GENESIS HEALTH VENTURES INC /PA
10-Q, 1998-05-15
SKILLED NURSING CARE FACILITIES
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<PAGE>

                                  UNITED STATES
                       SECURITIES AND EXCHANGE COMMISSION
                              Washington, DC 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 March 31, 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: 1-11666


                          GENESIS HEALTH VENTURES, INC.
             (Exact name of registrant as specified in its charter)

        Pennsylvania                                     06-1132947
(State or other jurisdiction of             (I.R.S. Employer Identification No.)
 incorporation or organization)

                              101 East State Street
                       Kennett Square, Pennsylvania 19348
          (Address, including zip code, of principal executive offices)

                                 (610) 444-6350
               (Registrant's telephone number including area code)


Indicate by check mark whether the registrant (1) has filed all reports required
to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during
the preceding 12 months (or for such shorter period that the registrant was
required to file such reports), and (2) has been subject to such filing
requirements for the past 90 days:

                                 YES [x] NO [ ]

Indicate the number of shares outstanding of each of the issuer's classes of
Common Stock, as of May 8, 1998: 35,154,917 shares of common stock


<PAGE>
                                TABLE OF CONTENTS

<TABLE>
<CAPTION>
                                                                                                 Page
                                                                                                 ----

<S>                                                                                                <C>
CAUTIONARY STATEMENT REGARDING FORWARD LOOKING STATEMENTS...........................................1


Part I:  FINANCIAL INFORMATION

         Item 1.  Financial Statements..............................................................2

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


Part II  OTHER INFORMATION

         Item 1.  Legal Proceedings................................................................22

         Item 2.  Changes in Securities............................................................22

         Item 3.  Defaults Upon Senior Securities..................................................22

         Item 4   Submission of Matters to a Vote of Security Holders..............................22

         Item 5.  Other Information................................................................22

         Item 6.  Exhibits and Reports on Form 8-K.................................................22


SIGNATURES ........................................................................................24

</TABLE>


<PAGE>
            CAUTIONARY STATEMENT REGARDING FORWARD LOOKING STATEMENTS

Certain oral statements made by management from time to time and certain
statements contained herein, including certain statements in "Management's
Discussion and Analysis of Financial Condition and Results of Operations" such
as statements concerning Medicaid and Medicare programs and the Company's
ability to meet its liquidity needs and control costs, certain statements in
Notes to Condensed Consolidated Financial Statements, such as certain Pro Forma
Financial Information; and other statements contained herein regarding matters
which are not historical facts are forward looking statements (as such term is
defined in the Securities Act of 1933) and because such statements involve risks
and uncertainties, actual results may differ materially from those expressed or
implied by such forward looking statements. Factors that could cause actual
results to differ materially include, but are not limited to those discussed
below:

1.   The Company's substantial indebtedness and significant debt service
     obligations.

2.   The Company's ability to secure the capital and the related cost of such
     capital necessary to fund its future growth through acquisition and
     development, as well as internal growth.

3.   Changes in the United States healthcare system, including changes in
     reimbursement levels under Medicaid and Medicare, implementation of a
     Medicare prospective payment system and consolidated billing and other
     changes in applicable government regulations that might affect the
     profitability of the Company.

4.   The Company's continued ability to operate in a heavily regulated
     environment and to satisfy regulatory authorities, thereby avoiding a
     number of potentially adverse consequences, such as the imposition of
     fines, temporary suspension of admission of patients, restrictions on the
     ability to acquire new facilities, suspension or decertification from
     Medicaid or Medicare programs, and, in extreme cases, revocation of a
     facility's license or the closure of a facility, including as a result of
     unauthorized activities by employees.

5.   The occurrence of changes in the mix of payment sources utilized by the
     Company's customers to pay for the Company's services.

6.   The adoption of cost containment measures by private pay sources such as
     commercial insurers and managed care organizations, as well as efforts by
     governmental reimbursement sources to impose cost containment measures.

7.   The level of competition in the Company's industry, including without
     limitation, increased competition from acute care hospitals, providers of
     assisted and independent living and providers of home health care and
     changes in the regulatory system, such as changes in certificate of need
     laws in the states in which the Company operates or anticipates operating
     in the future that facilitate such competition.

8.   The Company's ability to identify suitable acquisition candidates, to
     consummate or complete development projects, or to profitably operate or
     successfully integrate enterprises into the Company's other operations,
     including the proposed acquisition of Vitalink Pharmacy Services, Inc.

These and other factors have been discussed in more detail in the Company's
periodic reports including its Annual Report on Form 10-K/A for the fiscal year
ended September 30, 1997.

                                       1

<PAGE>

                          PART 1: FINANCIAL INFORMATION

                          Item I. Financial Statements

                 Genesis Health Ventures, Inc. and Subsidiaries
                 Unaudited Condensed Consolidated Balance Sheets
                 (in thousands, except share and per share data)
<TABLE>
<CAPTION>

                                                                            March 31,        September 30,
- ----------------------------------------------------------------------------------------------------------
                                                                              1998                1997
- ----------------------------------------------------------------------------------------------------------
<S>                                                                           <C>                  <C>   
Assets:                                                                                     
Current assets:                                                                            
        Cash and equivalents                                             $    15,574          $    11,651
        Investments in marketable securities                                  18,839               14,729
        Accounts receivable, net of allowance for doubtful accounts of                     
          $53,085 at March 31, 1998 and $39,418 at September 30, 1997        256,127              205,129
        Cost report receivables                                               63,224               60,865
        Inventory                                                             35,778               25,568
        Prepaid expenses and other current assets                             36,225               26,675
        Income taxes receivable                                                   --                7,820
- ----------------------------------------------------------------------------------------------------------
              Total current assets                                           425,767              352,437
- ----------------------------------------------------------------------------------------------------------
                                                                                           
Property, plant and equipment, net                                           572,749              578,397
Notes receivable and other investments                                        99,612              108,714
Other long-term assets                                                        67,120               31,722
Investments in unconsolidated affiliates                                     330,773                2,887
Goodwill and other intangibles, net                                          420,991              359,956
- ----------------------------------------------------------------------------------------------------------
              Total assets                                               $ 1,917,012          $ 1,434,113
==========================================================================================================
                                                                                           
Liabilities and Shareholders' Equity:                                                       
Current liabilities:                                                                       
        Accounts payable and accrued expenses                            $   136,152          $   117,234
        Income taxes payable                                                   1,586                 --
        Current installments of long-term debt                                27,242                8,273
- ----------------------------------------------------------------------------------------------------------
              Total current liabilities                                      164,980              125,507
- ----------------------------------------------------------------------------------------------------------
Long-term debt                                                             1,057,404              651,667
Deferred income taxes                                                         41,487               37,745
Deferred gain and other long-term liabilities                                 23,573               11,173
Shareholders' equity:                                                                      
        Common stock, par $.02, authorized 60,000,000 shares,                              
         issued and outstanding 35,153,004 and 35,107,403 at                              
         March 31, 1998; 35,117,075 and 35,071,474 at September 30, 1997         721                  702
        Additional paid-in capital                                           453,294              457,232
        Retained earnings                                                    175,796              150,330
        Treasury stock, at cost                                                 (243)                (243)
- ----------------------------------------------------------------------------------------------------------
              Total shareholders' equity                                     629,568              608,021
- ----------------------------------------------------------------------------------------------------------
              Total liabilities and shareholders'equity                  $ 1,917,012          $ 1,434,113
==========================================================================================================
</TABLE>
                                                              
See accompanying notes to condensed consolidated financial statements

                                       2

<PAGE>

                 Genesis Health Ventures, Inc. and Subsidiaries
            Unaudited Condensed Consolidated Statements Of Operations
                 (in thousands, except share and per share data)

<TABLE>
<CAPTION>

                                                                            Three months
                                                                           ended March 31,
- -----------------------------------------------------------------------------------------------
                                                                         1998           1997
- -----------------------------------------------------------------------------------------------

<S>                                                                       <C>            <C>         
Net revenues:
       Basic healthcare services                                   $    137,033   $    136,825
       Specialty medical services                                       176,922        124,488
       Management services and other, net                                30,344         11,950
- -----------------------------------------------------------------------------------------------
          Total net revenues                                            344,299        273,263
- -----------------------------------------------------------------------------------------------
                                                                                    
Operating expenses:                                                                 
       Salaries, wages and benefits                                     143,594        130,395
       Other operating expenses                                         125,544         84,886
       General corporate expense                                         14,139          9,907
Depreciation and amortization                                            12,667         10,620
Lease expense                                                             7,868          7,244
Interest expense, net                                                    18,688          8,960
- -----------------------------------------------------------------------------------------------
                                                                                    
       Income before income taxes and equity in net income                          
       of unconsolidated affiliates                                      21,799         21,251
Income taxes                                                              7,957          7,757
- -----------------------------------------------------------------------------------------------
       Income before equity in net income of unconsolidated                         
       affiliates                                                        13,842         13,494
Equity in net income of unconsolidated affiliates                           726             --
- -----------------------------------------------------------------------------------------------
          Net income                                               $     14,568   $     13,494
===============================================================================================
                                                                                    
Per common share data:                                                              
       Basic:                                                                       
        Net income                                                 $       0.42   $       0.39
        Weighted average shares of common stock                      35,093,962     34,873,809
- -----------------------------------------------------------------------------------------------
       Diluted:                                                                     
        Net income                                                 $       0.41   $       0.38
        Weighted average shares of common stock and equivalents      35,647,451     35,773,885
===============================================================================================
</TABLE>
                                                                               
See accompanying notes to condensed consolidated financial statements

                                       3
<PAGE>

                 Genesis Health Ventures, Inc. and Subsidiaries
            Unaudited Condensed Consolidated Statements of Operations
                 (in thousands, except share and per share data)

<TABLE>
<CAPTION>
                                                                                     Six months
                                                                                  ended March 31,
- ------------------------------------------------------------------------------------------------------------
                                                                            1998                    1997
- ------------------------------------------------------------------------------------------------------------
<S>                                                                         <C>                      <C>         
Net revenues:
        Basic healthcare services                                     $    275,049             $    270,917
        Specialty medical services                                         319,587                  238,667
        Management services and other, net                                  52,228                   22,223
- ------------------------------------------------------------------------------------------------------------
           Total net revenues                                              646,864                  531,807
- ------------------------------------------------------------------------------------------------------------

Operating expenses:
        Salaries, wages and benefits                                       283,948                  255,450
        Other operating expenses                                           218,532                  165,018
        General corporate expense                                           26,176                   19,529
Depreciation and amortization                                               24,353                   20,101
Lease expense                                                               14,511                   14,182
Interest expense, net                                                       38,331                   18,155
- ------------------------------------------------------------------------------------------------------------

        Income before income taxes, equity in net income
        of unconsolidated affiliates and extraordinary items                41,013                   39,372
Income taxes                                                                14,970                   14,370
- ------------------------------------------------------------------------------------------------------------
        Income before equity in net income of unconsolidated
        affiliates and extraordinary items                                  26,043                   25,002
Equity in net income of unconsolidated affiliates                            1,347                        -
- ------------------------------------------------------------------------------------------------------------
        Income before extraordinary items                                   27,390                   25,002
Extraordinary items, net of tax                                             (1,924)                    (553)
- ------------------------------------------------------------------------------------------------------------
           Net income                                                 $     25,466                 $ 24,449
============================================================================================================

Per common share data:
        Basic:
           Income before extraordinary items                          $       0.78             $       0.74
           Extraordinary items                                               (0.05)                   (0.02)
           Net Income                                                 $       0.73             $       0.72
           Weighted average shares of common stock                      35,084,965               33,996,555
- ------------------------------------------------------------------------------------------------------------
        Diluted:
           Income before extraordinary items                          $       0.77             $       0.71
           Extraordinary items                                               (0.05)                   (0.02)
           Net Income                                                 $       0.71             $       0.70
           Weighted average shares of common stock and equivalents      35,658,191               35,589,134
============================================================================================================
</TABLE>

See accompanying notes to condensed consolidated financial statements

                                       4
<PAGE>

                 Genesis Health Ventures, Inc. and Subsidiaries
            Unaudited Condensed Consolidated Statements of Cash Flows
                                 (in thousands)


<TABLE>
<CAPTION>
                                                                                                Six months ended
                                                                                                     March 31,
                                                                                               1998             1997
- ------------------------------------------------------------------------------------------------------------------------

<S>                                                                                      <C>                 <C>       
Cash flows from operating activities:
       Net income                                                                        $     25,466        $   24,449
       Adjustments to reconcile net income to
            net cash provided by operating activities:
       Charges (credits) included in operations not requiring funds:
               Provision for deferred taxes                                                     3,742             3,592
               Depreciation and amortization                                                   24,353            20,101
               Amortization of deferred gain and debt premium                                    (592)             (230)
               Equity in net income of unconsolidated affiliates                               (1,347)                -
               Extraordinary items, net of tax                                                  1,924               553
       Changes in assets and liabilities excluding the effects of acquisitions:
               Accounts receivable                                                            (24,613)          (27,363)
               Cost reports receivable                                                         (2,436)           (5,907)
               Inventory                                                                       (2,873)           (5,236)
               Prepaid expenses and other current assets                                       (6,650)           (5,069)
               Accounts payable and accrued expenses                                           (1,283)            6,983
               Income taxes receivable and payable                                              9,396             6,522
- ------------------------------------------------------------------------------------------------------------------------
       Total adjustments                                                                         (379)           (6,054)
- ------------------------------------------------------------------------------------------------------------------------
       Net cash provided by operations                                                         25,087            18,395
- ------------------------------------------------------------------------------------------------------------------------

Cash flows from investing activities:
       Capital expenditures                                                                   (24,342)          (33,778)
       Payments for acquisitions, net of cash acquired                                       (100,929)         (233,665)
       Investments in unconsolidated affiliates                                              (326,539)                -
       Net proceeds from the sale of assets                                                    60,555                 -
       Notes receivable and other investment and asset additions, net                         (26,977)          (11,025)
- ------------------------------------------------------------------------------------------------------------------------
       Net cash used in investing activities                                                 (418,232)         (278,468)
- ------------------------------------------------------------------------------------------------------------------------

Cash flows from financing activities:
       Net borrowings (repayments) under working capital revolving credit                    (181,024)          140,783
       Repayment of long term debt                                                             (9,583)           (1,955)
       Proceeds from issuance of long-term debt                                               611,241           125,000
       Debt issuance costs                                                                    (19,648)           (3,750)
       Purchase of common stock call options                                                   (4,442)                -
       Common stock options exercised                                                             524             1,067
- ------------------------------------------------------------------------------------------------------------------------
       Net cash provided by financing activities                                              397,068           261,145
- ------------------------------------------------------------------------------------------------------------------------

Net increase in cash and equivalents                                                            3,923             1,072
Cash and equivalents
       Beginning of period                                                                     11,651            12,763
       End of period                                                                     $     15,574        $   13,835
========================================================================================================================

Supplemental disclosure of cash flow information
        Interest paid                                                                    $     38,664        $   14,533
        Income taxes paid                                                                $      1,821        $    6,873
========================================================================================================================
</TABLE>

See accompanying notes to condensed consolidated financial statements

                                       5

<PAGE>



                 GENESIS HEATLH VENTURES, INC. AND SUBSIDIARIES
         NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

1.       General

The accompanying unaudited condensed consolidated financial statements should be
read in conjunction with the consolidated financial statements and the notes
thereto included in the Company's annual report for the fiscal year ended
September 30, 1997. The information furnished is unaudited but reflects all
adjustments which are, in the opinion of management, necessary for a fair
presentation of the financial information for the periods shown. Such
adjustments are of a normal recurring nature. Interim results are not
necessarily indicative of results expected for the full year. Certain prior
period balances have been reclassified to conform with the current period
presentation.

2.       Sale of Assets

On January 30, 1998, Genesis successfully completed deleveraging transactions
with ElderTrust, a newly formed Maryland healthcare real estate investment
trust. Genesis, a co-registrant on the ElderTrust initial public offering,
received approximately $78,000,000 in proceeds from the sale of 13 properties to
ElderTrust, including four properties it had purchased from Crozer-Keystone
Health System in anticipation of resale to ElderTrust. Subsequently, Genesis
received an additional $14,000,000 from the sale of a loan and two additional
assisted living facilities and the recoupment of amounts advanced and expenses
incurred in connection with the formation of ElderTrust. Additionally,
ElderTrust has funded approximately $13,200,000 of a commitment to finance the
development and expansion of four additional assisted living facilities. Genesis
repaid a portion of the revolving credit component of its bank credit facility
with the proceeds from these transactions. The sale of properties to ElderTrust
resulted in a gain of approximately $12,000,000 which has been deferred and is
being amortized over the ten year term of the lease contracts with ElderTrust.

3.       Long-Term Debt

In October 1997, in connection with the Multicare Transaction (defined below),
Genesis entered into a new credit facility with Mellon Bank, N.A., Citicorp
Securities, Inc., Citibank N.A., First Union Capital Markets Corp., First Union
National Bank and NationsBank, N.A. (the "Lenders") pursuant to which the
Lenders provided Genesis and its subsidiaries with loan facilities totaling
$850,000,000 (the "Genesis Bank Financing") for the purpose of refinancing
certain existing indebtedness of Genesis; funding interest and principal
payments on the facilities and certain remaining indebtedness; funding permitted
acquisitions; funding Genesis' commitments in connection with the Merger
(defined below); and funding Genesis' and its subsidiaries' working capital for
general corporate purposes, including fees and expenses of the transactions. The
Genesis Bank Financing facilities consist of three $200,000,000 term loans
(collectively, the "Term Loans"), a $250,000,000 revolving credit loan (the
"Revolving Credit Facility"), which includes one or more Swing Loans
(collectively, the "Swing Loan Facility") in integral principal multiples of
$500,000 up to an aggregate unpaid principal amount of $15,000,000. The Term
Loans amortize in quarterly installments beginning in fiscal 1998 through 2005,
of which $19,000,000 is payable over the next twelve months. The Term Loans
consist of (1) a $200,000,000 six year term loan (the "Tranche A Term
Facility"); (2) a $200,000,000 seven year term loan (the "Tranche B Term
Facility"); and (3) a $200,000,000 eight year term loan (the "Tranche C Term
Facility"). The Revolving Credit Facility becomes payable in full on September
30, 2003.

The Genesis Bank Financing facilities are secured by a first priority security
interest in all of the stock, partnership interests and other equity of all of
Genesis' present and future subsidiaries (including the Genesis Elder Care
Corp.) other than stock of Multicare and its subsidiaries. Loans under the
Genesis Bank Financing bear, at Genesis' option, interest at the per annum Prime
Rate as announced by the administrative agent, or the applicable Adjusted LIBOR.
Loans under the Tranche A Term Facility bear interest at an annual rate equal to
LIBOR plus a margin up to 2.5%, loans under the Tranche B Term Facility bear
interest at an annual rate equal to LIBOR plus a margin up to 2.75%; loans under
the Tranche C Term Facility bear interest at an annual rate equal to LIBOR plus
a margin up to 3.0%; loans under the Revolving Credit Facility bear interest at
a rate equal to LIBOR plus a margin up to 2.5%, and loans under the Swing Loan
Facility bear interest at the Prime Rate unless otherwise agreed to by the
parties. Subject to meeting certain financial covenants, the above referenced
interest rates will be reduced.

