, or shall, at the direction of the Required Banks, proceed to
protect and enforce the rights of the Banks by suit in equity, action at law
and/or other appropriate proceeding either for specific performance of any
covenant or condition contained in this Agreement or any Note or in any
instrument delivered to each Bank pursuant to this Agreement, or in aid of the
exercise of any power granted in this Agreement or any Note or any such
instrument or assignment, and (y) the Agent may, with the consent of the
Required Banks, or shall, at the direction of the Required Banks, by notice in
writing to the Company terminate the
<PAGE>
 
                                                                              37

obligations of the Banks to make the Loans hereunder, and thereupon such
obligations shall terminate forthwith and (z) (unless there shall have occurred
an Event of Default under subsection 6.1(f), in which case the obligations of
the Banks to make the Loans hereunder shall automatically terminate and the
unpaid balance of the Indebtedness hereunder and accrued interest thereon and
all other amounts payable hereunder (the "Bank Obligations") shall automatically
become due and payable) the Agent may, with the consent of the Required Banks,
or shall, at the direction of the Required Banks, by notice in writing to the
Company declare all or any part of the unpaid balance of the Bank Obligations
then outstanding to be forthwith due and payable, and thereupon such unpaid
balance or part thereof shall become so due and payable without presentment,
protest or further demand or notice of any kind, all of which are hereby
expressly waived, the obligations of the Banks to make further Loans hereunder
shall terminate forthwith, and the Agent may, with the consent of the Required
Banks, or shall, at the direction of the Required Banks, proceed to enforce
payment of such balance or part thereof in such manner as the Agent may elect,
and each Bank may offset and apply toward the payment of such balance or part
thereof, and to the curing of any such Event of Default, any Indebtedness from
such Bank to the Company, including any Indebtedness represented by deposits in
any general or special account maintained with such Bank.

            6.2  Annulment of Defaults.  An Event of Default shall not be deemed
to be in existence for any purpose of this Agreement if the Agent, with the
consent of or at the direction of the Required Banks, subject to subsection 8.1,
shall have waived such event in writing or stated in writing that the same has
been cured to its reasonable satisfaction, but no such waiver shall extend to or
affect any subsequent Event of Default or impair any rights of the Agent or the
Banks upon the occurrence thereof.

            6.3  Waivers.  The Company hereby waives to the extent permitted by
applicable law (a) all presentments, demands for performance, notices of
nonperformance (except to the extent required by the provisions hereof),
protests, notices of protest and notices of dishonor in connection with any of
the Indebtedness hereunder or evidenced by the Notes, (b) any requirement of
diligence or promptness on the part of any Bank in the enforcement of its rights
under the provisions of this Agreement or any Note, and (c) any and all notices
of every kind and description which may be required to be given by any statute
or rule of law and any defense of any kind which the Company may now or
hereafter have with respect to its liability under this Agreement or any Note.

            6.4  Course of Dealing.  No course of dealing between the Company
and any Bank shall operate as a waiver of any of the Banks' rights under this
Agreement or any Note. No delay or omission on the part of any Bank in
exercising any right under this Agreement or any Note or with respect to any of
the Bank Obligations shall operate as a waiver of such right or any other right
hereunder. A waiver on any one occasion shall not be construed as a bar to or
waiver of any right or remedy on any future occasion. No waiver or consent shall
be binding upon any Bank unless it is in writing and signed by the Agent or such
of the Banks as may be required by the provisions of this Agreement. The making
of a Loan hereunder during the existence of a Default shall not constitute a
waiver thereof.
<PAGE>
 
                                                                              38

            SECTION 7.  THE AGENT

            7.1  Appointment.  Each Bank hereby irrevocably designates and
appoints Chase as the Agent of such Bank under this Agreement, and each such
Bank irrevocably authorizes Chase, as the Agent for such Bank, to take such
action on its behalf under the provisions of this Agreement and to exercise such
powers and perform such duties as are expressly delegated to the Agent, by the
terms of this Agreement, together with such other powers as are reasonably
incidental thereto.  Notwithstanding any provision to the contrary elsewhere in
this Agreement, the Agent shall not have any duties or responsibilities, except
those expressly set forth herein, or any fiduciary relationship with any Bank,
and no implied covenants, functions, responsibilities, duties, obligations or
liabilities shall be read into this Agreement or otherwise exist against the
Agent.

            7.2  Delegation of Duties.  The Agent may execute any of its duties
under this Agreement by or through agents or attorneys-in-fact and shall be
entitled to advice of counsel concerning all matters pertaining to such duties.
The Agent shall not be responsible for the negligence or misconduct of any
agents or attorneys-in-fact selected by it with reasonable care.

