RENAL TREATMENT CENTERS INC /DE/
10-Q, 1997-08-14
SPECIALTY OUTPATIENT FACILITIES, NEC
Previous: DHB CAPITAL GROUP INC /DE/, 10QSB, 1997-08-14
Next: PRUDENTIAL SECURITIES AGGRESSIVE GROWTH FUND LP, 10-Q, 1997-08-14



<PAGE>
 
                                   Form 10-Q

                      SECURITIES AND EXCHANGE COMMISSION

(Mark One)                   Washington, D.C. 20549



(X)  QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES
      EXCHANGE ACT OF 1934

For the quarterly period ended    June 30, 1997
                               ------------------------

( )  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 1-14142

 
                         Renal Treatment Centers, Inc.
- --------------------------------------------------------------------------------
            (Exact name of registrant as specified in its charter)

              Delaware                                     23-2518331
- --------------------------------------              -----------------------
  (State or other jurisdiction of                       (I.R.S. Employer
   incorporation or organization)                      Identification No.)

      1180 W. Swedesford Road
       Building 2, Suite 300
            Berwyn, PA                                       19312
- --------------------------------------              -----------------------
(Address of principal executive offices)                   (Zip code)


Registrant's telephone number, including area code: 610-644-4796

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 the latest practicable date:

     Class                                Outstanding at August 7, 1997
     -----                           -----------------------------------------
Common Stock, Par Value $.01                   24,989,141 shares
<PAGE>
 
                 RENAL TREATMENT CENTERS, INC. AND SUBSIDIARIES

                                     INDEX

<TABLE> 
<CAPTION> 

                                                                            Page
                                                                            ----
<S>       <C>                                                               <C> 
PART I.   FINANCIAL INFORMATION

Item 1.   Financial Statements (Unaudited)
 
          Consolidated Balance Sheets--
          June 30, 1997 and December 31, 1996.................................3

          Consolidated Statements of Income--
          Three and six months ended June 30, 1997 and 1996...................4

          Consolidated Statements of Cash Flows--
          Six months ended June 30, 1997 and 1996.............................5

          Notes to Consolidated Financial Statements..........................6
 
Item 2.   Management's Discussion and Analysis of
          Financial Condition and Results of Operations....................7-12
 
 
PART II.  OTHER INFORMATION
 
Item 2.   Changes in Securities..............................................13

Item 4.   Submission of Matters to a Vote of Security Holders................13

Item 6.   Exhibits and Reports on Form 8-K...................................13

SIGNATURES...................................................................15

EXHIBITS....................................................................16-

</TABLE> 

                                       2
<PAGE>
 
PART I.  FINANCIAL INFORMATION

Item 1.   Financial Statements


                 Renal Treatment Centers, Inc. and Subsidiaries
                          CONSOLIDATED BALANCE SHEETS
                                  (Unaudited)

<TABLE>
<CAPTION>
 
                                                                                 June 30,     December 31,
                                                                                   1997           1996
- ----------------------------------------------------------------------------------------------------------
<S>                                                                           <C>             <C>
Assets
Current Assets:
     Cash                                                                     $  9,129,138    $  1,445,798
     Investments                                                                         -      41,202,123
     Accounts Receivable, net of allowance for doubtful accounts of 
        $4,213,059 in 1997 and $4,233,552 in 1996                               94,948,837      79,138,388
     Inventories                                                                 5,064,238       4,388,290
     Deferred Taxes                                                                765,145         765,145
     Prepaid expenses and other current assets                                   6,943,142       2,749,497
- ----------------------------------------------------------------------------------------------------------
          Total current assets                                                 116,850,502     129,689,241
- ----------------------------------------------------------------------------------------------------------
Property and equipment (net of accumulated depreciation of $24,832,100 
     in 1997 and $19,691,015 in 1996)                                           51,891,707      39,578,245
Intangibles (net of accumulated amortization of $40,523,648 in 1997 and
     $32,934,871 in 1996)                                                      187,097,297     130,645,378
Deferred Taxes, non-current                                                      2,807,064       2,807,064
- ----------------------------------------------------------------------------------------------------------
          Total assets                                                        $358,646,570    $302,719,928
- ----------------------------------------------------------------------------------------------------------
Liabilities and Stockholders' Equity
Current liabilities:
     Current portion of long-term debt                                        $  1,313,808    $ 12,369,365
     Accounts payable                                                           10,848,340      11,341,983
     Accrued compensation                                                        4,464,111       3,838,502
     Accrued expenses                                                            5,956,394       4,051,614
     Accrued income taxes                                                        1,280,317         164,535
     Accrued interest                                                            3,430,002       3,638,874
- ----------------------------------------------------------------------------------------------------------
          Total current liabilities                                             27,292,972      35,404,873
- ----------------------------------------------------------------------------------------------------------
Long-term debt, net                                                            175,629,792     130,573,685
Commitments and contingencies
Stockholders' equity:
     Preferred stock, $.01 par value, 5,000,000 shares authorized: none
      issued                            
     Common stock, $.01 par value, 45,000,000 shares authorized:     
      issued and outstanding 25,025,739 and 24,430,256 shares in 1997 
      and 1996, respectively                                                       250,257         244,303
Additional paid-in capital                                                      94,094,774      87,890,138
Retained earnings                                                               61,766,453      49,001,005
- ----------------------------------------------------------------------------------------------------------
                                                                               156,111,484     137,135,446
- ----------------------------------------------------------------------------------------------------------
     Less treasury stock, 36,598 shares in 1997 and 37,202 shares in
      1996, at cost                                                               (387,678)       (394,076)
- ----------------------------------------------------------------------------------------------------------
                                                                               155,723,806     136,741,370
- ----------------------------------------------------------------------------------------------------------
Total liabilities and stockholders' equity                                    $358,646,570    $302,719,928
- ----------------------------------------------------------------------------------------------------------
 
</TABLE>

          See accompanying notes to consolidated financial statements.

                                       3
<PAGE>
 
                 Renal Treatment Centers, Inc. and Subsidiaries
                       CONSOLIDATED STATEMENTS OF INCOME
                                  (Unaudited)

<TABLE>
<CAPTION>
 
                                                        Three Months Ended June 30,  Six Months Ended June 30,
                                                             1997          1996          1997          1996
- ------------------------------------------------------------------------------------------------------------------
<S>                                                       <C>           <C>          <C>           <C>
Net patient revenue                                       $77,273,282   $55,583,123  $148,380,503  $106,132,950
Patient care costs                                         36,672,989    26,997,151    70,998,558    51,482,378
- ------------------------------------------------------------------------------------------------------------------
 
Operating profit                                           40,600,293    28,585,972    77,381,945    54,650,572
General and administrative expense                         19,270,596    13,479,366    36,748,462    26,632,717
Provision for doubtful accounts                             2,047,197     1,737,321     4,238,674     3,308,507
Depreciation and amortization expense                       6,333,987     4,072,917    12,067,654     7,645,118
Merger expenses                                                     -             -             -     1,708,247
- ------------------------------------------------------------------------------------------------------------------
 
Income from operations                                     12,948,513     9,296,368    24,327,155    15,355,983
- ------------------------------------------------------------------------------------------------------------------ 

Interest expense, net                                       2,154,831       856,313     3,978,874     1,553,433
- ------------------------------------------------------------------------------------------------------------------
 
Income before income taxes                                 10,793,682     8,440,055    20,348,281    13,802,550
Provision for income taxes                                  4,047,631     3,009,329     7,582,832     4,999,536
- ------------------------------------------------------------------------------------------------------------------ 
Net income                                                $ 6,746,051   $ 5,430,726  $ 12,765,449  $  8,803,014
- ------------------------------------------------------------------------------------------------------------------ 
 
Per share data:
 
Primary earnings per common and common  
 stock equivalent                                               $0.26         $0.20         $0.50         $0.34
 
Weighted average number of common and           
 common stock equivalents outstanding                      25,714,787    26,740,469    25,490,834    26,211,155
                                                
Fully diluted earnings per common and
 common stock equivalent                                        $0.26         $0.20         $0.50         $0.33
 
Weighted average number of common and
 common stock equivalents outstanding                      25,844,770    27,256,337    25,789,820    26,711,952
 
</TABLE>



          See accompanying notes to consolidated financial statements.

                                       4
<PAGE>
 
                 Renal Treatment Centers, Inc. and Subsidiaries
                     CONSOLIDATED STATEMENTS OF CASH FLOWS
                                  (Unaudited)
<TABLE> 
<CAPTION> 
                                                                                                      Six Months Ended    
                                                                                                          June 30,       
                                                                                                    1997           1996  
- ------------------------------------------------------------------------------------------------------------------------------      

<S>                                                                                             <C>            <C>       
Cash flows from operating activities:                                                                                           
   Net income                                                                                   $ 12,765,449   $  8,803,014  
   Adjustments to reconcile net income to net cash provided by                                                                
   operating activities:                                                                                                      
       Depreciation and amortization                                                              12,255,154      7,666,084  
       Deferred income taxes                                                                               -              -  
       Provision for doubtful accounts                                                             4,238,674      3,308,507  
       Equity in (earnings) losses from affiliates                                                   (74,377)             -  
       Changes in operating assets and liabilities, net of effects of companies acquired:                                    
       Accounts receivable                                                                       (20,049,123)   (11,355,559) 
       Inventories                                                                                  (238,434)      (673,916) 
       Prepaid expenses and other current assets                                                  (4,096,908)       239,556 
       Accounts payable and accrued expenses                                                       1,298,221     (5,722,617) 
       Accrued income taxes                                                                        1,010,596     (1,898,668) 
- ------------------------------------------------------------------------------------------------------------------------------
          Net cash (used in) provided by operating activities                                      7,109,252        366,401  
- ------------------------------------------------------------------------------------------------------------------------------ 
Cash flows from investing activities:                                                                                           
       Capital expenditures                                                                       (9,939,392)    (6,188,493)      
       Purchase of businesses, net of cash acquired                                              (71,138,095)   (37,030,623) 
       Purchase of investments                                                                             -    (55,311,043)      
       Sale of investments                                                                        41,202,123      9,347,962       
       Other                                                                                       1,137,712       (979,804)      
- ------------------------------------------------------------------------------------------------------------------------------  
          Net cash used in investing activities                                                  (38,737,652)   (90,162,001)      
- ------------------------------------------------------------------------------------------------------------------------------   
Cash flows from financing activities:                                                             
       Proceeds from long-term debt borrowings                                                    48,000,000     30,500,000
       Repayments of debt                                                                         (8,910,952)   (70,420,804)      
       Issuance of 5 5/8% convertible subordinated notes                                                   -    125,000,000       
       Net borrowings under line of credit                                                                 -        (50,000)      
       Proceeds from issuance of common stock                                                        827,118      2,137,012       
       Payment of dividends                                                                                -       (658,500)      
       Debt issuance costs                                                                                 -     (3,750,000)      
       Increase in financing fees                                                                          -              -       
       Payments on capital lease obligations                                                        (604,426)    (1,535,784)      
       Cash portion of consideration received for common stock                                             -        963,699       
- ------------------------------------------------------------------------------------------------------------------------------    
          Net cash (used in) provided by financing activities                                     39,311,740     82,185,623       
- ------------------------------------------------------------------------------------------------------------------------------    
Net increase (decrease) in cash and cash equivalents                                               7,683,340     (7,609,977)      
Cash and cash equivalents at beginning of period                                                   1,445,798      8,231,421
- ------------------------------------------------------------------------------------------------------------------------------
Cash and cash equivalents at end of period                                                      $  9,129,138   $    621,444       
============================================================================================================================== 
</TABLE>

          See accompanying notes to consolidated financial statements.

                                       5
<PAGE>
 
                Renal Treatment Centers, Inc. and Subsidiaries

Notes to Consolidated Financial Statements
(Unaudited)

1.  BASIS OF PRESENTATION:

The accompanying unaudited consolidated financial statements have been prepared
by the Company in accordance with generally accepted accounting principles for
interim financial information and pursuant to the rules and regulations of the
Securities and Exchange Commission. Accordingly, they do not include all of the
information and footnotes required by generally accepted accounting principles
for complete financial statements. In the opinion of management, all adjustments
(consisting only of normal recurring accruals) considered necessary for a fair
presentation have been included. Operating results for the six months ended June
30, 1997 are not necessarily indicative of the results that may be expected for
the year ending December 31, 1997. The interim consolidated financial statements
should be read in conjunction with the consolidated financial statements and
footnotes thereto included in the Company's Form 10-K filed with the Securities
and Exchange Commission on March 28, 1997.

2.  COMMITMENTS AND CONTINGENCIES:

The Company is a party to certain legal actions arising in the ordinary course
of business. The Company believes it has adequate legal defenses and/or
insurance coverage for these actions and that the ultimate outcome of these
actions will not have a material adverse effect on the Company's results of
operations, financial condition or liquidity.

3.  SIGNIFICANT EVENTS:

Business Acquisitions:

During the second quarter of 1997, the Company acquired thirteen dialysis
centers. Ten of the centers are located in the Republic of Argentina, two
centers are located in Texas and one center is located in Pennsylvania.
Combined, these centers provide care to an effective patient base of
approximately 800.

During the first quarter of 1997, the Company acquired twelve dialysis centers,
including one center operating under a management agreement. Eight of the
centers are located in Texas, two centers are located in the Republic of
Argentina and one center each is located in Nevada, Florida and Pennsylvania.
Combined, these centers provide care to an effective patient base of
approximately 830.

Other Events:

On May 2, 1997, the Company amended its revolving credit/term facility ("Credit
Agreement") to increase the amount available under the Credit Agreement from
$100,000,000 to $200,000,000 and to make certain other changes to the terms of
the Credit Agreement, including amendments to certain covenants, the
amortization schedule and the interest rates.

In March 1997, the Financial Accounting Standards Board issued Statement of
Financial Accounting Standard (SFAS) No. 128, "Earnings Per Share."  This
statement establishes standards for computing and presenting earnings per share
(EPS) and applies to entities with publicly held common stock or potential
common stock.  In addition, this statement is effective for financial statements
issued for periods ending after December 15, 1997, including interim periods.
This statement requires restatement for all prior-period EPS data presented.

Although the Company is not permitted to adopt this statement in an earlier
period, pro-forma disclosures as if the Company had adopted the requirements
beginning in 1996 are presented below:

<TABLE>
<CAPTION> 
                                                       Three Months Ended       Six Months Ended 
                                                            June 30,                June 30,     
                                                      1997          1996       1997         1996 
- -----------------------------------------------------------------------------------------------------
<S>                                               <C>          <C>          <C>          <C>         
Basic:                                                                                              
  Basic earnings per share                             $0.27        $0.21        $0.52        $0.35 
  Weighted average number of shares               24,962,389   25,828,734   24,737,326   25,284,349 
                                                                                                    
Dilutive:                                                                                           
  Dilutive earnings per share                          $0.26        $0.20        $0.50        $0.33 
  Weighted average number of common and   
    common stock equivalents outstanding          25,884,770   25,464,145   25,789,820   26,711,952  
</TABLE>

                                       6
<PAGE>
 
Item 2.         Renal Treatment Centers, Inc. and Subsidiaries
                     Management's Discussion and Analysis
               of Financial Condition and Results of Operations

Overview

Renal Treatment Centers, Inc. (the "Company") provides dialysis treatments and
ancillary services to patients suffering from chronic kidney failure, primarily
in its freestanding outpatient dialysis treatment centers or in the patient's
home.  The Company also provides acute inpatient dialysis services to hospitals.
As of August 1, 1997, the Company operated 150 outpatient dialysis centers in 23
states, the District of Columbia and the Republic of Argentina and provided
dialysis services for approximately 10,400 patients.  In addition, the Company
provided inpatient dialysis services to over 100 hospitals.

Results of Operations

The following table sets forth, for the periods indicated, selected financial
information expressed as a percentage of net patient revenue and the period-to-
period percentage changes in such information.

<TABLE>
<CAPTION>
                                                Percentage of                                 Percentage of 
                                             Net Patient Revenue                           Net Patient Revenue   
                                             Three Months Ended      Period-to-Period        Six Months Ended    Period-to-Period  
                                                   June 30,          Percentage Change           June 30,        Percentage Change
- -----------------------------------------------------------------------------------------------------------------------------------
                                               1997       1996         1997 vs. 1996        1997          1996     1997 vs. 1996 
- -----------------------------------------------------------------------------------------------------------------------------------
<S>                                           <C>        <C>         <C>                   <C>           <C>     <C>   
Net patient revenue                           100.0%     100.0%            39.0%           100.0%        100.0%         39.8%    
Patient care costs                             47.5%      48.6%            35.8%            47.8%         48.5%         37.9%    
General and administrative expense             24.9%      24.3%            43.0%            24.8%         25.1%         38.0%    
Provision for doubtful accounts                 2.6%       3.1%            17.8%             2.9%          3.1%         28.1%    
Depreciation and amortization expense           8.2%       7.3%            55.5%             8.1%          7.2%         57.8%    
Merger expenses                                ----       ----             ----             ----           1.6%         ----     
Income from operations                         16.8%      16.7%            39.3%            16.4%         14.5%         58.4%    
Interest expense, net                           2.8%       1.5%           151.6%             2.7%          1.5%        156.1%    
Income before income taxes                     14.0%      15.2%            27.9%            13.7%         13.0%         47.4%    
Provision for income taxes                      5.2%       5.4%            34.5%             5.1%          4.7%         51.7%    
Net income                                      8.7%       9.8%            24.2%             8.6%          8.3%         45.0%     
</TABLE>

Six Months Ended June 30, 1997 Compared to Six Months Ended June 30, 1996

Net Patient Revenue. Net patient revenue for the six months ended June 30, 1997
was $148,380,503 as compared to $106,132,950 for the same period in 1996,
representing an increase of 39.8%. Of this increase, $30,956,229 was
attributable to the revenue generated from the operations of 35 centers and
certain acute care agreements acquired in separate purchase transactions and the
development of six new dialysis centers ("de novo" developments) from April 1996
through June 1997. Of the remaining increase of $11,291,324, $6,945,424 was
attributable to an increase in same-center treatments and $4,345,900 was
attributable to an increase in the average same-center revenue per treatment,
which, in turn, was due to an increase in the administration of Erythropoietin
("EPO") and other ancillary revenue items and an improvement in the Company's
third party payor mix.

Patient Care Costs.  Patient care costs increased 37.9% to $70,998,558 for the
six months ended June 30, 1997 from $51,482,378 for the same period in 1996.
The increase was principally the result of acquisitions that were completed from
April 1996 through June 1997.  However, as a percentage of net patient revenue,
patient care costs decreased to 47.8% for the six months ended June 30, 1997
from 48.5% for the same period in 1996.   This percentage decrease was primarily
related to the increase in same-center net revenue per treatment.  The increase
in same-center net revenue per treatment was partially offset by the additional
costs related to the increased administration of EPO and other ancillary revenue
items.

                                       7
<PAGE>
 
Management's Discussion and Analysis of Financial Condition and Results of
Operations (continued)

General and Administrative Expense. General and administrative expense increased
$10,115,745, or 38.0%, to $36,748,462 for the six months ended June 30, 1997, as
compared to $26,632,717 for the same period in 1996. This increase was primarily
the result of additional facility operating costs as well as additional
corporate and facility personnel required to support the centers acquired and
opened from April 1996 through June 1997. As a percentage of net patient
revenue, general and administrative expense decreased to 24.8% for the six
months ended June 30, 1997, as compared to 25.1% for the six months ended June
30, 1996. The decrease as a percentage of net patient revenue was attributable
to the Company's ability to maintain certain support costs, while increasing net
revenues through acquisitions, internal growth and de novo developments.

Provision for doubtful accounts.  Provision for doubtful accounts increased
$930,167, or 28.1%, to $4,238,674 for the six months ended June 30, 1997, as
compared to $3,308,507 for the same period in 1996.  This increase was
principally a result of the additional net patient revenue generated from
acquisitions that occurred subsequent to the first quarter of 1996.  As a
percentage of net patient revenue, the provision for doubtful accounts was 2.9%
for the six months ended June 30, 1997 and 3.1% for the same period in 1996.

Depreciation and Amortization Expense. Depreciation and amortization expense
increased $4,422,536, or 57.8%, for the six months ended June 30, 1997, when
compared to the same period in 1996. As a percentage of net patient revenue,
depreciation and amortization expense was 8.1% for the six months ended June 30,
1997, as compared to 7.2% for the six months ended June 30, 1996. Both the
dollar and percentage increases were attributable to the purchase acquisitions
completed from April 1996 through June 1997.

Merger Expenses. There were no merger expenses for the six months ended June 30,
1997, as compared to $1,708,247 for the same period in 1996. For the six months
ended June 30, 1996, merger expenses were incurred as a result of the mergers
with Intercontinental Medical Services, Inc. and Midwest Dialysis Units and its
affiliates which were completed on February 20, 1996 and February 29, 1996,
respectively, and were accounted for under the pooling-of-interests method of
accounting. Merger expenses include investment banking, legal, accounting and
other fees and expenses.

Income from Operations.  Income from operations increased 58.4% to $24,327,155
for the six months ended June 30, 1997 from $15,355,983 for the same period in
1996.  This increase was primarily due to the increase in net revenues from the
centers acquired, from April 1996 through June 1997, which exceeded the increase
in patient care costs, general and administrative expense and depreciation and
amortization expense related to such acquired businesses.  In addition, the
Company did not incur any merger expenses during the six months ended June 30,
1997 as compared to $1,708,247 incurred in the same period last year.  Same-
center treatment and revenue per treatment growth also contributed to the
increase in income from operations.

Interest Expense, net. Interest expense (net) was $3,978,874 for the six months
ended June 30, 1997 as compared to interest expense (net) of $1,553,433 for the
same period in 1996. The increase in interest expense (net) was attributable to
the interest expense associated with the Company's issuance of $125,000,000
principal amount of 5 5/8% in Convertible Subordinated Notes due 2006 ("the
Notes") on June 12, 1996.

Provision for Income Taxes.  Provision for income taxes increased 51.7% to
$7,582,832 from $4,999,536 for the six months ended June 30, 1997 and 1996,
respectively. The increase was primarily due to an increase in income before
taxes of 47.4%.  For the six months ended June 30, 1997, the Company's effective
tax rate was 37.3%, compared to an effective tax rate of 36.2% during the same
period in 1996.  The increase in the effective rate is primarily due to the
acquisition the Company completed in July 1996 with Panama City Artificial
Kidney Center ("PCAKC") and North Florida Artificial Kidney Center ("NFAKC").
This acquisition was accounted for as a pooling-of-interests and thus given
retroactive effect as if the acquisition occurred on January 1, 1994.  Since
PCAKC and NFAKC were S Corporations, no income taxes were recorded with respect
to PCAKC and NFAKC for the six months ended June 30, 1996.

Net Income. Net income increased 45.0% to $12,765,449 for the six months ended
June 30, 1997 from $8,803,014 for the same period in 1996. The increase was due
to each of the items discussed above.

Three Months Ended June 30, 1997 Compared to Three Months Ended June 30, 1996

Net Patient Revenue. Net patient revenue for the three months ended June 30,
1997 was $77,273,282 as compared to $55,583,123 for the same period in 1996,
representing an increase of 39.0%. Of this increase, $16,570,594 was
attributable to the revenue generated from the operations of 34 centers and
certain acute care agreements acquired in separate purchase transactions and six
de novo developments from May 1996 through June 1997. Of the remaining increase
of $5,119,555, $3,818,494 was attributable to an increase in same-center
treatments and $1,301,061 was attributable to an increase in the average same-
center revenue per treatment, which, in turn, was due to an increase in the
administration of EPO and other ancillary revenue items and an improvement in
the Company's third party payor mix.

Patient Care Costs. Patient care costs increased 35.8% to $36,672,989 for the
three months ended June 30, 1997 from $26,997,151 for the same period in 1996.
The increase was principally the result of acquisitions that were completed from
May 1996 through June 1997. However, as a percentage of net patient revenue,
patient care costs decreased to 47.5% for the three months ended June 30, 1997
from 48.6% for the same period in 1996. This percentage decrease was primarily
related to the increase in same-center net revenue per treatment. The increase
in same-center net revenue per treatment was partially offset by the additional
costs related to the increased administration of EPO and other ancillary revenue
items.

                                       8
<PAGE>
 
Management's Discussion and Analysis of Financial Condition and Results of
Operations (continued)

General and Administrative Expense.  General and administrative expense
increased $5,791,230, or 43.0%, to $19,270,596 for the three months ended June
30, 1997, as compared to $13,479,366 for the same period in 1996.  This increase
was primarily the result of additional facility operating costs as well as
additional corporate and facility personnel required to support the centers
acquired and opened from May 1996 through June 1997.  As a percentage of net
patient revenue, general and administrative expense increased to 24.9% for the
three months ended June 30, 1997, as compared to 24.3% for the three months
ended June 30, 1996.

Provision for doubtful accounts.  Provision for doubtful accounts increased
$309,876, or 17.8%, to $2,047,197 for the three months ended June 30, 1997, as
compared to $1,737,321 for the same period in 1996.  This increase was
principally a result of the additional net patient revenue generated from
acquisitions that occurred subsequent to the first quarter of 1996.  As a
percentage of net patient revenue the provision for doubtful accounts was 2.6%
for the three months ended June 30, 1997 and 3.1% for the same period in 1996.

Depreciation and Amortization Expense.  Depreciation and amortization expense
increased $2,261,070, or 55.5%, for the three months ended June 30, 1997, when
compared to the same period in 1996.  As a percentage of net patient revenue,
depreciation and amortization expense was 8.2% for the three months ended June
30, 1997, as compared to 7.3% for the three months ended June 30, 1996.  Both
the dollar and percentage increases were attributable to the purchase
acquisitions completed from May 1996 through June 1997.

Income from Operations.  Income from operations increased 39.3% to $12,948,513
for the three months ended June 30, 1997 from $9,296,368 for the same period in
1996.  This increase was primarily due to the increase in net revenues from the
centers acquired, from May 1996 through April 1997, which exceeded the increase
in patient care costs, general and administrative expense and depreciation and
amortization expense related to such acquired businesses.  In addition, same-
center treatment and revenue per treatment growth contributed to the increase in
income from operations.

Interest Expense, net.  Interest expense (net) was $2,154,831 for the three
months ended June 30, 1997 as compared to interest expense (net) of $856,313 for
the same period in 1996.  The increase in interest expense (net) was
attributable to the interest expense associated with the Company's issuance of
$125,000,000 principal amount of the Notes on June 12, 1996.

Provision for Income Taxes. Provision for income taxes increased 34.5% to
$4,047,631 from $3,009,329 for the three months ended June 30, 1997 and 1996,
respectively. The increase was primarily due to an increase in income before
taxes of 27.9%. For the three months ended June 30, 1997, the Company's
effective tax rate was 37.5% compared to an effective tax rate of 35.7% during
the same period in 1996. The increase in the effective rate is primarily due to
the acquisition the Company completed in July 1996 with PCAKC and NFAKC. This
acquisition was accounted for as a pooling-of-interests and thus given
retroactive effect as if the acquisition occurred on January 1, 1994. Since
PCAKC and NFAKC were S Corporations, no income taxes were recorded with respect
to PCAKC and NFAKC for the three months ended June 30, 1996.

Net Income. Net income increased 24.2% to $6,746,051 for the three months ended
June 30, 1997 from $5,430,726 for the same period in 1996.  The increase was due
to each of the items discussed above.

Liquidity and Capital Resources

The Company requires capital for the acquisition and development of dialysis
centers, for the expansion of operations of its existing dialysis centers,
including the replacement of equipment and addition of leasehold improvements,
for the integration of new centers into its network of existing dialysis
services and for meeting working capital requirements.

During the six months ended June 30, 1997, expenditures for acquisitions totaled
$71,138,095 compared to $37,030,623 for the six months ended June 30, 1996.  The
expenditures in 1997 resulted from the acquisition of ten centers in January,
one center in February, one center in March, two centers in April, seven centers
in May and four centers in June, as compared to the expenditures in 1996, which
resulted from the acquisition of one center in March, one center in April, three
centers in May and one center in June.  For the six months ended June 30, 1997
and 1996, capital expenditures were $9,939,392 and $6,188,493, respectively.
Cash from operations before investing and financing activities was $7,109,252
and $366,401 for the six months ended June 30, 1997 and 1996, respectively.  The
principal sources of the Company's liquidity during the first six months of 1997
were earnings, borrowings under the Credit Agreement and remaining proceeds from
the issuance of the Notes.  The Company had cash and cash equivalents of
$9,129,138 at June 30, 1997.

The Credit Agreement, as amended on May 2, 1997, provides for a $200,000,000
revolving credit term facility available to fund acquisitions and general
working capital requirements, of which $48,000,000 and $0 were outstanding as of
June 30, 1997 and December 31, 1996, respectively. The revolving credit term
facility converts into a term loan March 31, 2000 that is payable in 16 equal
quarterly installments commencing June, 2000 and continuing through March, 2004.
Borrowings under the Credit Agreement bear interest, at the Company's option, at
either (i) the agent bank's base rate payable on a quarterly basis or (ii) a 
one-, two-, three-, or six-month period LIBOR rate

                                       9
<PAGE>
 
Management's Discussion and Analysis of Financial Condition and Results of
Operations (continued)

plus .50% to 1.50%, depending on the Company's ratio of consolidated debt to
annualized cash flow, payable at maturity. The weighted average interest rate of
all loans outstanding at June 30, 1997 was 6.8%. Loans under the Credit
Agreement are collateralized by the pledge of all stock of the Company's
subsidiaries and the assignment of all intercompany notes.

The Company has historically expended the majority of its capital resources to
implement its growth strategy and the Company intends to pursue a strategy of
growth through the acquisition and development of dialysis centers.  Management
estimates that the development of a new center, depending on its size, requires
approximately $500,000 to $1,000,000 for construction costs and the purchase of
certain furniture and equipment (leasing certain of the assets can decrease
initial cash flow) and approximately $75,000 to $150,000 in working capital.
Acquisition of a dialysis center with an existing patient base typically
requires more capital investment, but each investment varies based on relative
size and other factors.  No assurance can be given that the Company will be
successful in implementing its growth strategy or that adequate sources of
capital will be available on terms acceptable to the Company to pursue its
growth strategy in the future.

The Company believes that capital resources available to it will be sufficient
to meet the needs of its business, both on a short- and long-term basis.

Risk Factors

In evaluating the Company, its business and its financial position, the
following risk factors should be carefully considered in addition to the other
information contained herein. The following factors, among others, could affect
the Company's future results and cause them to differ materially from any
forward-looking statements made by or on behalf of the Company, including,
without limitation, the statements under "Liquidity and Capital Resources"
relating to the costs of developing dialysis centers.

Dependence on Medicare, Medicaid and Other Sources of Reimbursement.
The Company is reimbursed for dialysis services primarily at fixed rates as
established in advance under the Medicare End Stage Renal Disease ("ESRD")
program.  Under this program, once a patient becomes eligible for Medicare
reimbursement, Medicare is responsible for payment of approximately 80% of the
composite rate for dialysis treatment.  The composite rate is determined by the
Health Care Financing Administration ("HCFA") for reimbursement of Medicare
patients.  Approximately 58% and 59% of the Company's net patient revenue during
the year ended December 31, 1996 and the six months ended June 30, 1997,
respectively, was funded by Medicare.  Since 1983, numerous Congressional
actions have resulted in changes in the Medicare composite reimbursement rate
from a national average of $138 per treatment in 1983 to a low of $125 per
treatment on average in 1986 and to approximately $126 per treatment on average
at present. The Company is not able to predict whether future rate changes will
be made. Reductions in composite rates could have a material adverse effect on
the Company's revenues and net earnings.  Furthermore, increases in operating
costs that are subject to inflation, such as labor and supply costs, without a
compensating increase in prescribed rates, may adversely affect the Company's
earnings in the future. The Company is also unable to predict whether certain
services, as to which the Company is currently separately reimbursed, may in the
future be included in the Medicare composite rate.

Since June 1, 1989, the Medicare ESRD program has provided reimbursement for the
administration to dialysis patients of EPO.  Most of the Company's dialysis
patients receive EPO.  Revenues associated with the administration of EPO are
significant to the Company and the Company cannot predict future changes in the
reimbursement rate, the typical dosage per administration or the cost of EPO.
EPO is produced by only one manufacturer, and any interruption of supply could
adversely affect the Company's operations.

All of the states in which the Company currently operates dialysis centers
provide Medicaid (or comparable) benefits to qualified recipients to supplement
their Medicare entitlement.  The Company estimates that approximately 4% of its
net patient revenue during the fiscal year ended December 31, 1996 and during
the six months ended June 30, 1997 was funded by Medicaid or comparable state
programs.  The Medicaid programs are subject to statutory and regulatory
changes, administrative rulings, interpretations of policy and governmental
funding restrictions, all of which may have the effect of decreasing program
payments, increasing costs or modifying the way the Company operates its
dialysis business.

Approximately 38% and 37% of the Company's net patient revenue during the fiscal
year ended December 31, 1996 and during the six months ended June 30, 1997,
respectively, was from sources other than Medicare and Medicaid.  These sources
include payments from third party, non-government payors and payments from
hospitals with which  the Company has agreements for the provision of inpatient
acute dialysis treatments, in each case at rates that generally exceed the
Medicare and Medicaid rates.  Any restriction or reduction of the Company's
ability to charge for such services at rates in excess of those paid by Medicare
would adversely affect the Company's net patient revenue and net income.  The
Company is unable to quantify or predict the degree, if any, of the risk of
reductions in payments under these various payment plans.

                                      10
<PAGE>
 
Management's Discussion and Analysis of Financial Condition and Results of
Operations (continued)

HCFA is conducting a four-year demonstration project, in which four managed care
companies have been awarded contracts to develop and implement capitated
reimbursement systems for ESRD patients in their respective markets. The project
is intended to assist HCFA in determining whether to allow open enrollment of
ESRD patients into managed care plans serving Medicare beneficiaries. Currently,
managed care companies are permitted to arrange for the provision of dialysis
services only to existing members in their programs who develop ESRD. The
Company is unable to predict whether the demonstration project will result in
large numbers of ESRD patients enrolling in managed care programs, or the impact
of the enrollment of ESRD patients in managed care programs on the Company. The
widespread introduction of managed care to dialysis services could result in a
reduction in the rates of reimbursement for the Company's services, which could
have a material adverse effect on the Company's revenues and net earnings.

Operations Subject to, and Potential Effects of, Governmental Regulation.
The Company is subject to extensive regulation by both the Federal government
and the states in which it conducts its business, including the illegal
remuneration provisions of the Social Security Act and similar state laws, which
impose civil and criminal sanctions on persons who solicit, offer, receive or
pay any remuneration, directly or indirectly, in consideration for referring a
patient for treatment that is paid for in whole or in part by Medicare, Medicaid
or similar state programs. The Federal government has published regulations that
provide exceptions or safe harbors for certain business transactions.
Transactions that are structured within the safe harbors are deemed not to
violate the illegal remuneration provisions. Transactions that do not satisfy
all elements of a relevant safe harbor do not necessarily violate the illegal
remuneration statute, but may be subject to greater scrutiny by enforcement
agencies. The arrangements between the Company and the physician directors of
its dialysis centers ("Physician Directors") have been structured to satisfy the
elements of the applicable safe harbors, but there can be no assurance that they
will not be found to violate the illegal remuneration provisions. In addition,
certain of the Company's Physician Directors from whom the Company has acquired
dialysis centers have received shares of the Company's Common Stock in full or
partial consideration for such acquisitions, and other Physician Directors may
have purchased shares of the Company's Common Stock in the open market. The
Company believes that such security ownership falls within one of the safe
harbors, but there can be no assurance that such security ownership will not be
found to violate the illegal remuneration provisions. Although the Company has
never been challenged under these statutes and believes it complies in all
material respects with these and all other applicable laws and regulations,
there can be no assurance that the Company will not be required to change its
practices or relationships with its Physician Directors or that the Company will
not experience material adverse effects as a result of any such challenge.

The Omnibus Budget Reconciliation Act of 1989 includes certain provisions
("Stark I") that restrict physician referrals for clinical laboratory services
to entities with which a physician or an immediate family member has a financial
relationship. HCFA has published regulations interpreting Stark I, which
specifically provide that services furnished in an ESRD facility that are
included in the composite billing rate are excluded from the coverage of Stark
I.  The Company believes that the language and legislative history of Stark I
indicate that Congress did not intend to include laboratory services provided
incidental to dialysis services within the Stark I prohibition; however,
laboratory services not included in the Medicare composite rate could be
included within the coverage of Stark I.  The Omnibus Budget Reconciliation Act
of 1993 includes certain provisions ("Stark II") that restrict physician
referrals for certain designated health services to entities with which a
physician or an immediate family member has a financial relationship.  The
Company believes that the language and legislative history of Stark II indicate
that Congress did not intend to include dialysis services and the services and
items provided incident to dialysis services within the Stark II prohibitions;
however, certain services, including the provision of, or arrangement and
assumption of financial responsibility for, outpatient prescription drugs,
including EPO, and clinical laboratory services, could be construed as
designated health services within the meaning of Stark II.

Violations of Stark I or Stark II are punishable by civil penalties, which may
include exclusion or suspension of the provider from future participation in
Medicare and Medicaid programs and substantial fines.  Due to the breadth of the
statutory provisions and the absence of regulations or court decisions
addressing laboratory services not included in the Medicare composite rate and
the specific arrangements by which the Company conducts its business, it is
possible that the Company's practices might be challenged under these laws.

Health care reform in general, and Medicare reform in particular, could bring
radical change in the financing and regulation of the health care business, and
the Company is unable to predict the effect of such changes on its future
operations.  There can be no assurance that future health care legislation or
other changes in the administration or interpretation of governmental health
care programs will not have a material adverse effect on the results of
operations of the Company.

Risks Inherent in Growth Strategy.
The Company's business strategy depends in significant part on its ability to
acquire or develop additional dialysis centers. This strategy is dependent on
the continued availability of suitable acquisition candidates at acceptable
prices and subjects the Company to the risks inherent in assessing the value,
strengths and weaknesses of acquisition candidates, integrating and managing the
operations of acquired companies and identifying suitable locations for
additional centers. The Company's growth is expected to place significant
demands on the Company's financial resources. The Company plans to borrow a
significant portion of the funds needed to acquire or develop centers in the
future. Although the Company's Credit Agreement with a consortium of bank
lenders includes up to $200,000,000 for acquisition and

                                      11
<PAGE>
 
Management's Discussion and Analysis of Financial Condition and Results of
Operations (continued)

development activities and general working capital requirements, additional
equity or debt financings are expected to be required in order for the Company
to fund its expansion plans.  There can be no assurance that the Company will
continue to be able to obtain necessary financing on acceptable terms for the
acquisition or development of centers or that the Company will otherwise be
successful in acquiring or developing new centers.  No assurance can be given
that the Company will make any additional acquisitions or develop any additional
centers.

Dependence on Physician Referrals.
The Company's centers are dependent upon referrals of ESRD patients for
treatment by physicians specializing in nephrology and practicing in the
communities served by the Company's dialysis centers.  As is customary in the
dialysis industry, at each center one or a few physicians account for all or a
significant portion of the patient referral base.  The loss of one or more key
referring physicians at a particular center could have a material adverse impact
on the operations of that center and could adversely affect the Company's
overall operations.  Financial relationships with physicians and other referral
sources are highly regulated.  The illegal remuneration provisions of the Social
Security Act and similar state laws prohibit contracts for referrals.

Competition.
The dialysis industry is fragmented and highly competitive, particularly from
the standpoint of competition for acquisition of existing dialysis centers and
developing relationships with referring physicians.  Competition for qualified
physicians to act as Physician Directors is also high.  Also, a number of health
care providers have entered or may decide to enter the dialysis business.
Certain of the Company's competitors have substantially greater financial
resources than the Company and may compete with the Company for acquisitions and
for development of centers in markets targeted by the Company.  There can be no
assurance that the Company can continue to compete effectively with such
providers.  In addition, competition has increased the cost of acquiring
existing dialysis centers and there can be no assurance that these costs will
not continue to increase as a result of future industry consolidation.
Furthermore, some of the Company's centers are in urban areas where there are
many competing centers in close proximity.  The Company has also experienced
competition from the establishment of centers by former Physician Directors and
referring physicians.

Dependence on Key Personnel.
The Company is dependent on certain key management personnel, particularly its
President and Chief Executive Officer, Robert L. Mayer, Jr., the loss of whom
could have an adverse effect on the Company's business.  Moreover, the Company
believes that its future success will be significantly dependent on its ability
to attract and retain qualified physicians to serve as Physician Directors of
its dialysis centers.  In addition, the Company will need to continue to attract
and retain highly skilled nurses, competition for whom is intense.

                                      12
<PAGE>
 
Part II.  Other Information
- -------   -----------------

Item 2.   Changes in Securities.

(c)       The Company issued 166,139 shares of the Company's Common Stock on
          April 1, 1997 and an additional 166,139 shares of Common Stock on May
          1, 1997, upon conversion of the remaining outstanding principal amount
          of a convertible note originally issued to the seller in an
          acquisition completed in June 1994. The note was convertible at a rate
          of $10.3425 principal amount per share of Common Stock. The shares
          were issued in a private placement pursuant to an exemption from
          registration under Section 4(2) of the Securities Act of 1933.
          Pursuant to an agreement between the Company and the seller entered
          into in February 1997, the Company prepaid the note, and the seller
          elected to convert the amounts prepaid into Common Stock, in three
          installments of 166,139 shares each, on March 1, April 1, and May 1,
          1997.

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

(a)       The Company's Annual Meeting of Stockholders was held on May 7, 1997.

(c)       1.  The stockholders elected the following persons as Class I
              directors of the Company:
<TABLE>
<CAPTION>
 
          Name                       For                     Withheld
          ----                       ---                     --------
          <S>                        <C>                     <C>
          Patrick T. Ryan            20,711,917              82,710
          Michael R. Walker          20,701,517              93,110
</TABLE> 
 
          There were no broker non-votes with respect to the election of
          directors.
 
          2.  The stockholders approved amendments to the Company's Amended and
              Restated 1990 Stock Plan to increase the number of shares of
              Common Stock covered thereby from 3,237,000 shares to 3,987,000
              shares and to change the provisions regarding submission of
              amendments to the plan to the Company's stockholders.
 
              For:  17,628,186    Against:  3,160,866        Abstain:  5,575
                    ----------              ---------                  -----

          There were no broker non-votes in connection with the approval of the
          amendments to the Company's Amended and Restated 1990 Stock Plan.

          3.  The stockholders approved amendments to the Company's Equity
              Incentive Plan for Outside Directors to increase the number of
              shares subject to options granted to outside directors from 1,000
              shares per year of the director's term to 3,000 shares per year.
 
              For: 20,154,952     Against: 635,975           Abstain:  3,700
                   ----------              -------                     -----

          There were no broker non-votes in connection with the approval of the
          amendments to the Company's Equity Incentive Plan for Outside
          Directors.

          4.  The stockholders ratified the appointment of Coopers & Lybrand,
              L.L.P. as independent public accountants for the Company for its
              1997 fiscal year.

              For:  20,781,114    Against:   2,948           Abstain:  10,565
                    ----------               -----                     ------

              There were no broker non-votes in connection with the ratification
              of the appointment of the Company's independent public
              accountants.

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

(a)       Exhibits

          10.11  Fifth Amended and Restated Loan Agreement dated as of May 2,
                 1997 between the Company and First Union National Bank of North
                 Carolina and the other lenders set forth therein.

                                       13
<PAGE>
 
Part II.  Item 6(a) continued:

          11.1    Computation of Primary and Fully Diluted Earnings Per Share.

          27.1  Financial Data Schedule.

(b)       Reports on Form 8-K

          None.

                                       14
<PAGE>
 
SIGNATURES

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


RENAL TREATMENT CENTERS, INC.


Date:      August 14, 1997               By:   /s/ Ronald H. Rodgers, Jr.
       ---------------------------             -----------------------------
                                               Ronald H. Rodgers, Jr.       
                                               Vice President - Finance and 
                                               Chief Financial Officer       
                                                                       
                                                                       

Date:    August 14, 1997                 By:   /s/ Keith W. Jones 
      ----------------------------             -----------------------------
                                               Keith W. Jones                   
                                               Chief Accounting Officer  
                                                                           
                                                                           

                                       15
<PAGE>
 
                 Renal Treatment Centers, Inc. and Subsidiaries
                                 Exhibit Index


 
Exhibit No.    Description
- -----------    -----------

10.11          Fifth Amended and Restated Loan Agreement dated as of May 2, 1997
               between the Company and First Union National Bank of North
               Carolina and the other lenders set forth therein

11.1           Computation of Primary and Fully Diluted Earnings Per Share

27             Financial Data Schedule

                                       16

<PAGE>
 
                                     FIFTH
                              AMENDED AND RESTATED
                                 LOAN AGREEMENT


                                     among


                  FIRST UNION NATIONAL BANK OF NORTH CAROLINA
                                    as Agent


                                VARIOUS LENDERS


                                      and


                         RENAL TREATMENT CENTERS, INC.
                                  as Borrower



                  $200,000,000 Revolving Credit/Term Facility



                                  May 2, 1997
<PAGE>
 
<TABLE>
<CAPTION>
                               TABLE OF CONTENTS

                                                                       Page
                                                                       ----
<S>                                                                    <C>    
RECITALS................................................................  1
<CAPTION> 
                                   ARTICLE I

                                  DEFINITIONS
 
<C>  <S>                                                                <C> 
1.1   Defined Terms.....................................................  2
1.2   Accounting Terms.................................................  27
1.3   Singular/Plural..................................................  28
1.4   Other Terms......................................................  28
<CAPTION> 
                                   ARTICLE II

                         AMOUNT AND TERMS OF THE LOANS;
                               LETTERS OF CREDIT
 
<C>   <S>                                                               <C> 
2.1   The Loans........................................................  28  
2.2   Borrowings.......................................................  28 
2.3   Revolving Credit/Term Notes......................................  31
2.4   Reduction of Commitments.........................................  31 
2.5   Payments; Voluntary, Mandatory...................................  32 
2.6   Interest.........................................................  33 
2.7   Fees.............................................................  34 
2.8   Interest Periods.................................................  36 
2.9   Conversions and Continuations....................................  36 
2.10  Method of Payments; Computations.................................  38 
2.11  Increased Costs, Change in Circumstances, etc....................  39 
2.12  Taxes............................................................  42 
2.13  Compensation.....................................................  45 
2.14  Use of Proceeds..................................................  45 
2.15  Recovery of Payments.............................................  46 
2.16  Pro Rata Borrowings..............................................  46 
2.17  Letters of Credit................................................  47  
2.18  Sale and Assignment of Existing Loans............................  53
<CAPTION> 
                                  ARTICLE III

                 CLOSING; CONDITIONS OF CLOSING AND BORROWING
 
<C>    <S>
3.1   Closing..........................................................  54
3.2   Conditions of Loans and Advances.................................  54
      3.2.1  Executed Loan Documents...................................  54
      3.2.2  Closing Certificates; etc.................................  55
      3.2.3  Consents; No Adverse Change...............................  56
      3.2.4  Financial Matters.........................................  57
      3.2.5  Miscellaneous.............................................  57 
</TABLE> 
<PAGE>
 
<TABLE> 
<C>   <S>                                                               <C> 
3.3   Conditions to All Loans and Advances.............................  58 
3.4   Acquisition Loans................................................  58 
3.5   Waiver of Conditions Precedent...................................  58 
<CAPTION> 
                                   ARTICLE IV

                         REPRESENTATIONS AND WARRANTIES
 
<C>   <S>
4.1   Corporate Organization and Power.................................  59
4.2   Litigation; Government Regulation................................  59
4.3   Taxes............................................................  60
4.4   Enforceability of Loan Documents; Compliance With   
      Other Instruments................................................  60
4.5   Governmental Authorization.......................................  60
4.6   Event of Default.................................................  61
4.7   Margin Securities................................................  61
4.8   Full Disclosure..................................................  61
4.9   Principal Places of Business.....................................  61 
4.10  ERISA; Employee Benefits.........................................  61
4.11  Subsidiaries.....................................................  63
4.12  Financial Statements.............................................  63
4.13  Title to Assets..................................................  63
4.14  Solvency.........................................................  64
4.15  Use of Proceeds..................................................  64
4.16  Assets for Conduct of Business...................................  64
4.17  Compliance With Laws.............................................  64
4.18  Environmental Matters............................................  64
4.19  Projections......................................................  65
4.20  First Priority...................................................  65
4.21  Contracts; Labor Disputes........................................  65
4.22  Insurance........................................................  65
4.23  Reimbursement from Third Party Payors............................  66
4.24  Fraud and Abuse..................................................  66
4.25  Single Business Enterprise.......................................  67
<CAPTION> 
                                   ARTICLE V

                             AFFIRMATIVE COVENANTS
 
<C>   <S>
5.1   Repayment of Obligations.........................................  67
5.2   Performance Under Loan Documents.................................  67
5.3   Financial and Business Information about the Borrower............  67
5.4   Notice of Certain Events.........................................  69
5.5   Corporate Existence and Maintenance of Properties................  70
5.6   Payment of Debt..................................................  70
5.7   Maintenance of Insurance.........................................  71
5.8   Inspection.......................................................  72
5.9   COBRA............................................................  72
5.10  Payment of Taxes.................................................  72
5.11  Compliance with Laws.............................................  72
5.12  Name Change......................................................  73
5.13  Creation or Acquisition of New Subsidiaries......................  73
</TABLE> 
<PAGE>
 
<TABLE> 
<C>   <S>                                                               <C> 
5.14  Disbursement of Proceeds By the Borrower.........................  74
5.15  Certain Acquisitions.............................................  74
5.16  Foreign Subsidiaries.............................................  76
<CAPTION> 
                                   ARTICLE VI

                               NEGATIVE COVENANTS
 
<C>   <S>                                                    
6.1   Merger, Consolidation............................................  76
6.2   Debt.............................................................  77
6.3   Contingent Obligations...........................................  77
6.4   Liens and Encumbrances...........................................  78
6.5   Disposition of Assets............................................  78
6.6   Transactions with Related Persons................................  78
6.7   Restricted Investments...........................................  79
6.8   Restricted Payments..............................................  79
6.9   Capital Expenditures.............................................  79
6.10  Consolidated Net Worth...........................................  80
6.11  Foreign Subsidiary EBITDA........................................  80
6.12  Cash Available to Fixed Charges..................................  80
6.13  Cash Available to Debt Service Ratio.............................  80
6.14  Consolidated Senior Debt to Annualized Cash Flow.................  80
6.15  Consolidated Debt to Annualized Cash Flow........................  80
6.16  Consolidated Debt to Consolidated Total Capital..................  80
6.17  Sale and Leaseback...............................................  80
6.18  New Business.....................................................  80
6.19  Subsidiaries or Partnerships.....................................  81
6.20  Transactions Affecting the Collateral............................  81
6.21  Hazardous Wastes.................................................  81
6.22  Fiscal Year......................................................  81
6.23  Amendments; Prepayments of Debt, etc.............................  81
6.24  Fraud and Abuse..................................................  82
6.25  Limitation on Certain Restrictions...............................  82
6.26  No Other Negative Pledges........................................  83
6.27  Accounting Changes...............................................  83 
<CAPTION> 
                                  ARTICLE VII

                               EVENTS OF DEFAULT
<C>   <S>                                                               <C> 
7.1   Events of Default................................................  83
<CAPTION> 
                                  ARTICLE VIII

                   RIGHTS AND REMEDIES AFTER EVENT OF DEFAULT
<C>  <S>
8.1   Remedies:  Termination of Commitments, Acceleration, etc.........  86
8.2   Right of Set-off.................................................  87
8.3   Rights and Remedies Cumulative; Non-Waiver; etc..................  87
</TABLE>
<PAGE>
 
                                  ARTICLE IX

                                   THE AGENT

 9.1     Appointment................................................  88
 9.2     Nature of Duties...........................................  88
 9.3     Absence of Reliance on the Agent...........................  88
 9.4     Certain Rights of the Agent................................  89
 9.5     Notice of Default..........................................  90
 9.6     Reliance by Agent..........................................  90
 9.7     Indemnification............................................  90
 9.8     The Agent in its Individual Capacity.......................  91
 9.9     Holders....................................................  91
 9.10    Successor Agent............................................  91
 9.11    Collateral Matters.........................................  92

                                   ARTICLE X

                                 MISCELLANEOUS

 10.1    Survival...................................................  93
 10.2    Governing Law; Consent to Jurisdiction.....................  93
 10.3    Arbitration; Remedies......................................  94
 10.4    Notice.....................................................  95
 10.5    Assignments, Participations................................  97
 10.6    Fees and Expenses.......................................... 100
 10.7    Indemnification............................................ 101
 10.8    Amendments, Waivers, Etc................................... 102
 10.9    Rights and Remedies Cumulative, Nonwaiver, etc............. 103
 10.10   Binding Effect, Assignment................................. 103
 10.11   Severability............................................... 104
 10.12   Entire Agreement........................................... 104
 10.13   Interpretation............................................. 104
 10.14   Counterparts, Effectiveness................................ 104
 10.15   Conflict of Terms.......................................... 104
 10.16   Injunctive Relief.......................................... 105
 10.17   Confidentiality............................................ 105
 10.18   Post-Closing Matters....................................... 105
 10.19   Acknowledgement............................................ 105
 
<PAGE>
 
                                    EXHIBITS

Exhibit A     - Form of Revolving Credit/Term Note
Exhibit B-1   - Form of Notice of Borrowing
Exhibit B-2   - Form of Notice of Conversion/Continuation
Exhibit B-3   - Form of Letter of Credit Request
Exhibit C     - Form of Compliance Certificate
Exhibit D     - Form of Assignment and Acceptance


                                   SCHEDULES

Schedule 1.1(a)    Existing Liens                      
Schedule 4.1       Foreign Jurisdictions; Names        
Schedule 4.2       Litigation; Government Regulation   
Schedule 4.3       Taxes                               
Schedule 4.4       Compliance with Other Agreements    
Schedule 4.9       Principal Place of Business         
Schedule 4.10      ERISA Matters                       
Schedule 4.11      Subsidiaries                        
Schedule 4.13      Title to Assets                     
Schedule 4.22      Insurance                           
Schedule 6.17      Sale and Leaseback                   
<PAGE>
 
                           FIFTH AMENDED AND RESTATED
                                 LOAN AGREEMENT



     THIS FIFTH AMENDED AND RESTATED LOAN AGREEMENT, dated as of the 2nd day of
May, 1997 (the "Loan Agreement" or "Agreement"), is made among RENAL TREATMENT
CENTERS, INC., a Delaware corporation (the "Borrower") with its principal
offices in Berwyn, Pennsylvania, the banks and other financial institutions from
time to time parties hereto (each, a "Lender," and collectively, the "Lenders"),
and FIRST UNION NATIONAL BANK OF NORTH CAROLINA, as Agent (the "Agent") and 
CORESTATES BANK, N.A., as documentation agent.