                                       6
<PAGE>

4.       Earnings Per Share

In the first quarter of 1998, the Company adopted the provisions of Statement of
Financial Accounting Standards No. 128 "Earnings Per Share" (Statement 128).
Statement 128, which makes the standards for computing earnings per share more
comparable to international standards, replaces the presentation of primary and
fully diluted earnings per share with a presentation of basic and diluted
earnings per share. Statement 128 requires dual presentation of basic and
diluted earnings per share on the face of the income statement of all entities
with complex capital structures. The Company has restated its earnings per share
data for the three and six months ended March 31, 1997 to conform to the
provisions of Statement 128 (amounts are in thousands except per share data):
<TABLE>
<CAPTION>

                                                      Three         Three         Six          Six
                                                      Months       Months       Months       Months 
                                                      Ended        Ended        Ended        Ended
                                                    March 31,     March 31,    March 31,     March 31,
                                                       1998         1997         1998          1997
                                                   ------------- ------------ ------------ --------------
<S>                                                     <C>          <C>          <C>            <C>    
Basic Earnings Per Share:
Income before extraordinary items                       $14,568      $13,494      $27,390        $25,002
Extraordinary items                                           -            -       (1,924)          (553)
                                                   ------------- ------------ ------------ --------------
Net income                                              $14,568      $13,494      $25,466        $24,449
                                                   ============= ============ ============ ==============


Weighted average shares                                  35,094       34,874       35,085         33,997
                                                   ------------- ------------ ------------ --------------

Earnings per share before extraordinary items             $0.42        $0.39        $0.78          $0.74
Earning per share - extraordinary items                       -            -        (0.05)         (0.02)
                                                   ------------- ------------ ------------ --------------
Earnings per share                                        $0.42        $0.39        $0.73          $0.72
                                                   ------------- ------------ ------------ --------------

Diluted Earnings Per Share:
Income before extraordinary items                       $14,568      $13,494      $27,390        $25,002
Extraordinary items                                           -            -       (1,924)          (553)
                                                   ------------- ------------ ------------ --------------
Net income                                              $14,568      $13,494      $25,466        $24,449
Adjustments to net income for interest expense,
amortization and other costs related to the
assumed conversion of convertible debentures                  -            -            -            303
                                                   ------------- ------------ ------------ --------------
Adjusted net income                                     $14,568      $13,494      $25,466        $24,752
                                                   ------------- ------------ ------------ --------------
Weighted Average Shares & Common Stock
Equivalents:
Common shares                                            35,094       34,874       35,085         33,997
Dilutive effect of unexcercised stock options               553          900          573            712
Convertible debenture shares                                  -            -                         880
                                                   ------------- ------------ ------------ --------------
Total                                                    35,647       35,774       35,658         35,589
                                                   ------------- ------------ ------------ --------------

Earnings per share before extraordinary items             $0.41        $0.38        $0.77          $0.71
Earnings per share - extraordinary items                      -            -        (0.05)         (0.02)
                                                   ------------- ------------ ------------ --------------
Earnings per share                                        $0.41        $0.38        $0.71          $0.70
</TABLE>

                                        7
<PAGE>



5.       Proforma Financial Information

On October 9, 1997 Genesis ElderCare Acquisition Corp. ("Acquisition Corp."), a
wholly-owned subsidiary of Genesis ElderCare Corp., a Delaware corporation
formed by Genesis, The Cypress Group L.L.C. (together with its affiliates,
"Cypress"), TPG Partners II, L.P., (together with its affiliates, "TPG") and
Nazem, Inc. (together with its affiliates "Nazem"), acquired 99.65% of the
shares of common stock of the Multicare Companies, Inc. ("Multicare"), pursuant
to a tender offer commenced on June 20, 1997 (the "Tender Offer"). On October
10, 1997, Genesis ElderCare Corp. completed the merger (the "Merger" or the
"Multicare Transaction") of Acquisition Corp. with and into Multicare in
accordance with the Agreement and Plan of Merger (the "Merger Agreement") dated
as of June 16, 1997, by and among Genesis ElderCare Corp., Acquisition Corp.,
Genesis and Multicare. Upon consummation of the Merger, Multicare became a
wholly-owned subsidiary of Genesis ElderCare Corp. Multicare is in the business
of providing eldercare and specialty medical services in selected geographic
regions. Included among the operations acquired by Genesis ElderCare Corp. are
operations relating to the provision of ( i ) eldercare services including
skilled nursing care, assisted living, Alzheimer's care and related support
activities traditionally provided in eldercare facilities, (ii) specialty
medical services consisting of (1) sub-acute care such as ventilator care,
intravenous therapy and various forms of coma, pain and wound management and (2)
rehabilitation therapies such as occupational, physical and speech therapy and
stroke and orthopedic rehabilitation and (iii) management services and
consulting services to eldercare centers.

In connection with the Merger, Multicare and Genesis entered into a management
agreement (the "Management Agreement") pursuant to which Genesis manages
Multicare's operations. The Management Agreement has a term of five years with
automatic renewals for two years unless either party terminates the Management
Agreement. Genesis is paid a fee of six percent of Multicare's net revenues for
its services under the Management Agreement provided that payment of such fee in
respect of any month in excess of the greater of ( i ) $1,992,000 or (ii) four
percent of Multicare's consolidated net revenues for such month, shall be
subordinate to the satisfaction of Multicare's senior and subordinate debt
covenants; and provided, further, that payment of such fee shall be no less than
$23,900,000 in any given year. Under the Management Agreement, Genesis is
responsible for Multicare's non-extraordinary sales, general and administrative
expenses (other than certain specified third-party expenses), and all other
expenses of Multicare are paid by Multicare. Genesis also entered into an asset
purchase agreement (the "Therapy Purchase Agreement") with Multicare and certain
of its subsidiaries pursuant to which Genesis acquired all of the assets used in
Multicare's outpatient and inpatient rehabilitation therapy business for
$24,000,000 subject to adjustment (the "Therapy Purchase") and a stock purchase
agreement (the "Pharmacy Purchase Agreement") with Multicare and certain
subsidiaries pursuant to which Genesis acquired all of the outstanding capital
stock and limited partnership interest of certain subsidiaries of Multicare that
are engaged in the business of providing institutional pharmacy services to
third parties for $50,000,000 subject to adjustment. The Company completed the
pharmacy purchase effective January 1, 1998.

Genesis ElderCare Corp. paid approximately $1,492,000,000 to (i) purchase the
Shares pursuant to the Tender Offer and the Merger, (ii) pay fees and expenses
to be incurred in connection with the completion of the Tender Offer, Merger and
the financing transactions in connection therewith, (iii) refinance certain
indebtedness of Multicare and (iv) make certain cash payments to employees. Of
the funds required to finance the foregoing, approximately $745,000,000 were
furnished to Acquisition Corp. as capital contributions by Genesis ElderCare
Corp. from the sale by Genesis ElderCare Corp. of its Common Stock ("Genesis
ElderCare Corp. Common Stock") to Cypress, TPG, Nazem and Genesis. Cypress, TPG
and Nazem purchased shares of Genesis ElderCare Corp. Common Stock for a
purchase price of $210,000,000, $199,500,000 and $10,500,000, respectively, and
Genesis purchased approximately 44% of the commons stock of Genesis ElderCare
Corp. for a purchase price of $325,000,000. The balance of the funds necessary
to finance the foregoing came from (i) the proceeds of loans from a syndicate of
lenders in the aggregate amount of $525,000,000 and (ii) $246,800,000 of
financing upon the completion of the sale of 9% Senior Subordinated Notes due
2007 (the "9% Notes") sold by Acquisition Corp. on August 11, 1997.

                                       8

<PAGE>

In connection with the Multicare Transaction, Genesis, Cypress, TPG and Nazem
entered into an agreement (the "Put/Call Agreement") pursuant to which, among
other things, Genesis will have the option, on the terms and conditions set
forth in the Put/Call Agreement, to purchase (the "Call") Genesis ElderCare
Corp. Common Stock held by Cypress, TPG and Nazem commencing on October 9, 2001
and for a period of 270 days thereafter, at a price determined pursuant to the
terms of the Put/Call Agreement. Cypress, TPG and Nazem will have the option, on
the terms and conditions set forth in the Put/Call Agreement, to require Genesis
to purchase (the "Put") such Genesis ElderCare Corp. Common Stock commencing on
October 9, 2002 and for a period of one year thereafter, at a price determined
pursuant to the Put/Call Agreement.

The prices determined for the Put and Call are based on a formula that
calculates the equity value attributable to Cypress', TPG's and Nazem's Genesis
ElderCare Corp. Common Stock, plus a portion of the Genesis Pharmacy business
(the "Calculated Equity Value"). The Calculated Equity Value will be determined
based upon a multiple of Genesis ElderCare Corp.'s earnings before interest,
taxes, depreciation, amortization and rental expenses, as adjusted ("EBITDAR")
after deduction of certain liabilities, plus a portion of the EBITDAR related to
the Genesis pharmacy business. The multiple to be applied to EBITDAR will depend
on whether the Put or the Call is being exercised. Any payment to Cypress, TPG
or Nazem under the Call or the Put may be in the form of cash or Genesis common
stock at Genesis' option.

Upon exercise of the Call, Cypress, TPG and Nazem will receive at a minimum
their original investment plus a 25% compound annual return thereon regardless
of the Calculated Equity Value. Any additional Calculated Equity Value
attributable to Cypress', TPG's or Nazem's Genesis ElderCare Corp. Common Stock
will be determined on the basis set forth in the Put/Call Agreement which
provides generally for additional Calculated Equity Value of Genesis ElderCare
Corp. to be divided based upon the proportionate share of the capital
contributions of the stockholders to Genesis ElderCare Corp. Upon exercise of
the Put by Cypress, TPG or Nazem, there will be no minimum return to Cypress, or
TPG or Nazem; any payment to Cypress, TPG or Nazem will be limited to Cypress',
TPG's or Nazem's share of the Calculated Equity Value based upon a formula set
forth in the terms of the Put/Call Agreement which provides generally for the
preferential return of the stockholders' capital contributions (subject to
certain priorities), a 25% compound annual return on Cypress', TPG's or Nazem's
capital contributions and the remaining Calculated Equity Value to be divided
based upon the proportionate share of the capital contributions of the
stockholders to Genesis ElderCare Corp.

Cypress', TPG's and Nazem's rights to exercise the Put will be accelerated upon
an event of bankruptcy of Genesis, a change of control of Genesis or an
extraordinary dividend or distribution or the occurrence of the leverage
recapitalization of Genesis. Upon an event of acceleration or the failure by
Genesis to satisfy its obligations upon exercise of the Put, Cypress, TPG and
Nazem will have the right to terminate the Stockholders' Agreement and
Management Agreement and to control the sale or liquidation of Genesis ElderCare
Corp. In the event of such sale, the proceeds from such sale will be distributed
among the parties as contemplated by the formula for the Put option exercise
price and Cypress, TPG and Nazem will retain a claim against Genesis for the
difference, if any, between the proceeds of such sale and the put option
exercise price. In the event of a bankruptcy or change of control of Genesis,
the option price shall be payable solely in cash provided any such payment will
be subordinated to the payment of principal and interest under the Genesis Bank
Financing.

The following unaudited pro forma statement of operations information gives
effect to the Multicare Transaction, which was accounted for using the equity
method of accounting and the Therapy Purchase and Pharmacy Purchase, using the
purchase method of accounting as though they had occurred on October 1, 1996,
after giving effect to certain adjustments, including recognition of management
fee income, amortization of goodwill, additional depreciation expense and
increased interest expense on debt related to the transactions. The pro forma
financial information, which includes preliminary allocations of purchase price
to goodwill and property, plant and equipment that are subject to change, does
not necessarily reflect the results of operations that would have occurred had
the transactions occurred at the beginning of period presented
 
                                      9
<PAGE>
<TABLE>
<CAPTION>

                                                     (In thousands, except per share data)
                                                        Six Months Ended        Six Months Ended
Pro Forma Statement of Operations Information:           March 31, 1998         March 31, 1997
                                                     ------------------         --------------

<S>                                                       <C>                   <C>           
Total net revenue                                         $     662,885         $      597,749
Income before extraordinary items                                26,990                 19,623
Net income                                                       25,066                 19,070
Earnings per share, before extraordinary items, diluted            0.76                   0.56
Earnings per share, diluted                               $        0.70         $         0.54
</TABLE>



6.       Summary financial information of unconsolidated affiliate

The following unaudited summary financial data for the Multicare Companies is as
of and for the three and six months ended March 31, 1998. Multicare is the
Company's only material unconsolidated affiliate.

(in thousands)
<TABLE>
<CAPTION>
                                                                              March 31, 1998
                                                                             -----------------
<S>                                                            <C>                    <C>     
Total assets                                                                        $1,708,216
Long-term debt                                                                         732,587
Total liabilities                                                                     $960,491

                                                          Three months          Six months 
                                                        ended March 31,       ended March 31, 
                                                              1998                  1998
                                                       ---------------------------------------

Revenues                                                       $170,164               $355,942
Net income                                                       $1,367                 $2,725
</TABLE>



7.       Subsequent Event

On April 26, 1998, Genesis Health Ventures, Inc. and its wholly owned subsidiary
V Acquisition Corporation, a Delaware corporation ("Newco"), entered into an
Agreement and Plan of Merger (the "Merger Agreement") with Vitalink Pharmacy
Services, Inc., a Delaware corporation ("Vitalink"). Pursuant to the Merger
Agreement, Vitalink will merge with and into Newco, and Newco shall be the
surviving corporation (the "Merger"). Each share of Vitalink Common Stock, par
value .01 per share, (the "Vitalink Common Stock") will be converted in the
Merger into the right to receive (1) .045 shares of Genesis Series G Cumulative
Convertible Preferred Stock, par value .01 per share, ("Genesis Preferred"), (2)
$22.50 per share in cash, or (3) a combination of cash and shares of Genesis
Preferred (collectively, the "Merger Consideration"), subject to statutory
appraisal rights. The Genesis Preferred will have an initial annual dividend of
5.9375%. The total consideration to be paid to stockholders of Vitalink to
acquire their shares (including shares which may be issued upon the exercise of
outstanding options) is approximately $600,000,000, of which approximately 50%
will be paid in cash and 50% in Genesis Preferred. As a result of the Merger,
Genesis will assume approximately $90,000,000 of indebtedness Vitalink has
outstanding. The transaction has been unanimously approved by the Boards of
Directors of both companies. The transaction is subject to regulatory and
shareholder approval of both companies as well as receipt of financing and is
expected to close in late fiscal year 1998.

                                       10
<PAGE>

Manor Care, Inc. ("Manor Care"), the holder of approximately 50% of the shares
of Vitalink, has agreed to elect to exchange all of its Vitalink shares for the
preferred stock. The form of Manor Care's consideration will be prorated to the
extent that other Vitalink shareholders elect to receive preferred stock.

The Genesis Preferred will not be transferable without the consent of Genesis
until the filing by the Company of the registration statement with the
Securities and Exchange Commission covering the sale of shares of Genesis
Preferred by the holders. Manor Care has the right to require Genesis to
register shares of its Genesis Preferred in certain circumstances beginning one
year after the date of the Merger. The Genesis Preferred will be convertible
into Genesis common shares at $37.20 per share and it may be called for
conversion after three years, provided Genesis' stock price reaches certain
trading levels. In addition, after the fourth year, the Genesis Preferred may be
called for conversion by Genesis subject to a market-based call premium
provision.

Manor Care has provided Genesis with an irrevocable proxy to vote its Vitalink
shares in favor of the merger. Upon closing of the transaction, it is
anticipated that Manor Care will own approximately 18% of Genesis' pro forma
diluted shares outstanding assuming the Vitalink shareholders other than Manor
Care elect to receive cash for their shares. Manor Care will be subject to
certain voting and standstill agreements and will have one representative on the
Genesis Board of Directors.

On and after April 29, 1998, certain shareholders of Vitalink filed suit in
Delaware state court against Vitalink and certain of its officers and directors,
Genesis, and Manor Care alleging, among other things, that Vitalink and Manor
Care have breached certain fiduciary duties to the Vitalink shareholders in
connection with the Merger Agreement and the transactions contemplated thereby,
and that Genesis has knowingly aided and abetted the alleged breach. The
shareholders mentioned above are seeking to enjoin Manor Care, Vitalink, and
Genesis from proceeding with the Merger and the transactions contemplated
thereby.

                                       11
<PAGE>



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

General

Since the Company began operations in July 1985, it has focused its efforts on
providing an expanding array of specialty medical services to geriatric
patients. The delivery of these services was originally concentrated in the
eldercare centers owned and leased by the Company, but now also includes managed
eldercare centers, independent healthcare facilities, outpatient clinics and
home health care. The Company generates revenues from three sources: basic
healthcare services, specialty medical services and management services and
other. The Company includes in basic healthcare services revenues all room and
board charges for its eldercare customers at its 111 owned and leased eldercare
centers. Specialty medical services include all revenues from providing
rehabilitation therapies, institutional pharmacy and medical supply services,
professional pharmacy services, subacute care programs, home health care,
physician services, and other specialized services to all centers owned, leased
or managed by Genesis, as well as to over 800 independent healthcare providers.
Management services and other include fees earned for management of eldercare
centers, other service related businesses and transactional revenues. Genesis
manages 213 eldercare centers, 115 of which are jointly-owned (including the
impact of the Multicare Transaction defined in Certain Transactions).

Certain Transactions

On April 26, 1998, Genesis Health Ventures, Inc. and its wholly owned subsidiary
V Acquisition Corporation, a Delaware corporation ("Newco"), entered into an
Agreement and Plan of Merger (the "Merger Agreement") with Vitalink Pharmacy
Services, Inc., a Delaware corporation ("Vitalink"). Pursuant to the Merger
Agreement, Vitalink will merge with and into Newco, and Newco shall be the
surviving corporation (the "Merger"). Each share of Vitalink Common Stock, par
value .01 per share, (the "Vitalink Common Stock") will be converted in the
Merger into the right to receive (1) .045 shares of Genesis Series G Cumulative
Convertible Preferred Stock, par value .01 per share, ("Genesis Preferred"), (2)
$22.50 per share in cash, or (3) a combination of cash and shares of Genesis
Preferred (collectively, the "Merger Consideration"), subject to statutory
appraisal rights. The Genesis Preferred will have an initial annual dividend of
5.9375%. The total consideration to be paid to stockholders of Vitalink to
acquire their shares (including shares which may be issued upon the exercise of
outstanding options) is approximately $600,000,000, of which approximately 50%
will be paid in cash and 50% in Genesis Preferred. As a result of the Merger,
Genesis will assume approximately $90,000,000 of indebtedness Vitalink has
outstanding. The transaction has been unanimously approved by the Boards of
Directors of both companies. The transaction is subject to regulatory and
shareholder approval of both companies as well as receipt of financing and is
expected to close in late fiscal year 1998.


On October 9, 1997, Genesis ElderCare Acquisition Corp. ("Acquisition Corp."), a
wholly-owned subsidiary of Genesis ElderCare Corp., a Delaware corporation
formed by Genesis, The Cypress Group L.L.C. (together with its affiliates,
"Cypress"), TPG Partners II, L.P., (together with its affiliates, "TPG") and
Nazem, Inc. (together with its affiliates, "Nazem"), acquired 99.65% of the
shares of common stock of the Multicare Companies, Inc. ("Multicare"), pursuant
to a tender offer commenced on June 20, 1997 (the "Tender Offer"). On October
10, 1997, Genesis ElderCare Corp. completed the merger (the "Merger or the
Multicare Transaction") of Acquisition Corp. with and into Multicare in
accordance with the Agreement and Plan of Merger (the "Merger Agreement") dated
as of June 16, 1997 by and among Genesis ElderCare Corp., Acquisition Corp.,
Genesis and Multicare. Upon consummation of the Merger, Multicare became a
wholly-owned subsidiary of Genesis ElderCare Corp. Multicare is in the business
of providing eldercare and specialty medical services in selected geographic
regions. Included among the operations acquired by Genesis ElderCare Corp. are
operations relating to the provision of ( i ) eldercare services including
skilled nursing care, assisted living, Alzheimer's care and related support
activities traditionally provided in eldercare facilities, (ii) specialty
medical services consisting of (1) sub-acute care such as ventilator care,
intravenous therapy and various forms of coma, pain and wound management and (2)
rehabilitation therapies such as occupational, physical and speech therapy and
stroke and orthopedic rehabilitation and (iii) management services and
consulting services to eldercare centers.

                                       12
<PAGE>

In connection with the Merger, Multicare and Genesis entered into a management
agreement (the "Management Agreement") pursuant to which Genesis manages
Multicare's operations. The Management Agreement has a term of five years with
automatic renewals for two years unless either party terminates the Management
Agreement. Genesis is paid a fee of six percent of Multicare's net revenues for
its services under the Management Agreement provided that payment of such fee in
respect of any month in excess of the greater of ( i ) $1,992,000 or (ii) four
percent of Multicare's consolidated net revenues for such month, shall be
subordinate to the satisfaction of Multicare's senior and subordinate debt
covenants; and provided, further, that payment of such fee shall be no less than
$23,900,000 in any given year. Under the Management Agreement, Genesis is
responsible for Multicare's non-extraordinary sales, general and administrative
expenses (other than certain specified third-party expenses), and all other
expenses of Multicare are paid by Multicare. Genesis also entered into an asset
purchase agreement (the "Therapy Sale Agreement") with Multicare and certain of
its subsidiaries pursuant to which Genesis acquired all of the assets used in
Multicare's outpatient and inpatient rehabilitation therapy business for
$24,000,000 subject to adjustment (the "Therapy Sales") and a stock purchase
agreement (the "Pharmacy Sale Agreement") with Multicare and certain
subsidiaries pursuant to which Genesis acquired all of the outstanding capital
stock and limited partnership intersest of certain subsidiaries of Multicare
that are engaged in the business of providing institutional pharmacy services to
third parties for $50,000,000, subject to adjustment. The Company completed the
pharmacy purchase effective Janauary 1, 1998.

Genesis Eldercare Corp. paid approximately $1,492,000,000 to (i) purchase the
Shares pursuant to the Tender Offer and the Merger, (ii) pay fees and expenses
to be incurred in connection with the completion of the Tender Offer, Merger and
the financing transactions in connection therewith, (iii) refinance certain
indebtedness of Multicare and (iv) make certain cash payments to employees. Of
the funds required to finance the foregoing, approximately $745,000,000 were
furnished to Acquisition Corp. as capital contributions by the Genesis ElderCare
Corp. from the sale by Genesis ElderCare Corp. of its Common Stock ("Genesis
ElderCare Corp. Common Stock") to Cypress, TPG, Nazem and Genesis. Cypress, TPG
and Nazem purchased shares of Genesis ElderCare Corp. Common Stock for a
purchase price of $210,000,000, $199,500,000 and $10,500,000, respectively, and
Genesis purchased approximately 44% of the common stock of Genesis ElderCare
Corp. fora purchase price of $325,000,000. The balance of the funds necessary to
finance the foregoing came from (i) the proceeds of loans from a syndicate of
lenders in the aggregate amount of $525,000,000 and (ii) $246,800,000 of
financing upon completion of the sale of 9% Senior Subordinated Notes due 2007
(the "9% Notes") sold by Acquisition Corp. on August 11, 1997.

