Document:

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                                                                     EXHIBIT 4.3

                                                                  EXECUTION COPY

                          REGISTRATION RIGHTS AGREEMENT

                                  BY AND AMONG

                      NATIONAL NEPHROLOGY ASSOCIATES, INC.

                   THE GUARANTORS LISTED ON APPENDIX I HERETO

                                       AND

                         BANC OF AMERICA SECURITIES LLC

                           J.P. MORGAN SECURITIES INC.

                       RBC DOMINION SECURITIES CORPORATION

                              HARRIS NESBITT CORP.

                          DATED AS OF OCTOBER 22, 2003

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                          REGISTRATION RIGHTS AGREEMENT

         This Registration Rights Agreement (this "Agreement") is made and
entered into as of October 22, 2003, by and among National Nephrology
Associates, Inc., a Delaware corporation (the "Company"), the Guarantors listed
on Appendix I hereto (the "Guarantors"), and Banc of America Securities LLC,
J.P. Morgan Securities Inc., RBC Dominion Securities Corporation and Harris
Nesbitt Corp. (each, an "Initial Purchaser" and, collectively, the "Initial
Purchasers"), each of whom has agreed to purchase the Company's 9% Senior
Subordinated Notes due 2011 (the "Initial Notes") pursuant to the Purchase
Agreement (as defined below). The obligations of the Company under the Initial
Notes will be fully and unconditionally guaranteed on a senior subordinated
basis by the Guarantors (the "Guarantees"). The Initial Notes and the Guarantees
attached thereto are collectively referred to herein as the "Initial
Securities".

         This Agreement is made pursuant to the Purchase Agreement, dated as of
October 16, 2003 (the "Purchase Agreement"), by and among the Company, the
Guarantors and the Initial Purchasers (i) for the benefit of each Initial
Purchaser and (ii) for the benefit of the holders from time to time of the
Securities (including each Initial Purchaser). In order to induce the Initial
Purchasers to purchase the Initial Securities, the Company has agreed to provide
the registration rights set forth in this Agreement. The execution and delivery
of this Agreement is a condition to the obligations of the Initial Purchasers
set forth in Section 5(j) of the Purchase Agreement.

         The parties hereby agree as follows:

SECTION 1. DEFINITIONS

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

                  Broker-Dealer: Any broker or dealer registered under the
         Exchange Act.

                  Closing Date: The date of this Agreement.

                  Commission: The Securities and Exchange Commission.

                  Consummate: A registered Exchange Offer shall be deemed
         "Consummated" for purposes of this Agreement upon the occurrence of (i)
         the filing and effectiveness under the Securities Act of the Exchange
         Offer Registration Statement relating to the Exchange Securities to be
         issued in the Exchange Offer, (ii) the keeping of the Exchange Offer
         open for a period not less than the minimum period required pursuant to
         Section 3(b) hereof, and (iii) the delivery by the Company to the
         Registrar under the Indenture of Exchange Securities in the same
         aggregate principal amount as the aggregate principal amount of Initial
         Securities that were tendered by Holders thereof pursuant to the
         Exchange Offer.

                  Effectiveness Target Date: As defined in Section 5.

                  Exchange Act: The Securities Exchange Act of 1934, as amended.

                  Exchange Offer: The registration by the Company under the
         Securities Act of the Exchange Securities pursuant to a Registration
         Statement pursuant to which the Company offers the Holders of all
         outstanding Transfer Restricted Securities the opportunity to exchange
         all such outstanding Transfer Restricted Securities held by such
         Holders for Exchange Securities in an aggregate principal amount equal
         to the aggregate principal amount of the Transfer Restricted Securities
         tendered in such exchange offer by such Holders.

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                  Exchange Offer Registration Statement: The Registration
         Statement relating to the Exchange Offer, including the related
         Prospectus.

                  Exchange Securities: The 9% Senior Subordinated Notes due
         2011, of the same series under the Indenture as the Initial Notes, and
         the guarantees thereof by the Guarantors, to be issued to Holders in
         exchange for Transfer Restricted Securities pursuant to this Agreement.

                  Exempt Resales: The transactions in which the Initial
         Purchasers propose to sell the Initial Securities to certain "qualified
         institutional buyers," as such term is defined in Rule 144A under the
         Securities Act, and to certain non-U.S. persons pursuant to Regulation
         S under the Securities Act.

                  Guarantees: As defined in the preamble hereto.

                  Guarantors: As defined in the preamble hereto.

                  Holders: As defined in Section 2(b) hereof.

                  Indemnified Holder: As defined in Section 8(a) hereof.

                  Indenture: The Indenture, dated as of October 22, 2003, among
         the Company, the Guarantors and Wells Fargo Bank Minnesota, N.A., as
         trustee (the "Trustee"), pursuant to which the Securities are to be
         issued, as such Indenture is amended or supplemented from time to time
         in accordance with the terms thereof.

                  Initial Purchaser: As defined in the preamble hereto.

                  Initial Notes: The 9% Senior Subordinated Notes due 2011, of
         the same series under the Indenture as the Exchange Notes, for so long
         as such securities constitute Transfer Restricted Securities.

                  Initial Placement: The issuance and sale by the Company of the
         Initial Securities to the Initial Purchasers pursuant to the Purchase
         Agreement.

                  Initial Securities: As defined in the preamble hereto.

                  Interest Payment Date: As defined in the Indenture and the
         Securities.

                  NASD: National Association of Securities Dealers, Inc.

                  Person: An individual, partnership, corporation, trust or
         unincorporated organization, or a government or agency or political
         subdivision thereof.

                  Prospectus: The prospectus included in a Registration
         Statement, as amended or supplemented by any prospectus supplement and
         by all other amendments thereto, including post-effective amendments,
         and all material incorporated by reference into such Prospectus.

                  Registration Default: As defined in Section 5 hereof.

                  Registration Statement: Any registration statement of the
         Company relating to (a) an offering of Exchange Securities pursuant to
         an Exchange Offer or (b) the registration for resale of Transfer
         Restricted Securities pursuant to the Shelf Registration Statement,
         which is filed pursuant to the provisions of this Agreement, in each
         case, including the Prospectus included therein, all amendments

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         and supplements thereto (including post-effective amendments) and all
         exhibits and material incorporated by reference therein.

                  Securities: The Initial Securities and the Exchange
         Securities.

                  Securities Act: The Securities Act of 1933, as amended.

                  Shelf Filing Deadline: As defined in Section 4 hereof.

