Document:

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                                                                  Exhibit (4)(p)

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                               GUARANTEE AGREEMENT

                                     BETWEEN

                              M&T BANK CORPORATION
                                 (as Guarantor)

                                       and

                                       [ ]
                             (as Guarantee Trustee)

                                   dated as of

                                    [ ], [ ]

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<PAGE>

            Certain Sections of this Guarantee Agreement relating to
                         Sections 310 through 318 of the
                          Trust Indenture Act of 1939:

<TABLE>
<CAPTION>
Trust Indenture                                                                  Guarantee Agreement
   Act Section                                                                         Section
---------------                                                                  --------------------
<S>               <C>                                                            <C>
Section 310       (a) (1)....................................................    4.1 (a)
                  (a) (2)....................................................    4.1 (a)
                  (a) (3)....................................................    Not Applicable
                  (a) (4)....................................................    Not Applicable
                  (b)........................................................    2.8, 4.1 (c)
Section 311       (a)........................................................    Not Applicable
                  (b)........................................................    Not Applicable
Section 312       (a)........................................................    2.2 (a)
                  (b)........................................................    2.2 (b)
                  (c)........................................................    Not Applicable
Section 313       (a)........................................................    2.3
                  (a) (4)....................................................    2.3
                  (b)........................................................    2.3
                  (c)........................................................    2.3
                  (d)........................................................    2.3
Section 314       (a)........................................................    2.4
                  (b)........................................................    2.4
                  (c) (1)....................................................    2.5
                  (c) (2)....................................................    2.5
                  (c) (3)....................................................    2.5
                  (e)........................................................    1.1, 2.5, 3.2
Section 315       (a)........................................................    3.1 (d)
                  (b)........................................................    2.7
                  (c)........................................................    3.1 (c)
                  (d)........................................................    3.1 (d)
                  (e)........................................................    Not Applicable
Section 316       (a)........................................................    1.1, 2.6, 5.4
                  (a) (1) (A)................................................    5.4
                  (a) (1) (B)................................................    5.4
                  (a) (2)....................................................    Not Applicable
                  (b)........................................................    5.3
                  (c)........................................................    Not Applicable
Section 317       (a) (1)....................................................    Not Applicable
                  (a) (2)....................................................    Not Applicable
                  (b)........................................................    Not Applicable
Section 318       (a)........................................................    2.1
</TABLE>

Note:    This reconciliation and tie shall not, for any purpose, be deemed to
         be a part of the Guarantee Agreement.

                                       2

<PAGE>

                                TABLE OF CONTENTS

<TABLE>
<CAPTION>
                                                                                           Page
                                                                                           ----
<S>                        <C>                                                             <C>
ARTICLE I.                 DEFINITIONS
         Section 1.1.                Definitions........................................    1

ARTICLE II.                TRUST INDENTURE ACT
         Section 2.1.                Trust Indenture Act; Application ..................    5
         Section 2.2.                List of Holders ...................................    5
         Section 2.3.                Reports by the Guarantee Trustee...................    5
         Section 2.4.                Periodic Reports to Guarantee Trustee..............    6
         Section 2.5.                Evidence of Compliance with Conditions Precedent ..    6
         Section 2.6.                Events of Default; Waiver..........................    6
         Section 2.7.                Event of Default; Notice     ......................    6
         Section 2.8.                Conflicting Interests    ..........................    7

ARTICLE III.               POWERS, DUTIES AND RIGHTS OF THE GUARANTEE
                           TRUSTEE
         Section 3.1.                Powers and Duties of the Guarantee Trustee ........    7
         Section 3.2.                Certain Rights of Guarantee Trustee................    8
         Section 3.3.                Indemnity..........................................    10
         Section 3.4.                Expenses...........................................    10

ARTICLE IV.                GUARANTEE TRUSTEE
         Section 4.1.                Guarantee Trustee; Eligibility ....................    10
         Section 4.2.                Appointment, Removal and Resignation of the
                                     Guarantee Trustee .................................    11

ARTICLE V.                 GUARANTEE
         Section 5.1.                Guarantee..........................................    12
         Section 5.2.                Waiver of Notice and Demand........................    12
         Section 5.3.                Obligations Not Affected...........................    12
         Section 5.4.                Rights of Holders..................................    13
         Section 5.5.                Guarantee of Payment...............................    13
         Section 5.6.                Subrogation........................................    13
         Section 5.7.                Independent Obligations............................    14

ARTICLE VI.                COVENANTS AND SUBORDINATION
         Section 6.1.                Subordination......................................    14
         Section 6.2.                Pari Passu Guarantees..............................    14

ARTICLE VII.               TERMINATION
         Section 7.1                 Termination........................................    14
</TABLE>

                                       i

<PAGE>

<TABLE>
<S>                        <C>                                                              <C>
ARTICLE VIII.              MISCELLANEOUS
         Section 8.1.                Successors and Assigns.............................    15
         Section 8.2.                Amendments.........................................    15
         Section 8.3.                Notices............................................    15
         Section 8.4.                Benefit............................................    16
         Section 8.5.                Interpretation.....................................    17
         Section 8.6.                Governing Law..... ................................    17
         Section 8.7.                Counterparts.......................................    17
</TABLE>

                                       ii

<PAGE>

                               GUARANTEE AGREEMENT

         This GUARANTEE AGREEMENT, dated as of [ ], [ ] is executed and
delivered by M&T BANK CORPORATION, a New York corporation (the "Guarantor"),
having its principal office at One M&T Plaza, Buffalo, New York 14203 and [ ], a
[ ] banking corporation, as trustee (the "Guarantee Trustee"), for the benefit
of the Holders (as defined herein) from time to time of the Capital Securities
(as defined herein) of M&T Capital Trust [IV][V][VI], a Delaware statutory trust
(the "Issuer Trust").

         WHEREAS, pursuant to an Amended and Restated Trust Agreement (the
"Trust Agreement"), dated as of [ ], [    ], among the Guarantor, as Depositor,
[ ], as Property Trustee (the "Property Trustee"), [    ], as Delaware Trustee
(the "Delaware Trustee") (collectively, the "Issuer Trustees") and the Holders
from time to time of preferred undivided beneficial interests in the assets of
the Issuer Trust, the Issuer Trust is issuing $[    ] aggregate Liquidation
Amount (as defined herein) of its Capital Securities, Liquidation Amount $[ ]
per preferred security (the "Capital Securities"), representing preferred
undivided beneficial interests in the assets of the Issuer Trust and having the
terms set forth in the Trust Agreement;

         WHEREAS, the Capital Securities will be issued by the Issuer Trust and
the proceeds thereof, together with the proceeds from the issuance of the Issuer
Trust's Common Securities (as defined herein), will be used to purchase the
Junior Subordinated Debentures due [ ], [ ] (as defined in the Trust Agreement)
(the "Junior Subordinated Debentures") of the Guarantor which will be deposited
with [ ], as Property Trustee under the Trust Agreement, as trust assets; and

         WHEREAS, as incentive for the Holders to purchase Capital Securities,
the Guarantor desires irrevocably and unconditionally to agree, to the extent
set forth herein, to pay to the Holders of the Capital Securities the Guarantee
Payments (as defined herein) and to make certain other payments on the terms and
conditions set forth herein.