            7.3  Exculpatory Provisions.  Neither the Agent nor any of its
officers, directors, employees, agents, attorneys-in-fact or Affiliates shall be
(a) liable for any action lawfully taken or omitted to be taken by it or such
Person under or in connection with this Agreement (except for its or such
Person's own gross negligence or willful misconduct), or (b) responsible in any
manner to any of the Banks for any recitals, statements, representations or
warranties made by the Company or any officer thereof contained in this
Agreement or in any certificate, report, statement or other document referred to
or provided for in, or received by the Agent under or in connection with, this
Agreement or for the value, validity, effectiveness, genuineness, enforceability
or sufficiency of this Agreement or the Notes or for any failure of the Company
to perform its obligations hereunder.  The Agent shall not be under any
obligation to any Bank to ascertain or to inquire as to the observance or
performance of any of the agreements contained in, or conditions of, this
Agreement, or to inspect the properties, books or records of the Company.

            7.4  Reliance by Agent.  The Agent shall be entitled to rely, and
shall be fully protected in relying, upon any Note, writing, resolution, notice,
consent, certificate, affidavit, letter, cablegram, telegram, telecopy, telex or
teletype message, statement, order or other document or conversation believed by
it to be genuine and correct and to have been signed, sent or made by the proper
Person or Persons and upon advice and statements of legal counsel (including,
without limitation, counsel to the Company), independent accountants and other
experts selected by the Agent.  The Agent may deem and treat the payee of any
Note as the owner thereof for all purposes unless a written notice of
assignment, negotiation or transfer thereof shall have been filed with the
Agent.  The Agent shall be fully justified in failing or refusing to take any
action under this Agreement unless it shall first receive such advice or
concurrence of the Required Banks as it deems appropriate or it shall first be
indemnified to its satisfaction by the Banks against any and all liability and
expense which may be incurred by it by reason of taking or continuing to take
any such action.  The Agent
<PAGE>
 
                                                                              39

shall in all cases be fully protected in acting, or in refraining from acting,
under this Agreement and the Notes in accordance with a request of the Required
Banks, and such request and any action taken or failure to act pursuant thereto
shall be binding upon all the Banks and all future holders of the Notes.

            7.5  Notice of Default.  The Agent shall not be deemed to have
knowledge or notice of the occurrence of any Default or Event of Default
hereunder unless the Agent has received notice from a Bank or the Company
referring to this Agreement, describing such Default or Event of Default and
stating that such notice is a "notice of default".  In the event that the Agent
receives such a notice, the Agent shall promptly give notice thereof to the
Banks.  The Agent shall take such action with respect to such Default or Event
of Default as shall be reasonably directed by the Required Banks; provided that,
unless and until the Agent shall have received such directions, the Agent may
(but shall not be obligated to) take such action, or refrain from taking such
action, with respect to such Default or Event of Default as it shall deem
advisable in the best interests of the Banks.

            7.6  Non-Reliance on Agent and Other Banks.  Each Bank expressly
acknowledges that neither the Agent nor any of its officers, directors,
employees, agents, attorneys-in-fact or Affiliates has made any representations
or warranties to it and that no act by the Agent hereinafter taken, including
any review of the affairs of the Company, shall be deemed to constitute any
representation or warranty by the Agent to any Bank.  Each Bank represents to
the Agent that it has, independently and without reliance upon the Agent or any
other Bank, and based on such documents and information as it has deemed
appropriate, made its own appraisal of and investigation into the business,
operations, property, financial and other condition and creditworthiness of the
Company and made its own decision to make its Loans hereunder and enter into
this Agreement.  Each Bank also represents that it will, independently and
without reliance upon the Agent or any other Bank, and based on such documents
and information as it shall deem appropriate at the time, continue to make its
own credit analysis, appraisals and decisions in taking or not taking action
under this Agreement, and to make such investigation as it deems necessary to
inform itself as to the business, operations, property, financial and other
condition and creditworthiness of the Company.  Except for notices, reports and
other documents expressly required to be furnished to the Banks by the Agent
hereunder, the Agent shall not have any duty or responsibility to provide any
Bank with any credit or other information concerning the business, operations,
property, financial and other condition or creditworthiness of the Company which
may come into the possession of the Agent or any of its officers, directors,
employees, agents, attorneys-in-fact or Affiliates.