                                    RECITALS


     A.   The Borrower, the Agent and certain of the Lenders entered into
certain credit facilities, dated as of September 4, 1991.

     B.   The Borrower, the Agent and the Lenders have restructured and
increased the credit facilities extended to the Borrower pursuant to a an
Amended and Restated Loan Agreement, dated as of September 30, 1992, a Second
Amended and Restated Loan Agreement, dated as of September 27, 1993, a Third
Amended and Restated Loan Agreement, dated as of November 3, 1994, and a Fourth
Amended and Restated Loan Agreement, dated as of June 5, 1996. Pursuant to the
Fourth Amended and Restated Loan Agreement, the Lenders have extended a
$100,000,000 revolving credit/term loan facility to the Borrower.

     C.   The Borrower has requested that the Lenders increase the revolving
credit/term loan facility to a principal amount of up to $200,000,000 and make
certain other amendments, and the Borrower, the Agent and the Lenders wish to
evidence this increase and other amendments by an amendment and restatement of
the Fourth Amended and Restated Loan Agreement.

     D.   The parties acknowledge that this Fifth Amended and Restated Loan
Agreement and each of the other Loan Documents (as hereinafter defined) have
been negotiated, executed and delivered in Charlotte, North Carolina.

     E.   The Lenders are willing to amend and restate the Fourth Amended and
Restated Loan Agreement and to make the Loans and issue certain Letters of
Credit described herein based on the terms and conditions set forth herein.

     NOW, THEREFORE, for good and valuable consideration, the receipt and
sufficiency of which are hereby acknowledged, the Borrower, the Lenders and the
Agent hereby agree as follows:
<PAGE>
 
                                   ARTICLE I

                                  DEFINITIONS

     1.1  Defined Terms. For purposes of this Loan Agreement, in addition to the
terms defined elsewhere in this Loan Agreement, the following terms shall have
the meanings set forth below:

     "Account Designation Letter" shall mean a letter from the Borrower to the 
Agent, duly completed and signed by an authorized officer and in such form and 
substance satisfactory to the Agent, listing any one or more accounts to which 
the Borrower may at any time and from time to time request the Agent to forward 
proceeds of any Loan made hereunder.

     "Accounts" shall mean all "accounts," within the meaning of the Uniform
Commercial Code, of the Borrower and its Subsidiaries, including, without
limitation, any existing and future Medicare, Medicaid and other similar
accounts receivable.

     "Acquisition" shall mean any bona fide transaction or series of related
transactions, consummated after the date hereof, by which the Borrower or any
Subsidiary (i) acquires all or a substantial part of the assets, or a going
business or division, of any Person, whether through purchase of assets or
securities, merger or otherwise, or (ii) directly or indirectly acquires control
of at least a majority in voting power of the securities or other ownership
interests of any Person.  For the purpose of this definition, "control" means
the possession, directly or indirectly, of the power to direct or cause the
direction of management and policies, whether through the ownership of voting
securities, by contract or otherwise.

     "Acquisition Amount" shall mean, with respect to any Permitted Acquisition,
the sum (without duplication) of (i) the aggregate original principal amount of
all Revolving Credit/Term Loans the proceeds of which are utilized to finance
such Acquisition, in part or in whole, (ii) the amount of cash paid by the
Borrower and its Subsidiaries in connection with such Acquisition, (iii) the
Fair Market Value of all capital stock or other ownership interests of the
Borrower or any Subsidiary issued or given in connection with such Acquisition,
(iv) the amount (determined by using the face amount or the amount payable at
maturity, whichever is greater) of all Debt incurred, assumed or acquired in
connection with such Acquisition, (v) all additional purchase price amounts in
the form of earnouts and other contingent obligations that should be recorded on
the financial statements of the Borrower and its Subsidiaries in accordance with
Generally Accepted Accounting Principles, (vi) all amounts paid in respect of
covenants not to compete, consulting agreements and other affiliated contracts
in connection with such Acquisition and (vii) the aggregate fair 
<PAGE>
 
market value of all other consideration given by the Borrower and its
Subsidiaries in connection with such Acquisition.

     "Adjusted Base Rate" shall mean, at any time with respect to any Loan, a
rate per annum equal to the Base Rate plus the Applicable Margin for Base Rate
Loans, each as in effect at such time.

     "Adjusted LIBOR Rate" shall mean, at any time with respect to any Loan, a
rate per annum equal to the LIBOR Rate plus the Applicable Margin for LIBOR
Loans, each as in effect at such time.

     "Affiliate" shall mean, as to any Person, each of the Persons that directly
or indirectly, through one or more intermediaries, owns or controls, or is
controlled by or under common control with, such Person.  Notwithstanding the
foregoing, with respect to the Borrower or any Subsidiary, the term "Affiliate"
shall not include First Union or any Affiliate of First Union.  For the purpose
of this definition, "control" means the possession, directly or indirectly, of
the power to direct or cause the direction of management and policies, whether
through the ownership of voting securities, by contract or otherwise.

     "Agent" shall mean First Union, in its capacity as appointed in Article IX
hereof, and its permitted successors and assigns.

     "Agreement" or "this Agreement" or "Loan Agreement" shall mean this Fifth
Amended and Restated Loan Agreement and any amendments, modifications and
supplements hereto, any replacements, renewals, extensions and restatements
hereof, and any substitutes herefor, in whole or in part and all schedules and
exhibits hereto, and shall refer to this Agreement as the same may be in effect
at the time such reference becomes operative.

     "Annualized Cash Flow" shall mean, with respect to the Borrower and its
Subsidiaries (other than Foreign Subsidiaries) on a consolidated basis as of the
last day of any fiscal quarter, twice the aggregate of (i) Consolidated Net
Income for the two (2) immediately preceding fiscal quarters then ended, plus
                                                                         ----
(ii) the sum of Interest Expense, taxes, depreciation, amortization and other
non-cash expenses or charges reducing income for such period (to the extent
taken into account in the calculation of Consolidated Net Income for such
period), minus (iii) non-cash credits increasing Consolidated Net Income for
         -----
such period (to the extent taken into account in the calculation of Consolidated
Net Income for such period).

     "Applicable Margin" shall mean, at any time with respect to any Loan, the
applicable percentage points as determined under the following matrix with
reference to the ratio of Consolidated Debt to Annualized Cash Flow, including
Foreign Subsidiaries calculated as provided below:
<PAGE>
 
<TABLE>
<CAPTION>
 
   Ratio of Consolidated Debt       
    to Annualized Cash Flow        Applicable Margin   Applicable Margin
(including Foreign Subsidiaries)     (LIBOR Rate)        (Base Rate)    
- --------------------------------  ------------------  ------------------
<S>                               <C>                 <C>
 
  Greater than or equal to
    3.5 to 1.0                           1.50%               0.00%
 
  Greater than or equal to
    3.0 to 1.0
    but less than 3.5 to 1.0             1.25%               0.00%
 
  Greater than or equal to
    2.5 to 1.0
    but less than 3.0 to 1.0             1.00%               0.00%
 
  Greater than or equal to
    2.0 to 1.0
    but less than 2.5 to 1.0            0.875%               0.00%
 
  Greater than or equal to
    1.5 to 1.0
    but less than 2.0 to 1.0             0.75%               0.00%
 
  Greater than or equal to
    1.0 to 1.0
    but less than 1.5 to 1.0             0.60%               0.00%
 
  Less than 1.0 to 1.0                   0.50%               0.00%
</TABLE>

The Applicable Margins shall be reset from time to time in accordance with the
above matrix on the fifth (5th) Business Day after receipt by the Agent in
accordance with Section 5.3 of financial statements together with a Compliance
Certificate attaching an Interest Rate Calculation Worksheet (reflecting the
computation of the ratio of Consolidated Debt to Annualized Cash Flow, including
Foreign Subsidiaries, as of the last day of the preceding fiscal quarter or
fiscal year, as appropriate) that provides for different Applicable Margins than
those then in effect; and provided however that, notwithstanding the foregoing,
                          -------- -------
if at any time the Borrower shall have failed to deliver the financial
statements and a Compliance Certificate as required by Section 5.3 (a), Section
5.3 (b), Section 5.3 (c) and Section 5.3 (d) (as the case may be), then at all
times from and including the date on which such statements and Compliance
Certificate are required to have been delivered, each Applicable Margin shall be
determined as if the ratio of Consolidated Debt to Annualized Cash Flow
(including Foreign Subsidiaries) were greater than or equal to 3.5 : 1.0
(notwithstanding the actual ratio).

     "Assignment Agreement" shall mean the Assignment Agreement, dated as of
July 27, 1992, as amended by a First Amendment to Assignment Agreement, dated as
of February 8, 1993, and as further amended, whereby the Borrower has assigned
to RTC Holdings as an equity contribution all of its right, title and interest
in and to the Intercompany Loan Documents referenced therein, and any further
amendments, modifications and supplements thereto, any replace-
<PAGE>
 
ments, renewals, extensions and restatements thereof, and any substitutes
therefor, in whole or in part.

     "Assignment and Acceptance" shall mean an Assignment and Acceptance
Agreement entered into between a Lender and an Eligible Assignee, and accepted
by the Agent, in substantially the form of Exhibit D.

     "Assignment Restrictions" shall mean, with respect to any contracts or
agreements assigned to the Agent, on behalf of the Lenders, as Collateral by the
Borrower or any Subsidiary, any restriction or prohibition on assignment that
has not been waived or consented to by the Person for whose benefit such
restriction or prohibition exists with respect to which the Agent has waived the
requirement of such waiver or consent and with respect to Medicare and Medicaid
accounts receivable, assignment restrictions as provided in the Medicare
Regulations and the Medicaid Regulations.

     "Bankruptcy Code" shall mean 11 U.S.C. (S) 101 et seq., as amended, and any
successor statute or statute having substantially the same function.

     "Base Rate" shall mean the higher of (i) the per annum interest rate
publicly announced from time to time by First Union in Charlotte, North
Carolina, to be its prime or base rate (which may not necessarily be its best
lending rate), as adjusted to conform to changes as of the opening of business
on the date of any such change in such prime or base rate, or (ii) one-half
percentage point (0.5%) in excess of the Federal Funds Rate, as adjusted to
conform to changes as of the opening of business on the date of any such change
in the Federal Funds Rate.

     "Base Rate Loan" shall mean, at any time, any Loan that bears interest at
such time at the Adjusted Base Rate.

     "Bloodborne Pathogens Standard" shall mean the Final Standard for
Occupational Exposure to Bloodborne Pathogens promulgated by OSHA at 56 Federal
Register 64004 et seq. (December 6, 1991) and codified at 29 C.F.R. (S)
1910.1030, or any similar regulation promulgated by any Governmental Authority.

     "Borrower" shall mean Renal Treatment Centers, Inc., a Delaware
corporation, and its successors and assigns.

     "Borrowing" shall mean the incurrence by the Borrower on a given date
(including as a result of conversions of outstanding Loans pursuant to Section
2.9) of one Type of Loan under a single Facility, provided that Base Rate Loans
incurred pursuant to Section 2.11(c) shall be considered part of the related
Borrowing of LIBOR Loans.
<PAGE>
 
     "Borrowing Date" shall have the meaning assigned to such term in Section
2.2(a).

     "Business Day" shall mean (i) any day other than a Saturday or Sunday, a
legal holiday or a day on which commercial banks in Charlotte, North Carolina
are required by law to be closed and (ii) in respect of any determination
relevant to a LIBOR Loan, any such day that is also a day on which tradings are
conducted in the London interbank Eurodollar market.

     "Capital Asset" shall mean any asset that would, in accordance with
Generally Accepted Accounting Principles, be required to be classified and
accounted for as a capital asset.

     "Capital Expenditures" shall mean the aggregate amount of all expenditures
and liabilities (including, without limitation, Capital Lease Obligations) made
and incurred in respect of the acquisition by the Borrower or any Subsidiary of
Capital Assets.

     "Capital Lease" shall mean any lease of any property that would, in
accordance with Generally Accepted Accounting Principles, be required to be
classified and accounted for as a capital lease on the balance sheet of the
lessee.

     "Capital Lease Obligation" shall mean, with respect to any Capital Lease,
the amount of the obligation of the lessee thereunder that would, in accordance
with Generally Accepted Accounting Principles, appear on a balance sheet as a
liability of such lessee in respect of such Capital Lease, net of any government
grant applicable to such Capital Lease.

     "Cash Available" shall mean, with respect to the Borrower and its
Subsidiaries (other than Foreign Subsidiaries) on a consolidated basis as of the
last day of any fiscal quarter, twice the aggregate of (i) Consolidated Net
Income for the two (2) immediately preceding fiscal quarters then ended, plus
                                                                         ----
(ii) the sum of Interest Expense, Lease Expense, depreciation, amortization and
other non-cash expenses or charges reducing income for such period (to the
extent taken into account in the calculation of Consolidated Net Income for such
period), minus (iii) non-cash credits increasing income for such period (to the
         -----
extent taken into account in the calculation of Consolidated Net Income for such
period).

     "Cash Collateral Account" shall have the meaning assigned to such term in
Section 2.17(i).

     "Cash Investments" shall mean (i) marketable direct obligations issued or
unconditionally guaranteed by the United States of America or issued by any
agency thereof and backed by the full faith and credit of the United States of
America, in each case maturing within one (1) year from the date of acquisition
thereof; (ii) marketable direct obligations issued by any state of the 
<PAGE>
 
United States of America or any political subdivision of any such state or any
public instrumentality thereof maturing within one (1) year from the date of
acquisition thereof and, at the time of acquisition, having the highest rating
obtainable from either Standard & Poor's Corporation or Moody's Investors
Service, Inc.; (iii) marketable commercial paper maturing no more than one (1)
year from the date of creation thereof and, at the time of acquisition, having a
rating of at least A-1 or the equivalent thereof by Standard & Poor's
Corporation or at least P-1 or the equivalent thereof by Moody's Investors
Service, Inc.; and (iv) demand deposits, time deposits and certificates of
deposit maturing within one (1) year from the date of issuance thereof and
issued by a bank or trust company organized under the laws of the United States
of America or any state thereof and having a long term debt rating by Standard &
Poor's Corporation of A or higher.

     "Change of Control" shall mean (i) any Person or "group" (within the 
meaning of Section 13(d)(3) of the Exchange Act), shall, directly or 
indirectly, as a result of a tender or exchange offer, open market purchases, 
privately negotiated purchases or otherwise have become, after the Closing Date,
the "beneficial owner" of securities of the Borrower representing 50% or more of
the combined voting power of the then outstanding securities of the Borrower 
ordinarily (and apart from rights accruing under special circumstances) having 
the right to vote in the election of directors, assuming the conversion, 
exchange or exercise into or for voting stock of all outstanding shares so 
convertible, or (ii) the members of the Board of Directors of the Borrower shall
cease to consist of a majority of the individuals (y) who constituted the Board 
of Directors as of the date hereof or (z) who shall have become members thereof 
subsequent to the date hereof after having been nominated, or otherwise approved
in writing, by at least a majority of individuals who constituted the Board of 
Directors of the Borrower as of the date hereof.  For purposes of this 
definition, "voting Power" shall be determined with reference to the then 
outstanding securities of the Borrower ordinarily (and apart from rights 
accruing under special circumstances) having the right to vote in the election 
of directors, assuming the conversion, exchange or exercise into or for voting 
stock of all outstanding securities of the Borrower other than voting stock.

     "Closing" shall have the meaning assigned to such term in Section 3.1.

     "Closing Date" shall mean the date referred to in Section 3.1 hereof.

     "Collateral" shall mean and include all Stock or other equity interest and
Intercompany Loan Documents of each Subsidiary (other than RTC-Argentina S.A.,
RTC Buenos Aires, S.A. and RTC Cordoba S.A.), whether now owned or hereafter
acquired, from time to time pledged by the Borrower to the Agent, for the
benefit of the Lenders, pursuant to the Pledge Agreement or the Subsidiary
Pledge
<PAGE>
 
Agreement, in either case directly or indirectly securing the Obligations or the
obligations of any Guarantor under the Guaranty Agreement, and all other
property and interests in property that shall, from time to time, directly or
indirectly secure the Obligations or the obligations of any Guarantor under the
Guaranty Agreement.

     "Commitment" shall mean, for any Lender, such Lender's Revolving
Credit/Term Commitment.

     "Compliance Certificate" shall mean a fully completed certificate in the
form of EXHIBIT C.

     "Consolidated Debt" shall mean, at any time, the aggregate (without
duplication) of all Debt of the Borrower and its Subsidiaries as of such date,
determined on a consolidated basis.

     "Consolidated Net Assets" shall mean, as to the last day of any fiscal 
year, the aggregate (without duplication) of all assets of the Borrower and its 
Subsidiaries that are required to be included in determining, in accordance with
Generally Accepted Accounting Principals, total assets as shown on the asset 
side of their consolidated balance sheet as of such date.

     "Consolidated Net Income" shall mean, for any fiscal quarter, the net
income (or loss) of the Borrower and its Subsidiaries (other than Foreign
Subsidiaries), on a consolidated basis and excluding intercompany items, for
such quarter, determined in accordance with Generally Accepted Accounting
Principles, but excluding as income: (a) gains on the sale, conversion or other
disposition of Capital Assets, (b) gains on the acquisition, retirement, sale or
other disposition of Stock of the Borrower or any Subsidiary, (c) gains on the
collection of life insurance proceeds, (d) any write-up of any asset, and (e)
any other gain or credit of an extraordinary nature. For purposes of calculating
the financial covenants contained in this Agreement, the Borrower may exclude,
without duplication, up to $6,000,000 of Excludable Acquisition Expenses,
including tax benefits related thereto, per fiscal year.

     "Consolidated Net Revenue" shall mean, for the applicable period, net
revenue of the Borrower and its Subsidiaries (other than Foreign Subsidiaries),
on a consolidated basis, calculated in accordance with Generally Accepted
Accounting Principles.

     "Consolidated Net Worth" shall mean, as of the last day of any fiscal
quarter, the net worth of the Borrower and its Subsidiaries (other than Foreign
Subsidiaries) as of such date, determined on a consolidated basis in accordance
with Generally Accepted Accounting Principles.
<PAGE>
 
     "Consolidated Senior Debt" shall mean, at any time, Consolidated Debt as of
such date less Consolidated Subordinated Debt as of such date.
          ----                                                

     "Consolidated Subordinated Debt" shall mean, at any time, the aggregate
(without duplication) of all Subordinated Debt of the Borrower and its
Subsidiaries as of such date, determined on a consolidated basis.

     "Consolidated Total Capital" shall mean, with respect to the Borrower and
its Subsidiaries, (other than Foreign Subsidiaries), the sum of Consolidated Net
Worth and Consolidated Debt.

     "Contingent Obligation" shall mean, with respect to any Person, any direct
or indirect liability of such Person with respect to any Debt, lease, dividend,
guaranty, letter of credit or other obligation (the "primary obligation") of
another Person (the "primary obligor"), whether or not contingent, (a) to
purchase, repurchase or otherwise acquire such primary obligations or any
property constituting direct or indirect security therefor, (b) to advance or
provide funds (i) for the payment or discharge of any such primary obligation or
(ii) to maintain working capital or equity capital of the primary obligor or
otherwise to maintain the net worth or solvency or any balance sheet item, level
of income or financial condition of the primary obligor, (c) to purchase
property, securities or services primarily for the purpose of assuring the owner
of any such primary obligation of the ability of the primary obligor in respect
thereof to make payment of such primary obligation or (d) otherwise to assure or
hold harmless the owner of any such primary obligation against loss or failure
or inability to perform in respect thereof.  The amount of any Contingent
Obligation shall be deemed to be an amount equal to the stated or determinable
amount of the primary obligation in respect of which such Contingent Obligation
is made or, if not stated or determinable, the maximum reasonably anticipated
liability in respect thereof as determined by such Person in good faith.

     "Convertible Notes" shall mean the notes issued pursuant to the Indenture.

     "Covenant Compliance Worksheet" shall mean a fully completed certificate in
the form of Attachment A to EXHIBIT C.

     "Debt" shall mean, with respect to any Person, (i) all indebtedness of such
Person for money borrowed, (ii) all reimbursement obligations of such Person
with respect to surety bonds, letters of credit and bankers' acceptances (in
each case, whether or not matured), (iii) all obligations of such Person
evidenced by notes, bonds, debentures or similar instruments, (iv) all
obligations of such Person to pay the deferred purchase price of property or
services (including earnouts and other similar contingent obligations,
calculated in accordance with Generally Accepted Accounting Principles), other
than trade payables, (v) all 
<PAGE>
 
indebtedness created or arising under any conditional sale or other title
retention agreement with respect to property acquired by such Person (even
though the rights and remedies of the seller or lender under such agreement in
the event of default are limited to repossession or sale of such property), (vi)
all Capital Lease Obligations of such Person, (vii) all obligations of such
Person to purchase, redeem, retire, defease or otherwise make any payment in
respect of any capital stock or other equity securities that, by their stated
terms (or by the terms of any equity securities issuable upon conversion thereof
or in exchange therefor), or upon the occurrence of any event, mature or are
mandatorily redeemable, or are redeemable at the option of the holder thereof,
in whole or in part, (viii) all indebtedness referred to in clauses (i) through
(vii) above secured by any lien on any property or asset owned or held by such
Person regardless of whether the indebtedness secured thereby shall have been
assumed by such Person or is nonrecourse to the credit of such Person, and (ix)
any Contingent Obligation of such Person.

     "Debt Service" shall mean, with respect to the Borrower and its
Subsidiaries (other than Foreign Subsidiaries) on a consolidated basis as of the
last day of any fiscal quarter, the sum of Fixed Charges for such period plus
                                                                         ----
current maturities (due within twelve (12) months) of all Debt of the Borrower
and its Subsidiaries.



     "Default" shall mean any event that, with the passage of time or giving of
notice, or both, would constitute an Event of Default.

     "Dollars" or "$" shall mean dollars of the United States of America.

     "Domestic Subsidiary" shall mean any subsidiary that is not a Foreign
Subsidiary.

     "Eligible Assignee" shall mean (i) a commercial bank organized under the
laws of the United States or any state thereof and having total assets in excess
of $5,000,000,000, (ii) a commercial bank organized under the laws of any other
country that is a member of the OECD or a political subdivision of any such
country and having total assets in excess of $5,000,000,000, provided that such
bank is acting through a branch or agency located in the United States, in the
country under the laws of which it is organized or in another country that is
also a member of the OECD, (iii) the central bank of any country that is a
member of the OECD, (iv) a finance company, mutual funds, insurance company or
other financial institution that is engaged in making, purchasing or otherwise
investing in commercial loans in the ordinary course of its business and having
total assets in excess of $3,000,000,000, (v) any Affiliate of an existing
Lender or (vi) any other Person (other than an Affiliate of the Borrower)
approved by the Agent and the Borrower, which approval shall not be unreasonably
withheld.
<PAGE>
 
     "Employee Plan" shall mean any "employee benefit plan" within the meaning
of Section 3(3) of ERISA maintained by the Borrower or any Subsidiary.

     "Environmental Claims" shall mean any and all administrative, regulatory or
judicial actions, suits, demands, demand letters, claims, liens, notices of
noncompliance or violation, investigations (other than internal reports prepared
by the Borrower or any Subsidiary solely in the ordinary course of its business
and not in response to any third party action or request of any kind) or
proceedings relating in any way to any Environmental Law or any permit issued,
or any approval given, under any such Environmental Law (hereinafter, "Claims"),
including, without limitation, (i) any and all Claims by Governmental
Authorities for enforcement, cleanup, removal, response, remedial or other
actions or damages pursuant to any applicable Environmental Law and (ii) any and
all Claims by any third party seeking damages, contribution, indemnification,
cost recovery, compensation or injunctive relief resulting from Hazardous
Substances or arising from alleged injury or threat of injury to health or the
environment.

     "Environmental Laws" shall mean any and all laws, subsequent enactments,
amendments and modifications, including, without limitation, federal, state and
local laws, statutes, ordinances, rules, regulations, permits, licenses,
approvals, interpretations and orders of courts or Governmental Authorities,
relating to the protection of human health or the environment, including, but
not limited to, requirements pertaining to the manufacture, processing,
distribution, use, treatment, storage, disposal, transportation, handling,
reporting, licensing, permitting, investigation or remediation of Hazardous
Substances.  Environmental Laws include, without limitation, the Comprehensive
Environmental Response, Compensation, and Liability Act (42 U.S.C. (S) 9601 et
seq.) ("CERCLA"), the Hazardous Material Transportation Act (49 U.S.C. (S) 1801
et seq.), the Resource Conservation and Recovery Act (42 U.S.C. (S) 6901 et
seq.) ("RCRA"), the Federal Water Pollution Control Act (33 U.S.C. (S) 1251 et
seq.), the Clean Air Act (42 U.S.C. (S) 7401 et seq.), the Toxic Substances
Control Act (15 U.S.C. (S) 2601 et seq.), the Safe Drinking Water Act (42 U.S.C.
(S) 300, et seq.), the Environmental Protection Agency's regulations relating to
underground storage tanks (40 C.F.R. Parts 280 and 281), and the Occupational
Safety and Health Act (29 U.S.C. (S) 651 et seq.) ("OSHA"), as such laws have
been amended or supplemented and any analogous future federal, or present or
future applicable state or local, statutes and the rules and regulations
promulgated thereunder.

     "ERISA" shall mean the Employee Retirement Income Security Act of 1974, as
amended from time to time, and all rules and regulations from time to time
promulgated thereunder.
<PAGE>
 
     "ERISA Event" means (a) a Reportable Event with respect to a Qualified Plan
(as defined in SECTION 4.10); (b) a withdrawal by any Borrower Affiliate from a
Qualified Plan subject to Section 4063 of ERISA during a plan year in which it
was a substantial employer (as defined in Section 4001(a)(2) of ERISA); (c) a
complete or partial withdrawal by any Borrower Affiliate from a Multiemployer
Plan; (d) the filing of a notice of intent to terminate, the treatment of a plan
amendment as a termination under Section 4041 or 4041A of ERISA or the
commencement of proceedings by the Pension Benefit Guaranty Corporation to
terminate a Qualified Plan or Multiemployer Plan subject to Title IV of ERISA;
(e) a failure to make required contributions to a Qualified Plan or
Multiemployer Plan; (f) an event or condition which might reasonably be expected
to constitute grounds under Section 4042 of ERISA for the termination of, or the
appointment of a trustee to administer, any Qualified Plan or Multiemployer
Plan; (g) the imposition of any liability under Title IV of ERISA, other than
Pension Benefit Guaranty Corporation premiums due but not delinquent under
Section 4007 of ERISA, upon any Borrower Affiliate; (h) an application for a
funding waiver or an extension of any amortization period pursuant to Section
412 of the Internal Revenue Code with respect to any Qualified Plan; (i) any
Borrower Affiliate engages in or otherwise becomes liable for a non-exempt
prohibited transaction; or (j) a violation of the applicable requirements of
Section 404 or 405 of ERISA or the exclusive benefit rule under Section 401(a)
of the Internal Revenue Code by any fiduciary with respect to any Qualified Plan
for which any Borrower Affiliate may be directly or indirectly liable.

     "Event of Default" shall have the meaning specified in ARTICLE VII hereof.

     "Exchange Act" shall mean the Securities Exchange Act of 1934, as amended
from time to time, and all rules and regulations from time to time promulgated
thereunder.

     "Excludable Acquisition Expenses" shall mean fees, costs and expenses
actually incurred by the Borrower and its Subsidiaries in connection with
Acquisitions permitted hereunder that are accounted for under Generally Accepted
Accounting Principles Board Opinion #16 as poolings of interest.

     "Facility" shall mean the Revolving Credit/Term Facility.

     "Fair Market Value" shall mean, with respect to any capital stock or other
ownership interests issued or given by the Borrower or any Subsidiary in
connection with a Permitted Acquisition, (i) in the case of common stock of the
Borrower that is then designated as a national market system security by the
National Association of Securities Dealers, Inc. ("NASDAQ") or is listed on a
national securities exchange, the average of the last reported bid and ask
quotations or prices reported thereon for such common stock or (ii) in all other
cases, the determination of the fair 
<PAGE>
 
market value thereof in good faith by a majority of disinterested members of the
board of directors of the Borrower or such Subsidiary, in each case effective as
of the close of business on the Business Day immediately preceding the closing
date of such Permitted Acquisition.

     "Federal Funds Rate" shall mean, for any day, the interest rate per annum
equal to the weighted average of the rates of overnight federal funds
transactions with members of the Federal Reserve System arranged by federal
funds brokers, as published for such day (or, if such day is not a Business Day,
for the next preceding Business Day) by the Federal Reserve Bank of New York, or
if such rate is not so published on the relevant Business Day, the average of
the quotations for such day on such transactions received by the Agent from
three (3) federal funds brokers of recognized standing selected by the Agent.

     "Fee Letter" shall mean the letter, dated March 18, 1997, as amended, from
First Union to the Borrower, relating to the agent's fee payable to the Agent
for its own account.

     "Financials" or "Financial Statements" shall mean the audited consolidated
financial statements of the Borrower and its Subsidiaries for the fiscal years
ended December 31, 1996, December 31, 1995, December 31, 1994, December 31,
1993, December 31, 1992 and December 31, 1991; interim financial statements of
the Borrower and its Subsidiaries for the three and all other financial
statements of the Borrower and its Subsidiaries that have previously been
delivered by the Borrower or any Subsidiary to the Agent or any Lender,
including, without limitation, interim financial statements.

     "First Union" shall mean First Union National Bank of North Carolina, a
national banking association, and its successors and assigns.

     "Fixed Charges" shall mean at any time, with respect to the Borrower and
its Subsidiaries (other than the Foreign Subsidiaries) on a consolidated basis
as of the last day of any fiscal quarter, twice the sum of Interest Expense and
Lease Expense for the two (2) immediately preceding fiscal quarters.

     "Foreign Acquisition" shall mean (i) any Acquisition in which a substantial
part of the assets or business being acquired is located outside of the United
States of America or (ii) the Acquisition of any Foreign Subsidiary.

     "Foreign Subsidiary" shall mean a Subsidiary that is organized under or
operates under the laws of, or is headquartered or maintains a significant
portion of its assets in, any jurisdiction located outside the United States of
America.

     "Foreign Subsidiary EBITDA" shall mean, for any applicable period, the 
aggregate of (i) the net income (or Loss) of the
<PAGE>
 
Foreign Subsidiaries, on a consolidated basis for such period, but excluding 
from income: (a) gains on the sale, conversion or other disposition of Capital  
Assets of the Foreign Subsidiaries, (b) gains on the acquisition, retirement, 
sale or other disposition of Stock of the Foreign Subsidiaries, (c) gains on the
collection of life insurance proceeds, (d) any write-up of any assets, and (e) 
any other gain or credit of an extraordinary nature, plus (ii) consolidated 
                                                     ----   
interest expense, foreign, federal, state, local and other income taxes, 
depreciation, amortization of intangible assets, and other non-cash expenses
or charges reducing income for such period of the Foreign Subsidiaries, all to 
the extent taken into account in the calculation of consolidated net income of 
the Foreign Subsidiaries for such period, minus (iii) non-cash credits 
                                          -----
increasing consolidated net income of the Foreign Subsidiaries for such period, 
to the extent taken into account in the calculation of consolidated net income 
of the Foriegn Subsidiaries for such period, all calculated in accordance with 
Generally Accepted Accounting Principles.

     "Generally Accepted Accounting Principles" shall mean generally accepted
accounting principles, as recognized by the American Institute of Certified
Public Accountants, consistently applied and maintained on a consistent basis
for the Borrower and its Subsidiaries on a consolidated basis throughout the
period indicated and consistent with the financial practice of the Borrower and
its Subsidiaries after the date hereof.

     "Governmental Authority" means any nation or government, any state or other
political subdivision thereof and any central bank thereof, any municipal,
local, city or county government, and any entity exercising executive,
legislative, judicial, regulatory or administrative functions of or pertaining
to government, and any corporation or other entity owned or controlled, through
stock or capital ownership or otherwise, by any of the foregoing.

     "Guarantors" shall mean RTC Supply, Renal-Lab, Renal-California, Renal-
Hawaii, Renal-Illinois, Renal-Management Acquisition, Renal-Mid-Atlantic,
Renal-Northeast, Renal-Southeast, Renal-West and any other Person that
guarantees the Obligations of the Borrower and the other Guarantors.

     "Guaranty Agreement" shall mean the Fourth Amended and Restated Guaranty
Agreement, dated as of the date hereof, executed by each Guarantor in favor of
the Agent, whereby each Guarantor has guaranteed to the Lenders the payment and
performance of the Obligations and the obligations of each of the other
Guarantors under the Guaranty Agreement, and all other similar agreements
executed and delivered from time to time by any Guarantor in form and substance
satisfactory to the Lenders, together with any amendments, modifications and
supplements thereto, any replacements, renewals, extensions and restatements
thereof, and any substitutes therefor, in whole or in part.
<PAGE>
 
     "Guaranty Documents" shall mean the Guaranty Agreement and the Subsidiary
Pledge Agreement and any other documents or agreements between the Agent and any
of the Guarantors, whereby certain Guarantors have pledged Collateral to the
Agent, together with any amendments, modifications and supplements thereto, any
replacements, renewals, extensions and restatements thereof, and any substitutes
therefor, in whole or in part.

     "HCFA" shall mean the United States Health Care Financing Administration
and any successor agency.

     "Hazardous Substances" means any substances or materials (i) that are or
become defined as hazardous wastes, hazardous substances, pollutants,
contaminants or toxic substances under any Environmental Law; (ii) that are
toxic, explosive, corrosive, flammable, infectious, radioactive, mutagenic or
otherwise hazardous and are or become regulated by any Governmental Authority;
(iii) the presence of which require investigation or remediation under any
Environmental Law or common law; (iv) that are deemed to constitute a nuisance,
a trespass or pose a health or safety hazard to persons or neighboring
properties; (v) materials consisting of underground or aboveground storage
tanks, whether empty, filled or partially filled with any substance; or (vi)
that contain, without limitation, asbestos, polychlorinated biphenyls, urea
formaldehyde foam insulation, petroleum hydrocarbons, petroleum derived
substances or waste, crude oil, nuclear fuel, natural gas or synthetic gas.

     "Hedge Agreement" shall mean any interest or foreign currency rate swap,
cap, collar, option, hedge, forward rate or other similar agreement or
arrangement designed to protect against fluctuations in interest rates or
currency exchange rates.

     "IRS" shall mean the Internal Revenue Service and any successor thereto.

     "Indemnified Costs" shall have the meaning assigned to such term in SECTION
10.7.

     "Indemnified Person" shall have the meaning assigned to such term in
SECTION 10.7.

     "Indenture" means the Indenture, dated June 12, 1996, between the Borrower
and PNC Bank, National Association, as Trustee, pursuant to which the Borrower
has issued certain convertible subordinated notes due 2006, as amended,
restated, modified or supplemented from time to time.

     "Intercompany Loan Documents" shall mean the intercompany notes issued from
time to time by any Subsidiary to the Borrower and contributed by the Borrower
to RTC Holdings as an equity contribution pursuant to the Assignment Agreement,
together with any amendments, modifications and supplements thereto, any
<PAGE>
 
replacements, renewals, extensions and restatements thereof, and any substitutes
therefor, in whole or in part.

     "Interest Expense" shall mean, for any period, total interest expense of
the Borrower and its Subsidiaries on a consolidated basis for such period
(including, without limitation, interest expense attributable to Capital Lease
Obligations), determined in accordance with Generally Accepted Accounting
Principles.

     "Interest Rate Calculation Worksheet" shall mean a fully completed
worksheet in the form of Attachment B to EXHIBIT C.

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

     "Issuing Bank" shall mean First Union, in its capacity as issuer of the
Letters of Credit, and its successors and assigns in such capacity.

     "L/C Participant" shall have the meaning assigned to such term in SECTION
2.17(C).

     "LIBOR Loan" shall mean, at any time, any Loan that bears interest at such
time at the Adjusted LIBOR Rate.

     "LIBOR Rate" shall mean, with respect to each LIBOR Loan comprising part of
the same Borrowing for any Interest Period, an interest rate per annum obtained
by dividing (i) (y) the rate of interest appearing on telerate page 3750 (or any
successor page or (z) if no such rate is available, the rate of interest
determined by the Agent to be the rate or the arithmetic mean of rates (rounded
upward, if necessary, to the nearest 1/16 of one percentage point) at which
Dollar deposits in immediately available funds are offered by first-tier banks
in the London interbank Eurodollar market to the Charlotte offices of First
Union; in each case under (y) and (z) above at approximately 10:00 a.m.,
Charlotte time, two (2) Business Days prior to the first day of such Interest
Period for a period equal to such Interest Period and in an amount substantially
equal to the amount of the Agent's LIBOR Loan in connection with such Borrowing,
by (ii) the amount equal to 1.00 minus the Reserve Requirement (expressed as a
decimal) for such Interest Period.

     "Lease Expense" shall mean, for any period, all amounts paid, payable or
accrued during such period by the Borrower and its Subsidiaries on a
consolidated basis with respect to all leases of real and personal property,
excluding intercompany items.

     "Lender" shall mean each financial institution signatory hereto and each
other financial institution that becomes a "Lender" hereto pursuant to SECTION
10.5, and their permitted successors and assigns.
<PAGE>
 
     "Lending Office" shall mean, with respect to any Lender, the branch or
branches (or Affiliates) from which any of such Lender's Loans are made or
maintained.

     "Letter of Credit Outstandings" shall mean, at any time, the sum of (i) the
aggregate Stated Amount of all outstanding Letters of Credit at such time and
(ii) the aggregate amount of all Reimbursement Obligations at such time.

     "Letter of Credit Request" shall have the meaning assigned to such term in
SECTION 2.17(B).

     "Letters of Credit" shall have the meaning assigned to such term in SECTION
2.17(A).

     "Loan Documents" shall mean and collectively refer to this Agreement, the
Revolving Credit/Term Notes, the Pledge Agreement, the Subsidiary Pledge
Agreement, the Guaranty Documents, the Intercompany Loan Documents, the
Assignment Agreement, the Letters of Credit, any Hedge Agreement to which the
Borrower and any Lender are parties and that is permitted hereunder, and any and
all agreements, instruments and documents, including, without limitation, notes,
guaranties, mortgages, deeds to secure debt, deeds of trust, chattel mortgages,
pledges, powers of attorney, consents, assignments, contracts, notices, security
agreements, trust account agreements and all other written matters whether
heretofore, now or hereafter executed by or on behalf of the Borrower or any
Subsidiary or delivered to the Agent or any Lender, with respect to this
Agreement or with respect to the transactions contemplated by this Agreement,
and in each case, together with any amendments, modifications and supplements
thereto, any replacements, renewals, extensions and restatements thereof, and
any substitutes therefor, in whole or in part.

     "Loans" shall mean and collectively refer to the Revolving Credit/Term
Loans.

     "Material Adverse Effect" or "Material Adverse Change" shall mean, in the
good faith opinion of the Required Lenders, a material adverse effect upon, or a
material adverse change in, any of (a) the financial condition, operations,
business, or properties of the Borrower and its Subsidiaries, taken as a whole;
(b) the ability of the Borrower or any Subsidiary to perform under any Loan
Document or any other material contract to which it is a party; (c) the
legality, validity or enforceability of any Loan Document; (d) the perfection or
priority of the liens of the Agent granted under the Loan Documents or the
rights and remedies of the Agent or the Lenders under the Loan Documents; or (e)
the condition or value of any material portion of the Collateral.

     "Medicaid Certification" shall mean, with respect to any health care
facility, certification by HCFA or another Governmental Authority, or any Person
under contract with HCFA, that such health 
<PAGE>
 
care facility is in compliance with all conditions of participation set forth in
the Medicaid Regulations, except where the failure to so comply would not have a
Material Adverse Effect.

     "Medicaid Provider Agreement" shall mean an agreement entered into between
any Person administering the Medicaid program and a health care facility under
which the health care facility agrees to provide services for Medicaid patients
in accordance with the terms of the agreement and Medicaid Regulations.

     "Medicaid Regulations" shall mean, collectively, (i) all federal statutes
(whether set forth in Title XIX of the Social Security Act, 42 USC (S)(S) 1396
et seq., or elsewhere) affecting the medical assistance program established by
Title XIX of the Social Security Act, and any statutes succeeding thereto; (ii)
all applicable provisions of all federal rules, regulations, manuals and orders
of all Governmental Authorities promulgated pursuant to or in connection with
the statutes described in clause (i) above and all federal administrative,
reimbursement and other guidelines of all Governmental Authorities having the
force of law promulgated pursuant to or in connection with the statutes
described in clause (i) above; (iii) all state statutes and plans for medical
assistance enacted in connection with the statutes and provisions described in
clauses (i) and (ii) above; and (iv) all applicable provisions of all rules,
regulations, manuals and orders of all Governmental Authorities promulgated
pursuant to or in connection with the statutes described in clause (iii) above
and all state administrative, reimbursement and other guidelines of all
Governmental Authorities having the force of law promulgated pursuant to or in
connection with the statutes described in clause (iii) above, in each case as
may be amended, supplemented or otherwise modified from time to time.

     "Medicare Certification" shall mean, with respect to any health care
facility, certification by HCFA or any other Governmental Authority, or any
Person under contract with HCFA, that such health care facility is in compliance
with all the conditions of participation set forth in the Medicare Regulations,
except where the failure to so comply would not have a Material Adverse Effect.

     "Medicare Provider Agreement" shall mean an agreement entered into between
any Person administering the Medicare program and a health care facility under
which the health care facility agrees to provide services for Medicare patients
in accordance with the terms of the agreement and Medicare Regulations.

     "Medicare Regulations" shall mean, collectively, all federal statutes
(whether set forth in Title XVIII of the Social Security Act, 42 USC (S)(S) 1396
et seq., or elsewhere) affecting the health insurance program for the aged and
disabled established by Title XVIII of the Social Security Act and any statutes
succeeding 
<PAGE>
 
thereto; together with all applicable provisions of all rules, regulations,
manuals and orders and administrative, reimbursement and other guidelines having
the force of law of all Governmental Authorities (including, without limitation,
Health and Human Services ("HHS"), HCFA, the Office of the Inspector General for
HHS, or any Person succeeding to the functions of any of the foregoing)
promulgated pursuant to or in connection with any of the foregoing having the
force of law, in each case as may be amended, supplemented or otherwise modified
from time to time.

     "Mellon" shall mean Mellon Bank, N.A., a national banking association, and
its successors and assigns.

     "Multiemployer Plan" shall mean any "multiemployer plan" within the meaning
of Section 4001(a)(3) of ERISA to which any Borrower or any Subsidiary is
required to make contributions.

     "Notice of Borrowing" shall have the meaning assigned to such term in
SECTION 2.2(A).

     "Notice of Conversion/Continuation" shall have the meaning assigned to such
term in SECTION 2.9(B).

     "Notification and Consent Agreement" shall mean the Notification and
Consent Agreement, dated as of September 30, 1992, as amended, among RTC
Holdings, Mellon and the Agent, whereby Mellon has agreed to hold the
Intercompany Loan Documents on behalf and as bailee of the Agent, for the
benefit of the Lenders, in order to perfect the Lenders' security interest
therein, together with any amendments, modifications and supplements thereto,
any replacements, renewals, extensions and restatements thereof, and any
substitutes therefor, in whole or in part.

     "OECD" shall mean the Organization for Economic Cooperation and Development
and any successor thereto.

     "OSHA" shall mean the Occupational Safety and Health Act, as amended from
time to time, and all rules and regulations from time to time promulgated
thereunder.

     "Obligations" shall mean and include (i) the Loans, any Reimbursement
Obligations and all other loans, advances, indebtedness, liabilities,
obligations, covenants and duties owing, arising, due or payable from the
Borrower to the Agent, the Issuing Bank or any Lender of any kind or nature,
present or future, howsoever evidenced, created, incurred, acquired or owing,
arising under this Agreement, the Revolving Credit/Term Notes or the other Loan
Documents or in any other way related to this Agreement, whether direct or
indirect (including those acquired by assignment), absolute or contingent,
primary or secondary, due or to become due, now existing or hereafter arising
and however acquired, and (ii) all interest (including, to the extent permitted
by law, all post-petition interest), charges, expenses, fees, 
<PAGE>
 
attorneys' fees and any other sums payable by the Borrower to the Agent, the
Issuing Bank or any Lender under this Agreement or any of the other Loan
Documents.