In the fourth quarter of 1997, the Company entered into an agreement with Blue
Cross Blue Shield of Maryland (BCBSMD) to insure, through a sub-capitation
agreement, the health care benefits of approximately 7,000 members of BCBSMD's
Care First Medicare risk product. In the second quarter of 1998, the Company
received approximately $7,300,000 of capitation revenue and incurred a like
amount of costs associated with this agreement. In the fourth quarter of 1997,
the Company recorded a pre-tax special charge of $5,000,000 to accrue for the
estimated loss inherent in the agreement.

Results of Operations

Three months ended March 31, 1998 compared to three months ended March 31, 1997.

The Company's total net revenues for the quarter ended March 31, 1998 were
$344,299,000 compared to $273,263,000 for the quarter ended March 31, 1997, an
increase of $71,036,000 or 26%. Basic healthcare services increased $208,000
principally due to providing care to higher acuity patients and rate increases,
offset by the termination of operations by Genesis of three leased eldercare
centers in September 1997.

                                       13
<PAGE>

Specialty medical services revenue increased $52,434,000 or 42% of which
approximately $26,200,000 is attributed to the purchase of the Multicare
pharmacy business, approximately $5,100,000 is attributed to the purchase of the
Multicare rehabilitation therapy business and the remaining increase of
approximately $21,100,000 is primarily due to other volume growth in the
institutional pharmacy, medical supply and contract therapy divisions, general
rate increases and increased acuity in the health centers division. Specialty
medical service revenue per patient day in the health centers division increased
11% to $38.32 in the quarter ended March 31, 1998 compared to $34.58 in the
quarter ended March 31, 1997 primarily due to treatment of higher acuity
patients. Management services and other income increased $18,394,000 or 154%.
This increase is due to approximately $10,200,000 of management fee revenue
earned from the management of the operations of the Multicare business,
approximately $7,300,000 of capitated revenue earned under a contract with
BlueCross / Blue Shield of Maryland with the remaining increase of approximately
$900,000 due to growth in revenue from existing management contracts and other
service related businesses.

The Company's operating expenses before depreciation, amortization, lease
expense, and interest expense were $283,277,000 for the quarter ended March 31,
1998 compared to $225,188,000 for the quarter ended March 31, 1997, an increase
of $58,089,000 or 26%, of which approximately $2,500,000 is due to the operating
costs incurred to service the Multicare management contract, approximately
$21,600,000 is due to the acquisition of the Multicare pharmacy operations,
approximately $4,500,000 is due the acquisition of the Multicare rehabilitation
therapy business, approximately $7,300,000 is due to costs incurred in
connection with capitation costs incurred under a contract with Blue Cross /
Blue Shield of Maryland and the remaining increase of approximately $22,200,000
is attributed to growth in the institutional pharmacy, medical supply and
contract therapy divisions, as well as increased costs in information technology
systems, community-based programs and marketing campaigns.

Interest expense increased $9,728,000 or 109%. This increase in interest expense
was primarily due to additional borrowings used to finance the Company's
investment in Multicare, the purchase of the Multicare pharmacy and
rehabilitation therapy businesses, and the acquisition and development of
eldercare centers, assisted living facilities and ancillary businesses.
Increased depreciation and amortization expense of $2,047,000 is attributed to
the amortization of goodwill and deferred financing costs in connection with the
Company's investment in Multicare and the purchase of the Multicare pharmacy and
rehabilitation therapy businesses, as well as depreciation of increased
investments in information systems. Lease expense increased $624,000 due to
additional lease expense incurred by seven properties formerly owned by Genesis
and now leased from ElderTrust, offset by decreased lease expense due to the
termination of operations of three leased eldercare centers in September 1997.

Six months ended March 31, 1998 compared to six months ended March 31, 1997.

The Company's total net revenues for the six months ended March 31, 1998 were
$646,864,000 compared to $531,807,000 for the six months ended March 31, 1997,
an increase of $115,057,000 or 22%. Basic healthcare services increased
$4,132,000 or 2% principally due to providing care to higher acuity patients and
rate increases, offset by the termination of operations by Genesis of three
leased eldercare centers in September 1997. Specialty medical services revenue
increased $80,920,000 or 34% of which approximately $26,200,000 is attributed to
the purchase of the Multicare pharmacy business, approximately $10,200,000 is
attributed to the purchase of the Multicare rehabilitation therapy business, and
the remaining increase of approximately $44,500,000 is primarily due to other
volume growth in the institutional pharmacy, medical supply and contract therapy
divisions, general rate increases and increased acuity in the health centers
division. Specialty medical service revenue per patient day in the health
centers division increased 16% to $36.41 in the six months ended March 31, 1998
compared to $31.49 in the six months ended March 31, 1997 primarily due to
treatment of higher acuity patients. Management services and other income
increased approximately $30,000,000 or 135%. This increase is due to
approximately $21,800,000 of management fee revenue earned from the management
of the operations of the Multicare business, approximately $7,300,000 of
capitated revenue earned under a contract with BlueCross / Blue Shield of
Maryland with the remaining increase of approximately $900,000 due to growth in
revenue from existing management contracts and other service related businesses.

                                       14
<PAGE>

The Company's operating expenses before, depreciation, amortization, lease
expense and interest expense were $528,656,000 for the six months ended March
31, 1998 compared to $439,997,000 for six months ended March 31, 1997, an
increase of $88,659,000 or 20%, of which approximately $6,800,000 is due to the
operating costs incurred to service the Multicare management contract,
approximately $21,600,000 is due to the acquisition of the Multicare pharmacy
operations, approximately $8,800,000 is due to the acquisition of the Multicare
rehabilitation therapy business, approximately $7,300,000 is due to costs
incurred in connection with capitation costs incurred under a contract with Blue
Cross / Blue Shield of Maryland and the remaining increase of approximately
$44,200,000 is attributed to growth in the institutional pharmacy, medical
supply and contract therapy divisions, as well as increased costs in information
technology systems, community-based programs and marketing campaigns.


Interest expense increased $20,176,000 or 111%. This increase in interest
expense was primarily due to additional borrowings used to finance the Company's
investment in Multicare, the purchase of the Multicare pharmacy and
rehabilitation therapy businesses, and the acquisition and development of
eldercare centers, assisted living facilities and ancillary businesses.
Increased depreciation and amortization expense of $4,252,000 is attributed to
the amortization of goodwill and deferred financing costs in connection with the
Company's investment in Multicare and the purchase of the Multicare pharmacy and
rehabilitation therapy businesses, as well as depreciation of increased
investments in information systems. Lease expense increased $329,000 due to
additional lease expense incurred by seven properties formerly owned by Genesis
and now leased from ElderTrust, offset by decreased lease expense due to the
termination of operations of three leased eldercare centers in September 1997.

In connection with the early repayment of debt in the quarters ended December
31, 1997 and 1996, the Company recorded an extraordinary loss net of tax of
approximately $1,924,000 ($3,030,000 before tax) and $553,000 ($871,000 before
tax), respectively, to write off unamortized deferred financing fees.

Liquidity and Capital Resources

Working capital increased $33,857,000 to $260,787,000 at March 31, 1998 from
$226,930,000 at September 30, 1997. Accounts receivable increased to
$256,127,000 at March 31, 1998 from $205,129,000 at September 30, 1997.
Approximately $6,500,000 of this increase relates to balances acquired in the
Multicare rehabilitation therapy business, approximately $18,700,000 relates to
balances acquired in the Multicare pharmacy business while the remaining
approximately $25,800,000 relates primarily to the continuing shift in business
mix to specialty medical services, which typically have a longer collection
period. Days revenue in accounts receivable decreased 1 day to 67 days during
this period from 68 days for the quarter ended December 31, 1997. The Company's
cash flow from operations for the six months ended March 31, 1998 was
approximately $25,100,000 compared to approximately $18,400,000 for the six
months ended March 31, 1997. The improvement in operating cash flow is primarily
due to growth in operations.

Investing activities for the six months ended March 31, 1998 include
approximately $24,342,000 of capital expenditures primarily related to
betterments and expansion of eldercare centers and investment in data processing
hardware and software. During the six months ended March 31, 1998, other long
term assets increased approximately $35,400,000, principally due to
approximately $20,000,000 of financing and other transaction costs incurred in
connection with the Multicare Transaction and the purchase of the Multicare
rehabilitation therapy business, and approximately $9,900,000 of subordinated
management fees due from Multicare.

                                       15

<PAGE>


On April 26, 1998, Genesis Health Ventures, Inc. and its wholly owned subsidiary
V Acquisition Corporation, a Delaware corporation ("Newco"), entered into an
Agreement and Plan of Merger (the "Merger Agreement") with Vitalink Pharmacy
Services, Inc., a Delaware corporation ("Vitalink"). Pursuant to the Merger
Agreement, Vitalink will merge with and into Newco, and Newco shall be the
surviving corporation (the "Merger"). Each share of Vitalink Common Stock, par
value .01 per share, (the "Vitalink Common Stock") will be converted in the
Merger into the right to receive (1) .045 shares of Genesis Series G Cumulative
Convertible Preferred Stock, par value .01 per share, ("Genesis Preferred"), (2)
$22.50 per share in cash, or (3) a combination of cash and shares of Genesis
Preferred (collectively, the "Merger Consideration"), subject to statutory
appraisal rights. The Genesis Preferred will have an initial annual dividend of
5.9375%. The total consideration to be paid to stockholders of Vitalink to
acquire their shares (including shares which may be issued upon the exercise of
outstanding options) is approximately $600,000,000, of which approximately 50%
will be paid in cash and 50% in Genesis Preferred. As a result of the Merger,
Genesis will assume approximately $90,000,000 of indebtedness Vitalink has
outstanding. The transaction has been unanimously approved by the Boards of
Directors of both companies. The transaction is subject to regulatory and
shareholder approval of both companies as well as receipt of financing and is
expected to close in late fiscal year 1998.

Manor Care, Inc. ("Manor Care"), the holder of approximately 50% of the shares
of Vitalink, has agreed to elect to exchange all of its Vitalink shares for the
preferred stock. The form of Manor Care's consideration will be prorated to the
extent that other Vitalink shareholders elect to receive preferred stock.

The Genesis Preferred will not be transferable without the consent of Genesis
until the filing by the Company of the registration statement with the
Securities and Exchange Commission covering the sale of shares of Genesis
Preferred by the holders. Manor Care has the right to require Genesis to
register shares of its Genesis Preferred in certain circumstances beginning one
year after the date of the Merger. The Genesis Preferred will be convertible
into Genesis common shares at $37.20 per share and it may be called for
conversion after three years, provided Genesis' stock price reaches certain
trading levels. In addition, after the fourth year, the Genesis Preferred may be
called for conversion by Genesis subject to a market-based call premium
provision.

Manor Care has provided Genesis with an irrevocable proxy to vote its Vitalink
shares in favor of the merger. Upon closing of the transaction, it is
anticipated that Manor Care will own approximately 18% of Genesis' pro forma
diluted shares outstanding assuming the Vitalink shareholders other than Manor
Care elect to receive cash for their shares. Manor Care will be subject to
certain voting and standstill agreements and will have one representative on the
Genesis Board of Directors.

Following the sale, Manor Care will continue to purchase from the Vitalink
operations all of its pharmacy services and related pharmacy consulting
services.

On and after April 29, 1998, certain shareholders of Vitalink filed suit in
Delaware state court against Vitalink and certain of its officers and directors,
Genesis, and Manor Care alleging, among other things, that Vitalink and Manor
Care have breached certain fiduciary duties to the Vitalink shareholders in
connection with the Merger Agreement and the transactions contemplated thereby,
and that Genesis has knowingly aided and abetted the alleged breach. The
shareholders mentioned above are seeking to enjoin Manor Care, Vitalink, and
Genesis from proceeding with the Merger and the transactions contemplated
thereby.


<PAGE>

On January 30, 1998, Genesis successfully completed deleveraging transactions
with ElderTrust, a newly formed Maryland healthcare real estate investment
trust. Genesis, a co-registrant on the ElderTrust initial public offering,
received approximately $78,000,000 in proceeds from the sale of 13 properties to
ElderTrust, including four properties it had purchased from Crozer-Keystone
Health System in anticipation of resale to ElderTrust. Subsequently, Genesis
received an additional $14,000,000 from the sale of a loan and two additional
assisted living facilities and the recoupment of amounts advanced and expenses
incurred in connection with the formation of ElderTrust. Additionally,
ElderTrust has funded approximately $13,200,000 of a commitment to finance the
development and expansion of four additional assisted living facilities. Genesis
repaid a portion of the revolving credit component of its bank credit facility
with the proceeds from these transactions. The sale of properties to ElderTrust
resulted in a gain of approximately $12,000,000 which has been deferred and is
being amortized over the ten year term of the lease contracts with ElderTrust.

In October 1997, in connection with the Multicare Transaction, Genesis entered
into a new credit facility with Mellon Bank, N.A., Citicorp Securities, Inc.,
Citibank N.A., First Union Capital Markets Corp., First Union National Bank and
NationsBank, N.A. (the "Lenders") pursuant to which the Lenders provided Genesis
and its subsidiaries with loan facilities totaling $850,000,000 (the "Genesis
Bank Financing") for the purpose of refinancing certain existing indebtedness of
Genesis; funding interest and principal payments on the facilities and certain
remaining indebtedness; funding permitted acquisitions; funding Genesis'
commitments in connection with the Merger; and funding Genesis' and its
subsidiaries' working capital for general corporate purposes, including fees and
expenses of the transactions. The Genesis Bank Financing facilities consist of
three $200,000,000 term loans (collectively, the "Term Loans"),a $250,000,000
revolving credit loan (the "Revolving Credit Facility") which includes one or
more Swing Loans (collectively, the "Swing Loan Facility") in integral principal
multiples of $500,000 up to an aggregate unpaid principal amount of $15,000,000.
The Term Loans amortize in quarterly installments beginning in fiscal 1998
through 2005, of which $19,000,000 is payable in fiscal 1998. The Term Loans
consist of (1) a $200,000,000 six year term loan (the "Tranche A Term
Facility"); (2) a $200,000,000 seven year term loan (the "Tranche B Term
Facility"); and (3) a $200,000,000 eight year term loan (the "Tranche C Term
Facility"). The Revolving Credit Facility becomes payable in full on September
30, 2003.

                                       16
<PAGE>

The Genesis Bank Financing facilities are secured by a first priority security
interest in all of the stock, partnership interests and other equity of all of
Genesis' present and future subsidiaries (including the Genesis Elder Care
Corp.) other than stock of Multicare and its subsidiaries. Loans under the
Genesis Bank Financing bear, at Genesis' option, interest at the per annum Prime
Rate as announced by the administrative agent, or the applicable Adjusted LIBOR.
Loans under the Tranche A Term Facility bear interest at an annual rate equal to
LIBOR plus a margin up to 2.5%, loans under the Tranche B Term Facility bear
interest at an annual rate equal to LIBOR plus a margin up to 2.75%; loans under
the Tranche C Term Facility bear interest at an annual rate equal to LIBOR plus
a margin up to 3.0%; loans under the Revolving Credit Facility bear interest at
a rate equal to LIBOR plus a margin up to 2.5%, and loans under the Swing Loan
Facility bear interest at the Prime Rate unless otherwise agreed to by the
parties. Subject to meeting certain financial covenants, the above referenced
interest rates will be reduced.


The Genesis Bank Financing contains a number of covenants that, among other
things, restrict the ability of Genesis and its subsidiaries to dispose of
assets, incur additional indebtedness, make loans and investments, pay
dividends, engage in mergers or consolidations, engage in certain transactions
with affiliates and change control of capital stock, and to make capital
expenditures; prohibit the ability of Genesis and its subsidiaries to prepay
debt to other persons, make material changes in accounting and reporting
practices, create liens on assets, give a negative pledge on assets, make
acquisitions and amend or modify documents; causes Genesis and its affiliates to
maintain the Management Agreement, the Put/Call Agreement, as defined below, and
corporate separateness; and will cause Genesis to comply with the terms of other
material agreements as well as comply with usual and customary covenants for
transactions of this nature.

In connection with the Multicare Transaction, Genesis, Cypress, TPG and Nazem
entered into an agreement (the "Put/Call Agreement") pursuant to which, among
other things, Genesis will have the option, on the terms and conditions set
forth in the Put/Call Agreement to purchase (the "Call") Genesis ElderCare Corp.
Common Stock held by Cypress, TPG and Nazem commencing on October 9, 2001 and
for a period of 270 days thereafter, at a price determined pursuant to the terms
of the Put/Call Agreement. Cypress, TPG and Nazem will have the option, on the
terms and conditions set forth in the Put/Call Agreement, to require Genesis to
purchase (the "Put") such Genesis ElderCare Corp. Common Stock commencing on
October 9, 2002 and for a period of one year thereafter, at a price determined
pursuant to the Put/Call Agreement.

The prices determined for the Put and Call are based on a formula that
calculates the equity value attributable to Cypress', TPG's and Nazem's Genesis
ElderCare Corp. Common Stock, plus a portion of the Genesis pharmacy business
(the "Calculated Equity Value"). The Calculated Equity Value will be determined
based upon a multiple of Genesis ElderCare Corp.'s earnings before interest,
taxes, depreciation, amortization and rental expenses, as adjusted ("EBITDAR")
after deduction of certain liabilities, plus a portion of the EBITDAR related to
the Genesis pharmacy business. The multiple to be applied to EBITDAR will depend
on whether the Put or the Call is being exercised. Any payment to Cypress, TPG
or Nazem under the Call or the Put maybe in the form of cash or Genesis common
stock at Genesis' option.

                                       17
<PAGE>

Upon exercise of the Call, Cypress, TPG and Nazem will receive at a minimum
their original investment plus a 25% compound annual return thereon regardless
of the Calculated Equity Value. Any additional Calculated Equity Value
attributable to Cypress', TPG's or Nazem's Genesis ElderCare Corp. Common Stock
will be determined on the basis set forth in the Put/Call Agreement which
provides generally for additional Calculated Equity Value of Genesis ElderCare
Corp. to be divided based upon the proportionate share of the capital
contributions of the stockholders to Genesis ElderCare Corp. Upon exercise of
the Put by Cypress, TPG or Nazem, there will be no minimum return to Cypress,
TPG or Nazem; any payment to Cypress, TPG or Nazem will be limited to Cypress'
TPG's or Nazem's share of the Calculated Equity Value based upon a formula set
forth in the terms of the Put/Call Agreement which provides generally for the
preferential return of the stockholders' capital contributions (subject to
certain priorities), a 25% compound annual return on Cypress', TPG's and Nazem
capital contributions and the remaining Calculated Equity Value to be divided
based upon the proportionate share of the capital contributions of the
stockholders to Genesis ElderCare Corp.

Cypress', TPG's and Nazem's rights to exercise the Put will be accelerated upon
an event of bankruptcy of Genesis, a change of control of Genesis or an
extraordinary dividend or distribution or the occurrence of the leverage
recapitalization of Genesis. Upon an event of acceleration or the failure by
Genesis to satisfy its obligations upon exercise of the Put, Cypress, TPG and
Nazem will have the right to terminate the Stockholders' Agreement and
Management Agreement and to control the sale or liquidation of Genesis ElderCare
Corp. In the event of such sale, the proceeds from such sale will be distributed
among the parties as contemplated by the formula for the Put option exercise
price and Cypress, TPG and Nazem will retain a claim against Genesis for the
difference, if any, between the proceeds of such sale and the put option
exercise price. In the event of a bankruptcy or change of control of Genesis,
the option price shall be payable solely in cash provided any such payment will
be subordinated to the payment of principal and interest under the Genesis Bank
Financing.

In December 1997, the Company purchased approximately 1,000,000 long-term call
options on the Company's Common Stock. The Company's Board of Directors approved
the purchase of up to 1,500,000 call options. The call options are purchased
by the Company in privately negotiated transactions designated to take advantage
of attractive share price levels, as determined by the Company's management, in
compliance with covenants governing existing financing arrangements. The timing
and the terms of the transactions, including maturities, will depend on market
conditions, the Company's liquidity and covenant requirements under its
financing arrangements, and other considerations. The Board of Directors also
approved a Senior Executive Stock Ownership Program. Under the terms of the
program, certain of the Company's current senior executive employees will be
required to own shares of the Company's Common Stock having a market value based
upon a multiple of the executive's salary. Each executive is required to own the
shares within three years of the date of the adoption of the program. Subject to
applicable laws, the Company may lend funds to one or more of the senior
executive employees for his or her purchase of the Company's Common Stock. As of
March 31, 1998, the Company loaned approximately $1,700,000 to senior executive
employees to purchase the Company's Common Stock.

In October 1996, the Company completed an offering of $125,000,000 9 1/4% Senior
Subordinated Notes due 2006. The Company used the net proceeds of approximately
$121,250,000 together with borrowings under the Credit Facility, to pay the cash
portion of the purchase price of the Geriatric and Medical Companies (GMC)
Transaction, to repay certain debt assumed as a result of the GMC Transaction
and to repurchase GMC accounts receivable which were previously financed.

Certain of the Company's other outstanding loans contain covenants which,
without the prior consent of the lenders, limit certain activities of the
Company. Such covenants contain limitations relating to the merger or
consolidation of the Company and the Company's ability to secure indebtedness,
make guarantees, grant security interests and declare dividends. In addition,
the Company must maintain certain minimum levels of cash flow and debt service
coverage, and must maintain certain liabilities to net worth. Under these loans,
the Company is restricted from paying cash dividends on the Common Stock, unless
certain conditions are met. The Company has not declared or paid any cash
dividends on its Common Stock since its inception.