                  Shelf Registration Statement: As defined in Section 4 hereof.

                  Trust Indenture Act: The Trust Indenture Act of 1939 (15
         U.S.C. Section 77aaa 77bbbb) as in effect on the date of the Indenture.

                  Transfer Restricted Securities: Each Security, until the
         earliest to occur of (a) the date on which such Security is exchanged
         in the Exchange Offer and entitled to be resold to the public by the
         Holder thereof without complying with the prospectus delivery
         requirements of the Securities Act, (b) the date on which such Security
         has been effectively registered under the Securities Act and disposed
         of in accordance with a Shelf Registration Statement and (c) the date
         on which such Security is distributed to the public pursuant to Rule
         144 under the Securities Act or by a Broker-Dealer pursuant to the
         "Plan of Distribution" contemplated by the Exchange Offer Registration
         Statement (including delivery of the Prospectus contained therein).
         Notwithstanding the foregoing, in no event will the Exchange Securities
         constitute Transfer Restricted Securities.

                  Underwritten Registration or Underwritten Offering: A
         registration in which securities of the Company are sold to an
         underwriter for reoffering to the public.

SECTION 2. SECURITIES SUBJECT TO THIS AGREEMENT

         (a) Transfer Restricted Securities. The securities entitled to the
benefits of this Agreement are the Transfer Restricted Securities.

         (b) Holders of Transfer Restricted Securities. A Person is deemed to be
a holder of Transfer Restricted Securities (each, a "Holder") whenever such
Person owns Transfer Restricted Securities.

SECTION 3. REGISTERED EXCHANGE OFFER

         (a) Unless the Exchange Offer shall not be permissible under applicable
law or Commission policy (after the procedures set forth in Section 6(a) below
have been complied with), the Company and the Guarantors shall (i) cause to be
filed with the Commission as soon as practicable after the Closing Date, but in
no event later than 180 calendar days after the Closing Date, a Registration
Statement under the Securities Act relating to the Exchange Securities and the
Exchange Offer, (ii) use their reasonable best efforts to cause such
Registration Statement to become effective at the earliest possible time, but in
no event later than 270 calendar days after the Closing Date, (iii) in
connection with the foregoing, file (A) all pre-effective amendments to such
Registration Statement as may be necessary in order to cause such Registration
Statement to become effective, (B) if applicable, a post-effective amendment to
such Registration Statement pursuant to Rule 430A under the Securities Act in
order to cause the Exchange Offer Registration Statement to be effective for a
period not less than the minimum period required pursuant to Section 3(b) hereof
and (C) cause all necessary filings in connection with the registration and
qualification of the Exchange Securities to be made under the Blue Sky laws of
such jurisdictions as are necessary to permit Consummation of the Exchange
Offer, and (iv) upon the effectiveness of such Registration Statement, commence
the Exchange Offer. The Exchange Offer shall be on the appropriate form
permitting registration of the Exchange Securities to be offered in exchange

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for the Transfer Restricted Securities and to permit resales of Securities held
by Broker-Dealers as contemplated by Section 3(c) below.

         (b) The Company and the Guarantors shall use their reasonable best
efforts to cause the Exchange Offer Registration Statement to be effective
continuously and shall keep the Exchange Offer open for a period of not less
than the minimum period required under applicable federal and state securities
laws to Consummate the Exchange Offer; provided, however, that in no event shall
such period be less than 30 days and not more than 45 days (or longer if
required by applicable law) after the date notice of the Exchange Offer is
mailed to the Holders. The Company shall cause the Exchange Offer to comply with
all applicable federal and state securities laws. No securities other than the
Securities shall be included in the Exchange Offer Registration Statement. The
Company shall use its reasonable best efforts to cause the Exchange Offer to be
Consummated on the earliest practicable date after the Exchange Offer
Registration Statement has become effective, but in no event later than 30
business days after the date on which the Exchange Offer Registration Statement
is declared effective under the Securities Act.

         (c) The Company shall indicate in a "Plan of Distribution" section
contained in the Prospectus forming a part of the Exchange Offer Registration
Statement that any Broker-Dealer who holds Initial Securities that are Transfer
Restricted Securities and that were acquired for its own account as a result of
market-making activities or other trading activities (other than Transfer
Restricted Securities acquired directly from the Company), may exchange such
Initial Securities pursuant to the Exchange Offer; however, such Broker-Dealer
may be deemed to be an "underwriter" within the meaning of the Securities Act
and must, therefore, deliver a prospectus meeting the requirements of the
Securities Act in connection with any resales of the Exchange Securities
received by such Broker-Dealer in the Exchange Offer, which prospectus delivery
requirement may be satisfied by the delivery by such Broker-Dealer of the
Prospectus contained in the Exchange Offer Registration Statement. Such "Plan of
Distribution" section shall also contain all other information with respect to
such resales by Broker-Dealers that the Commission may require in order to
permit such resales pursuant thereto, but such "Plan of Distribution" shall not
name any such Broker-Dealer or disclose the amount of Securities held by any
such Broker-Dealer except to the extent required by the Commission as a result
of a change in policy after the date of this Agreement.

         The Company and the Guarantors shall use their reasonable best efforts
to keep the Exchange Offer Registration Statement continuously effective,
supplemented and amended as required by the provisions of Section 6(c) below to
the extent necessary to ensure that it is available for resales of Securities
acquired by Broker-Dealers for their own accounts as a result of market-making
activities or other trading activities, and to ensure that it conforms with the
requirements of this Agreement, the Securities Act and the policies, rules and
regulations of the Commission as announced from time to time, for a period
ending on the earlier of (i) 180 days from the date on which the Exchange Offer
Registration Statement is declared effective and (ii) the date on which a
Broker-Dealer is no longer required to deliver a prospectus in connection with
market-making or other trading activities.

         The Company shall provide sufficient copies of the latest version of
such Prospectus to Broker-Dealers promptly upon request at any time during such
180-day (or shorter as provided in the foregoing sentence) period in order to
facilitate such resales.