            7.7  Indemnification.  The Banks agree to indemnify the Agent in its
capacity as such (to the extent not reimbursed by the Company and without
limiting the obligation of the Company to do so), ratably according to the
respective amounts of their then existing Loans hereunder, from and against any
and all liabilities, obligations, losses, damages, penalties, actions,
judgments, suits, costs, expenses or disbursements of any kind whatsoever which
may at any time (including without limitation at any time following the payment
of the Indebtedness hereunder or pursuant to the Notes) be imposed on, incurred
by or asserted against the Agent in any way relating to or arising out of this
Agreement, or any documents
<PAGE>
 
                                                                              40

contemplated by or referred to herein or the transactions contemplated hereby or
any action taken or omitted by the Agent under or in connection with any of the
foregoing; provided that no Bank shall be liable for the payment of any portion
of such liabilities, obligations, losses, damages, penalties, actions,
judgments, suits, costs, expenses or disbursements resulting solely from the
Agent's gross negligence or willful misconduct.  The agreements in this
subsection shall survive the payment of the Notes and all other amounts payable
hereunder.

            7.8  Agent in Its Individual Capacity.  The Agent and its Affiliates
may make loans to, accept deposits from and generally engage in any kind of
business with the Company as though the Agent was not the Agent hereunder.  With
respect to its Loans made or renewed by it and any Note issued to it, the Agent
shall have the same rights and powers under this Agreement as any Bank and may
exercise the same as though it were not the Agent, and the terms "Bank" and
"Banks" shall include the Agent in its individual capacity.

            7.9  Successor Agent.  The Agent may resign as Agent, as the case
may be, upon 10 days' notice to the Banks. If the Agent shall resign as Agent,
under this Agreement, then the Required Banks shall appoint from among the Banks
a successor agent for the Banks which successor agent shall be approved by the
Company, whereupon such successor agent shall succeed to the rights, powers and
duties of the Agent, and the term "Agent" shall mean such successor agent
effective upon its appointment, and the former Agent's rights, powers and duties
as Agent shall be terminated, without any other or further act or deed on the
part of such former Agent or any of the parties to this Agreement or any holders
of the Notes. After any retiring Agent's resignation hereunder as Agent, the
provisions of this subsection 7.9 shall inure to its benefit as to any actions
taken or omitted to be taken by it while it was Agent under this Agreement.


            SECTION 8.  MISCELLANEOUS

            8.1  Amendments and Waivers.  Neither this Agreement, any Note, nor
any terms hereof or thereof may be amended, supplemented or modified except in
accordance with the provisions of this subsection.  With the written consent of
the Required Banks, the Agent and the Company may, from time to time, enter into
written amendments, supplements or modifications hereto for the purpose of
adding any provisions to this Agreement or the Notes or changing in any manner
the rights of the Banks or of the Company hereunder or thereunder or waiving, on
such terms and conditions as the Agent may specify in such instrument, any of
the requirements of this Agreement or the Notes or any Default or Event of
Default and its consequences; provided, however, that no such waiver and no such
amendment, supplement or modification shall (a) extend the maturity (whether as
stated, by acceleration or otherwise) of any Indebtedness hereunder, or reduce
the rate or extend the time of payment of interest thereon, or reduce any fee
payable to the Banks hereunder, or reduce the principal amount thereof, or
change the amount of any Bank's Commitment or amend, modify or waive any
provision of this subsection 8.1 or reduce the percentage specified in the
definition of Required Banks, or consent to the assignment or transfer by the
Company of any of its rights and obligations under this Agreement, in each case
without the written consent of each Bank directly affected thereby, or (b)
amend, modify or waive any
<PAGE>
 
                                                                              41

provision of Section 7 without the written consent of the then Agent.  Any such
waiver and any such amendment, supplement or modification shall apply equally to
each of the Banks and shall be binding upon the Company, the Banks, the Agent
and all future holders of the Notes.  In the case of any waiver, the Company,
the Banks and the Agent shall be restored to their former position and rights
hereunder and under the outstanding Notes, and any Default or Event of Default
waived shall be deemed to be cured and not continuing; but no such waiver shall
extend to any subsequent or other Default or Event of Default, or impair any
right consequent thereon.