     "Participant" shall mean any Person, now or at any time hereafter,
participating with any Lender in the Loans pursuant to this Agreement, and its
permitted successors and assigns.

     "Pension Plan" shall mean any "employee pension benefit plan" within the
meaning of Section 3(2) of ERISA maintained by the Borrower or any Subsidiary
(other than any Multiemployer Plan that is subject to the provisions of Title IV
of ERISA).

     "Percentage" shall mean, with respect to any Lender at any time, such
Lender's Revolving Credit/Term Percentage at such time.

     "Permitted Acquisition" shall mean an Acquisition with respect to which the
following conditions are satisfied:

     (i)   The Person, or division or business thereof, being acquired engages
           chiefly in the business of providing kidney dialysis services and
           ancillary services relating to the needs of patients with end stage
           renal disease, including, without limitation, laboratories
           predominately performing dialysis related functions;

     (ii)  To the extent that any Subsidiaries are created or acquired in
           connection with the Acquisition, the Borrower and each such
           Subsidiary shall have complied with the provisions of SECTION 5.13;

     (iii) The Borrower and each Subsidiary shall have executed and delivered
           such other Loan Documents as the Agent or the Required Lenders shall
           have reasonably requested; and

     (iv)  Any borrowing in connection with a Permitted Acquisition must be in
           compliance with SECTION 2.2(A)(I)-(VI) hereof.

     (v)   Immediately prior to and after giving effect to the Acquisition, no
           Default or Event of Default shall have occurred and be continuing.

     "Permitted Liens" shall mean any of the following liens, restrictions or
encumbrances securing any liability or indebtedness of the Borrower or any
Subsidiary on, or otherwise affecting, any of the Borrower's or such
Subsidiary's property, real or personal, whether now owned or hereafter
acquired; provided that, in addition to and notwithstanding the other
restrictions set forth in this definition, any lien or other restriction
described in this definition (other than liens described in clause (A) or (B))
shall 
<PAGE>
 
be a Permitted Lien only if the sum of (i) the principal amount of Debt of
the Borrower and its Subsidiaries secured by such lien or restriction, (ii) the
aggregate principal amount of all Debt of the Borrower and its Subsidiaries
secured by all other liens or restrictions described in this definition (other
than liens or restrictions described in clause (A) or (B)), and (iii) the
aggregate amount of all other Debt of the Borrower and its Subsidiaries
permitted hereunder only by SECTION 6.2(VI), does not exceed $4,000,000.

     (a)   Liens granted to the Agent, for the benefit of the Lenders;

     (b)   Liens imposed by mandatory provisions of law of carriers,
warehousemen, mechanics, repairmen and materialmen and other like liens required
by provisions of law and incurred in the ordinary course of business for sums
not yet due and payable (or with respect to any obligation not greater than
$200,000, not more than sixty (60) days past the date of service) or that are
being contested in good faith and with due diligence by appropriate proceedings;

     (c)   Liens incurred in the ordinary course of business in connection with
worker's compensation, unemployment insurance or other forms of governmental
insurance or benefits, or liens arising from good faith deposits in connection
with letters of credit, bids, tenders, statutory obligations, leases and
contracts (other than for borrowed money) entered into in the ordinary course of
business, or to secure obligations on surety or appeal bonds provided that all
such liens in the aggregate have no Material Adverse Effect;

     (d)   Liens for current taxes, assessments or other governmental charges
that are not delinquent or remain payable without any penalty or that are being
contested in good faith and with due diligence by appropriate proceedings,
provided that all such liens in the aggregate have no Material Adverse Effect
and, if reasonably requested by the Agent, the Borrower or such Subsidiary has
established reserves reasonably satisfactory to the Agent with respect thereto;

     (e)   Liens upon property leased under a Capital Lease and placed upon such
property at the time of, or within ten (10) days after, the commencement of the
lease thereof to secure the lease payments under such Capital Lease, provided
that any such lien (i) shall not encumber any other property of the Borrower or
any Subsidiary, (ii) shall not exceed the total of such lease payments and (iii)
shall not be pursuant to a lease that is for a term of less than thirty-six (36)
months;

     (f)   Liens set forth on SCHEDULE 1.1(A) attached hereto, provided that
such liens are not renewed, extended or increased;
<PAGE>
 
     (g)   Purchase money liens incurred in the purchase of equipment permitted
under SECTION 6.9 hereof, provided that any such lien (i) attaches to such asset
concurrently with or within ten (10) days after the acquisition thereof, (ii)
shall not encumber any other property of the Borrower or any Subsidiary and
(iii) shall not exceed the purchase price of such asset;

     (h)   Assignment Restrictions;

     (i)   Easements, rights of way, zoning restrictions and other similar
encumbrances on real estate that do not materially impair the value of the
property to which they relate; and

     (j)   Any other liens or encumbrances as the Required Lenders may approve
in writing from time to time.

     "Person" shall mean a corporation, an association, a joint venture, a
partnership, an organization, a business, an individual, a trust or a government
or political subdivision thereof or any government agency or any other legal
entity.

     "Pledge Agreement" shall mean the Third Amended and Restated Pledge
Agreement, dated as of the date hereof, between the Borrower and the Agent, as
amended, whereby the Borrower has pledged all of the Stock of its Subsidiaries
and the Intercompany Loan Documents to the Agent as Collateral for the
Obligations, together with any amendments, modifications and supplements
thereto, any replacements, renewals, extensions and restatements thereof, and
any substitutes therefor, in whole or in part.

     "Prime Rate" shall mean the per annum interest rate publicly announced from
time to time by First Union from its principal office in Charlotte, North
Carolina, to be its Prime Rate, which may not necessarily be its best lending
rate, as adjusted to conform to changes as of the opening of business on the
date of any such change in the Prime Rate.  In the event First Union shall
abolish or abandon the practice of announcing its Prime Rate or should the same
be unascertainable, the Agent shall designate a comparable reference rate that,
upon the Borrower's consent (which shall not be unreasonably withheld), shall be
deemed to be the Prime Rate under this Loan Agreement and the other Loan
Documents.

     "Prohibited Transaction" shall mean any transaction described in (i)
Section 406 of ERISA that is not exempt by reason of Section 408 of ERISA or
(ii) Section 4975(c) of the Internal Revenue Code that is not exempt by reason
of Section 4975(c) or 4975(d).

     "Projections" shall mean the financial projections delivered to the Agent
by the Borrower pursuant to SECTION 4.19 hereof.
<PAGE>
 
     "Pro Rata Share" of any amount shall mean, with respect to any Lender at
any time, the product of (i) such amount, multiplied by (ii) such Lender's
                                          ---------- --                   
Percentage at such time under the Facility or Facilities under which such amount
is being paid or advanced or to which such amount relates.

     "RTC Holdings" shall mean RTC Holdings, Inc., a Delaware corporation, and
its successors and assigns.

     "RTC Holdings International" shall mean RTC Holdings International, Inc., a
Delaware corporation, and its successors and assigns.

     "RTC Supply" shall mean RTC Supply, Inc., a Delaware corporation, and its
successors and assigns.

     "RTC TN" shall mean RTC TN, Inc., a Delaware corporation and its succesors 
and assigns.

     "Regulation G" shall mean Regulation G of the Board of Governors of the
Federal Reserve System, 12 C.F.R. Part 207, or any successor or other regulation
hereafter promulgated by said Board to replace the prior Regulation G and having
substantially the same function.

     "Regulation U" shall mean Regulation U promulgated by the Board of
Governors of the Federal Reserve System, 12 C.F.R. Part 221, or any successor or
other regulation hereafter promulgated by said Board to replace the prior
Regulation U and having substantially the same function.

     "Regulation X" shall mean Regulation X promulgated by the Board of
Governors of the Federal Reserve System, 12 C.F.R. Part 224, or any successor or
other regulation hereafter promulgated by said Board to replace the prior
Regulation X and having substantially the same function.

     "Reimbursement Obligation" shall have the meaning assigned to such term in
SECTION 2.17(D).

     "Renal-California" shall mean Renal Treatment Centers - California, Inc., a
Delaware corporation, and its successors and assigns.

     "Renal-Hawaii" shall mean Renal Treatment Centers - Hawaii, Inc., a
Delaware corporation, and its successors and assigns.

     "Renal-Illinois" shall mean Renal Treatment Centers - Illinois, Inc., a
Delaware corporation, and its successors and assigns.

     "Renal-Lab" shall mean Renal Treatment Centers-Lab, Inc., a Delaware 
corporation, and its successors or assigns.

<PAGE>

     "Renal-Management Acquisition" shall mean Renal Treatment Centers - 
Management Acquisition, Inc., a Delaware corporation, and its successors and 
assigns.
 
     "Renal-Mid-Atlantic" shall mean Renal Treatment Centers - Mid-Atlantic,
Inc., a Delaware corporation, and its successors and assigns.

     "Renal-Northeast" shall mean Renal Treatment Centers - Northeast, Inc., a
Delaware corporation, and its successors and assigns.

     "Renal-Southeast" shall mean Renal Treatment Centers - Southeast, Inc., a
Delaware corporation, and its successors and assigns.

     "Renal-West" shall mean Renal Treatment Centers - West, Inc., a Delaware
corporation, and its successors and assigns.

     "Reportable Event" shall mean a reportable event as defined in Section
4043(b) of ERISA (other than an event for which notice is waived under the ERISA
regulations).

     "Required Lenders" shall mean, at any time, the Lenders owning or holding
66-2/3% or more of the sum of (i) the then aggregate principal amount of the
Loans then outstanding plus (ii) the aggregate Stated Amount of all Letters of
                       ----                                                   
Credit then outstanding; or, if no Loans or Letters of Credit are then
outstanding, the Lenders with 66-2/3% or more of the aggregate of all
Commitments at such time.  For purposes of this definition, the Stated Amount of
each outstanding Letter of Credit shall be considered to be owed to the Lenders
according to their respective Revolving Credit/Term Percentages.

     "Requirement of Law" means, as to any Person, the charter, articles or
certificate of incorporation and bylaws or other organizational or governing
documents of such Person, and any statute, law, treaty, rule, regulation, order,
decree, writ, injunction or determination of any arbitrator or a court or other
Governmental Authority, in each case applicable to or binding upon such Person
or any of its property or to which such Person or any of its property is
subject.

     "Reserve Requirement" shall mean, with respect to any Interest Period, the
reserve percentage (expressed as a decimal) applicable two (2) Business Days
before the first day of such Interest Period determined by the Agent to be in
effect on such day, as provided by the Board of Governors of the Federal Reserve
System (or any successor governmental body), applied for determining the maximum
reserve requirements (including, without limitation, basic, supplemental,
marginal and emergency reserves) applicable to the Lenders under Regulation D
with respect to "Eurocurrency liabilities" within the meaning of Regulation D,
or under any 
<PAGE>
 
similar or successor regulation with respect to Eurocurrency liabilities or
Eurocurrency funding.

     "Revolving Credit/Term Commitment" shall mean, with respect to any Lender
at any time, the amount set forth under such Lender's name on its signature page
hereto under the caption "Revolving Credit/Term Commitment" or, if such Lender
has entered into one or more Assignment and Acceptances, the amount set forth
for such Lender at such time in the Register maintained by the Agent pursuant to
SECTION 10.5(C) as such Lender's "Revolving Credit/Term Commitment," as such
amount may be reduced at or prior to such time pursuant to the terms hereof.

     "Revolving Credit/Term Facility" shall mean the revolving line of credit
established by the Lenders under SECTION 2.1(A).

     "Revolving Credit/Term Facility Conversion Date" shall mean March 31, 2000.

     "Revolving Credit/Term Facility Maturity Date" shall mean March 31, 2004.

     "Revolving Credit/Term Facility Termination Date" shall mean the Revolving
Credit/Term Facility Conversion Date, or such earlier date of termination of the
Total Revolving Credit/Term Commitment in accordance with SECTION 2.4(A) or
SECTION 8.1.

     "Revolving Credit/Term Loans" shall have the meaning assigned to such term
in SECTION 2.1(A).

     "Revolving Credit/Term Notes" shall mean the promissory notes of the
Borrower in substantially the form of EXHIBIT A, executed and delivered to the
Lenders with Revolving Credit/Term Commitments pursuant to SECTION 2.3(A) or, in
connection with an Assignment and Acceptance, pursuant to SECTION 10.5(D),
together with any amendments, modifications and supplements thereto and
restatements thereof, in whole or in part.

     "Revolving Credit/Term Percentage" shall mean, with respect to any Lender
at any time, a fraction (expressed as a percentage) the numerator of which is
the Revolving Credit/Term Commitment of such Lender at such time and the
denominator of which is the Total Revolving Credit/Term Commitment at such time;
provided that if the Revolving Credit/Term Percentage of any Lender is to be
determined after the Revolving Credit/Term Commitments have been terminated,
then such Revolving Credit/Term Percentage shall be determined immediately prior
(and without giving effect) to such termination.

     "Solvent" shall mean, as to any Person on any particular date, that such
Person (i) has capital sufficient to carry on its business and transactions and
all business and transactions in which it is about to engage, (ii) is able to
pay its debts as they 
<PAGE>
 
mature, (iii) owns property having a fair saleable value greater than the amount
required to pay its probable liability on existing debts as they mature
(including known reasonable contingencies and contingencies that should be
included in notes of the Financial Statements pursuant to Generally Accepted
Accounting Principles), and (iv) does not intend to, and does not believe that
it will, incur debts or probable liabilities beyond its ability to pay such
debts or liabilities as they mature.

     "Stated Amount" shall mean, with respect to any Letter of Credit at any
time, the maximum amount available to be drawn thereunder at such time
(regardless of whether any conditions for drawing could then be met).

     "Stock" shall mean all shares, options, interests or other equivalents
(howsoever designated) of or in a corporation, whether voting or non-voting,
including, without limitation, common stock, warrants, preferred stock,
convertible debentures and all agreements, instruments and documents
convertible, in whole or in part, into any one or more or all of the foregoing.
For purposes of this Agreement, prior to conversion, the Convertible Notes shall
not constitute stock.

     "Subordinated Debt" shall mean (i) the Convertible Notes and (ii) any Debt
of the Borrower or any Subsidiary to the extent such Debt is expressly
subordinated and made junior to the payment and performance of the Obligations
and evidenced as such by a written instrument the terms and conditions
(including, without limitation, subordination provisions) of which are
satisfactory in form and substance to the Required Lenders in their sole
discretion and are approved in writing by the Agent.

     "Subsidiary" shall mean any corporation or other entity of which more than
fifty percent (50%) of the outstanding Stock having ordinary voting power to
elect a majority of the board of directors is at the time, directly or
indirectly, owned by any Person or one or more of its Subsidiaries (irrespective
of whether, at the time, Stock of any other class or classes of such corporation
shall have or might have voting power by reason of the happening of any
contingency).  When used without reference to a parent corporation, the term
"Subsidiary" shall be deemed to refer to a Subsidiary of the Borrower.

     "Subsidiary Pledge Agreement" shall mean the Second Amended and Restated
Subsidiary Pledge Agreement, dated as of the date hereof, between each Guarantor
and the Agent, which each Guarantor has pledged all of the Stock of its
Subsidiaries and its Intercompany Loan Documents, to the Agent as Collateral,
together with any amendment, modifications and supplements thereto, any
replacements, renewals, extensions and restatements thereof, and any substitutes
therefor, in whole or in part.
<PAGE>
 
     "Target" shall have the meaning assigned to such term in Section
5.15(c)(i).

     "Taxes" shall have the meaning assigned to such term in Section 2.12(a).

     "Total Commitment" shall mean, at any time, the sum of all Commitments at
such time.

     "Total Revolving Credit/Term Commitment" shall mean, at any time, the sum
of the Revolving Credit/Term Commitment of each Lender at such time.

     "Total Unutilized Revolving Credit/Term Commitment" shall mean, at any
time, the sum of the Unutilized Revolving Credit/Term Commitments of each Lender
at such time.

     "Type" shall have the meaning assigned to such term in Section 2.1(b).

     "Uniform Commercial Code" shall mean the Uniform Commercial Code of the
State of North Carolina, as amended from time to time, unless in any particular
instance the Uniform Commercial Code of another state is applicable, in which
case it shall mean the Uniform Commercial Code of such state.

     "Unutilized Revolving Credit/Term Commitment" shall mean, with respect to
any Lender at any time, such Lender's Revolving Credit/Term Commitment at such
time less the sum of (i) the aggregate principal amount of all Revolving
     ----                                                               
Credit/Term Loans made by such Lender that are outstanding at such time and (ii)
such Lender's Pro Rata Share of all Letter of Credit Outstandings at such time.

     1.2   Accounting Terms. Any accounting terms used in this Agreement that
are not specifically defined shall have the meanings customarily given them in
accordance with Generally Accepted Accounting Principles; provided, however,
that, in the event that changes in Generally Accepted Accounting Principles
shall be mandated by the Financial Accounting Standards Board, or any similar
accounting body of comparable standing, or shall be recommended by the
Borrower's certified public accountants, to the extent that such changes would
modify or could modify such accounting terms or the interpretation or
computation thereof, such changes shall be followed in defining such accounting
terms only from and after the date this Agreement shall have been amended in
accordance with the terms of this Agreement to the extent necessary to reflect
any such changes in the financial covenants and other terms and conditions of
this Agreement.
<PAGE>
 
     1.3  Singular/Plural. Unless the context otherwise requires, words in the
singular include the plural and words in the plural include the singular.

     1.4  Other Terms. All other terms contained in this Agreement shall, when
the context so indicates, have the meanings provided for by the Uniform
Commercial Code of the State of North Carolina to the extent the same are used
or defined therein.


                                  ARTICLE II

                         AMOUNT AND TERMS OF THE LOANS;
                               LETTERS OF CREDIT

     2.1  The Loans.

     (a)  Each Lender having a Revolving Credit/Term Commitment severally
agrees, subject to and on the terms and conditions of this Agreement, to make
Loans (each, a "Revolving Credit/Term Loan" and collectively, the "Revolving
Credit/Term Loans") to the Borrower, from time to time on any Business Day
during the period from the date hereof to the Revolving Credit/Term Facility
Termination Date, provided that (i) the aggregate principal amount of Revolving
Credit/Term Loans at any time outstanding for any Lender shall not exceed the
difference between (A) such Lender's Revolving Credit/Term Commitment at such
time less (B) such Lender's Pro Rata Share (calculated based on its Revolving
     ----                                             
Credit/Term Percentage) of the aggregate Letter of Credit Outstandings at such
time (exclusive of Reimbursement Obligations that are repaid with the proceeds
of, and simultaneously with the incurrence of, Revolving Credit/Term Loans) and
(ii) no Borrowing of Revolving Credit/Term Loans shall be permitted if,
immediately before or after giving effect thereto, a Default or Event of Default
exists. Subject to and on the terms and conditions of this Agreement, the
Borrower may borrow, repay and reborrow Revolving Credit/Term Loans.

     (b)  The Loans shall, at the option of the Borrower and subject to the
terms and conditions of this Agreement, be either Base Rate Loans or LIBOR Loans
(each such type of Loan, a "Type"), provided that all Loans comprising the same
Borrowing shall, unless otherwise specifically provided herein, be of the same
Type.

     2.2  Borrowings.

     (a)  Whenever the Borrower desires to make a Borrowing (other than
continuations or conversions of outstanding Loans pursuant to Section 2.9) under
the Revolving Credit/Term Facility, the Borrower will give the Agent written
notice (by telecopier or otherwise), prior to 11:00 a.m., Charlotte time, at
least three (3) Business Days prior to each Borrowing to be comprised of LIBOR
Loans and at least one (1) Business Day prior to each Borrowing to be comprised
<PAGE>
 
of Base Rate Loans. Each such notice (each, a "Notice of Borrowing") shall be
irrevocable, shall be given in the form of Exhibit B-1 and shall be
appropriately completed to specify (i) the aggregate principal amount and Type
of the Loans to be made pursuant to such Borrowing (and, in the case of a
Borrowing of LIBOR Loans, the initial Interest Period to be applicable thereto)
and (ii) the requested date of the Borrowing (the "Borrowing Date"), which shall
be a Business Day. Notwithstanding anything to the contrary contained herein:

     (i)  the aggregate principal amount of each Borrowing hereunder (y) in
          the case of Borrowings comprised of Base Rate Loans, shall not be
          less than $500,000 and, if greater, shall be in an integral
          multiple of $100,000 in excess thereof, and (z) in the case of
          Borrowings comprised of LIBOR Loans, shall not be less than
          $3,000,000 and, if greater, shall be in an integral multiple of
          $1,000,000 in excess thereof;
          
    (ii)  the aggregate principal amount of all Borrowings under the
          Revolving Credit/Term Facility, the proceeds of which are utilized
          to finance any single Permitted Acquisition, in part or in whole,
          shall not be more than $20,000,000, without the prior written
          consent of the Required Lenders;
          
   (iii)  no Revolving Credit/Term Loans may be incurred to the extent that,
          immediately after giving effect thereto, the aggregate original
          principal amount of all Revolving Credit/Term Loans the proceeds of
          which were utilized to finance Permitted Acquisitions during any
          single fiscal year, in part or in whole, shall exceed $75,000,000,
          without the prior written consent of the Required Lenders;
          
    (iv)  if the Borrower shall have failed to designate the Type of Loans
          comprising a Borrowing, the Borrower shall be deemed to have
          requested a Borrowing comprised of Base Rate Loans;
          
     (v)  if the Borrower shall have failed to select the duration of the
          Interest Period to be applicable to any Borrowing of LIBOR Loans,
          then the Borrower shall be deemed to have selected an Interest
          Period with a duration of one (1) month; and
          
    (vi)  LIBOR Loans under the Revolving Credit/Term Facility may not be
          outstanding under more than five (5) separate Interest Periods at
          any one time.

     (b)  Upon the receipt of a Notice of Borrowing, the Agent will promptly
notify each Lender with a Revolving Credit/Term Commitment of the proposed
Borrowing, of such Lender's Pro Rata 
<PAGE>
 
Share thereof and of the other matters specified in the Notice of Borrowing.
Each such Lender will make the amount of its Pro Rata Share of such Borrowing
available to the Agent at its office referred to in SECTION 10.4, for the
account of the Borrower, in Dollars and in immediately available funds, prior to
12:00 noon, Charlotte time, on the Borrowing Date. To the extent the relevant
Lenders have made such amounts available to the Agent as provided hereinabove,
the Agent will make the aggregate of such amounts available to the Borrower's
account at the Agent's office and in like funds as received by the Agent, prior
to 3:30 p.m., Charlotte time, on the Borrowing Date.

     (c)  Unless the Agent has received, prior to 12:00 noon, Charlotte time, on
any Borrowing Date, written notice from a Lender that such Lender will not make
available to the Agent its Pro Rata Share of the relevant Borrowing, the Agent
may assume that such Lender has made its Pro Rata Share of such Borrowing
available to the Agent on such Borrowing Date in accordance with subsection (B)
above, and the Agent may, in reliance upon such assumption, make a corresponding
amount available to the Borrower on such Borrowing Date. If and to the extent
that such Lender shall not have made such Pro Rata Share available to the Agent,
and the Agent shall have made such corresponding amount available to the
Borrower, such Lender, on the one hand, and the Borrower, on the other,
severally agree to pay to the Agent forthwith on demand such corresponding
amount, together with interest thereon for each day from the date such amount is
made available to the Borrower until the date such amount is repaid to the
Agent, (i) if recovered from such Lender, at the Federal Funds Rate, and (ii) if
recovered from the Borrower, at the rate of interest applicable to Loans
comprising such Borrowing, as determined under SECTION 2.6. If such Lender shall
repay to the Agent such corresponding amount, such amount so repaid shall
constitute such Lender's Loan as part of such Borrowing for purposes of this
Agreement.

     (d)  The failure of any Lender to make any Loan required to be made by it
as part of any Borrowing shall not relieve any other Lender of its obligation
hereunder to make its Loan on the respective Borrowing Date or relieve any
Lender (including the Lender that failed to make such amount available) of its
obligation, if any, hereunder to make its Pro Rata Share of any subsequent
Borrowing available, but no Lender shall be responsible for the failure of any
other Lender to make the Loan to be made by such other Lender as part of any
Borrowing.

     2.3  Revolving Credit/Term Notes.

     (a)  The Revolving Credit/Term Loans made by each Lender shall be evidenced
by a Revolving Credit/Term Note appropriately completed in substantially the
form of EXHIBIT A.
<PAGE>
 
     (b)  The Revolving Credit/Term Note issued to each Lender with a Revolving
Credit/Term Commitment shall (i) be executed by the Borrower, (ii) be payable to
the order of such Lender, (iii) be dated as of the Closing Date (or, in the case
of Revolving Credit/Term Notes issued pursuant to an Assignment and Acceptance,
as of the date thereof), (iv) be in a stated principal amount equal to such
Lender's Revolving Credit/Term Commitment, (v) bear interest in accordance with
the provisions of Section 2.6, as the same may be applicable to the Revolving
Credit/Term Loans made by such Lender from time to time, and (vi) be entitled to
all of the benefits of this Agreement and the other Loan Documents and subject
to the provisions hereof and thereof. The Revolving Credit/Term Notes are an
amendment, restatement and renewal of a series of Third Amended and Restated
Renewal Revolving Credit/Term Promissory Notes, dated June 5, 1996, in the
original aggregate principal amount of up to $100,000,000, each executed and
delivered by the Borrower to the Lenders to evidence the loans made under the
Revolving Credit/Term Facility, pursuant to the Fourth Amended and Restated Loan
Agreement. Upon execution and delivery of the Revolving Credit/Term Notes, the
notes amended, restated and renewed thereby will be marked: "Renewed and
reevidenced by a series of promissory notes dated May 2, 1997, which are
substituted herefor in entirety."

     (c)  Each Lender will record on its internal records the amount of each
Loan made by it and each payment received by it in respect thereof and will, in
the event of any transfer of any of its Revolving Credit/Term Notes, either
endorse on the reverse side thereof the outstanding principal amount of the
Loans evidenced thereby as of the date of transfer or provide such information
on Annex I to the Assignment and Acceptance relating to such transfer; provided,
however, that the failure of any Lender to make any such recordation or provide
any such information, or any error in such recordation or information, shall not
affect the Borrower's obligations in respect of such Loans.

     2.4  Reduction of Commitments.

     (a)  At any time and from time to time, upon at least five (5) Business
Days' prior written notice to the Agent, the Borrower may terminate in whole or
reduce in part the Total Unutilized Revolving Credit/Term Commitment, provided
that any such partial reduction shall be in an aggregate amount of not less than
$1,000,000 or integral multiples thereof. The amount of any termination or
reduction made under this subsection (a) may not thereafter be reinstated.

     (b)  Each reduction of the Revolving Credit/Term Commitment under this
Section shall be applied ratably to the Revolving Credit/Term Commitments of the
Lenders according to their respective Percentages under the Revolving
Credit/Term Facility. 
<PAGE>
 
After any such reduction, the fee provided for in Sections 2.7(a) shall be
calculated with respect to the reduced Commitments.

     2.5  Payments; Voluntary, Mandatory.

     (a)  The Borrower shall have the right from time to time to prepay the
Loans, in whole or in part, upon written notice to the Agent prior to 11:00
a.m., Charlotte time, at least three (3) Business Days' prior to each intended
prepayment of LIBOR Loans and at least one (1) Business Day prior to each
intended prepayment of Base Rate Loans, provided that (i) each partial
prepayment shall be in an aggregate principal amount of no less than $500,000 or
an integral multiple thereof, (ii) no partial prepayment of LIBOR Loans made
pursuant to any single Borrowing shall reduce the outstanding principal amount
of the remaining LIBOR Loans under such Borrowing to less than $3,000,000 and,
if greater, in an integral multiple of $1,000,000 in excess thereof and (iii)
unless made together with all amounts required under Section 2.13 to be paid as
a consequence of such prepayment, a prepayment of a LIBOR Loan may be made only
on the last day of the Interest Period applicable thereto. Each such notice
shall specify (x) the proposed date of such prepayment and (y) the aggregate
principal amount and the Types of the Loans to be prepaid (and, in the case of
LIBOR Loans, the specific Borrowing or Borrowings pursuant to which made) and
shall be irrevocable and shall bind the Borrower to make such prepayment on the
terms specified therein. Amounts prepaid under the Revolving Credit/Term
Facility pursuant to this subsection (a) may be reborrowed, subject to the terms
and conditions of this Agreement.

     (b)  In the event that the sum of (i) the aggregate principal amount of the
Revolving Credit/Term Loans outstanding on any date plus (ii) the aggregate
                                                    ----                   
Letter of Credit Outstandings as of such date exceeds the Total Revolving
Credit/Term Commitment as of such date (after giving effect to any termination
or reduction thereof as of such date), the Borrower will repay the principal
amount of the Revolving Credit/Term Loans on such date in the amount of such
excess; provided that, (A) such payment shall be accompanied by all amounts
required under Section 2.13 if applied to a LIBOR Loan and such payment is not
made on the last day of the Interest Period applicable thereto, and (B) to the
extent such excess amount required to be repaid is greater than the aggregate
principal amount of the Revolving Credit/Term Loans outstanding immediately
prior to the application of such repayment, the amount so repaid shall be
retained by the Agent and held in the Cash Collateral Account as security for
the Borrower's Reimbursement Obligations, as more particularly described in
Section 2.17(i).

     (c)  The Borrower shall repay the Revolving Credit/Term Notes in full on
the Revolving Credit/Term Facility Termination Date; provided, however, that if 
no Default or Event of Default shall have occurred and be continuing and the
Revolving Credit/Term Facility
<PAGE>
 
Termination Date occurs on, and solely because of, the occurrence of the
Revolving Credit/Term Facility Conversion Date, the aggregate outstanding
principal balance of the Revolving Credit/Term Loans on the Revolving
Credit/Term Facility Conversion Date will be converted to a term loan and shall
be due and payable and repaid by the Borrower in sixteen (16) equal quarterly
installments, on March 31, June 30, September 30 and December 31 in each year,
commencing on June 30, 2000 through and including the Revolving Credit/Term
Facility Maturity Date. Prepayments of such term loan shall be applied to 
installments of the Loans in inverse order of maturity.

     2.6  Interest.

     (a)  The Borrower will pay interest in respect of the unpaid principal
amount of each Loan, from the date of Borrowing thereof until such principal
amount shall be paid in full, (i) at the Adjusted Base Rate, as in effect from
time to time during such periods as such Loan is a Base Rate Loan, and (ii) at
the Adjusted LIBOR Rate, as in effect from time to time during such periods as
such Loan is a LIBOR Loan.

     (b)  Any principal amounts of the Loans not paid when due and, to the
greatest extent permitted by law, all interest accrued on the Loans and all
other fees and amounts hereunder not paid when due (whether at maturity,
pursuant to acceleration or otherwise), shall bear interest at a rate per annum
equal to the interest rate then applicable to such Loans (whether the Adjusted
Base Rate or the Adjusted LIBOR Rate) plus two percentage points (2.0%), and
such default interest shall be payable on demand. Further, but without
duplication of the foregoing, during the existence of any Event of Default in
response to which the Lenders do not elect to declare the outstanding principal
amounts of the Revolving Credit/Term Loans immediately due and payable, if
required by the Required Lenders, the Borrower will pay interest on the dates
provided pursuant to subsection (c), below, in respect of the unpaid principal
amount of each Revolving Credit/Term Loan, from the date the Event of Default
first exists until it is cured, at a rate per annum equal to the Adjusted Base
Rate plus two percentage points (2.0%). To the greatest extent permitted by law,
interest shall continue to accrue after the filing by or against the Borrower of
any petition seeking any relief in bankruptcy or under any act or law pertaining
to insolvency or debtor relief, whether state, federal or foreign.

     (c)  Accrued (and theretofore unpaid) interest shall be payable (i) in
respect of each Base Rate Loan, in arrears on the last Business Day of each
fiscal quarter, beginning with the last Business Day of the fiscal quarter
ending June 30, 1997 and (ii) in respect of each LIBOR Loan, in arrears on the
last Business Day of the Interest Period applicable thereto (subject to the
provisions of clause (iv) in Section 2.8) and for any Interest Period longer
<PAGE>
 
than three (3) months, interest shall also be payable on the first Business Day
occurring three (3) months after the first day of such Interest Period and (iii)
in respect of any Loan, on the date of any repayment or prepayment in full, at
maturity (whether pursuant to acceleration or otherwise) and, after maturity, on
demand.

     (d)  Nothing contained in this Agreement or in any other Loan Document
shall be deemed to establish or require the payment of interest to any Lender at
a rate in excess of the maximum rate permitted by applicable law. If the amount
of interest payable for the account of any Lender on any interest payment date
would exceed the maximum amount permitted by applicable law to be charged by
such Lender, the amount of interest payable for its account on such interest
payment date shall be automatically reduced to such maximum permissible amount.
In the event of any such reduction affecting any Lender, if from time to time
thereafter the amount of interest payable for the account of such Lender on any
interest payment date would be less than the maximum amount permitted by
applicable law to be charged by such Lender, then the amount of interest payable
for its account on such subsequent interest payment date shall be automatically
increased to such maximum permissible amount, provided that at no time shall the
aggregate amount by which interest paid for the account of any Lender has been
increased pursuant to this sentence exceed the aggregate amount by which
interest paid for its account has theretofore been reduced pursuant to the
previous sentence.

     (e)  The Agent shall promptly notify the Borrower and the Lenders upon
determining the interest rate for each Borrowing after its receipt of the
relevant Notice of Borrowing or Notice of Conversion/Continuation; provided,
however, that the failure of the Agent to provide the Borrower or the Lenders
with any such notice shall neither affect any obligations of the Borrower or the
Lenders hereunder nor result in any liability on the part of the Agent to the
Borrower or any Lender. Each such determination (including each determination of
the Reserve Requirement in connection with a Borrowing of LIBOR Loans) shall,
absent manifest error, be final and conclusive and binding on all parties
hereto.

     2.7  Fees.  The Borrower agrees to pay:

     (a)  To the Agent, for the account of each Lender with a Revolving
Credit/Term Commitment, a commitment fee per annum for the period from the
Closing Date to the Revolving Credit/Term Facility Termination Date, at the
applicable percentage per annum determined under the following matrix and
applied to the average daily Unutilized Revolving Credit/Term Commitment of such
Lender, payable in arrears (i) on the last Business Day of each fiscal quarter,
beginning with the last Business Day of the fiscal quarter ending June 30, 1997,
and (ii) on the Revolving Credit/Term Facility Termination Date:
<PAGE>
 
<TABLE> 
<CAPTION> 

            Ratio of Consolidated Debt                    
             to Annualized Cash Flow                      Commitment Fee
         (including Foreign Subsidiaries)                   Percentage   
         --------------------------------                 --------------
           <S>                                             <C> 
             Greater than or equal to
               3.0 to 1.0                                     0.25%
                                                   
             Greater than or equal to              
               2.0 to 1.0                          
               but less than 3.0 to 1.0                       0.225%
                                                   
             Less than 2.0 to 1.0                             0.20%
</TABLE> 

     (b)  To the Agent, for the account of each Lender with a Revolving
Credit/Term Commitment, a letter of credit fee in respect of each Letter of
Credit for the period from the date of its issuance to the date of its
termination, at a rate per annum equal to the Applicable Margin for LIBOR Loans
in effect from time to time during such period on the daily average Stated
Amount thereof, payable in arrears (i) on the last Business Day of each fiscal
quarter, beginning with the last Business Day of the fiscal quarter ending June
30, 1997, and (ii) on the later of the Revolving Credit/Term Facility
Termination Date or the date of termination of the last outstanding Letter of
Credit;

     (c)  To the Issuing Bank, for its own account, a facing fee in respect of
each Letter of Credit for the period from the date of its issuance to the date
of its termination, at the rate of 0.125% per annum on the daily average Stated
Amount thereof, payable in arrears (i) on the last Business Day of each fiscal
quarter, beginning with the last Business Day of the fiscal quarter ending June
30, 1997, and (ii) on the later of the Revolving Credit/Term Facility
Termination Date and the date of termination of the last outstanding Letter of
Credit;

     (d)  To the Issuing Bank, for its own account, such commissions, issuance
fees, transfer fees and other fees and charges incurred in connection with the
issuance and administration of each Letter of Credit as are customarily charged
from time to time by the Issuing Bank for the performance of such services in
connection with similar letters of credit, or as may be otherwise agreed to by
the Issuing Bank, but without duplication of amounts payable under subsection
(C) above; and

     (e)  To the Agent, for its own account, the annual agency fee in the amount
and at the times provided in the Fee Letter, such fee to accrue from the Closing
Date to the date upon which all of the Obligations have been indefeasibly paid
in full and the Commitments have been terminated.

     2.8  Interest Periods.  Concurrently with the giving of any Notice
of Borrowing or Notice of Conversion/Continuation in respect of any Borrowing
comprised of LIBOR Loans, the Borrower shall have the 
<PAGE>
 
right to elect, pursuant to such notice, the interest period (each, an "Interest
Period") to be applicable to such LIBOR Loans, which Interest Period shall, at
the option of the Borrower, be a one, two, three or six-month period (subject to
availability); provided, however, that:

     (i)  all LIBOR Loans comprising a single Borrowing shall at all times have
          the same Interest Period;
          
    (ii)  the initial Interest Period for any LIBOR Loan shall commence on the
          date of the Borrowing of such Loan (including the date of any
          continuation of, or conversion into, such LIBOR Loan), and each
          successive Interest Period applicable to such LIBOR Loan shall
          commence on the day on which the next preceding Interest Period
          applicable thereto expires;
          
   (iii)  the Borrower may not select any Interest Period that expires after
          the Revolving Credit/Term Facility Maturity Date, with respect to
          Revolving Credit/Term Loans that are to be maintained as LIBOR Loans;
          
    (iv)  if any Interest Period otherwise would expire on a day that is not a
          Business Day, such Interest Period shall expire on the next succeeding
          Business Day unless such next succeeding Business Day falls in another
          calendar month, in which case such Interest Period shall expire on the
          next preceding Business Day;
          
     (v)  if any Interest Period begins on a day for which there is no
          numerically corresponding day in the calendar month during which such
          Interest Period would otherwise expire, such Interest Period shall
          expire on the last Business Day of such calendar month; and
          
    (vi)  if, upon the expiration of any Interest Period applicable to a
          Borrowing of LIBOR Loans, the Borrower shall have failed to elect a
          new Interest Period to be applicable to such LIBOR Loans, then the
          Borrower shall be deemed to have elected to convert such LIBOR Loans
          into Base Rate Loans as of the expiration of the then current
          Interest Period applicable thereto.

     2.9  Conversions and Continuations.

     (a)  The Borrower shall have the right, on any Business Day, to elect (y)
to convert all (or a portion in an amount not less than (A) in the case of Base
Rate Loans, $500,000 or, if greater, an integral multiple of $100,000 in excess
thereof and (B) in the case of LIBOR Loans, $3,000,000 or, if greater, an
integral multiple of $1,000,000 in excess thereof) of the outstanding principal
amount of any Loans of one Type made pursuant to one or 

<PAGE>
 
more Borrowings under any Facility (and, in the case of LIBOR Loans, having the
same Interest Period) into a Borrowing or Borrowings of Loans (under the same
Facility) of the other Type, or (z) to continue all (or a portion, subject to
the restrictions as to amount set forth in clause (B) of the parenthetical in
clause (y) above) of the outstanding principal amount of any LIBOR Loans made
pursuant to one or more Borrowings under any Facility (and having the same
Interest Period) for an additional Interest Period, provided that (i) except as
otherwise provided for in Section 2.11(d), LIBOR Loans may be converted into
Base Rate Loans only on the last day of the Interest Period applicable thereto
(and, in any event, if a LIBOR Loan is converted into a Base Rate Loan on any
day other than the last day of the Interest Period applicable thereto, the
Borrower will pay, upon such conversion, all amounts required under Section 2.13
to be paid as a consequence thereof), (ii) if any partial conversion of LIBOR
Loans into Base Rate Loans shall have reduced the outstanding principal amount
of the remaining LIBOR Loans made pursuant to a single Borrowing (and thereby
continued) to less than $3,000,000 and, if greater, an integral multiple of
$1,000,000 in excess thereof, such remaining LIBOR Loans shall be converted
immediately into Base Rate Loans and may not thereafter be converted into or
continued as LIBOR Loans unless the requirements of clause (y) above are
satisfied, (iii) no conversion of Base Rate Loans into LIBOR Loans or
continuation of LIBOR Loans shall be permitted during the existence of a Default
or Event of Default and (iv) no conversion or continuation under this Section
shall result in a greater number of separate Interest Periods in respect of
LIBOR Loans under either Facility than is permitted under Section 2.2(a)(vi).

     (b)  The Borrower shall make each such election by delivering written
notice to the Agent prior to 11:00 a.m., Charlotte time, at least three (3)
Business Days prior to the effective date of any conversion of Base Rate Loans
into, or continuation of, LIBOR Loans and at least one (1) Business Day prior to
the effective date of any conversion of LIBOR Loans into Base Rate Loans. Each
such notice (each, a "Notice of Conversion/Continuation") shall be irrevocable,
shall be given in the form of Exhibit B-2 and shall be appropriately completed
to specify (x) the date of such conversion or continuation, (y) in the case of a
conversion into, or a continuation of, LIBOR Loans, the Interest Period to be
applicable thereto and (z) the aggregate amount and Type of the Loans being
converted or continued. Upon the receipt of a Notice of Conversion/Continuation,
the Agent will promptly notify each Lender having a Commitment under the
Facility pursuant to which such conversion or continuation is elected of the
proposed conversion or continuation, of such Lender's Pro Rata Share thereof and
of the other matters specified in the Notice of Conversion/Continuation. In the
event that the Borrower shall fail to deliver a Notice of Conversion/
Continuation as provided hereinabove with respect to any Borrowing of LIBOR
Loans, such LIBOR Loans shall automatically be
<PAGE>
 
converted to Base Rate Loans upon the expiration of the then current Interest
Period applicable thereto.

     2.10 Method of Payments; Computations.

     (a)  All payments by the Borrower hereunder and under the Revolving
Credit/Term Notes shall be made without setoff, counterclaim or other defense,
in Dollars and in immediately available funds to the Agent, for the account of
the Lenders (except as otherwise provided in SECTIONS 2.7(C), 2.7(D), 2.7(E),
2.11, 2.12, 2.13, 2.17, 10.6 and 10.7 as to payments required to be made
directly to the Issuing Bank and the Lenders) to First Union, ABA Routing
#053000219, to the Credit of First Union National Bank of North Carolina,
Charlotte, North Carolina, Attention: Syndication Agency Services, G/L #465906,
RC # 5007, RE: Renal Treatment Centers, prior to 12:00 noon, Charlotte time, on
the date payment is due. Any payment made as required hereinabove, but after
12:00 noon, Charlotte time, shall be deemed to have been made on the next
succeeding Business Day. If any payment falls due on a day that is not a
Business Day, then such due date shall be extended to the next succeeding
Business Day (except that in the case of LIBOR Loans to which the provisions of
clause (iv) in SECTION 2.8 are applicable, such due date shall be the next
preceding Business Day), and such extension of time shall then be included in
the computation of payment of interest, fees or other applicable amounts.

     (b)  The Agent will distribute to the Lenders like amounts relating to
payments made to the Agent for the account of such Lenders as follows: (i) if
the payment is received by 12:00 noon, Charlotte time, in immediately available
funds, the Agent will make available to each such Lender on the same date, by
wire transfer of immediately available funds, such Lender's Pro Rata Share of
such payment, and (ii) if such payment is received after 12:00 noon, Charlotte
time, or in other than immediately available funds, the Agent will make
available to each such Lender its Pro Rata Share of such payment by wire
transfer of immediately available funds on the next succeeding Business Day (or
in the case of uncollected funds, as soon as practicable after collected). If
the Agent shall not have made a required distribution to the appropriate Lenders
as required hereinabove after receiving a payment for the account of such
Lenders, the Agent will pay to each such Lender, on demand, its Pro Rata Share
of such payment with interest thereon at the Federal Funds Rate for each day
from the date such amount was required to be disbursed by the Agent until the
date repaid to such Lender. The Agent will distribute to the Issuing Bank like
amounts relating to payments made to the Agent for the account of the Issuing
Bank in the same manner, and subject to the same terms and conditions, as set
forth hereinabove with respect to distributions of amounts to the Lenders.
<PAGE>
 
     (c)  Unless the Agent shall have received notice from the Borrower prior to
the date on which any payment is due to any Lender hereunder that such payment
will not be made in full, the Agent may assume that the Borrower has made such
payment in full to the Agent on such date, and the Agent may, in reliance on
such assumption, cause to be distributed to each Lender on such due date an
amount equal to the amount then due to each such Lender. If and to the extent
the Borrower shall not have so made such payment in full to the Agent, each such
Lender shall repay to the Agent forthwith on demand such amount so distributed
to such Lender, together with interest thereon for each day from the date such
amount is so distributed to such Lender until the date repaid to the Agent, at
the Federal Funds Rate.

     (d)  The Borrower hereby authorizes each Lender, if and to the extent that
any payment owed to such Lender is not made when due hereunder or under any
Revolving Credit/Term Note held by such Lender, to charge from time to time
against any or all of the accounts of the Borrower with such Lender any amount
so due.

     (e)  With respect to each payment on the Loans hereunder, except as
specifically provided otherwise herein or in any of the other Loan Documents,
the Borrower may designate by written notice to the Agent prior to or
concurrently with such payment the Types of Loans that are to be repaid or
prepaid and, in the case of LIBOR Loans, the specific Borrowing or Borrowings
pursuant to which made, provided that (i) unless made together with all amounts
required under SECTION 2.13 to be paid as a consequence thereof, a prepayment of
a LIBOR Loan may be made only on the last day of the Interest Period applicable
thereto, (ii) if any partial prepayment of LIBOR Loans made pursuant to any
single Borrowing shall reduce the outstanding principal amount of the remaining
LIBOR Loans under such Borrowing to less than $3,000,000, and if greater, in
integral multiples of $1,000,000 in excess thereof, such remaining LIBOR Loans
shall be converted immediately into Base Rate Loans and (iii) each prepayment of
Loans comprising a single Borrowing shall be applied pro rata among such Loans.
In the absence of any such designation by the Borrower, the Agent shall, subject
to the foregoing, make such designation in its sole discretion.

     (f)  All computations of interest and fees hereunder (including
computations of the Reserve Requirement) shall be made on the basis of a year
consisting of 360 days and the actual number of days (including the first day,
but excluding the last day) elapsed; provided, that interest on Base Rate Loans
shall be computed on the basis of 365/366-day year and the actual days elapsed.

     2.11 Increased Costs, Change in Circumstances, etc.

     (a)  If, at any time after the Closing Date and from time to time, the
adoption or modification of any applicable law, rule or
<PAGE>
 
regulation, or any interpretation or administration thereof by any Governmental
Authority or central bank (whether or not having the force of law) charged with
the interpretation, administration or compliance of the Lenders with any of such
requirements, shall:

     (i)  subject any Lender to, or increase the net amount of, any tax,
          impost, duty, charge or withholding with respect to any amount
          received or to be received hereunder in connection with LIBOR Loans
          (other than taxes imposed on net income or profits of, or any branch
          or franchise tax applicable to, such Lender or a Lending Office of
          such Lender);

    (ii)  change the basis of taxation of payments to any Lender in connection
          with LIBOR Loans (other than changes in taxes on the net income or
          profits of, or any branch or franchise tax applicable to, such Lender
          or a Lending Office of such Lender);

   (iii)  impose, increase or render applicable any reserve (other than the
          Reserve Requirement), capital adequacy, special deposit or similar
          requirement against assets of, deposits with or for the account of,
          or loans, credit or commitments extended by, any Lender or a Lending
          Office of such Lender; or

    (iv)  impose on any Lender or in the London interbank Eurodollar market any
          other condition or requirement affecting this Agreement or LIBOR
          Loans;

and the result of any of the foregoing is to increase the costs to any Lender of
agreeing to make, making, funding or maintaining any LIBOR Loans or to reduce
the yield or rate of return of or any sum received or receivable by such Lender
on any LIBOR Loans to a level below that which such Lender could have achieved
or received pursuant to this Agreement but for the adoption or modification of
any such requirements, the Borrower will, within fifteen (15) days after
delivery to the Borrower by such Lender of written demand therefor (with a copy
thereof to the Agent), pay to such Lender such additional amounts as shall
compensate such Lender for such increase in costs or reduction in return.

     (b)  If, at any time after the Closing Date and from time to time, any
Lender shall have determined that the adoption or modification of any applicable
federal, state or local law, rule or regulation regarding such Lender's (or a 
corporation controlling such Lender) required level of capital (including any
allocation of capital requirements or conditions, but excluding federal, state
or local income tax liability), or the implementation of any such requirements
previously adopted but not implemented prior to the Closing Date, or any
interpretation or administration thereof by any Governmental Authority (whether
or not having the force of law) charged with the interpretation, administration
or compliance of
<PAGE>
 
     such Lender (or a corporation controlling such Lender) with any of such
     requirements, has or would have the effect of reducing the rate of return
     on such Lender's capital (or the capital of any corporation controlling
     such Lender) as a consequence of its Commitments, Loans or participations
     in Letters of Credit hereunder to a level below that which such Lender (or
     a corporation controlling such Lender) could have achieved but for such
     adoption, modification, implementation or interpretation (taking into
     account such Lender's policies with respect to capital adequacy), the
     Borrower will, within fifteen (15) days after delivery to the Borrower by
     such Lender of written demand therefor (with a copy thereof to the Agent),
     pay to such Lender such additional amounts as will compensate such Lender
     for such reduction in return.