SECTION 4. SHELF REGISTRATION

         (a) Shelf Registration. If (i) the Company and the Guarantors are not
required to file an Exchange Offer Registration Statement or to consummate the
Exchange Offer because the Exchange Offer is not permitted by applicable law or
Commission policy (after the procedures set forth in Section 6(a) below have
been complied with), (ii) for any reason the Exchange Offer is not Consummated
within the time period prescribed by Section 3(b) hereof, (iii) with respect to
any Holder of Transfer Restricted Securities such Holder notifies the Company
prior to the 20th day following consummation of the Exchange Offer that (A) such
Holder is prohibited by applicable law or Commission policy from participating
in the Exchange Offer, or (B)

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such Holder may not resell the Exchange Securities acquired by it in the
Exchange Offer to the public without delivering a prospectus and that the
Prospectus contained in the Exchange Offer Registration Statement is not
appropriate or available for such resales by such Holder, or (C) such Holder is
a Broker-Dealer and holds Initial Securities acquired directly from the Company
or one of its affiliates, or (iv) an Initial Purchaser, who is unable to
exchange Securities in connection with the Exchange Offer, requests, then, upon
such Holder's or Initial Purchaser's request, the Company and the Guarantors
shall

                  (x) cause to be filed a shelf registration statement pursuant
         to Rule 415 under the Securities Act, which may be an amendment to the
         Exchange Offer Registration Statement (in either event, the "Shelf
         Registration Statement") on or prior to 45 days after the earliest of
         (1) the date on which the Company determines that it is not required to
         file the Exchange Offer Registration Statement or the Exchange Offer
         Registration Statement cannot be filed as a result of clause (i) above,
         (2) if the Exchange Offer is not Consummated in the case of clause (ii)
         above, the date on which the Exchange Offer should have been
         consummated pursuant to Section 3(b) hereof, and (3) the date on which
         the Company receives notice specified in clause (iii) above (such date
         being the "Shelf Filing Deadline"), which Shelf Registration Statement
         shall provide for resales of all Transfer Restricted Securities the
         Holders of which shall have provided the information required pursuant
         to Section 4(b) hereof; and

                  (y) use their reasonable best efforts to cause such Shelf
         Registration Statement to be declared effective by the Commission on or
         before the 90th day after the Shelf Filing Deadline.

The Company and the Guarantors shall use their reasonable best efforts to keep
such Shelf Registration Statement continuously effective, supplemented and
amended as required by the provisions of Sections 6(b) and (c) hereof to the
extent necessary to ensure that it is available for resales of Securities by the
Holders of Transfer Restricted Securities entitled to the benefit of this
Section 4(a), and to ensure that it conforms with the requirements of this
Agreement, the Securities Act and the policies, rules and regulations of the
Commission as announced from time to time, for a period of at least two years
following the effective date of such Shelf Registration Statement (or shorter
period that will terminate when all the Securities covered by such Shelf
Registration Statement have been sold pursuant to such Shelf Registration
Statement). To the extent the Company is required to include any Securities in a
Shelf Registration Statement, the Company may include such Securities on any
other shelf registration statement otherwise being filed by the Company with
respect to other of its securities, so long as the Company and the Guarantors
comply with all of the procedures described herein with respect to the Shelf
Registration Statement.

         (b) Provision by Holders of Certain Information in Connection with the
Shelf Registration Statement. No Holder of Transfer Restricted Securities may
include any of its Transfer Restricted Securities in any Shelf Registration
Statement pursuant to this Agreement unless and until such Holder furnishes to
the Company in writing, within 20 business days after receipt of a request
therefor, such information as the Company may reasonably request for use in
connection with any Shelf Registration Statement or Prospectus or preliminary
Prospectus included therein. Each Holder as to which any Shelf Registration
Statement is being effected agrees to furnish promptly to the Company all
information required to be disclosed in order to make the information previously
furnished to the Company by such Holder not materially misleading.

SECTION 5. LIQUIDATED DAMAGES

         If (i) any of the Registration Statements required by this Agreement is
not filed with the Commission on or prior to the date specified for such filing
in this Agreement, (ii) any of such Registration Statements has not been
declared effective by the Commission on or prior to the date specified for such
effectiveness in this Agreement (the "Effectiveness Target Date"), (iii) the
Exchange Offer has not been Consummated within 30 business days after the
Effectiveness Target Date with respect to the Exchange Offer Registration
Statement or (iv) any Registration Statement required by this Agreement is filed
and declared effective but shall thereafter cease to be effective or fail to be
usable for its intended purpose for more than 30

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days (each such event referred to in clauses (i) through (iv), a "Registration
Default"), the Company hereby agrees to pay liquidated damages ("Liquidated
Damages") to each Holder of Transfer Restricted Securities with respect to the
first 30-day period following the filing deadline referred to in clause (i)
above or the first 90-day period following the periods referred to in clauses
(ii), (iii) or (iv) above in an amount equal to $0.05 per week per $1,000
principal amount of Securities held by such Holder. The amount of Liquidated
Damages will increase by an additional $0.05 per week per $1,000 principal
amount of Securities at the beginning of each subsequent 30-day period in the
case of clause (i) above or 90-day period in the case of clauses (ii), (iii) or
(iv) above, up to a maximum amount of Liquidated Damages of $0.30 per week per
$1,000 principal amount of Securities. Upon (x) the filing of the Exchange Offer
Registration Statement, the effectiveness of the Exchange Offer Registration
Statement, the consummation of the Exchange Offer, (y) the effectiveness of a
Shelf Registration Statement, or (z) any Registration Statement, in the case of
clause (iv) above, once again becoming usable, as the case may be, Liquidated
Damages will cease to accrue from the date of the event described in clauses
(x), (y) or (z), as the case may be, provided, however, that, if after the date
such Liquidated Damages cease to accrue, a different Registration Default
occurs, Liquidated Damages may again commence accruing pursuant to the foregoing
provisions.

         All references herein to "interest" include the Liquidated Damages
payable pursuant to this Section 5, and all accrued Liquidated Damages shall be
paid to the Holders entitled thereto, in the manner provided for the payment of
interest in the Indenture, on each Interest Payment Date, as more fully set
forth in the Indenture and the Securities. All obligations of the Company and
the Guarantors set forth in the preceding paragraph that are outstanding with
respect to any Transfer Restricted Securities shall survive until such time as
all such obligations with respect to such Securities shall have been satisfied
in full.