            8.2  Notices.  All notices, requests and demands to or upon the
respective parties hereto to be effective shall be in writing (including by
telecopy), and, unless otherwise expressly provided herein, shall be deemed to
have been duly given or made when delivered by hand, or three days after being
deposited in the mail, postage prepaid, or, in the case of telecopy notice, when
sent, confirmation of receipt received, addressed as follows in the case of the
Company and the Agent and as set forth in Schedule I in the case of the other
parties hereto, or to such other address as may be hereafter notified by the
respective parties hereto and any future holders of the Notes:

     The Company:             Columbia/HCA Healthcare Corporation
                              One Park Plaza
                              Nashville, Tennessee 37203
                              Attention:  David Anderson
                              Telecopy:  (615) 344-2015

     The Agent:               The Chase Manhattan Bank
                              270 Park Avenue - 48th Floor
                              New York, New York  10017
                              Attention: Dawn Lee Lum
                              Telecopy:  (212) 270-3279

     with a copy to:          Chase Agent Bank Services
                              1 Chase Manhattan Plaza - 8th Floor 
                              New York, New York  10081
                              Attention:  Janet Belden
                              Telecopy:  (212) 552-5658

provided that any notice, request or demand to or upon the Agent or the Banks
pursuant to Section 2 shall not be effective until received.

            8.3  No Waiver; Cumulative Remedies.  No failure to exercise and no
delay in exercising, on the part of the Agent or any Bank, any right, remedy,
power or privilege hereunder, shall operate as a waiver thereof; nor shall any
single or partial exercise of any right, remedy, power or privilege hereunder
preclude any other or further exercise thereof or the exercise of any other
right, remedy, power or privilege.  The rights, remedies, powers and privileges
herein provided are cumulative and not exclusive of any rights, remedies, powers
and privileges provided by law.
<PAGE>
 
                                                                              42

            8.4  Survival of Representations and Warranties.  All
representations and warranties made hereunder and in any document, certificate
or statement delivered pursuant hereto or in connection herewith shall survive
the execution and delivery of this Agreement and the Notes.

            8.5  Payment of Expenses and Taxes; Indemnity.  (a)  The Company
agrees (i) to pay or reimburse the Agent for all its reasonable out-of-pocket
costs and expenses incurred in connection with the development, preparation and
execution of, and any amendment, supplement or modification to, this Agreement
and the Notes and any other documents prepared in connection herewith, and the
consummation of the transactions contemplated hereby and thereby, including,
without limitation, the reasonable fees and disbursements of counsel to the
Agent, (ii) to pay or reimburse each Bank and the Agent for all their reasonable
costs and expenses incurred in connection with the enforcement or preservation
of any rights under this Agreement, the Notes and any such other documents,
including, without limitation, reasonable fees and disbursements of counsel to
the Agent and to each of the Banks and (iii) to pay, indemnify, and hold each
Bank and the Agent harmless from, any and all recording and filing fees and any
and all liabilities with respect to, or resulting from any delay in paying,
stamp, excise and other taxes, if any, which may be payable or determined to be
payable in connection with the execution and delivery of, or consummation of any
of the transactions contemplated by, or any amendment, supplement or
modification of, or any waiver or consent under or in respect of, this
Agreement, the Notes and any such other documents.

            (b)  The Company will indemnify each of the Agent and the Banks and
the directors, officers and employees thereof and each Person, if any, who
controls each one of the Agent and the Banks (any of the foregoing, an
"Indemnified Person") and hold each Indemnified Person harmless from and against
any and all claims, damages, liabilities and expenses (including without
limitation all fees and disbursements of counsel with whom an Indemnified Person
may consult in connection therewith and all expenses of litigation or
preparation therefor) which an Indemnified Person may incur or which may be
asserted against it in connection with any litigation or investigation involving
this Agreement, the use of any proceeds of any Loans under this Agreement by the
Company or any Subsidiary, any officer, director or employee thereof other than
litigation commenced by the Company against any of the Agent or the Banks which
(i) seeks enforcement of any of the Company's rights hereunder and (ii) is
determined adversely to any of the Agent or the Banks.

            (c)  The agreements in this subsection 8.5 shall survive repayment
of the Notes and all other amounts payable hereunder.

            8.6  Successors and Assigns; Participations; Purchasing Banks.  (a)
This Agreement shall be binding upon and inure to the benefit of the Company,
the Banks, the Agent, all future holders of the Notes and their respective
successors and assigns, except that the Company may not assign or transfer any
of its rights or obligations under this Agreement without the prior written
consent of each Bank.
<PAGE>
 