                                       18
<PAGE>

Legislative and regulatory action has resulted in continuing change in the
Medicare and Medicaid reimbursement programs which has adversely impacted the
Company. The changes have limited, and are expected to continue to limit,
payment increases under these programs. Also, the timing of payments made under
the Medicare and Medicaid programs is subject to regulatory action and
governmental budgetary constraints; in recent years, the time period between
submission of claims and payment has increased. Implementation of the Company's
strategy to expand specialty medical services to independent providers should
reduce the impact of changes in the Medicare and Medicaid reimbursement programs
on the Company as a whole. Within the statutory framework of the Medicare and
Medicaid programs, there are substantial areas subject to administrative rulings
and interpretations which may further affect payments made under those programs.
Further, the federal and state governments may reduce the funds available under
those programs in the future or require more stringent utilization and quality
reviews of eldercare centers.

Pursuant to the Balanced Budget Act of 1997 (the "Act"), beginning on or after
July 1, 1998, Medicare reimbursement for skilled nursing facilities will be on a
prospective payment system ("PPS"). Skilled nursing facilities will be paid a
per diem rate for all covered Part A skilled nursing facility services as well
as many services for which payment may be made under Part B during a period when
a beneficiary is provided covered skilled nursing facility care. The per diem
rate is adjusted based upon the resource utilization group of a resident. This
payment will cover rehabilitation and non-rehabilitation ancillary services;
however the per diem rate will not cover physician, nursing, physician assistant
and certain related services. For the first three cost reporting periods
beginning on or after July 1, 1998, the per diem rate will be based on a blend
of a facility specific rate and a federal per diem rate. In subsequent periods,
and for facilities first receiving payments for Medicare services on or after
October 1, 1995, the federal per diem rate will be used without any facility
specific blending.

The Act also required consolidated billing for skilled nursing facilities. The
skilled nursing facility must submit all Medicare claims for Part A and Part B
services received by its residents with the exception of physician, nursing,
physician assistant and certain related services. Medicare will pay the skilled
nursing facilities directly for all services on the consolidated bill and
outside suppliers of services to residents of the skilled nursing facilities
must collect payment from the skilled nursing facility.

The Act also repealed the Boren Amendment which required Medicaid payments to
nursing facilities to be "reasonable and adequate" to cover the costs of
efficiently and economically operated facilities. Under the Act, states must now
use a public notice and comment process for determining Medicaid rates and give
interested parties a reasonable opportunity to comment on proposed rates, rate
methodology and justifications. It is unclear what impact the Balanced Budget
Act of 1997 will have on the Company.

The Company believes that its liquidity needs can be met by expected operating
cash flow and availability of borrowings under its credit facilities. At May 11,
1998, approximately $160,000,000 was outstanding under the Revolving Credit
Facility, and approximately $71,200,000 was available under the credit
facilities after giving effect to approximately $18,800,000 in outstanding
letters of credit issued under the credit facilities.

Seasonality

The Company's earnings generally fluctuate from quarter to quarter. This
seasonality is related to a combination of factors which include the timing of
Medicaid rate increases, seasonal census cycles and the number of calendar days
in a given quarter.

                                       19
<PAGE>

Impact of Inflation

The healthcare industry is labor intensive. Wages and other labor costs are
especially sensitive to inflation and marketplace labor shortages. To date, the
Company has offset its increased operating costs by increasing charges for its
services and expanding its services. Genesis has also implemented cost control
measures to limit increases in operating costs and expenses but cannot predict
its ability to control such operating cost increases in the future.

Year 2000

The Company is aware of issues associated with the programming code in many
existing computer systems (the "Year 2000" issue) as the millennium approaches.
The Company has conducted a review of its computer systems to identify hardware
and software affected by the Year 2000 issue. This issue affects computers
systems having date sensitive programs that may not properly recognize the Year
2000. Systems that do not properly recognize such information could generate
erroneous data or cause a system to fail resulting in business interruption.

With respect to its existing computer systems, the Company is upgrading,
generally, in order to meet the demands of its expanding business. In the
process, the Company is taking steps to identify, correct, or reprogram and test
its existing systems for Year 2000 compliance. It is anticipated that all new
system upgrades or reprogramming efforts will be completed by late calendar year
1998, allowing adequate time for testing. The Company presently believes that
with modification to existing software and conversions to new software, the Year
2000 issue can be mitigated. However, given the complexity of the Year 2000
issue, there can be no assurances that the Company will be able to address the
problem without costs and uncertainties that might affect future financial
results or cause reported financial information not to be necessarily indicative
of future operating results or future financial condition.

The Company has incurred, and expects to incur additional, internal costs as
well as other expenses to address the necessary software upgrades, training,
data conversion, testing and implementation related to the Year 2000 issue. Such
costs are being expensed as incurred. The Company does not expect the amounts
required to be expensed to have a material effect on its financial position or
results of operations. The Year 2000 issue is expected to affect the systems of
various entities with which the Company interacts including payors, suppliers
and vendors. There can be no assurance that data produced by systems of other
entities on which the Company's systems rely will be converted on a timely basis
or that a failure by another entity's system to be Year 2000 compliant will not
have a material adverse effect on the Company.

New Accounting Pronouncements

In June 1997, the Financial Accounting Standards Board, (the "FASB") issued
Statement of Financial Accounting Standards No. 130, Reporting Comprehensive
Income ("Statement 130"). Statement 130 requires that all items that are
required to be recognized under accounting standards as components of
comprehensive income be reported in a financial statement that is displayed with
the same prominence as other financial statements. This Statement is effective
for fiscal years beginning after December 15, 1997, or the Company's fiscal year
end September 30, 1999. The Company plans to adopt this accounting standard as
required. The adoption of this standard will have no material impact on the
Company's earnings, financial condition or liquidity, but will require the
Company to classify items other than comprehensive income in the financial
statements and display the accumulated balance of other comprehensive income
separately in the equity section of the balance sheet.

                                       20
<PAGE>

In June 1997, the FASB also issued Statement of Financial Accounting Standards
No. 131, Disclosures about Segments of an Enterprise and Related Information
("Statement 131"). Statement 131 supersedes Statement of Financial Accounting
Standards No. 14, Financial Reporting of a Business Enterprise, and establishes
new standards for reporting information about operation segments in annual
financial statements and requires selected information about operating segments
in interim financial reports. Statement 131 also establishes standards for
related disclosures about products and services, geographic areas and major
customers. Statement 131 is effective for years beginning after December 15,
1997, or the Company's fiscal year end September 30, 1999. This statement
affects reporting in financial statements only and will have no impact on the
Company's results of operations, financial condition or liquidity.

                                       21

<PAGE>



                           PART II: OTHER INFORMATION

Item 1.  Legal Proceedings

                  Not Applicable

Item 2.  Changes in Securities

                  Not Applicable

Item 3.  Defaults Upon Senior Securities

                  Not Applicable

Item 4.  Submission of Matters to Vote of Security Holders

                  On February 24, 1998, the Company held its Annual Meeting of
                  Shareholders (the "Annual Meeting"). Proxies were solicited
                  for the Annual Meeting pursuant to Regulation 14 of the
                  Securities Act of 1934.

                  At the Annual Meeting the following matters were voted on: (1)
                  Roger C. Lipitz and Alan B. Miller were elected to serve on
                  the Board of Directors of the Company for three-year terms
                  until after their respective successors are duly elected and
                  qualified, with Roger C. Lipitz receiving 28,456,989 votes for
                  election and zero against election (with 6,511,549 broker
                  non-votes and abstentions); and Alan B. Miller receiving
                  28,491,740 votes for election and zero against election (with
                  6,595,129 broker non-votes and abstentions) and (2) an
                  amendment to the Company's Amended and Restated Employee Stock
                  Option Plan (the "Plan") increasing the number of shares which
                  may be issued under the Plan to 6,250,000 shares which was
                  approved by a vote of 26,295,300 for the amendment and
                  2,132,425 votes against the amendment (with 6,659,144 broker
                  non-votes and abstentions).

Item 5.  Other Information

                  Not Applicable

Item 6.  Exhibits and Reports on Form 8-K

         (a)      Exhibits

         Number          Description



          2.1(1)         Agreement and Plan of Merger by and among Vitalink 
                         Pharmacy Services,  Inc., Genesis Health Ventures,
                         Inc., and the V Acquisition Corporation dated as of
                         April 26, 1998.

          3.1            The Company's Amended and Restated Bylaws

         10.1            The Company's Amended and Restated Stock Option Plan

                                       22
<PAGE>


         10.2            Rights  Agreement dated as of April 26, 1998, by and 
                         among Genesis Health  Ventures, Inc., a Pennsylvania 
                         and Manor Care, Inc., a Delaware corporation.

         10.3(2)         Voting  Agreement dated as of April 26, 1998, by and 
                         among Genesis Health  Ventures, Inc., a Pennsylvania 
                         and Manor Care, Inc., a Delaware corporation.



         27              Financial Data Schedule

         (1) - Incorporated by Reference to Schedule 13D filed by the Company
               with respect to Vitalink Pharmacy Services, Inc. dated 
               April 26, 1998.

         (2) - Incorporated by reference to the Company's Form 8-K dated May 6,
               1998.

         (b)     Reports on Form 8-K


                    The Company filed a current report on Form 8-K/A, dated
                    January 26, 1998 which amended the current report dated
                    October 9, 1997 to include or incorporate by reference the
                    following financial information:

                  Financial Statements of businesses acquired:

                  The Multicare Companies, Inc.

                  (1)  Independent Auditors' Report
                  (2)  Consolidated Balance Sheets as of December 31, 1995 and 
                       1996 
                  (3)  Consolidated Statements of Operations for the years ended
                       December 31, 1994, 1995 and 1996.
                  (4)  Consolidated Statements of Stockholders' Equity for the 
                       years ended December 31, 1994, 1995 and 1996.
                  (5)  Consolidated Statements of Cash Flows for the years 
                       ended December 31, 1994, 1995 and 1996.
                  (6)  Notes to Consolidated Financial Statements 
                  (7)  Unaudited Consolidated Balance Sheet as of September 30, 
                       1997 
                  (8)  Unaudited Consolidated Statement of Operations for the 
                       three and nine months ended September 30, 1997
                  (9)  Unaudited Consolidated Statement of Cash Flows for the 
                       nine months ended September 30, 1997.
                  (10) Unaudited Notes to Consolidated Financial Statements

                  Genesis Health Ventures, Inc. and Subsidiaries

                  Pro Forma Financial Statements

                  (1) Unaudited  Pro  Forma  Condensed  Consolidated  Balance 
                      Sheet  as  of September 30, 1997 and Notes Thereto
                  (2) Unaudited  Pro Forma  Condensed  Consolidated  Statement 
                      of Operations for the Twelve Months Ended September 30, 
                      1997 and Notes Thereto

                                       23
<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 thereto duly authorized.


                                    GENESIS HEALTH VENTURES, INC.


Date:  May 15, 1998                 /S/ George V. Hager, Jr.
                                    ------------------------------
                                    Senior Vice President and 
                                    Chief Financial Officer




                                       24





<PAGE>

                              AMENDED AND RESTATED

                                   B Y L A W S

                                       of

                          GENESIS HEALTH VENTURES, INC.

                  These Bylaws are adopted by the Corporation and are
                  supplemental to the Pennsylvania Business Corporation Law as
                  the name shall from time to time be in effect.

ARTICLE I.        SHAREHOLDERS AND DIRECTORS

         Section 101.1. Place of Shareholders' Meetings. All meetings of the
shareholders shall be held at such place or places, inside or outside the
Commonwealth of Pennsylvania, as determined by the Board of Directors from time
to time.

         Section 101.2. Annual Shareholders' Meeting. The annual meeting of the
shareholders, for the election of directors and the transaction of other
business which is properly brought before such meeting, shall be held in each
calendar year, at a time and place determined by the Board of Directors.

         Section 101.3. Special Meetings of Shareholders. Special meetings of
the shareholders may be called at any time by the Board of Directors or the
Chairman of the Board and Chief Executive Officer.

         Section 101.4. Conduct of Shareholders' Meetings. The Chairman of the
Board shall preside at all Shareholders' meetings. In the absence of the
Chairman of the Board, the President shall preside or, in his or her absence,
any officer designated by the Board of Directors. The officer presiding over the
shareholders' meeting may establish such rules and regulations for the conduct
of the meeting as he or she may deem to be reasonably necessary or desirable for
the orderly and expeditious conduct of the meeting. Unless the officer presiding
over the shareholders' meeting otherwise requires, shareholders need not vote by
ballot on any questions.

         Section 102.1. Management by Board of Directors. The business and
affairs of the Corporation shall be managed by its Board of Directors. The Board
of Directors may exercise all such powers of the Corporation and do all such
lawful acts and things as are not by statute, regulation, the Amended and
Restated Articles of Incorporation or these Amended and Restated Bylaws directed
or required to be exercised or done by the shareholders.



<PAGE>



         Section 102.2. Nomination for Directors. Beginning with the annual
meeting of the shareholders to be held in 1992, nominations by shareholders for
directors to be elected at a meeting of shareholders and which have not been
previously approved by the Board of Directors must be submitted to the Secretary
of the Corporation in writing, either by personal delivery, nationally
recognized express mail or United States mail, postage prepaid, not later than
(i) with respect to an election to be held at an annual meeting of shareholders,
the latest date upon which shareholder proposals must be submitted to the
Corporation for inclusion in the Corporation's proxy statement relating to such
meeting pursuant to Rule 14a-8 under the Securities Exchange Act of 1934, as
amended, or other applicable rules or regulations under the federal securities
laws or, if no such rules apply, at least ninety (90) days prior to the date one
year from the date of the immediately preceding annual meeting of shareholders,
and (ii) with respect to an election to be held at a special meeting of
shareholders, the close of business on the tenth day following the date on which
notice of such meeting is first given to shareholders. Each such nomination
shall set forth: (i) the name and address of the shareholder making the
nomination and of the person or persons nominated; (ii) a representation that
the shareholder is a holder of record of capital stock of the Corporation
entitled to vote at such meeting and intends to appear in person or by proxy at
the meeting to vote for the person or persons nominated; (iii) a description of
all arrangements and understandings between the shareholder and each nominee and
any other person or persons (naming such person or persons) pursuant to which
the nomination or nominations were made by the shareholder; (iv) such other
information regarding each nominee proposed by such shareholder as would be
required to be included in a proxy statement filed pursuant to the proxy rules
of the Securities and Exchange Commission had the nominee been nominated by the
Board of Directors; and (v) the consent of each nominee to serve as a director
of the Corporation if so elected. All late nominations shall be rejected.
Notwithstanding the foregoing, at any time prior to the election of directors at
a meeting of shareholders, the Board of Directors may designate a substitute
nominee to replace any bona fide nominee who was nominated as set forth above
and who, for any reason, becomes unavailable for election as a director.

         Section 102.3. Number of Directors. The Board of Directors shall
consist of at least eight (8) directors and be divided into three classes in
accordance with the Corporation's Amended and Restated Articles of
Incorporation.

         Section 102.4. Term of Directors. Each director shall serve until his
successor is elected and qualifies, even though his term of office has otherwise
expired, except in the event of his earlier resignation, removal or
disqualification.

         Section 102.5. Resignations of Directors. Any director may resign at
any time. Such resignation shall be in writing, but the acceptance thereof shall
not be necessary to make it effective.

         Section 102.6. Vacancies in the Board of Directors. Vacancies in the
Board of Directors resulting from an increase in the number of directors shall
be filled by the affirmative vote of at least a majority of the members of the
Board though less than a quorum and each person so elected shall be a director
until his successor is elected by the shareholders. In the event of a vacancy in
the Board of Directors resulting for any reason other than an increase in the
number of directors, a special meeting of shareholders shall be duly called for
the purpose of filling such vacancy.


<PAGE>


         Section 102.7. Compensation of Directors. Unless the Board of Directors
otherwise determines, directors shall not be entitled to any compensation for
their services as directors; provided that directors who are not also employees
of the Corporation shall be reimbursed by the Corporation for all out-of-pocket
expenses actually incurred by such directors in attending meetings of the Board
of Directors or any committees thereof. Any director may serve the Corporation
in other capacities and be entitled to such compensation therefor as is
determined by the Board of Directors.

         Section 102.8. Annual Meeting of Directors. An annual meeting of the
Board of Directors shall be held each year immediately following the annual
meeting of the shareholders and at such other times as the Board shall from time
to time designate or as may be designated in any notice from the Secretary
calling the meeting.

         Section 102.9. Meetings of the Directors. Meetings of the Board of
Directors may be called by the Chairman or any three members of the Board of
Directors. Any one member of the Board of Directors may request that the
Chairman of the Board of Directors call a meeting of the Board of Directors.
Upon the request of the Chairman or such three directors, it shall be the duty
of the Secretary of the Corporation to fix the date of such meeting to be held
at such time, not less than three (3) business days after the receipt of such
request as the Secretary may determine and to give due notice thereof for any
such meeting to be held at the principal office of the Corporation or at any
other place designated in the notice of the meeting; or, in the alternative, not
less than twenty-four (24) hours after the receipt of such request as the
Secretary may determine and to give due notice thereof for any such meeting
where any director may participate by using a conference telephone or similar
communications equipment, by means of which all such persons participating in
the meeting can hear each other.

         Section 102.10. Notice of Directors' Meetings. Whenever notice of a
meeting of the Board of Directors is required, it shall be in writing and shall
be made to each director to his or her address appearing on the books of the
Corporation by hand delivery, first class or express mail (postage prepaid),
courier service (charges prepaid) or by facsimile transmission. Unless otherwise
required by law or these Bylaws, neither the business to be transacted at, nor
the purpose of, any regular meeting of the Board of Directors need be specified
in the notice or waiver of notice of such meeting.

         Section 102.11. Reports and Records. The reports of officers and
committees and the records of the proceedings of all committees shall be filed
with the Secretary of the Corporation and presented to the Board of Directors,
if practicable, at its next regular meeting. The Board of Directors shall keep
complete records of its proceedings in a minute book kept for that purpose. When
a director shall request it, the vote of each director upon a particular
question shall be recorded in the minutes.

         Section 102.12. Committees. The following committees of the Board of
Directors shall be established by the Board of Directors in addition to any
other committee the Board of Directors may in its discretion establish: (a)
Executive Committee; (b) Audit Committee; and (c) Compensation Committee.


<PAGE>


         Section 102.13. Executive Committee. The Executive Committee shall
consist of at least three (3) directors. Meetings of the Committee may be called
whenever two or more members of the Committee so request in writing. The
Executive Committee shall have and exercise the authority of the Board of
Directors in the management of the business of the Corporation between the dates
of regular meetings of the Board.

         Section 102.14. Audit Committee. The Audit Committee shall consist of
at least three (3) directors, a majority of which shall be independent. Meetings
of the Audit Committee may be called at any time by the Chairman or Secretary of
the Audit Committee, and shall be called whenever two or more members of the
Committee so request in writing. The Audit Committee shall have the following
authority, powers and responsibilities:

                  (a) To recommend each year to the Board the independent
accountants to audit the annual financial statements of the Corporation and its
consolidated subsidiaries and to review the fees charged for such audits or for
special engagements given to such accountants;

                  (b) To meet with the independent accountants, Chief Executive
Officer, Chief Financial Officer and any other Corporation executives as the
Audit Committee deems appropriate at such times as the Audit Committee shall
determine to review: (i) the scope of the audit plan; (ii) the Corporation's
financial statements; (iii) the results of external and internal audits; (iv)
the effectiveness of the Corporation's system of internal controls; (v) any
limitations imposed by Corporation personnel on the independent public
accountants; and (vi) such other matters as the Audit Committee shall deem
appropriate;

                  (c) To report to the entire Board at such time as the Audit
Committee shall determine;

                  (d) To take such other action as the Audit Committee shall
deem necessary or appropriate to assure that the interests of the Company are
adequately protected.

         Section 102.15. Compensation Committee. The Compensation Committee
shall consist of at least two (2) directors. Meetings of the Committee may be
called at any time by the Chairman or Secretary of the Committee, and shall be
called whenever two or more members of the Committee so request in writing. The
Committee shall review compensation of executive officers and make
recommendations to the Board of Directors regarding executive compensation and
shall have such other duties as the Board of Directors prescribes.

         Section 102.16. Appointment of Committee Members. The Board of
Directors shall appoint or shall establish a method of appointing the members of
the Executive, Audit and Compensation Committees and of any other committees
established by the Board of Directors, and the Chairman of each such committee,
to serve until the next annual meeting of shareholders.



<PAGE>


         Section 102.17. Organization and Proceedings. Each committee of the
Board of Directors shall effect its own organization by the appointment of a
Secretary and such other officers, except the Chairman, as it may deem
necessary. The Secretary of the Executive Committee shall be the Secretary of
the Corporation, but the Secretary of the Audit and Compensation Committees and
of any other committee need not be the Secretary of the Corporation. A record of
the proceedings of all committees shall be kept by the Secretary of such
committee and filed and presented as provided in Section 102.12 of these Bylaws.

         Section 102.18. Committees. In the absence or disqualification of any
member of any committee established by the Board Directors, the members thereof
who are present at any meeting such committee and are not disqualified from
voting, whether or not they constitute a quorum, may unanimously appoint another
director to act at such meeting in the place of such absent or disqualified
member.