         NOW, THEREFORE, in consideration of the purchase of Capital Securities
by each Holder, which purchase the Guarantor hereby acknowledges shall benefit
the Guarantor, and intending to be legally bound hereby, the Guarantor executes
and delivers this Guarantee Agreement for the benefit of the Holders from time
to time of the Capital Securities.

                                    ARTICLE I

                                   DEFINITIONS

Section 1.1.      Definitions.

         As used in this Guarantee Agreement, the terms set forth below shall,
unless the context otherwise requires, have the following meanings. Capitalized
terms used but not otherwise defined herein shall have the meanings assigned to
such terms in the Trust Agreement or, if not defined therein, in the Indenture
as in effect on the date hereof.

<PAGE>

         "Additional Amount" has the meaning specified in the Trust Agreement.

         "Affiliate" of any specified Person means any other Person directly or
indirectly controlling or controlled by or under direct or indirect common
control with such specified Person. For the purposes of this definition,
"control" when used with respect to any specified Person means the power to
direct the management and policies of such Person, directly or indirectly,
whether through the ownership of voting securities, by contract or otherwise;
and the terms "controlling" and "controlled" have meanings correlative to the
foregoing.

         "Capital Securities" shall have the meaning specified in the first
recital of this Guarantee Agreement.

         "Common Securities" means the securities representing common undivided
beneficial interests in the assets of the Issuer Trust.

         "Delaware Trustee" shall have the meaning specified in the first
recital of this Guarantee Agreement.

         "Distributions" means preferential cumulative cash distributions
accumulating from [    ], [ ] and payable [monthly] [quarterly] [semi-annually]
in arrears on [    ], [    ], [    ], and [    ] of each year, commencing [   ],
[ ] at the annual rate of [ ]% of the Liquidation Amount.

         "Event of Default" means (a) a default by the Guarantor in any of its
payment obligations under this Guarantee Agreement, or (b) a default by the
Guarantor in any other obligation hereunder that remains unremedied for 30 days.

         "Guarantee Agreement" means this Guarantee Agreement, as modified,
amended or supplemented from time to time.

         "Guarantee Payments" means the following payments or distributions,
without duplication, with respect to the Capital Securities, to the extent not
paid or made by or on behalf of the Issuer Trust: (a) any accumulated and unpaid
Distributions (as defined in the Trust Agreement) required to be paid on the
Capital Securities, to the extent the Issuer Trust shall have funds on hand
available therefor at such time, (b) the Redemption Price, with respect to the
Capital Securities called for redemption by the Issuer Trust to the extent that
the Issuer Trust shall have funds on hand available therefor at such time, and
(c) upon a voluntary or involuntary termination, winding-up or liquidation of
the Issuer Trust, unless Junior Subordinated Debentures are distributed to the
Holders, the lesser of (i) the Liquidation Amount and all accumulated and unpaid
Distributions to the date of payment to the extent the Issuer Trust shall have
funds on hand available to make such payment at such time and (ii) the amount of
assets of the Issuer Trust remaining available for distribution to Holders in
liquidation of the Issuer Trust (in either case, the "Liquidation
Distribution").

                                       2

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         "Guarantee Trustee" means [ ], until a Successor Guarantee Trustee has
been appointed and has accepted such appointment pursuant to the terms of this
Guarantee Agreement and thereafter means each such Successor Guarantee Trustee.

         "Guarantor" shall have the meaning specified in the first paragraph of
this Guarantee Agreement.

         "Holder" means any holder, as registered on the books and records of
the Issuer Trust, of any Capital Securities; provided, however, that, in
determining whether the holders of the requisite percentage of Capital
Securities have given any request, notice, consent or waiver hereunder, "Holder"
shall not include the Guarantor, the Guarantee Trustee, or any Affiliate of the
Guarantor or the Guarantee Trustee.

         "Indenture" means the Junior Subordinated Indenture dated as of [ ], [
], between M&T Bank Corporation and [ ], as trustee, as may be modified, amended
or supplemented from time to time.

         "Issuer Trust" shall have the meaning specified in the first paragraph
of this Guarantee Agreement.

         "Issuer Trustees" shall have the meaning specified in the first recital
of this Guarantee Agreement.

         "Junior Subordinated Debentures" shall have the meaning specified in
the first recital of this Guarantee Agreement.

         "Like Amount" means (a) with respect to a redemption of Capital
Securities, Capital Securities having a Liquidation Amount equal to the
principal amount of Junior Subordinated Debentures to be contemporaneously
redeemed in accordance with the Indenture, the proceeds of which will be used to
pay the Redemption Price of such Capital Securities, (b) with respect to a
distribution of Junior Subordinated Debentures to Holders of Capital Securities
in connection with a dissolution or liquidation of the Issuer Trust, Junior
Subordinated Debentures having a principal amount equal to the Liquidation
Amount of the Capital Securities of the Holder to whom such Junior Subordinated
Debentures are distributed, and (c) with respect to any distribution of an
Additional Amount to Holders of Capital Securities, Junior Subordinated
Debentures having a principal amount equal to the Liquidation Amount of the
Capital Securities in respect of which such distribution is made.

         "Liquidation Amount" means the stated amount of $[ ] per Capital
Security.

         "Majority in Liquidation Amount of the Capital Securities" means,
except as provided by the Trust Indenture Act, Capital Securities representing
more than 50% of the aggregate Liquidation Amount of all then outstanding
Capital Securities issued by the Issuer Trust.

         "Officers' Certificate" means, with respect to any Person, a
certificate signed by the Chairman of the Board, Chief Executive Officer,
President or a Vice President, and by the Chief

                                       3

<PAGE>

Financial Officer, Treasurer, an Associate Treasurer, an Assistant Treasurer,
the Secretary or an Assistant Secretary of such Person, and delivered to the
Guarantee Trustee. Any Officers' Certificate delivered with respect to
compliance with a condition or covenant provided for in this Guarantee Agreement
shall include:

                  (a)      a statement by each officer signing the Officers'
Certificate that such officer has read the covenant or condition and the
definitions relating thereto;

                  (b)      a brief statement of the nature and scope of the
examination or investigation undertaken by such officer in rendering the
Officers' Certificate;

                  (c)      a statement that such officer has made such
examination or investigation as, in such officer's opinion, is necessary to
enable such officer to express an informed opinion as to whether or not such
covenant or condition has been complied with; and

                  (d)      a statement as to whether, in the opinion of such
officer, such condition or covenant has been complied with.