          (c) If, on or prior to the first day of any Interest Period, (i) the
     Agent shall have received written notice from any Lender of such Lender's
     determination that Dollar deposits in the amount of such Lender's required
     LIBOR Loan pursuant to such Borrowing are not generally available in the
     London interbank Eurodollar market or that the rate at which such Dollar
     deposits are being offered will not adequately and fairly reflect the cost
     to such Lender of making or maintaining its LIBOR Loan during such Interest
     Period or (ii) the Agent shall have determined that adequate and reasonable
     means do not exist for ascertaining the applicable LIBOR Rate for such
     Interest Period, the Agent will forthwith so notify the Borrower and the
     Lenders, whereupon the obligation of (y) in the case of clause (i) above,
     each such affected Lender, and (z) in the case of clause (ii) above, all
     Lenders, in each case to make, to convert Base Rate Loans into, or to
     continue, LIBOR Loans shall be suspended (including pursuant to the
     Borrowing to which such Interest Period applies), and any Notice of
     Borrowing or Notice of Conversion/Continuation given at any time thereafter
     with respect to LIBOR Loans shall be deemed to be a request for Base Rate
     Loans (but in the case of clause (i) above, only to the extent of such
     affected Lender's Pro Rata Share thereof) until the Agent or the affected
     Lender, as the case may be, shall have determined that the circumstances
     giving rise to such suspension no longer exist (and the affected Lender, if
     making such determination, shall have so notified the Agent), and the Agent
     shall have so notified the Borrower and the Lenders.

          (d) Notwithstanding any other provision in this Agreement, if, at any
     time after the Closing Date and from time to time, any Lender shall have
     determined that the adoption or modification of any applicable law, rule or
     regulation, or any interpretation or administration thereof by any
     Governmental Authority or central bank (whether or not having the force of
     law) charged with the interpretation, administration or compliance of such
     Lender with any of such requirements, has or would have the effect of
     making it unlawful for such Lender to honor its obligation to make LIBOR
     Loans or to continue to make or maintain LIBOR Loans, such Lender will
     forthwith so notify the Agent and the Borrower, whereupon (i) each of such
     Lender's outstanding LIBOR Loans shall 
<PAGE>
 
     automatically, on the expiration date of the respective Interest Period
     applicable thereto or, to the extent any such LIBOR Loan may not lawfully
     be maintained as a LIBOR Loan until such expiration date, upon such notice,
     be converted into a Base Rate Loan and (ii) the obligation of such Lender
     to make, to convert Base Rate Loans into, or to continue, LIBOR Loans shall
     be suspended, and any Notice of Borrowing or Notice of
     Conversion/Continuation given at any time thereafter with respect to LIBOR
     Loans shall, as to such Lender, be deemed to be a request for Base Rate
     Loans, until such Lender shall have determined that the circumstances
     giving rise to such suspension no longer exist and shall have so notified
     the Agent, and the Agent shall have so notified the Borrower.

          (e) Determinations by the Agent or any Lender for purposes of this
     Section of any increased costs, reduction in return, market contingencies,
     illegality or any other matter shall, absent manifest error, be conclusive,
     provided that such determinations are made in good faith. Each Lender
     agrees that, upon the occurrence of any event giving rise to the operation
     of this Section with respect to such Lender, it will, if requested by the
     Borrower and to the extent permitted by law, endeavor in good faith to
     designate another Lending Office for its LIBOR Loans, but only if such
     designation would make it lawful for such Lender to continue to make or
     maintain LIBOR Loans hereunder; provided that such designation is made on
     such terms that such Lender, in its good faith determination, suffers no
     increased cost or economic, legal or regulatory disadvantage, with the
     object of avoiding the consequence of the event giving rise to the
     operation of this Section.

          (f) Each demand for payment under this Section shall be preceded by a
     notice to the Borrower of such anticipated demand, which notice shall
     specify in reasonable detail the basis for such demand, but the failure to
     provide such advance notice shall not relieve the Borrower of any of its
     obligations hereunder. No failure by the Agent or any Lender to demand
     payment of any amounts payable under this Section shall constitute a waiver
     of its right to demand payment of any additional amounts arising at any
     subsequent time. Nothing in this Section shall be construed or so operate
     as to require the Borrower to pay any interest, fees, costs or charges in
     excess of that permitted by applicable law.

          2.12 Taxes.

          (a)  Any and all payments by the Borrower hereunder or under any
     Revolving Credit/Term Note shall be made, in accordance with the terms
     hereof and thereof, free and clear of and without deduction for any and all
     present or future taxes, levies, imposts, deductions, charges or
     withholdings, and all liabilities with respect thereto (other than net
     income and franchise taxes imposed on the Agent, the Issuing Bank or any
     Lender) (y) by the jurisdiction under the laws of which the Agent, the
     Issuing Bank or 
<PAGE>
 
     such Lender, as the case may be, is organized or any political subdivision
     thereof and (z) in the case of each Lender, by the jurisdiction in which
     any Lending Office of such Lender is located or any political subdivision
     thereof (all such nonexcluded taxes, levies, imposts, deductions, charges,
     withholdings and liabilities being hereinafter referred to as "Taxes"). If
     the Borrower shall be required by law to deduct any Taxes from or in
     respect of any sum payable hereunder or under any Revolving Credit/Term
     Note to the Agent, the Issuing Bank or any Lender, (i) the sum payable
     shall be increased as may be necessary so that after making all required
     deductions (including deductions applicable to additional sums payable
     under this Section), the Agent, the Issuing Bank or such Lender, as the
     case may be, receives an amount equal to the sum it would have received had
     no such deductions been made, (ii) the Borrower will make such deductions
     and (iii) the Borrower will pay the full amount deducted to the relevant
     taxation authority or other authority in accordance with applicable law.

          (b) The Borrower will indemnify the Agent, the Issuing Bank and each
     Lender for the full amount of Taxes (including, without limitation, any
     Taxes imposed by any jurisdiction on amounts payable under this Section)
     paid by the Agent, the Issuing Bank or such Lender, as the case may be, and
     any liability (including penalties, interest and expenses) arising
     therefrom or with respect thereto, whether or not such Taxes were correctly
     or legally asserted. This indemnification shall be made within 30 days from
     the date the Agent, the Issuing Bank or any Lender, as the case may be,
     makes written demand therefor. Within thirty (30) days after the date of
     any payment of Taxes pursuant to this Section, the Borrower will furnish to
     the Agent, the Issuing Bank or the relevant Lender, as the case may be, the
     original or a certified copy of a receipt evidencing payment thereof.

          (c) If any Lender is a "foreign corporation, partnership or trust"
     within the meaning of the Code, and such Lender claims exemption from
     United States withholding tax under Section 1441 or 1442 of the Code, such
     Lender will deliver to the Agent and the Borrower:

          (i)  if such Lender claims an exemption from, or a reduction of,
               withholding tax under a United States tax treaty, properly
               completed IRS Forms 1001 and W-8 before the payment of any
               interest in the first calendar year, and before the payment of
               any interest in each third succeeding calendar year, during which
               interest may be paid to such Lender under this Agreement;

          (ii) if such Lender claims that interest paid under this Agreement is
               exempt from United States withholding tax because it is
               effectively connected with a United States trade or business of
               such Lender, two (2) properly completed and executed copies of
               IRS Form 4224 before the payment of any interest is due in the
               first 
<PAGE>
 
               taxable year of such Lender, and in each succeeding taxable
               year of such Lender, during which interest may be paid to such
               Lender under this Agreement, and IRS Form W-9; and

         (iii) such other form or forms as may be required under the Code or
               other laws of the United States as a condition to exemption
               from, or reduction of, United States withholding tax.

          Each such Lender will promptly notify the Agent and the Borrower of
     any changes in circumstances that would modify or render invalid any
     claimed exemption or reduction.

          (d)  If any Lender is entitled to a reduction in the applicable
     withholding tax, the Agent may withhold from any interest payment to such
     Lender an amount equivalent to the applicable withholding tax after taking
     into account such reduction. If the forms or other documentation required
     under subsection (c) above are not delivered to the Agent, then the Agent
     may withhold from any interest payment to such Lender not providing such
     forms or other documentation an amount equivalent to the applicable
     withholding tax. For purposes of this Section, a distribution hereunder by
     the Agent to or for the account of any Lender shall be deemed a payment by
     the Borrower.

          (e) If the IRS or any other Governmental Authority, domestic or
     foreign, asserts a claim that the Agent did not properly withhold tax from
     amounts paid to or for the account of any Lender (whether because the
     appropriate form was not delivered or was not properly executed, because
     such Lender failed to notify the Agent of a change in circumstances that
     rendered the exemption from, or reduction of, withholding tax ineffective,
     or for any other reason), such Lender shall indemnify the Agent fully for
     all amounts paid, directly or indirectly, by the Agent as tax or otherwise,
     including penalties and interest, and including any taxes imposed by any
     jurisdiction on the amounts payable to the Agent under this subsection (e),
     together with all costs, expenses and reasonable attorneys' fees incurred
     or paid in connection therewith.

          (f) If at any time the Borrower requests any Lender to deliver any
     forms or other documentation pursuant to subsection (c) above, then the
     Borrower shall, upon demand of such Lender, reimburse such Lender for any
     reasonable costs or expenses incurred by such Lender in the preparation or
     delivery of such forms or other documentation.

          (g) Each Lender agrees that, if the Borrower is required to pay
     additional amounts to any Lender pursuant to subsection (a) above, then
     such Lender will, if requested by the Borrower and to the extent permitted
     by law, endeavor in good faith to designate another Lending Office for its
     LIBOR Loans, but only if such 
<PAGE>
 
designation would make it lawful for such Lender to continue to make or maintain
LIBOR Loans hereunder; provided that such designation is made on such terms that
such Lender, in its good faith determination, suffers no increased cost or
economic, legal or regulatory disadvantage, with the object of avoiding the
consequence of the event giving rise to the operation of this Section.

          2.13 Compensation.  The Borrower will compensate each Lender, upon its
written request (which request shall set forth the basis for requesting such
compensation and shall be copied to the Agent), for all losses, expenses and
liabilities (including, without limitation, any loss, expense or liability
incurred by reason of the liquidation or reemployment of deposits or other funds
required by such Lender to fund its LIBOR Loans) that such Lender may sustain
(i) if for any reason (other than a default by such Lender or the Agent) a
Borrowing of, or conversion of or into, LIBOR Loans does not occur on a date
specified therefor in a Notice of Borrowing or Notice of Conversion/
Continuation, (ii) if any repayment, prepayment or conversion of any of its
LIBOR Loans occurs on a date other than the last day of an Interest Period
applicable thereto, (iii) if any prepayment of any of its LIBOR Loans is not
made on any date specified in a notice of prepayment given by the Borrower or
(iv) as a consequence of any other failure by the Borrower to make any payments
with respect to LIBOR Loans when due hereunder, including as a consequence of
acceleration of the maturity of such Loans pursuant to Section 8.1. In addition,
the Borrower will pay to the Agent, for its own account, an administrative fee
of $500 concurrently with any payments made in respect of any single occurrence
pursuant to this Section. Calculation of all amounts payable to a Lender under
this Section shall be made as though such Lender had actually funded its
relevant LIBOR Loan through the purchase of a Eurodollar deposit bearing
interest at the LIBOR Rate in an amount equal to the amount of such LIBOR Loan,
having a maturity comparable to the relevant Interest Period and through the
transfer of such Eurodollar deposit from an offshore Lending Office of such
Lender to a Lending Office of such Lender in the United States; provided,
however, that each Lender may fund each of its LIBOR Loans in any manner it sees
fit and the foregoing assumption shall be utilized only for the calculation of
amounts payable under this Section. Determinations by any Lender for purposes of
this Section 2.13 of any such losses, expenses or liabilities shall, absent
manifest error, be conclusive, provided that such determinations are made in
                               --------
good faith.

          2.14 Use of Proceeds.  The proceeds of the Revolving Credit/Term
Loans shall be used by the Borrower solely (i) to refinance existing Debt, (ii)
to provide working capital and for general corporate purposes for the Borrower
and its Subsidiaries and (iii) to finance Permitted Acquisitions pursuant to
this Agreement.
<PAGE>
 
          2.15 Recovery of Payments.

          (a)  The Borrower agrees that to the extent the Borrower makes a
     payment or payments to or for the account of the Agent, the Lenders or the
     Issuing Bank, which payment or payments or any part thereof are
     subsequently invalidated, declared to be fraudulent or preferential, set
     aside or required to be repaid to a trustee, receiver or any other party
     under any bankruptcy, insolvency or similar state or federal law, common
     law or equitable cause, then, to the extent of such payment or repayment,
     the Obligation intended to be satisfied shall be revived and continued in
     full force and effect as if such payment had not been received.

          (b)  If any amounts distributed by the Agent to a Lender are
     subsequently returned or repaid by the Agent to the Borrower or its
     representative or successor in interest, whether by court order or by
     settlement approved by the Lender in question, such Lender will, promptly
     upon receipt of notice thereof from the Agent, pay the Agent such amount.
     If any such amounts are recovered by the Agent from the Borrower or its
     representative or successor in interest, the Agent shall redistribute such
     amounts to the Lenders on the same basis as such amounts were originally
     distributed.

          2.16 Pro Rata Borrowings.

          (a)  All Borrowings, continuations and conversions of Loans shall be
     made by the Lenders pro rata on the basis of their respective Percentages,
     as appropriate from time to time, rounded to the nearest penny.

          (b)  Each Lender agrees that if it shall receive any amount hereunder
     (whether by voluntary payment, realization upon security, exercise of the
     right of setoff or banker's lien, counterclaim or cross action, enforcement
     of any right under the Loan Documents, or otherwise) applicable to the
     payment of any of the Obligations that exceeds its Pro Rata Share of
     payments on account of such Obligations then or therewith obtained by all
     the Lenders to which such payments are required to have been made, such
     Lender shall forthwith purchase from the other Lenders such participations
     in such Obligations as shall be necessary to cause such purchasing Lender
     to share the excess payment or other recovery ratably with each of them;
     provided, however, that if all or any portion of such excess payment is
     thereafter recovered from such purchasing Lender, such purchase from each
     such other Lender shall be rescinded and each such other Lender shall repay
     to the purchasing Lender the purchase price to the extent of such recovery
     together with an amount equal to such other Lender's ratable share
     (according to the proportion of (i) the amount of such other Lender's
     required repayment to (ii) the total amount so recovered from the
     purchasing Lender) of any interest or other amount paid or payable by the
     purchasing Lender in respect of the total amount so recovered. The Borrower
     agrees that any Lender so purchasing a participation from 
<PAGE>
 
     another Lender pursuant to the provisions of this Section may, to the
     fullest extent permitted by law, exercise any and all rights of payment
     (including, without limitation, setoff, banker's lien or counterclaim) with
     respect to such participation as fully as if such participant were a direct
     creditor of the Borrower in the amount of such participation.

          2.17 Letters of Credit.

          (a)  Subject to and upon the terms and conditions herein set forth, so
     long as no Default or Event of Default has occurred and is continuing, the
     Issuing Bank will, at any time and from time to time on and after the
     Closing Date and prior to the Revolving Credit/Term Facility Termination
     Date, and upon request by the Borrower in accordance with the provisions of
     Section 2.17(b), issue for the account of the Borrower one or more
     irrevocable standby letters of credit denominated in Dollars and in a form
     customarily used or otherwise approved by the Issuing Bank (together with
     all amendments, modifications and supplements thereto, substitutions
     therefor and renewals and restatements thereof, collectively, the "Letters
     of Credit"). The Stated Amount of each Letter of Credit shall not be less
     than such amount as may be acceptable to the Issuing Bank. Notwithstanding
     the foregoing:

          (i)  No Letter of Credit shall be issued the Stated Amount upon
               issuance of which (i) when added to all other Letter of Credit
               Outstandings at such time, would exceed $10,000,000 or (ii) when
               added to all other Letter of Credit Outstandings at such time and
               the aggregate principal amount of all Revolving Credit/Term Loans
               then outstanding, would exceed the Total Revolving Credit/Term
               Commitment at such time;

         (ii)  No Letter of Credit shall be issued that by its terms expires
               more than one (1) year after its date of issuance or later than
               the seventh day prior to the Revolving Credit/Term Facility
               Conversion Date; provided, however, that a Letter of Credit may,
               if requested by the Borrower, provide by its terms, and on terms
               acceptable to the Issuing Bank, for renewal for successive
               periods of one year or less (but not beyond the seventh day prior
               to the Revolving Credit/Term Facility Conversion Date), unless
               and until the Issuing Bank shall have delivered a notice of
               nonrenewal to the beneficiary of such Letter of Credit; and

        (iii)  The Issuing Bank shall be under no obligation to issue any Letter
               of Credit if, at the time of such proposed issuance, (A) any
               order, judgment or decree of any Governmental Authority or
               arbitrator shall purport by its terms to enjoin or restrain the
               Issuing Bank from issuing such Letter of Credit, or any
               Requirement of 
<PAGE>
 
               Law applicable to the Issuing Bank or any request or directive
               (whether or not having the force of law) from any Governmental
               Authority with jurisdiction over the Issuing Bank shall prohibit,
               or request that the Issuing Bank refrain from, the issuance of
               letters of credit generally or such Letter of Credit in
               particular or shall impose upon the Issuing Bank with respect to
               such Letter of Credit any restriction or reserve or capital
               requirement (for which the Issuing Bank is not otherwise
               compensated) not in effect on the Closing Date, or any
               unreimbursed loss, cost or expense that was not applicable, in
               effect or known to the Issuing Bank as of the Closing Date and
               that the Issuing Bank in good faith deems material to it, or (B)
               the Issuing Bank shall have actual knowledge, or shall have
               received notice from any Lender, prior to the issuance of such
               Letter of Credit that one or more of the conditions specified in
               Section 3.2 (if applicable) or 3.3 are not then satisfied or that
               the issuance of such Letter of Credit would violate the
               provisions of subsection (i) above.

          (b)  Whenever the Borrower desires the issuance of a Letter of Credit,
     the Borrower will notify the Issuing Bank (with copies to the Agent) in
     writing, by 11:00 a.m., Charlotte time, at least three (3) Business Days'
     (or such shorter period as is acceptable to the Issuing Bank in any given
     case) prior to the requested date of issuance thereof. Each such request
     (each, a "Letter of Credit Request") shall be irrevocable, shall be given
     in the form of Exhibit B-3 and shall be appropriately completed to specify
     (i) the proposed date of issuance (which shall be a Business Day), (ii) the
     proposed Stated Amount and expiry date of the Letter of Credit, and (iii)
     the name and address of the proposed beneficiary or beneficiaries of the
     Letter of Credit. The Borrower will also complete any application
     procedures and documents required by the Issuing Bank in connection with
     the issuance of any Letter of Credit. The Agent will, promptly upon its
     receipt thereof, notify each Lender of the Letter of Credit Request. Upon
     its issuance of any Letter of Credit, the Issuing Bank will promptly notify
     each Lender of such issuance and will notify each Lender with a Revolving
     Credit/Term Commitment of the amount of its participation therein under
     Section 2.17(c).

          (c)  Immediately upon the issuance of any Letter of Credit, the
     Issuing Bank shall be deemed to have sold and transferred to each Lender
     with a Revolving Credit/Term Commitment, and each such Lender (each, in
     such capacity, an "L/C Participant") shall be deemed irrevocably and
     unconditionally to have purchased and received from the Issuing Bank,
     without recourse or warranty, an undivided interest and participation, pro
     rata to the extent of its Revolving Credit/Term Percentage at such time, in
     such Letter of Credit, each drawing made thereunder and the obligations of
     the Borrower under this Agreement with respect thereto and any security
<PAGE>
 
     therefor (including the Collateral) or guaranty pertaining thereto;
     provided, however, that the fees and other charges relating to Letters of
     Credit described in Sections 2.7(c) and (d) shall be payable directly to
     the Issuing Bank as provided therein, and the L/C Participants shall have
     no right to receive any portion thereof. Upon any change in the Revolving
     Credit/Term Commitments of any of the Lenders pursuant to Section 10.5,
     with respect to all outstanding Letters of Credit and Reimbursement
     Obligations there shall be an automatic adjustment to the participations
     pursuant to this Section to reflect the new Revolving Credit/Term
     Percentages of the assigning Lender and the Eligible Assignee.

          (d)  The Borrower hereby agrees to reimburse the Issuing Bank by
     making payment to the Agent, for the account of the Issuing Bank, in
     immediately available funds, for any payment made by the Issuing Bank under
     any Letter of Credit (each such amount so paid until reimbursed, together
     with interest thereon payable as provided hereinbelow, a "Reimbursement
     Obligation") immediately after, and in any event on the date of, such
     payment, together with interest on the amount so paid by the Issuing Bank,
     to the extent not reimbursed prior to 2:00 p.m., Charlotte time, on the
     date of such payment or disbursement, (i) for the period from the date of
     the respective payment to the date of receipt by the Borrower from the
     Issuing Bank of notice of such payment, the Adjusted Base Rate as in effect
     from time to time during such period, and (ii) for the period from the date
     of receipt by the Borrower from the Issuing Bank of notice of such payment
     to the date the Reimbursement Obligation created thereby is satisfied, the
     Base Rate as in effect from time to time during such period plus two
     percentage points (2.0%), such interest also to be payable on demand. The
     Issuing Bank will provide the Agent and the Borrower with prompt notice of
     any payment or disbursement made under any Letter of Credit, although the
     failure to give, or any delay in giving, any such notice shall not release,
     diminish or otherwise affect the Borrower's obligations under this Section
     or any other provision of this Agreement.

          (e)  In the event that the Issuing Bank makes any payment under any
     Letter of Credit and the Borrower shall not have timely satisfied in full
     its Reimbursement Obligation to the Issuing Bank pursuant to Section
     2.17(d), and to the extent that any amounts then held in the Cash
     Collateral Account established pursuant to Section 2.17(i) shall be
     insufficient to satisfy such Reimbursement Obligation in full, the Issuing
     Bank will promptly notify the Agent, and the Agent will promptly notify
     each L/C Participant, of such failure. If the Agent gives such notice prior
     to 11:00 a.m., Charlotte time, on any Business Day to any L/C Participant,
     such L/C Participant will make available to the Agent, for the account of
     the Issuing Bank, its Pro Rata Share (calculated with respect to its
     Revolving Credit/Term Percentage) of the amount of such payment on such
     Business Day in immediately available funds. If the Agent gives such notice
     after 11:00 a.m., Charlotte time, on any Business 
<PAGE>
 
     Day to any such L/C Participant, such L/C Participant shall make its Pro
     Rata Share of such amount available to the Agent on the next succeeding
     Business Day. If and to the extent such L/C Participant shall not have so
     made its Pro Rata Share of the amount of such payment available to the
     Agent, such L/C Participant agrees to pay to the Agent, for the account of
     the Issuing Bank, forthwith on demand such amount, together with interest
     thereon, for each day from such date until the date such amount is paid to
     the Agent at the Federal Funds Rate. The failure of any L/C Participant to
     make available to the Agent its Pro Rata Share of any payment under any
     Letter of Credit shall not relieve any other L/C Participant of its
     obligation hereunder to make available to the Agent its Pro Rata Share of
     any payment under any Letter of Credit on the date required, as specified
     above, but no L/C Participant shall be responsible for the failure of any
     other L/C Participant to make available to the Agent such other L/C
     Participant's Pro Rata Share of any such payment. Each such payment by an
     L/C Participant under this Section 2.17(e) of its Pro Rata Share of an
     amount paid by the Issuing Bank shall constitute a Revolving Credit/Term
     Loan by such Lender (the Borrower being deemed to have given a timely
     Notice of Borrowing therefor) and shall be treated as such for all purposes
     of this Agreement; provided that for purposes of determining the available
     unused portion of the Total Revolving Credit/Term Commitment immediately
     prior to giving effect to the application of the proceeds of such Revolving
     Credit/Term Loans, the Reimbursement Obligation being satisfied thereby
     shall be deemed not to be outstanding at such time.

          (f)  Whenever the Issuing Bank receives a payment in respect of a
     Reimbursement Obligation as to which the Agent has received, for the
     account of the Issuing Bank, any payments from the L/C Participants
     pursuant to Section 2.17(e), the Issuing Bank will promptly pay to the
     Agent, and the Agent will promptly pay to each L/C Participant that has
     paid its Pro Rata Share thereof, in immediately available funds, an amount
     equal to such L/C Participant's ratable share (based on the proportionate
     amount funded by such L/C Participant to the aggregate amount funded by all
     L/C Participants) of such Reimbursement Obligation.

          (g)  The Reimbursement Obligations of the Borrower, and the
     obligations of the L/C Participants to make payments to the Agent, for the
     account of the Issuing Bank, with respect to Letters of Credit, shall be
     irrevocable, shall remain in effect until the Issuing Bank shall have no
     further obligations to make any payments or disbursements under any
     circumstances with respect to any Letter of Credit, and, except to the
     extent resulting from any gross negligence or willful misconduct on the
     part of the Issuing Bank as finally determined by a court of competent
     jurisdiction and not subject to any appeal (or pursuant to arbitration as
     set forth herein), shall not be subject to counterclaim, setoff or other
     defense or any other qualification or exception whatsoever and shall be
     made in accordance with the terms and conditions of this 
<PAGE>
 
     Agreement under all circumstances, including, without limitation, any of
     the following circumstances:

          (i)  Any lack of validity or enforceability of this Agreement, any of
               the other Loan Documents or any documents or instruments relating
               to any Letter of Credit;

         (ii)  Any change in the time, manner or place of payment of, or in any
               other term of, all or any of the Obligations in respect of any
               Letter of Credit or any other amendment, modification or waiver
               of or any consent to departure from any Letter of Credit or any
               documents or instruments relating thereto, in each case whether
               or not the Borrower has notice or knowledge thereof;

        (iii)  The existence of any claim, setoff, defense or other right that
               the Borrower may have at any time against a beneficiary named in
               a Letter of Credit, any transferee of any Letter of Credit (or
               any Person for whom any such transferee may be acting), the
               Agent, the Issuing Bank, any Lender or other Person, whether in
               connection with this Agreement, any Letter of Credit, the
               transactions contemplated hereby or any unrelated transactions
               (including any underlying transaction between the Borrower and
               the beneficiary named in any such Letter of Credit);

         (iv)  Any draft, certificate or any other document presented under the
               Letter of Credit proving to be forged, fraudulent, invalid or
               insufficient in any respect or any statement therein being untrue
               or inaccurate in any respect, any errors, omissions,
               interruptions or delays in transmission or delivery of any
               messages, by mail, telecopier or otherwise, or any errors in
               translation or in interpretation of technical terms;

          (v)  Any defense based upon the failure of any drawing under a Letter
               of Credit to conform to the terms of the Letter of Credit (the
               Issuing Bank's sole obligation, in determining whether to pay
               under any Letter of Credit, being in good faith to confirm that
               any documents required to be delivered under such Letter of
               Credit have been delivered and that they appear on their face to
               comply with the requirements of such Letter of Credit), any
               nonapplication or misapplication by the beneficiary or any
               transferee of the proceeds of such drawing or any other act or
               omission of such beneficiary or transferee in connection with
               such Letter of Credit;

         (vi)  The exchange, release, surrender or impairment of any Collateral
               or other security for the Obligations;
<PAGE>
 
        (vii)  The occurrence of any Default or Event of Default; or

       (viii)  Any other circumstance or event whatsoever, including, without
               limitation, any other circumstance that might otherwise
               constitute a defense available to, or a discharge of, the
               Borrower or a guarantor.

None of the foregoing shall impair, prevent or otherwise affect any of the
rights and powers granted to the Issuing Bank hereunder. Any action taken or
omitted to be taken by the Issuing Bank under or in connection with any Letter
of Credit, if taken or omitted in the absence of gross negligence or willful
misconduct, shall be binding upon the Borrower and each L/C Participant and
shall not create or result in any liability of the Issuing Bank to the Borrower
or any L/C Participant.

          (h)  If at any time after the Closing Date the Issuing Bank or any L/C
Participant determines that the introduction of or any change in any applicable
law, rule, regulation, order, guideline or request or in the interpretation or
administration thereof by any Governmental Authority charged with the
interpretation or administration thereof, or compliance by the Issuing Bank or
any L/C Participant with any request or directive by any such authority (whether
or not having the force of law) shall either (i) impose, modify or make
applicable any reserve, deposit, capital adequacy or similar requirement against
Letters of Credit issued by the Issuing Bank or participated in by any L/C
Participant or (ii) impose on the Issuing Bank or any L/C Participant any other
conditions relating, directly or indirectly, to this Agreement or any Letter of
Credit, and the result of any of the foregoing is to increase the cost to the
Issuing Bank or L/C Participant of issuing, maintaining or participating in any
Letter of Credit, or to reduce the amount of any sum received or receivable by
the Issuing Bank or such L/C Participant hereunder or reduce the rate of return
on its capital with respect to Letters of Credit, then the Borrower will, within
fifteen (15) days after delivery to the Borrower by the Issuing Bank or such L/C
Participant of written demand therefor (with a copy thereof to the Agent), pay
to the Issuing Bank or such L/C Participant such additional amounts as shall
compensate the Issuing Bank or such L/C Participant for such increase in costs
or reduction in return. A certificate submitted to the Borrower by the Issuing
Bank or such L/C Participant, as the case may be (a copy of which certificate
shall be sent by the Issuing Bank or such L/C Participant to the Agent), setting
forth the basis for the determination of such additional amount or amounts
necessary to compensate the Issuing Bank or such L/C Participant as aforesaid,
shall be conclusive and binding on the Borrower absent manifest error.

          (i)  At any time and from time to time (i) during the continuance of
an Event of Default, the Agent may, and at the direction of the Required Lenders
shall, require the Borrower to deliver to the Agent such additional amount of
cash as is equal to

<PAGE>
 
the aggregate Stated Amount of all Letters of Credit at any time outstanding
(whether or not any beneficiary under any Letter of Credit shall have drawn or
be entitled at such time to draw thereunder) or (ii) in the event of a repayment
under Section 2.5(b), the Agent will retain such amount as may then be required
to be retained under the proviso in Section 2.5(b), such amount in each case
under clauses (i) and (ii) above to be held by the Agent in a non-interest
bearing cash collateral account (the "Cash Collateral Account") as security for,
and for application to, the Borrower's Reimbursement Obligations. In the event
of a drawing, and subsequent payment by the Issuing Bank, under any Letter of
Credit at any time during which any amounts are held in the Cash Collateral
Account, the Agent will deliver to the Issuing Bank an amount equal to the
Reimbursement Obligation created as a result of such payment (or, if the amounts
so held are less than such Reimbursement Obligation, all of such amounts) to
reimburse the Issuing Bank therefor. Any amounts remaining in the Cash
Collateral Account after the expiration of all Letters of Credit and
reimbursement in full of the Issuing Bank for all of its obligations thereunder
shall be held by the Agent, for the benefit of the Borrower, to be applied
against the Obligations in such order as the Agent may direct.

          (j)  Notwithstanding any termination of the Commitments or repayment
of the Loans, or both, the obligations of the Borrower under this Section 2.17
shall remain in full force and effect until the Issuing Bank and the L/C
Participants shall have no further obligations to make any payments or
disbursements under any circumstances with respect to any Letter of Credit.

          2.18 Sale and Assignment of Existing Loans. 

          Each of the original Lenders party hereto that is selling Loans in 
existence immediately prior to the date hereof ("Existing Loans") pursuant to 
this Section 2.18 (each, a "Selling Lender," and collectively, the "Selling 
Lenders") hereby represents and warrants to (i) each of the Lenders party hereto
that is not an original Lender, and (ii) each other original lender party hereto
that is purchasing Existing Loans pursuant to this Section 2.18 (the Lenders 
described under (i) and (ii), each, a "Purchasing Lender," and collectively, the
"Purchasing Lenders"), that it is the legal and beneficial owner of the interest
in the Existing Loans being assigned by it hereunder and that such interest is 
free and clear of any adverse claim. In order to give effect to the assignment 
to the Purchasing Lenders of their respective pro rata shares of the Existing 
Loans to be concurrently converted to Loans hereunder as of the Closing Date, 
all as contemplated hereunder, each Selling lender shall and does hereby sell 
and assign to each Purchasing Lender, without recourse, representation or 
warranty (except as set forth in the first sentence of this subsection (a)), and
each Purchasing Lender shall and does hereby purchase and assume from each 
Selling lender, a portion of all of the rights and
<PAGE>
 
obligations of each Selling Lender with respect to such Existing Loans converted
to Loans hereunder as of the Closing Date and each of the Loan Documents, in 
each case in the amounts set forth in Annex A hereto (the "Assigned Rights"), 
                                      -------
such that after giving effect to such sale and assignment, the Lenders shall own
the Existing Loans converted to Loans hereunder in proportion to their 
respective Commitments.


                                  ARTICLE III

                 CLOSING; CONDITIONS OF CLOSING AND BORROWING

     3.1   Closing.  The closing of the transactions contemplated by this
Loan Agreement (the "Closing") shall take place at the offices of Robinson,
Bradshaw & Hinson, P.A., 1900 Independence Center, 101 North Tryon Street,
Charlotte, North Carolina 28246 at 10:00 a.m. on May 2, 1997, or at such other
place or time as the parties hereto shall mutually agree.

     3.2   Conditions of Loans and Advances. The obligations of the Lenders to
enter into this financing and to make the Loans under this Agreement on the
Closing Date and the obligation of the Issuing Bank to issue any Letter of 
Credit on the Closing Date are subject to the satisfaction of the following
conditions:

     3.2.1 Executed Loan Documents.

     (a)   Revolving Credit/Term Notes. The Revolving Credit/Term Notes required
under Sections 2.3 shall have been duly authorized, executed and delivered to
the appropriate Lenders by the Borrower, in form and substance satisfactory to
the Lenders, shall be in full force and effect and no Default shall exist
thereunder, each Lender shall have received its original Revolving Credit/Term
Note and a copy of each other Revolving Credit/Term Note, and the Agent shall
have received a copy of each Revolving Credit/Term Note.

     (b)   Pledge Agreements. The Pledge Agreement and the Subsidiary Pledge
Agreement shall have been duly authorized, executed and delivered to the Agent
and each Lender by the Borrower and Guarantors, respectively, in form and
substance satisfactory to the Lenders, together with all certificates for the
Stock being pledged thereunder and duly executed undated stock powers for each
such certificate, shall be in full force and effect and no Default shall exist
thereunder, and the Agent and each Lender shall have received a fully executed
original thereof.

     (c)   Guaranty Agreement.  Each Guarantor shall have duly authorized,
executed and delivered to the Agent and each Lender the Guaranty Agreement, or a
confirmation thereof, in form and substance satisfactory to the Lenders, each
such document shall be in full force and effect and no Default shall exist
thereunder, and 
<PAGE>
 
the Agent and each Lender shall have received a fully executed original thereof.

     (d)   Intercompany Loan Documents. A promissory note in respect of
intercompany indebtedness shall have been duly authorized, executed and
delivered by each Guarantor and assigned by the Borrower to the Agent, in form
and substance satisfactory to the Agent, such assignment shall be evidenced and
perfected in a manner satisfactory to the Agent, each such document shall be in
full force and effect and no Default shall exist thereunder.

     3.2.2 Closing Certificates; etc.

     (a)   Certificate of the Borrower. The Agent and each Lender shall have
received a certificate dated as of the Closing Date from the President or Vice
President and Secretary of the Borrower, in form and substance satisfactory to
the Lenders, to the effect that, to the best of their knowledge after diligent
inquiry, all representations and warranties of the Borrower contained in this
Agreement and the other Loan Documents are true, correct and complete as of the
Closing Date; that the Borrower is not in violation of any of the covenants
contained in this Agreement and the other Loan Documents; that, after giving
effect to the transactions contemplated by this Agreement, no Default or Event
of Default has occurred and is continuing; and that the Borrower has satisfied
each of the conditions set forth in this Section.

     (b)   Secretaries' Certificates.  The Agent and each Lender shall have
received a certificate dated as of the Closing Date from the Secretary or an
Assistant Secretary of the Borrower and each Guarantor, in form and substance
satisfactory to the Lenders, certifying: (i) that attached thereto is a true and
complete copy of the bylaws of such corporation as in effect on the date of such
certification; (ii) that attached thereto is a true and complete copy of
resolutions adopted by the Board of Directors and stockholders (if necessary) of
such corporation, authorizing the execution, delivery and performance of this
Agreement and the other Loan Documents, as applicable; and (iii) as to the
incumbency and genuineness of the signature of each officer of such corporation
executing this Agreement or any of the other Loan Documents, as applicable.

     (c)   Articles of Incorporation. The Agent and each Lender shall have
received copies of the articles or certificate of incorporation of the Borrower
and each Guarantor and all amendments thereto, each certified as of a recent
date by the Secretary of State (or other equivalent officer) of its state of
incorporation, together with a certification by the Secretary or an Assistant
Secretary of the Borrower and each Guarantor that such articles of incorporation
have not been amended since such date.
<PAGE>
 
     (d)   Certificates of Good Standing. The Agent and each Lender shall have
received (i) long-form certificates as of a recent date of the good standing of
the Borrower and each Guarantor under the laws of its state of incorporation and
each state where the Borrower and each Guarantor is qualified to transact
business, and (ii) where reasonably available, certificates as of a recent date
from the department of revenue or other appropriate Governmental Authority of
each such state indicating that the Borrower or such Guarantor, as appropriate,
has filed all required tax returns and owes no delinquent taxes.

     (e)   Opinion of Counsel to the Borrower and the Guarantors. The Agent and
each Lender shall have received the favorable opinion of Duane, Morris &
Heckscher, counsel to the Borrower and the Guarantors, addressed to the Agent,
for the benefit of the Lenders, the Issuing Bank and each Lender, in form and
substance satisfactory to the Agent and each Lender.

     (f)   UCC Search. The Agent and each Lender shall have received the results
of a search of all filings made against the Borrower and each Guarantor under
the Uniform Commercial Code as in effect in any state in which any assets of the
Borrower or any Guarantor are located, indicating that the Collateral is free
and clear of any liens or encumbrances except for Permitted Liens.

     (g)   Insurance. The Agent shall have received certificates, and copies of
policies, of insurance, in form and substance satisfactory to the Agent, upon
the Collateral and the business of the Borrower and each Guarantor, with the
mortgagee and loss payable clauses and endorsements required by SECTION 5.7.

     3.2.3 Consents; No Adverse Change.

     (a)   Consents and Approvals. All necessary approvals, authorizations and
consents, if any be required, of any Person and all Governmental Authorities
having jurisdiction with respect to the Collateral and the transactions
contemplated by this Agreement shall have been obtained.

     (b)   No Injunction, Etc. No action, proceeding, investigation, claim,
regulation or legislation shall have been instituted, threatened or proposed
before any court or other Governmental Authority to enjoin, restrain or
prohibit, or to obtain substantial damages in respect of, or that is related to
or arises out of this Agreement or the consummation of the transactions
contemplated hereby or that, in the Required Lenders' discretion, would make
inadvisable the consummation of the transactions contemplated by this Agreement.

     (c)   No Material Adverse Change. Since December 31, 1996, there shall not
have occurred any Material Adverse Change or any event,
<PAGE>
 
condition or state of facts that could reasonably be expected to have a Material
Adverse Effect, other than as specifically contemplated by this Agreement and
the other Loan Documents.

     (d)   Event of Default. No Default or Event of Default shall have occurred
and be continuing.

     3.2.4 Financial Matters.

     (a)   Financial Statements. The Lenders shall have received the Financial
Statements from the Borrower, in form and substance satisfactory to the Lenders.

     (b)   Projections. The Lenders shall have received the Projections from the
Borrower, together with a certificate of the chief financial officer of the
Borrower as to the assumptions used in preparing the Projections, all in form
and substance satisfactory to the Lenders.

     (c)   Financial Condition Certificate. The Lenders shall have received a
certificate of the Borrower, in form and substance satisfactory to the Lenders,
executed by the chief financial officer of the Borrower, to the effect that on a
consolidated basis the Borrower and each of its Subsidiaries is Solvent as of
the Closing Date, taking into account any rights of contribution that may exist
between the Subsidiaries or between any Subsidiary and the Borrower.

     (d)   Taxes. All taxes, fees and other charges in connection with the
execution, delivery, recording, filing and registration of any of the Loan
Documents shall have been paid by the Borrower.

     3.2.5 Miscellaneous.

     (a)   Account Designation Letter.  The Agent shall have received an Account
Designation Letter, together with written instructions from an authorized 
officer, including wire transfer information, directing payment of the proceeds 
of the initial Loan or Loans to be made hereunder.

     (b)   Disbursement Instructions. The Agent shall have received written
instructions from the Borrower to the Agent directing the payment of any
proceeds of Loans made hereunder that are to be paid on the Closing Date.

     (c)   Proceedings and Documents. The Agent and the Lenders shall have
received copies of all other documents, certificates, opinions, instruments and
other evidence as each may reasonably request, in form and substance
satisfactory to the Agent and the Lenders, with respect to the transactions
contemplated by this Agreement and the taking of all actions in connection
therewith.
<PAGE>
 
     3.3   Conditions to All Loans and Advances. The obligation of the Lenders
to make any Loan hereunder (including any Loans made on the Closing Date) and
the obligation of the Issuing Bank to issue any Letters of Credit are subject to
the continued validity of all Loan Documents and the satisfaction of the
following conditions precedent on the relevant Borrowing Date:

     (a)   Each of the representations and warranties made by the Borrower
contained in ARTICLE IV shall be true and correct on and as of such Borrowing
Date with the same effect as if made on and as of the Borrowing Date, except to
the extent the facts upon which such representation and warranty are based may
be changed as a result of transactions permitted or contemplated hereby and such
representation or warranty relates solely to a prior date; and

     (b)   No Default or Event of Default shall have occurred and be continuing
on the Borrowing Date with respect to such Loan or Letter of Credit or after
giving effect to the Loans to be made or Letters of Credit to be issued on such
Borrowing Date.

     (c)   The security interest in certain Collateral previously pledged to the
Agent, for the benefit of the Lenders, pursuant to the Loan Documents shall
remain in full force and effect.

     3.4   Acquisition Loans. The obligation of the Lenders to make any
Revolving Credit/Term Loan the proceeds of which are requested to be used, in
whole or in part, to pay all or a portion of the purchase price in connection
with a Permitted Acquisition, shall be subject to the following conditions, in
addition to the other conditions precedent set forth in this ARTICLE III:

     (a)   All acquisition agreements and other material agreements and
documents relating to the Permitted Acquisition shall have been fully executed
and, to the extent necessary, recorded or filed with the appropriate
Governmental Authorities;

     (b)   All conditions to the Borrower's and any Subsidiary's obligations
with respect to the Permitted Acquisition shall have been satisfied or waived,
and the Permitted Acquisition shall have been consummated (before or concurrent
with such Loan); and

     (c)   The Permitted Acquisition complies with the provisions of SECTION
5.15.

     3.5   Waiver of Conditions Precedent. If any Lender makes any Loan
hereunder, or if the Issuing Bank issues any Letter of Credit, prior to the
fulfillment of any of the conditions precedent set forth in this ARTICLE III,
the making of such Loan or the issuance of such Letter of Credit shall
constitute only an extension of time for the fulfillment of such condition and
not a waiver thereof, and unless the Required Lenders indicate otherwise in
writing, the Borrower shall thereafter use its best efforts to fulfill each such
<PAGE>
 
condition promptly. No failure by the Borrower to fulfill any such condition
precedent shall constitute a Default or an Event of Default hereunder, except to
the extent any such failure is continuing after the expiration of any period
within which such condition is specifically required to be fulfilled.


                                  ARTICLE IV

                         REPRESENTATIONS AND WARRANTIES

     In order to induce the Lenders to enter into this Loan Agreement, to make
the Loans and to continue to make the Loans, and to induce the Issuing Bank to
issue, and the Lenders to participate in, the Letters of Credit, the Borrower
makes the following warranties and representations to the Agent, the Issuing
Bank and each Lender:

     4.1   Corporate Organization and Power. The Borrower and each Subsidiary
(a) is a corporation duly organized, validly existing and in good standing under
the laws of the jurisdiction set forth opposite its name on SCHEDULE 4.1; (b) is
qualified to do business and is in good standing in every other jurisdiction
where the nature of its business or the ownership of its properties requires it
to be so qualified and where the failure to be so qualified would have a
Material Adverse Effect, which jurisdictions are set forth on SCHEDULE 4.1; (c)
except as set forth on SCHEDULE 4.1, has no Subsidiaries or Affiliates (other
than its officers, directors and shareholders) and is not a partner or joint
venturer in any partnerships or joint ventures; (d) has the corporate power to
own and give a lien on and security interest in its respective Collateral and to
engage in the transactions contemplated hereby; and (e) has the full corporate
power, authority and legal right to execute and deliver this Agreement and the
other Loan Documents to which it is a party and to perform and observe the terms
and provisions thereof. Neither the Borrower nor any of its Subsidiaries has,
during the preceding five (5) years, been known as or used any other corporate,
fictitious or trade names in the United States other than as set forth on
SCHEDULE 4.1.

     4.2   Litigation; Government Regulation. Except as set forth in SCHEDULE
4.2, (a) there are no material actions, suits, investigations or proceedings
pending (pursuant to which the Borrower or any Subsidiary has been served) or,
to the knowledge of the Borrower, threatened against or affecting the Borrower
or any Subsidiary or its business, or that question the validity of this
Agreement or any of the Loan Documents, at law or in equity before any court,
arbitrator or Governmental Authority, and (b) neither the Borrower nor any
Subsidiary is in violation of or in default under any Requirement of Law where
such violation could have a Material Adverse Effect.
<PAGE>
 
     4.3   Taxes. Except as set forth in SCHEDULE 4.3, neither the Borrower nor
any Subsidiary is delinquent in the payment of any taxes that have been levied
or assessed by any Governmental Authority against it or its assets. Except as
set forth in SCHEDULE 4.3, the Borrower and each Subsidiary (a) has timely filed
all tax returns that are required by law to be filed prior to the date hereof,
and has paid all taxes shown on said returns and all other assessments or fees
levied upon it or upon its properties to the extent that such taxes, assessments
or fees have become due, and if not due, such taxes have been adequately
provided for and sufficient reserves therefor established on its books of
account, and (b) is current with respect to payment of all federal and state
withholding taxes, social security taxes and other payroll taxes.

     4.4   Enforceability of Loan Documents; Compliance With Other Instruments.
Each of the Loan Documents to which the Borrower or any Guarantor is a party, as
the case may be, has been duly authorized by all necessary corporate action on
the part of the Borrower or such Guarantor, has been validly executed and
delivered by the Borrower or such Guarantor and is the legal, valid and binding
obligation of the Borrower or such Guarantor, enforceable against the Borrower
or such Guarantor in accordance with its terms. Except as set forth in SCHEDULE
4.4, neither the Borrower nor any Subsidiary is in default in any material
respect with respect to any indenture, loan agreement, mortgage, lease, deed or
similar agreement related to the borrowing of monies to which it is a party or
by which it, or any of its property, is bound. Neither the execution, delivery
or performance of the Loan Documents by the Borrower and the Guarantors, nor
compliance by the Borrower and the Guarantors therewith: (a) conflicts or will
conflict with or results or will result in any breach of, or constitutes or will
constitute with the passage of time or the giving of notice or both, a default
under, (i) any Requirement of Law or (ii) any agreement or instrument to which
the Borrower or any Guarantor is a party or by which it, or any of its property,
is bound or (b) results or will result in the creation or imposition of any
lien, charge or encumbrance upon the properties of the Borrower or any
Subsidiary pursuant to any such agreement or instrument, except for Permitted
Liens.

     4.5   Governmental Authorization.

     (a)   No authorization, consent or approval of, notice to, or declaration
or filing with, any Governmental Authority is required for the valid execution,
delivery and performance by the Borrower or any Guarantor of the Loan Documents
to which it is a party or the consummation by the Borrower or any Guarantor of
the transactions contemplated thereby. The Borrower and each Subsidiary has, and
is in good standing with respect to, all material licenses, approvals, permits,
certificates, inspections, consents and franchises of Governmental Authorities
and other Persons necessary to continue to conduct its business as heretofore
conducted and to own or lease and operate its respective properties
<PAGE>
 
as now owned or leased by it. None of such licenses, approvals, permits,
certificates, consents, or franchises contains any term, provision, condition or
limitation more burdensome than such as are generally applicable to Persons
engaged in the same or similar business as the Borrower or such Subsidiary.
Without limitation of the foregoing, the Borrower and each Subsidiary has, to
the extent applicable, (i) obtained (or been duly assigned) all required
certificates of need or determinations of need, as required by the relevant
state Governmental Authority, for the acquisition, construction, expansion of,
investment in or operation of its businesses as currently operated; (ii)
obtained and maintains Medicare Certification; and (iii) entered into and
maintains in good standing its Medicaid Provider Agreement.

     4.6   Event of Default. No Default or Event of Default has occurred and is
continuing.

     4.7   Margin Securities. None of the proceeds of the Loans will be used,
directly or indirectly, for the purpose of purchasing or carrying any "margin
stock," as such term is defined in Regulation U, or for the purposes of
maintaining, reducing or retiring any Debt originally incurred to purchase or
carry margin stock or for any other purpose that might constitute the
transactions contemplated herein a "purpose credit" within the meaning of
Regulation U, Regulation X or Regulation G or any other regulations of the Board
of Governors of the Federal Reserve System, as in effect from time to time.