         Section 103. Absentee Participation in Meetings. A director or
shareholder (as the case may be) may participate in a meeting of the Board of
Directors, a meeting of a committee established by the Board of Directors, or a
meeting of the shareholders, by use of a conference telephone or similar
communications equipment, by means of which all persons participating in the
meeting can hear each other.

ARTICLE II.                OFFICERS

         Section 201. Officers. The Corporation shall have a Chairman, a
President, a Secretary and a Treasurer, and may have one or more Vice
Presidents, one or more Assistant Secretaries, and one or more Assistant
Treasurers and other officers and assistant officers as the Board of Directors
may from time to time deem advisable.

         Section 202. Election and Term of Officers. The Chairman and Chief
Executive Officer, President and Chief Operating Officer, Secretary, and
Treasurer of the Corporation shall be elected annually by the Board of Directors
at the annual meetings of the Board of Directors. All other officers and
assistant officers shall be elected by the Board of Directors at the time, in
the manner, and for such term as the Board of Directors from time to time
determines. Each officer and assistant officer shall serve until his successor
is duly elected and qualifies, or until he resigns or is removed from office.

         Section 203. Compensation. Unless otherwise provided by the Board of
Directors, the compensation of officers and assistant officers shall be fixed by
the Chairman.

         Section 204. Chairman and Chief Executive Officer. The Chairman shall
be the chief executive officer of the Corporation, and, subject to the direction
and control of the Board of Directors, shall in general supervise and control
all of the business and affairs of the Corporation. Unless a designation to the
contrary is made at a meeting, the Chairman, when present, shall preside at all
meetings of the shareholders and of the Board of Directors. As authorized by the
Board of Directors, the Chairman may execute and seal, or cause to be sealed,
all instruments requiring such execution. Upon request of the Board of
Directors, the Chairman shall report to it all matters which the interests of
the Corporation may require to be brought to the attention of the Board of
Directors.



<PAGE>


         Section 205. President and Chief Operating Officer. The president shall
be the chief operating officer of the Corporation. As authorized by the Board of
Directors, the President may execute and seal, or cause to be sealed, all
instruments requiring such execution, except to the extent that signing and
execution thereof is expressly delegated by the Board of Directors to some other
officer or agent of the Corporation. In the absence or disability of the
Chairman, the President, unless otherwise determined by the Board of Directors,
shall perform the duties and exercise the powers of the Chairman.

         Section 206. Vice President, Secretary, Treasurer, and Assistant
Officers. In the absence or disability of the President, the Vice President or
Vice Presidents, in the order of their seniority, unless otherwise determined by
the Board of Directors or the Chairman shall perform the duties and exercise the
powers of the President.

                  The Vice President or Vice Presidents, the Secretary, the
Treasurer, the Assistant Secretary or Secretaries, and the Assistant Treasurer
or Treasurers, shall act under the direction of the Chairman and shall perform
all duties which are prescribed by the Chairman or the Board of Directors.

ARTICLE III.               PERSONAL LIABILITY AND INDEMNIFICATION

         Section 301.1.1.  Personal Liability of Directors.

                  (a) A director of this Corporation shall not be personally
liable for monetary damages as such for any action taken, or any failure to take
any action, unless:

                           (1) the director has breached or failed to perform
the duties of his office under Section 1721 of the Pennsylvania Business
Corporation of 1988 (which, as amended from time to time, is hereafter called
the Business Corporation Law); and

                           (2) the breach or failure to perform constitutes
self-dealing, willful misconduct or recklessness.

                   (b) This Section 301.1.1 shall not limit a director's
liability for monetary damages to the extent prohibited by Section 1721 of the
Business Corporation Law.



<PAGE>


         Section 301.1.2. Mandatory Indemnification. The Corporation shall, to
the fullest extent permitted by applicable law, indemnify its members, directors
and officers who were or are a party or are threatened to be made a party to any
threatened, pending or completed action, suit or proceeding, whether civil,
criminal, administrative or investigative (whether or not such action, suit or
proceeding arises or arose by or in the right of the Corporation or other
entity) by reason of the fact that such member, director or officer is or was a
member, director or officer of the Corporation or is or was serving at the
request of the Corporation as a director, officer, employee, general partner,
agent or fiduciary of another corporation, partnership, joint venture, trust or
other enterprise (including service with respect to employee benefit plans),
against expenses (including, but not limited to, attorneys' fees and costs),
judgments, fines (including excise taxes assessed on a person with respect to
any employee benefit plan) and amounts paid in settlement actually and
reasonably incurred by such director or officer in connection with such action,
suit or proceeding, except as otherwise provided in Section 301.1.4 hereof.
Persons who were members, directors or officers of the Corporation prior to the
date this Section is approved by members of the Corporation, but who do not hold
such office on or after such date, shall not be covered by this Section 301.1. A
director or officer of the Corporation entitled to indemnification under this
Section 301.1.2 is hereafter called a "person covered by Section 301.1.2
hereof".

         Section 301.1.3. Expenses. Expenses incurred by a person covered by
Section 301.1.2 hereof in defending a threatened, pending or completed 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 such person to repay such amount if it shall
ultimately be determined that such person is not entitled to be indemnified by
the Corporation, except as otherwise provided in Section 301.1.4.

         Section 301.1.4. Exceptions. No indemnification under Section 301.1.2
or advancement or reimbursement of expenses under Section 301.1.3 shall be
provided to a person covered by Section 301.1.2 hereof (a) if a final
unappealable judgment or award establishes that such member, director or officer
engaged in intentional misconduct or transaction from which the member, director
or officer derived an improper personal benefit; (b) for expenses or liabilities
of any type whatsoever (including, but not limited to, judgments, fines, and
amounts paid in settlement) which have been paid directly to such person by an
insurance carrier under a policy of officers' and directors' liability insurance
maintained by the Corporation or other enterprise; and (c) for amounts paid in
settlement of any threatened, pending or completed action, suit or proceeding
without the written consent of the Corporation, which written consent shall not
be unreasonably withheld. The Board of Directors of the Corporation is hereby
authorized, at any time by resolution, to add to the above list of exceptions
from the right of indemnification under Section 301.1.2 or advancement or
reimbursement of expenses under Section 301.1.3, but any such additional
exception shall not apply with respect to any event, act or omission which has
occurred prior to the date that the Board of Directors in fact adopts such
resolution. Any such additional exception may, at any time after its adoption,
be amended, supplemented, waived or terminated by further resolution of the
Board of Directors of the Corporation.

         Section 301.1.5. Continuation of Rights. The indemnification and
advancement or reimbursement of expenses provided by, or granted pursuant to,
this Section 301.1 shall continue as to a person who has ceased to be a member,
director or officer of the Corporation, and shall inure to the benefit of the
heirs, executors and administrators of such person.



<PAGE>

         Section 301.1.6.  General Provisions.

                  (a) The term "to the fullest extent permitted by applicable
law", as used in this Section 301.1, shall mean the maximum extent permitted by
public policy, common law or statute. Any person covered by Section 301.1.2
hereof may, to the fullest extent permitted by applicable law, elect to have the
right to indemnification or to advancement or reimbursement of expenses,
interpreted, at such person's option, (i) on the basis of the applicable law on
the date this Section was approved by the members, or (ii) on the basis of the
applicable law in effect at the time of the occurrence of the event or events
giving rise to the action, suit or proceeding, or (iii) on the basis of the
applicable law in effect at the time indemnification is sought.

                  (b) The right of a person covered by Section 301.1.2 hereof to
be indemnified or to receive an advancement or reimbursement of expenses
pursuant to Section 301.1.3 (i) may also be enforced as a contract right
pursuant to which the person entitled thereto may bring suit as if the
provisions hereof were set forth in a separate written contract between the
Corporation and such person, (ii) to the fullest extent permitted by applicable
law, is intended to be retroactive and shall be available with respect to events
occurring prior to the adoption hereof, and (iii) shall continue to exist after
the rescission or restrictive modification (as determined by such person) of
this Section with respect to events, acts or omissions occurring before such
rescission or restrictive modification is adopted.

                  (c) If a request for indemnification or for the advancement or
reimbursement of expenses pursuant hereto is not paid in full by the Corporation
within thirty days after a written claim has been received by the Corporation
together with all supporting information reasonably requested by the
Corporation, the claimant may at any time thereafter bring suit against the
Corporation to recover the unpaid amount of the claim (plus interest at the
prime rate announced from time to time by the Corporation's primary banker) and,
if successful in whole or in part, the claimant shall be entitled also to be
paid the expenses (including, but not limited to, attorneys' fees and costs) of
prosecuting such claim. Neither the failure of the Corporation (including its
Board of Directors or independent legal counsel) to have made a determination
prior to the commencement of such action that indemnification of or the
advancement or reimbursement of expenses to the claimant is proper in the
circumstances, nor an actual determination by the Corporation (including its
Board of Directors or independent legal counsel) that the claimant is not
entitled to indemnification or to the reimbursement or advancement of expenses,
shall be a defense to the action or create a presumption that the claimant is
not so entitled.

                  (d) The indemnification and advancement or reimbursement of
expenses provided by, or granted pursuant to, this Section 301.1 shall not be
deemed exclusive of any other rights to which those seeking indemnification or
advancement or reimbursement of expenses may be entitled under any bylaw,
agreement, vote of shareholders or disinterested directors or otherwise.

                  (e) Nothing contained in this Section 301.1 shall be construed
to limit the rights and powers the Corporation possesses under Chapter 17,
Subchapter D of the Business Corporation Law, or otherwise, including, but not
limited to, the powers to purchase and maintain insurance, create funds to
secure or insure its indemnification obligations, and any other rights or powers
the Corporation may otherwise have under applicable law.



<PAGE>


                  (f) The provisions of this Section 301.1 may, at any time (and
whether before or after there is any basis for a claim for indemnification or
for the advancement or reimbursement of expenses pursuant hereto), be amended,
supplemented, waived, or terminated, in whole or in part, with respect to any
person covered by Section 301.1.2 hereof by a written agreement signed by the
Corporation and such person.

                  (g) The Corporation shall have the right to appoint the
attorney for a person covered by Section 301.1.2 hereof, provided such
appointment is not unreasonable under the circumstances.

         Section 301.1.7. Optional Indemnification. The Corporation may, to the
fullest extent permitted by applicable law, indemnify, and advance or reimburse
expenses for, persons in all situations other than that covered by this Section
301.1.

ARTICLE IV.       SHARES OF CAPITAL STOCK

         Section 401. Authority to Sign Share Certificate. Every share
certificate of the Corporation shall be signed by the Chairman and Chief
Executive Officer and by the Secretary or one of the Assistant Secretaries. If
the certificate is signed by a transfer agent or registrar, the signature of any
officer of the Corporation on the certificate may be facsimile, engraved or
printed.

         Section 402. Lost or Destroyed Certificates. Any person claiming a
share certificate to be lost, destroyed or wrongfully taken shall receive a
replacement certificate if such shareholder: (a) requests such replacement
certificate before the Corporation has notice that the shares have been acquired
by a bona fide purchaser; (b) files with the Corporation an indemnity bond
deemed sufficient by the Board of Directors; and (c) satisfies any other
reasonable requirements fixed by the Board of Directors.

ARTICLE V.        GENERAL

         Section 501. Fiscal Year. The fiscal year of the Corporation shall be
determined by the Board of Directors.

         Section 502. Record Date. The Board of Directors may fix any time prior
to the date of any meeting of shareholders as a record date for the
determination of shareholders entitled to notice of, or to vote at, the meeting,
which time, except in the case of an adjourned meeting, shall be not more than
ninety (90) days prior to the date of the meeting of shareholders. The Board of
Directors may fix any time whatsoever (whether or not the same is more than
ninety (90) days) prior to the date for the payment of any dividend or
distribution, or the date for the allotment of rights, or the date when any
change or conversion or exchange of shares will be made or will go into effect,
as a record date for the determination of the shareholders entitled to receive
payment of any such dividend or distribution, or to receive any such allotment
of rights, or to exercise the rights in respect to any such change, conversion
or exchange of shares.



<PAGE>


         Section 503. Emergency Bylaws. In the event of any emergency resulting
from an attack on the United States, a nuclear disaster or another catastrophe
as a result of which a quorum cannot be readily assembled and during the
continuance of such emergency, the following Bylaw provisions shall be in
effect, notwithstanding any other provisions of these Bylaws.

                  (a) A meeting of the Board of Directors or of any committee
thereof may be called by any officer or director upon one hour's notice to all
persons entitled to notice whom, in the sole judgment of the notifier, it is
feasible to notify;

                  (b) The director or directors in attendance at the meeting of
the Board of Directors or of any committee thereof shall constitute a quorum;
and

                  (c) These Bylaws may be amended or repealed, in whole or in
part, by a majority vote of the directors attending any meeting of the Board of
Directors, provided such amendment or repeal shall only be effective for the
duration of such emergency.

         Section 504. Severability. If any provision of these Bylaws is illegal
or unenforceable as such, such illegality or unenforceability shall not affect
any other provision of these Bylaws and such other provisions shall continue in
full force and effect.

ARTICLE VI.       AMENDMENTS

         Section 601. Amendment or Repeal by the Board of Directors. Except as
provided by applicable law, these Bylaws may be amended or repealed, in whole or
in part, by a majority vote of the members of the Board of Directors present and
voting at any duly convened regular or special meeting of the Board.

         Section 602. Amendment or Repeal by Shareholders. These Bylaws may be
amended or repealed, in whole or in part, by shareholders as follows: (i) in the
case of an amendment or repeal that has previously received the approval of the
Board of Directors, by a majority of the votes cast by shareholders at any duly
convened annual or special meeting of the shareholders; and (ii) in the case of
an amendment or repeal that has not previously received the approval of the
Board of Directors, by a vote of shareholders entitled to cast at least 75
percent of the votes which all shareholders are entitled to cast thereon at any
annual or special meeting of the shareholders. This Section 602 may be amended
or repealed, in whole or in part, only by a vote of shareholders entitled to
cast at least 75 percent of the votes which all shareholders are entitled to
cast thereon at any duly convened annual or special meeting of shareholders.

         Section 602. Recording Amendments. The text of all amendments to these
Bylaws shall be attached hereto, and a notation of the date of its adoption and
a notation of whether it was adopted by the directors or the shareholders shall
be made in Section 702 hereof.


<PAGE>

ARTICLE VII.      ADOPTION OF BYLAWS AND RECORD OF AMENDMENTS THERETO

         Section 701. Adoption and Effective Date. These Bylaws have been
adopted as the Bylaws of the Corporation this 26th day of June, 1991, and shall
be effective as of said date.

         Section 702.  Amendments to Bylaws.

         Section Amended            Date Amended              Adopted By
         ---------------            ------------              ----------

         102.6                      October 11, 1993          Board of Directors

         "RESOLVED, that Section 102.6 of the Bylaws be amended to read as
         follows:

         Should a vacancy occur or be created, whether arising through death,
         resignation, retirement or removal of a Director, such vacancy shall be
         filled by a majority vote of the remaining Directors. A Director so
         elected to fill a vacancy shall serve for the remainder of the then
         present term of office of the class to which he was elected."

         102.3                      January 17, 1996          Board of Directors

         Section 102.3 of the Bylaws of the Company is hereby amended and
         restated in its entirety as follows:

         "Section 102.3. Number of Directors. The Board of Directors shall
         consist of at least eight (8) directors and be divided into three
         classes in accordance with the Corporation's Amended and Restated
         Articles of Incorporation."

         102.3                      February 24, 1997         Board of Directors

         Section 102.3 of the Bylaws of the Company shall be amended and
         restated in its entirety as follows:

         "Section 102.3. Number of Directors. The Board of Directors shall
         consist of no less than five (5) and no more than nine (9) directors
         and shall be divided into three classes in accordance with the
         Corporation's Amended and Restated Articles of Incorporation."






<PAGE>

                                  EXHIBIT 10.1

                          GENESIS HEALTH VENTURES, INC.

                 AMENDED AND RESTATED EMPLOYEE STOCK OPTION PLAN


         1.       Purpose of Plan

                  The purpose of this Amended and Restated Employee Stock Option
Plan (the "Plan") is to provide additional incentive to officers and key
employees of Genesis Health Ventures, Inc. (the "Company") and each present or
future parent or subsidiary corporation by encouraging them to invest in shares
of the Company's common stock, par value $.02 per share ("Common Stock"), and
thereby acquire a proprietary interest in the Company and an increased personal
interest in the Company's continued success and progress, to the mutual benefit
of directors, officers, employees and stockholders.

         2.       Aggregate Number of Shares

                  6,250,000 shares of the Company's Common Stock shall be the
aggregate number of shares which may be issued under this Plan. Notwithstanding
the foregoing, in the event of any change in the outstanding shares of the
Common Stock of the Company by reason of a stock dividend, stock split,
combination of shares, recapitalization, merger, consolidation, transfer of
assets, reorganization, conversion or what the Compensation Committee,
hereinafter referred to, deems in its sole discretion to be similar
circumstances, the aggregate number and kind of shares which may be issued under
this Plan shall be appropriately adjusted in a manner determined in the sole
discretion of the Compensation Committee. Reacquired shares of the Company's
Common Stock, as well as unissued shares, may be used for the purpose of this
Plan. Common Stock of the Company subject to options which have terminated
unexercised, either in whole or in part, shall be available for future options
granted under this Plan.

         3.       Class of Persons Eligible to Receive Options

                  All officers and key employees of, and consultants and
advisors to, the Company and any present or future Company parent or subsidiary
corporation are eligible to receive an option or options under this Plan,
provided that Incentive Stock Options (as described below) may be issued only to
employees. The individuals who shall, in fact, receive an option or options
shall be selected by the Compensation Committee, in its sole discretion, except
as otherwise specified in Section 4 hereof. The maximum number of options which
may be granted to any participant in any one year is options for 750,000 shares
of Common Stock subject to appropriate adjustment in the event of any change in
the outstanding shares of the Common Stock of the Company by reason of a stock
dividend, stock split, combination of shares, recapitalization, merger,
consolidation, transfer of assets, reorganization, conversion or what the
Compensation Committee deems in its sole discretion to be similar circumstances.
<PAGE>

         4.       Administration of Plan

                  (a) This Plan shall be administered by the Compensation
Committee (the "Committee") appointed by the Company's Board of Directors. The
Committee shall consist of a minimum of two and a maximum of seven members of
the Board of Directors, each of whom shall be a "disinterested person" as
defined in Rule 16b-3(d)(3) under the Securities Exchange Act of 1934, as
amended, of the Securities and Exchange Commission (the "SEC") or any future
corresponding rule. The Committee shall, in addition to its other authority and
subject to the provisions of this Plan, determine which individuals are eligible
to receive options under this Plan, which individuals shall in fact be granted
an option or options, whether the option shall be an incentive stock option or a
non-qualified stock option, the number of shares to be subject to each of the
options, the time or times at which the options shall be granted, the rate of
option exercisability, and, subject to Section 5 hereof, the price at which each
of the options is exercisable and the duration of the option.

                  (b) The Committee shall adopt such rules for the conduct of
its business and administration of this Plan as it considers desirable. A
majority of the members of the Committee shall constitute a quorum for all
purposes. The vote or written consent of a majority of the members of the
Committee on a particular matter shall constitute the act of the Committee on
such matter. The Committee shall have the right to construe the Plan and the
options issued pursuant to it, to correct defects and omissions and to reconcile
inconsistencies to the extent necessary to effectuate the Plan and the options
issued pursuant to it, and such action shall be final, binding and conclusive
upon all parties concerned. No member of the Committee or the Board of Directors
shall be liable for any act or omission (whether or not negligent) taken or
omitted in good faith, or for the exercise of an authority or discretion granted
in connection with the Plan to a Committee or the Board of Directors, or for the
acts or omissions of any other members of a Committee or the Board of Directors.
Subject to the numerical limitations on Committee membership set forth in
Section 4(a) hereof, the Board of Directors may at any time appoint additional
members of the Committee and may at any time remove any member of the Committee
with or without cause. Vacancies in the Committee, however caused, may be filled
by the Board of Directors, if it so desires.

         5.       Incentive Stock Options and Non-Qualified Stock Options

                  (a) Options issued pursuant to this Plan may be either
Incentive Stock Options granted pursuant to Section 5(b) hereof or Non-Qualified
Stock Options granted pursuant to Section 5(c) hereof, as determined by the
Committee. An "Incentive Stock Option" is an option which satisfies all of the
requirements of Section 422A of the Code and the regulations thereunder, and a 
"Non-Qualified Stock Option" is an option which either does not satisfy all of
those requirements or the terms of the option provide that it will not be
treated as an Incentive Stock Option. The Committee may grant both an Incentive
Stock Option and a Non-Qualified Stock Option to the same person, or more than
one of each type of option to the same person. The option price for Incentive
Stock Options issued under this Plan shall be equal at least to the fair market
value (as defined below) of the Company's Common Stock on the date of the grant
of the option. The option price for Non-Qualified Stock Options issued under
this Plan shall be at least equal to the fair market value of the Common Stock
on the date of the grant of the option except that the minimum option price may
be equal to or greater than 85% of the fair market value of the Company's Common
Stock as of the date of the grant of the option if the discount is expressly
granted in lieu of a reasonable amount of salary or cash bonus. If an Incentive

                                      -2-
<PAGE>

Stock Option is granted to an individual who, at the time the option is granted,
owns shares of Common Stock equal to more than 10 percent of the total combined
voting power of the Common Stock of the Company or any subsidiary corporation of
the Company (a "10% Stockholder"), the option price shall not be less than 110
percent of the fair market value, as determined by the Committee in accordance
with its interpretation of the requirements of Section 422A of the Code and the
regulations thereunder, of the Company's Common Stock on the date of grant of
the option, and such option shall not be exercisable after the expiration of
five years from the date the option is granted. The fair market value of the
Company's Common Stock on any particular date shall mean the last reported sale
price of a share of the Company's Common Stock on any stock exchange on which
such stock is then listed or admitted to trading, or on the NASDAQ National
Market System, on such date, or if no sale took place on such day, the last such
date on which a sale took place, or if the Common Stock is not then quoted on
the NASDAQ National Market System, or listed or admitted to trading on any stock
exchange, the average of the bid and asked prices in the over-the-counter market
on such date, or if none of the foregoing, a price determined by the Committee.