SECTION 6. REGISTRATION PROCEDURES

         (a) Exchange Offer Registration Statement. In connection with the
Exchange Offer, the Company and the Guarantors shall comply with all of the
provisions of Section 6(c) below, shall use their reasonable best efforts to
effect such exchange to permit the sale of Transfer Restricted Securities being
sold in accordance with the intended method or methods of distribution thereof,
and shall comply with all of the following provisions:

             (i) If in the reasonable opinion of counsel to the Company there is
a question as to whether the Exchange Offer is permitted by applicable law, the
Company and the Guarantors hereby agree to seek a no-action letter or other
favorable decision from the Commission allowing the Company and the Guarantors
to Consummate an Exchange Offer for the Initial Securities. The Company and the
Guarantors each hereby agrees to pursue the issuance of such a decision to the
Commission staff level but shall not be required to take commercially
unreasonable action to effect a change of Commission policy. In connection with
the foregoing, the Company and the Guarantors hereby agree to take all such
other commercially reasonable actions required in connection with the issuance
of such decision, including without limitation (A) participating in telephonic
conferences with the Commission, (B) delivering to the Commission staff an
analysis prepared by counsel to the Company setting forth the legal bases, if
any, upon which such counsel has concluded that such an Exchange Offer should be
permitted and (C) diligently pursuing a favorable resolution by the Commission
staff of such submission.

             (ii) As a condition to its participation in the Exchange Offer
pursuant to the terms of this Agreement, each Holder of Transfer Restricted
Securities shall furnish, upon the request of the Company, prior to the
Consummation thereof, a written representation to the Company (which may be
contained in the letter of transmittal contemplated by the Exchange Offer
Registration Statement) to the effect that (A) it is not an affiliate of the
Company, (B) it is not engaged in, and does not intend to engage in, and has no
arrangement or understanding with any person to participate in, a distribution
of the Exchange Securities to be issued in the Exchange Offer and (C) it is
acquiring the Exchange Securities in its ordinary course of business. In
addition, all such Holders of Transfer Restricted Securities shall otherwise
cooperate in the Company's preparations for the Exchange Offer. Each Holder
hereby acknowledges and agrees that any Broker-Dealer and any such

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Holder using the Exchange Offer to participate in a distribution of the
securities to be acquired in the Exchange Offer (1) could not under Commission
policy as in effect on the date of this Agreement rely on the position of the
Commission enunciated in Morgan Stanley and Co., Inc. (available June 5, 1991)
and Exxon Capital Holdings Corporation (available May 13, 1988), as interpreted
in the Commission's letter to Shearman & Sterling dated July 2, 1993, and
similar no-action letters (which may include any no-action letter obtained
pursuant to clause (i) above), and (2) must comply with the registration and
prospectus delivery requirements of the Securities Act in connection with a
secondary resale transaction and that such a secondary resale transaction should
be covered by an effective registration statement containing the selling
security holder information required by Item 507 or 508, as applicable, of
Regulation S-K if the resales are of Exchange Securities obtained by such Holder
in exchange for Initial Securities acquired by such Holder directly from the
Company.

         (b) Shelf Registration Statement. In connection with the Shelf
Registration Statement, the Company and the Guarantors shall comply with all the
provisions of Section 6(c) below and shall use their reasonable best efforts to
effect such registration to permit the sale of the Transfer Restricted
Securities being sold in accordance with the intended method or methods of
distribution thereof, and pursuant thereto upon there being an obligation to
file a Shelf Registration Statement pursuant to Section 4(a), the Company will
as expeditiously as possible prepare and file with the Commission a Registration
Statement relating to the registration on any appropriate form under the
Securities Act, which form shall be available for the sale of the Transfer
Restricted Securities in accordance with the intended method or methods of
distribution thereof within the time periods and otherwise in accordance with
the provisions thereof.

         (c) General Provisions. In connection with any Registration Statement
and any Prospectus required by this Agreement to permit the sale or resale of
Transfer Restricted Securities (including, without limitation, any Registration
Statement and the related Prospectus required to permit resales of Securities by
Broker-Dealers), the Company and the Guarantors shall:

             (i) use their reasonable best efforts to keep such Registration
Statement continuously effective and provide all requisite financial statements
(including, if required by the Securities Act or any regulation thereunder,
financial statements of the Guarantors for the period specified in Section 3 or
4 of this Agreement, as applicable); upon the occurrence of any event that would
cause any such Registration Statement or the Prospectus contained therein (A) to
contain a material misstatement or omission or (B) not to be effective and
usable for resale of Transfer Restricted Securities during the period required
by this Agreement, the Company shall file promptly an appropriate amendment to
such Registration Statement, in the case of clause (A), correcting any such
misstatement or omission, and, in the case of either clause (A) or (B), use its
reasonable best efforts to cause such amendment to be declared effective and
such Registration Statement and the related Prospectus to become usable for
their intended purpose(s) as soon as practicable thereafter;

             (ii) prepare and file with the Commission such amendments and
post-effective amendments to the applicable Registration Statement as may be
necessary to keep the Registration Statement effective for the applicable period
set forth in Section 3 or 4 hereof, as applicable, or such shorter period as
will terminate when all Transfer Restricted Securities covered by such
Registration Statement have been sold; cause the Prospectus to be supplemented
by any required Prospectus supplement, and as so supplemented to be filed
pursuant to Rule 424 under the Securities Act, and to comply fully with the
applicable provisions of Rules 424 and 430A under the Securities Act in a timely
manner; and comply with the provisions of the Securities Act with respect to the
disposition of all securities covered by such Registration Statement during the
applicable period in accordance with the intended method or methods of
distribution by the sellers thereof set forth in such Registration Statement or
supplement to the Prospectus;

             (iii) advise the underwriter(s), if any, and selling Holders
promptly and, if requested by such Persons, to confirm such advice in writing,
(A) when the Prospectus or any Prospectus supplement or post-effective amendment
has been filed, and, with respect to any Registration Statement or any
post-effective

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amendment thereto, when the same has become effective, (B) of any request by the
Commission for post-effective amendments to the Registration Statement or
amendments or supplements to the Prospectus or for additional information
relating thereto, (C) of the issuance by the Commission of any stop order
suspending the effectiveness of the Registration Statement under the Securities
Act or of the suspension by any state securities commission of the qualification
of the Transfer Restricted Securities for offering or sale in any jurisdiction,
or the initiation of any proceeding for any of the preceding purposes, (D) of
the existence of any fact or the happening of any event that makes any statement
of a material fact made in the Registration Statement, the Prospectus, any
amendment or supplement thereto, or any document incorporated by reference
therein untrue, or that requires the making of any additions to or changes in
the Registration Statement in order to make the statements therein not
misleading, or that requires the making of any additions to or changes in the
Prospectus in order to make the statements therein, in light of the
circumstances under which they were made not misleading. If at any time the
Commission shall issue any stop order suspending the effectiveness of the
Registration Statement, or any state securities commission or other regulatory
authority shall issue an order suspending the qualification or exemption from
qualification of the Transfer Restricted Securities under state securities or
Blue Sky laws, the Company and the Guarantors shall use their reasonable best
efforts to obtain the withdrawal or lifting of such order at the earliest
possible time;