         "Person" means a legal person, including any individual, corporation,
estate, partnership, joint venture, association, joint stock company, limited
liability company, trust, unincorporated association, or government or any
agency or political subdivision thereof, or any other entity of whatever nature.

         "Property Trustee" shall have the meaning specified in the first
recital of this Guarantee Agreement.

         "Redemption Date" means, with respect to any Capital Security to be
redeemed, the date fixed for such redemption by or pursuant to the Trust
Agreement; provided that each Junior Subordinated Debenture Redemption Date (as
such term is defined in the Indenture) and the stated maturity of the Junior
Subordinated Debentures shall be a Redemption Date for a Like Amount of Capital
Securities.

         "Redemption Price" shall have the meaning specified in the Trust
Agreement.

         "Responsible Officer" means, when used with respect to the Guarantee
Trustee, any officer assigned to the Corporate Trust Office, including any
managing director, principal, vice president, assistant vice president,
assistant treasurer, assistant secretary or any other officer of the Guarantee
Trustee customarily performing functions similar to those performed by any of
the above designated officers, and having direct responsibility for the
administration of this Guarantee Agreement, and also, with respect to a
particular matter, any other officer to whom such matter is referred because of
such officer's knowledge of and familiarity with the particular subject.

         "Senior Indebtedness" shall have the meaning specified in the
Indenture.

                                       4

<PAGE>

         "Successor Guarantee Trustee" means a successor Guarantee Trustee
possessing the qualifications to act as Guarantee Trustee under Section 4.1.

         "Trust Agreement" means the Amended and Restated Trust Agreement, dated
[    ], [ ], executed by M&T Bank Corporation, as Depositor, [    ], as Delaware
Trustee, and [ ], as Property Trustee and subscribed to and accepted by the
Administors.

         "Trust Indenture Act" means the Trust Indenture Act of 1939, as amended
by the Trust Indenture Reform Act of 1990, or any successor statute, in each
case as amended from time to time.

                                   ARTICLE II

                               TRUST INDENTURE ACT

Section 2.1.      Trust Indenture Act; Application.

         If any provision hereof limits, qualifies or conflicts with a provision
of the Trust Indenture Act that is required under such Act to be a part of and
govern this Guarantee Agreement, the provision of the Trust Indenture Act shall
control. If any provision of this Guarantee Agreement modifies or excludes any
provision of the Trust Indenture Act that may be so modified or excluded, the
latter provision shall be deemed to apply to this Guarantee Agreement as so
modified or excluded, as the case may be.

Section 2.2.      List of Holders.

         (a)      In the event that the Guarantee Trustee is not also acting as
the Securities Registrar, the Guarantor will furnish or cause to be furnished to
the Guarantee Trustee:

                  (i)      not less than one day nor more than 15 days prior to
         every Interest Payment Date, a list, in such form as the Guarantee
         Trustee may reasonably require, of the names and addresses of the
         Holders as of such date; and

                  (ii)     at such other times as the Guarantee Trustee may
         request in writing, within 30 days after the receipt by the Guarantor
         of any such request, a list of similar form and content as of a date
         not more than 15 days prior to the time such list is furnished.

         (b)      The Guarantee Trustee shall comply with the requirements of
Section 312(b) of the Trust Indenture Act.

Section 2.3.      Reports by the Guarantee Trustee.

         Within 60 days of January 31 of each year commencing January 31, [ ],
the Guarantee Trustee shall provide to the Holders such reports, if any, as are
required by Section 313 of the Trust Indenture Act in the form and in the manner
provided by Section 313 of the Trust

                                       5

<PAGE>

Indenture Act. The Guarantee Trustee shall also comply with the requirements of
Section 313(d) of the Trust Indenture Act.

Section 2.4.      Periodic Reports to the Guarantee Trustee.

         The Guarantor shall provide to the Guarantee Trustee and the Holders
such documents, reports and information, if any, as required by Section 314 of
the Trust Indenture Act and the compliance certificate required by Section 314
of the Trust Indenture Act, in the form, in the manner and at the times required
by Section 314 of the Trust Indenture Act.

Section 2.5.      Evidence of Compliance with Conditions Precedent.

         The Guarantor shall provide to the Guarantee Trustee such evidence of
compliance with such conditions precedent, if any, provided for in this
Guarantee Agreement that relate to any of the matters set forth in Section
314(c) of the Trust Indenture Act. Any certificate or opinion required to be
given by an officer pursuant to Section 314(c)(1) may be given in the form of an
Officers' Certificate.

Section 2.6.      Events of Default; Waiver.

         The Holders of a Majority in Liquidation Amount of the Capital
Securities may, by vote, on behalf of the Holders, waive any past Event of
Default and its consequences. Upon such waiver, any such Event of Default shall
cease to exist, and any Event of Default arising therefrom shall be deemed to
have been cured, for every purpose of this Guarantee Agreement, but no such
waiver shall extend to any subsequent or other default or Event of Default or
impair any right consequent therefrom.

Section 2.7.      Event of Default; Notice.

         (a)      The Guarantee Trustee shall, within 90 days after the
occurrence of an Event of Default, transmit by mail, first class postage
prepaid, to the Holders, notices of all Events of Default known to the Guarantee
Trustee, unless such Events of Default have been cured before the giving of such
notice; provided that, except in the case of a default in the payment of a
Guarantee Payment, the Guarantee Trustee shall be protected in withholding such
notice if and so long as the Board of Directors, the executive committee or a
trust committee of directors and/or Responsible Officers of the Guarantee
Trustee in good faith determines that the withholding of such notice is in the
interests of the Holders.

         (b)      The Guarantee Trustee shall not be deemed to have knowledge of
any Event of Default unless a Responsible Officer charged with the
administration of this Guarantee Agreement shall have received written notice of
such Event of Default.

                                       6

<PAGE>

Section 2.8.      Conflicting Interests.

         The Trust Agreement shall be deemed to be specifically described in
this Guarantee Agreement for the purposes of clause (i) of the first proviso
contained in Section 310(b) of the Trust Indenture Act.