                  (b) Subject to the authority of the Committee set forth in
Section 4(a) hereof, Incentive Stock Options issued pursuant to this Plan shall
be issued substantially in the form set forth in Appendix I hereof, which form
is hereby incorporated by reference and made a part hereof, and shall contain
substantially the terms and conditions set forth therein. Incentive Stock
Options shall not be exercisable after the expiration of ten years (five years
in the case of 10% Stockholders) from the date such options are granted, unless
terminated earlier under the terms of the option. At the time of the grant of an
Incentive Stock Option hereunder, the Committee may, in its discretion, modify
or amend any of the option terms contained in Appendix I for any particular
optionee, provided that the option as modified or amended satisfies the
requirements of Section 422A of the Code and the regulations thereunder. Each of
the options granted pursuant to this Section 5(b) is intended, if possible, to
be an "Incentive Stock Option" as that term is defined in Section 422A of the
Code and the regulations thereunder. In the event this Plan or any option
granted pursuant to this Section 5(b) is in any way inconsistent with the
applicable legal requirements of the Code or the regulations thereunder for an
Incentive Stock Option, this Plan and such option shall be deemed automatically
amended as of the date hereof to conform to such legal requirements, if such
conformity may be achieved by amendment.

                  (c) Subject to the authority of the Committee set forth in
Section 4(a) hereof, Non-Qualified Stock Options issued pursuant to this Plan
shall be issued substantially in the form set forth in Appendix II hereof, which
form is hereby incorporated by reference and made a part hereof, and shall
contain substantially the terms and conditions set forth therein. Non-Qualified
Stock Options shall expire ten years after the date they are granted, unless
terminated earlier under the option terms. At the time of granting a
Non-Qualified Stock Option hereunder, the Committee may, in its discretion,
modify or amend any of the option terms contained in Appendix II for any
particular optionee.

                  (d) Neither the Company nor any of its current or future
parent, subsidiaries or affiliates, nor their officers, directors, stockholders,
stock option plan committees, employees or agents shall have any liability to
any optionee in the event (i) an option granted pursuant to Section 5(b) hereof
does not qualify as an "Incentive Stock Option" as that term is used in Section
422A of the Code and the regulations thereunder; (ii) any optionee does not
obtain the tax treatment pertaining to an Incentive Stock Option; or (iii) any
option granted pursuant to Section 5(c) hereof is an "Incentive Stock Option."

                                      -3-
<PAGE>

         6.       Modification, Amendment, Suspension and Termination

                  Options shall not be granted pursuant to this Plan after
August 1, 2004. The Board of Directors reserves the right at any time, and from
time to time, to modify or amend this Plan in any way, or to suspend or
terminate it, effective as of such date, which date may be either before or
after the taking of such action, as may be specified by the Board of Directors;
provided, however, that such action shall not affect options granted under the
Plan prior to the actual date on which such action occurred. If a modification
or amendment of this Plan is required by the Code or the regulations thereunder
to be approved by the stockholders of the Company in order to permit the
granting of "Incentive Stock Options" (as that term is defined in Section 422A
of the Code and regulations thereunder) pursuant to the modified or amended
Plan, such modification or amendment shall also be approved by the stockholders
of the Company in such manner as is prescribed by the Code and the regulations
thereunder. If the Board of Directors voluntarily submits a proposed
modification, amendment, suspension or termination for stockholder approval,
such submission shall not require any future modifications, amendments (whether
or not relating to the same provision or subject matter), suspensions or
terminations to be similarly submitted for stockholder approval.

         7.       Effectiveness of Plan

                  This Plan shall become effective on the date of its adoption
by the Company's Board of Directors, subject however to approval by the holders
of the Company's Common Stock in the manner as prescribed in the Code and the
regulations thereunder. Options may be granted under this Plan prior to
obtaining stockholder approval, provided such options shall not be exercisable
until stockholder approval is obtained.

         8.       General Conditions

                  (a) Nothing contained in this Plan or any option granted
pursuant to this Plan shall confer upon any employee the right to continue in
the employ of the Company or any affiliated or subsidiary corporation or
interfere in any way with the rights of the Company or any affiliated or
subsidiary corporation to terminate his employment in any way.

                  (b) Corporate action constituting an offer of stock for sale
to any employee under the terms of the options to be granted hereunder shall be
deemed complete as of the date when the Committee authorizes the grant of the
option to the employee, regardless of when the option is actually delivered to
the employee or acknowledged or agreed to by him or her.

                  (c) Except as provided below, the terms "parent corporation"
and "subsidiary corporation" as used throughout this Plan, and the options
granted pursuant to this Plan, shall (except as otherwise provided in the option
form) have the meaning that is ascribed to that term when contained in Section
422A(b) of the Code and the regulations thereunder, and the Company shall be
deemed to be the grantor corporation for purposes of applying such meaning. The
term "subsidiary corporation" shall also include The Multicare Companies, Inc.
(provided that only Non-Qualified Stock Options may be granted to officers and
key employees of, and consultant and advisors to The Multicare Companies, Inc.).

                  (d) References in this Plan to the Code shall be deemed to
also refer to the corresponding provisions of any future United States revenue
law.

                  (e) The use of the masculine pronoun shall include the
feminine gender whenever appropriate.

                                      -4-
<PAGE>

                                   APPENDIX I

                             INCENTIVE STOCK OPTION


To:
         ----------------------------------------------------------------------
         Name

         ----------------------------------------------------------------------
         Address

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

Date of Grant:
              -----------------------------

         You are hereby granted an option, effective as of the date hereof, to
purchase            shares of common stock, par value $.02 per share ("Common
Stock"), of Genesis Health Ventures, Inc. (the "Company") at a price of $      
per share pursuant to the Company's Amended and Restated Employee Stock Option
Plan (the "Plan").

         Your option may first be exercised on and after            , but not
before that time. [On and after               and prior to             , your
option may be exercised for up to     % of the total number of shares subject to
the option minus the number of shares previously purchased by exercise of the
option (as adjusted for any change in the outstanding shares of the Common Stock
of the Company by reason of a stock dividend, stock split, combination of
shares, recapitalization, merger, consolidation, transfer of assets,
reorganization, conversion or what the Compensation Committee deems in its sole
discretion to be similar circumstances). Each succeeding year thereafter, your
option may be exercised for up to an additional      % of the total number of
shares subject to the option minus the number of shares previously purchased by
exercise of the option (as adjusted for any change in the outstanding shares of
the Common Stock of the Company by reason of a stock dividend, stock split,
combination of shares, recapitalization, merger, consolidation, transfer of
assets, reorganization, conversion or what the Compensation Committee deems in
its sole discretion to be similar circumstances).](1) No fractional shares shall
be issued or delivered.

         This option shall terminate and is not exercisable after [five/ten]
years from the date of its grant (the "Scheduled Termination Date"), except if
terminated earlier as hereafter provided.

         You may exercise your option by giving written notice to the Secretary
of the Company on forms supplied by the Company at its then principal executive
office, accompanied by payment of the option price for the total number of
shares you specify that you wish to purchase. The payment may be in any of the
following forms: (a) cash, which may be evidenced by a check; (b) certificates
representing shares of Common Stock of the Company, which will be valued by the
Secretary of the Company at the fair market value per share of the Company's
Common Stock (as determined in accordance with the Plan) on the last trading day
immediately preceding the delivery of such certificates to the Company,
accompanied by an assignment of the stock to the Company; or (c) any combination
of cash and Common Stock of the Company valued as provided in clause (b). Any
assignment of stock shall be in a form and substance satisfactory to the
Secretary of the Company, including guarantees of signature(s) and payment of
all transfer taxes if the Secretary deems such guarantees necessary or
desirable.

- --------
    (1) The bracketed portion of this paragraph should be included if the number
 of shares which may be acquired upon exercise of the option will increase over
 time.
<PAGE>

         Your option will, to the extent not previously exercised by you,
terminate three months after the date on which your employment by the Company or
a Company subsidiary corporation is terminated other than by reason of (i)
disability as defined in Section 22(e)(3) of the Internal Revenue Code of 1986,
as amended (the "Code"), and the regulations thereunder, in which case your
option will terminate one year from the onset of disability, or death (but in no
event later than the Scheduled Termination Date), whether such termination be
voluntary or not. After the date your employment is terminated, as aforesaid,
you may exercise this option only for the number of shares which you had a right
to purchase and did not purchase on the date your employment terminated. If you
are employed by a Company subsidiary corporation, your employment shall be
deemed to have terminated on the date your employer ceases to be a Company
subsidiary corporation, unless you are on that date transferred to the Company
or another Company subsidiary corporation. Your employment shall not be deemed
to have terminated if you are transferred from the Company to a Company
subsidiary corporation, or vice versa, or from one Company subsidiary
corporation to another Company subsidiary corporation.

         If you die while employed by the Company or a Company subsidiary
corporation, your legatee(s), distributee(s), executor or administrator, as the
case may be, may, at any time within one year after the date of your death (but
in no event later than the Scheduled Termination Date), exercise the option as
to any shares which you had a right to purchase and did not purchase during your
lifetime. If your employment by the Company or a Company subsidiary corporation
is terminated by reason of your becoming disabled (within the meaning of Section
22(e)(3) of the Code and the regulations thereunder), you or your legal guardian
or custodian may at any time within one year after the date of such termination
(but in no event later than the Scheduled Termination Date), exercise the option
as to any shares, which you have a right to purchase and did not purchase prior
to such termination. Your executor, administrator, guardian or custodian must
present proof of his authority satisfactory to the Company prior to being
allowed to exercise this option.

         In the event of any change in the outstanding shares of the Common
Stock of the Company by reason of a stock dividend, stock split, combination of
shares, recapitalization, merger, consolidation, transfer of assets,
reorganization, conversion or what the Compensation Committee deems in its sole
discretion to be similar circumstances, the number and kind of shares subject to
this option and the option price of such shares shall be appropriately adjusted
in a manner to be determined in the sole discretion of the Compensation
Committee.

         This option is not transferable otherwise than by will or the laws of
descent and distribution, and is exercisable during your lifetime only by you,
including, for this purpose, your legal guardian or custodian in the event of
disability. Until the option price has been paid in full pursuant to due
exercise of this option and the purchased shares are delivered to you, you do
not have any rights as a stockholder of the Company. The Company reserves the
right not to deliver to you the shares purchased by virtue of the exercise of
this option during any period of time in which the Company deems, in its sole
discretion, that such delivery would violate a federal, state, local or
securities exchange rule, regulation or law.

                                      -2-
<PAGE>

         Notwithstanding anything to the contrary contained herein, this option
is not exercisable until all the following events occur and during the following
periods of time:

                  (a) Until the Plan pursuant to which this option is granted is
approved by the stockholders of the Company in the manner prescribed by the Code
and the regulations thereunder;

                  (b) Until this option and the optioned shares are approved
and/or registered with such federal, state or local regulatory bodies or
agencies and securities exchanges as the Company may deem necessary or
desirable; or

                  (c) During any period of time in which the Company deems that
the exercisability of this option, the offer to sell the shares optioned
hereunder, or the sale hereof, may violate a federal, state, local or securities
exchange rule, regulation or law, or may cause the Company to be legally
obligated to issue or sell more shares than the Company is legally entitled to
issue or sell.

         The following two paragraphs shall be applicable if, on the date of
exercise of this option, the Common Stock to be purchased pursuant to such
exercise has not been registered under the Securities Act of 1933, as amended,
and under applicable state securities laws, and shall continue to be applicable
for so long as such registration has not occurred:

                  (a) The optionee hereby agrees, warrants and represents that
he will acquire the Common Stock to be issued hereunder for his or her own
account for investment purposes only, and not with a view to, or in connection
with, any resale or other distribution of any of such shares, except as
hereafter permitted. The optionee further agrees that he or she will not at any
time make any offer, sale, transfer, pledge or other disposition of such Common
Stock to be issued hereunder without an effective registration statement under
the Securities Act of 1933, as amended, and under any applicable state
securities laws or an opinion of counsel acceptable to the Company to the effect
that the proposed transaction will be exempt from such registration. The
optionee shall execute such instruments, representations, acknowledgments and
agreements as the Company may, in its sole discretion, deem advisable to avoid
any violation of federal, state, local or securities exchange rule, regulation
or law.

                  (b) The certificates for Common Stock to be issued to the
optionee hereunder shall bear the following legend:

                  "The shares represented by this certificate have not been
         registered under the Securities Act of 1933, as amended, or under
         applicable state securities laws. The shares have been acquired for
         investment and may not be offered, sold, transferred, pledged or
         otherwise disposed of without an effective registration statement under
         the Securities Act of 1933, as amended, and under any applicable state
         securities laws or an opinion of counsel acceptable to the Company that
         the proposed transaction will be exempt from such registration."

The foregoing legend shall be removed upon registration of the legended shares
under the Securities Act of 1933, as amended, and under any applicable state
laws or upon receipt of an opinion of counsel acceptable to the Company that
said registration is no longer required.

                                      -3-
<PAGE>

         The sole purpose of the agreements, warranties, representations and
legend set forth in the two immediately preceding paragraphs is to prevent
violations of the Securities Act of 1933, as amended, and any applicable state
securities laws.

         It is the intention of the Company and you that this option shall, if
possible, be an "incentive stock option" as that term is used in Section 422A of
the Code and the regulations thereunder. In the event this option is in any way
inconsistent with the legal requirements of the Code or the regulations
thereunder for an "incentive stock option," this option shall be deemed
automatically amended as of the date hereof to conform to such legal
requirements, if such conformity may be achieved by amendment.

         This option shall be subject to the terms of the Plan in effect on the
date this option is granted, which terms are hereby incorporated herein by
reference and made a part hereof. In the event of any conflict between the terms
of this option and the terms of the Plan in effect on the date of this option,
the terms of the Plan shall govern. This option constitutes the entire
understanding between the Company and you with respect to the subject matter
hereof and no amendment, modification or waiver of this option, in whole or in
part, shall be binding upon the Company unless in writing or signed by the
President of the Company. This option and the performances of the parties
hereunder shall be construed in accordance with and governed by the laws of the
Commonwealth of Pennsylvania.

         Please sign the copy of this option and return it to the Company's
Secretary, thereby indicating your understanding of and agreement with its terms
and conditions.

                                            GENESIS HEALTH VENTURES, INC.


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

         I hereby acknowledge receipt of a copy of the foregoing stock option
and, having read it hereby signify my understanding of, and my agreement with,
its terms and conditions.


- -----------------------------------           ---------------------------------
(Signature)                                   (Date)

                                      -4-


<PAGE>

                                   APPENDIX II

                           NON-QUALIFIED STOCK OPTION

To:
         ----------------------------------------------------------------------
         Name

         ----------------------------------------------------------------------
         Address

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

Date of Grant:
              ----------------------------------

         You are hereby granted an option, effective as of the date hereof, to
purchase           shares of common stock, par value $.02 per share ("Common
Stock"), of Genesis Health Ventures, Inc. (the "Company") at a price of $ 
per share pursuant to the Company's Amended and Restated Employee Stock Option
Plan (the "Plan").

         Your option may first be exercised on and after           , but not
before that time. [On and after             and prior to         , your option
may be exercised for up to     % of the total number of shares subject to the
option minus the number of shares previously purchased by exercise of the option
(as adjusted for any change in the outstanding shares of the Common Stock of the
Company by reason of a stock dividend, stock split, combination of shares,
recapitalization, merger, consolidation, transfer of assets, reorganization,
conversion or what the Compensation Committee deems in its sole discretion to be
similar circumstances). Each succeeding year thereafter, your option may be
exercised for up to an additional      % of the total number of shares subject
to the option minus the number of shares previously purchased by exercise of the
option (as adjusted for any change in the outstanding shares of the Common Stock
of the Company by reason of a stock dividend, stock split, combination of
shares, recapitalization, merger, consolidation, transfer of assets,
reorganization, conversion or what the Compensation Committee deems in its sole
discretion to be similar circumstances).](1) No fractional shares shall be 
issued or delivered.

         This option shall terminate and is not exercisable after ten years from
the date of its grant (the "Scheduled Termination Date"), except if terminated
earlier as hereafter provided.

         You may exercise your option by giving written notice to the Secretary
of the Company on forms supplied by the Company at its then principal executive
office, accompanied by payment of the option price for the total number of
shares you specify that you wish to purchase. The payment may be in any of the
following forms: (a) cash, which may be evidenced by a check; (b) certificates
representing Common Stock of the Company which will be valued by the Secretary
of the Company at the fair market value per share of the Company's Common Stock
(as determined in accordance with the Plan) on the last trading day immediately
preceding the delivery of such certificates to the Company, accompanied by an
assignment of the stock to the Company; or (c) any combination of cash and
Common Stock of the Company valued as provided in clause (b). Any assignment of
stock shall be in a form and substance satisfactory to the Secretary of the
Company, including guarantees of signature(s) and payment of all transfer taxes
if the Secretary deems such guarantees necessary or desirable.

- ----------
    (1) The bracketed portion of this paragraph should be included if the number
of shares which may be acquired upon exercise of the option will increase over
time.
<PAGE>

         Your option will, to the extent not previously exercised by you,
terminate three months after the date on which your employment by the Company or
a Company subsidiary corporation is terminated other than by reason of (i)
disability as defined in Section 22(e)(3) of the Internal Revenue Code of 1986,
as amended (the "Code"), and the regulations thereunder, in which case your
option will terminate one year from the onset of disability, or death (but in no
event later than the Scheduled Termination Date), whether such termination be
voluntary or not. After the date your service or employment is terminated, as
aforesaid, you may exercise this option only for the number of shares which you
had a right to purchase and did not purchase on the date you ceased to be a
director or your employment terminated. If you are employed by a Company
subsidiary corporation, your employment shall be deemed to have terminated on
the date your employer ceases to be a Company subsidiary corporation, unless you
are on that date transferred to the Company or another Company subsidiary
corporation. Your employment shall not be deemed to have terminated if you are
transferred from the Company to a Company subsidiary corporation, or vice versa,
or from one Company subsidiary corporation to another Company subsidiary
corporation.

         If you die while employed by the Company or a Company subsidiary
corporation, your legatee(s), distributee(s), executor or administrator, as the
case may be, may, at any time within one year after the date of your death (but
in no event later than the Scheduled Termination Date), exercise the option as
to any shares which you had a right to purchase and did not purchase during your
lifetime. If your service with the Company or a Company parent or subsidiary
corporation is terminated by reason of your becoming disabled (within the
meaning of Section 22(e)(3) of the Code and the regulations thereunder), you or
your legal guardian or custodian may at any time within one year after the date
of such termination (but in no event later than the Scheduled Termination Date),
exercise the option as to any shares which you had a right to purchase and did
not purchase prior to such termination. Your executor, administrator, guardian
or custodian must present proof of his authority satisfactory to the Company
prior to being allowed to exercise this option.

         In the event of any change in the outstanding shares of the Common
Stock of the Company by reason of a stock dividend, stock split, combination of
shares, recapitalization, merger, consolidation, transfer of assets,
reorganization, conversion or what the Compensation Committee deems in its sole
discretion to be similar circumstances, the number and kind of shares subject to
this option and the option price for such shares shall be appropriately adjusted
in a manner to be determined in the sole discretion of the Compensation
Committee.

         This option is not transferable otherwise than by will or the laws of
descent and distribution, and is exercisable during your lifetime only by you,
including, for this purpose, tour legal guardian or custodian in the event of
disability. Until the option price has been paid in full pursuant to due
exercise of this option and the purchased shares are delivered to you, you do
not have any rights as a stockholder of the Company. The Company reserves the
right not to deliver to you the shares purchased by virtue of exercise of this
option during any period of time in which the Company deems, in its sole
discretion, that such delivery may not be consummated without violating a
federal, state, local or securities exchange rule, regulation or law.

                                      -2-
<PAGE>

         Notwithstanding anything to the contrary contained herein, this option
is not exercisable until all the following events occur and during the following
periods of time:

                  (a) Until the Plan pursuant to which this option is granted is
approved by the stockholders of the Company in the manner prescribed by the Code
and the regulations thereunder;

                  (b) Until this option and the optioned shares are approved
and/or registered with such federal, state and local regulatory bodies or
agencies and securities exchanges as the Company may deem necessary or
desirable; or

                  (c) During any period of time in which the Company deems that
the exercisability of this option, the offer to sell the shares optioned
hereunder, or the sale thereof, may violate a federal, state, local or
securities exchange rule, regulation or law, or may cause the Company to be
legally obligated to issue or sell more shares than the Company is legally
entitled to issue or sell.