     4.8   Full Disclosure. None of (i) the Loan Documents, (ii) any document,
report or other correspondence filed with the Securities and Exchange Commission
or distributed to the Borrower's stockholders pursuant to the requirements of
the Exchange Act, or (iii) any statements furnished to the Agent or any Lender
by or on behalf of the Borrower or any Subsidiary in connection with the Loan
Documents, contains any untrue statement of a material fact or, to the
Borrower's knowledge, omits to state a material fact necessary to make the
statements contained therein or herein, in light of the circumstances under
which they were made, not misleading. To the Borrower's knowledge, there is no
fact that the Borrower or any other Person has not disclosed to the Agent or the
Lenders that may result in a Material Adverse Effect.

     4.9   Principal Places of Business. SCHEDULE 4.9 lists the chief executive
office and principal place of business, as provided in the Uniform Commercial
Code, of the Borrower and each Subsidiary as of the Closing Date.

     4.10  ERISA; Employee Benefits.

     (a)   SCHEDULE 4.10 (i) lists, as of the Closing Date, all Employee Plans
and Pension Plans ("Plans") maintained or sponsored by the Borrower and its
Subsidiaries or to which the Borrower or 
<PAGE>
 
any Subsidiary is obligated to contribute and (ii) separately identifies all
Qualified Plans (as defined below) and all Multiemployer Plans.

     (b)   Each such Plan is in compliance in all material respects (or may be
brought into compliance without a Material Adverse Effect) with the applicable
provisions of ERISA, the Internal Revenue Code and other federal or state law,
including all requirements under the Internal Revenue Code or ERISA for filing
reports (which are true and correct in all material respects as of the date
filed), and benefits have been paid in accordance with the provisions of each
such Plan.

     (c)   The form of each Plan intended to be qualified under Section 401 of
the Internal Revenue Code ("Qualified Plan") in the opinion of Borrower
qualifies under Section 401 of the Internal Revenue Code, and the trusts created
thereunder are, in the opinion of the Borrower, exempt from tax under the
provisions of Section 501 of the Internal Revenue Code, and to the knowledge of
the Borrower nothing has occurred that would cause the loss of such
qualification or tax-exempt status.

     (d)   There is no outstanding liability under Title IV of ERISA with
respect to any Plan maintained or sponsored by the Borrower and its Subsidiaries
(as to which the Borrower or any Subsidiary is or may be liable), nor with
respect to any Plan to which the Borrower or any Subsidiary (wherein the
Borrower or any Subsidiary is or may be liable) contributes or is obligated to
contribute.

     (e)   None of the Qualified Plans subject to Title IV of ERISA has any
unfunded benefit liability (as to which the Borrower or any Subsidiary is or may
be liable).

     (f)   No Plan maintained or sponsored by the Borrower or any Subsidiary
provides medical or other welfare benefits or extends coverage relating to such
benefits beyond the date of a participant's termination of employment with the
Borrower or such Subsidiary, except to the extent required by Section 4980B of
the Internal Revenue Code and at the sole expense of the participant or the
beneficiary of the participant to the fullest extent permissible under such
Section of the Internal Revenue Code. The Borrower and its Subsidiaries have
complied in all material respects with the notice and continuation coverage
requirements of Section 4980B of the Internal Revenue Code.

     (g)   No ERISA Event has occurred or is reasonably expected to occur with
respect to any Plan maintained or sponsored by the Borrower and its Subsidiaries
or to which the Borrower or any Subsidiaries is obligated to contribute.

     (h)   As of the Closing Date, there are no pending or, to the knowledge of
the Borrower, threatened claims, actions or lawsuits, 
<PAGE>
 
other than routine claims for benefits in the usual and ordinary course,
asserted or instituted against (i) any Plan maintained or sponsored by the
Borrower and its Subsidiaries or their assets, or (ii) any fiduciary with
respect to any Plan for which the Borrower or any Subsidiary may be directly or
indirectly liable, through indemnification obligations or otherwise.

     (i)   Neither the Borrower nor any Subsidiary has incurred or, to the
knowledge of the Borrower, reasonably expects to incur (i) any liability (and no
event has occurred that, with the giving of notice under Section 4219 of ERISA,
would result in such liability) under Section 4201 or 4243 of ERISA with respect
to a Multiemployer Plan or (ii) any liability under Title IV of ERISA (other
than premiums due and not delinquent under Section 4007 of ERISA) with respect
to a Plan.

     (j)   Neither the Borrower nor any Subsidiary has engaged, directly or
indirectly, in a non-exempt prohibited transaction (as defined in Section 4975
of the Internal Revenue Code or Section 406 of ERISA) in connection with any
Plan that has a Material Adverse Effect.

     4.11  Subsidiaries.  SCHEDULE 4.11 contains a complete and accurate list of
the Subsidiaries of the Borrower as of the Closing Date, showing, as to each
Subsidiary, the number of shares of each class of capital stock authorized and
outstanding. Except as set forth on SCHEDULE 4.11, all of such issued and
outstanding shares of capital stock of all of the Borrower's Subsidiaries have
been duly authorized and validly issued, are fully paid and nonassessable and
are owned by the Borrower, free and clear of any liens, charges, encumbrances,
security interests, claims or restrictions of any nature whatsoever, except for
liens in favor of the Agent, for the benefit of the Lenders, granted under the
Loan Documents, and there are no other equity securities of any Subsidiary
issued and outstanding or reserved for any purpose.

     4.12  Financial Statements. The Financial Statements delivered to the
Lenders have been prepared by the Borrower and its Subsidiaries and, in the case
of the annual Financial Statements, audited in accordance with Generally
Accepted Accounting Principles by Coopers & Lybrand, independent certified
public accountants, contain no material misstatement or omission and fairly
present the financial position, assets and liabilities of the Borrower and its
Subsidiaries on a consolidated basis as of the respective dates thereof and the
consolidated results of operations of the Borrower and its Subsidiaries for the
respective periods then ended.  Since December 31, 1996, there has been no 
Material Adverse Change. 

     4.13  Title to Assets. Except as set forth on SCHEDULE 4.13, (a) the
Borrower and each Subsidiary holds interests as lessee under leases in full
force and effect with respect to all leased real and personal property used in
connection with its business, 
<PAGE>
 
and has good and indefeasible title to the Collateral and the other assets owned
by it that are reflected in the most recent Financial Statements, in each case
free and clear of all liens, claims, security interests and encumbrances except
Permitted Liens; and (b) no financing statement that names the Borrower or any
Subsidiary as debtor has been filed and is still in effect or has been
authorized to be filed, other than financing statements evidencing Permitted
Liens.

     4.14  Solvency.  The Borrower and each Subsidiary (i) is Solvent, and (ii)
after giving effect to the transactions contemplated hereby, will be Solvent.

     4.15  Use of Proceeds. The Borrower's use of the proceeds of any Loans made
by the Lenders to the Borrower pursuant to this Agreement are and will be legal
and proper corporate uses, duly authorized by the Board of Directors of the
Borrower, and such uses are and will be consistent with all applicable laws and
statutes, as in effect from time to time.

     4.16  Assets for Conduct of Business. The Borrower and each Subsidiary
possesses adequate assets, licenses and trade names to continue to conduct its
business as heretofore conducted without any material conflict with the rights
of other Persons.

     4.17  Compliance With Laws. The Borrower and each Subsidiary has duly
complied with, and the Collateral and their business operations and leaseholds
are in compliance in all material respects with, all Requirements of Law,
including, without limitation, all federal and state securities laws, OSHA,
Titles XVIII and XIX of the Social Security Act (42 U.S.C. (S)(S) 1395 et seq.
and (S)(S) 1396 et seq., respectively, as amended from time to time), the
Bloodborne Pathogens Standard, the Medicare Regulations and the Medicaid
Regulations, other than those the failure to comply with which would not have
a Material Adverse Effect.

     4.18  Environmental Matters.

     (a)   All activities and operations of the Borrower and its Subsidiaries
are in material compliance with all applicable Environmental Laws.

     (b)   Neither the Borrower nor any Subsidiary is involved in any suit or
proceeding or has received any notice from any Governmental Authority with
respect to a release of Hazardous Substances or has received notice of any
claims from any Person relating to personal injuries from exposure to Hazardous
Substances.




<PAGE>
 
     (c)   The Borrower and each Subsidiary has timely filed all reports
required to be filed, has acquired all necessary certificates, approvals and
permits and has generated and maintained in all material respects all required
data, documentation and records under all applicable Environmental Laws.

     (d)   Neither the Borrower nor any Subsidiary has ever sent a Hazardous
Substance to a site that, pursuant to any Environmental Law, (1) has been placed
on the "National Priorities List" or "CERCLIS List" of hazardous waste sites (or
any similar state list) or (2) that is subject to a claim, an administrative
order or other request to take "removal" or "remedial" action (as defined under
CERCLA) or to pay for the costs of cleaning up such a site.

     4.19  Projections. Prior to the date hereof, the Borrower has delivered to
the Lenders projected financial statements of the Borrower and its Subsidiaries
(the "Projections"). The Projections have been prepared by the executive and
financial personnel of the Borrower in light of the past business of the
Borrower and its Subsidiaries and on the basis of the assumptions that are set
forth therein, and give effect to the transactions contemplated by this
Agreement. The Projections have been prepared in good faith, have a reasonable
basis and represent the good faith opinion of the Borrower and senior management
of the Borrower as to the projected results of the operations of the Borrower
and its Subsidiaries, on a consolidated basis.

     4.20  First Priority. Except for Permitted Liens, when the initial Loans
are made hereunder, this Agreement, together with the other Loan Documents, will
create valid and perfected first priority security interests and liens in and
upon the Collateral covered thereby, in each case enforceable against the
Borrower or such Subsidiary and all other Persons in all relevant jurisdictions
and securing the payment of all Obligations purported to be secured thereby.

     4.21  Contracts; Labor Disputes. Neither the Borrower nor any Subsidiary is
a party to any contract or agreement, or subject to any charge, corporate
restriction, judgment, injunction, decree, rule, regulation or order of any
court or other Governmental Authority, that has or could reasonably be expected
to have a Material Adverse Effect. Neither the Borrower nor any Subsidiary is a
party to, and there is not pending or, to the Borrower's knowledge, threatened,
any labor dispute, strikes, lock-out, grievance, work stoppage or walkouts
relating to any labor contract to which the Borrower or any Subsidiary is a
party.

     4.22  Insurance. SCHEDULE 4.22 accurately summarizes all insurance policies
or programs of the Borrower and its Subsidiaries in effect as of the Closing
Date, and indicates the insurer's name, policy number, expiration date, amount
of coverage, type of 
<PAGE>
 
coverage, annual premiums, exclusions and deductibles, and also indicates any
self-insurance program that is in effect.

     4.23  Reimbursement from Third Party Payors. The Accounts of the Borrower
and its Subsidiaries have been and will continue to be adjusted to reflect
reimbursement policies of third party payors such as Medicare, Medicaid, Blue
Cross/Blue Shield, private insurance companies, health maintenance
organizations, preferred provider organizations, alternative delivery systems,
managed care systems and other third party payors. In particular, Accounts
relating to such third party payors do not and shall not exceed amounts the
Borrower and its Subsidiaries are entitled to receive under any capitation
arrangement, fee schedule, discount formula, cost-based reimbursement or other
adjustment or limitation to the usual charges of the Borrower and its
Subsidiaries.

     4.24  Fraud and Abuse. Neither the Borrower nor any Subsidiary, nor any of
their respective stockholders, officers or directors have engaged on behalf of
Borrower or any Subsidiary in any activities that are prohibited under the
federal Medicare and Medicaid statutes, 42 U.S.C. (S) 1320a-7b, or the
regulations promulgated pursuant to such statutes or related state or local
statutes or regulations, including but not limited to the following: (i)
knowingly and willfully making or causing to be made a false statement or
representation of a material fact in any applications for any benefit or
payment; (ii) knowingly and willfully making or causing to be made any false
statement or representation of a material fact for use in determining rights to
any benefit or payment; (iii) failing to disclose knowledge by a claimant of the
occurrence of any event affecting the initial or continued right to any benefit
or payment on its own behalf or on behalf of another, with intent to secure such
benefit or payment fraudulently; (iv) knowingly and willfully soliciting or
receiving any remuneration (including any kickback, bribe or rebate), directly
or indirectly, overtly or covertly, in cash or in kind or offering to pay such
remuneration (a) in return for referring an individual to a Person for the
furnishing or arranging for the furnishing of any item or service for which
payment may be made in whole or in part by Medicare, Medicaid or other
applicable third party payors, or (b) in return for purchasing, leasing or
ordering or arranging for or recommending the purchasing, leasing or ordering of
any good, facility, service, or item for which payment may be made in whole or
in part by Medicare, Medicaid or other applicable third party payors. With
respect to this Section, knowledge by an individual director or officer of the
Borrower or a Subsidiary of any of the events described in this Section shall
not be imputed to the Borrower or such Subsidiary unless such knowledge was
obtained or learned by the director or officer in his or her official capacity
as a director or officer of the Borrower or such Subsidiary. No activity of the
Borrower or any Subsidiary shall be considered to be a breach of this Section,
except in the case of a knowing and willful violation thereof, until the
Borrower 
<PAGE>
 
or such Subsidiary has received notification, written or oral, by a Governmental
Authority of competent jurisdiction as to any such violation.

     4.25  Single Business Enterprise. The Borrower and the Guarantors have
historically operated as, and intend to continue operating as, a single business
enterprise. Although separate entities, the Borrower and the Guarantors operate
under a common business plan. Each of the Borrower and the Guarantors will
accordingly benefit from the financing arrangement established by this
Agreement. The Borrower acknowledges that, but for the agreement by each
Guarantor to execute and deliver the Guaranty Documents, the Borrower would not
have qualified separately for the total amount of the credit facilities
established hereby.


                                  ARTICLE V

                             AFFIRMATIVE COVENANTS

     Until payment in full of all Obligations and the termination of the
Lenders' obligation to make Loans and the Issuing Bank's obligation, on behalf
of the Lenders, to issue Letters of Credit, the Borrower covenants and agrees
that:

     5.1   Repayment of Obligations. The Borrower will repay the Obligations
when due, whether due by maturity, acceleration of maturity or otherwise,
including, without limitation, the amounts due under the Revolving Credit/Term
Notes, according to the terms of this Agreement and the other Loan Documents.

     5.2   Performance Under Loan Documents. The Borrower will perform, and will
cause each of its Subsidiaries to perform, all obligations required to be
performed by it under the terms of this Agreement and the other Loan Documents
and any other agreements now or hereafter existing or entered into between the
Borrower or any of its Subsidiaries and the Lenders (or the Agent on their
behalf).

     5.3   Financial and Business Information about the Borrower. The Borrower
shall deliver to the Agent and the Lenders:

     (a)   Within forty-five (45) days after the close of each of the first
three fiscal quarters of each fiscal year of the Borrower, beginning with the
current fiscal quarter, an unaudited consolidated balance sheet of the Borrower
and its Subsidiaries as of the close of such fiscal quarter and unaudited
consolidated statements of income, retained earnings and cash flows for the
Borrower and its Subsidiaries for the fiscal quarter then ended and for that
portion of the fiscal year then ended, all prepared in accordance with Generally
Accepted Accounting Principles (subject to the absence of notes required by
Generally Accepted Accounting Principles and subject to normal and reasonable
year-end audit 
<PAGE>
 
adjustment) applied on a basis consistent with that of the preceding quarter or
containing disclosure of the effect on the financial position or results of
operation of any change in the application of accounting principles and
practices during the quarter, and certified by the Vice President - Finance of
the Borrower to be true and accurate in all material respects (subject to normal
and reasonable year-end audit adjustment);

     (b)   Within one hundred (100) days after the close of each fiscal year of
the Borrower, beginning with the current fiscal year, an audited consolidated
and unaudited consolidating balance sheet of the Borrower and its Subsidiaries
as of the close of such fiscal year and audited consolidated and unaudited
consolidating statements of operations, retained earnings and cash flows for the
Borrower and its Subsidiaries for the fiscal year then ended, including the
notes to each, prepared by Coopers & Lybrand or any other independent certified
public accountant acceptable to the Required Lenders, in accordance with
Generally Accepted Accounting Principles applied on a basis consistent with that
of the preceding year or containing disclosure of the effect on the financial
position or results of operation of any change in the application of accounting
principles and practices during the year, and accompanied by a report thereon by
such certified public accountants, containing an opinion that is not qualified
with respect to scope limitations imposed by the Borrower or its Subsidiaries or
with respect to accounting principles followed by the Borrower or its
Subsidiaries not in accordance with Generally Accepted Accounting Principles;

     (c)   Concurrently with the delivery of the financial statements described
in subsection (B) above, a report from the independent certified public
accountant that in making its audit of the consolidated financial statements of
the Borrower and its Subsidiaries, that nothing came to their attention
regarding any Event of Default, or Default under SECTIONS 6.9 through 6.16 as of
December 31 of the fiscal year subject to audit or a statement specifying the
nature and period of existence of any such Default or Event of Default disclosed
by their examination, it being understood that such audit was not performed
primarily for the purpose of obtaining knowledge of noncompliance with this
Agreement or the Loan Documents;

     (d)   Concurrently with the delivery of the financial statements described
in subsections (A) and (B) above, a Compliance Certificate with respect to the
period covered by the financial statements then being delivered, attaching an
Interest Rate Calculation Worksheet and a Covenant Compliance Worksheet
reflecting the computation of the financial covenants set forth in ARTICLE VI as
of the last day of the period covered by such financial statements;

     (e)   As soon as practicable and in any event within thirty (30) days after
the close of each fiscal year of the Borrower, 
<PAGE>
 
beginning with the current fiscal year, an annual operating budget and capital
budget prepared on a quarterly basis for the Borrower and its Subsidiaries on a
consolidated basis, in form and detail acceptable to the Agent;

     (f)   Promptly upon their becoming available, copies of (i) all financial
statements, reports, notices and proxy statements that the Borrower or any
Subsidiary shall send or make available generally to its stockholders, (ii) all
regular, periodic and special reports, registration statements and prospectuses
that the Borrower or any Subsidiary shall render to or file with the Securities
and Exchange Commission, the National Association of Securities Dealers or any
national securities exchange, (iii) all material reports and other statements
(other than routine reports prepared in the ordinary course of business that
would not result in any adverse action) that the Borrower or any Subsidiary may
render to or file with any other Governmental Authority, including, without
limitation, HCFA, the Environmental Protection Agency, OSHA and state
environmental and health authorities and agencies, (iv) all press releases and
other statements that the Borrower or any Subsidiary shall make available
generally to the public concerning developments in the business of the Borrower
or any of its Subsidiaries, other than press releases or statements issued in
the ordinary course of business, and (v) all material consulting reports and
other similar business reports that the Borrower or any Subsidiary shall request
of any Person from time to time, other than routine reports received in the
ordinary course of business;

     (g)   Promptly after review by the Borrower's Board of Directors, but in
any event within thirty (30) days after the Borrower's receipt thereof, copies
of any management letters from certified public accountants;

     (h)   Concurrently with each delivery of the financial statements described
in Subsections (a) and (b) an aging of the accounts receivable of the Borrower
and its Subsidiaries by payor class as of the end of such fiscal quarter;

     (i)   Concurrently with the delivery thereof or immediately (but not more
than three (3) Business Days after receipt) upon the receipt thereof, copies of
any notices to or from the trustee or the noteholders delivered pursuant to the
Indenture.

     (j)   Upon the Agent's or any Lender's request, such other information
about the Collateral or the financial condition and operations of the Borrower
and its Subsidiaries as the Agent or any Lender may from time to time reasonably
request.

     5.4   Notice of Certain Events. The Borrower shall promptly, but in no
event later than five (5) Business Days after the Borrower obtains knowledge
thereof, give written notice to the Agent and the Lenders of:
<PAGE>
 
     (a)  Any litigation or proceeding brought against the Borrower or any
Subsidiary that could reasonably be expected to have a Material Adverse Effect;

     (b)  Any written notice of a violation received by the Borrower or any
Subsidiary from any Governmental Authority that, if such violation were
established and not promptly corrected, could reasonably be expected to have a
Material Adverse Effect;

     (c)  Any attachment, judgment, lien, levy or order in excess of $100,000
that may be placed on, assessed against or threatened against the Borrower or
any Subsidiary or any of the Collateral, except for Permitted Liens;

     (d)  Any Default or Event of Default;

     (e)  Any material default or event of default under any agreement or
instrument to which the Borrower or any Subsidiary is a party or by which the
Borrower or any Subsidiary, or any of their respective property, is bound, the
termination of which could reasonably be expected to have a Material Adverse
Effect; and

     (f)  Any other matter that has resulted in a Material Adverse Change.

     5.5  Corporate Existence and Maintenance of Properties. The Borrower shall,
and shall cause each of its Subsidiaries to:

     (a)  Maintain and preserve in full force and effect its corporate
existence, except as otherwise permitted by Section 6.1, and all material
rights, privileges and franchises;

     (b)  Conduct its business in an orderly and efficient manner, keep its
properties in good working order and condition (normal wear and tear excepted)
and from time to time make all needed repairs to, renewals of or replacements of
its properties (except to the extent that any of such properties are obsolete or
are being replaced) so that the efficiency of its business operations shall be
fully maintained and preserved; and

     (c)  File or cause to be filed in a timely manner all reports,
applications, estimates and licenses required by any Governmental Authority
that, if not timely filed, could reasonably be expected to have a Material
Adverse Effect.

    5.6   Payment of Debt.  The Borrower shall, and shall cause each of its
Subsidiaries to, pay all Debt when due and all other obligations in accordance
with customary trade practices.
<PAGE>
 
     5.7  Maintenance of Insurance.

     (a)  The Borrower shall, and shall cause each of its Subsidiaries to,
maintain and pay for insurance on its properties, assets and business, now owned
or hereafter acquired, against such casualties, risks and contingencies, and in
such types and amounts and with such insurance companies, as shall be
satisfactory to the Agent (and in any event in such amounts as shall be adequate
to cover the Collateral), and deliver certificates and policies of such
insurance to the Agent with satisfactory standard loss payable endorsements
naming the Agent as loss payee, additional insured and mortgagee thereunder, as
appropriate.

     (b)  Each such policy of insurance shall contain a clause requiring the
insurer to give not less than ten (10) days prior written notice to the Agent
before any cancellation of the policies due to nonpayment and not less than
thirty (30) days prior written notice before any cancellation of the policies
for any other reason whatsoever, and a clause that the interest of the Agent
shall not be impaired or invalidated by any act or neglect of the Borrower or
any Subsidiary or the owner of the property nor by the occupation of the
premises wherein such property is located for purposes more hazardous than are
permitted by such policy. The Borrower hereby directs, and will cause each of
its Subsidiaries to direct, all insurers under policies of property and casualty
insurance on the Collateral to pay all proceeds payable thereunder for losses in
excess of $250,000 per occurrence directly to the Agent. The Agent, on behalf of
the Lenders, shall hold all such proceeds for the account of the Borrower and
its Subsidiaries. So long as no Default or Event of Default has occurred and is
continuing, the Agent shall, at the Borrower's request, disburse such proceeds
as payment for the purpose of replacing or repairing destroyed or damaged
assets, as and when required to be paid and upon presentation of evidence
satisfactory to the Agent of such required payments and such other documents as
the Agent may reasonably request, or shall apply such proceeds in whole or in
part as a prepayment of the Loans, in such order as the Borrower may determine.
Upon and during the continuance of a Default or Event of Default, the Agent
shall apply such proceeds as a prepayment of the Revolving Credit/Term Loans in
accordance with Section 2.5(a). The Borrower hereby irrevocably makes,
constitutes and appoints the Agent (and all officers, employees or agents
designated by the Agent) as its true and lawful attorney (and agent-in-fact) for
the purpose of making, settling and adjusting claims under such policies of
insurance, endorsing its name or the name of any Subsidiary on any check, draft,
instrument or other item or payment for the proceeds of such policies of
insurance and for making all determinations and decisions with respect to such
policies of insurance.

     (c)  If the Borrower or any Subsidiary fails to obtain and maintain any of
the policies of insurance required to be maintained 
<PAGE>
 
hereunder or to pay any premium in whole or in part, then the Agent may, at the
Borrower's expense, without waiving or releasing any obligation or Default by
the Borrower hereunder, procure the same, but shall not be required to do so.
All sums so disbursed by the Agent, including reasonable attorneys' fees, court
costs, expenses and other charges related thereto, shall be payable on demand by
the Borrower to the Lenders and shall be additional Obligations hereunder,
secured by the Collateral.

     (d)   Upon the reasonable request of the Agent from time to time, the
Borrower shall deliver to the Agent evidence that the insurance required to be
maintained pursuant to this Agreement is in effect.

     5.8   Inspection.  The Borrower shall, and shall cause each of its
Subsidiaries to, permit employees or agents of the Agent (or any Lender, at the
Lenders' expense), at any reasonable time during normal business hours upon
reasonable notice to inspect its properties and to examine or audit its books,
records, reports, accounts and other papers and make copies and memoranda of
them, and to discuss its affairs, finances and accounts with its officers and
employees and, upon notice to the Borrower, the independent public accountants
of the Borrower and its Subsidiaries (and by this provision the Borrower and
each Subsidiary authorizes said accountants to discuss the finances and affairs
of the Borrower or such Subsidiary), all at such reasonable times and as often
as may be reasonably requested without undue interference in the business and
operations of the Borrower and its Subsidiaries.

     5.9   COBRA.  The Employee Plans of the Borrower and its Subsidiaries shall
be operated in such a manner that neither the Borrower nor any Subsidiary will
incur any material tax liability under Section 4980B of the Internal Revenue
Code or any material liability to any qualified beneficiary as defined in
Section 4980B.

     5.10  Payment of Taxes.  The Borrower shall, and shall cause each of its
Subsidiaries to, pay and discharge all taxes, assessments and governmental
charges or levies imposed upon it or upon its income or profits, or upon any
properties belonging to it, prior to the date on which penalties would attach
thereto, and all lawful claims that, if unpaid, might become a lien or charge
upon any of its properties; provided, however, that the Borrower or any
Subsidiary may in good faith by appropriate proceedings and with due diligence
contest any such tax, assessment, charge, levy or claim if the Borrower or such
Subsidiary establishes any reserves reasonably requested by the Agent with
respect thereto in accordance with Generally Accepted Accounting Principles.

     5.11  Compliance with Laws.  The Borrower shall, and shall cause each of
its Subsidiaries to, (i) have all material licenses, permits, certifications,
approvals and authorizations required by Governmental Authorities necessary to
the ownership, occupation or 
<PAGE>
 
use of its properties or the conduct of its business, including, without
limitation, certificates of need, and maintain the same at all times in full
force and effect, and (ii) comply with all Requirements of Law in respect of the
conduct of its business, the ownership of its property and the Collateral,
including, without limitation, Titles XVIII and XIX of the Social Security Act,
Medicare Regulations, Medicaid Regulations, ERISA, OSHA and the Bloodborne
Pathogens Standard, other than those the failure to comply with which would not
have a Material Adverse Effect.

     5.12  Name Change.  The Borrower shall notify the Agent and the Lenders at
least thirty (30) days prior to the effective date of any change of its name or
the name of any Subsidiary, and prior to such effective date the Borrower or
such Subsidiary shall have taken such actions and executed such documents as the
Agent shall reasonably require.

     5.13  Creation or Acquisition of New Subsidiaries.  The Borrower and its
Subsidiaries may from time to time create or acquire new Subsidiaries, provided
that, at any time promptly upon request by the Agent (and in any event, with
respect to any new Subsidiary that is created or acquired in connection with a
Permitted Acquisition or that receives proceeds of any Borrowings, prior to or
concurrently with satisfaction of the conditions set forth in clauses (y) and
(z) of clause (i) below or, if earlier, the consummation of such Permitted
Acquisition), (i) each such new Subsidiary (y) having assets with a gross value
(determined in accordance with Generally Accepted Accounting Principles) in
excess of $25,000, and (z) having commenced the conduct of an active business,
will execute and deliver to the Agent (with sufficient copies for each Lender)
an amendment or supplement to the Guaranty Agreement and such other Guaranty
Documents as may be requested by the Required Lenders, each in form and
substance satisfactory to the Agent, pursuant to which such new Subsidiary shall
become a party thereto, (ii) the Borrower or any Subsidiary that is the parent
of such new Subsidiary, as applicable, will execute and deliver to the Agent
(with sufficient copies for each Lender) an amendment or supplement to the
Pledge Agreement or the Subsidiary Pledge Agreement, in form and substance
satisfactory to the Agent, pursuant to which all of the capital stock or other
ownership interests of such new Subsidiary that is directly or indirectly owned
by the Borrower or such parent Subsidiary shall be pledged to the Agent under
the Pledge Agreement or the Subsidiary Pledge Agreement, together with the
certificates representing such capital stock or other ownership interests and
stock powers duly executed in blank, and (iii) the Borrower will cause each such
new Subsidiary to execute and deliver, and will cause to be delivered, all
documentation of the type described in Sections 3.2.2(b), (c) and (d) as such
new Subsidiary would have had to deliver were it a Subsidiary on the Closing
Date. In addition, with respect to any newly created or acquired Foreign
Subsidiary, the Borrower shall cause to be
<PAGE>
 
delivered an opinion of counsel in form and substance satisfactory to the Agent
and each Lender regarding the due organization of such Foreign Subsidiary and
the due authorization, execution and enforceability of the Loan Documents
related thereto. The Borrower will provide the Agent with written notice 
concurrently with or prior to the creation or acquisition of any new Subsidiary 
that is required to become a Guarantor pursuant to this Section 5.13.

     5.14  Disbursement of Proceeds By the Borrower.

     (a)   The Borrower shall obtain Intercompany Loan Documents with respect to
advances of any portion of the Loans to any Subsidiary and such other amounts
owing from any Subsidiary to the Borrower from time to time, and shall promptly
thereafter grant to the Agent a first priority perfected security interest in
such Intercompany Loan Documents as security for the Obligations. The Borrower
will not be required to obtain a security interest in the assets of such
Subsidiaries to secure any amounts owing under the Intercompany Loan Documents,
nor will the Borrower be required to assign any such intercompany security
interest to the Lenders.

     (b)   Subject to the security interest of the Agent therein under the
Pledge Agreement, the Borrower may assign any Intercompany Loan Documents to RTC
Holdings as a contribution to capital, pursuant to the Assignment Agreement and
in accordance with Section 6.6. In such instance, RTC Holdings need not enter
into any Intercompany Loan Documents as a borrower thereunder in order to
evidence such assignment. For purposes of this Agreement, the receipt and
possession by Mellon, as custodian under the Notification and Consent Agreement
and pursuant to the terms thereof, of any Intercompany Loan Documents assigned
by the Borrower to RTC Holdings, shall be deemed evidence of perfection of the
assignment thereof.

     (c)   Should any Subsidiary become a debtor under the Bankruptcy Code, the
Agent, on behalf of the Lenders, is authorized, but not required, to file proofs
of claim on the Borrower's behalf and vote the rights of the Borrower in any
plan of reorganization. The Agent, on behalf of the Lenders, is further
empowered to demand, sue for, collect and receive every payment and distribution
on such Debt owing to the Borrower in such Subsidiary's bankruptcy proceeding.

     5.15  Certain Acquisitions.  Subject to the provisions of this Section and
the requirements contained in the definition of Permitted Acquisition, and
subject to the other terms and conditions of this Agreement, the Borrower may
from time to time after the Closing Date effect Permitted Acquisitions, provided
that (unless consented to in writing by the Required Lenders):

     (a)   With respect to each Permitted Acquisition financed, in whole or in
part, with the proceeds of Revolving Credit/Term Loans, 
<PAGE>
 
the conditions set forth in Section 2.2(a) shall be satisfied with respect to
all Borrowings comprised of such Revolving Credit/Term Loans;

     (b)   With respect to each Permitted Acquisition, no Default or Event of
Default shall have occurred and be continuing at the time of the consummation of
such Permitted Acquisition or would exist immediately after giving effect
thereto;

     (c)   Not less than five (5) days prior to the consummation of any
Permitted Acquisition with respect to which the Acquisition Amount is
$12,000,000 or more, the Borrower shall have delivered to the Agent (and the
Agent shall provide the Lenders) the following items:

     (i)   a reasonably detailed description of the material terms of such
           Acquisition (including, without limitation, the purchase price and
           method and structure of payment) and of each Person or business that
           is the subject of such Permitted Acquisition (each, a "Target")
           and draft copies of the primary material acquisition documents;

    (ii)   historical financial statements of each Target for the two (2) most
           recent fiscal years available and for any interim periods since the
           most recent fiscal year-end for which such interim statements are
           available;

   (iii)   projected income statements with respect to each Target for the five-
           year period following the consummation of such Permitted Acquisition,
           in reasonable detail, together with any appropriate statement of
           assumptions and pro forma adjustments; and

    (iv)   a certificate executed by the chief financial officer or Vice
           President-Finance of the Borrower setting forth the Borrower's good
           faith calculation of the Acquisition Amount (together with any
           supporting calculations) and further to the effect that, to the best
           of his knowledge, (A) the consummation of such Permitted Acquisition
           will not result in a violation of any provision of this Section 5.15,
           (B) after giving effect to any Borrowings made in connection
           therewith, the Borrower is in covenant compliance with the financial
           covenants contained in Sections 6.9 through 6.16 at the most recent
           calculation period taking into account the Borrowing (such
           calculations to be attached to the certificate) and (C) the Borrower
           believes in good faith that such financial covenants will continue to
           be met for the one-year period following the date of the consummation
           of such Permitted Acquisition (such calculations to be based on the
           projections required by subparagraph (iii) above and attached to the
           certificate).
<PAGE>
 
     (d)   Within forty-five (45) days after the end of each fiscal quarter, the
Borrower will deliver to the Agent (i) with respect to any Permitted Acquisition
during such fiscal quarter, a copy of the fully executed acquisition agreement
(including schedules and exhibits thereto) and (ii) with respect to any
Permitted Acquisition during such fiscal quarter with respect to which the
Acquisition Amount is less than $12,000,000, the items described in clauses (i),
(ii) and (iii) of subsection (C) above, each in form and substance reasonably
satisfactory to the Agent.

     The consummation of each Permitted Acquisition subject to this Section
shall be deemed to be a representation and warranty by the Borrower that all
conditions thereto have been satisfied, that the same is permitted in accordance
with the terms of this Agreement and that the matters certified to by the chief
financial officer of the Borrower in the certificate referred to in subsection
(c)(iv) above are true and correct as of the date such certificate is given,
which representation and warranty shall be deemed to be a representation and
warranty for all purposes hereunder, including, without limitation, for purposes
of Sections 3.3 and 7.1.

     5.16  Foreign Subsidiaries.  Within three (3) months following the Closing 
Date, the Borrower shall cause RTC-Argentina S.A., RTC Buenos Aires S.A. and RTC
Cordoba S.A. to execute and deliver to the Agent valid, binding and enforceable 
Guaranty Agreement and Guaranty Documents, together with opinions of Argentina 
counsel and other Loan Documents required by the Agent with respect thereto.


                                  ARTICLE VI

                               NEGATIVE COVENANTS

     Until payment in full of the Obligations and termination of the Lenders'
obligation to make Loans and the Issuing Bank's obligation, on behalf of the
Lenders, to issue Letters of Credit, the Borrower covenants and agrees that the
Borrower will not, and will not permit any of its Subsidiaries to, individually
or in the aggregate:

     6.1   Merger, Consolidation. Liquidate, wind up or dissolve, or enter into
any consolidation, merger or other combination, or agree to do any of the
foregoing; provided, however, that:

     (i)   the Borrower may merge or consolidate with another Person so long as
           (x) the Borrower is the surviving corporation, (y) if such merger or
           consolidation is in connection with a Permitted Acquisition, the
           applicable conditions of Section 5.15 shall be satisfied and (z)
           immediately after giving effect thereto, no Default or Event of
           Default would exist;
<PAGE>
 
     (ii)  any Subsidiary may merge or consolidate with another Person so long
           as (w) the Person surviving such merger or consolidation is the
           Borrower or a Guarantor, (y) if such merger or consolidation is in
           connection with a Permitted Acquisition, the applicable conditions of
           Sections 5.13 and 5.15 shall be satisfied and (z) immediately after
           giving effect thereto, no Default or Event of Default would exist.

      6.2  Debt.   Create, incur, assume or suffer to exist any Debt other than:

      (i)  Debt incurred pursuant to this Agreement;
 
     (ii)  Subordinated Debt;

    (iii)  accrued expenses, current trade payables and other current
           liabilities arising in the ordinary course of business and not
           incurred through the borrowing of money;

     (iv)  unsecured Debt (x) of any Subsidiary to the Borrower (pursuant to
           Intercompany Loan Documents), (y) of any Subsidiary to a Subsidiary
           and (z) of the Borrower to any Subsidiary, provided that any such
           Debt under this clause (iv) is incurred in the ordinary course of
           business consistent with past practice, is evidenced by one or more
           promissory notes pledged to the Agent pursuant to the Pledge
           Agreement or Subsidiary Pledge Agreement, is payable on demand and is
           fully subordinated in right of payment to the Obligations;

      (v)  Contingent Obligations permitted by Section 6.3; and

     (vi)  other Consolidated Senior Debt (including, without limitation, Debt
           secured by liens described in clauses (e) and (h) of the definition
           of Permitted Liens and Capital Lease Obligations) in an aggregate
           principal amount at any time outstanding not to exceed $20,000,000
           for the Borrower and its Subsidiaries.

      6.3  Contingent Obligations.  Create, incur, assume or suffer to exist any
           Contingent Obligation other than:

      (i)  endorsements of instruments or items of payment for deposit or
           collection in the ordinary course of business;

     (ii)  Contingent Obligations incurred pursuant to the Guaranty Agreements;
<PAGE>
 
    (iii)  customary indemnification obligations of the Borrower and its
           Subsidiaries incurred in connection with Permitted Acquisitions made
           in compliance with Section 5.15;

     (iv)  guarantees by the Borrower of obligations of Subsidiaries under
           leases permitted hereunder;

      (v)  guarantees by the Borrower of any other Debt permitted under 
           Section 6.2; and

     (vi)  other guarantees, not covered in clauses (i) through (v) above, of
           Debt of Domestic Subsidiaries in an aggregate amount not to exceed
           $2,500,000 at any time.

      6.4  Liens and Encumbrances.  Create, assume or suffer to exist any deed
of trust, mortgage or encumbrance, lien (including a lien of attachment,
judgment or execution) or security interest (including the interest of a
conditional seller of goods), securing a charge or obligation, in or on any of
its property, real or personal, whether now owned or hereafter acquired, except
for Permitted Liens.

      6.5  Disposition of Assets.  Sell, lease, transfer, convey or otherwise
dispose of any of its assets or property, including, without limitation, the
Collateral, except for (i) sales of inventory in the ordinary course of
business; (ii) the sale or exchange of used equipment, to the extent the
proceeds of such sale are applied towards, or such equipment is exchanged for,
similar replacement equipment; (iii) dispositions not exceeding $2,000,000 in
the aggregate, for the Borrower and its Subsidiaries, for any fiscal year; (iv)
the assignment of any Intercompany Loan Documents by the Borrower to RTC
Holdings pursuant to the Assignment Agreement; and (v) any sale, lease, transfer
or conveyance from one Subsidiary to another Subsidiary or to the Borrower or
from the Borrower to any, Subsidiary in accordance with Section 6.6, provided
that, (y) immediately after giving effect thereto, no Default or Event of
Default would exist, and (z) with respect to any transfer from the Borrower or a
Guarantor to a Subsidiary that is not a Guarantor, the Borrower shall notify the
Agent and the Lenders thereof and, shall cause the transferee Subsidiary to
comply with the provisions of Section 5.13 as if such transferee Subsidiary were
a new Subsidiary.

     6.6   Transactions with Related Persons.  Except as otherwise permitted by
Sections 5.15, 6.2 and 6.7, directly or indirectly make any loan or advance to,
or purchase, assume or guarantee any Debt to or from, any of its officers,
directors, stockholders or Affiliates, or subcontract any operations to any
Affiliate, or enter into any transaction with any Affiliate, except (a) in the
ordinary course of and pursuant to the reasonable requirements of the Borrower's
or such Subsidiary's business and (b) upon fair and reasonable terms 
<PAGE>
 
no less favorable to the Borrower or such Subsidiary than would obtain in a
comparable arm's-length transaction with a Person not an Affiliate; provided,
however, that the provisions of this Section shall not prohibit the assignment
of any Intercompany Loan Documents by the Borrower to RTC Holdings made in
compliance with subsection (B) above.

     6.7   Restricted Investments.  Purchase, own, invest in or otherwise
acquire, directly or indirectly, any Stock, evidence of indebtedness or other
obligation or security or any interest whatsoever in any other Person, or make
or permit to exist any loans, advances or extensions of credit to, or any
investment in cash or by delivery of property in, any Person, or consummate an
Acquisition, or make a commitment or otherwise agree to do any of the foregoing,
except for (a) investments in Cash Investments, (b) investments in Domestic
Subsidiaries evidenced by the Intercompany Loan Documents, (c) loans and
advances to employees for reasonable travel and business expenses in the
ordinary course of business, (d) prepaid expenses incurred in the ordinary
course of business, (e) trade accounts receivable created in the ordinary course
of business, (f) investments in corporations that are Domestic Subsidiaries in
existence as of the Closing Date or in new Domestic Subsidiaries created or
acquired in compliance with Sections 5.13 and 6.19, (g) Permitted Acquisitions
other than Foreign Acquisitions in compliance with Section 5.15, (h) investments
related to Foreign Acquisitions or in Foreign Subsidiaries in compliance with
Sections 5.13, 5.15 and 6.19 in an aggregate amount for the Borrower and its
Subsidiaries on a consolidated basis not to exceed ten percent (10%) of
Consolidated Net Assets in the aggregate for the most recent fiscal year end at
any time, (i) other investments not covered in clauses (a) through (h) having an
aggregate cost to the Borrower and its Subsidiaries not to exceed $5,000,000 at
any time.

     6.8   Restricted Payments.  Except as set forth on Schedule 6.8, declare or
pay any dividends upon any of its Stock (other than dividends paid in Stock and
dividends paid to the Borrower or by a Subsidiary to another Subsidiary), or
purchase, redeem, retire or otherwise acquire for value other than Stock,
directly or indirectly, any shares of its Stock, any shares of Stock of any
Affiliate or any option, warrant or other right to acquire shares of its Stock
or Stock of any Affiliate, or make any distribution of cash, property or assets
other than Stock among the holders of shares of its Stock.

     6.9   Capital Expenditures.  Make any Capital Expenditure not as part of an
Acquisition if, after giving effect to such Capital Expenditure, (a) the
aggregate amount of all such Capital Expenditures made by the Borrower and its
Subsidiaries (other than Capital Expenditures described in clause (b) below)
during any fiscal year, beginning with the current fiscal year, shall exceed an
amount equal to ten percent (10%) of Consolidated Net Revenue
<PAGE>
 
for such fiscal year, and (b) the amount of all such Capital Expenditures made
by the Borrower and its Subsidiaries associated with the construction and start-
up of the Borrower's laboratory operations shall exceed $10,000,000 in the
aggregate after the Closing Date.

     6.10  Consolidated Net Worth.  Permit Consolidated Net Worth at the end of
any fiscal quarter after the Closing Date, beginning with the current fiscal
quarter, to be less than (i) $125,000,000, increased by 80% of Consolidated Net
Income (if positive) for each full fiscal quarter after the Closing, plus (ii)
                                                                     ----
90% of the positive amount of all increases in capital stock and additional 
paid-in capital from issuances of equity securities or other capital 
investments.

     6.11  Foreign Subsidiary EBITDA.  The Borrower will not permit Foreign 
Subsidiary EBITDA, as of the end of any fiscal quarter, to be less than $1.

     6.12  Cash Available to Fixed Charges.  Permit the ratio of Cash Available
to Fixed Charges at the end of any fiscal quarter to be less than 2.25 to 1.0.

     6.13  Cash Available to Debt Service Ratio.  Permit the ratio of Cash
Available to Debt Service at the end of any fiscal quarter to be less than 1.20
to 1.0.

     6.14  Consolidated Senior Debt to Annualized Cash Flow.  Permit the ratio
of Consolidated Senior Debt to Annualized Cash Flow as of the end of any fiscal
quarter to be greater than 3.0 to 1.0.

     6.15  Consolidated Debt to Annualized Cash Flow.  Permit the ratio of
Consolidated Debt to Annualized Cash Flow as of the end of any fiscal quarter to
be greater than 4.25 to 1.0.

     6.16  Consolidated Debt to Consolidated Total Capital.  Permit the ratio of
Consolidated Debt to Consolidated Total Capital as of the end of any fiscal
quarter to be greater than 0.65 to 1.0.

     6.17  Sale and Leaseback.  Except as set forth in Schedule 6.17, enter into
any arrangement with any Person (other than the Borrower or any Subsidiary,
provided the provisions of Section 6.6 are satisfied) providing for the leasing
by the Borrower or any Subsidiary of any asset that has been sold or transferred
by the Borrower or such Subsidiary to such Person.

     6.18  New Business.  Engage in any business other than the business in
which the Borrower or such Subsidiary is currently engaged or a business
reasonably related thereto, including, without limitation, laboratories
predominately performing dialysis related functions, or make any material change
in any of its 
<PAGE>
 
business objectives, purposes and operations that would be reasonably likely to
materially adversely affect the repayment of the Obligations.

     6.19  Subsidiaries or Partnerships.  (a) Become a partner or joint venturer
in any partnership or joint venture, or (b) create or acquire any new
Subsidiary; provided that the Borrower or any Subsidiary may (i) create or
acquire one or more Subsidiaries in connection with a Permitted Acquisition
consummated in compliance with this Agreement, and (ii) create a Subsidiary de
novo; provided further that, in any such instance, the created or acquired
Subsidiary complies with the provisions of Section 5.13. RTC Holdings 
International will not engage in any activities other than holding the stock of
its operating Subsidiaries and ordinary course administrative functions.

     6.20  Transactions Affecting the Collateral.  Enter into any transaction
that adversely affects the Collateral or the ability of the Borrower to repay
any Debt or the Obligations, commit or allow the commission of any forgiveness
or release of Collateral pursuant to the Intercompany Loan Documents or permit
or agree to any material extension, compromise or settlement or make any
material change or modification of any kind or nature with respect to any
Account.

     6.21  Hazardous Wastes.  Permit any Hazardous Substances the removal of
which is required or the maintenance of which is restricted, prohibited or
penalized by any Governmental Authority, to be unlawfully brought on to any real
property owned or leased by the Borrower or any Subsidiary, or if so brought or
found located thereon, fail to immediately remove such materials, with proper
disposal, in accordance with required cleanup procedures under applicable
Environmental Laws.

     6.22  Fiscal Year.  Change its fiscal year from a December 31 year end.

     6.23  Amendments; Prepayments of Debt, etc.  Except with respect to the
Debt created under the Loan Documents, (a) amend or modify (or permit the
amendment or modification of) any of the terms or provisions of any Debt or any
agreement related thereto (including without limitation, the Indenture) or (b)
make any voluntary or optional payment or prepayment or redemption or
acquisition (other than for Stock) for value of (including, without limitation,
by way of depositing with any trustee with respect thereto money or securities
before due for the purpose of paying when due), or exchange (other than for
Stock), any Debt (including, without limitation, any redemption pursuant to
Article III of the Indenture or any deposit of funds by the Borrower with the
trustee pursuant to Article XIII of the Indenture). Notwithstanding the
foregoing, conversion of the Convertible Notes for Stock (and cash for
<PAGE>
 
fractional shares) in accordance the terms of the Indenture shall be permitted.
  
     6.24  Fraud and Abuse.  Neither the Borrower nor any Subsidiary, nor any of
their respective officers or directors, shall engage on behalf of Borrower or
any Subsidiary in any activities that are prohibited under the federal Medicare
and Medicaid statutes, 42 U.S.C. (S) 1320a-7b, or the regulations promulgated
pursuant to such statutes or related state or local statutes or regulations,
including but not limited to the following: (i) knowingly and willfully making
or causing to be made a false statement or representation of a material fact in
any applications for any benefit or payment; (ii) knowingly and willfully making
or causing to be made any false statement or representation of a material fact
for use in determining rights to any benefit or payment; (iii) failing to
disclose knowledge by a claimant of the occurrence of any event affecting the
initial or continued right to any benefit or payment on its own behalf or on
behalf of another, with intent to secure such benefit or payment fraudulently;
(iv) knowingly and willfully soliciting or receiving any remuneration (including
any kickback, bribe or rebate), directly or indirectly, overtly or covertly, in
cash or in kind or offering to pay such remuneration (a) in return for referring
an individual to a person for the furnishing or arranging for the furnishing of
any item or service for which payment may be made in whole or in part by
Medicare, Medicaid or other applicable third party payors, or (b) in return for
purchasing, leasing or ordering or arranging for or recommending the purchasing,
leasing or order of any good, facility, service, or item for which payment may
be made in whole or in part by Medicare, Medicaid or other applicable third
party payors. With respect to this Section, knowledge by an individual director
or officer of the Borrower or a Subsidiary of any event described in this
Section shall not be imputed to the Borrower or such Subsidiary unless such
knowledge was obtained or learned by the director or officer in his or her
official capacity as a director or officer of the Borrower or such Subsidiary.
Neither the Borrower nor any Subsidiary shall be considered to have breached
this Section, except in the case of a knowing and willful violation thereof,
until the Borrower or such Subsidiary has received notification, written or
oral, by a Governmental Authority of competent jurisdiction as to any such
violation.