                                   ARTICLE III

                        POWERS, DUTIES AND RIGHTS OF THE
                                GUARANTEE TRUSTEE

Section 3.1.      Powers and Duties of the Guarantee Trustee.

         (a)      This Guarantee Agreement shall be held by the Guarantee
Trustee for the benefit of the Holders, and the Guarantee Trustee shall not
transfer this Guarantee Agreement to any Person except to a Holder exercising
his or her rights pursuant to Section 5.4(d) or to a Successor Guarantee Trustee
on acceptance by such Successor Guarantee Trustee of its appointment to act as
Successor Guarantee Trustee hereunder. The right, title and interest of the
Guarantee Trustee, as such, hereunder shall automatically vest in any Successor
Guarantee Trustee, upon acceptance by such Successor Guarantee Trustee of its
appointment hereunder, and such vesting and cessation of title shall be
effective whether or not conveyancing documents have been executed and delivered
pursuant to the appointment of such Successor Guarantee Trustee.

         (b)      If an Event of Default actually known to a Responsible Officer
of the Guarantee Trustee has occurred and is continuing, the Guarantee Trustee
shall enforce this Guarantee Agreement for the benefit of the Holders.

         (c)      The Guarantee Trustee, before the occurrence of any Event of
Default and after the curing of all Events of Default that may have occurred,
shall be obligated to perform only such duties as are specifically set forth in
this Guarantee Agreement (including pursuant to Section 2.1), and no implied
covenants shall be read into this Guarantee Agreement against the Guarantee
Trustee. If an Event of Default has occurred (that has not been cured or waived
pursuant to Section 2.6), the Guarantee Trustee shall exercise such of the
rights and powers vested in it by this Guarantee Agreement, and use the same
degree of care and skill in its exercise thereof, as a prudent person would
exercise or use under the circumstances in the conduct of his or her own
affairs.

         (d)      No provision of this Guarantee Agreement shall be construed to
relieve the Guarantee Trustee from liability for its own negligent action, its
own negligent failure to act or its own willful misconduct, except that:

                  (i)      prior to the occurrence of any Event of Default and
         after the curing or waiving of all such Events of Default that may have
         occurred:

                           (A)      the duties and obligations of the Guarantee
                  Trustee shall be determined solely by the express provisions
                  of this Guarantee Agreement

                                       7

<PAGE>

                  (including pursuant to Section 2.1), and the Guarantee Trustee
                  shall not be liable except for the performance of such duties
                  and obligations as are specifically set forth in this
                  Guarantee Agreement (including pursuant to Section 2.1), and
                  no implied covenants or obligations, shall be read into this
                  Guarantee Agreement against the Guarantee Trustee; and

                           (B)      in the absence of bad faith on the part of
                  the Guarantee Trustee, the Guarantee Trustee may conclusively
                  rely, as to the truth of the statements and the correctness of
                  the opinions expressed therein, upon any certificates or
                  opinions furnished to the Guarantee Trustee and conforming to
                  the requirements of this Guarantee Agreement; but in the case
                  of any such certificates or opinions that by any provision
                  hereof or of the Trust Indenture Act are specifically required
                  to be furnished to the Guarantee Trustee, the Guarantee
                  Trustee shall be under a duty to examine the same to determine
                  whether or not they conform to the requirements of this
                  Guarantee Agreement;

                  (ii)     the Guarantee Trustee shall not be liable for any
         error of judgment made in good faith by a Responsible Officer of the
         Guarantee Trustee, unless it shall be proved that the Guarantee Trustee
         was negligent in ascertaining the pertinent facts upon which such
         judgment was made;

                  (iii)    the Guarantee Trustee shall not be liable with
         respect to any action taken or omitted to be taken by it in good faith
         in accordance with the direction of the Holders of not less than a
         Majority in Liquidation Amount of the Capital Securities relating to
         the time, method and place of conducting any proceeding for any remedy
         available to the Guarantee Trustee, or exercising any trust or power
         conferred upon the Guarantee Trustee under this Guarantee Agreement;
         and

                  (iv)     no provision of this Guarantee Agreement shall
         require the Guarantee Trustee to expend or risk its own funds or
         otherwise incur personal financial liability in the performance of any
         of its duties or in the exercise of any of its rights or powers if the
         Guarantee Trustee shall have reasonable grounds for believing that the
         repayment of such funds or liability is not assured to it under the
         terms of this Guarantee Agreement or adequate indemnity against such
         risk or liability is not reasonably assured to it.

Section 3.2.      Certain Rights of Guarantee Trustee.

         (a)      Subject to the provisions of Section 3.1:

                  (i)      the Guarantee Trustee may conclusively rely and shall
         be fully protected in acting or refraining from acting upon any
         resolution, certificate, statement, instrument, opinion, report,
         notice, request, direction, consent, order, bond, debenture, note,
         other evidence of indebtedness or other paper or document reasonably
         believed by it to be genuine and to have been signed, sent or presented
         by the proper party or parties;

                                       8

<PAGE>

                  (ii)     any direction or act of the Guarantor contemplated by
         this Guarantee Agreement shall be sufficiently evidenced by an
         Officers' Certificate unless otherwise prescribed herein;

                  (iii)    whenever, in the administration of this Guarantee
         Agreement, the Guarantee Trustee shall deem it desirable that a matter
         be proved or established before taking, suffering or omitting to take
         any action hereunder, the Guarantee Trustee (unless other evidence is
         herein specifically prescribed) may, in the absence of bad faith on its
         part, request and conclusively rely upon an Officers' Certificate
         which, upon receipt of such request from the Guarantee Trustee, shall
         be promptly delivered by the Guarantor;

                  (iv)     the Guarantee Trustee may consult with legal counsel,
         and the advice or written opinion of such legal counsel with respect to
         legal matters shall be full and complete authorization and protection
         in respect of any action taken, suffered or omitted to be taken by it
         hereunder in good faith and in accordance with such advice or opinion.
         Such legal counsel may be legal counsel to the Guarantor or any of its
         Affiliates and may be one of its employees. The Guarantee Trustee shall
         have the right at any time to seek instructions concerning the
         administration of this Guarantee Agreement from any court of competent
         jurisdiction;

                  (v)      the Guarantee Trustee shall be under no obligation to
         exercise any of the rights or powers vested in it by this Guarantee
         Agreement at the request or direction of any Holder, unless such Holder
         shall have provided to the Guarantee Trustee such security and
         indemnity as would satisfy a reasonable person in the position of the
         Guarantee Trustee, against the costs, expenses (including attorneys'
         fees and expenses) and liabilities that might be incurred by it in
         complying with such request or direction, including such reasonable
         advances as may be requested by the Guarantee Trustee;