         The following two paragraphs shall be applicable if, on the date of
exercise of this option, the Common Stock to be purchased pursuant to such
exercise has not been registered under the Securities Act of 1933, as amended,
and under applicable state securities laws, and shall continue to be applicable
for so long as such registration has not occurred:

                  (a) The optionee hereby agrees, warrants and represents that
he will acquire the Common Stock to be issued hereunder for his own account for
investment purposes only, and not with a view to, or in connection with, any
resale or other distribution of any of such shares, except as hereafter
permitted. The optionee further agrees that he will not at any time make any
offer, sale, transfer, pledge or other disposition of such Common Stock to be
issued hereunder without an effective registration statement under the
Securities Act of 1933, as amended, and under any applicable state securities
laws or an opinion of counsel acceptable to the Company to the effect that the
proposed transaction will be exempt from such registration. The optionee shall
execute such instruments, representations, acknowledgments and agreements as the
Company may, in its sole discretion, deem advisable to avoid any violation of
federal, state, local or securities exchange rule, regulation or law.

                  (b) The certificates for Common Stock to be issued to the
optionee hereunder shall bear the following legend:

                  "The shares represented by this certificate have not been
         registered under the Securities Act of 1933, as amended, or under
         applicable state securities laws. The shares have been acquired for
         investment and may not be offered, sold, transferred, pledged or
         otherwise disposed of without an effective registration statement under
         the Securities Act of 1933, as amended, and under any applicable state
         securities laws or an opinion of counsel acceptable to the Company that
         the proposed transaction will be exempt from such registration."

                                      -3-
<PAGE>

The foregoing legend shall be removed upon registration of the legended shares
under the Securities Act of 1933, as amended, and under any applicable state
laws or upon receipt of an opinion of counsel acceptable to the Company that
said registration is no longer required.

         The sole purpose of the agreements, warranties, representations and
legend set forth in the two immediately preceding paragraphs is to prevent
violations of the Securities Act of 1933, as amended, and any applicable state
securities laws.

         It is the intention of the Company and you that this option shall not
be an "incentive stock option" as that term is used in Section 422A of the Code
and the regulations thereunder.

         This option shall be subject to the terms of the Plan in effect on the
date this option is granted, which terms are hereby incorporated herein by
reference and made a part hereof. In the event of any conflict between the terms
of this option and the terms of the Plan in effect on the date of this option,
the terms of the Plan shall govern. This option constitutes the entire
understanding between the Company and you with respect to the subject matter
hereof and no amendment, modification or waiver of this option, in whole or in
part, shall be binding upon the Company unless in writing and signed by the
President of the Company. This option and the performances of the parties
hereunder shall be construed in accordance with and governed by the laws of the
Commonwealth of Pennsylvania.

         Please sign the copy of this option and return it to the Company's
Secretary, thereby indicating your understanding of and agreement with its terms
and conditions.

                                          GENESIS HEALTH VENTURES, INC.


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


I hereby acknowledge receipt of a copy of the foregoing stock option and, having
read it hereby signify my understanding of, and my agreement with, its terms and
conditions.



- --------------------------------------           -----------------------------
(Signature)                                      (Date)

                                      -4-


<PAGE>

                                                                       EXHIBIT B
                                RIGHTS AGREEMENT


                  RIGHTS AGREEMENT (the "Agreement"), dated as of April 26,
1998, by and between GENESIS HEALTH VENTURES, INC., a Pennsylvania corporation
("Genesis") and Manor Care Inc., a Delaware corporation ("Manor Care").


                              W I T N E S S E T H :

                  WHEREAS, Genesis, The Acquisition Corporation, a Delaware
corporation and wholly-owned subsidiary of Genesis ("Acquisition Corporation"),
and Vitalink Pharmacy Services, Inc., a Delaware corporation ("Vitalink"), have
entered into an Agreement and Plan of Merger dated April 26, 1998 (the "Merger
Agreement");

                  WHEREAS, as a result of the Merger (capitalized terms used
without definition herein having the meanings ascribed thereto in the Merger
Agreement), Manor Care will beneficially own shares of preferred stock, par
value $.01 per share, of Genesis (the "Preferred Stock"), which Preferred Stock
is convertible into shares of common stock, par value $.02 per share, of Genesis
(the "Common Stock"); and

                  WHEREAS, Genesis and Manor Care have agreed that this
Agreement shall become effective at the Effective Time of the Merger.

                  NOW, THEREFORE, in consideration of the mutual covenants and
agreements set forth herein, Genesis and Manor Care hereby agree as follows:

                                   STANDSTILL


Section 1.  Manor Care Standstill Obligations.

                  Prior to the earlier of April 26, 2005 or the occurrence of a
Director Change (as defined below) and subject to the further provisions hereof:

                  (a) Neither Manor Care nor any Affiliate of Manor Care
including, without limitation, New ManorCare Health Services, Inc.
(collectively, the "Manor Care Group") will, without the prior written consent
of Genesis, directly or indirectly, acquire any shares of any class of capital
stock of Genesis which is entitled to vote generally in the election of
directors or is convertible or exchangeable for any class of capital stock which
is entitled to vote generally in the election of directors (all such classes of
capital stock of Genesis being referred to herein as "Voting Securities")
(except for the Preferred Stock, the Common Stock or other securities issuable
upon conversion of the Preferred Stock and pursuant to stock splits, stock
dividends or other distributions or offerings made available to holders of
Voting Securities generally); provided, however, that if at any time the Manor
Care Voting Power shall be less than the Maximum Percentage of the Total Voting
Power, then the Manor Care Group may acquire Voting 
<PAGE>


Securities unless the effect of such acquisition would be to increase the
aggregate voting power in the election of directors of all Voting Securities
then owned by all members of the Manor Care Group (such aggregate voting power
of all Voting Securities owned by all members of the Manor Care Group being
referred to herein as the "Manor Care Voting Power") to greater than 15% (the
"Maximum Percentage") of the total combined voting power in the election of
directors of all the Voting Securities then outstanding (such total combined
voting power of all the Voting Securities outstanding being referred to herein
as the "Total Voting Power").

                  If at any time the Manor Care Voting Power shall be increased
to more than the Maximum Percentage of the Total Voting Power as a result of a
repurchase of Voting Securities by Genesis or any other change in Genesis's
capitalization, no member of the Manor Care Group shall be required to dispose
of any Voting Securities.

                  As used in this Agreement, the following terms shall have the
following meanings:

                  The term "affiliate" shall have the meaning set forth in Rule
12b-2 under the Exchange Act.

                  "Continuing Director" shall mean any member of the Board of
Directors of Genesis, while such person is a member of the Board of Directors
who either (i) was a member of the Board of Directors on the date hereof, (ii)
subsequently becomes a member of the Board of Directors, if such person was
recommended or elected to succeed the Continuing Directors by a majority of the
Continuing Directors or (iii) was appointed at the direction of Manor Care.

                  "Director Change" shall mean (i) the Chief Executive Officer
of Genesis on the date hereof is removed from office by the Board of Directors
or the Board of Directors materially alters his authority or responsibilities
such that he does not exercise the authority or have the responsibilities
formerly associated with his position as the Chief Executive Officer, or (ii)
the majority of the Board of Directors does not consist of Continuing Directors.

                  All references to securities "owned" or "acquired" by a person
shall include all securities owned of record by such person and all securities
over which such person has beneficial ownership within the meaning of Section
13(d) of the Exchange Act.

                  The term "person" shall mean any person or group of persons
within the meaning of Section 13(d)(3) of the Securities Exchange Act of 1934,
as amended, and the rules and regulations promulgated thereunder (the "Exchange
Act").

                  (b) No member of the Manor Care Group shall make any
"solicitation" of "proxies" to vote or become a "participant" in a
"solicitation" (as such terms are defined in Regulation 14A under the Exchange
Act) in opposition to the recommendation of the majority of the directors of
Genesis with respect to any matter.

                                      -2-

<PAGE>

                  (c) No member of the Manor Care Group shall join a
partnership, limited partnership, syndicate or other group, or otherwise act in
concert with any other person, for the purpose of acquiring, holding, voting or
disposing of Voting Securities in violation of Section 1(a), or otherwise become
a "person" within the meaning of Section 13(d)(3) of the Exchange Act (in each
case other than solely with members of the Manor Care Group), nor shall any
member of the Manor Care Group deposit any Voting Securities in a voting trust
or similar arrangement or subject any Voting Securities to any voting agreement
or pooling arrangement other than in accordance with Section 4(b).

                  (d) No member of the Manor Care Group shall seek to call, or
request the call of, a special meeting of the shareholders of Genesis or seek to
make, or make, a shareholder proposal at any meeting of the shareholders of
Genesis.

                  (e) No member of the Manor Care Group shall commence or
announce any intention to commence any tender offer for any shares of Stock, or
take any action that would require the Manor Care Group to file with or send to
the Securities and Exchange Commission (the "SEC") an amendment to Item 4 or
Item 6 of its Schedule 13D under the Exchange Act with respect to the Voting
Securities.

                  (f) No member of the Manor Care Group shall, directly or
indirectly, assist, encourage or induce any person to bid for or acquire
outstanding Voting Securities or propose a tender offer, exchange offer or
change of control of Genesis; provided, however, that the mere sale of Voting
Securities by any member of the Manor Care Group and any action taken by the
Manor Care Director or Manor Care Observer in connection with his role as a
board member or observer shall not constitute assisting, encouraging or inducing
within the meaning of this Section 1(f).

                  (g) No member of the Manor Care Group shall otherwise act
alone or in concert with others to seek control or influence the management,
Board of Directors or policies of Genesis other than pursuant to this Agreement
or any action taken by the Manor Care Director or Manor Care Observer in
connection with its role as a board member or observer.

                  (h) No member of the Manor Care Group shall arrange, or in any
way participate in, any financing for any transaction referred to in clauses (a)
through (g) above inclusive.

                  (i) No member of the Manor Care Group shall make public, or
cause or facilitate the public disclosure (including by disclosure to any
journalist or other representative of the media) of, any request, or otherwise
seek (in any fashion that would require public disclosure by Genesis), to obtain
any waiver or amendment of any provision of this Section 1, or to take any
action restricted hereby.

                  (j) In the event a tender or exchange offer is made by any
person (other than an affiliate of, or any person acting in concert with, any
member of the Manor Care Group) any member of the Manor Care Group holding
Voting Securities may tender or exchange its Voting Securities according to the
terms of the offer.

                                      -3-

<PAGE>


                  (k) If, at any time prior to April 26, 2003, the Manor Care
Group proposes to transfer to a third party Voting Securities having in excess
of 15% of the Total Voting Power, then as a condition to such transfer the
transferee must agree to be bound by the provisions of this Section 1 with
respect to such Voting Securities. Notwithstanding the foregoing, the Manor Care
Group shall not transfer Voting Securities to any person who owns any Voting
Securities of Genesis, if such transfer will result in such transferee having in
excess of 15% of the Total Voting Power. Any purported transfer in violation of
this section will be void.

Section 2.  Genesis Standstill Obligations.

                  (a) Genesis will not, without the prior written consent of
Manor Care, take or recommend to its shareholders any action during the term of
this Agreement which would impose limitations on the legal rights of the Manor
Care Group as Genesis shareholders other than those imposed pursuant to the
express terms of this Agreement which disproportionately affect the Manor Care
Group compared to holders of Preferred Stock or Common Stock generally.

                  (b) Prior to the Effective Time, Genesis shall have taken
appropriate action with respect to its stockholders rights plan so as to exempt
(i) the holders of Preferred Stock or (ii) any person that is the direct
assignee of any holder of Preferred Stock to the extent that such assignee (A)
acquires in a single transaction from a holder of Preferred Stock over 15% of
the Voting Securities and (B) owns no other shares of Voting Securities from the
restrictions of such stockholders rights plan with respect to such shares of
Preferred Stock and shares of Common Stock issuable upon conversion thereof and
from and after the Effective Time, Genesis shall take no action which would
subject such holders of Preferred Stock to the restrictions of Genesis's
stockholders rights plan or any similar plan adopted after the Effective Time.

                  (c) Genesis will not require any Manor Care Director or Manor
Care Observer to enter into any confidentiality agreement or other arrangement
that would limit the ability of such Manor Care Director or Manor Care Observer
to communicate with Manor Care as contemplated by Section 3(c) hereof.


                         BOARD REPRESENTATION AND VOTING


Section 3.  Covenants Regarding Board Representation.

                  (a) Designation. As promptly as practicable after receipt of
written notice from Manor Care, Genesis will cause one person designated by
Manor Care to be appointed to Genesis's Board of Directors (the "Manor Care
Director") by such Board to serve as a member of Class I. At the end of the term
of any Manor Care Director, Manor Care shall have the right to designate the
same or a different person to serve as the Manor Care Director for the next term
and Genesis's Board of Directors shall appoint such person to its Board of
Directors. If at any time the Manor Care 

                                      -4-

<PAGE>

Director is not elected or the Manor Care Observer is prohibited from attending
Board meetings, Genesis shall appoint another person designated by Manor Care to
be a Manor Care Director or Manor Care Observer, as the case may be. Any such
designation of a Manor Care Director for appointment to Genesis's Board of
Directors or, pursuant to Section 3(c), of a person to attend Board meetings as
an observer, shall be made after consultation with Genesis, and any such Manor
Care Director or Manor Care Observer shall be reasonably acceptable to Genesis's
Board of Directors (which agreement will not be unreasonably withheld). Genesis
hereby agrees and acknowledges that Jack Anderson and James H. Rempe are
acceptable to Genesis's Board of Directors as a Manor Care Director or Manor
Care Observer. Genesis's Board of Directors shall include in the slate of
nominees recommended by such Board to Genesis's shareholders for election as a
director at each annual meeting of the shareholders of Genesis at which members
of Class I directors are elected, the person then designated by Manor Care for
election to Genesis's Board of Directors in accordance with the provisions of
this Section 3(a). In the event that the Manor Care Director shall cease to
serve as a director for any reason, the vacancy resulting therefrom shall be
filled by a designee of Manor Care being appointed by the Board of Directors
according to the procedures described above.

                  (b) Manor Care Observer. At any time that the Manor Care Group
does not have a Manor Care Director serving on Genesis's Board of Directors,
Manor Care shall be entitled to designate a non-voting observer for such Board
seat and such observer shall be entitled to attend all Board meetings (the
"Manor Care Observer").

                  (c) Confidential Information. The parties acknowledge and
agree that the Manor Care Director or Manor Care Observer, as the case may be,
will be under an obligation to Manor Care not to disclose to any person outside
of Manor Care, or use in any business other than Manor Care's, any confidential
information or material relating to the business of Manor Care or its
subsidiaries and that the Manor Care Director or Manor Care Observer shall be
under no obligation to disclose to Genesis any corporate opportunities that the
Manor Care Director or Manor Care Observer becomes aware of because of his or
her position as an officer, director or employee of Manor Care or any of its
affiliates. The parties acknowledge that there shall be no obligation on the
part of such Manor Care Director or Manor Care Observer to disclose any such
information or material to Genesis, even if such disclosure would be of interest
or value to Genesis. In addition, the parties acknowledge and agree that any
Manor Care Director or Manor Care Observer will be under an obligation to
Genesis not to disclose to any person outside of Genesis, or use in any business
other than Genesis's, any confidential information or material relating to the
business of Genesis or its subsidiaries; provided that the Manor Care Director
or Manor Care Observer may disclose to the officers and directors of Manor Care
information about the financial position or results of operations of Genesis
(which information shall not include specific information about the day to day
operations of Genesis's business or any proposed acquisition, disposition or
other material action to be taken by Genesis) if any such Manor Care officer or
director agrees that any confidential information so disclosed to him or her
shall not be disclosed by him or her to any other person to whom such
information has not been so disclosed by the Manor Care Director or Manor Care
Observer, except as may be compelled by law or legal process.

                                      -5-
   

<PAGE>

                 (d) Removal of Directors; Vacancies. Manor Care shall have the
right to request the removal by Genesis's Board of Directors of the Manor Care
Director. Any such removal shall be subject to the applicable provisions of the
Amended and Restated Articles of Incorporation and By-Laws of Genesis
(including, without limitation, any shareholder vote requirement), as well as
applicable statutory provisions; provided that Genesis will use its best efforts
to cause the Genesis Board of Directors to vote in favor of such requested
removal. In the event that the Manor Care Director for any reason ceases to
serve as a member of the Genesis Board of Directors during his or her term of
office and at such time Manor Care would have the right to designate a Manor
Care Director hereunder (a) the director to fill such vacancy ("Manor Care
Director Vacancy") shall be designated by Manor Care and shall be reasonably
acceptable to Genesis's Board of Directors, and (b) such Manor Care Director
Vacancy shall be filled in accordance with Article Eighth of Genesis's Amended
and Restated Articles of Incorporation.

Section 4.  Voting of Genesis Common Stock and Other Related Matters

                  (a) Each member of the Manor Care Group that is a holder of
record of Voting Securities shall be present, and each member of the Manor Care
Group that is a beneficial owner of Voting Securities shall cause the holder of
record to be present, in person or by proxy, at all meetings of shareholders of
Genesis so that all Voting Securities owned of record or beneficially by the
Manor Care Group may be counted for the purpose of determining the presence of a
quorum at such meetings.

                  (b) At any time prior to April 26, 2001, other than with
respect to a proposed Change of Control, the Manor Care Group will take all such
action as may be required so that all Voting Securities owned by the Manor Care
Group are voted (in person or by proxy) on all matters to be voted on by holders
of Voting Securities in accordance with the recommendation of the Board of
Directors. Manor Care shall cause the Manor Care Director to take such action as
may be necessary and to vote in accordance with the recommendation of Genesis's
Board of Directors to fill any vacancies in Genesis's Board of Directors (other
than a Manor Care Director Vacancy).

                  (c) Manor Care shall not, with respect to a proposed Change of
Control approved by the Board of Directors of Genesis and the shareholders of
Genesis, make any demand for payment pursuant to Section 262 of the Delaware
General Corporation Law.

                  As used herein, a proposed "Change of Control" occurs (A) when
the shareholders of Genesis are asked to approve an agreement or plan (i) to
merge or consolidate Genesis with or into another company (other than a merger
or consolidation which would result in the Voting Securities outstanding
immediately prior thereto continuing to represent (either by remaining
outstanding or by being converted into voting securities of the surviving
entity) more than 50% of the combined voting power of the voting securities of
Genesis or such surviving entity outstanding immediately after such merger or
consolidation), or (ii) to sell, or otherwise dispose of, all or substantially
all of Genesis's property and assets, or (iii) to liquidate, dissolve or wind-up
Genesis or (B) when Genesis is the subject of a transaction pursuant to Rule
13e-3 under the Exchange Act.

                                      -6-

<PAGE>


                               REGISTRATION RIGHTS


Section 5.  Registration Rights.

                  Genesis covenants and agrees as follows:

                  5.01.  Definitions.  For purposes of this Section 5:

                  (a) The terms "register," "registered" and "registration"
refer to a registration effected by preparing and filing a registration
statement in compliance with the Securities Act of 1933, as amended, and the
rules and regulations promulgated thereunder (the "Act").

                  (b) The term "Registrable Securities" means the shares of
Preferred Stock and Common Stock underlying such shares of Preferred Stock held,
from time to time, by the Manor Care Group.

                  (c) The term "Holder" means any member of the Manor Care Group
which owns of record Registrable Securities.

                  5.02.  Request for Registration.

                  (a) If Genesis shall, at any time following the first
anniversary of the Effective Time, receive a written request from the Holders of
Registrable Securities representing at least 25% of the Voting Securities
acquired by the Manor Care Group at the Effective Time that Genesis file a
registration statement under the Act covering the registration of Registrable
Securities, then Genesis shall, within 10 days after the receipt thereof, give
written notice of such request to all Holders and effect within 90 days of the
receipt of such request, the registration under the Act on a Form S-1 or other
appropriate form covering the sale of all Registrable Securities which the
Holders request to be registered.

                  (b) If the Holders initiating the registration request
hereunder (the "Initiating Holders") intend to distribute the Registrable
Securities covered by their request by means of an underwriting, they shall so
advise Genesis as a part of their request made pursuant to this Section 5.02 and
Genesis shall include such information in the written notice referred to in
Section 5.02(a). In such event, the right of any Holder to include Registrable
Securities in such registration shall be conditioned upon such Holder's
participation in such underwriting and the inclusion of such Holder's
Registrable Securities in the underwriting to the extent provided herein. All
Holders proposing to distribute Registrable Securities through such underwriting
shall (together with Genesis) enter into an underwriting agreement in customary
form with the underwriter or underwriters selected for such underwriting by the
Initiating Holders and reasonably acceptable to Genesis. Genesis at its sole
discretion may offer a right to

                                      -7-

<PAGE>


participate in any registration statement filed pursuant to this Section 5.02 to
other holders of Common Stock, and may itself participate in any registration
statement filed pursuant to this Section 5.02. However, notwithstanding any
other provision of this Section 5.02, if the offering is an underwritten
offering and the lead managing underwriter advises the Initiating Holders that
marketing factors require a limitation of the number of shares of Preferred
Stock or Common Stock to be underwritten, then (subject to any contrary
provisions in registration rights agreements executed by Genesis prior to the
date hereof) the total number of shares of Preferred Stock or Common Stock to be
underwritten shall be reduced, with such reduction coming first from selling
stockholders who are not Holders, and then from Genesis.