             (iv) furnish without charge to each of the Initial Purchasers,
each selling Holder named in any Registration Statement, and each of the
underwriter(s), if any, before filing with the Commission, copies of any
Registration Statement or any Prospectus included therein or any amendments or
supplements to any such Registration Statement or Prospectus (including all
documents incorporated by reference after the initial filing of such
Registration Statement), which documents will be subject to the review and
comment of such Holders and underwriter(s) in connection with such sale, if any,
for a period of at least five business days, and the Company will not file any
such Registration Statement or Prospectus or any amendment or supplement to any
such Registration Statement or Prospectus (including all such documents
incorporated by reference) to which an Initial Purchaser of Transfer Restricted
Securities covered by such Registration Statement or the underwriter(s), if any,
shall reasonably object in writing within five business days after the receipt
thereof (such objection to be deemed timely made upon confirmation of telecopy
transmission within such period). The objection of an Initial Purchaser or
underwriter, if any, shall be deemed to be reasonable if such Registration
Statement, amendment, Prospectus or supplement, as applicable, as proposed to be
filed, contains a material misstatement or omission;

             (v) promptly prior to the filing of any document that is to be
incorporated by reference into a Registration Statement or Prospectus, provide
copies of such document to the Initial Purchasers, each selling Holder named in
any Registration Statement, and to the underwriter(s), if any, make the
Company's management officers and other representatives available and management
officers and other representatives of the Guarantors available for discussion of
such document and other customary due diligence matters, and include such
information in such document prior to the filing thereof as such selling Holders
or underwriter(s), if any, reasonably may request;

             (vi) make available at reasonable times for inspection by the
Initial Purchasers, any managing underwriter participating in any disposition
pursuant to such Registration Statement and any attorney or accountant retained
by such Initial Purchasers or any of the underwriter(s), all pertinent financial
and other records, corporate documents and properties of the Company and each of
the Guarantors and cause the Company's and the Guarantors' officers, directors
and employees to supply all information reasonably requested by any such Holder,
underwriter, attorney or accountant in connection with such Registration
Statement or any post-effective amendment thereto subsequent to the filing
thereof and prior to its effectiveness and make available the Company's
management, officers and other representatives for meetings with investors
typical for road shows of underwritten securities to the extent requested by any
Holder, Initial Purchaser or underwriter;

             (vii) if requested by any selling Holders or the underwriter(s), if
any, promptly incorporate in any Registration Statement or Prospectus, pursuant
to a supplement or post-effective

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amendment if necessary, such information as such selling Holders and
underwriter(s), if any, may reasonably request to have included therein,
including, without limitation, information relating to the "Plan of
Distribution" of the Transfer Restricted Securities, information with respect to
the principal amount of Transfer Restricted Securities being sold to such
underwriter(s), the purchase price being paid therefor and any other terms of
the offering of the Transfer Restricted Securities to be sold in such offering;
and make all required filings of such Prospectus supplement or post-effective
amendment as soon as practicable after the Company is notified of the matters to
be incorporated in such Prospectus supplement or post-effective amendment;

             (viii) use reasonable best efforts to cause the Transfer Restricted
Securities covered by the Registration Statement to be rated with the
appropriate rating agencies, if so requested by the Holders of a majority in
aggregate principal amount of Securities covered thereby or the underwriter(s),
if any;

             (ix) if requested by any selling Holders or the underwriters, if
any, furnish to each such selling Holder and each of such underwriter(s), if
any, without charge, at least one copy of the Registration Statement, as first
filed with the Commission, and of each amendment thereto, including financial
statements and schedules, all documents incorporated by reference therein and
all exhibits (including exhibits incorporated therein by reference);

             (x) deliver to each selling Holder and each of the underwriter(s),
if any, without charge, as many copies of the Prospectus (including each
preliminary prospectus) and any amendment or supplement thereto as such Persons
reasonably may reasonably request; the Company and the Guarantors hereby consent
to the use of the Prospectus and any amendment or supplement thereto by each of
the selling Holders and each of the underwriter(s), if any, in connection with
the offering and the sale of the Transfer Restricted Securities covered by the
Prospectus or any amendment or supplement thereto;

             (xi) enter into, and cause the Guarantors to enter into, such
agreements (including an underwriting agreement), and make, and cause the
Guarantors to make, such representations and warranties, and take all such other
actions in connection therewith in order to expedite or facilitate the
disposition of the Transfer Restricted Securities pursuant to any Registration
Statement contemplated by this Agreement, all to such extent as may be
reasonably requested by any Initial Purchaser or by any Holder of Transfer
Restricted Securities or underwriter in connection with any sale or resale
pursuant to any Registration Statement contemplated by this Agreement; and
whether or not an underwriting agreement is entered into and whether or not the
registration is an Underwritten Registration, the Company and the Guarantors
shall:

                  (A) furnish to each Initial Purchaser, each selling Holder and
         each underwriter, if any, in such substance and scope as they may
         reasonably request and as are customarily made by issuers to
         underwriters in primary underwritten offerings, upon the date of the
         Consummation of the Exchange Offer and, if applicable, the
         effectiveness of the Shelf Registration Statement:

                           (1) in the event of an underwritten public offering
                  of Securities pursuant to the Shelf Registration Statement, a
                  certificate, dated the date of Consummation of the Exchange
                  Offer or the date of effectiveness of the Shelf Registration
                  Statement, as the case may be, signed by (y) the President or
                  any Vice President and (z) a principal financial or accounting
                  officer of each of the Company and the Guarantors, confirming,
                  as of the date thereof, the matters set forth in paragraphs
                  (i), (ii) and (iii) of Section 5 (f) of the Purchase Agreement
                  and such other matters as such parties may reasonably request;

                           (2) an opinion, dated the date of Consummation of the
                  Exchange Offer or the date of effectiveness of the Shelf
                  Registration Statement, as the case may be, of counsel for the
                  Company and the Guarantors, covering the matters set forth in
                  paragraph (c) of Section 5 of the Purchase Agreement and such
                  other matters as such parties may reasonably request, and in
                  the event of an underwritten public offering of Securities
                  pursuant to the Shelf Registration Statement, including a
                  statement to the effect that such counsel has participated