                  (vi)     the Guarantee Trustee shall not be bound to make any
         investigation into the facts or matters stated in any resolution,
         certificate, statement, instrument, opinion, report, notice, request,
         direction, consent, order, bond, debenture, note, other evidence of
         indebtedness or other paper or document, but the Guarantee Trustee, in
         its discretion, may make such further inquiry or investigation into
         such facts or matters as it may see fit;

                  (vii)    the Guarantee Trustee may execute any of the trusts
         or powers hereunder or perform any duties hereunder either directly or
         by or through its agents or attorneys, and the Guarantee Trustee shall
         not be responsible for any negligence or willful misconduct on the part
         of any such agent or attorney appointed with due care by it hereunder.
         Nothing herein shall be construed as limiting or restricting the right
         of the Guarantor to bring any action directly against any agent or
         attorney appointed by the Guarantee Trustee for any negligence or
         willful misconduct on the part of such agent or attorney; and

                  (viii)   whenever in the administration of this Guarantee
         Agreement the Guarantee Trustee shall deem it desirable to receive
         instructions with respect to enforcing any remedy or right or taking
         any other action hereunder, the Guarantee Trustee (A) may

                                       9

<PAGE>

         request instructions from the Holders, (B) may refrain from enforcing
         such remedy or right or taking such other action until such
         instructions are received and (C) shall be fully protected in relying
         upon or acting in accordance with such instructions.

         (b)      No provision of this Guarantee Agreement shall be deemed to
impose any duty or obligation on the Guarantee Trustee to perform any act or
acts or exercise any right, power, duty or obligation conferred or imposed on it
in any jurisdiction in which it shall be illegal, or in which the Guarantee
Trustee shall be unqualified or incompetent in accordance with applicable law,
to perform any such act or acts or to exercise any such right, power, duty or
obligation. No permissive power or authority available to the Guarantee Trustee
shall be construed to be a duty to act in accordance with such power and
authority.

Section 3.3.      Indemnity.

         The Guarantor agrees to indemnify the Guarantee Trustee, its directors,
officers, employees and agents for, and to hold them harmless against, any loss,
liability or expense incurred without negligence, willful misconduct or bad
faith on the part of the Guarantee Trustee, its directors, officers, employees
and agents, arising out of or in connection with the acceptance or
administration of this Guarantee Agreement, including the costs and expenses of
defending against any claim or liability in connection with the exercise or
performance of any of its powers or duties hereunder. The Guarantee Trustee will
not claim or exact any lien or charge on any Guarantee Payments as a result of
any amount due to it under this Guarantee Agreement. The obligation to indemnify
as set forth in this Section 3.3 shall survive the termination of this Guarantee
Agreement and the resignation or removal of the Guarantee Trustee.

Section 3.4.      Expenses.

         The Guarantor shall from time to time reimburse the Guarantee Trustee
for its reasonable expenses and costs (including reasonable attorneys' or
agents' fees) incurred in connection with the performance of its duties
hereunder.

                                   ARTICLE IV

                                GUARANTEE TRUSTEE

Section 4.1.      Guarantee Trustee; Eligibility.

         (a)      There shall at all times be a Guarantee Trustee which shall:

                  (i)      not be an Affiliate of the Guarantor; and

                  (ii)     be a Person that is eligible pursuant to the Trust
         Indenture Act to act as such and has a combined capital and surplus of
         at least $50,000,000, and shall be a corporation meeting the
         requirements of Section 310(a) of the Trust Indenture Act. If such
         corporation publishes reports of condition at least annually, pursuant
         to law or to the requirements of the supervising or examining
         authority, then, for the purposes of this

                                       10

<PAGE>

         Section and to the extent permitted by the Trust Indenture Act, the
         combined capital and surplus of such corporation shall be deemed to be
         its combined capital and surplus as set forth in its most recent report
         of condition so published.

         (b)      If at any time the Guarantee Trustee shall cease to be
eligible to so act under Section 4.1(a), the Guarantee Trustee shall immediately
resign in the manner and with the effect set out in Section 4.2(b).

         (c)      If the Guarantee Trustee has or shall acquire any "conflicting
interest" within the meaning of Section 310(b) of the Trust Indenture Act, the
Guarantee Trustee and Guarantor shall in all respects comply with the provisions
of Section 310(b) of the Trust Indenture Act.

Section 4.2.      Appointment, Removal and Resignation of the Guarantee Trustee.

         (a)      No resignation or removal of the Guarantee Trustee and no
appointment of a Successor Guarantee Trustee pursuant to this Article shall
become effective until the acceptance of appointment by the Successor Guarantee
Trustee by written instrument executed by the Successor Guarantee Trustee and
delivered to the Holders and the Guarantee Trustee.

         (b)      Subject to the immediately preceding paragraph, a Guarantee
Trustee may resign at any time by giving written notice thereof to the Holders.
The Guarantor shall appoint a successor by requesting from at least three
Persons meeting the eligibility requirements such Person's expenses and charges
to serve as the Guarantee Trustee, and selecting the Person who agrees to the
lowest expenses and charges. If the instrument of acceptance by the Successor
Guarantee Trustee shall not have been delivered to the Guarantee Trustee within
60 days after the giving of such notice of resignation, the Guarantee Trustee
may petition, at the expense of the Guarantor, any court of competent
jurisdiction for the appointment of a Successor Guarantee Trustee.

         (c)      The Guarantee Trustee may be removed for cause at any time by
Act (within the meaning of Section 6.8 of the Trust Agreement) of the Holders of
at least a Majority in Liquidation Amount of the Capital Securities, delivered
to the Guarantee Trustee.

         (d)      If the Guarantor shall fail to appoint a successor, or if a
Guarantee Trustee shall be removed or become incapable of acting as Guarantee
Trustee, or if any vacancy shall occur in the office of any Guarantee Trustee
for any cause, the Holders of the Capital Securities, by Act of the Holders of
record of not less than 25% in aggregate Liquidation Amount of the Capital
Securities then outstanding delivered to such Guarantee Trustee, shall promptly
appoint a successor Guarantee Trustee. If no Successor Guarantee Trustee shall
have been so appointed by the Holders of the Capital Securities and such
appointment accepted by the Successor Guarantee Trustee, any Holder, on behalf
of himself and all others similarly situated, may petition any court of
competent jurisdiction for the appointment of a Successor Guarantee Trustee.

                                       11

<PAGE>

                                    ARTICLE V

                                    GUARANTEE

Section 5.1.      Guarantee.