                  (c) Genesis is obligated to effect no more than three such
registrations pursuant to this Section 5.02.

                  (d) Notwithstanding the foregoing, if Genesis shall furnish to
Holders requesting a registration statement pursuant to this Section 5.02 a
certificate signed by the Chief Executive, Chief Operating, or Chief Financial
Officer of Genesis stating that, in the good faith judgment of a majority of the
disinterested directors, it would be materially detrimental to Genesis for such
registration statement to be filed, Genesis shall have the right to defer such
filing for a period of not more than 90 days after receipt of the request of the
Initiating Holders; provided, however, that Genesis may not utilize this right
more than once in any 12-month period.

                  5.03.  Piggyback Registration.

                  (a) If (but without any obligation to do so), prior to April
26, 2003, Genesis proposes to register any of its Common Stock under the Act in
connection with the public offering of such Common Stock by Genesis (other than
a registration relating solely to the sale of securities to participants in a
dividend reinvestment plan, stock plan or employee benefit plan; a registration
relating solely to the issuance of securities to the security holders of an
acquired company in connection with an acquisition; or a registration on any
form which does not permit inclusion of selling stockholders), or Genesis
proposes to register any of its Common Stock on behalf of a holder of Common
Stock exercising demand registration rights similar to those set forth in
Section 5.02, (which shall not include a shelf registration) Genesis shall, at
such time, promptly give each Holder written notice of such registration. Upon
the written request of each Holder given within 15 days after mailing of such
notice by Genesis, Genesis shall cause to be registered under the Act all of the
Common Stock that each such Holder has requested to be registered.

                  However, notwithstanding any other provision of this Section
5.03, if the offering is an underwritten offering and the lead managing
underwriter advises the Holders that marketing factors require a limitation of
the number of shares of Common Stock to be underwritten, then (subject to any
contrary provisions in registration rights agreements executed by Genesis prior
to the date hereof) the total number of shares of Common Stock to be
underwritten shall be reduced, with such reduction coming first from the
Holders.

                                      -8-

<PAGE>
                  5.04.  Expenses of Registration.

                  All expenses incurred by or on behalf of Genesis in connection
with registrations, filings or qualifications pursuant to Sections 5.02 and
5.03, including, without limitation, all registration, filing and qualification
fees, printers' and accounting fees, and fees and disbursements of counsel for
Genesis and one counsel to the selling Holders, shall be borne by Genesis. In no
event shall Genesis be obligated to bear any underwriting discounts or
commissions relating to Registrable Securities.

                  5.05. Obligations of Genesis. Whenever required under this
Section 5 to effect the registration of any Registrable Securities, Genesis
shall, as expeditiously as reasonably possible:

                  (a) Prepare and file with the SEC a registration statement
with respect to such Registrable Securities and use its reasonable efforts to
cause such registration statement to become effective, and, upon the request of
the Holders of a majority of the Registrable Securities registered thereunder,
keep such registration statement effective for up to fifteen business days.

                  (b) Prepare and file with the SEC such amendments and
supplements to such registration statement and the prospectus used in connection
with such registration statement as may be necessary to comply with the
provisions of the Act with respect to the disposition of all securities covered
by such registration statement.

                  (c) Furnish to the Holders such numbers of copies of a
prospectus, including a preliminary prospectus, in conformity with the
requirements of the Act, and such other documents as they may reasonably request
in order to facilitate the disposition of Registrable Securities owned by them.

                  (d) Use its best efforts to register and qualify the
securities covered by such registration statement under such other securities or
Blue Sky laws of such states or other jurisdictions as shall be reasonably
requested by the Holders, provided that Genesis shall not be required to qualify
to do business or to file a general consent to service of process in any such
states or jurisdictions.

                  (e) In the event of any underwritten public offering, enter
into and perform its obligations under an underwriting agreement, in usual and
customary form, with the underwriters of such offering. Each Holder
participating in such underwriting shall also enter into and perform its
obligations under such an agreement.

                  (f) Notify each Holder of Registrable Securities covered by
such registration statement at any time when a prospectus relating thereto is
required to be delivered under the Act of the happening of any event as a result
of which the prospectus included in such registration statement, as then in
effect, includes an untrue statement of a material fact or omits to state a
material fact required to be stated therein or necessary to make the statements
therein not misleading in the light of the circumstances then existing, and then
use its best efforts to promptly correct such statement or omission.
Notwithstanding the foregoing and anything to the contrary set forth in this
Section 5.05, each Holder acknowledges that there may occasionally be

                                      -9-
<PAGE>

times when Genesis must suspend the use of the prospectus forming a part of the
registration statement until such time as an amendment to the registration
statement has been filed by Genesis and declared effective by the SEC, or until
such time as Genesis has filed an appropriate report with the SEC pursuant to
the Exchange Act. Each Holder hereby covenants that it will (a) keep any such
notice strictly confidential, and (b) not sell any shares of Preferred Stock or
Common Stock pursuant to such prospectus during the period commencing at the
time at which Genesis gives the Holder notice of the suspension of the use of
such prospectus and ending at the time Genesis gives the Holder notice that it
may thereafter effect sales pursuant to such prospectus. Genesis shall only be
able to suspend the use of such prospectus for periods aggregating no more than
60 days in respect of any registration.

                  5.06.  Indemnification.

                  In the event any Registrable Securities are included in a
registration statement under this Section 5:

                  (a) To the extent permitted by law, Genesis will indemnify and
hold harmless each Holder and the affiliates of such Holder, and their
respective directors, officers, general and limited partners, agents and
representatives (and the directors, officers, affiliates and controlling persons
thereof), and each other person, if any, who controls such Holder within the
meaning of the Act, against any losses, claims, damages, or liabilities (joint
or several) to which they may become subject under the Act, the Exchange Act or
other federal or state law, insofar as such losses, claims, damages or
liabilities (or actions in respect thereof) arise out of or are based upon any
of the following (collectively a "Violation"): (i) any untrue statement or
alleged untrue statement of a material fact contained in such registration
statement, including any preliminary prospectus (but only if such statement is
not corrected in the final prospectus) contained therein or any amendments or
supplements thereto, or (ii) the omission or alleged omission to state therein a
material fact required to be stated therein, or necessary to make the statements
therein not misleading (but only if such omission is not corrected in the final
prospectus); provided, however, that the indemnity agreement contained in this
Section 5.06(a) shall not apply to amounts paid in settlement of any such loss,
claim, damage, liability or action if such settlement is effected without the
consent of Genesis (which consent shall not be unreasonably withheld), nor shall
Genesis be liable in any such case for any such loss, claim, damage, liability
or action which arises solely out of or is solely based upon a Violation which
occurs in reliance upon and in conformity with written information furnished
expressly for use in such registration statement by any such Holder or
indemnified person.

                  Each indemnified party shall furnish such information
regarding itself or the claim in question as an indemnifying party may
reasonably request in writing and as shall be reasonably required in connection
with defense of such claim and litigation resulting therefrom.

                                      -10-

<PAGE>
                  (b) To the extent permitted by law, each selling Holder will
indemnify and hold harmless Genesis, each of its directors, each of its officers
who has signed the registration statement, each person, if any, who controls
Genesis within the meaning of the Act, any underwriter, any other Holder selling
securities in such registration statement and any controlling person of any such
underwriter or other Holder, against any losses, claims, damages or liabilities
(joint or several) to which any of the foregoing persons may become subject,
under the Act, the Exchange Act or other federal or state law, insofar as any
such loss, claim, damage, liability or action arises solely out of or is solely
based upon (i) any Violation that occurs in reliance upon and in conformity with
written information furnished by such Holder expressly for use in such
registration statement and (ii) the failure of the selling Holder, after actual
receipt of any notice from the Company of the happening of any event of the kind
described in Section 5.05(f), to discontinue disposition of such Registrable
Securities covered by such registration statement until such selling Holder has
received copies of a supplemented or amended prospectus, or until it is advised
in writing by the Company that the use of the applicable prospectus may be
resumed, and has received copies of any amendments or supplements thereto; and
each such Holder will pay, as incurred, any legal or other expenses reasonably
incurred by any person intended to be indemnified pursuant to this Section
5.06(b) in connection with investigating or defending any such loss, claim,
damage, liability or action; provided, however, that the indemnity agreement
contained in this Section 5.06(b) shall not apply to amounts paid in settlement
of any such loss, claim, damage, liability or action if such settlement is
effected without the consent of such Holder, which consent shall not be
unreasonably withheld; provided, that, in no event shall any indemnity under
this Section 5.06(b) exceed the gross proceeds from the offering received by
such Holder.

                  (c) Promptly after receipt by an indemnified party under this
Section 5.06 of notice of the commencement of any action (including any
governmental action), such indemnified party will, if a claim in respect thereof
is to be made against any indemnifying party under this Section 5.06, deliver to
the indemnifying party a written notice of the commencement thereof and the
indemnifying party shall have the right to participate in, and, to the extent
the indemnifying party so desires, jointly with any other indemnifying party
similarly noticed, to assume the defense thereof with counsel mutually
satisfactory to the parties. The failure to deliver written notice to the
indemnifying party within a reasonable time after the commencement of any such
action, if materially prejudicial to its ability to defend such action, shall
relieve such indemnifying party of any liability to the indemnified party under
this Section 5.06 to the extent of such prejudice, but the omission so to
deliver written notice to the indemnifying party will not relieve it of any
liability that it may have to any indemnified party otherwise than under this
Section 5.06. The indemnified party shall have the right, but not the
obligation, to participate in the defense of any action referred to above
through counsel of its own choosing and shall have the right, but not the
obligation, to assert any and all separate defenses, cross claims or
counterclaims which it may have, and the fees and expenses of such counsel shall
be at the expense of such indemnified party unless (i) the employment of such
counsel has been specifically authorized in advance by the indemnifying party,
(ii) counsel advises that there is a conflict of interest that prevents counsel
for the indemnifying party from adequately representing the interests of the
indemnified party, (iii) the indemnifying party does not employ counsel

                                      -11-

<PAGE>


that is reasonably satisfactory to the indemnified party, or (iv) the
indemnifying party fails to assume the defense or does not reasonably contest
such action in good faith, in which case, if the indemnified party notifies the
indemnifying party that it elects to employ separate counsel, the indemnifying
party shall not have the right to assume the defense of such action on behalf of
the indemnified party and the reasonable fees and expenses of such separate
counsel shall be borne by the indemnifying party; provided, however, that, the
indemnifying party shall not, in connection with any proceeding or related
proceedings in the same jurisdiction, be liable for the reasonable fees and
expenses of more than one separate firm (in addition to one firm acting as local
counsel) for all indemnified parties.

                  (d) If the indemnification provided for in Section 5.06(a) or
5.06(b) is for any reason unavailable to an indemnified party in respect of any
losses, claims, damages or liabilities which are indemnifiable pursuant to such
Sections, then each indemnifying party under such paragraphs, in lieu of
indemnifying such indemnified party thereunder and in order to provide for just
and equitable contribution, shall contribute to the amount paid or payable by
such indemnified party as a result of such losses, claims, damages or
liabilities in such proportion as is appropriate to reflect the relative fault
of the indemnifying party or parties on the one hand and the indemnified party
or parties on the other in connection with the statements or omissions or
alleged statements or omissions that resulted in such losses, claims, damages or
liabilities (or actions in respect thereof). The relative fault of the parties
shall be determined by reference to, among other things, whether the untrue or
alleged untrue statement of a material fact or the omission or alleged omission
to state a material fact relates to information supplied by Genesis on the one
hand or such Holder or such other indemnified party, as the case may be, on the
other, the parties' relative intent, knowledge, access to information and
opportunity to correct or prevent such statement or omission, and any other
equitable considerations appropriate in the circumstances.

                  (e) The obligations of Genesis and the Holders under this
Section 5.06 shall survive the completion of any offering of Registrable
Securities in a registration statement under this Section 5.06 and the
termination of this Agreement.

                  (f) The underwriting agreement (if any) entered into in
connection with any underwritten public offering of the Registrable Securities
shall contain provisions on indemnification and contribution that are no less
favorable to Holders of Registrable Securities than those provisions contained
in this Agreement. To the extent that the provisions on indemnification and
contribution contained in such underwriting agreement satisfy the foregoing
sentence but are in conflict with the provisions of Section 5.06, the provisions
in such underwriting agreement shall control.

                  5.07.  Reports Under the Exchange Act.

                  With a view to making available to the Holders the benefits of
Rule 144 and any other rule or regulation of the SEC that may at any time permit
a Holder to sell securities of Genesis to the public without registration or
pursuant to a registration on Form S-3, Genesis agrees to:

                                      -12-

<PAGE>

                  (a) use its commercially reasonable best efforts to make and
keep public information available, as those terms are understood and defined in
Rule 144;

                  (b) use its commercially reasonable best efforts to file with
the SEC in a timely manner all reports and other documents required under the
Act and the Exchange Act; and

                  (c) furnish to any Holder forthwith upon request (i) a written
statement by Genesis as to its compliance with the reporting requirements of
Rule 144, (ii) a copy of the most recent annual or quarterly report of Genesis
and such other reports and documents so filed by Genesis, and (iii) such other
information as may be reasonably requested in availing any Holder of any rule or
regulation of the SEC which permits the selling of any such securities without
registration.

                  5.08.  Assignment of Registration Rights.

                  The rights to cause Genesis to register Registrable Securities
pursuant to Section 5.02 may only be assigned by a Holder to a transferee or
assignee of any Registrable Securities if immediately following such transfer
the further disposition of such securities by the transferee or assignee is
restricted under the Act and any such transferee or assignee shall be a Holder
for purposes of Section 5 entitled to the rights and subject to the obligations
of Section 5, including without limitation, the requirement that a request for
registration under Section 5.02 must be made by holders of at least 25% of the
Voting Securities acquired by the Manor Care Group at the Effective Time.

Section 6.  Termination.

                  (a) Notwithstanding any other provision of this Agreement,
this Agreement may be terminated, upon 60 days prior written notice to the other
party (i) by Manor Care, in its sole discretion, if Genesis breaches any of its
material obligations pursuant to this Agreement and such breach is continuing on
the 61st day following such notice, provided, however that the rights of Manor
Care contained in Sections 3 and 5 hereof shall survive such termination; (ii)
by Genesis, in its sole discretion, if Manor Care breaches any of its material
obligations pursuant to this Agreement and such breach is continuing on the 61st
day following such notice or (iii) by either party, in its sole discretion, if
the Merger Agreement is terminated.

                  (b) Upon the disposition by the Manor Care Group to persons
who are not members of the Manor Care Group of greater than 50% of the Voting
Securities acquired by the Manor Care Group at the Effective Time, the
provisions of Sections 1, 2, 3 and 4 hereof shall terminate and be of no further
force or effect.

Section 7.  Miscellaneous.

                  (a) Manor Care and Genesis each acknowledges and agrees that
irreparable damage would occur in the event any of the provisions of this
Agreement were not performed in accordance with their specific terms or were
otherwise breached. It is accordingly agreed that the parties shall be entitled
to an injunction or injunctions to

                                      -13-

<PAGE>

prevent breaches of the provisions of this Agreement and to enforce specifically
the terms and provisions hereof in any court of the United States or any state
thereof having jurisdiction, in addition to any other remedy to which they may
be entitled at law or equity.





                  (b) If any provision of this Agreement is in violation of any
statute, rule, regulation, order or decree of any governmental authority, court
or agency, or subjects any member of the Manor Care Group to governmental
regulation to which it would not be subject except for such provision, then such
member of the Manor Care Group shall be relieved of its obligations under such
provision to the minimum extent necessary to cure such violation or eliminate
the applicability of such regulation.

                  (c) If requested in writing by Genesis, Manor Care shall
present or cause to be presented promptly all certificates representing Voting
Securities now owned or hereafter acquired by members of the Manor Care Group,
for the placement thereon of the following legend, which will remain thereon as
long as such Voting Securities are subject to the restrictions contained in this
Agreement:

                  THE SECURITIES REPRESENTED BY THIS CERTIFICATE ARE SUBJECT TO
         THE RESTRICTIONS ON TRANSFER AND THE OTHER PROVISIONS OF A RIGHTS
         AGREEMENT DATED AS OF APRIL 26, 1998, BETWEEN GENESIS HEALTH VENTURES,
         INC. AND MANOR CARE, INC., AND MAY NOT BE SOLD OR TRANSFERRED EXCEPT IN
         ACCORDANCE THEREWITH. A COPY OF SAID AGREEMENT IS ON FILE AT THE OFFICE
         OF THE CORPORATE SECRETARY OF GENESIS HEALTH VENTURES, INC.

                  Genesis agrees that upon any transfer of Voting Securities
represented by legended certificates made in compliance with the provisions of
this Agreement, it will, upon the presentation to its transfer agent of the
certificates containing such legend, remove such legend from the certificates
being sold or registered.

                  (d) Descriptive headings are for convenience only and shall
not control or affect the meaning or construction of any provision of this
Agreement.

                  (e) This Agreement contains the entire understanding of the
parties with respect to the transactions contemplated hereby and may be amended
only by an agreement in writing executed by the parties hereto.

                  (f) For the convenience of the parties, any number of
counterparts of this Agreement may be executed by the parties hereto and each
such executed counterpart shall be deemed to be, an original instrument.

                  (g) All notices and other communications hereunder shall be in
writing and shall be delivered personally, by next-day courier or mailed by
registered or certified mail (return receipt requested), first class postage
prepaid, or sent by facsimile, telegram or telex, to the parties at the
addresses specified below (or at such other address for a party as shall be
specified by like notice; provided that notices of a 

                                      -14-

<PAGE>

change of address shall be effective only upon receipt thereof). Any such notice
shall be effective upon receipt, if personally delivered or telecommunicated,
one day after delivery to a courier for next-day delivery, or three days after
mailing, if deposited in the U.S. mail, first class postage prepaid.

                  (i)      if to Manor Care, to:

                           Manor Care, Inc.
                           11555 Darnestown Road
                           Gaithersburg, Maryland  20878

                           Attention:  James H. Rempe, Esq.,
                                 General Counsel

                           with a copy to:

                           Cahill Gordon & Reindel
                           80 Pine Street
                           New York, New York  10005
                           Telecopy:  (212) 269-5420

                           Attention:  W. Leslie Duffy, Esq.


                  (ii)     if to Genesis, to:

                           Genesis Health Ventures, Inc.
                           148 West State Street
                           Kennett Square, Pennsylvania  19348

                           Attention:  Ira Gubervick, Esq.,
                                 General Counsel


                           with a copy to:

                           Blank Rome Comisky & McCauley LLP
                           One Logan Square
                           Philadelphia, Pennsylvania  19103

                           Attention:  Stephen E. Luongo, Esq.

                  (h) This Agreement shall be governed by and construed and
enforced in accordance with the laws of the State of Delaware applicable to
contracts made and to be performed therein.

                  (i) Each of Manor Care and Genesis has all necessary power and
authority to execute and deliver this Agreement, to perform its obligations
hereunder

                                      -15-
<PAGE>

and to consummate the transactions contemplated hereby. The execution
and delivery of this Agreement by each of Manor Care and Genesis and the
consummation by each of Manor Care and Genesis of the transactions contemplated
hereby have been duly and validly authorized by all necessary corporate action
on the part of Manor Care and Genesis, respectively. This Agreement has been
duly and validly executed and delivered by each of Manor Care and Genesis and,
assuming the due authorization, execution and delivery by the other party,
constitutes a legal, valid and binding obligation of each of Manor Care and
Genesis, enforceable against each of them in accordance with its terms, except
that such enforceability may be limited by bankruptcy, insolvency,
reorganization, moratorium, fraudulent conveyance or other similar laws
affecting creditors' rights generally.

                  (j) This Agreement and all of the provisions hereof shall be
binding upon and inure to the benefit of the parties hereto and their respective
successors and permitted assigns, but, except as set forth in Section 5.08 of
this Agreement, this Agreement and any of the rights, interests or obligations
hereunder shall not be assigned by any of the parties hereto without the prior
written consent of the other parties; provided, however, that Manor Care may
assign all of its rights and obligations under this Agreement to a direct or
indirect subsidiary of Manor Care which is to be spun off as provided in the
Form 10 filed with the Securities and Exchange Commission by New ManorCare
Health Services, Inc. and Manor Care shall be released from any further
obligations under or with respect to this Agreement other than pursuant to
Section 1. Genesis hereby consents to the Manor Care Group's transfer of any or
all shares of Preferred Stock or Common Stock owned by the Manor Care Group to
Manor Care, New Manor Care Heath Services, Inc., or any of their respective
wholly owned subsidiaries if such transferee agrees to be bound by the terms of
this Agreement.

                                      -16-

<PAGE>


                  IN WITNESS WHEREOF, Manor Care and Genesis have caused this
Agreement to be duly executed by their respective officers, each of whom is duly
authorized, all as of the day and year first above written.

                                   GENESIS HEALTH VENTURES, INC.


                                    By:____________________________
                                        Name:
                                        Title:


                                    MANOR CARE, INC.


                                    By:_____________________________
                                        Name:
                                        Title:

                                      -17-

<TABLE> <S> <C>

<ARTICLE> 5
<CIK> 0000874265
<NAME> GENSIS HEALTH VENTURES,INC & SUBSIDIARIES
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<CURRENCY> U.S. DOLLARS
<RESTATED>
       
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<PERIOD-END>                               MAR-31-1998           MAR-31-1997 
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