                                       9
<PAGE>

                  in conferences with officers and other representatives of the
                  Company and the Guarantors and representatives of the
                  independent public accountants for the Company and the
                  Guarantors in connection with the preparation of such
                  Registration Statement and the related Prospectus and have
                  considered the matters required to be stated therein and the
                  statements contained therein, although such counsel has not
                  independently verified the accuracy, completeness or fairness
                  of such statements; and that such counsel advises that, on the
                  basis of the foregoing (relying as to materiality to a large
                  extent upon facts provided to such counsel by officers and
                  other representatives of the Company and without independent
                  check or verification), no facts came to such counsel's
                  attention that caused such counsel to believe that the
                  applicable Registration Statement, at the time such
                  Registration Statement or any post-effective amendment thereto
                  became effective, and, in the case of the Exchange Offer
                  Registration Statement, as of the date of Consummation,
                  contained an untrue statement of a material fact or omitted to
                  state a material fact required to be stated therein or
                  necessary to make the statements therein not misleading, or
                  that the Prospectus contained in such Registration Statement
                  as of its date and, in the case of the opinion dated the date
                  of Consummation of the Exchange Offer, as of the date of
                  Consummation, contained an untrue statement of a material fact
                  or omitted to state a material fact necessary in order to make
                  the statements therein, in light of the circumstances under
                  which they were made, not misleading. Without limiting the
                  foregoing, such counsel may state further that such counsel
                  assumes no responsibility for, and has not independently
                  verified, the accuracy, completeness or fairness of the
                  financial statements, notes and schedules and other financial
                  data included in any Registration Statement contemplated by
                  this Agreement or the related Prospectus; provided that such
                  statement be subject to modification and to such exceptions
                  and/or qualifications to the same extent as was any such
                  statement included in the opinion of counsel delivered upon
                  consummation of the offer and sale of the Initial Securities
                  to the Initial Purchasers; and

                           (3) a customary comfort letter, dated as of the date
                  of Consummation of the Exchange Offer or the date of
                  effectiveness of the Shelf Registration Statement, as the case
                  may be, from the Company's independent accountants, in the
                  customary form and covering matters of the type customarily
                  covered in comfort letters by underwriters in connection with
                  underwritten public offerings, and covering the matters set
                  forth in the comfort letters delivered pursuant to Section
                  5(a) of the Purchase Agreement;

                  (B) set forth in full or incorporate by reference in the
         underwriting agreement, if any, the indemnification provisions and
         procedures of Section 8 hereof with respect to all parties to be
         indemnified pursuant to said Section; and

                  (C) deliver such other documents and certificates as may be
         reasonably requested by such parties to evidence compliance with clause
         (A) above and with any customary conditions contained in the
         underwriting agreement or other agreement entered into by the Company
         or the Guarantors pursuant to this clause (xi), if any.

         If at any time the representations and warranties of the Company and
the Guarantors contemplated in clause (A)(1) above cease to be true and correct,
the Company or the Guarantors shall so advise the Initial Purchasers and the
underwriter(s), if any, and each selling Holder promptly and, if requested by
such Persons, shall confirm such advice in writing;

             (xii) prior to any public offering of Transfer Restricted
Securities, cooperate with, and cause the Guarantors to cooperate with, the
selling Holders, the underwriter(s), if any, and their respective counsel in
connection with the registration and qualification of the Transfer Restricted
Securities under the securities or Blue Sky laws of such jurisdictions as the
selling Holders or underwriter(s) may request and do any and all other acts or
things necessary or advisable to enable the disposition in such jurisdictions of
the Transfer Restricted Securities covered by the Shelf Registration Statement;
provided, however, that neither the

                                       10

<PAGE>

Company nor the Guarantors shall be required to register or qualify as a foreign
corporation where it is not then so qualified or to take any action that would
subject it to the service of process in suits or to taxation, other than as to
matters and transactions relating to the Registration Statement, in any
jurisdiction where it is not then so subject;

             (xiii) shall issue, upon the request of any Holder of Initial
Securities covered by the Shelf Registration Statement, Exchange Securities,
having an aggregate principal amount equal to the aggregate principal amount of
Initial Securities surrendered to the Company by such Holder in exchange
therefor or being sold by such Holder; such Exchange Securities to be registered
in the name of such Holder or in the name of the purchaser(s) of such
Securities, as the case may be; in return, the Initial Securities held by such
Holder shall be surrendered to the Company for cancellation;

             (xiv) cooperate with, and cause the Guarantors to cooperate with,
the selling Holders and the underwriter(s), if any, to facilitate the timely
preparation and delivery of certificates representing Transfer Restricted
Securities to be sold and not bearing any restrictive legends; and enable such
Transfer Restricted Securities to be in such denominations and registered in
such names as the Holders or the underwriter(s), if any, may request at least
two business days prior to any sale of Transfer Restricted Securities made by
such underwriter(s);

             (xv) use their reasonable best efforts to cause the Transfer
Restricted Securities covered by the Registration Statement to be registered
with or approved by such other governmental agencies or authorities as may be
necessary to enable the seller or sellers thereof or the underwriter(s), if any,
to consummate the disposition of such Transfer Restricted Securities;

             (xvi) if any fact or event contemplated by clause (c)(iii)(D) above
shall exist or have occurred, prepare a supplement or post-effective amendment
to the Registration Statement or related Prospectus or any document incorporated
therein by reference or file any other required document so that, as thereafter
delivered to the purchasers of Transfer Restricted Securities, the Prospectus
will not contain an untrue statement of a material fact or omit to state any
material fact necessary to make the statements therein not misleading;

             (xvii) provide a CUSIP number for all Transfer Restricted
Securities not later than the effective date of the Registration Statement and
provide the Trustee under the Indenture with printed certificates for the
Transfer Restricted Securities which are in a form eligible for deposit with the
Depository Trust Company;

             (xviii) cooperate and assist in any filings required to be made
with the NASD and in the performance of any due diligence investigation by any
underwriter (including any "qualified independent underwriter") that is required
to be retained in accordance with the rules and regulations of the NASD, and use
its reasonable best efforts to cause such Registration Statement to become
effective and approved by such governmental agencies or authorities as may be
necessary to enable the Holders selling Transfer Restricted Securities to
consummate the disposition of such Transfer Restricted Securities;

             (xix) otherwise use its reasonable best efforts to comply with all
applicable rules and regulations of the Commission, and make generally available
to its security holders, as soon as practicable, a consolidated earnings
statement meeting the requirements of Rule 158 (which need not be audited) for
the twelve-month period (A) commencing at the end of any fiscal quarter in which
Transfer Restricted Securities are sold to underwriters in a firm or best
efforts Underwritten Offering or (B) if not sold to underwriters in such an
offering, beginning with the first month of the Company's first fiscal quarter
commencing after the effective date of the Registration Statement;