         The Guarantor irrevocably and unconditionally agrees to pay in full on
a subordinated basis as set forth in Section 6.1 hereof to the Holders the
Guarantee Payments (without duplication of amounts theretofore paid by or on
behalf of the Issuer Trust), as and when due, regardless of any defense, right
of set-off or counterclaim which the Issuer Trust may have or assert, except the
defense of payment. The Guarantor's obligation to make a Guarantee Payment may
be satisfied by direct payment of the required amounts by the Guarantor to the
Holders or by causing the Issuer Trust to pay such amounts to the Holders. The
Guarantor shall give prompt written notice to the Guarantee Trustee in the event
it makes any direct payment hereunder.

Section 5.2.      Waiver of Notice and Demand.

         The Guarantor hereby waives notice of acceptance of the Guarantee
Agreement and of any liability to which it applies or may apply, presentment,
demand for payment, any right to require a proceeding first against the
Guarantee Trustee, the Issuer Trust or any other Person before proceeding
against the Guarantor, protest, notice of nonpayment, notice of dishonor, notice
of redemption and all other notices and demands.

Section 5.3.      Obligations Not Affected.

         The obligations, covenants, agreements and duties of the Guarantor
under this Guarantee Agreement shall in no way be affected or impaired by reason
of the happening from time to time of any of the following:

         (a)      the release or waiver, by operation of law or otherwise, of
the performance or observance by the Issuer Trust of any express or implied
agreement, covenant, term or condition relating to the Capital Securities to be
performed or observed by the Issuer Trust;

         (b)      the extension of time for the payment by the Issuer Trust of
all or any portion of the Distributions (other than an extension of time for
payment of Distributions that results from the extension of any interest payment
period on the Junior Subordinated Debentures as so provided in the Indenture),
Redemption Price, Liquidation Distribution or any other sums payable under the
terms of the Capital Securities or the extension of time for the performance of
any other obligation under, arising out of, or in connection with, the Capital
Securities;

         (c)      any failure, omission, delay or lack of diligence on the part
of the Holders to enforce, assert or exercise any right, privilege, power or
remedy conferred on the Holders pursuant to the terms of the Capital Securities,
or any action on the part of the Issuer Trust granting indulgence or extension
of any kind;

                                       12

<PAGE>

         (d)      the voluntary or involuntary liquidation, dissolution, sale of
any collateral, receivership, insolvency, bankruptcy, assignment for the benefit
of creditors, reorganization, arrangement, composition or readjustment of debt
of, or other similar proceedings affecting, the Issuer Trust or any of the
assets of the Issuer Trust;

         (e)      any invalidity of, or defect or deficiency in, the Capital
Securities;

         (f)      the settlement or compromise of any obligation guaranteed
hereby or hereby incurred; or

         (g)      any other circumstance whatsoever that might otherwise
constitute a legal or equitable discharge or defense of a guarantor (other than
payment of the underlying obligation), it being the intent of this Section 5.3
that the obligations of the Guarantor hereunder shall be absolute and
unconditional under any and all circumstances.

         There shall be no obligation of the Holders to give notice to, or
obtain the consent of, the Guarantor with respect to the happening of any of the
foregoing.

Section 5.4.      Rights of Holders.

         The Guarantor expressly acknowledges that: (a) this Guarantee Agreement
will be deposited with the Guarantee Trustee to be held for the benefit of the
Holders; (b) the Guarantee Trustee has the right to enforce this Guarantee
Agreement on behalf of the Holders; (c) the Holders of a Majority in Liquidation
Amount of the Capital Securities have the right to direct the time, method and
place of conducting any proceeding for any remedy available to the Guarantee
Trustee in respect of this Guarantee Agreement or exercising any trust or power
conferred upon the Guarantee Trustee under this Guarantee Agreement; and (d) any
Holder may institute a legal proceeding directly against the Guarantor to
enforce its rights under this Guarantee Agreement, without first instituting a
legal proceeding against the Guarantee Trustee, the Issuer Trust or any other
Person.

Section 5.5.      Guarantee of Payment.

         This Guarantee Agreement creates a guarantee of payment and not of
collection. This Guarantee Agreement will not be discharged except by payment of
the Guarantee Payments in full (without duplication of amounts theretofore paid
by the Issuer Trust) or upon the distribution of Junior Subordinated Debentures
to Holders as provided in the Trust Agreement.

Section 5.6.      Subrogation.

         The Guarantor shall be subrogated to all rights (if any) of the Holders
against the Issuer Trust in respect of any amounts paid to the Holders by the
Guarantor under this Guarantee Agreement; provided, however, that the Guarantor
shall not (except to the extent required by mandatory provisions of law) be
entitled to enforce or exercise any rights which it may acquire by way of
subrogation or any indemnity, reimbursement or other agreement, in all cases as
a result of payment under this Guarantee Agreement, if at the time of any such
payment, any

                                       13

<PAGE>

amounts are due and unpaid under this Guarantee Agreement. If any amount shall
be paid to the Guarantor in violation of the preceding sentence, the Guarantor
agrees to hold such amount in trust for the Holders and to pay over such amount
to the Holders.

Section 5.7.      Independent Obligations.

         The Guarantor acknowledges that its obligations hereunder are
independent of the obligations of the Issuer Trust with respect to the Capital
Securities and that the Guarantor shall be liable as principal and as debtor
hereunder to make Guarantee Payments pursuant to the terms of this Guarantee
Agreement notwithstanding the occurrence of any event referred to in subsections
(a) through (g), inclusive, of Section 5.3 hereof.

                                   ARTICLE VI

                           COVENANTS AND SUBORDINATION

Section 6.1.      Subordination.

         This Guarantee Agreement will constitute an unsecured obligation of the
Guarantor and will rank subordinate and junior in right of payment to all Senior
Indebtedness of the Guarantor to the extent and in the manner set forth in the
Indenture with respect to the Junior Subordinated Debentures, and the provisions
of Article [XIII] of the Indenture will apply, mutatis mutandis, to the
obligations of the Guarantor hereunder. The obligations of the Guarantor
hereunder do not constitute Senior Indebtedness of the Guarantor.

Section 6.2.      Pari Passu Guarantees.

         The obligations of the Guarantor under this Guarantee Agreement shall
rank pari passu with any similar guarantee agreements issued by the Guarantor on
behalf of the holders of preferred or capital securities issued by the Issuer
Trust and with any other security, guarantee or other obligation that is
expressly stated to rank pari passu with the obligations of the Guarantor under
this Guarantee Agreement.

                                   ARTICLE VII

                                   TERMINATION

Section 7.1.      Termination.