                                                                              43

            (b)  Any Bank may, in the ordinary course of its commercial banking
business and in accordance with applicable law, at any time sell to one or more
banks or other entities ("Participants") participating interests in any Loans
owing to such Bank, any Notes held by such Bank, any Commitments of such Bank or
any other interests of such Bank hereunder.  In the event of any such sale by a
Bank of a participating interest to a Participant, such Bank's obligations under
this Agreement to the other parties under this Agreement shall remain unchanged,
such Bank shall remain solely responsible for the performance thereof, such Bank
shall remain the holder of any such Notes for all purposes under this Agreement,
and the Company and the Agent shall continue to deal solely and directly with
such Bank in connection with such Bank's rights and obligations under this
Agreement.  The Company agrees that if amounts outstanding under this Agreement
and the Notes are due or unpaid, or shall have been declared or shall have
become due and payable upon the occurrence of an Event of Default, each
Participant shall be deemed to have the right of offset in respect of its
participating interest in amounts owing under this Agreement and any Notes to
the same extent as if the amount of its participating interest were owing
directly to it as a Bank under this Agreement or any Notes, provided that such
right of offset shall be subject to the obligation of such Participant to share
with the Banks, and the Banks agree to share with such Participant, as provided
in subsection 8.7.  The Company also agrees that each Participant shall be
entitled to the benefits of subsections 2.11, 2.12 and 2.14 with respect to its
participation in the Commitments and the Eurodollar Loans outstanding from time
to time; provided that no Participant shall be entitled to receive any greater
amount pursuant to such subsections than the transferor Bank would have been
entitled to receive in respect of the amount of the participation transferred by
such transferor Bank to such Participant had no such transfer occurred.  No
Participant shall be entitled to consent to any amendment, supplement,
modification or waiver of or to this Agreement or any Note, unless the same is
subject to clause (a) of the proviso to subsection 8.1.

            (c)  Any Bank may, in the ordinary course of its commercial banking
business and in accordance with applicable law, at any time sell to any Bank or
any affiliate thereof, and, with the consent of the Company and the Agent (which
in each case shall not be unreasonably withheld) to one or more additional banks
or financial institutions ("Purchasing Banks") all or any part of its rights and
obligations under this Agreement and the Notes pursuant to a Commitment Transfer
Supplement, executed by such Purchasing Bank, such transferor Bank and the Agent
(and, in the case of a Purchasing Bank that is not then a Bank or an affiliate
thereof, by the Company); provided, however, that (i) the Commitments purchased
by such Purchasing Bank that is not then a Bank shall be equal to or greater
than $10,000,000 and (ii) the transferor Bank which has transferred part of its
Loans and Commitments to any such Purchasing Bank shall retain a minimum
Commitment, after giving effect to such sale, equal to or greater than
$10,000,000.  Upon (i) such execution of such Commitment Transfer Supplement,
(ii) delivery of an executed copy thereof to the Company and (iii) payment by
such Purchasing Bank, such Purchasing Bank shall for all purposes be a Bank
party to this Agreement and shall have all the rights and obligations of a Bank
under this Agreement, to the same extent as if it were an original party hereto
with the Commitment Percentage of the Commitments set forth in such Commitment
Transfer Supplement.  Such Commitment Transfer Supplement shall be deemed to
amend this Agreement to the extent, and only to the extent, necessary to reflect
the addition of such Purchasing Bank and the
<PAGE>
 
                                                                              44

resulting adjustment of Commitment Percentages arising from the purchase by such
Purchasing Bank of all or a portion of the rights and obligations of such
transferor Bank under this Agreement and the Notes.  Upon the consummation of
any transfer to a Purchasing Bank, pursuant to this subsection 8.6(c), the
transferor Bank, the Agent and the Company shall make appropriate arrangements
so that, if required, replacement Notes are issued to such transferor Bank and
new Notes or, as appropriate, replacement Notes, are issued to such Purchasing
Bank, in each case in principal amounts reflecting their Commitment Percentages
or, as appropriate, their outstanding Loans as adjusted pursuant to such
Commitment Transfer Supplement.

            (d)  The Agent shall maintain at its address referred to in
subsection 8.2 a copy of each Commitment Transfer Supplement delivered to it and
a register (the "Register") for the recordation of the names and addresses of
the Banks and the Commitment of, and principal amount of the Loans owing to,
each Bank from time to time. The entries in the Register shall be conclusive, in
the absence of manifest error, and the Company, the Agent and the Banks may
treat each Person whose name is recorded in the Register as the owner of the
Loan recorded therein for all purposes of this Agreement. The Register shall be
available for inspection by the Company or any Bank at any reasonable time and
from time to time upon reasonable prior notice.

            (e)  Upon its receipt of a Commitment Transfer Supplement executed
by a transferor Bank and a Purchasing Bank (and, in the case of a Purchasing
Bank that is not then a Bank or an affiliate thereof, by the Company and the
Agent) together with payment to the Agent of a registration and processing fee
of $2,500, the Agent shall (i) promptly accept such Commitment Transfer
Supplement (ii) on the Transfer Effective Date determined pursuant thereto
record the information contained therein in the Register and give notice of such
acceptance and recordation to the Banks and the Company.