             (xx) cause the Indenture to be qualified under the Trust Indenture
Act not later than the effective date of the first Registration Statement
required by this Agreement, and, in connection therewith,

                                       11

<PAGE>

cooperate, and cause the Guarantors to cooperate with, the Trustee and the
Holders of Securities to effect such changes to the Indenture as may be required
for such Indenture to be so qualified in accordance with the terms of the Trust
Indenture Act; and to execute, and cause the Guarantors to execute, and use
their reasonable best efforts to cause the Trustee to execute, all documents
that may be required to effect such changes and all other forms and documents
required to be filed with the Commission to enable such Indenture to be so
qualified in a timely manner;

             (xxi) cause all Transfer Restricted Securities covered by the
Registration Statement to be listed on each securities exchange on which similar
securities issued by the Company are then listed if requested by the Holders of
a majority in aggregate principal amount of Initial Securities or the managing
underwriter(s), if any; and

             (xxii) provide promptly to each Holder upon request each document
filed with the Commission pursuant to the requirements of Section 13 and Section
15 of the Exchange Act.

         Each Holder agrees by acquisition of a Transfer Restricted Security
that, upon receipt of any notice from the Company of the existence of any fact
of the kind described in Section 6(c)(iii)(D) hereof, such Holder will forthwith
discontinue disposition of Transfer Restricted Securities pursuant to the
applicable Registration Statement until such Holder's receipt of the copies of
the supplemented or amended Prospectus contemplated by Section 6(c)(xvi) hereof,
or until it is advised in writing (the "Advice") by the Company that the use of
the Prospectus may be resumed, and has received copies of any additional or
supplemental filings that are incorporated by reference in the Prospectus. If so
directed, each Holder hereby agrees that it will either (i) destroy any
Prospectuses, other than permanent file copies, then in such Holder's possession
which have been replaced by the Company with more recently dated prospectuses or
(ii) each Holder will deliver to the Company (at the Company's expense) all
copies, other than permanent file copies then in such Holder's possession, of
the Prospectus covering such Transfer Restricted Securities that was current at
the time of receipt of such notice. In the event the Company shall give any such
notice, the time period regarding the effectiveness of such Registration
Statement set forth in Section 3 or 4 hereof, as applicable, shall be extended
by the number of days during the period from and including the date of the
giving of such notice pursuant to Section 6(c)(iii)(D) hereof to and including
the date when each selling Holder covered by such Registration Statement shall
have received the copies of the supplemented or amended Prospectus contemplated
by Section 6(c)(xvi) hereof or shall have received the Advice; however, no such
extension shall be taken into account in determining whether Liquidated Damages
are due pursuant to Section 5 hereof or the amount of such Liquidated Damages,
it being agreed that the Company's option to suspend use of a Registration
Statement pursuant to this paragraph shall be treated as a Registration Default
for purposes of Section 5.

SECTION 7. REGISTRATION EXPENSES

         All expenses incident to the Company's or the Guarantors' performance
of or compliance with this Agreement will be borne jointly and severally by the
Company or the Guarantors, regardless of whether a Registration Statement
becomes effective, including without limitation: (i) all registration and filing
fees and expenses (including filings made by any Initial Purchaser or Holder
with the NASD (and, if applicable, the fees and expenses of any "qualified
independent underwriter" and its counsel that may be required by the rules and
regulations of the NASD)); (ii) all fees and expenses of compliance with federal
securities and state Blue Sky or securities laws; (iii) all expenses of printing
(including printing certificates for the Exchange Securities to be issued in the
Exchange Offer and printing of Prospectuses), messenger and delivery services
and telephone; (iv) all fees and disbursements of counsel for the Company and
the Guarantors; (v) all application and filing fees in connection with any
listing of the Exchange Securities on a national securities exchange or
automated quotation system pursuant to the requirements thereof; and (vi) all
fees and disbursements of independent certified public accountants of the
Company and the Guarantors (including the expenses of any special audit and
comfort letters required by or incident to such performance).

                                       12
<PAGE>

         The Company will, in any event, bear its and the Guarantors' internal
expenses (including, without limitation, all salaries and expenses of its
officers and employees performing legal or accounting duties), the expenses of
any annual audit and the fees and expenses of any Person, including special
experts, retained by the Company or the Guarantors.

SECTION 8. INDEMNIFICATION

         (a) The Company agrees and the Guarantors, jointly and severally, agree
to indemnify and hold harmless (i) each Holder and (ii) each person, if any, who
controls (within the meaning of Section 15 of the Securities Act or Section 20
of the Exchange Act) any Holder (any of the persons referred to in this clause
(ii) being hereinafter referred to as a "controlling person") and (iii) the
respective officers, directors, partners, employees, representatives and agents
of any Holder or any controlling person (any person referred to in clause (i),
(ii) or (iii) may hereinafter be referred to as an "Indemnified Holder"), to the
fullest extent lawful, from and against any and all losses, claims, damages,
liabilities, judgments, actions and expenses (including without limitation and
as incurred, reimbursement of all reasonable costs of investigating, preparing,
pursuing, settling, compromising, paying or defending any claim or action, or
any investigation or proceeding by any governmental agency or body, commenced or
threatened, including the reasonable fees and expenses of counsel to any
Indemnified Holder), joint or several, directly or indirectly caused by, related
to, based upon, arising out of or in connection with any untrue statement or
alleged untrue statement of a material fact contained in any Registration
Statement or Prospectus (or any amendment or supplement thereto), or any
omission or alleged omission to state therein a material fact required to be
stated therein or necessary to make the statements therein not misleading,
except insofar as such losses, claims, damages, liabilities, judgments, actions
or expenses are caused by an untrue statement or omission or alleged untrue
statement or omission that is made in reliance upon and in conformity with
information relating to any of the Holders furnished in writing to the Company
by any of the Holders expressly for use therein. This indemnity agreement shall
be in addition to any liability which the Company may otherwise have.