         This Guarantee Agreement shall terminate and be of no further force and
effect upon (a) full payment of the Redemption Price of all Capital Securities,
(b) the distribution of Junior Subordinated Debentures to the Holders in
exchange for all of the Capital Securities or (c) full payment of the amounts
payable in accordance with Article [IX] of the Trust Agreement upon liquidation
of the Issuer Trust. Notwithstanding the foregoing, this Guarantee Agreement
will continue to be effective or will be reinstated, as the case may be, if at
any time any Holder is

                                       14

<PAGE>

required to repay any sums paid with respect to the Capital Securities or this
Guarantee Agreement.

                                  ARTICLE VIII

                                  MISCELLANEOUS

Section 8.1.      Successors and Assigns.

         All guarantees and agreements contained in this Guarantee Agreement
shall bind the successors, assigns, receivers, trustees and representatives of
the Guarantor and shall inure to the benefit of the Holders of the Capital
Securities then outstanding. Except in connection with a consolidation, merger
or sale involving the Guarantor that is permitted under Article [VIII] of the
Indenture and pursuant to which the assignee agrees in writing to perform the
Guarantor's obligations hereunder, the Guarantor shall not assign its
obligations hereunder, and any purported assignment that is not in accordance
with these provisions shall be void.

Section 8.2.      Amendments.

         Except with respect to any changes that do not materially adversely
affect the rights of the Holders (in which case no consent of the Holders will
be required), this Guarantee Agreement may only be amended with the prior
approval of the Holders of not less than a Majority in Liquidation Amount of the
Capital Securities. The provisions of Article [VI] of the Trust Agreement
concerning meetings of the Holders shall apply to the giving of such approval.

Section 8.3.      Notices.

         Any notice, request or other communication required or permitted to be
given hereunder shall be in writing, duly signed by the party giving such
notice, and delivered, telecopied (confirmed by delivery of the original) or
mailed by first class mail as follows:

         (a)      if given to the Guarantor, to the address or telecopy number
set forth below or such other address or telecopy number or to the attention of
such other Person as the Guarantor may give notice to the Holders:

                           M&T Bank Corporation
                           One M&T Plaza
                           Buffalo, NY 14203
                           Facsimile No.: (716) 842-5021
                           Attention: Corporate Secretary

                                       15

<PAGE>

         (b)      if given to the Issuer Trust, in care of the Guarantee
Trustee, at the Issuer Trust's (and the Guarantee Trustee's) address set forth
below or such other address or telecopy number or to the attention of such other
Person as the Guarantee Trustee on behalf of the Issuer Trust may give notice to
the Holders:

                           M&T Capital Trust [IV][V][VI]
                           c/o M&T Bank Corporation
                           One M&T Plaza
                           Buffalo, NY 14203
                           Facsimile No.: (716) 842-5021
                           Attention: [Corporate Finance]

                           with a copy to:
                           [   ]
                           [   ]
                           [   ]
                           Facsimile No.: [   ]
                           Attention: [   ]

         (c)      if given to the Guarantee Trustee:

                           [   ]
                           [   ]
                           [   ]
                           Facsimile No.: [   ]
                           Attention: [   ]

         (d)      if given to any Holder, at the address set forth on the books
and records of the Issuer Trust.

         All notices hereunder shall be deemed to have been given when received
in person, telecopied with receipt confirmed, or mailed by first class mail,
postage prepaid, except that if a notice or other document is refused delivery
or cannot be delivered because of a changed address of which no notice was
given, such notice or other document shall be deemed to have been delivered on
the date of such refusal or inability to deliver.

Section 8.4.      Benefit.

         This Guarantee Agreement is solely for the benefit of the Holders and
is not separately transferable from the Capital Securities.

                                       16

<PAGE>

Section 8.5.      Interpretation.

         In this Guarantee Agreement, unless the context otherwise requires:

         (a)      capitalized terms used in this Guarantee Agreement but not
defined in the preamble hereto have the respective meanings assigned to them in
Section 1.1;

         (b)      a term defined anywhere in this Guarantee Agreement has the
same meaning throughout;

         (c)      all references to "the Guarantee Agreement" or "this Guarantee
Agreement" are to this Guarantee Agreement as modified, supplemented or amended
from time to time;

         (d)      all references in this Guarantee Agreement to Articles and
Sections are to Articles and Sections of this Guarantee Agreement unless
otherwise specified;

         (e)      a term defined in the Trust Indenture Act has the same meaning
when used in this Guarantee Agreement unless otherwise defined in this Guarantee
Agreement or unless the context otherwise requires;

         (f)      a reference to the singular includes the plural and vice
versa; and

         (g)      the masculine, feminine or neuter genders used herein shall
include the masculine, feminine and neuter genders.

Section 8.6.      Governing Law.

         THIS GUARANTEE AGREEMENT SHALL BE GOVERNED BY AND CONSTRUED AND
INTERPRETED IN ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK WITHOUT REGARD
TO THE CONFLICT OF LAW PRINCIPLES THEREOF.

Section 8.7.      Counterparts.

         This instrument may be executed in any number of counterparts, each of
which so executed shall be deemed to be an original, but all such counterparts
shall together constitute but one and the same instrument.

                    [SIGNATURES APPEAR ON THE FOLLOWING PAGE]

                                       17

<PAGE>

         THIS GUARANTEE AGREEMENT is executed as of the day and year first above
written.

                                    M&T BANK CORPORATION
                                    as Guarantor

                                        By:____________________________________
                                        Name:
                                        Title:

                                    [  ],
                                    as Guarantee Trustee
                                    and not in its individual capacity

                                        By:____________________________________
                                        Name:
                                        Title:

                                       18Exhibit 10.1

                 AMENDMENT NO. 4 TO LOAN AND SECURITY AGREEMENT
                 ----------------------------------------------

THIS AMENDMENT NO. 4 TO LOAN AND SECURITY AGREEMENT (the "Amendment") is made as
of  this  13 day  of  January, 2005, by and between/among "Borrower" (as defined
below)  and  "Lender"  (as  defined  below).

                                    RECITALS
                                    --------

A.     As  used  herein,  the  term  "Borrower"  shall  mean  the  following
collectively:  New  York  Health  Care,  Inc., a New York corporation ("New York
Health  Care");  and  NYHC  Newco  Paxxon,  Inc.,  a  New  York  corporation.

B.     As  used  herein,  the  term "Lender" shall mean GE HFS Holdings, Inc., a
Delaware  corporation,  f/k/a  Heller  Healthcare  Finance,  Inc.