            (f)  Subject to subsection 5.5(g), the Company authorizes each Bank
to disclose to any Participant or Purchasing Bank (each, a "Transferee") and any
prospective Transferee any and all financial information in such Bank's
possession concerning the Company which has been delivered to such Bank by the
Company pursuant to this Agreement or which has been delivered to such Bank by
the Company in connection with such Bank's credit evaluation of the Company
prior to entering into this Agreement.

            (g)  If, pursuant to this subsection 8.6, any interest in this
Agreement or any Note is transferred to any Transferee which is organized under
the laws of any jurisdiction other than the United States or any State thereof,
the transferor Bank shall cause such Transferee, concurrently with the
effectiveness of such transfer, (i) to represent to the transferor Bank (for the
benefit of the transferor Bank, the Agent and the Company) that under applicable
law and treaties no taxes will be required to be withheld by the Agent, the
Company or the transferor Bank with respect to any payments to be made to such
Transferee in respect of the Loans, (ii) to furnish to the transferor Bank (and,
in the case of any Purchasing Bank registered in the Register, the Agent and the
Company) either U.S. Internal Revenue Service Form 4224 or U.S. Internal Revenue
Service Form 1001 (wherein such Transferee claims entitlement to complete
exemption from U.S. federal withholding tax on all
<PAGE>
 
                                                                              45

interest payments hereunder) and (iii) to agree (for the benefit of the
transferor Bank, to provide the transferor Bank (and, in the case of any
Purchasing Bank registered in the Register, the Agent and the Company) a new
form 4224 or Form 1001 upon the obsolescence of any previously delivered form
and comparable statements in accordance with applicable U.S. laws and
regulations and amendments duly executed and completed by such Transferee, and
to comply from time to time with all applicable U.S. laws and regulations with
regard to such withholding tax exemption.

            (h)  For avoidance of doubt, the parties to this Agreement
acknowledge that the provisions of this subsection 8.6 concerning assignments of
Loans and Notes relate only to absolute assignments and that such provisions do
not prohibit assignments creating security interests, including any pledge or
assignment by a Bank of any Loan or Note to any Federal Reserve Bank in
accordance with applicable law.

            8.7  Adjustments; Set-off.  If any Bank (a "Benefitted Bank") shall
at any time receive any payment of all or part of its Loans, or interest
thereon, or receive any collateral in respect thereof (whether voluntarily or
involuntarily, by offset, pursuant to events or proceedings of the nature
referred to in subsection 6.1(f), or otherwise) in a greater proportion than any
such payment to and collateral received by any other Bank, if any, in respect of
such other Bank's Loans, or interest thereon, such Benefitted Bank shall
purchase for cash from the other Banks such portion of each such other Bank's
Loans, or shall provide such other Banks with the benefits of any such
collateral, or the proceeds thereof, as shall be necessary to cause such
Benefitted Bank to share the excess payment or benefits of such collateral or
proceeds ratably with each of the Banks; provided, however, that if all or any
portion of such excess payment or benefits is thereafter recovered from such
Benefitted Bank, such purchase shall be rescinded, and the purchase price and
benefits returned, to the extent of such recovery, but without interest. The
Company agrees that each Bank so purchasing a portion of another Bank's Loan may
exercise all rights of a payment (including, without limitation, rights of
offset) with respect to such portion as fully as if such Bank were the direct
holder of such portion.

            8.8  Counterparts.  This Agreement may be executed by one or more of
the parties to this Agreement on any number of separate counterparts and all of
said counterparts taken together shall be deemed to constitute one and the same
instrument.  A set of the copies of this Agreement signed by all the parties
shall be lodged with the Company and the Agent.

            8.9  GOVERNING LAW.  THIS AGREEMENT AND THE NOTES AND THE RIGHTS AND
OBLIGATIONS OF THE PARTIES UNDER THIS AGREEMENT AND THE NOTES SHALL BE GOVERNED
BY, AND CONSTRUED AND INTERPRETED IN ACCORDANCE WITH, THE LAW OF THE STATE OF
NEW YORK.

            8.10  WAIVERS OF JURY TRIAL.  THE COMPANY, THE AGENT AND THE BANKS
EACH HEREBY IRREVOCABLY AND UNCONDITIONALLY WAIVE TRIAL BY JURY IN ANY LEGAL
ACTION OR PROCEEDING RELATING
<PAGE>
 
                                                                              46

TO THIS AGREEMENT, THE NOTES OR ANY OTHER DOCUMENT AND FOR ANY COUNTERCLAIM
THEREIN.