     6.25  Limitation on Certain Restrictions.  The Borrower will not, and will
not permit or cause any of its Subsidiaries to, directly or indirectly, create
or otherwise cause or suffer to exist or become effective any restriction or
encumbrance on (i) the ability of the Borrower and its Subsidiaries to perform
and comply with their respective obligations under the Loan Documents or (ii)
the ability of any Subsidiary of the Borrower to make any dividend payments or
other distributions in respect of its Stock, to repay Debt owed to the Borrower
or any other Subsidiary, to make loans or advances to the Borrower or any other
Subsidiary, or to transfer any of its 
<PAGE>
 
assets or properties to the Borrower or any other Subsidiary, in each case other
than such restrictions or encumbrances existing under or by reason of (i) the
Loan Documents, (ii) applicable Requirements of Law, and (iii) customary non-
assignment provisions in any lease governing a leasehold interest.

     6.26  No Other Negative Pledges.  The Borrower will not, and will not
permit or cause any of its Subsidiaries to, directly or indirectly, enter into
or suffer to exist any agreement or restriction that prohibits or conditions the
creation, incurrence or assumption of any Lien upon or with respect to any part
of its properties or assets, whether now owned or hereafter acquired, or agree
to do any of the foregoing, other than as set forth in this Agreement and the
other Loan Documents.

     6.27  Accounting Changes.  The Borrower will not, and will not permit or
cause any of its Subsidiaries to, make or permit any material change in its
accounting policies or reporting practices, except as may be required by
Generally Accepted Accounting Principles.


                                  ARTICLE VII

                               EVENTS OF DEFAULT

     7.1   Events of Default.  The occurrence of any one or more of the
following events shall constitute an "Event of Default":

     (a)   The Borrower fails to pay when due any principal, fees or interest on
the Obligations;

     (b)   The Borrower or any Subsidiary fails or neglects to observe, perform
or comply with any term, provision, condition or covenant contained in SECTIONS
2.14, 5.1, 5.3, 5.4 or 5.5 (A), 5.13, 5.15 or ARTICLE VI;

     (c)   The Borrower or any Subsidiary fails or neglects to observe, perform
or comply with any term, provision, condition or covenant contained herein
except those specified in subsections (A) and (B) above (and except to the
extent that violations of any such provisions or covenants otherwise trigger an
Event of Default under any of the other subparagraphs of this SECTION 7.1,
including, without limitation, violations of SECTION 5.6 to the extent covered
by subparagraph (e) below), and the same is not cured to the Required Lenders'
satisfaction within thirty (30) Business Days after the Borrower or such
Subsidiary acquires knowledge thereof;

     (d)   If any representation or warranty made in writing by or on behalf of
the Borrower or any Subsidiary in this Agreement, in the other Loan Documents or
in any other agreement now existing or hereafter executed between the 
<PAGE>
 
Borrower or any Subsidiary and the Agent or any Lender, or in connection with
the transactions contemplated hereby or thereby, shall prove to have been false
or misleading in any material respect when made;

     (e)   (i) the occurrence of any payment default on the part of the Borrower
or any Subsidiary under the terms of any agreement, document or instrument
pursuant to which the Borrower or such Subsidiary has incurred any Debt
(including, without limitation, the Indenture) having an individual or aggregate
principal amount of greater than $500,000 (other than the Obligations and Debt
under the Intercompany Loan Documents), or (ii) the occurrence of any nonpayment
default or event of default on the part of the Borrower or any Subsidiary under
the terms of any agreement, document or instrument pursuant to which the
Borrower or such Subsidiary has incurred any Debt (including, without
limitation, the Indenture) having an individual principal amount greater than
$1,000,000 or aggregate principal amount greater than $2,500,000 (other than the
Obligations and Debt under the Intercompany Loan Documents);

     (f)   The termination of any agreement, contract or instrument to which a
Borrower or any Subsidiary is a party or by which it or any of its properties
are bound, and such termination results in a Material Adverse Effect;

     (g)   The occurrence of an event of default under any of the Loan Documents
or in any other agreement now existing or hereafter executed evidencing or
securing any of the Obligations;

     (h)   The occurrence of any material uninsured damage to or loss, theft or
destruction of the Collateral or other assets of the Borrower or any Subsidiary
that has a Material Adverse Effect;

     (i)   The filing by the Borrower or any Subsidiary of any voluntary
petition seeking liquidation, reorganization, arrangement, readjustment of debts
or for any other relief under the Bankruptcy Code or under any other act or law
pertaining to insolvency or debtor relief, whether state, federal or foreign,
now or hereafter existing;

     (j)   The filing against the Borrower or any Subsidiary of any involuntary
petition seeking liquidation, reorganization, arrangement, readjustment of debts
or for any other relief under the Bankruptcy Code or under any other act or law
pertaining to insolvency or debtor relief, whether state, federal or foreign,
now or hereafter existing, which petition is not dismissed within sixty (60)
days after the date of filing;

     (k)   A custodian, trustee, receiver or assignee for the benefit of
creditors is appointed or takes possession of the Collateral or any other assets
of the Borrower or any Subsidiary;
<PAGE>
 
          (l)  The Borrower or any of its Subsidiaries (other than an immaterial
     Subsidiary) ceases to be Solvent (taking into account any rights of
     contribution), or ceases to conduct its business as now conducted or is
     enjoined, restrained or in any way prevented by court order from conducting
     all or any material part of its business affairs, except as otherwise
     specifically permitted under SECTION 6.1;

          (m)  A notice of lien, levy or assessment in excess of $500,000 is
     filed of record against any portion of the assets of the Borrower or any
     Subsidiary by the United States, or any department, agency or
     instrumentality thereof, or by any other Governmental Authority, including,
     without limitation, the Pension Benefit Guaranty Corporation, or if any
     taxes or debts owing at any time or times hereafter to any one of them
     becomes a lien or encumbrance (other than a Permitted Lien) upon the
     Collateral or any other asset of the Borrower or any Subsidiary, and the
     same is not dismissed, released or discharged within thirty (30) days after
     the same becomes a lien or encumbrance or, in the case of ad valorem taxes,
     prior to the last day when payment may be made without penalty;

          (n)  The entry of a judgment or the issuance of a warrant of
     attachment, execution or similar process against the Borrower or any
     Subsidiary or any of their respective assets in excess of $500,000 which
     shall not be dismissed, discharged, stayed pending appeal or bonded within
     thirty (30) days after entry or is otherwise covered by insurance;

          (o)  The occurrence of any of the following events: (i) the happening
     of a Reportable Event that could give rise to liability (that is not waived
     by the by the Pension Benefit Guaranty Corporation or by the Required
     Lenders, or if such liability can be avoided by any corrective action of
     the Borrower, such corrective action is not completed within ninety (90)
     days after the occurrence of such Reportable Event) with respect to any
     Pension Plan; (ii) the termination of any Pension Plan in a "distress
     termination" under the provisions of Section 4041 of ERISA; (iii) the
     appointment of a trustee by an appropriate United States District Court to
     administer any Pension Plan; (iv) the institution of any proceedings by the
     Pension Benefit Guaranty Corporation to terminate any Pension Plan or to
     appoint a trustee to administer any such plan; and (v) the failure of the
     Borrower to notify the Lenders promptly upon receipt by the Borrower of any
     notice of the institution of any proceeding or any other actions that may
     result in the termination of any such plan;

          (p)  The Borrower or any Subsidiary, to the extent presently
     participating or required by law to participate, in Medicaid or Medicare
     programs shall fail to be eligible for any reason to participate in
     Medicaid or Medicare programs or to accept assignments or rights to
     reimbursement under Medicaid Regulations
<PAGE>
 
     or Medicare Regulations except in the case where such failure is de minimis
     or immaterial;

          (q)  The occurrence of any Material Adverse Change; or

          (r)  Robert L. Mayer, Jr. shall cease (i) to be the chief executive
     officer of the Borrower, (ii) to perform for the Borrower the normal and
     customary duties of a chief executive officer, or (iii) to be involved in
     the day-to-day operations of the Borrower, unless in any such event the
     Borrower shall have hired a new chief executive officer of comparable skill
     and expertise, reasonably acceptable to the Required Lenders, within ninety
     (90) days of such occurrence; or

          (s)  The occurrence of a Change of Control. 


                                  ARTICLE VIII

                   RIGHTS AND REMEDIES AFTER EVENT OF DEFAULT

          8.1      Remedies: Termination of Commitments, Acceleration, etc. Upon
     and at any time after the occurrence and during the continuance of any
     Event of Default, the Agent shall at the direction, or may with the
     consent, of the Required Lenders, take any or all of the following actions
     at the same or different times:

          (a)  Declare the Commitments of each Lender, and the Issuing Bank's
     obligation to issue Letters of Credit, to be terminated, whereupon the same
     shall terminate (provided that, upon the occurrence of an Event of Default
     pursuant to SECTIONS 7.1(I), (J) or (K), all of the Commitments, together
     with the Issuing Bank's obligation to issue Letters of Credit, shall
     automatically be terminated);

          (b)  Declare all or any part of the outstanding principal amount of
     the Loans, all unpaid interest accrued thereon, and all other amounts
     payable under this Agreement, the Revolving Credit/Term Notes and the other
     Loan Documents to be immediately due and payable, whereupon such
     outstanding principal amounts, accrued interest and other such amounts
     shall become immediately due and payable without presentment, demand,
     protest, notice of intent to accelerate or other notice or legal process of
     any kind, all of which are hereby knowingly and expressly waived by the
     Borrower (provided that, upon the occurrence of an Event of Default
     pursuant to SECTIONS 7.1(I), (J) or (K), all of such outstanding principal
     amounts, accrued interest and other such amounts shall automatically become
     immediately due and payable);

          (c)  Direct the Borrower to deliver (and the Borrower hereby agrees,
     upon receipt of notice of such direction from the Agent, to deliver) to the
     Agent from time to time such additional amount of
<PAGE>
 
     cash as is equal to the aggregate Stated Amount of all Letters of Credit
     then outstanding (whether or not any beneficiary under any Letter of Credit
     shall have drawn or be entitled at such time to draw thereunder), such
     amount to be held by the Agent in the Cash Collateral Account as security
     for the Borrower's Reimbursement Obligations as described in SECTION
     2.17(I); and

          (d)  Exercise all rights and remedies available to it under this
     Agreement, the other Loan Documents and applicable law.

          8.2     Right of Set-off. The Agent and each Lender (and each of their
     Affiliates) may, and are
     hereby authorized by the Borrower, at any time and from time to time, to
     the fullest extent permitted by applicable law, without advance notice to
     the Borrower (any such notice being expressly waived by the Borrower) and
     irrespective of demand for payment, to set off and apply any and all
     deposits (general or special, time or demand, provisional or final) at any
     time held in other than a fiduciary account and any other indebtedness at
     any time owing by such Lender (or any of its Affiliates) to or for the
     credit or the account of the Borrower against any or all of the Obligations
     now or hereafter existing, whether or not such Obligations have matured.
     The Agent agrees to notify the Borrower after any such setoff or
     application, provided that the failure to give such notice shall not affect
     the validity of such set-off and application.

          8.3     Rights and Remedies Cumulative; Non-Waiver; etc. The
     enumeration of the Agent's and the Lenders' rights and remedies set forth
     in this Agreement is not intended to be exhaustive, and the exercise by the
     Agent or any Lender of any right or remedy shall not preclude the exercise
     of any other rights or remedies, all of which shall be cumulative, and
     shall be in addition to any other right or remedy given hereunder, under
     the Loan Documents or under any other agreement between the Borrower or any
     Subsidiary and the Agent or the Lenders or that may now or hereafter exist
     in law or in equity or by suit or otherwise. No delay or failure to take
     action on the part of the Agent or any Lender in exercising any right,
     power or privilege shall operate as a waiver thereof, nor shall any single
     or partial exercise of any such right, power or privilege preclude other or
     further exercise thereof or the exercise of any other right, power or
     privilege or shall be construed to be a waiver of any Event of Default. No
     course of dealing between the Borrower or any Subsidiary and the Agent or
     the Lenders or their agents or employees shall be effective to change,
     modify or discharge any provision of this Agreement or any of the other
     Loan Documents or to constitute a waiver of any Event of Default.
<PAGE>
 
                                  ARTICLE IX

                                   THE AGENT

          9.1     Appointment. The Lenders and the Issuing Bank (for purposes of
this Article, any reference to the Lenders or any Lender shall be deemed also to
include a reference to the Issuing Bank) hereby designate and appoint First
Union as Agent to act as specified herein and in the other Loan Documents. Each
Lender hereby authorizes, and each holder of any Revolving Credit/Term Note by
the acceptance of such Revolving Credit/Term Note shall be deemed to authorize,
the Agent to take such action as agent on its behalf under the provisions of
this Agreement and the other Loan Documents and any other instruments and
agreements referred to herein or therein, and to exercise such powers and to
perform such duties hereunder and thereunder, as are specifically delegated to
or required of the Agent by the terms hereof or thereof and such other powers as
are reasonably incidental thereto. The Agent may execute any of its duties under
this Agreement or any other Loan Document by or through agents or attorneys-in-
fact and shall not be responsible for the negligence or misconduct of any agents
or attorneys-in-fact that it selects with reasonable care.

          9.2     Nature of Duties. The Agent shall have no duties or
responsibilities other than those expressly set forth in this Agreement and the
other Loan Documents. Neither the Agent nor any of its officers, directors,
employees or agents shall be liable for any action taken or omitted by it or
them as such hereunder or under any other Loan Document or in connection
herewith or therewith, unless caused by its or their gross negligence or willful
misconduct. The duties of the Agent shall be mechanical and administrative in
nature; the Agent shall not have by reason of this Agreement or any other Loan
Document a fiduciary relationship in respect of any Lender or the holder of any
Revolving Credit/Term Note; and nothing in this Agreement or any other Loan
Document, express or implied, is intended to or shall be so construed as to
impose upon the Agent any obligations or liabilities in respect of this
Agreement or any other Loan Document except as expressly set forth herein or
therein.

          9.3     Absence of Reliance on the Agent.

          (a)     Each Lender acknowledges that neither the Agent nor any of its
officers, directors, employees or agents has made any representation or warranty
to it and that no act by the Agent hereinafter taken, including any review of
the affairs of the Borrower and its Subsidiaries, shall be deemed to constitute
any representation or warranty by the Agent to any Lender.

          (b)     Each Lender acknowledges that, independently and without
reliance upon the Agent or any other Lender and based on such documents and
information as it has deemed and may deem 
<PAGE>
 
appropriate, (i) it has made its own appraisal of and investigation into the
business, prospects, operations, properties, financial and other condition and
creditworthiness of the Borrower and its Subsidiaries in connection with its
decision to enter into this Agreement and extend credit to the Borrower
hereunder, and (ii) it will continue to make its own credit analysis, appraisals
and decisions in taking or not taking action hereunder.

          (c)     Except as expressly provided in this Agreement, the Agent
shall have no duty or responsibility, either initially or on a continuing basis,
to provide any Lender or the holder of any Revolving Credit/Term Note with any
credit or other information concerning the business, prospects, operations,
properties, financial or other condition or creditworthiness of the Borrower,
its Subsidiaries or any other Person that may come into its possession, whether
before the making of the initial Loans, the participation in the initial Letters
of Loan or at any time or times thereafter.

          (d)     The Agent shall not be responsible to any Lender or the holder
of any Revolving Credit/Term Note for any recitals, statements, information,
representations or warranties herein or in any other Loan Document or in any
document, instrument, certificate or other writing delivered in connection
herewith or therewith or for the execution, effectiveness, genuineness,
validity, enforceability, perfection, priority or sufficiency of this Agreement
or any other Loan Document or the financial condition of the Borrower, its
Subsidiaries or any other Person, or be required to make any inquiry concerning
either the performance or observance of any of the terms, provisions or
conditions of this Agreement or any other Loan Document, or the financial
condition of the Borrower, its Subsidiaries or any other Person or the existence
or possible existence of any Default or Event of Default.

          (e)     The Agent shall be under no obligation or duty to take any
action under this Agreement or any other Loan Document if taking such action (i)
would subject the Agent to a tax in any jurisdiction where it is not then
subject to a tax, (ii) would require the Agent to qualify to do business in any
jurisdiction where it is not then so qualified, unless the Agent receives
security or indemnity satisfactory to it against any tax or other liability in
connection with such qualification or resulting from the taking of such action
in connection therewith or (iii) would subject the Agent to in personam
jurisdiction in any location where it is not then so subject.

          9.4     Certain Rights of the Agent.  If the Agent shall request
instructions from the Required Lenders with respect to any act or action
(including failure to act) in connection with this Agreement or any other Loan
Document, the Agent shall be entitled to refrain from such act or taking such
action unless and until it shall have received such instructions, and the Agent
shall incur no liability 
<PAGE>
 
by reason of so refraining. The Agent shall not be obligated to take any action
hereunder or under any other Loan Document (i) if such action would, in the
reasonable opinion of the Agent, be contrary to applicable law or this Agreement
or the other Loan Documents, (ii) if it shall not receive such advice or
concurrence of the Required Lenders as it reasonably deems appropriate or (iii)
if it shall not first be indemnified to its satisfaction by the Lenders
requesting such action against any and all liability and expense that may be
incurred by it by reason of taking or continuing to take any such action.
Without limiting the foregoing, no Lender or holder of any Revolving Credit/Term
Note shall have any right of action whatsoever against the Agent as a result of
the Agent's acting or refraining from acting hereunder or under any other Loan
Document in accordance with the instructions of the Required Lenders.

          9.5     Notice of Default.  The Agent shall not be deemed to have
knowledge or notice of the occurrence of any Default or Event of Default, other
than any Default or Event of Default arising out of the failure to pay any
principal, interest, fees or other amounts payable to the Agent for the account
of the Lenders, unless the Agent has received written notice from the Borrower
or a Lender describing such Default or Event of Default and stating that such
notice is a "notice of default."  In the event that the Agent receives such a
notice, the Agent shall give notice thereof to the Lenders as soon as reasonably
practicable; provided, however, that if any such notice has also been furnished
to the Lenders, the Agent shall have no obligation to notify the Lenders with
respect thereto.  Each Lender shall promptly give the Agent such a notice upon
its actual knowledge of a Default or an Event of Default; provided, however,
that the failure of any Lender to deliver such notice in the absence of gross
negligence or willful misconduct shall not affect its rights hereunder or under
the other Loan Documents.

          9.6     Reliance by Agent. The Agent shall be entitled to rely, and
shall be fully protected in relying, upon any note, writing, resolution, notice,
statement, consent, certificate, telex, teletype or facsimile message, order or
other documentary, teletransmission or telephone message believed by it in good
faith to be genuine and correct and to have been signed, sent or made by the
proper Person. The Agent may consult with legal counsel (including counsel for
the Borrower), independent public accountants and other experts selected by it
with respect to all matters pertaining to this Agreement and the other Loan
Documents and its duties hereunder and thereunder and shall not be liable for
any action taken or omitted to be taken by it in good faith in accordance with
the advice of such counsel, accountants or experts.

          9.7     Indemnification. To the extent the Agent is not reimbursed by
or on behalf of the Borrower, and without limiting the obligation of the
Borrower to do so, the Lenders will reimburse and indemnify the Agent, in
proportion to their respective percentages 
<PAGE>
 
as used in determining the Required Lenders, from and against any and all
liabilities, obligations, losses, damages, penalties, actions, judgments, suits,
costs, expenses (including attorneys' fees and expenses) or disbursements of any
kind or nature whatsoever that may at any time (including at any time following
the indefeasible repayment in full of the Loans) be imposed on, incurred by or
asserted against the Agent in any way relating to or arising out of this
Agreement or any other Loan Document or the transactions contemplated hereby or
thereby or any action taken or omitted by the Agent under or in connection with
any of the foregoing, and in particular will reimburse the Agent for out-of-
pocket expenses promptly upon demand by the Agent therefor; provided, however,
that no Lender shall be liable for any portion of such liabilities, obligations,
losses, damages, penalties, actions, judgments, suits, costs, expenses or
disbursements finally determined by a court of competent jurisdiction and not
subject to any appeal (or pursuant to arbitration as set forth herein) to have
resulted from the Agent's gross negligence or willful misconduct.

          9.8     The Agent in its Individual Capacity.  With respect to its
Commitments, the Loans made by it and the Revolving Credit/Term Notes issued to
it, the Agent shall have the same rights and powers under the Loan Documents as
any other Lender or holder of a Revolving Credit/Term Note and may exercise the
same as though it were not performing the agency duties specified herein; and
the terms "Lenders," "Required Lenders," "holders of Revolving Credit/Term
Notes" and any similar terms shall, unless the context clearly otherwise
indicates, include the Agent in its individual capacity.  The Agent may accept
deposits from, lend money to and generally engage in any kind of banking, trust,
financial advisory or other business with the Borrower or any of its
Subsidiaries or any of their respective Affiliates as if it were not performing
the agency duties specified herein, and may accept fees and other consideration
from the Borrower for services in connection with this Agreement and otherwise
without having to account for the same to the Lenders.

          9.9     Holders.  The Agent may deem and treat the payee of any
Revolving Credit/Term Note as the holder thereof for all purposes hereof unless
and until a written notice of the assignment, transfer or endorsement thereof,
as the case may be, shall have been filed with the Agent.  Any request,
authority or consent of any Person that, at the time of making such request or
giving such authority or consent, is the holder of any Revolving Credit/Term
Note, shall be conclusive and binding on any subsequent holder, transferee,
assignee or endorsee, as the case may be, of such Revolving Credit/Term Note or
of any Revolving Credit/Term Note or Revolving Credit/Term Notes issued in
exchange therefor.

          9.10    Successor Agent.  The Agent may resign at any time upon
sixty (60) days' prior written notice to the Borrower and the Lenders.  The
Agent may be removed with or without cause by the 
<PAGE>
 
Required Lenders (and, so long as no Default or Event of Default has occurred
and is continuing, with the consent of the Borrower, which consent shall not be
unreasonably withheld), at any time upon sixty (60) days' prior written notice
to the Borrower and the Agent. Such resignation or removal, as the case may be,
shall take effect upon the appointment of a successor Agent as provided
hereinbelow. Upon any such notice of resignation or removal (and, in the case of
removal, upon the consent of the Borrower, if required as provided hereinabove),
the Required Lenders (so long as no Default or Event of Default has occurred and
is continuing, with the consent of the Borrower, which consent shall not be
unreasonably withheld) will appoint from among the Lenders a successor Agent. If
no successor Agent shall have been appointed within such sixty-day period, the
Agent may appoint, after consulting with the Lenders and the Borrower, a
successor agent from among the Lenders, who shall serve as Agent until such
time, if any, as the Required Lenders shall have appointed a successor Agent as
provided hereinabove. Upon the written acceptance of any appointment as Agent
hereunder by a successor Agent, such successor Agent shall thereupon succeed to
and become vested with all the rights, powers, privileges and duties of the
retiring Agent, and the retiring Agent shall be discharged from its duties and
obligations hereunder and under the other Loan Documents. After any retiring
Agent's resignation as Agent, the provisions of this Article shall inure to its
benefit as to any actions taken or omitted to be taken by it while it was Agent.

          9.11    Collateral Matters.

          (a)     The Agent is hereby authorized on behalf of all the Lenders,
without the necessity of any notice to or further consent from the Lenders, from
time to time (but without any obligation) to take any action with respect to the
Collateral, the Pledge Agreement and the Subsidiary Pledge Agreement that may be
necessary to perfect and maintain perfected the liens upon the Collateral
granted pursuant to the Pledge Agreement, the Subsidiary Pledge Agreement or the
other Loan Documents.

          (b)     The Lenders hereby irrevocably authorize the Agent, at its
option and in its discretion, to release any lien granted to or held by the
Agent upon any Collateral (i) upon termination of the Commitments and
indefeasible payment in full of all Obligations, (ii) constituting property sold
or to be sold or disposed of as part of or in connection with a disposition
permitted hereunder, (iii) constituting property in which neither the Borrower
nor any Subsidiary owned any interest at the time such lien was granted or at
any time thereafter or (iv) if approved, authorized or ratified in writing by
the Lenders or the Required Lenders, as may be required with respect to any such
release in accordance with SECTION 10.8(B). Upon request by the Agent at any
time, the Lenders will confirm in writing the Agent's authority to release
Collateral pursuant to this subsection (b).
<PAGE>
 
                                   ARTICLE X

                                 MISCELLANEOUS

          10.1    Survival. The representations and warranties made by or on
behalf of the Borrower or any Subsidiary in this Agreement and in each other
Loan Document shall survive the execution and delivery of this Agreement and
each such other Loan Document. Notwithstanding any other provision herein or
anything provided or implied by law to the contrary, no termination or
cancellation (regardless of cause or procedure) of the Commitments, this
Agreement or any of the other Loan Documents shall in any way affect or impair
the rights and obligations of the parties hereto with respect to any of the
provisions of (i) SECTION 10.3 hereof, (ii) SECTION 2.15 or (iii) this Agreement
and the other Loan Documents relating to indemnification or payment of costs and
expenses, including, without limitation, all of the provisions of SECTIONS
2.11(a), 2.11(b), 2.12, 2.13, 2.17(h), 9.7, 10.6 and 10.7, and, in each case,
such provisions shall survive any such termination or cancellation and the
making and repayment of the Loans.

          10.2    Governing Law; Consent to Jurisdiction. THIS AGREEMENT HAS
BEEN EXECUTED, DELIVERED AND ACCEPTED IN, AND SHALL BE DEEMED TO HAVE BEEN MADE
IN, NORTH CAROLINA AND SHALL BE INTERPRETED, AND THE RIGHTS AND LIABILITIES OF
THE PARTIES HERETO DETERMINED, IN ACCORDANCE WITH THE INTERNAL LAWS (AS OPPOSED
TO CONFLICTS OF LAW PROVISIONS) OF THE STATE OF NORTH CAROLINA; PROVIDED THAT
EACH LETTER OF CREDIT SHALL BE GOVERNED BY, AND SHALL BE CONSTRUED AND ENFORCED
IN ACCORDANCE WITH, THE LAWS OR RULES DESIGNATED IN SUCH LETTER OF CREDIT OR, IF
NO SUCH LAWS OR RULES ARE DESIGNATED, THE UNIFORM CUSTOMS AND PRACTICES FOR
DOCUMENTARY CREDITS, INTERNATIONAL CHAMBER OF COMMERCE, AS IN EFFECT FROM TIME
TO TIME (THE "UNIFORM CUSTOMS") AND, AS TO MATTERS NOT GOVERNED THEREBY, THE
INTERNAL LAWS OF THE STATE OF THE DOMICILE OF THE ISSUING BANK. AS PART OF THE
CONSIDERATION FOR NEW VALUE THIS DAY RECEIVED, THE BORROWER HEREBY CONSENTS TO
THE JURISDICTION OF ANY STATE COURT WITHIN MECKLENBURG COUNTY, NORTH CAROLINA OR
ANY FEDERAL COURT LOCATED WITHIN THE WESTERN DISTRICT OF THE STATE OF NORTH
CAROLINA FOR ANY PROCEEDING INSTITUTED HEREUNDER OR UNDER ANY OF THE OTHER LOAN
DOCUMENTS, OR ARISING OUT OF OR IN CONNECTION WITH THIS AGREEMENT OR ANY OF THE
OTHER LOAN DOCUMENTS, OR ANY PROCEEDING TO WHICH THE AGENT, THE ISSUING BANK,
ANY LENDER OR THE BORROWER IS A PARTY, INCLUDING ANY ACTIONS BASED UPON, ARISING
OUT OF, OR IN CONNECTION WITH ANY COURSE OF CONDUCT, COURSE OF DEALING,
STATEMENT (WHETHER ORAL OR WRITTEN) OR ACTIONS OF THE AGENT, THE ISSUING BANK,
ANY LENDER OR THE BORROWER. THE BORROWER IRREVOCABLY AGREES TO BE BOUND (SUBJECT
TO ANY AVAILABLE RIGHT OF APPEAL) BY ANY JUDGMENT RENDERED OR RELIEF GRANTED
THEREBY AND FURTHER WAIVES ANY OBJECTION THAT IT MAY HAVE BASED ON LACK OF
JURISDICTION OR IMPROPER VENUE OR FORUM NON CONVENIENS TO THE CONDUCT OF ANY
SUCH 
<PAGE>
 
PROCEEDING. THE BORROWER CONSENTS THAT ALL SERVICE OF PROCESS BE MADE BY
REGISTERED OR CERTIFIED MAIL DIRECTED TO RENAL TREATMENT CENTERS, INC. AT ITS
ADDRESS SET FORTH HEREINBELOW, AND SERVICE SO MADE SHALL BE DEEMED TO BE
COMPLETED UPON THE EARLIER OF ACTUAL RECEIPT THEREOF OR THREE (3) DAYS AFTER
DEPOSIT IN THE UNITED STATES MAILS, PROPER POSTAGE PREPAID AND PROPERLY
ADDRESSED. NOTHING IN THIS SECTION SHALL AFFECT THE RIGHT TO SERVE LEGAL PROCESS
IN ANY OTHER MANNER PERMITTED BY LAW OR AFFECT THE RIGHT TO BRING ANY ACTION OR
PROCEEDING AGAINST THE BORROWER OR ITS PROPERTY IN THE COURTS OF ANY OTHER
JURISDICTION.

          10.3    Arbitration; Remedies.

          (a)     Upon demand of any party hereto, whether made before or after
institution of any judicial proceeding, any dispute, claim or controversy
arising out of, connected with or relating to this Agreement or any of the Loan
Documents ("Disputes") between or among parties hereto or thereto shall be
resolved by binding arbitration as provided herein. Institution of a judicial
proceeding by a party does not waive the right of that party to demand
arbitration hereunder. Disputes may include, without limitation, tort claims,
counterclaims, claims brought as class actions, claims arising from documents
executed in the future, or claims arising out of or connected with the
transaction contemplated by this Agreement or any of the Loan Documents.
Arbitration shall be conducted under and governed by the Commercial Financial
Disputes Arbitration Rules (the "Arbitration Rules") of the American Arbitration
Association (the "AAA"), as in effect from time to time, and Title 9 of the U.S.
Code, as amended. All arbitration hearings shall be conducted in Charlotte,
North Carolina. The expedited procedures set forth in Rule 51 et seq. of the
Arbitration Rules shall be applicable to claims of less than $1,000,000. All
applicable statutes of limitation shall apply to any Dispute. A judgment upon
the award may be entered in any court having jurisdiction. The panel from which
all arbitrators are selected shall be comprised of licensed attorneys. The
single arbitrator selected for expedited procedure shall be a retired judge from
the highest court of general jurisdiction, state or federal, of the state where
the hearing will be conducted. Notwithstanding the foregoing, this arbitration
provision does not apply to Disputes under or related to any Hedge Agreements.

          (b)     Notwithstanding the foregoing, the parties hereto agree to
preserve, without diminution, certain remedies, more particularly described
below, that any party hereto may employ or exercise freely, either alone, in
conjunction with or during a Dispute; provided, however, that the Borrower
preserves its right to seek injunctive or other appropriate judicial relief from
a court of competent jurisdiction with respect to the foregoing pending final
resolution of the Dispute pursuant to subsection (A) above. The Agent, on behalf
of the Lenders, shall have the right to proceed in any court of proper
jurisdiction or by self-help to 
<PAGE>
 
exercise or prosecute the following remedies, as applicable: (i) all rights to
foreclose against any real or personal property or other security by exercising
a power of sale granted under any Loan Documents or under applicable law or by
judicial foreclosure and sale, including a proceeding to confirm the sale; (ii)
all rights of self-help including peaceful occupation of real property and
collection of rents, set-off, and peaceful possession of personal property;
(iii) obtaining provisional or ancillary remedies including injunctive relief,
sequestration, garnishment, attachment, appointment of receiver and filing an
involuntary bankruptcy proceeding; and (iv) when applicable, a judgment by
confession of judgment. Preservation of these remedies does not limit the power
of any arbitrator to grant similar remedies that may be requested by a party in
a Dispute.

          The parties hereto agree that they shall not have a remedy of punitive
or exemplary damages against any other party in any Dispute, and hereby waive
any right or claim to punitive or exemplary damages they have now or which may
arise in the future in connection with any Dispute whether the Dispute is
resolved by arbitration or judicially.]

          10.4    Notice. All notices and other communications provided for
hereunder shall be in writing (including telegraphic, telex, facsimile
transmission or cable communication) and mailed, telegraphed, telexed,
telecopied, cabled or delivered to the party to be notified at the following
addresses:

          If to the Borrower:   Renal Treatment Centers, Inc.
                                1180 W. Swedesford Road
                                Building 2, Suite 300
                                Berwyn, Pennsylvania  19312
                                Attention:  Ronald H. Rogers, Jr.
                                            Vice President and
                                            and Thomas J. Karl
                                            President and General Counsel
                                Telephone:  (610) 644-4796
                                Telecopy:   (610) 889-7415

          With copies to:       Duane, Morris & Heckscher
                                One Liberty Place
                                Philadelphia, Pennsylvania 11903-7396
                                Attention:  Jeffrey S. Henderson  
                                Telephone:  (215) 979-1262
                                Telecopy:   (215) 979-1020
<PAGE>
          If to the Agent
          or the Issuing Bank:  First Union National Bank of 
                                 North Carolina        
                                One First Union Center, TW10
                                Charlotte, North Carolina  28288-0608
                                Attention:  Syndication Agency Services
                                Telephone:  (704) 388-0281
                                Telecopy:   (704) 383-0288

          with a copy to:       First Union National Bank of
                                 North Carolina
                                One First Union Center, 5th Floor     
                                301 South College Street
                                Charlotte, North Carolina  28288-0735
                                Attention:  Healthcare Finance Group
                                Telephone:  (704) 383-6249
                                Telecopy:   (704) 383-9144

                                Robinson, Bradshaw & Hinson, P.A.
                                101 North Tryon Street
                                1900 Independence Center
                                Charlotte, North Carolina 28246
                                Attention:  Stokely G. Caldwell, Jr.
                                Telephone:  (704) 377-2536
                                Telecopier: (704) 378-4000

          If to any Lender:     At the address set forth on its signature page 
                                hereto

or to such other address as any party may designate for itself by like notice to
all other parties hereto. All such notices and communications shall be deemed to
have been given (i) if mailed as provided above by any method other than 
overnight delivery service, on the third Business Day after deposit in the 
mails, (ii) if mailed by overnight delivery service, telegraphed, telexed, 
telecopied or cabled, when delivered for overnight delivery, delivered to the 
telegraph company, confirmed by telex answerback, transmitted by telecopier or 
delivered to the cable company, respectively, or (iii) if delivered by hand, 
upon delivery; provided that notices and communications to the Agent shall not 
be effective until received by the Agent.

     All wire transfers to the Agent shall be sent to First Union National Bank 
of North Carolina, ABA Routing #053000219, to the credit of First Union National
Bank of North Carolina, Charlotte, North Carolina, Attention:   Syndication 
Agency Services, G/L #465906, RC #5007, RE: Renal Treatment Centers, Inc., 
unless otherwise instructed by the Agent.
<PAGE>
 
          10.5 Assignments, Participations.

          (a)  With the prior consent of the Agent and the Borrower, which
     consent shall not be unreasonably withheld, each Lender may assign to one
     or more other Persons all or a portion of its rights and obligations under
     this Agreement (including, without limitation, all or a portion of its
     Commitments, the outstanding Revolving Credit/Term Loans made by it and the
     Revolving Credit/Term Note or Revolving Credit/Term Notes held by it);
     provided, however, that (i) except in the case of an assignment to an
     Affiliate of such Lender or a Person that, immediately prior to such
     assignment, was a Lender, the amount of the Commitments of such assigning
     Lender being assigned pursuant to each such assignment (determined as of
     the date of the Assignment and Acceptance with respect to each such
     assignment) shall in no event be less than the lesser of (y) the aggregate
     Commitments of such Lender immediately prior to such assignment or (z)
     $10,000,000, (ii) each such assignment shall be to an Eligible Assignee and
     (iii) the parties to each such assignment will execute and deliver to the
     Agent, for its acceptance and recording in the Register, an Assignment and
     Acceptance, together with any Revolving Credit/Term Note or Revolving
     Credit/Term Notes subject to such assignment, and will pay a processing fee
     of $3,000 to the Agent for its own account. Upon such execution, delivery,
     acceptance and recording of the Assignment and Acceptance, from and after
     the effective date specified therein (a) the assignee thereunder shall be
     deemed a party hereto and, to the extent that rights and obligations
     hereunder have been assigned to it pursuant to such Assignment and
     Acceptance, shall have the rights and obligations of such Lender hereunder
     with respect thereto and (b) the assigning Lender shall, to the extent that
     rights and obligations hereunder have been assigned by it pursuant to such
     Assignment and Acceptance, relinquish its rights (other than rights under
     the provisions of this Agreement and the other Loan Documents relating to
     indemnification or payment of fees, costs and expenses, to the extent such
     rights relate to the time prior to the effective date of such Assignment
     and Acceptance) and be released from its obligations under this Agreement
     (and, in the case of an Assignment and Acceptance covering all or the
     remaining portion of such assigning Lender's rights and obligations under
     this Agreement, such Lender shall cease to be a party hereto).

          (b)  By executing and delivering an Assignment and Acceptance, the
     assigning Lender and the assignee thereunder confirm to and agree, with
     each other and with the other parties hereto, as follows: (i) other than as
     may be provided in such Assignment and Acceptance, such assigning Lender
     makes no representation or warranty and assumes no responsibility with
     respect to any statements, warranties or representations made in or in
     connection with this Agreement or any other Loan Document or the execution,
     legality, validity, enforceability, genuineness, sufficiency or value of
     this Agreement or any other Loan Document 
<PAGE>
 
     or any other instrument or document furnished hereto or pursuant thereto;
     (ii) such assigning Lender makes no representation or warranty and assumes
     no responsibility with respect to the financial condition of the Borrower
     or any of its Subsidiaries or the performance or observance by the Borrower
     or any of its Subsidiaries of any of their respective obligations under
     this Agreement or any other Loan Document or any other instrument or
     document furnished pursuant hereto or thereto; (iii) such assignee confirms
     that it has received a copy of this Agreement, together with copies of the
     Financial Statements and such other documents and information as it has
     deemed appropriate to make its own credit analysis and decision to enter
     into this Agreement; (iv) such assignee will, independently and without
     reliance upon the Agent, the assigning Lender or any other Lender, and
     based on such documents and information as it shall deem appropriate at the
     time, continue to make its own credit decisions in taking or not taking
     action under this Agreement; (v) such assignee confirms that it is an
     Eligible Assignee; (vi) such assignee appoints and authorizes the Agent to
     take such action as agent on its behalf and to exercise such powers and
     discretion under this Agreement and the other Loan Documents and any other
     instruments and agreements referred to herein or therein, and to exercise
     such powers and to perform such duties hereunder and thereunder, as are
     specifically delegated to or required of the Agent by the terms hereof or
     thereof and such other powers as are reasonably incidental thereto; and
     (vii) such assignee agrees that it will perform in accordance with their
     terms all of the obligations that by the terms of this Agreement are
     required to be performed by it as a Lender.

          (c)  The Agent will maintain a copy of each Assignment and Acceptance
     delivered to and accepted by it and a register for the recordation of the
     names and addresses of the Lenders and the Commitments of, and principal
     amount of the Loans owing to, each Lender from time to time (the
     "Register"). The entries in the Register shall be conclusive and binding
     for all purposes, absent manifest error, and the Borrower, the Agent, the
     Issuing Bank and the Lenders may treat each Person whose name is recorded
     in the Register as a Lender hereunder for all purposes of this Agreement.
     The Register shall be available for inspection by the Borrower, the Issuing
     Bank or any Lender at any reasonable time and from time to time upon
     reasonable prior notice.

          (d)  Upon its receipt of an Assignment and Acceptance executed by an
     assigning Lender and an assignee, together with any Revolving Credit/Term
     Note or Revolving Credit/Term Notes subject to such assignment, the Agent
     will, if such Assignment and Acceptance has been completed and is in
     substantially the form of EXHIBIT D, (i) accept such Assignment and
     Acceptance, (ii) record the information contained therein in the Register
     and (iii) give notice thereof to the Borrower. Within five (5) Business
     Days after its receipt of such notice, the Borrower, at its own expense,
     will execute and deliver to the Agent in exchange for the surrendered
     Revolving Credit/Term Note or Revolving Credit/Term 
<PAGE>
 
     Notes a new Revolving Credit/Term Note or Revolving Credit/Term Notes to
     the order of such assignee in an amount equal to the Commitment or
     Commitments assumed by it pursuant to such Assignment and Acceptance and,
     to the extent the assigning Lender has retained its Commitments hereunder,
     a new Revolving Credit/Term Note or Revolving Credit/Term Notes to the
     order of the assigning Lender in an amount equal to the Commitment or
     Commitments retained by it hereunder. Such new Revolving Credit/Term Note
     or Revolving Credit/Term Notes shall be in an aggregate principal amount
     equal to the aggregate principal amount of such surrendered Revolving
     Credit/Term Note or Revolving Credit/Term Notes, shall be dated the
     effective date of such Assignment and Acceptance and shall otherwise be in
     substantially the form of EXHIBIT A.

          (e)  Each Lender may sell to one or more other Persons participations
     in any portion comprising less than all of its rights and obligations under
     this Agreement (including, without limitation, a portion of its
     Commitments, the outstanding Loans made by it and the Revolving Credit/Term
     Note or Revolving Credit/Term Notes held by it); provided, however, that
     (i) such Lender's obligations under this Agreement shall remain unchanged,
     (ii) such Lender shall remain solely responsible for the performance of
     such obligations, (iii) the Borrower, the Issuing Bank, the Agent and the
     other Lenders shall continue to deal solely and directly with such Lender
     in connection with such Lender's rights and obligations under this
     Agreement, (iv) any such participation shall be in an amount of not less
     than $5,000,000, (v) no Lender shall sell any participation that, when
     taken together with all other participations, if any, sold by such Lender,
     covers all of such Lender's rights and obligations under this Agreement
     (including, without limitation, all of its Commitments, the outstanding
     Loans made by it and the Revolving Credit/Term Note or Revolving
     Credit/Term Notes held by it) and (vi) no Lender shall permit any
     participant to have any voting rights or any right to control the vote of
     such Lender with respect to any amendment, modification, waiver, consent or
     other action hereunder or under any other Loan Document except as to
     actions of the type described in SECTION 10.8(A). In the case of a
     participation, the participant shall not have any rights under this
     Agreement or any of the other Loan Documents, the participant's rights
     against the granting Lender in respect of such participation to be those
     set forth in the participation agreement, and all amounts payable by the
     Borrower hereunder shall be determined as if such Lender had not sold such
     participation; provided, however, that each such participant shall have the
     rights of a Lender for purposes of SECTIONS 2.11(A), 2.11(B), 2.12, and
     2.13, and shall be entitled to the benefits thereto, to the extent that the
     Lender selling such participation would be entitled to such benefits if the
     participation had not been sold.

          (f)  With the prior consent of the Required Lenders and the Borrower,
     which consent shall not be unreasonably withheld, the 
<PAGE>
 
     Issuing Bank may assign all, but not less than all, of its rights and
     obligations as Issuing Bank under this Agreement, including, without
     limitation, its commitment to issue Letters of Credit, to any Eligible
     Assignee, and upon acceptance of such assignment, the successor Issuing
     Bank shall succeed to such rights and obligations and the assigning Issuing
     Bank shall be discharged therefrom.

          (g)  The Agent, the Issuing Bank and each Lender may, in connection
     with any assignment or participation or proposed assignment or
     participation pursuant to this Section, disclose to the assignee or
     participant, or proposed assignee or participant, any information relating
     to the Borrower and its Subsidiaries furnished to it by or on behalf of any
     other party hereto, provided that such assignee or participant or proposed
     assignee or participant agrees in writing to the Agent, the Issuing Bank or
     such Lender, as the case may be, to keep such information confidential to
     the same extent required of the Lenders under Section 10.17.

          (h)  Notwithstanding any other provision set forth in this Agreement,
     any Lender may at any time pledge all or any portion of its Loans and
     Revolving Credit/Term Note to any Federal Reserve Bank in connection with
     borrowings from the Federal Reserve Bank (provided that any such pledge
     shall not affect the obligations of such Lender hereunder).

          10.6 Fees and Expenses.  Whether or not the transactions
     contemplated by this Agreement shall be consummated, the Borrower shall be
     obligated:

          (a)  to pay or reimburse the Agent upon demand and after notice in
     accordance with Section 10.4 for all reasonable expenses (including,
     without limitation, reasonable attorneys' fees, but excluding salaries of
     the Agent's regularly employed personnel and overhead) incurred or paid by
     the Agent in connection with: (i) the preparation, execution, delivery,
     interpretation, modification, amendment or termination of this Agreement or
     the other Loan Documents or any consent or waiver requested by the Borrower
     hereunder or thereunder; (ii) charges for appraisers, examiners,
     environmental consultants, auditors or similar Persons whom the Agent may
     engage with respect to rendering opinions concerning the financial
     condition of the Borrower and its Subsidiaries; and (iii) any commercially
     reasonable attempt to inspect, verify, protect, preserve, collect, sell,
     liquidate or otherwise dispose of the Collateral or any other assets of the
     Borrower or any Guarantor;

          (b)  to pay or reimburse the Agent and each Lender upon demand and
     after notice in accordance with Section 10.4 for all reasonable expenses
     (including, without limitation, reasonable attorneys' fees, but excluding
     salaries of the Agent's or such Lender's regularly employed personnel and
     overhead) incurred or
<PAGE>
 
     or paid by the Agent or such Lender in connection with: (i) any litigation,
     contest, dispute, suit or proceeding or action (whether instituted by the
     Agent, the Lenders, or any of them, the Borrower or any other Person) in
     any way relating to this Agreement or the other Loan Documents or to the
     Borrower's or any Subsidiary's affairs (other than a dispute solely between
     or among the Lenders); (ii) any attempt by the Agent or such Lender to
     enforce any of its rights against the Borrower or any other Person that may
     be obligated to the Agent or such Lender by virtue of this Agreement or the
     other Loan Documents; and (iii) any Default or Event of Default, including
     without limitation, any refinancing or restructuring of the credit
     arrangement provided under this Agreement in the nature of a "work-out" or
     in any insolvency or bankruptcy proceeding;

          (c)  to pay and hold the Agent and each Lender harmless from and
     against any and all liability and loss with respect to or resulting from
     the nonpayment or delayed payment of any and all intangibles, documentary
     stamp and other similar taxes, fees and excises, if any, including any
     interest and penalties, that may be, or be determined to be, payable in
     connection with the transactions contemplated by this Agreement and the
     other Loan Documents or in any modification hereof or thereof; and

          (d)  to pay and hold the Agent and each Lender harmless from and
     against any and all finder's or brokerage fees and commissions that may be
     payable in connection with the transactions contemplated by this Agreement
     and the other Loan Documents, other than any fees or commissions of finders
     or brokers engaged by the Agent or any Lender.

          10.7 Indemnification.  From and at all times after the date of
     this Agreement, and in addition to the costs and expenses payable under
     Section 10.6 and all of the Agent's and the Lenders' other rights and
     remedies against the Borrower, the Borrower agrees to indemnify and hold
     harmless the Agent, the Issuing Bank and each Lender and each of their
     directors, officers, employees, agents and Affiliates (each, an
     "Indemnified Person") against any and all claims, losses, damages,
     liabilities, costs and expenses of any kind or nature whatsoever,
     including, without limitation, attorneys' fees, costs and expenses
     (collectively, "Indemnified Costs") incurred by or asserted against any
     such Indemnified Person from and after the date hereof, whether direct,
     indirect or consequential, as a result of or arising from or in any way
     relating to any suit, action or proceeding (including any inquiry or
     investigation) by any Person, whether threatened or initiated, asserting a
     claim for any legal or equitable remedy under any statute or regulation,
     including, without limitation, any federal or state securities laws, or
     under any common law or equitable cause or otherwise, arising from or in
     connection with the negotiation, preparation, execution, performance or
     enforcement of this Agreement or the other Loan Documents or any of the
<PAGE>
 
     transactions contemplated herein or therein, and including, without
     limitation, Environmental Claims, whether or not such Indemnified Person is
     a party to any such action, proceeding or suit or the target of any such
     inquiry or investigation; provided, however, that no Indemnified Person
     shall have the right to be indemnified hereunder for any Indemnified Costs
     resulting primarily from the gross negligence or willful misconduct of such
     Indemnified Person (as finally determined by a court of competent
     jurisdiction or pursuant to arbitration as set forth herein). All of the
     foregoing losses, damages, costs and expenses of any Indemnified Person
     shall be payable by the Borrower, as and when incurred and upon demand, and
     shall be additional Obligations hereunder. In the event that the foregoing
     indemnity is unavailable or insufficient to hold each Indemnified Person
     harmless, then the Borrower will contribute to amounts paid or payable by
     such Indemnified Persons in respect of their losses, claims, damages or
     liabilities in such proportions as appropriately reflect the relative
     benefits received by and fault of the Borrower and such Indemnified Persons
     in connection with the matters as to which such losses, claims, damages or
     liabilities relate and other equitable considerations.