C.     One  or  more  of  the  entities  designated  above as "Borrower" are the
existing  borrowers  under  a  certain  Loan  and Security Agreement dated as of
November  28,  2000,  by  and between such existing borrowers and Lender (as the
same may have been amended, restated or modified from time to time, including by
that  certain  Amendment  No.  1  to Loan and Security Agreement and Consent and
Waiver,  dated  as  of November 26, 2002, by and among Borrower and Lender, that
certain  Amendment  No. 2 to Loan and Security Agreement and Consent and Waiver,
dated  as  of March 29, 2004, by and among Borrower and Lender, and that certain
Amendment  No.  3 to Loan and Security Agreement, dated as of November 29, 2004,
by  and  among  Borrower  and  Lender,  and  as  the same may be amended by this
Amendment,  the  "Loan Agreement").  All capitalized terms not otherwise defined
herein  shall  have  the  meanings  given  them  in  the  Loan  Agreement.

D.     Borrower  and  Lender  desire  hereby  to  amend  the  Loan  Agreement as
hereinafter  provided.

NOW,  THEREFORE, in consideration of the premises set forth above, the terms and
conditions  contained  in  this  Amendment,  and  other  good  and  valuable
consideration,  the  receipt  and  sufficiency of which are hereby acknowledged,
Lender  and  Borrower  have  agreed  to  the  following  amendments  to the Loan
Agreement:

1.     Recitals.  The  foregoing  recitals, including all terms defined therein,
       --------
are  incorporated  herein  and  made  a  part  hereof.

2.     Definition  of  "Change in Control".  Section 1.10a of the Loan Agreement
       -----------------------------------
is hereby deleted in its entirety, and in its place there is hereby inserted the
following:

          "SECTION  1.10A.  CHANGE  IN  CONTROL.  "Change  in Control" means (a)
                            --------------------
     individuals who, as of the Closing Date, constituted the board of directors
     of  Borrower  (together with any new directors whose election by that board
     of  directors  or  whose  nomination  for  election  by the stockholders of
     Borrower was approved by two-thirds of the directors of Borrower then still
     in office who were either directors at the beginning of the period or whose
     election or nomination for election was previously approved), cease for any
     reason  to constitute a majority of the board of directors of Borrower then
     in  office, (b) either of Jerry Braun or Jacob Rosenberg ceases to be Chief
     Executive Officer or Chief Financial Officer and Chief Operating Officer of
     the  home  healthcare  business of Borrower, respectively, or (c) either of
     Jerry  Braun or Jacob Rosenberg ceases on a day to day basis to function as
     an  executive  member  of the management of the home healthcare business of
     Borrower,  as  determined  by  Lender  in  its  sole  discretion."

3.     Miscellaneous.
       --------------

     (a)     Further  Documentation.  In  the event any further documentation or
             ----------------------
information  is deemed necessary or appropriate by Lender in the exercise of its
rights  under  the  Loan  Documents  or  to  correct patent mistakes in the Loan
Documents,  Borrower  shall  provide,  or  cause  to be provided, to Lender such
documentation  or information. Borrower shall execute and deliver to Lender such
documentation,  including  but  not  limited  to,  any  amendments, corrections,
deletions or additions to the Loan Documents as is required by Lender; provided,

<PAGE>
however,  that Borrower shall not be required to do anything that has the effect
of  changing  the  essential  economic  terms  of the loan set forth in the Loan
Documents.

     (b)     References.  Upon  the  effectiveness  of  this  Amendment,  each
             ----------
reference  in  the  Loan  Agreement  to "this Agreement," "hereunder," "hereof,"
"herein"  or  words  of similar import shall mean and be a reference to the Loan
Agreement  as  amended  by  this  Amendment.

     (c)     Affirmation.  Except  as  specifically  amended  above,  the  Loan
             -----------
Agreement,  and  all  other Loan Documents (and all covenants, terms, conditions
and  agreements  therein), shall remain in full force and effect, and are hereby
ratified  and  confirmed  in  all  respects  by Borrower. Borrower covenants and
agrees  to  comply  with  all of the terms, covenants and conditions of the Loan
Agreement,  as  amended  hereby,  notwithstanding  any  prior course of conduct,
waivers,  releases  or  other  actions or inactions on Lender's part which might
otherwise  constitute or be construed as a waiver of or amendment to such terms,
covenants  and  conditions.

     (d)     No  Waiver.  The  execution,  delivery  and  effectiveness  of this
             ----------
Amendment  shall not, except as expressly provided in this Amendment, operate as
a waiver of any right, power or remedy of Lender, nor constitute a waiver of any
provision  of  the  Loan  Agreement,  the Loan Documents or any other documents,
instruments  and  agreements executed or delivered in connection with any of the
foregoing.  Nothing  herein is intended or shall be construed as a waiver of any
existing  defaults  or  Events of Default under the Loan Agreement or other Loan
Documents  or any of Lender's rights and remedies in respect of such defaults or
Events  of  Default.

     (e)     No  Novation.  This  Amendment  (together  with  any other document
             ------------
executed  in  connection  herewith)  is  not  intended  to  be,  nor shall it be
construed  as,  a  novation  of  the  Loan  Agreement.

     (f)     Governing  Law.  This  Amendment shall be governed by and construed
             --------------
in  accordance  with  the  laws  of the State of Maryland, without regard to any
otherwise  applicable  conflicts  of  law  principles.

     (g)     Headings.  Section  headings  in  this  Amendment  are included for
             --------
convenience  of reference only and shall not constitute a part of this Amendment
for  any  other  purpose.

     (h)     Counterparts.  This  Amendment may be executed in counterparts, and
             ------------
both  counterparts taken together shall be deemed to constitute one and the same
instrument.

<PAGE>
IN  WITNESS  WHEREOF,  intending  to  be  legally bound, and intending that this
instrument constitute an instrument executed under seal, the parties have caused
this  Amendment  to  be  executed  as  of  the  date  first  written  above.

                              LENDER:

                              GE  HFS  HOLDINGS,  INC.
                              f/k/a  HELLER  HEALTHCARE  FINANCE,  INC.
                              a  Delaware  corporation

                              By:  /s/  R.Hanes  Whiteley
                              ---------------------------
                              Name:  R.  Hanes  Whiteley
                              Title:  Duly  Authorized  Signature

                              BORROWER:

                              NEW  YORK  HEALTH  CARE,  INC.
                              a  New  York  corporation

                              By:  /s/  Jacob  Rosenberg
                              --------------------------
                              Name:  Jacob  Rosenberg
                              Title:     C.O.O.

                              NYHC  NEWCO  PAXXON,  INC.
                              a  New  York  corporation

                              By:  /s/  Jacob  Rosenberg
                              --------------------------
                              Name:  Jacob  Rosenberg
                              Title:  C.O.O.

<PAGE>

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