            8.11 Submission To Jurisdiction; Waivers.  The Company hereby
irrevocably and unconditionally:

                 (i)     submits for itself and its property in any legal action
     or proceeding relating to this Agreement, or for recognition and
     enforcement of any judgment in respect thereof, to the non-exclusive
     general jurisdiction of the Courts of the State of New York, the courts of
     the United States of America for the Southern District of New York, and
     appellate courts from any thereof; and

                 (ii)    consents that any such action or proceeding may be
     brought in such courts, and waives any objection that it may now or
     hereafter have to the venue of any such action or proceeding in any such
     court or that such action or proceeding was brought in an inconvenient
     court and agrees not to plead or claim the same.
<PAGE>
 
                                                                              47


          IN WITNESS WHEREOF, the parties hereto have caused this Agreement to
be duly executed and delivered by their proper and duly authorized officers as
of the day and year first above written.


                                   COLUMBIA/HCA HEALTHCARE CORPORATION


                                   By:  /s/ David G. Anderson
                                       -----------------------------------------
                                        Name:  David G. Anderson
                                        Title: Vice President Finance and 
                                               Treasurer


                                   THE CHASE MANHATTAN BANK, as Agent and as a 
                                   Bank


                                   By:  /s/ Dawn Lee Lum
                                       -----------------------------------------
                                        Name:  Dawn Lee Lum
                                        Title: Vice President


                                   ABN AMRO BANK N.V., as a Bank


                                   By:  /s/ Thomas S. Thornhill
                                       -----------------------------------------
                                        Name:  Thomas S. Thornhill
                                        Title: Group Vice President

                                   By:  /s/ Larry K. Kelley
                                       -----------------------------------------
                                        Name:  Larry K. Kelley
                                        Title: Group Vice President


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


                                   By:  /s/ J. Gregory Seibly
                                       -----------------------------------------
                                        Name:  J. Gregory Seibly
                                        Title: Vice President
<PAGE>
 
                                                                              48

                                  THE BANK OF NEW YORK, as Co-Agent


                                  By:  /s/ Ann Marie Hughes
                                      ------------------------------------------
                                       Name:  Ann Marie Hughes
                                       Title: Vice President


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


                                  By:  /s/ W.J. Brown
                                      ------------------------------------------
                                       Name:  W.J. Brown
                                       Title: Vice President


                                  DEUTSCHE BANK SECURITIES, INC., 
                                  as Co-Syndication Agent


                                  By:  /s/ Jean M. Hannigan      Iain Stewart
                                      ------------------------------------------
                                       Name:  Jean M. Hannigan   Iain Stewart
                                       Title: Vice President     Vice President


                                  DEUTSCHE BANK AG, NEW YORK AND/OR CAYMAN 
                                  ISLANDS BRANCH(ES), as a Bank


                                  By:  /s/ Jean M. Hannigan     Susan L. Pearson
                                      ------------------------------------------
                                       Name:  Jean M. Hannigan  Susan L. Pearson
                                       Title: Vice President    Director


                                  FIRST AMERICAN NATIONAL BANK, as a Bank


                                  By:  /s/ Sandy Hamrick 
                                      ------------------------------------------
                                       Name:  Sandy Hamrick
                                       Title: Senior Vice President
<PAGE>
 
                                                                              49

                                   THE FIRST NATIONAL BANK OF CHICAGO,
                                   as Co-Agent


                                   By:  /s/ L. Richard Schiller
                                       -----------------------------------------
                                        Name:  L. Richard Schiller
                                        Title: Vice President


                                   FIRST UNION NATIONAL BANK, as a Bank


                                   By:  /s/ James A. Hobensack
                                       -----------------------------------------
                                        Name:  James A. Hobensack
                                        Title: Senior Vice President


                                   FLEET NATIONAL BANK, as Co-Agent


                                   By:  /s/ Maryann S. Smith
                                       -----------------------------------------
                                        Name:  Maryann S. Smith
                                        Title: Vice President


                                   KEYBANK NATIONAL ASSOCIATION, as a Bank


                                   By:  /s/ Thomas J. Purcell
                                       -----------------------------------------
                                        Name:  Thomas J. Purcell
                                        Title: Vice President


                                   NATIONSBANK, N.A. as Documentation Agent and 
                                   as a Bank


                                   By:  /s/ Kevin Wagley
                                       -----------------------------------------
                                        Name:  Kevin Wagley
                                        Title: Vice President
<PAGE>
 