          10.8 Amendments, Waivers, Etc.  Except as may be otherwise
     specifically set forth in this Agreement or the other Loan Documents,
     neither this Agreement nor any other Loan Document nor any provision hereof
     or thereof may be amended, modified, waived, discharged or terminated, and
     no consent to any departure by the Borrower from any provision hereof or
     thereof may be given, except in a writing signed by the Required Lenders;
     provided, however, that:

          (a)  no such amendment, modification, waiver, discharge, termination
     or consent shall, without the consent of each Lender holding Obligations
     directly affected thereby, (i) reduce the principal amount of, or rate of
     interest on, any Loan, or reduce any fees or other Obligations (other than
     fees payable to the Agent for its own account) or any obligations of any
     Person now or hereafter primarily or contingently liable with respect to
     the Obligations or (ii) postpone any date fixed for any payment of
     principal, interest (other than additional interest payable under Section
     2.6(B) during the continuance of an Event of Default), fees (other than
     fees payable to the Agent for its own account) or any other Obligations 
     including any mandatory prepayment;

          (b)  no such amendment, modification, waiver, discharge, termination
     or consent shall, without the consent of all Lenders, (i) increase the
     Commitments of any Lender (it being understood that a waiver of any Default
     or Event of Default or of any mandatory reduction in either Total
     Commitment shall not constitute such an increase), (ii) change the
     definition of "Required Lenders" or otherwise change the number or
     percentage of Lenders that shall be required for the Lenders or any of them
     to take or approve, or direct the Agent to take, any action hereunder,
     (iii) amend, modify or waive any of the provisions for extending, or take
     action to 
<PAGE>
 
     extend, the term of the Revolving Credit/Term Facility, (iv) affect the
     obligation of the Lenders having Revolving Credit/Term Commitments to
     become L/C Participants, (v) amend any provision of this Section, (vi)
     release all or substantially all of the Collateral or (vii) consent to the
     assignment or transfer by the Borrower, or by any other Person now or
     hereafter primarily or contingently liable with respect to the Obligations,
     of any of its rights and obligations under this Agreement or any of the
     other Loan Documents;

          (c)  no provision relating to the rights or obligations of the Issuing
     Bank under this Agreement or any of the other Loan Documents may be
     amended, modified or waived without the consent of the Issuing Bank; and

          (d)  no provision relating to the rights or obligations of the Agent
     under this Agreement or any of the other Loan Documents may be amended,
     modified or waived without the consent of the Agent.

          10.9 Rights and Remedies Cumulative, Non-waiver, etc.  The
     enumeration of the Agent's and the Lenders' rights and remedies set forth
     in this Agreement and the other Loan Documents is not intended to be
     exhaustive, and the exercise by the Agent or any Lender of any right or
     remedy shall not preclude the exercise of any other rights or remedies, all
     of which shall be cumulative, and shall be in addition to any other right
     or remedy given hereunder, under the other Loan Documents or under any
     other agreement between the Borrower and the Lenders, or any of them (or
     the Agent on their behalf), or that may now or hereafter exist in law or in
     equity or by suit or otherwise. No delay or failure to take action on the
     part of the Agent or any Lender in exercising any right, power or privilege
     shall operate as a waiver thereof, nor shall any single or partial exercise
     of any such right, power or privilege preclude other or further exercise
     thereof or the exercise of any other right, power or privilege or shall be
     construed to be a waiver of any Event of Default. No course of dealing
     between any of the Borrower and the Agent or the Lenders or their agents or
     employees shall be effective to change, modify or discharge any provision
     of this Agreement or to constitute a waiver of any Event of Default. No
     notice to or demand upon the Borrower in any case shall entitle the
     Borrower to any other or further notice or demand in similar or other
     circumstances or constitute a waiver of the right of the Agent or any
     Lender to exercise any right or remedy or take any other or further action
     in any circumstances without notice or demand.

          10.10 Binding Effect, Assignment.  All of the terms of this
     Agreement shall be binding upon, inure to the benefit of and be enforceable
     by the respective successors and assigns of the Borrower, the Agent, the
     Issuing Bank and each Lender; provided, however, that (i) the Borrower may
     not sell, assign or transfer this Agreement or any 
<PAGE>
 
     portion hereof or thereof, including, without limitation, any of its
     rights, title, interests, remedies, powers and duties hereunder or
     thereunder and (ii) any assignees and participants and any successor
     Issuing Bank shall have such rights and obligations with respect to this
     Agreement and the other Loan Documents as are provided for in and pursuant
     to Section 10.5.

          10.11 Severability.  To the extent any provision of this
     Agreement is prohibited by or invalid under applicable law, such provision
     shall be ineffective to the extent of such prohibition or invalidity,
     without invalidating the remainder of such provision or the remaining
     provisions of this Agreement.

          10.12 Entire Agreement.  THIS AGREEMENT AND THE DOCUMENTS AND
     INSTRUMENTS EXECUTED AND DELIVERED CONTEMPORANEOUSLY HEREWITH EMBODY THE
     ENTIRE AGREEMENT AND UNDERSTANDING BETWEEN THE PARTIES HERETO AND SUPERSEDE
     ALL PRIOR AGREEMENTS AND UNDERSTANDINGS OF SUCH PERSONS, VERBAL OR WRITTEN,
     RELATING TO THE SUBJECT MATTER HEREOF EXCEPT FOR THE FEE LETTER AND ANY
     PRIOR ARRANGEMENTS MADE WITH RESPECT TO PAYMENT BY THE BORROWER OF (OR ANY
     INDEMNIFICATION FOR) ANY FEES, COSTS OR EXPENSES PAYABLE TO OR INCURRED (OR
     TO BE INCURRED) BY OR ON BEHALF OF THE AGENT, THE ISSUING BANK OR ANY
     LENDER, THE PROVISIONS OF WHICH FEE LETTER AND ANY SUCH PRIOR ARRANGEMENTS
     ARE HEREBY INCORPORATED INTO THIS AGREEMENT BY THIS REFERENCE. THIS
     AGREEMENT, THE REVOLVING CREDIT/TERM NOTES, THE OTHER LOAN DOCUMENTS AND
     THE INSTRUMENTS AND DOCUMENTS EXECUTED IN CONNECTION HEREWITH REPRESENT THE
     FINAL AGREEMENT BETWEEN THE PARTIES AND MAY NOT BE CONTRADICTED BY EVIDENCE
     OF PRIOR, CONTEMPORANEOUS OR SUBSEQUENT ORAL AGREEMENTS OF THE PARTIES.
     THERE ARE NO UNWRITTEN ORAL AGREEMENTS BETWEEN THE PARTIES.

          10.13 Interpretation.  The captions to the various sections and
     subsections of this Agreement have been inserted for convenience only and
     shall not limit or affect any of the terms hereof. Unless the context
     otherwise requires, words in the singular include the plural and words in
     the plural include the singular, and the use of any gender shall be
     applicable to all genders.

          10.14 Counterparts, Effectiveness.  This Agreement may be
     executed in any number of counterparts and by different parties hereto on
     separate counterparts, each of which, when so executed and delivered, shall
     be an original, but all of which shall together constitute one and the same
     instrument. This Agreement shall become effective upon the execution of a
     counterpart hereof by each of the parties hereto.

          10.15 Conflict of Terms.  The provisions of the exhibits and
     schedules hereto and the other Loan Documents are incorporated in this
     Agreement by this reference thereto. Except as otherwise provided in this
     Agreement and except as otherwise provided in the other Loan Documents, if
     any provision contained in this Agreement is in conflict with, or
     inconsistent with, any provision of the 
<PAGE>
 
     other Loan Documents, the provision contained in this Agreement shall
     control.

          10.16 Injunctive Relief.  The Borrower recognizes that in the
     event it fails to perform, observe or discharge any of its obligations or
     liabilities under this Agreement, any remedy of law may prove to be
     inadequate relief to the Agent and the Lenders. The Borrower therefore
     agrees that the Agent and the Lenders, if the Agent so requests, shall be
     entitled to temporary and permanent injunctive relief without the necessity
     of proving actual damages in any case where a remedy at law, in the
     reasonable opinion of the Required Lenders, may prove to be inadequate
     relief.

          10.17 Confidentiality.  Each Lender agrees to take normal and
     reasonable precautions and exercise due care to maintain the
     confidentiality of all non-public confidential information provided in
     connection with this Agreement or any other Loan Document and agrees and
     undertakes that it shall not use any such information for any purpose or in
     any manner other than pursuant to the terms contemplated by this Agreement.
     Any Lender may disclose such information (i) at the request of any bank
     regulatory authority or in connection with an examination of such Lender by
     any such authority, (ii) pursuant to subpoena or other court process, (iii)
     when required to do so in accordance with the provisions of any applicable
     law, (iv) at the express direction of any agency of any State of the United
     States of America or of any other jurisdiction in which such Lender
     conducts its business or (v) to such Lender's directors, employees,
     affiliates, independent auditors and other professional advisors that have
     a reasonable need or basis for access thereto, (vi) to the extent the same
     has become publicly available other than as a result of a breach of this
     Agreement or (vii) pursuant to and in accordance with the provisions of
     Section 10.5(g).

          10.18 Post-Closing Matters.  The Borrower will, and will cause
     each of its Subsidiaries to, use its best efforts to assist the Agent in
     the syndication of the Facilities and the resultant addition of Lenders
     after the Closing Date.

          10.19 Acknowledgement.  The Borrower covenants and agrees that
     it shall not use any credit facility provided by First Union or any
     affiliate thereof for the purpose of making any payment of principal,
     interest or dividends on any securities of the Borrower underwritten or
     privately placed by First Union Capital Markets Corp. It is understood that
     it is not practical for the Borrower to segregate or trace funds and that
     it does not contemplate doing so.
<PAGE>
 
     IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be
executed in their corporate names by their duly authorized corporate officers as
of the date first above written.


                          RENAL TREATMENT CENTERS, INC.


                          By: /s/ Ronald H. Rodgers, Jr.,
                              -----------------------------------
                              Ronald H. Rodgers, Jr.,
                              Vice President



                          FIRST UNION NATIONAL BANK
                            OF NORTH CAROLINA, AS AGENT


                          By: /s/ Joseph H. Towell
                              -----------------------------------
                              Joseph H. Towell,
                              Senior Vice President



                             (signatures continued)
<PAGE>
 
                                 ABN AMRO BANK N.V., New York Branch        
                                                                            
                                 By: /s/ Nancy W. Lanzoni                    
                                     -------------------------------------- 
                                 Title: Group Vice President                
                                        ----------------------------------- 
                                                                            
                                 By: /s/ Thomas T. Rogers                    
                                     -------------------------------------- 
                                 Title: Assistant Vice President            
                                        ----------------------------------- 
                                                                            
                                    Revolving Credit/                       
                                    Term Commitment           $7,500,000.00 
                                                                            
                                                                            
                                    Address:                                
                                                                            
                                    500 Park Avenue                         
                                    New York, New York 10022                
                                    Attention:  Stephen Van Besien,         
                                                Vice President              
                                    Telephone:  212-446-4386                
                                    Telecopy:   212-446-4237                
                                                                            
                                                                            
                                    Wiring Instructions:                    
                                                                            
                                    ABN AMRO BANK, N.V.                     
                                    New York Branch                         
                                    ABA #026009580                          
                                    Account Name:  Loan Suspense            
                                    Account Number:  516-0-820172-00        
                                    Reference:  Renal Treatment Centers,    
                                                Inc.                        

<PAGE>
 
                               BANQUE PARIBAS                                   
                                                                                
                               By: /s/ Judith A. Kirshner
                                   --------------------------------------       
                                   Judith A. Kirshner,                          
                                   Vice President                               
                                                                                
                               By: /s/ David I. Canavan
                                   --------------------------------------       
                                   David I. Canavan                             
                                   Group Vice President                         
                                                                                
                                                                                
                                                                                
                                  Revolving Credit/                             
                                  Term Commitment           $7,500,000.00       
                                                                                
                                                                                
                                  Address:                                      
                                                                                
                                  787 Seventh Avenue                            
                                  New York, New York 10019                      
                                  Attention:  Judith A. Kirshner,               
                                              Vice President                    
                                  Telephone:  212-841-2568                      
                                  Telecopy:   212-841-2292                      
                                                                                
                                                                                
                                  Wiring Instructions:                          
                                                                                
                                  Bankers Trust New York                        
                                  New York, New York                            
                                  ABA #021001033                                
                                  For Account of:  Banque Paribas               
                                  A/C # 04-202-195                              
                                  Reference:  Renal Treatment Centers,          
                                              Inc.                              

<PAGE>
 
                                       COOPERATIEVE CENTRALE RAIFFEISEN-
                                       BOERENLEENBANK, B.A., "RABOBANK
                                       NEDERLAND", New York branch


                                       By: /s/ Ian Reece
                                           ----------------------------------
                                            Title:     IAN REECE
                                                   --------------------------
                                                    Senior Credit Officer

                                       By: /s/ M. Christina Debler
                                           ----------------------------------
                                            Title: M. Christina Debler
                                                   --------------------------
                                                    Vice President

                                         Revolving Credit/
                                         Term Commitment:      $12,500,000.00


                                         Address:

                                         Rabobank Nederland
                                         245 Park Avenue
                                         New York, New York 10167
                                         Attention: Corporate Services Dept.
                                         Telephone: 212-916-7800
                                         Telecopy:  212-818-0233

                                         Wiring Instructions:

                                         Bank of New York
                                         New York, New York
                                         ABA #021000018
                                         Account: 802-6002-533
                                         Account Name: Rabobank Nederland,
                                                       New York Branch
                                         Attention: Ref: Renal Treatment
                                                         Centers, Inc.

<PAGE>
 
                         CORESTATES BANK, N.A.


                         By: /s/ Lisa Rothenberger, Commercial Officer
                             -----------------------------------------
                             Lisa Rothenberger, Commercial Officer


                           Revolving Credit/
                           Term Commitment:     $30,000,000.00


                           Address:

                           Corestates Bank, N.A.
                           1339 Chestnut Street, 3rd Floor
                           FC1-8-3-22
                           Philadelphia, Pennsylvania  19101
                           Attention:  Lisa S. Rothenberger
                                       Commercial Officer
                           Telephone:  (215) 973-1838
                           Telecopy:   (215) 973-2738


                           Wiring Instructions:

                           Corestates Bank, N.A.
                           Philadelphia, Pennsylvania
                           ABA #031000011
                           Attn:  Joy Ditre, Commercial Loan
                           Account #0132-0452
                           Reference:  Renal Treatment Centers, Inc.
<PAGE>
 
                               CREDIT LYONNAIS NEW YORK BRANCH
                                                                               
                               By: /s/ F. Tavangar 
                                   --------------------------------------      
                                   Farboud Tavangar 
                                   First Vice President 
                                                                               
                                                                               
                                                                               
                                  Revolving Credit/                            
                                  Term Commitment           $12,500,000.00      
                                                                               
                                                                               
                                  Address:                                     
                                                                               
                                  Health Care Group 
                                  1301 Avenue of the Americas
                                  New York, New York 10019                     
                                  Attention:  Evan S. Wasser,
                                              Vice President                   
                                  Telephone:  212-261-7685 
                                  Telecopy:   212-261-3440
                                                                               
                                                                               
                                  Wiring Instructions:                         
                                                                               
                                  Credit Lyonnais 
                                  New York Branch
                                  ABA #0260-0807-3
                                  Account:  01-88179-3701
                                  Attn:  Loan Servicing
                                  Reference:  Renal Treatment Centers,         
                                              Inc.                              

<PAGE>
 
                            FIRST UNION NATIONAL BANK
                            OF NORTH CAROLINA


                          By: /s/ Joseph H. Towell
                              ----------------------------------
                              Joseph H. Towell,
                              Senior Vice President



                           Revolving Credit/
                           Term Commitment:     $31,000,000.00


                           Address:

                           First Union National Bank
                           of North Carolina
                           One First Union Center, TW19
                           301 South College Street
                           Charlotte, North Carolina  28288-0735
                           Attention:  Healthcare Finance Group
                           Telephone:  (704) 383-6249
                           Telecopy:  (704) 383-9144


                           Wiring Instructions:

                           First Union National Bank
                           of North Carolina
                           Charlotte, North Carolina
                           ABA #053000219
                           Attn:  Syndications Agency Services
                           G/L #465906, RC #5007
                           Account #465906 0001802
                           Reference:  Renal Treatment Centers, Inc.
<PAGE>
 
                                          FLEET NATIONAL BANK

                                          By:  /s/ Ginger Stolzenthaler
                                              ---------------------------------
                                              Ginger Stolzenthaler,
                                              Senior Vice President

                                          Revolving Credit/
                                          Term Commitment:       $12,500,000.00


                                          Address:

                                          75 State Street
                                          MABOFO 4A
                                          Boston, Massachusetts 02109
                                          Attention:  Ginger Stolzenthaler,
                                                      Senior Vice President
                                          Telephone:  617-346-1647
                                          Telecopy:   617-346-1634

                                          Wiring Instructions:

                                          Fleet National Bank
                                          Boston, Massachusetts
                                          ABA #011000138
                                          G/L Acct.:  1510351-03156
                                          Reference:  Renal Treatment Centers,
                                                      Inc.
<PAGE>
 
                                       LTCB TRUST COMPANY



                                       By: /s/ Jun Ebihara
                                          -------------------------------------
                                          Jun Ebihara, Vice President



                                         Revolving Credit
                                         Term Commitment:     $12,500,000.00

                                         Address:

                                         165 Broadway
                                         New York, New York 10006
                                         Attention:  Jun Ebihara
                                                     Vice President
                                         Telephone:  212-335-4477
                                         Telecopy:   212-608-2371
                                       
                                         Wiring Instructions:

                                         Bankers Trust Company
                                         New York, New York
                                         ABA  #021001033
                                         Account #:  04203606
                                         Account Name:  LTCB Trust Company
                                         Ref:  Renal Treatment Centers, Inc.
                                         Attn:  Winston Brown


<PAGE>
 
                                       MELLON BANK, N.A.



                                       By:  /s/ Carol Paige
                                          ------------------------------------
                                          Carol Paige, Vice President



                                         Revolving Credit/
                                         Term Commitment:         $12,500,000.00

                                         Address:

                                         Health Care Banking
                                         610 West Germantown Pike, Suite 200
                                         Plymouth Meeting, Pennsylvania 19462
                                         Attention:  Carol Paige,
                                                     Vice President
                                         Telephone:  610-941-8409
                                         Telecopy:   610-941-4136

                                         Wiring Instructions:

                                         Mellon Bank, N.A.
                                         ABA #031-000-037
                                         A/C #:  990873703
                                         Attn:  Patricia Stewart
                                         Reference:  Renal Treatment Centers, 
                                                     Inc.

<PAGE>
 
                                       NATIONAL CITY BANK OF KENTUCKY


                                       By:  /s/ Roderic M. Brown
                                          -------------------------------------
                                          Roderic M. Brown, Vice President



                                         Revolving Credit/
                                         Term Commitment:       $7,500,000.00


                                         Address:

                                         101 S. Fifth Street
                                         Louisville, Kentucky 40202
                                         Attention:  Roderic M. Brown
                                                     Vice President
                                         Telephone:  502-581-4369
                                         Telecopy:   502-581-4424


                                         Wiring Instructions:

                                         National City Bank of Kentucky
                                         Louisville, Kentucky
                                         ABA #083000056
                                         Reference:  Renal Treatment Centers, 
                                                     Inc.


<PAGE>
 
                                       NATIONSBANK, N.A.


                                       By: /s/ Kevin Wagley
                                          ------------------------------------
                                          Kevin Wagley, Vice President



                                         Revolving Credit/
                                         Term Commitment:      $12,500,000.00


                                         Address:

                                         1 NationsBank Plaza, 5th Floor
                                         Nashville, Tennessee 37239
                                         Attention:  Kevin Wagley,
                                                     Vice President
                                         Telephone:  615-749-3802
                                         Telecopy:   615-749-4640


                                         Wiring Instructions:

                                         NationsBank, N.A.
                                         ABA #053000196
                                         Acct #:  136621-22506
                                         Attn:  Corporate Credit Services
                                         Reference:  Renal Treatment Centers, 
                                                     Inc.



                                       
<PAGE>
 
                                       PNC BANK, NATIONAL ASSOCIATION


                                       By: /s/ Gabrielle Wanamaker
                                          -----------------------------------
                                          Gabrielle Wanamaker, Vice President



                                       Revolving Credit/
                                       Term Commitment:         $21,500,000.00
                                       
                                       
                                       Address:

                                       PNC Bank, National Association
                                       1600 Market Street, 22nd Floor
                                       Philadelphia, Pennsylvania 19103
                                       Attention:  Gabrielle Wanamaker,
                                                   Vice President
                                       Telephone:  215-595-6389
                                       Telecopy:   215-585-6987


                                       Wiring Instructions:

                                       PNC Bank, National Association
                                       Philadelphia, Pennsylvania
                                       ABA #031000053
                                       Credit:  Comm'l Loans in Process,
                                       G/L Acct. #13076-156
                                       Reference:  Renal Treatment Centers,
                                                   Inc.
                                       Add'l Info:  Contact Donna
                                       (215) 585-5237 upon receipt


<PAGE>
 
                                       UNION BANK OF CALIFORNIA, N.A.


                                       By:  /s/ Albert W. Kelley
                                          ------------------------------------
                                          Albert W. Kelley, Vice President



                                         Revolving Credit/
                                         Term Commitment:        $12,500,000.00


                                         Address:

                                         Union Bank of California
                                         445 So. Figueroa St., 16th Floor
                                         Los Angeles, CA  90071
                                         Attention:  Albert W. Kelley,
                                                     Vice President
                                         Telephone:  213-236-4284
                                         Telecopy:   213-236-7814

                                         Wiring Instruction:

                                         Union Bank of California
                                         ABA #070196431
                                         Attn:  Wire Clearing Account
                                         Reference:  Renal Treatment Centers,
                                                     Inc.


<PAGE>
 
                                       UNION BANK OF SWITZERLAND,
                                       NEW YORK BRANCH


                                       By: /s/ Leo L. Baltz
                                          ----------------------------------
                                          Title:  LEO L. BALTZ
                                                ----------------------------
                                                  VICE PRESIDENT

                                       By: /s/ Stephen A. Caver  
                                          ----------------------------------
                                          Title:  Stephen A. Caver
                                                ---------------------------- 
                                                  Assistant Vice President

                                         Revolving Credit/
                                         Term Commitment:         $7,500,000.00


                                         Address:

                                         Union Bank of Switzerland
                                         New York Branch
                                         299 Park Avenue, 40th Floor
                                         New York, New York  10171
                                         Attention:  Leo L. Baltz
                                                     Vice President
                                         Telephone:  212-821-5372
                                         Telecopy:   212-821-3914

                                       
                                         Wiring Instructions:

                                         Union Bank of Switzerland
                                         New York Branch
                                         ABA #026008439
                                         Ref:  Loan Servicing
                                         By order of:  Renal Treatment Centers,
                                                       Inc.
<PAGE>
 
                                                   Annex A to Fifth Amended and
                                                     Restated Loan Agreement
                                                   First Union National Bank of
                                                     North Carolina, as Agent
                                                   Renal Treatment Centers, Inc.
                                                    May 2, 1997 / $200,000,000
                                                   -----------------------------

<TABLE>
<CAPTION>
 
 
================================================================================================================================== 
                                                                                       Amount
                                             Existing Loans       Existing Loans     Purchased      Pro Rata                    
                 Lender                   (Prior to Agreement)  (After Assignments)    (Sold)         Share         Commitment  
- ----------------------------------------------------------------------------------------------------------------------------------
<S>                                       <C>                   <C>                  <C>            <C>            <C>          
                                                                                                                                
First Union National                                                                                                            
Bank of North Carolina                    $                     $                                      %           $            
- ----------------------------------------------------------------------------------------------------------------------------------
PNC Bank, National 
Association                               $                     $                                      %           $            
- ----------------------------------------------------------------------------------------------------------------------------------
Corestates Bank, NA                       $                     $                                      %           $            
- ----------------------------------------------------------------------------------------------------------------------------------
First National Bank of Boston             $                     $                                      %           $            
- ----------------------------------------------------------------------------------------------------------------------------------
                                          $                     $                                      %           $            
- ----------------------------------------------------------------------------------------------------------------------------------
                                          $                     $                                      %           $            
- ----------------------------------------------------------------------------------------------------------------------------------
Total                                     $                     $ 200,000,000                       100%           $ 200,000,000 
==================================================================================================================================
</TABLE>
<PAGE>
 
                                                  Exhibit A to Fifth Amended and
                                                     Restated Loan Agreement
                                                  First Union National Bank of
                                                     North Carolina, as Agent
                                                  Renal Treatment Centers, Inc.
                                                    May 2, 1997 / $200,000,000
                                                  ------------------------------



                                    FORM OF
                      FOURTH AMENDED AND RESTATED RENEWAL
                           REVOLVING CREDIT/TERM NOTE


$                                                                         , 1997
 -----------------                                             -----------
                                                       Charlotte, North Carolina

     FOR VALUE RECEIVED, RENAL TREATMENT CENTERS, INC., a Delaware corporation
(the "Borrower"), hereby promises to pay to the order of

     _______________________________________, (the "Lender"), at the offices of
First Union National Bank of North Carolina (the "Agent") located at One First
Union Center, TW19, 301 South College Street, Charlotte, North Carolina 28288-
0735 (or at such other place or places as the Agent may designate), the
principal sum of up to

     ______________________________ DOLLARS ($__________), or such lesser amount
as may constitute the unpaid principal amount of the Revolving Credit/Term Loans
payable to the Lender, under the terms and conditions of this Fourth Amended and
Restated Renewal Revolving Credit/Term Note (this "Revolving Credit/Term Note")
and that certain Fifth Amended and Restated Loan Agreement, dated as of the date
hereof, by and between the Borrower, the Agent and the Lenders set forth therein
(as the same may be amended, modified, renewed, restated, extended or
supplemented from time to time, the "Loan Agreement").  This Revolving
Credit/Term Note is an amendment, restatement and renewal in part of a series of
Third Amended and Restated Renewal Revolving Credit/Term Notes, dated June 5,
1996, in the original aggregate principal amount of up to $100,000,000, each
executed and delivered by the Borrower to certain lenders pursuant to a Fourth
Amended and Restated Loan Agreement, dated as of June 5, 1996, between the
Borrower, the Agent and the lenders set forth therein.  Upon execution and
delivery of this Revolving Credit/Term Note, the notes amended, restated and
renewed hereby shall be attached hereto and marked "Renewed and reevidenced by a
series of promissory notes dated May 2, 1997, which are substituted herefor in
entirety."

     The Borrower also unconditionally promises to pay interest on the aggregate
unpaid principal amount of this Revolving Credit/Term Note at the rates provided
in the Loan Agreement.

     This Revolving Credit/Term Note is one of a series of Revolving Credit/Term
Notes (as defined in the Loan Agreement) 
<PAGE>
 
issued to evidence the Revolving Credit/Term Facility made pursuant to Article
II of the Loan Agreement. The defined terms in the Loan Agreement are used
herein with the same meanings. All of the terms, conditions and covenants of the
Loan Agreement are expressly made a part of this Revolving Credit/Term Note by
reference in the same manner and with the same effect as if set forth herein at
length, and any holder of this Revolving Credit/Term Note is entitled to the
benefits of and remedies provided in the Loan Agreement and the other Loan
Documents. Reference is made to the Loan Agreement for provisions relating to
the interest rate, maturity, payment, prepayment, acceleration and other terms
affecting this Revolving Credit/Term Note.

     The Borrower may borrow, repay and reborrow under this Revolving
Credit/Term Note in accordance with the terms and conditions of the Loan
Agreement.  The Borrower shall repay the Revolving Credit/Term Notes in full on
the Revolving Credit/Term Facility Termination Date; provided, however, that if
the Revolving Credit/Term Facility Termination Date occurs on, and solely
because of, the occurrence of the Revolving Credit/Term Facility Conversion
Date, the aggregate outstanding principal balance of the Revolving Credit/Term
Loans on the Revolving Credit/Term Facility Conversion Date will be converted to
a term loan and shall be due and payable and repaid by the Borrower in sixteen
(16) equal quarterly installments, on March 31, June 30, September 30 and
December 31 in each year, commencing on June 30, 2000 through and including the
Revolving Credit/Term Facility Maturity Date.

     In the event of an acceleration of the maturity of this Revolving
Credit/Term Note, this Revolving Credit/Term Note, and all other indebtedness of
the Borrower to the Lender, shall become immediately due and payable, without
presentation, demand, protest or notice of any kind, all of which are hereby
waived by the Borrower.

     In the event this Revolving Credit/Term Note is not paid when due at any
stated or accelerated maturity, the Borrower agrees to pay, in addition to the
principal and interest, all costs of collection, including reasonable attorneys'
fees.

     This Revolving Credit/Term Note shall be governed by and construed in
accordance with the internal laws and judicial decisions of the State of North
Carolina.  The Borrower hereby submits to the jurisdiction and venue of the
federal and state courts located in Mecklenburg County, North Carolina, although
the Lender shall not be limited to bringing an action in such courts.
<PAGE>
 
     IN WITNESS WHEREOF, the Borrower has caused this Revolving Credit/Term Note
to be executed under seal by its duly authorized corporate officers as of the
day and year first above written.


                                RENAL TREATMENT CENTERS, INC.


[CORPORATE SEAL]                By:  
                                    --------------------------------------
                                    Title: 
                                          --------------------------------

ATTEST:


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


Title:                      Tax Identification Number:  23-2518331
      ---------------------
<PAGE>
 
                                                Exhibit B-1 to Fifth Amended and
                                                    Restated Loan Agreement
                                                  First Union National Bank of
                                                    North Carolina, as Agent
                                                 Renal Treatment Centers, Inc.
                                                  May 2, 1997 / $200,000,000
                                                --------------------------------



                                    FORM OF
                              NOTICE OF BORROWING


                                     [Date]



First Union National Bank
  of North Carolina, as Agent
Syndication Agency Services
One First Union Center, TW-10
301 South College Street
Charlotte, North Carolina 28288-0608

Attention:  Syndication Agency Services

Ladies and Gentlemen:

     The undersigned, Renal Treatment Centers, Inc. (the "Borrower"), refers to
the Fifth Amended and Restated Loan Agreement, dated as of May 2, 1997, among
the Borrower, certain banks and other financial institutions from time to time
parties thereto (the "Lenders"), and you, as Agent for the Lenders (as amended,
modified, supplemented or restated from time to time, the "Loan Agreement," the
terms defined therein being used herein as therein defined), and, pursuant to
Section 2.2(a) of the Loan Agreement, hereby gives you irrevocable notice that
the undersigned hereby requests a Borrowing under the Loan Agreement, and to
that end sets forth below the information relating to such Borrowing (the
"Proposed Borrowing") as required by Section 2.2(a) of the Loan Agreement:


          (i)  The Business Day of the Proposed Borrowing is _______________ 
     (the "Borrowing Date")./1/

         (ii)  The aggregate principal amount of the Proposed Borrowing is
     $_______________.

        (iii)  The Loans comprising the Proposed Borrowing shall be initially 
     maintained as [Base Rate Loans] [LIBOR Loans].

- --------------------
     /1/Shall be a Business Day at least one Business Day after the date hereof
(in the case of Base Rate Loans) or at least three Business Days after the date
hereof (in the case of LIBOR Loans).
<PAGE>
 
        [(iv)  The initial Interest Period for each Loan made as part of the
     Proposed Borrowing shall be [one/two/three/six months].]/2/

     The undersigned hereby certifies that the following statements are true on
the date hereof and will be true on the Borrowing Date:

 
          (A)  Each of the representations and warranties contained in Article
     IV of the Loan Agreement and in the other Loan Documents are and will be
     true and correct before and after giving effect to the Proposed Borrowing
     and to the application of the proceeds therefrom, as though made on each
     such date (except to the extent any such representation or warranty relates
     solely to a prior date); and

          (B)  No Default or Event of Default has occurred and is continuing or
     would result from the Proposed Borrowing or from the application of the
     proceeds therefrom.


                                        Very truly yours,

                                        RENAL TREATMENT CENTERS, INC.


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

                                        Title: 
                                               ------------------------------  
- ----------------------
     /2/To be included for a Proposed Borrowing comprised of LIBOR Loans.
<PAGE>
 
                                                Exhibit B-2 to Fifth Amended and
                                                     Restated Loan Agreement
                                                  First Union National Bank of
                                                     North Carolina, as Agent
                                                  Renal Treatment Centers, Inc.
                                                    May 2, 1997 / $200,000,000
                                                --------------------------------



                                    FORM OF
                       NOTICE OF CONVERSION/CONTINUATION


                                     [Date]



First Union National Bank
  of North Carolina, as Agent
Syndication Agency Services
One First Union Center, TW-10
301 South College Street
Charlotte, North Carolina 28288-0735

Attention:  Syndication Agency Services

Ladies and Gentlemen:

     The undersigned, Renal Treatment Centers, Inc. (the "Borrower"), refers to
the Fifth Amended and Restated Loan Agreement, dated as of May 2, 1997, among
the Borrower, certain banks and other financial institutions from time to time
parties thereto (the "Lenders"), and you, as Agent for the Lenders (as amended,
modified, supplemented or restated from time to time, the "Loan Agreement," the
terms defined therein being used herein as therein defined), and, pursuant to
Section 2.9(b) of the Loan Agreement, hereby gives you irrevocable notice that
the undersigned hereby requests a [conversion] [continuation] of Loans under the
Loan Agreement, and to that end sets forth below the information relating to
such [conversion] [continuation] (the "Proposed [Conversion] [Continuation]") as
required by Section 2.9(b) of the Loan Agreement:


          (i)  The Business Day of the Proposed [Conversion] [Continuation] 
     is _______________./1/


- --------------------
     /1/Shall be a Business Day at least one Business Day after the date hereof
(in the case of any conversion of LIBOR Loans into Base Rate Loans) or at least
three Business Days after the date hereof (in the case of any conversion of Base
Rate Loans into, or continuation of, LIBOR Loans), and additionally, in the case
of any conversion of LIBOR Loans into Base Rate Loans, or continuation of LIBOR
Loans, shall be the last day of the Interest Period applicable thereto.
<PAGE>
 
         (ii)  The Proposed [Conversion] [Continuation] involves $____________
     in aggregate principal amount of Revolving Credit/Term Loans [made pursuant
     to a Borrowing on ____________.]/2/

        (iii)  The Loans referred to in clause (ii) above are presently
     maintained as [Base Rate] [LIBOR] Loans and are proposed hereby to be
     [converted into Base Rate/LIBOR Loans] [continued as LIBOR Loans].

        [(iv)  The initial Interest Period for each Loan being [converted into]
     [continued as] a LIBOR Loan as part of the Proposed [Conversion]
     [Continuation] shall be [one/two/three/six months].]/3/


     The undersigned hereby certifies that the following statements are true on
the date hereof and will be true on the effective date of the Proposed
[Conversion] [Continuation]:

 
          (A)  Each of the representations and warranties contained in Article
     IV of the Loan Agreement and in the other Loan Documents are and will be
     true and correct before and after giving effect to the Proposed
     [Conversion] [Continuation], as though made on each such date (except to
     the extent any such representation or warranty relates solely to a prior
     date); and

          (B)  No Default or Event of Default has occurred and is continuing or
     would result from the Proposed [Conversion] [Continuation].


                                        Very truly yours,

                                        RENAL TREATMENT CENTERS, INC.


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

                                        Title: 
                                               ------------------------------  


- ----------------------
     /2/Applicable to Revolving Credit/Term Loans only.

     /3/To be included in the case of any conversion of Base Rate Loans into, or
continuation of, LIBOR Loans.
<PAGE>
 
                                                Exhibit B-3 to Fifth Amended and
                                                     Restated Loan Agreement
                                                  First Union National Bank of
                                                     North Carolina, as Agent
                                                  Renal Treatment Centers, Inc.
                                                    May 2, 1997 / $200,000,000
                                                --------------------------------



                                    FORM OF
                            LETTER OF CREDIT REQUEST


                                     [Date]



First Union National Bank
  of North Carolina, as Issuing Bank
Specialized Industries/Healthcare
One First Union Center, TW-5
301 South College Street
Charlotte, North Carolina  28288-0735

Attention:  Healthcare Finance Group

Ladies and Gentlemen:

     The undersigned, Renal Treatment Centers, Inc. (the "Borrower"), refers to
the Fifth Amended and Restated Loan Agreement, dated as of May 2, 1997, among
the Borrower, certain banks and other financial institutions from time to time
parties thereto (the "Lenders"), and First Union National Bank of North
Carolina, as Agent for the Lenders (as amended, modified, supplemented or
restated from time to time, the "Loan Agreement," the terms defined therein
being used herein as therein defined), and, pursuant to SECTION 2.17(B) of the
Loan Agreement, hereby gives you, as Issuing Bank, irrevocable notice that the
undersigned hereby requests the issuance of a Letter of Credit for its account
under the Loan Agreement, and to that end sets forth below the information
relating to Letter of Credit (the "Proposed Letter of Credit") as required by
SECTION 2.17(B) of the Loan Agreement:


          (i)  The Business Day on which the Proposed Letter of Credit is 
     to be issued is _______________ (the "Issuance Date")./1/

         (ii)  The Stated Amount of the Proposed Letter of Credit is 
     $________________.

        (iii)  The expiry date of the Proposed Letter of Credit is 
     ______________.

- ----------------------
     /1/Shall be at least three Business Days (or such shorter period as is
acceptable to the Issuing Bank in any given case) after the date hereof.
<PAGE>
 
       (iv)  The name and address of the beneficiary of the Proposed Letter 
     of Credit is _________________________________________________________.

     The undersigned hereby certifies that the following statements are true on
the date hereof and will be true on the Issuance Date:

 
          (A)  Each of the representations and warranties contained in Article
     IV of the Loan Agreement and in the other Loan Documents are and will be
     true and correct before and after giving effect to the issuance of the
     Proposed Letter of Credit, as though made on each such date (except to the
     extent any such representation or warranty relates solely to a prior date);
     and

          (B)  No Default or Event of Default has occurred and is continuing or
would result from the issuance of the Proposed Letter of Credit.

     The undersigned agrees to complete all application procedures and documents
required by you in connection with the Proposed Letter of Credit.


                                        Very truly yours,

                                        RENAL TREATMENT CENTERS, INC.


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

                                        Title: 
                                               ------------------------------  
<PAGE>
 
                                                  Exhibit C to Fifth Amended and
                                                      Restated Loan Agreement
                                                   First Union National Bank of
                                                      North Carolina, as Agent
                                                   Renal Treatment Centers, Inc.
                                                    May 2, 1997 / $200,000,000
                                                  ______________________________



                                    FORM OF
                             COMPLIANCE CERTIFICATE


     THIS CERTIFICATE is given pursuant to SECTION 5.3(D) of the Fifth Amended
and Restated Loan Agreement, dated as of May 2, 1997, among Renal Treatment
Centers, Inc. (the "Borrower"), certain banks and other financial institutions
from time to time parties thereto (the "Lenders"), and you, as Agent for the
Lenders (as amended, modified, supplemented or restated from time to time, the
"Loan Agreement," the terms defined therein being used herein as therein
defined).

     The undersigned hereby certifies that:

     i.    He is the duly elected [President] [Chief Financial Officer] of
the Borrower.

     ii.   Enclosed with this Certificate are copies of the financial
statements of the Borrower and its Subsidiaries as of _____________, and for the
[________-month period] [year] then ended, required to be delivered under
SECTION [5.3(A)] [5.3(B)] of the Loan Agreement.  Such financial statements
fairly present the financial condition of the Borrower and its Subsidiaries on a
consolidated basis as of the date indicated and the results of operation of the
Borrower and its Subsidiaries on a consolidated basis for the period covered
thereby.

     iii.  The undersigned has reviewed the terms of the Loan Agreement and
has made, or caused to be made under the supervision of the undersigned, a
review in reasonable detail of the transactions and condition of the Borrower
and its Subsidiaries during the accounting period covered by such financial
statements.

     iv.   The examination described in paragraph 3 above did not disclose,
and the undersigned has no knowledge of the existence of, any Default or Event
of Default during or at the end of the accounting period covered by such
financial statements or as of the date of this Certificate. [, except as set
forth below.

     Describe here or in a separate attachment any exceptions to paragraph 4
above by listing, in reasonable detail, the nature of the Default or Event of
Default, the period during which it existed and the action that the Borrower has
taken or proposes to take with respect thereto.]

     v.    Attached to this Certificate as Attachments A and B, respectively,
are a Covenant Compliance Worksheet and an Interest 
<PAGE>
 
Rate Calculation Worksheet reflecting the computation of the financial covenants
set forth in Article VI of the Loan Agreement as of the last day of the period
covered by the financial statements enclosed herewith.

     IN WITNESS WHEREOF, the undersigned has executed and delivered this
Certificate as of the _______ day of _____________, ____.


                                    [signature of President or CFO or
                                    ---------------------------------
                                    VP-Finance]
                                    -----------


                                    Name: _______________________________

                                    Title: ______________________________
<PAGE>
 
                                  ATTACHMENT A

                         COVENANT COMPLIANCE WORKSHEET



- --------------------------------------------------------------------------------
CONSOLIDATED NET WORTH
(SECTION 6.10 OF THE LOAN AGREEMENT):               NOT LESS THAN THE FOLLOWING:
- --------------------------------------------------------------------------------
(1)  Base for calculating required Consolidated Net Worth           $125,000,000
                                                                    ============
 
(2)  Consolidated Net Income for
     each fiscal quarter (if positive) ending
     after the Closing Date                       $
                                                   ------------
 
     Multiplied by:                                          80%
 
     Equals:  Net income adjustment                                 $
                                                                    ============
 
(3)  Aggregate amount of all increases 
     in the stated capital and additional 
     paid-in capital accounts of the Borrower 
     resulting from the issuance of equity
     securities or other capital investments
     after the Closing Date                       $
                                                   ------------
 
     Multiplied by:                                         90%
 
     Equals:  Capital adjustment                                    $
                                                                    ============
 
(4)  Required Consolidated Net Worth:
       Add Lines 1, 2 and 3                                         $
                                                                    ============
 
(5)  Actual Consolidated Net Worth as
     of measurement date                                            $
                                                                    ============
 
- --------------------------------------------------------------------------------
 
<PAGE>
 
- --------------------------------------------------------------------------------
RATIO OF CASH AVAILABLE TO FIXED CHARGES
(SECTION 6.12 OF THE LOAN AGREEMENT):                  NOT LESS THAN 2.25 TO 1.0
 
RATIO OF CASH AVAILABLE TO DEBT SERVICE
(SECTION 6.13 OF THE LOAN AGREEMENT):                  NOT LESS THAN 1.20 TO 1.0
- --------------------------------------------------------------------------------
(1)  Cash Available:
 
    (a)  Consolidated Net Income for the period of 
         two fiscal quarters most recently ended                   $
                                                                    ------------
 
    (b)  The sum of the following for such period:
 
         Interest Expense                                  $
                                                            ------------
         Lease Expense                                     $
                                                            ------------
         Depreciation                                      $
                                                            ------------
         Amortization                                      $
                                                            ------------
         Other non-cash expenses or charges reducing
         income (to the extent taken into account in the
         calculation of Consolidated Net Income for
         such period)                                      $
                                                            ------------
 
                                                                   $
                                                                    ------------
 
    (c)  To the extent taken into account in the
         calculation of Consolidated Net Income for
         such period, non-cash credits increasing
         income for such period                                   ($           )
                                                                    ------------
 
     (d)  Add Lines 1(a) and 1(b) and subtract Line 1(c)           $
                                                                    ------------
 
     (e)  Cash Available:  Multiply Line 1(d) by two               $
                                                                    ============
 
(2)  Fixed Charges:
 
     (a)  The sum of Interest Expense and Lease
          Expense for the period of two fiscal
          quarters most recently ended                             $
                                                                    ------------
 
     (b)  Fixed Charges:  Multiply Line 2(a) by two                $
                                                                    ------------
 
(3)  Debt Service:
 
    (a)  Current maturities of Debt of the Borrower and
         its Subsidiaries as of the measurement date               $
                                                                    ------------
 
    (b)  Debt Service:  Add Lines 2(b) and 3(a)                    $
                                                                    ============
 
(4)  Ratio of Cash Available to Fixed Charges:
       Divide Line 1(e) by Line 2(b)                               $
                                                                    ============
 
(5)  Ratio of Cash Available to Debt Service:
       Divide Line 1(e) by Line 3(b)                               $
                                                                    ============

================================================================================
<PAGE>
 
- --------------------------------------------------------------------------------
RATIO OF CONSOLIDATED DEBT TO ANNUALIZED CASH FLOW
(SECTION 6.14 OF THE LOAN AGREEMENT):                NOT GREATER THAN 3.0 TO 1.0
 
CONSOLIDATED DEBT TO ANNUALIZED CASH FLOW
(SECTION 6.15 OF THE LOAN AGREEMENT):               NOT GREATER THAN 4.25 TO 1.0
- --------------------------------------------------------------------------------
 
(1)  Consolidated Debt as of the measurement date                  $
                                                                    ============
 
(2)  Annualized Cash Flow:
 
    (a)  Consolidated Net Income for the period of
         two fiscal quarters most recently ended                   $
                                                                    ------------
 
    (b)  The sum of the following for such period:
 
         Interest Expense                                   $
                                                             ------------
         Taxes                                              $
                                                             ------------
         Depreciation                                       $
                                                             ------------
         Amortization                                       $
                                                             ------------
         Other non-cash expenses or charges reducing
         income (to the extent taken into account in the
         calculation of Consolidated Net Income for
         such period)                                       $
                                                             ------------
 
                                                                   $
                                                                    ------------
 
    (c)  To the extent taken into account in the
         calculation of Consolidated Net Income for
         such period, non-cash credits increasing
         income for such period                                   ($           )
                                                                    ------------
 
    (d)  Add Lines 2(a) and 2(b) and subtract
         Line 2(c)                                                 $
                                                                    ------------
 
    (e)  Annualized Cash Flow:  Multiply Line 2(d) by two          $
                                                                    ============
 
(3)  Ratio of Consolidated Debt to Annualized Cash Flow:
         Divide Line 1 by Line 2(e)
                                                                    ============
 
- --------------------------------------------------------------------------------
 
<PAGE>
 
- --------------------------------------------------------------------------------
RATIO OF CONSOLIDATED DEBT TO CONSOLIDATED TOTAL CAPITAL
(SECTION 6.16 OF THE LOAN AGREEMENT):               NOT GREATER THAN 0.65 TO 1.0
- --------------------------------------------------------------------------------
 
(1)  Consolidated Debt as of the measurement date                  $
                                                                   =============
 
(2)  Consolidated Total Capital:
 
    (a)  Consolidated Net Worth as of the
         measurement date                                          $
                                                                    ------------
 
    (b)  Consolidated Debt as of the
         measurement date                                          $
                                                                    ------------
 
    (c)  Consolidated Total Capital:
         Add Lines 2(a) and 2(b)                                   $
                                                                    ------------
 
(3)  Ratio of Consolidated Debt to Consolidated Total Capital:
         Divide Line 1 by Line 2(c)                                $
                                                                    ============

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


- --------------------------------------------------------------------------------
Excluded Acquisition Expenses
- --------------------------------------------------------------------------------
          Attach Detail
- --------------------------------------------------------------------------------
<PAGE>
 
                                  ATTACHMENT B

                      INTEREST RATE CALCULATION WORKSHEET

- --------------------------------------------------------------------------------
 
 Ratio of Consolidated Debt to Annualized Cash Flow:
- --------------------------------------------------------------------------------

 (1)   Consolidated Senior Debt as of the measurement date            $
                                                                      ==========

 (2)   Annualized Cash Flow:
 
       (a)  Consolidated Net Income for the period of 
            two fiscal quarters most recently ended                   $
                                                                       =========

       (b)  The sum of the following for such period:
 
            Interest Expense                                    $
                                                                 ------------
            Taxes                                               $
                                                                 ------------
            Depreciation                                        $
                                                                 ------------
            Amortization                                        $
                                                                 ------------
            Other non-cash expenses or charges reducing
            income (to the extent taken into account in 
            the calculation of Consolidated Net Income
            for such period)                                    $
                                                                 ------------
                                                                      $
                                                                       ---------
       (c)  To the extent taken into account in the
            calculation of Consolidated Net Income
            for such period, non-cash credits increasing
            income for such period                                   ($        )
                                                                       --------
       (d)  Add Lines 2(a) and 2(b) and subtract
            Line 2(c)                                                 $
                                                                       ---------

       (e)  Annualized Cash Flow:  Multiply Line 2(d) by two          $
                                                                      ==========
(3)    Ratio of Consolidated Debt to Annualized Cash Flow:
             Divide Line 1 by Line 2(e)
                                                                      ==========
(4)    Applicable Margins effective as of the fifth (5th) day
       after delivery hereof (based on the matrix set forth in 
       the definition of Applicable Margin in the
       Loan Agreement):
 
            Applicable Margin (Base Rate Loans)
                                                                      ==========
            Applicable Margin (LIBOR Loans)
                                                                      ==========

- --------------------------------------------------------------------------------
<PAGE>
 
                                               Exhibit D to Fifth Amended and
                                                  Restated Loan Agreement
                                                First Union National Bank of
                                                  North Carolina, as Agent
                                                Renal Treatment Centers, Inc.
                                                May 2, 1997 / $200,000,000
                                                --------------------------------



                                    FORM OF
                           ASSIGNMENT AND ACCEPTANCE



      THIS ASSIGNMENT AND ACCEPTANCE (this "Assignment and Acceptance") is made
this _____ day of ____________, ____, by and between
_______________________________ (the "Assignor"), and _________________________
(the "Assignee").  Reference is made to the Fifth Amended and Restated Loan
Agreement, dated as of May 2, 1997 (as amended, modified, supplemented or
restated from time to time, the "Loan Agreement"), among Renal Treatment
Centers, Inc. (the "Borrower"), certain banks and other financial institutions
from time to time parties thereto (the "Lenders"), and First Union National Bank
of North Carolina, as Agent for the Lenders.  Unless otherwise defined herein,
terms defined in the Loan Agreement are used herein with the same meaning.

      The Assignor and the Assignee hereby agree as follows:

      1.  ASSIGNMENT AND ASSUMPTION.  Subject to the terms and conditions
          -------------------------                                      
hereof, the Assignor hereby sells and assigns to the Assignee, and the Assignee
hereby purchases and assumes from the Assignor, without recourse and, except as
expressly provided herein, without representation or warranty, that interest as
of the Effective Date (as hereinafter defined) in and to all of the Assignor's
rights and obligations under the Loan Agreement (in its capacity as a Lender
thereunder), represented by the percentage interest or interests specified in
Item 4 of Annex I of the aggregated outstanding rights and obligations of the
- ------    -------                                                            
Lenders under the Loan Agreement with respect to the Revolving Credit/Term
Facility (each such assigned interest, an "Assigned Share"), including, without
limitation, all rights and obligations of the Assignor with respect to the
Revolving Credit/Term Note(s) held by the Assignor and the Assigned Share of the
Revolving Credit/Term Loans and the Assignor's participations in Letters of
Credit. After giving effect to such sale and assignment, the Assignee's
Commitments, and the aggregate outstanding principal amounts of the Loans owing
to the Assignee, will be as set forth in Item 4 of Annex I.
                                         ------    ------- 

      2.  THE ASSIGNOR.  The Assignor (i) represents and warrants that it
          ------------                                                   
is the legal and beneficial owner of the interest being assigned by it hereunder
and that such interest is free and clear of any adverse claim, (ii) makes no
representation or warranty and assumes no responsibility with respect to any
statements, warranties or representations made in or in connection with the Loan
Agreement or any other Loan Document or the execution, legality, validity,
enforceability, genuineness, sufficiency or 
<PAGE>
 
value of the Loan Agreement or any other Loan Document or any other instrument
or document furnished pursuant thereto and (iii) makes no representation or
warranty and assumes no responsibility with respect to the financial condition
of the Borrower or any of its Subsidiaries or the performance or observance by
the Borrower or any of its Subsidiaries of any of their respective obligations
under the Loan Agreement or any other Loan Document or any other instrument or
document furnished pursuant thereto.

      3.  THE ASSIGNEE.  The Assignee (i) confirms that it has received a
          ------------                                                   
copy of the Loan Agreement, together with copies of the Financial Statements and
such other documents and information as it has deemed appropriate to make its
own credit analysis and decision to enter into this Assignment and Acceptance,
(ii) agrees that it will, independently and without reliance upon the Agent, the
Assignor or any other Lender, and based on such documents and information as it
shall deem appropriate at the time, continue to make its own credit decisions in
taking or not taking action under the Loan Agreement, (iii) confirms that it is
an Eligible Assignee, (iv) appoints and authorizes the Agent to take such action
as agent on its behalf and to exercise such powers and discretion under the Loan
Agreement and the other Loan Documents and any other instruments and agreements
referred to therein, and to exercise such powers and to perform such duties
thereunder, as are specifically delegated to or required of the Agent by the
terms thereof and such other powers as are reasonably incidental thereto, (v)
agrees that it will perform in accordance with their terms all of the
obligations that by the terms of the Loan Agreement are required to be performed
by it as a Lender, [and] (vi) specifies as its address for payments and notices
the office set forth beneath its name on its signature page hereto [, and (vii)
to the extent legally entitled to do so, attaches the forms described in SECTION
2.12(C) of the Loan Agreement]./2/


      4.  EFFECTIVE DATE.  Following the execution of this Assignment and
          --------------                                                 
Acceptance by the Assignor and the Assignee, an executed original hereof,
together with all attachments hereto and the processing fee referred to in
SECTION 10.5(A) of the Loan Agreement, shall be delivered to the Agent.  The
effective date of this Assignment and Acceptance (the "Effective Date") shall be
the later of (i) the date of acceptance hereof by the Agent or (ii) the date, if
any, designated as the Effective Date in Item 5 of Annex I.  As of the Effective
                                         ------    -------                      
Date, (y) the Assignee shall be a party to the Loan Agreement and, to the extent
provided in this Assignment and Acceptance, shall have the rights and
obligations of a Lender thereunder and under the other Loan Documents, and (z)
the Assignor shall, to the extent provided in this Assignment and Acceptance,
relinquish its rights and be released from its 

- -------------------
      /2/Insert if the Assignee is organized under the laws of a jurisdiction
outside of the United States.
<PAGE>
 
obligations under the Loan Agreement and the other Loan Documents [and shall
cease to be a party thereto]/3/.


      5.  PAYMENTS; SETTLEMENT.  From and after the Effective Date, the
          --------------------                                         
Agent will make all payments required to be made by it under the Loan Agreement
in respect of each Assigned Share under the Facilities (including, without
limitation, all payments of principal, interest and fees in respect of the
Assigned Share of all Loans, participations in Letters of Credit and Commitments
assigned hereunder) directly to the Assignee.  Upon the Effective Date, and as a
condition to the effectiveness of this Assignment and Acceptance, the Assignee
will pay to the Assignor an amount, to be specified in writing by the Assignor
to the Assignee, that represents the Assigned Share of the principal amount of
all Loans that are outstanding under the Loan Agreement on the Effective Date
and are being assigned to the Assignee hereunder, net of any closing costs.  The
Assignor and Assignee will be responsible for making between themselves all
appropriate adjustments in payments due under the Loan Agreement in respect of
the period prior to the Effective Date.  [Notwithstanding any other provision of
this Assignment and Acceptance, the Loan Agreement or any of the other Loan
Documents, the Assignor shall be entitled to retain for its own account any fees
that may have been paid or may be payable to the Assignor under the Loan
Agreement or the other Loan Documents in a capacity other than as a Lender,
including, to the extent applicable, as Agent and as Issuing Bank.]/4/



      6.  GOVERNING LAW.  This Assignment and Acceptance shall be
          -------------                                          
governed by, and construed in accordance with, the internal laws of the State of
North Carolina (without regard to the conflicts of laws principles thereof).

      7.  ENTIRE AGREEMENT.  This Assignment and Acceptance, together
          ----------------                                           
with the Loan Agreement and the other Loan Documents, embody the entire
agreement and understanding between the parties hereto and supersede all prior
agreements and understandings of the parties, verbal or written, relating to the
subject matter hereof.

      8.  SUCCESSORS AND ASSIGNS.  This Assignment and Acceptance shall
          ----------------------                                       
be binding upon, and shall inure to the benefit of, the parties hereto and their
respective successors and assigns.

      9.  COUNTERPARTS.  This Assignment and Acceptance may be executed
          ------------                                                 
in any number of counterparts and by different parties hereto on separate
counterparts, each of which, when so executed 

- -------------------
      /3/Insert if Assignment and Acceptance covers all or the remaining portion
of the Assignor's rights and obligations under the Loan Agreement.

      /4/Insert if First Union is the Assignor.
<PAGE>
 
and delivered, shall be an original, but all of which shall together constitute
one and the same instrument.
<PAGE>
 
     IN WITNESS WHEREOF, the parties have caused this Assignment and Acceptance
to be executed by their duly authorized officers as of the date first above
written.


                                  ASSIGNOR:


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


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

                                  Title: 
                                         -----------------------------

 


                                  ASSIGNEE:


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


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

                                  Title: 
                                         -----------------------------



Accepted this _______ day of
______________, 19___:

FIRST UNION NATIONAL BANK OF
  NORTH CAROLINA, as Agent


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

Title: 
       ----------------------------


Consented and agreed to:

RENAL TREATMENT CENTERS, INC.


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

Title: 
       ----------------------------
<PAGE>
 
                                    ANNEX I
                                    -------
                          TO ASSIGNMENT AND ACCEPTANCE
                          ----------------------------



1.  Borrower: Renal Treatment Centers, Inc.

2.  Name and Date of Loan Agreement:

    Fifth Amended and Restated Loan Agreement, dated as of May 2, 1997, among
    Renal Treatment Centers, Inc., certain Lenders from time to time parties
    thereto, and First Union National Bank of North Carolina, as Agent.

3.  Date of Assignment and Acceptance:  ________________, 19___.

4.  Amounts (as of date of Item 3 above):
                                 ------        

                                Aggregate                        Amount of
                                 for all           Assigned      Assigned
                                 Lenders            Share          Share
                                ---------          -------        ---------


    Revolving Credit/Term
    Commitment                  $_________         _________%    $_________

    Revolving Credit/Term
    Loans                       $_________         _________%    $_________

5.  Effective Date:

6.  Addresses for Payments and Notices:

    Assignor:        _________________________________
                     _________________________________
                     _________________________________
                     Attention: ______________________
                     Telecopy: _______________________
                     Reference: ______________________

    Assignee:        _________________________________
                     _________________________________
                     _________________________________
                     Attention: ______________________
                     Telecopy: _______________________
                     Reference: ______________________
<PAGE>
 
                           Schedule 1.1(a) to Fifth Amended and Restated Loan
                           Agreement
                           First Union National Bank of North Carolina, as Agent
                           Renal Treatment Centers, Inc.
                           May 2, 1997/$200,000,000


                                     FIFTH
                             AMENDED AND RESTATED
                                LOAN AGREEMENT

                         Renal Treatment Centers, Inc.
                                      and
                    First Union National of North Carolina
                       and Certain Lending Institutions

                                SCHEDULE 1.1(a)

                                                              Dated: May 2, 1997

                                Existing Liens
                                --------------


1.1(a)(i)    Lease subordination provisions in the real estate lease agreements 
             of Borrower and Subsidiaries.

1.1(a)(ii)   Financing statements filed under equipment leases (see attached).

1.1(a)(iii)  Rights of first refusal to purchase facilities, subject to certain 
             conditions:

             (A)   as provided in Medical Directors Agreement dated August 31,
                   1985, as amended October 15, 1990 with Dr. Constante J. Tan
                   Associates, P.A., Constante J. Tan, M.D. and Benito S. Chan,
                   M.D.;

             (B)   as provided in the Amended and Restated Physician Director
                   Agreement dated May __, 1995 with Leslie S. Feinsmith, M.D.,
                   P.C.;

             (C)   as provided in Shareholder Guaranty, Indemnity and Right of
                   First Refusal Agreement, dated October 15, 1992 with Memorial
                   Investment Corp., SCH Enterprises, Inc., Mid Jersey Health
                   Corporation and Nephrology-Hypertension Associates of
                   Morristown, P.A.;

             (D)   as provided in Physician Director Agreement dated February 
                   12, 1993 with Edward J. Fillipone, M.S.;
<PAGE>
 
                (E)   as provided in the Asset Purchase Agreement dated as of
                      June 30, 1994 between Renal Treatment Centers - New
                      Jersey, Inc. and Jersey Shore Medical Center, Inc.;

                (F)   as provided in the Asset Purchase Agreement dated July 13,
                      1994 between Renal Treatment Centers - Texas, Inc. and
                      Rodolfo Maldonado East Side Kidney Clinic, Inc.;

                (G)   as provided in the Asset Purchase Agreement dated December
                      30, 1994 between Renal Treatment Centers - Texas, Inc. and
                      Daughters of Charity Health Services of Austin.

1.1(a)(iv)      liens under the Loan Documents;

1.1(a)(v)       liens under the Intercompany Loan Documents.
<PAGE>
 
                           Schedule 4.1 to Fifth Amended and Restated Loan
                           Agreement
                           First Union National Bank of North Carolina, as Agent
                           Renal Treatment Centers, Inc.
                           May 2, 1997/$200,000,000

                                     FIFTH
                             AMENDED AND RESTATED
                                LOAN AGREEMENT

                         Renal Treatment Centers, Inc.
                                      and
                  First Union National Bank of North Carolina
                                      and
                         Certain Lending Institutions

                                 SCHEDULE 4.1

                                                              Dated: May 2, 1997

Except as otherwise noted, all first tier subsidiaries are owned 100% by Renal 
Treatment Centers, Inc.

<TABLE> 
<CAPTION> 

                                                                                    Foreign
                                                     Incorporation                  Qualification
                                                     -------------                  -------------
<S>                                                  <C>                            <C> 

0   Renal Treatment Centers, Inc.                             DE                    PA

01  Renal Treatment Centers - Mid-Atlantic, Inc.              DE                    GA, MD, VA,
                                                                                    NC, DC

02  Renal Treatment Centers - Northeast, Inc.                 DE                    PA, NJ

03  RTC Supply, Inc.                                          DE                    LA, MD, GA,
                                                                                    PA, NJ, FL, HI,
                                                                                    CO, OK, KS,
                                                                                    CA, VA, D.C.,
                                                                                    MO, NC, TX,
                                                                                    NV, IL

04  Renal Treatment Centers - California, Inc.                DE                    CA

05  Renal Treatment Centers - West, Inc.                      DE                    CO, OK, WY,
                                                                                    KS, NE, NV
</TABLE> 
<PAGE>
 
<TABLE> 

<S>  <C>                                            <C>         <C> 
06   Renal Treatment Centers - Southeast, Inc.      DE          TX,FL,
                                                                LA, AL

     06.1   RTC-Texas Acquisition, Inc. (100%)      TX          --

07   Renal Treatment Centers - Illinois, Inc.       DE          IL, MO,
                                                                IN, OH
08   Renal Treatment Centers - Management
     Acquisition, Inc.                              DE          TN, D.C., VA

09   Renal Treatment Centers - Hawaii, Inc.         DE          HI

10   RTC TN, Inc.                                   DE          --

     10.1   RTC Holdings, Inc. (100%)               DE          --

11   Renal Treatment Centers - Lab, Inc.            DE          NV

12   RTC Holdings International, Inc. (95%)         DE          ARG

     12.1   RTC Argentina S.A. (99.99%)             ARG         --

     12.2   RTC Buenos Aires S.A. (79.99%)          ARG         --

     12.3   RTC Cordoba S.A. (79.99%)               ARG         --
</TABLE> 

                    Corporate History and Fictitious Names
                    --------------------------------------

                                 See Attached
<PAGE>
 
                           Schedule 4.2 to Fifth Amended and Restated Loan
                           Agreement
                           First Union National Bank of North Carolina, as Agent
                           Renal Treatment Centers, Inc.
                           May 2, 1997/$200,000,000

                                     FIFTH
                             AMENDED AND RESTATED
                                LOAN AGREEMENT

                         Renal Treatment Centers, Inc.
                                      and
                  First Union National Bank of North Carolina
                                      and
                         Certain Lending Institutions

                                 SCHEDULE 4.2

                                                              Dated: May 2, 1997

                       Litigation: Government Regulation
                       ---------------------------------

                                     NONE

No material litigation, but the matters on the attached pages are outstanding.
<PAGE>
 
Ethel Smith v. Renal Treatment Centers - Delaware, Inc., EEOC charge number
- ------------------------------------------------------- 
17085316. Ms. Smith claims that the Company dismissed her in violation of the  
Americans With Disabilities Act. Ms. Smith slipped on ice in the parking lot of 
the facility and broke her leg. The Company's Workers' Compensation insurance 
has indemnified the former employee for part of her alleged losses. The claimant
has also initiated a third party action against the landlord of the facility. 
There have been no further proceedings. This action was settled for $65,000 in 
February 1997. A request for additional information was received and responded 
to in February 1997. There have been no further proceedings. The Company 
believes that it and its employees did not violate the law and will defend 
itself vigorously in this matter. An outcome in this matter unfavorable to the 
Company is neither probable nor remote. An estimate of the range of potential 
loss cannot be made within acceptable bounds of accuracy.

Yenis v. Renal Treatment Centers - Pennsylvania, Inc. City of Philadelphia
- ----------------------------------------------------- 
Commission On Human Relation Charge #E-73633H. Ms. Yenis claims that the Company
dismissed her in violation of the Pennsylvania Human Relations Act (PHRA)
because of her alleged disability. The Company has complied with requests for
information and attended a fact finding conference. The Commission has issued a
preliminary report announcing its intent to find no discrimination. There have
been no further proceedings. The Company believes that it and its employees did
not violate the law and will defend itself vigorously in this matter. An outcome
in this matter unfavorable to the Company is neither probable nor remote. An
estimate of the range of potential loss cannot be made within acceptable bounds
of accuracy.

Harris v. Renal Treatment Centers - Hawaii, Inc. EEOC Charge #7603/###-##-####.
- ------------------------------------------------ 
Mr. Harris claims racial and sexual harassment. Settlement discussions continue.
The Company believes that it and its employees did not violate the law and 
will defend itself vigorously in this matter. An outcome in this matter 
unfavorable to the Company is neither probable nor remote. An estimate of the 
range of potential loss cannot be made within acceptable bounds of accuracy.

Racoma v. Renal Treatment Centers - Hawaii, Inc. DOL Docket No. E00155-WI. Mr.
- ------------------------------------------------ 
Racoma claims retaliatory discharge for filing a Workers' Compensation claim. 
RTC is responding to the DOL request for information. The Company believes that 
it and its employees did not violate the law and will defend itself vigorously 
in this matter. An outcome in this matter unfavorable to the Company is neither 
probable nor remote. An estimate of the range of potential loss cannot be made 
within acceptable bounds of accuracy.

Twyman v. Renal Treatment Centers. Inc. Pennsylvania Human Relations Commission
- --------------------------------------- 
Charge #E81266AD. Ms. Twyman claims that the Company dismissed her in violation 
of the Pennsylvania Human Relations Act (PHRA) because of her race and age. The 
Company is pursuing settlement discussions. There have been no further 
proceedings. The Company believes that it and its employees did not violate the 
law and will defend itself vigorously in this matter. An outcome in this matter 
unfavorable to the Company is neither probable nor remote. An estimate of the 
range of potential loss cannot be made within acceptable bounds of accuracy.

Ali v. Rental Treatment Centers, Inc. Pennsylvania Human Relations Commission
- ------------------------------------- 
Charge  #E81902AD. Ms. Ali claims that the Company dismissed her in violation of
the Pennsylvania Human Relations Act (PHRA) because of her race and age. The
Company is pursuing settlement

                                  EX10_11-155
<PAGE>
 
discussions. There have been no further proceedings. The Company believes that 
it and its employees did not violate the law and will defend itself vigorously 
in this matter. An outcome in this matter unfavorable to the Company is neither 
probable nor remote. An estimate of the range of potential loss cannot be made 
within acceptable bounds of accuracy.

Williams v. Renal Treatment Centers, Inc. EEOC Charge #170970596. Mr. Williams
- ----------------------------------------- 
alleges that he was discriminated against based upon his race, African American.
The Company is pursuing settlement discussions. There have been no further 
proceedings. The Company believes that it and its employees did not violate the
law and will defend itself vigorously in this matter. An outcome in this matter 
unfavorable to the Company is neither probable nor remote. An estimate of the 
range of potential loss cannot be made within acceptable bounds of accuracy.

Marshall v. Renal Treatment Centers - Hawaii, Inc. Hawaii Civil Rights 
- --------------------------------------------------
Commission Charge #8250, EEOC Charge #378970084. Ms. Marshall alleges that she 
was discriminated against based upon her race, Asian American. The Company is 
pursuing settlement discussions. There have been no further proceedings. The 
Company believes that it and its employees did not violate the law and will 
defend itself vigorously in this matter. An outcome in this matter unfavorable 
to the Company is neither probable nor remote. An estimate of the range of 
potential loss cannot be made within acceptable bounds of accuracy.

Renal Treatment Centers - Missouri, Inc. v. Braxton. No. CV695-2616CC (Cape
- --------------------------------------------------- 
Girardeau Missouri 1995) is a breach of contract action initiated by Renal 
Treatment Centers - Missouri, Inc. ("RTC-Missouri") (now known as Renal 
Treatment Centers-Illinois, Inc.) in the Circuit Court of Cape Girardeau, 
Missouri against Dr. Frank W. Braxton, who is the medical director of three 
dialysis facilities owned by RTC-Missouri. In the action, RTC-Missouri demands 
an injunction to preclude Dr. Braxton from violating a covenant not to compete 
with two of RTC-Missouri's dialysis facilities. In September 1996, the court 
denied RTC-Missouri's request for an injunction. The court held that the 
covenant was not enforceable for a number of reasons, including its finding 
that, regarding Dr. Braxton, RTC-Missouri did not have a protectible interest in
its contacts with patients because Dr. Braxton met patients in his role as a
physician and not in his role as a medical director. RTC-Missouri appealed the
Court's decision to the Missouri Court of Appeals unsuccessfully. Dr Braxton has
made no counterclaims against RTC-Missouri.

<PAGE>
 
                           Schedule 4.3 to Fifth Amended and Restated Loan
                           Agreement
                           First Union National Bank of North Carolina, as Agent
                           Rental Treatment Centers, Inc.
                           May 2, 1997/$200,000,000

                                     FIFTH
                             AMENDED AND RESTATED
                                LOAN AGREEMENT

                         Renal Treatment Centers, Inc.
                                      and
                  First Union National Bank of North Carolina
                                      and
                         Certain Lending Institutions

                                 SCHEDULE 4.3

                                                              Dated: May 2, 1997

                                     Taxes
                                     -----

                                     NONE




<PAGE>
 
                           Schedule 4.4 to Fifth Amended and Restated Loan
                           Agreement
                           First Union National Bank of North Carolina, as Agent
                           Renal Treatment Centers, Inc.
                           May 2, 1996/$200,000,000

                                    FIFTH
                             AMENDED AND RESTATED
                                LOAN AGREEMENT

                        Renal Treatment Centers, Inc.
                                     and
                  First Union National Bank of North Carolina
                                      and
                         Certain Lending Institutions

                                 SCHEDULE 4.4

                                                              Dated: May 2, 1997

                   Material Defaults Under Other Agreements
                   -----------------------------------------

                                     NONE
                            
<PAGE>
 
                           Schedule 4.9 to Fifth Amended and Restated Loan
                           Agreement
                           First Union National Bank of North Carolina, as Agent
                           Renal Treatment Centers, Inc.
                           May 2, 1997/$200,000,000


                                     FIFTH
                             AMENDED AND RESTATED
                                LOAN AGREEMENT

                         Renal Treatment Centers, Inc.
                                      and
                  First Union National Bank of North Carolina
                                      and
                         Certain Lending Institutions

                                 SCHEDULE 4.9

                                                              Dated: May 2, 1997

                         Principal Places of Business
                         ----------------------------

The following are possible principal places of business and chief executive 
offices as provide in the Uniform Commercial Code, of the borrower and each of 
its Subsidiaries:

00.  Renal Treatment Centers, Inc.
     00.1 1180 West Swedesford Road, Suite 300, Berwyn, Chester County,  
          Pennsylvania 19312

01.  Renal Treatment Centers - Mid-Atlantic, Inc.
     01.1 1180 West Swedesford Road, Suite 300, Berwyn, Chester County, 
          Pennsylvania 19312
     01.2 2310 Parklake Drive, N.E., Suite 530, Atlanta, Georgia 30345
     01.3 Mt. Washington Mill, 1340 Smith Avenue, Baltimore, Maryland 21209
     01.4 4451 Brookfield Corp. Drive., Suite 206, Chantilly, Virginia 20151
     01.5 1135 Carthage Street, Medical Arts Building #101, Sanford, North 
          Carolina 27330
     01.6 5000 Nannie Helen Burroughs Ave, N.E., Washington, D.C. 20019

02.  Renal Treatment Centers - Northeast, Inc.
     02.1 1180 West Swedesford Road, Suite 300, Berwyn, Chester County, 
          Pennsylvania 19312
     02.2 701 Foulk Road, Suite 2G, Wilmington, Delaware 19803
     02.3 Howell Heritage Plaza, 3502 Route 9 South, Howell, New Jersey 07731
     02.4 Plaza 21 Building, 1st Floor, 425 N. 21st Street, Camp Hill, 
          Cumberland County, Pennsylvania 17011

03.  RTC Supply, Inc.
     03.1 1180 West Swedesford Road, Suite 300, Berwyn, Chester County, 
          Pennsylvania 19312
<PAGE>
 

04.  Renal Treatment Centers - California, Inc.
     04.1   1180 West Swedesford Road, Suite 300, Berwyn, Chester County, 
            Pennsylvania 19312
     04.2   2535 Camino del Rio South, Suite 130, San Diego, California 92108

05.  Renal Treatment Centers - West, Inc.
     05.1   1180 West Swedesford Road, Suite 300, Berwyn, Chester County, 
            Pennsylvania 19312
     05.2   1601 East 19th Avenue, Suite 3200, Denver, Colorado 80218
     05.3   909 North Topeka, Wichita, Sedgewick County, Kansas 67214
     05.4   4300 N. Classen Blvd., Oklahoma City, Oklahoma 73118
     05.5   111 South Jefferson, Suite 116, Casper, Wyoming 82601
     05.6   2345 E. Prater Way, Suite 100, Sparks, Nevada 89434
     05.7   3700 Avenue B, Scottsbluff, Nebraska 69361

06.  Renal Treatment Centers - Southeast, Inc.
     06.1   1180 W. Swedesford Road, Suite 300, Berwyn, Chester County, 
            Pennsylvania 19312
     06.2   4200 N. Lamar St., Suite 100, Austin, Travis County, Texas, 78756
     06.3   4528 Freret Street, New Orleans, Orleans Parish, Louisiana 70115
     06.4   400 Security Square, Winter Haven, Polk County, Florida 33880
     06.5   1900 Opelika Road, Phenix City, Alabama 36867

07.  Renal Treatment Centers - Illinois, Inc.
     07.1   1180 W. Swedesford Road, Suite 300, Berwyn, Chester County, 
            Pennsylvania 19312
     07.2   129 North Eighth St., 3rd Fl., East. St. Louis, St. Clair County, 
            Illinois 62201
     07.3   815 Eastgate Blvd. South, Cincinnati, Clermont County, Ohio 45245
     07.4   1041 State Road, Batesville, Franklin County, Indiana 47006
     07.5   2610 Clark Avenue, St. Louis, Missouri 63103

08.  Renal Treatment Centers - Management Acquisition, Inc.
     08.1   1180 W. Swedesford Road, Suite 300, Berwyn, Chester County, 
            Pennsylvania 19312

09.  Renal Treatment Centers - Hawaii, Inc.
     09.1   1180 W. Swedesford Road, Suite 300, Berwyn, Chester County, 
            Pennsylvania 19312
     09.2   226 N. Kuakini St., Honolulu, Honolulu County, Hawaii 96817

10.  RTC Holdings, Inc.
     10.1   911 Washington Street, Wilmington, New Castle County, Delaware 19801

11.  Renal Treatment Centers - Lab, Inc.
     11.1   1180 W. Swedesford Road, Suite 300, Berwyn, Chester County, 
            Pennsylvania 19312
     11.2   7090 Pollock Road, Las Vegas, Nevada

12.  RTC Holdings International, Inc.
     12.1   200 West Ninth Street Plaza, Wilmington, New Castle County, Delaware
            19899

13.  RTC TN, Inc.
     13.1   200 West Ninth Street Plaza, Wilmington, New Castle County, Delaware
            19899

<PAGE>
 
14.  RTC - Texas Acquisition, Inc.
     14.1  1180 W. Swedesford Road, Suite 300, Berwyn, Chester County 
           Pennsylvania 19312
     14.2  1405 Victoria Station, Victoria, Texas 77901

     Argentine Companies Intentionally Omitted

<PAGE>
 
                           Schedule 4.10 to Fifth Amended and Restated Loan
                           Agreement
                           First Union National Bank of North Carolina, as Agent
                           Renal Treatment Centers, Inc.
                           May 2, 1997/$200,000,000


                                     FIFTH
                             AMENDED AND RESTATED
                                LOAN AGREEMENT

                         Renal Treatment Centers, Inc.
                                      and
                  First Union National Bank of North Carolina
                                     and 
                         Certain Lending Institutions

                                 SCHEDULE 4.10

                                                             Dated:  May 2, 1997

                                 ERISA Matters
                                 -------------

Employee Plans and Pension Plans

1.   Renal Treatment Centers Healthcare Plan
2.   Renal Treatment Centers CIGNA HMO Plan
3.   Renal Treatment Centers CIGNA Dental Plan
4.   Sharp Health Plan of California
5.   Kaiser Health Plan of California
6.   Prudential Health Plan
7.   Delta Dental Plan of Hawaii
8.   Renal Treatment Centers, Inc. Short Term Disability Plan
9.   Renal Treatment Centers, Inc. Group Long Term Disability Program
10.  Renal Treatment Centers, Inc. Savings Plan
11.  Educational Assistance Benefit
12.  Group Life Insurance Benefit
13.  Flexible Spending Accounts
14.  Renal Treatment Centers - IMS Defined Benefit Plan
15.  HMSA Plan
16.  Kaiser of Hawaii Plan

Qualified Plans:

1.   Renal Treatment Centers, Inc. Savings Plan

Multiemployer Plans:

None
<PAGE>
 
                           Schedule 4.11 to Fifth Amended and Restated Loan
                           Agreement
                           First Union National Bank of North Carolina, as Agent
                           Renal Treatment Centers, Inc.
                           May 2, 1997/$200,000,000


                                     FIFTH
                             AMENDED AND RESTATED
                                LOAN AGREEMENT

                         Renal Treatment Centers, Inc.
                                      and
                  First Union National Bank of North Carolina
                                      and
                         Certain Lending Institutions

                                 SCHEDULE 4.11

                                                              Dated: May 2, 1997

                                 Subsidiaries
                                 ------------

<TABLE> 
<CAPTION> 

                                                      Class            Shares           Shares
                                                     of Stock        Authorized       Outstanding
                                                     --------        ----------       -----------
<S>                                                  <C>             <C>              <C> 
0    Renal Treatment Centers, Inc.                   Common             1000              100
                                                                 
01   Renal Treatment Centers - Mid-Atlantic Inc.     Common             1000              100
                                                                 
02   Renal Treatment Centers - Northeast, Inc.       Common             1000              100
                                                                 
03   RTC Supply, Inc.                                Common             1000              100
                                                                 
04   Renal Treatment Centers - California, Inc.      Common             1000              100
                                                                 
05   Renal Treatment Centers - West, Inc.            Common             1000              100
                                                                 
06   Renal Treatment Centers - Southeast, Inc.       Common             1000              1000
                                                                 
     06.1  RTC - Texas Acquisition, Inc.             Common             1000              1000
                                                                 
07   Renal Treatment Centers - Illinois, Inc.        Common             1000              100
                                                                 
08   Renal Treatment Centers - Management            Common             1000              100
     Acquisitions, Inc.                                          
                                                                 
09   Renal Treatment Centers - Hawaii, Inc.          Common             1000              100
</TABLE> 
<PAGE>
 
                           Schedule 4.11 to Fifth Amended and Restated Loan
                           Agreement
                           First Union National Bank of North Carolina, as Agent
                           Renal Treatment Centers, Inc.
                           May 2, 1997/$200,000,000

<TABLE> 
<CAPTION> 

                                            Class         Shares       Shares
                                            of Stock    Authorized   Outstanding
                                            --------    ----------   -----------
                                  
<S>                                         <C>         <C>          <C>    
10   RTC TN, Inc.                           Common          3000         1000
                                  
     10.1  RTC Holdings, Inc.               Common          1000         100
                                  
11   Renal Treatment Centers - Lab, Inc.    Common          1000         100

12   RTC Holdings International, Inc.       Common          3000         1000

     12.1  RTC Argentina S.A.               Common          88000        88000*
 
     12.2  RTC Buenos Aires S.A.            Common          12000        12000*

     12.3  RTC Cordoba S.A.                 Common          12000        12000*
</TABLE> 

*Under Argentine law capital stock may be fully paid over a period of two years 
from the formation of such entity.  The Argentine subsidiaries (RTC Argentina 
S.A., RTC Buenos Aires S.A. and RTC Cordoba S.A.) have been capitalized in 
accordance with the laws of the Republic of Argentina and the capital stock will
be fully paid in accordance with Argentine laws which currently permit capital 
stock to be paid in over a two year period from the date of formation.
<PAGE>
 
                           Schedule 4.13 to Fifth Amended and Restated Loan
                           Agreement
                           First Union National Bank of North Carolina, as Agent
                           Renal Treatment Centers, Inc.
                           May 2, 1997/$200,000,000




                                     FIFTH
                             AMENDED AND RESTATED
                                LOAN AGREEMENT

                         Renal Treatment Centers, Inc.
                                      and
                  First Union National Bank of North Carolina
                                      and
                         Certain Lending Institutions

                                 SCHEDULE 4.13

        
                                                             Dated: May 2, 1997

                          Additional Title Exceptions
                          ---------------------------


                                     NONE
<PAGE>
 
                           Schedule 4.22 to Fifth Amended and Restated Loan
                           Agreement
                           First Union National Bank of North Carolina, as Agent
                           Renal Treatment Centers, Inc.
                           May 2, 1997/$200,000,000




                                     FIFTH
                             AMENDED AND RESTATED
                                LOAN AGREEMENT

                         Renal Treatment Centers, Inc.
                                      and
                  First Union National Bank of North Carolina
                                     and 
                         Certain Lending Institutions

                                 SCHEDULE 4.22

                                                              Dated: May 2, 1997

                 Schedule of Property and Liability Insurance
                 --------------------------------------------
<TABLE> 
<CAPTION> 
Coverage            Limit($)         Deductible($)      Insurer        Period
- --------            --------         -------------      -------        ------
<S>                 <C>              <C>                <C>            <C> 
A. Liability                                                      

1. General*         1,000,000 per        None            PHICO         7/19/96-
                    occurrence                                         7/19/97
                    3,000,000                                     
                    annual                                        
                    facility                                      
                    aggregate                                     
                                                                  
2. Professional     3,000,000 (per       25,000/         PHICO         7/19/96-
                    occurrence/          100,000                       7/19/97
                    annual                                        
                    facility                                      
                    aggregate)                                    
                                                                  
3. Automobile       1,000,000 (per       None            Hartford      12/23/96-
                    accident)                                          12/23/97
                                                                  
4. Workers'**       Statutory            None            Legion        12/23/96-
   Compensation                                                        12/23/97
                                                                  
5. Employers'       500,000              None            Legion        12/23/96-
   Liability                                                           12/23/97
</TABLE> 

<PAGE>
 
<TABLE> 
<CAPTION> 

Schedule of Property and Liability Insurance
- --------------------------------------------
Page 2

Coverage                Limit(s)                Deductible($)           Insurer                 Period
- --------                --------                -------------           -------                 ------
<S>                     <C>                     <C>                     <C>                     <C> 
 
6.  Umbrella            5,000,000 (per          underlying,             PHICO                   7/19/96-
                        occurrence/             GL,PL,E.L.                                      7/19/97
                        aggregate)              and AUTO limit

7.  Directors and       5,000,000               None for                National Union          7/19/96-
    Officers            (aggregate)             D&O; 100,000            Fire Insurance          7/19/97
                                                for corporation;        Company 
                                                250,000 for SEC

8.  Fiduciary           2,000,000               2,500                   Fidelity & Deposit      9/21/96-
                                                                                                9/21/97

B.  Property

1.  All Risk            31,316,771              500                     Hartford                12/23/96-
                                                                                                12/23/97

2.  Business            2,496,952               None                    Hartford                12/23/96-
    Interruption/                                                                               12/23/97
    Extra Expense

3.  Crime (Employee     $1,000,000              $5,000/$2,000/          Continental             11/4/95-
    Dishonesty/         (each for ED,           $5,000/2,000                                    7/19/97
    Forgery &           F&A, CF)        
    Alteration/         ($50,000 for CCF)
    Computer Fraud/
    Credit Card Forgery)

4.  Auto Physical       Value of                Collision - $500        Hartford                12/23/96-
    Damage              Vehicle                 Comprehensive-                                  12/23/97
                                                $250
</TABLE> 
C.  Life-all policies canceled.











<PAGE>
 
Schedule of Property and Liability Insurance
- --------------------------------------------
Page 3

<TABLE> 
<CAPTION> 
Coverage                     Limit(s)                      Deductible($)                 Insurer             Period
- --------                     --------                      -------------                 -------             ------
<S>                          <C>                           <C>                           <C>                 <C> 


D.  Argentina

1.  General Liability        U.S. $1,000,000                    None                     Cigna               4/1/97-
                             per occurrence                                              Argentina           4/1/98
                                                                                         Compana de          (San Luis)
                                                                                         Seguros S.A.        9/25/96-
                                                                                                             9/25/97
                                                                                                             (Buenos
                                                                                                             Aires)
                                                                                                             3/1/97-
                                                                                                             3/1/98
                                                                                                             (Cordoba)

2.  Property                 U.S. $276,000                      U.S. $5,000              Sud America         3/11/97
                             (San Luis)                                                  Seguros             3/11/98
                             U.S. $30,000
                             (Argentina)
                             U.S. $260,000
                             (Buenos Aires)
                             To be determined
                             (Cordoba and
                             Mercedes)

3.  Professional             U.S. $1,000,000                    U.S. $10,000/            American            4/1/97-
    Liability                U.S. $5,000,000                    claim                    Continental         4/1/98
                             excess                                                      Insurance
                                                                                         Company, Inc.
                                                                                         (fronted by
                                                                                         Sud America
                                                                                         Seguros)

4.  Workers' compensation***

</TABLE> 

____________________________________________
*  includes employee benefits liability coverage subject to $1,000 deductible.
** Insurers for Louisiana, Ohio and Wyoming are the State Workers' Compensation 
   Funds.
***Compulsory taxation system in Argentina

<PAGE>
 

                           Schedule 6.17 to Fifth Amended and Restated Loan
                           Agreement
                           First Union National Bank of North Carolina, as Agent
                           Renal Treatment Centers, Inc.
                           May 2, 1997/$200,000,000



                                     FIFTH
                             AMENDED AND RESTATED
                                LOAN AGREEMENT

                         
                         Renal Treatment Centers, Inc.
                                      and
                  First Union National Bank of North Carolina
                                      and
                         Certain Lending Institutions

                                 SCHEDULE 6.17

                                                              Dated: May 2, 1997


                        Schedule of Sale and Leaseback
                        ------------------------------

1. Sale and leaseback in connection with the relocation of the facility located 
   at 5000 Nannie Helen Burroughs Ave., N.E., Washington, DC  20019.

2. Sale and leaseback of dialysis facilities located on owned properties as 
   follows:

               Renal Treatment Centers - Illinois, Inc.
               3231 Bloomfield Road
               Cape Girardeau, MO  63703

               Renal Treatment Centers - West, Inc.
               2645 W. Elk
               Duncan, OK  73533

               Renal Treatment Centers - Southeast, Inc.
               510 N. MacArthur Avenue
               Panama City, FL  32401     
<PAGE>
 
                           Schedule 6.8 to Fifth Amended and Restated Loan
                           Agreement
                           First Union National Bank of North Carolina, as Agent
                           Renal Treatment Centers, Inc.
                           May 2, 1997/$200,000,000


                                     FIFTH
                             AMENDED AND RESTATED
                                LOAN AGREEMENT

                         Renal Treatment Centers, Inc.
                                      and
                  First Union National Bank of North Carolina
                                      and
                         Certain Lending Institutions

                                 SCHEDULE 6.8


                                                              Dated: May 2, 1997

                              Restricted Payments
                              -------------------

Cash dividends paid ratably to the holders of the Stock of any Foreign 
Subsidiary in which any Person that is not the Borrower or a Subsidiary of the 
Borrower is a holder of Stock.
<PAGE>
 
                              Schedule 1 to Opinion of Duane, Morris & Heckscher


                Renal Treatment Centers, Inc. and Subsidiaries
                ----------------------------------------------
                            Foreign Qualifications
                            ----------------------


00.  RENAL TREATMENT CENTERS, INC.

State of Incorporation:              Delaware
Date of Incorporation:               8/11/88

Foreign Qualifications:              State                         Date   
                                     -----                         ----   
                                                                          
                                     Pennsylvania                  08/15/88


01.  RENAL TREATMENT CENTERS - MID-ATLANTIC, INC.

State of Incorporation:              Delaware
Date of Incorporation:               12/12/88

Foreign Qualifications:              State                         Date   
                                     -----                         ----   
                                                                          
                                     Georgia                       12/27/88
                                                        Amended    01/29/97
                                     Maryland                      12/27/96
                                                        Amended    03/27/97
                                     Virginia                      01/07/97
                                                        Amended    01/24/97
                                     North Carolina                12/31/96
                                                        Amended    01/22/97
                                     Washington, D.C.              01/02/97
                                                        Amended    01/30/97

<PAGE>
 
                              Schedule 1 to Opinion of Duane, Morris & Heckscher


02.  RENAL TREATMENT CENTERS - NORTHEAST, INC.

State of Incorporation:              Delaware
Date of Incorporation:               01/04/93

Foreign Qualifications:              State                         Date   
                                     -----                         ----   
                                                                          
                                     Pennsylvania                  12/27/96
                                                        Amended    01/31/97
                                     New Jersey                    12/30/96
                                                        Amended    01/28/97


03.  RTC SUPPLY, INC.

State of Incorporation:              Delaware
Date of Incorporation:               11/06/92

Foreign Qualifications:              State                         Date   
                                     -----                         ----   
                                                                          
                                     Louisiana                     11/12/92
                                     Maryland                      11/12/92
                                     Georgia                       11/13/92
                                     Pennsylvania                  11/12/92
                                     New Jersey                    11/12/92
                                     Florida                       07/26/93
                                     Hawaii                        03/20/96
                                     Colorado                      10/06/95
                                     Oklahoma                      02/29/96
                                     Kansas                        08/29/95
                                     California                    12/08/93
                                     Virginia                      07/08/94
                                     Washington, D.C.              02/28/95
                                     Missouri                      02/27/95
                                     North Carolina                02/28/95
                                     Texas                         08/28/96
                                     Nevada                        01/16/97
                                     Illinois                      02/27/95
 

<PAGE>
 
                              Schedule 1 to Opinion of Duane, Morris & Heckscher


04.  RENAL TREATMENT CENTERS - CALIFORNIA, INC.

State of Incorporation:              Delaware
Date of Incorporation:               10/06/93

Foreign Qualifications:              State                         Date   
                                     -----                         ----   
                                                                          
                                     California                    10/12/93


05.  RENAL TREATMENT CENTERS - WEST, INC.             

State of Incorporation:              Delaware
Date of Incorporation:               04/27/94

Foreign Qualifications:              State                         Date   
                                     -----                         ----   
                                                                          
                                     Colorado                      05/03/94
                                                        Amended    01/21/97
                                     Oklahoma                      12/27/96
                                                        Amended    01/21/97
                                     Wyoming                       12/27/96
                                                        Amended    01/21/97
                                     Kansas                        12/27/96
                                                        Amended    02/05/97
                                     Nebraska                      01/08/97
                                                        Amended    02/30/97
                                     Nevada                        12/27/97
                                                        Amended    02/03/97
<PAGE>
 
                              Schedule 1 to Opinion of Duane, Morris & Heckscher


06.  RENAL TREATMENT CENTERS - SOUTHWEST, INC.

State of Incorporation:              Delaware
Date of Incorporation:               12/09/94

Foreign Qualifications:              State                         Date   
                                     -----                         ----   
                                                                          
                                     Texas                         12/13/94
                                                        Amended    01/15/97
                                     Florida                       12/27/96
                                                        Amended    01/28/97
                                     Louisiana                     01/07/97
                                                        Amended    01/23/97
                                     Alabama                       12/27/96
                                                        Amended    01/23/97
                                       

07.  RENAL TREATMENT CENTERS - ILLINOIS, INC.

State of Incorporation:              Delaware
Date of Incorporation:               02/07/95

Foreign Qualifications:              State                         Date   
                                     -----                         ----   
                                                                          
                                     Illinois                      02/14/95
                                     Missouri                      01/01/97
                                     Indiana                       01/06/97
                                     Ohio                          12/31/96


08.  RENAL TREATMENT CENTERS - MANAGEMENT ACQUISITION, INC.

State of Incorporation:              Delaware
Date of Incorporation:               02/07/95

Foreign Qualifications:              State                         Date   
                                     -----                         ----   

                                     Tennessee                     03/10/95
                                     Washington, D.C.              04/18/96
                                     Virginia                      04/22/96

<PAGE>
 
                              Schedule 1 to Opinion of Duane, Morris & Heckscher


09.  RENAL TREATMENT CENTERS - HAWAII, INC.

State of Incorporation:              Delaware
Date of Incorporation:               12/15/95

Foreign Qualifications:              State                         Date   
                                     -----                         ----   

                                     Hawaii                        12/26/95
                                       

10.  RENAL TREATMENT CENTER HOLDINGS - LAB, INC.

State of Incorporation:              Delaware
Date of Incorporation:               01/23/97

Foreign Qualifications:              State                         Date   
                                     -----                         ----   
                                                                          
                                     Nevada                        02/05/97


11.  RTC - TEXAS ACQUISITION, INC.                          

State of Incorporation:              Texas
Date of Incorporation:               01/14/97

Foreign Qualifications:              None                                 


<PAGE>
 
                                                                 Exhibit 11.1(a)

                 Renal Treatment Centers, Inc. and Subsidiaries
                COMPUTATION OF FULLY DILUTED EARNINGS PER SHARE
           for the three and six months ended June 30, 1997 and 1996


<TABLE>
<CAPTION>
                                                       Three Months Ended         Six Months Ended
                                                            June 30,                  June 30,
                                                       1997         1996         1997         1996
- ------------------------------------------------------------------------------------------------------
<S>                                                <C>          <C>          <C>          <C>
Net income                                         $ 6,746,051  $ 5,430,726  $12,765,449  $ 8,803,014
Add back interest on note, tax effected                 34,122       62,708       34,122      130,373
- ------------------------------------------------------------------------------------------------------
Net income available to common stockholders        $ 6,780,173  $ 5,493,434  $12,799,571  $ 8,933,387
======================================================================================================
Weighted average number of shares outstanding       24,962,389   25,828,734   24,737,326   25,284,349
                                            
Weighted average number of maximum shares 
 subject to exercise under outstanding               
 stock options                                       2,175,818    1,349,743    1,948,920    1,349,743
                                            
Weighted average shares assumed issued upon                        
 conversion of note                                     54,771      661,501      246,914      661,501
- ------------------------------------------------------------------------------------------------------
                                                    27,192,978   27,839,978   26,933,160   27,295,593

Less treasury shares assumed purchased with 
 proceeds from assumed exercise of 
 outstanding common stock options                    1,348,208      583,641    1,143,340      583,641
- ------------------------------------------------------------------------------------------------------
Weighted average number of common and 
 common stock equivalents outstanding               25,844,770   27,256,337   25,789,820   26,711,952
======================================================================================================
                                                  
Net income per common and common stock 
 equivalent                                              $0.26        $0.20        $0.50        $0.33
======================================================================================================
</TABLE>                                   
<PAGE>
 
                                                           Exhibit 11.1(b)



                 Renal Treatment Centers, Inc. and Subsidiaries
                   COMPUTATION OF PRIMARY EARNINGS PER SHARE
           for the three and six months ended June 30, 1997 and 1996


<TABLE>  
<CAPTION> 

                                                         Three Months Ended         Six Months Ended
                                                               June 30,                  June 30,
                                                          1997         1996         1997         1996
- ---------------------------------------------------------------------------------------------------------
<S>                                                   <C>          <C>          <C>          <C>
Net income                                            $ 6,746,051  $ 5,430,726  $12,765,449  $ 8,803,014
- ---------------------------------------------------------------------------------------------------------
Weighted average number of shares outstanding          24,962,389   25,828,734   24,737,326   25,284,349
                               
Weighted average number of maximum shares subject 
 to exercise under outstanding stock options            2,175,818    1,789,894    1,948,714    1,789,894
                               
Less treasury shares assumed purchased with 
 proceeds from assumed exercise of outstanding 
 common stock options                                   1,423,420      878,159    1,195,206      863,088
- ---------------------------------------------------------------------------------------------------------
Weighted average number of common and common             
 stock equivalents outstanding                         25,714,787   26,740,469   25,490,834   26,211,155
=========================================================================================================
                               
Net income per common and common stock equivalent           $0.26        $0.20        $0.50  $      0.34
=========================================================================================================
</TABLE>

<TABLE> <S> <C>

<PAGE>
<ARTICLE> 5
       
<S>                             <C>                     <C>
<PERIOD-TYPE>                   6-MOS                   3-MOS
<FISCAL-YEAR-END>                          DEC-31-1997             DEC-31-1997
<PERIOD-START>                             JAN-01-1997             APR-01-1997
<PERIOD-END>                               JUN-30-1997             JUN-30-1997
<CASH>                                       9,129,138               9,129,138
<SECURITIES>                                         0                       0
<RECEIVABLES>                               99,161,896              99,161,896
<ALLOWANCES>                                 4,213,059               4,213,059
<INVENTORY>                                  5,064,238               5,064,238
<CURRENT-ASSETS>                           116,850,502             116,850,502
<PP&E>                                      76,723,807              73,723,807
<DEPRECIATION>                              24,832,100              24,832,100
<TOTAL-ASSETS>                             358,646,570             358,646,570
<CURRENT-LIABILITIES>                       27,292,972              27,292,972
<BONDS>                                    175,629,792             175,629,792
                                0                       0
                                          0                       0
<COMMON>                                       250,257                 250,257
<OTHER-SE>                                 155,473,549             155,473,549
<TOTAL-LIABILITY-AND-EQUITY>               358,646,570             358,646,570
<SALES>                                              0                       0
<TOTAL-REVENUES>                           148,380,503              77,273,282
<CGS>                                                0                       0
<TOTAL-COSTS>                               70,998,558              36,672,989
<OTHER-EXPENSES>                                     0                       0
<LOSS-PROVISION>                             4,238,674               2,047,197
<INTEREST-EXPENSE>                           3,978,874               2,154,831
<INCOME-PRETAX>                             20,348,281              10,793,682
<INCOME-TAX>                                 7,582,832               4,047,631
<INCOME-CONTINUING>                         12,765,449               6,746,051
<DISCONTINUED>                                       0                       0
<EXTRAORDINARY>                                      0                       0
<CHANGES>                                            0                       0
<NET-INCOME>                                12,765,449               6,746,051
<EPS-PRIMARY>                                      .50                     .26
<EPS-DILUTED>                                      .50                     .26
        

</TABLE>


© 2022 IncJournal is not affiliated with or endorsed by the U.S. Securities and Exchange Commission