                                                                              50

                                   SUNTRUST BANK, NASHVILLE, N.A., as a Bank


                                   By:  /s/ Mark D. Mattson
                                       -----------------------------------------
                                        Name:  Mark D. Mattson
                                        Title: Vice President


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


                                   By:  /s/ Jorge A. Garcia
                                       -----------------------------------------
                                        Name:  Jorge A. Garcia
                                        Title: Vice President


                                   UNION PLANTERS BANK OF MIDDLE TENNESSEE, 
                                   N.A., as a Bank


                                   By:  /s/ William A. Collier
                                       -----------------------------------------
                                        Name:  William A. Collier
                                        Title: Vice President


                                   WACHOVIA BANK OF GEORGIA, N.A., as Co-Agent


                                   By:  /s/ Kenneth Washington
                                       -----------------------------------------
                                        Name:  Kenneth Washington
                                        Title: Vice President

<PAGE>
 
                                                                      EXHIBIT 12
 
                      COLUMBIA/HCA HEALTHCARE CORPORATION
               COMPUTATION OF RATIO OF EARNINGS TO FIXED CHARGES
          FOR THE QUARTERS AND SIX MONTHS ENDED JUNE 30, 1998 AND 1997
                             (DOLLARS IN MILLIONS)
 
<TABLE>
<CAPTION>
                                                         QUARTER   SIX MONTHS
                                                        --------- -------------
                                                        1998 1997  1998   1997
                                                        ---- ---- ------ ------
<S>                                                     <C>  <C>  <C>    <C>
EARNINGS:
Income from continuing operations before minority
 interests and income taxes............................ $309 $688 $  710 $1,495
Fixed charges, excluding capitalized interest..........  179  156    367    302
                                                        ---- ---- ------ ------
                                                        $488 $844 $1,077 $1,797
                                                        ==== ==== ====== ======
FIXED CHARGES:
Interest charged to expense............................ $145 $123 $  298 $  236
Interest portion of rental expense and amortization of
 deferred loan costs...................................   34   33     69     66
                                                        ---- ---- ------ ------
Fixed charges, excluding capitalized interest..........  179  156    367    302
Capitalized interest...................................    6    4     10     10
                                                        ---- ---- ------ ------
                                                        $185 $160 $  377 $  312
                                                        ==== ==== ====== ======
Ratio of earnings to fixed charges..................... 2.64 5.26   2.86   5.75
                                                        ==== ==== ====== ======
</TABLE>
 
                                       38

<TABLE> <S> <C>

<PAGE>
 
<ARTICLE> 5
<LEGEND>
THIS SCHEDULE CONTAINS SUMMARY FINANCIAL INFORMATION EXTRACTED FROM THE
STATEMENTS OF INCOME AND BALANCE SHEETS AND IS QUALIFIED IN ITS ENTIRETY BY
REFERENCE TO SUCH FINANCIAL STATEMENTS.
</LEGEND>
<MULTIPLIER> 1,000,000
       
<S>                             <C>
<PERIOD-TYPE>                   6-MOS
<FISCAL-YEAR-END>                          DEC-31-1998
<PERIOD-START>                             JAN-01-1998
<PERIOD-END>                               JUN-30-1998
<CASH>                                              25
<SECURITIES>                                         0
<RECEIVABLES>                                    4,086
<ALLOWANCES>                                     1,659
<INVENTORY>                                        462
<CURRENT-ASSETS>                                 4,046
<PP&E>                                          16,814
<DEPRECIATION>                                   6,442
<TOTAL-ASSETS>                                  21,048
<CURRENT-LIABILITIES>                            5,019
<BONDS>                                          5,693
                                0
                                          0
<COMMON>                                             6
<OTHER-SE>                                       7,574
<TOTAL-LIABILITY-AND-EQUITY>                    21,048
<SALES>                                              0
<TOTAL-REVENUES>                                 9,682
<CGS>                                                0
<TOTAL-COSTS>                                    5,476
<OTHER-EXPENSES>                                 1,901
<LOSS-PROVISION>                                   683
<INTEREST-EXPENSE>                                 298
<INCOME-PRETAX>                                    672
<INCOME-TAX>                                       280
<INCOME-CONTINUING>                                392
<DISCONTINUED>                                    (117)
<EXTRAORDINARY>                                      0
<CHANGES>                                            0
<NET-INCOME>                                       275
<EPS-PRIMARY>                                      .43<F1>
<EPS-DILUTED>                                      .43<F2>
<FN>
<F1> Basic per SFAS No. 128
<F2> Diluted per SFAS No. 128
</FN>
        

</TABLE>


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