         In case any action or proceeding (including any governmental or
regulatory investigation or proceeding) shall be brought or asserted against any
of the Indemnified Holders with respect to which indemnity may be sought against
the Company or the Guarantors, such Indemnified Holder (or the Indemnified
Holder controlled by such controlling person) shall promptly notify the Company
and the Guarantors in writing (provided, that the failure to give such notice
shall not relieve the Company or the Guarantors of their respective obligations
pursuant to this Agreement, except to the extent they are prejudiced as a
proximate result of such failure). Such Indemnified Holder shall have the right
to employ its own counsel in any such action and the fees and expenses of such
counsel shall be paid, as incurred, by the Company and the Guarantors
(regardless of whether it is ultimately determined that an Indemnified Holder is
not entitled to indemnification hereunder); provided that if it is ultimately
determined that such Holder was not entitled to indemnification hereunder, such
fees and expenses shall be promptly reimbursed to the Company and the
Guarantors. The Company and the Guarantors shall not, in connection with any one
such action or proceeding or separate but substantially similar or related
actions or proceedings in the same jurisdiction arising out of the same general
allegations or circumstances, be liable for the reasonable fees and expenses of
more than one separate firm of attorneys (in addition to any local counsel) at
any time for such Indemnified Holders, which firm shall be designated by the
Holders. The Company shall be liable for any settlement of any such action or
proceeding effected with the Company's and the Guarantors' prior written
consent, which consent shall not be withheld unreasonably, and the Company and
the Guarantors agree to indemnify and hold harmless any Indemnified Holder from
and against any loss, claim, damage, liability or expense by reason of any
settlement of any action effected with the written consent of the Company and
the Guarantors. The Company shall not, without the prior written consent of each
Indemnified Holder, settle or compromise or consent to the entry of judgment in
or otherwise seek to terminate any pending or threatened action, claim,
litigation or proceeding in respect of which indemnification or contribution may
be sought hereunder (whether or not any Indemnified Holder is a party thereto),
unless such settlement, compromise, consent or termination includes an
unconditional release of each Indemnified Holder from all liability arising out
of such action, claim, litigation or proceeding.

                                       13
<PAGE>

         (b) Each Holder of Transfer Restricted Securities agrees, severally and
not jointly, to indemnify and hold harmless the Company and the Guarantors and
their respective directors, officers of the Company who sign a Registration
Statement, and any person controlling (within the meaning of Section 15 of the
Securities Act or Section 20 of the Exchange Act) the Company and the
Guarantors, and the respective officers, directors, partners, employees,
representatives and agents of each such person, to the same extent as the
foregoing indemnity from the Company and the Guarantors to each of the
Indemnified Holders, but only with respect to claims and actions based on
information relating to such Holder furnished in writing by such Holder
expressly for use in any Registration Statement, Prospectus or amendment or
supplement thereto. In case any action or proceeding shall be brought against
the Company or the Guarantors or their directors or officers or any such
controlling person in respect of which indemnity may be sought against a Holder
of Transfer Restricted Securities, such Holder shall have the rights and duties
given the Company and the Guarantors, and the Company and the Guarantors, or
their directors or officers or such controlling person shall have the rights and
duties given to each Holder by the preceding paragraph. In no event shall the
liability of any selling Holder hereunder be greater in amount than the dollar
amount of the proceeds received by such Holder upon the sale of the Securities
giving rise to such indemnification obligation.

         (c) If the indemnification provided for in this Section 8 is
unavailable to an indemnified party under Section 8(a) or Section 8(b) hereof
(other than by reason of exceptions provided in those Sections) in respect of
any losses, claims, damages, liabilities, judgments, actions or expenses
referred to therein, then each applicable indemnifying party, in lieu of
indemnifying such indemnified party, shall contribute to the amount paid or
payable by such indemnified party as a result of such losses, claims, damages,
liabilities or expenses in such proportion as is appropriate to reflect the
relative benefits received by the Company and the Guarantors, on the one hand,
and the Holders, on the other hand, from the Initial Placement (which in the
case of the Company and the Guarantors shall be deemed to be equal to the total
gross proceeds from the Initial Placement as set forth on the cover page of the
Offering Memorandum), the amount of Liquidated Damages which did not become
payable as a result of the filing of the Registration Statement resulting in
such losses, claims, damages, liabilities, judgments actions or expenses, and
such Registration Statement, or if such allocation is not permitted by
applicable law, the relative fault of the Company and the Guarantors on the one
hand, and of the Indemnified Holder, on the other hand, in connection with the
statements or omissions which resulted in such losses, claims, damages,
liabilities or expenses, as well as any other relevant equitable considerations.
The relative fault of the Company and the Guarantors on the one hand and of the
Indemnified Holder on the other hand shall be determined by reference to, among
other things, whether the untrue or alleged untrue statement of a material fact
or the omission or alleged omission to state a material fact relates to
information supplied by the Company and or any of the Guarantors on the one
hand, or by the Indemnified Holder on the other hand, and the parties' relative
intent, knowledge, access to information and opportunity to correct or prevent
such statement or omission. The amount paid or payable by a party as a result of
the losses, claims, damages, liabilities and expenses referred to above shall be
deemed to include, subject to the limitations set forth in the second paragraph
of Section 8(a), any legal or other fees or expenses reasonably incurred by such
party in connection with investigating or defending any action or claim.

         The Company, the Guarantor and each Holder of Transfer Restricted
Securities agree that it would not be just and equitable if contribution
pursuant to this Section 8(c) were determined by pro rata allocation (even if
the Holders were treated as one entity for such purpose) or by any other method
of allocation which does not take account of the equitable considerations
referred to in the immediately preceding paragraph. The amount paid or payable
by an indemnified party as a result of the losses, claims, damages, liabilities
or expenses referred to in the immediately preceding paragraph shall be deemed
to include, subject to the limitations set forth above, any legal or other
expenses reasonably incurred by such indemnified party in connection with
investigating or defending any such action or claim. Notwithstanding the
provisions of this Section 8, none of the Holders (and its related Indemnified
Holders) shall be required to contribute, in the aggregate, any amount in excess
of the amount by which the total discount received by such Holder with respect
to the Initial Securities exceeds the amount of any damages which such Holder
has otherwise been required to pay by reason of such untrue or alleged untrue
statement or omission or alleged omission. No person guilty of fraudulent
misrepresentation (within the meaning of Section 11(f) of the Securities Act)
shall

                                       14
<PAGE>

be entitled to contribution from any person who was not guilty of such
fraudulent misrepresentation. The Holders' obligations to contribute pursuant to
this Section 8(c) are several in proportion to the respective principal amount
of Initial Securities held by each of the Holders hereunder and not joint.

SECTION 9. RULE 144A

         The Company and the Guarantors each hereby agrees with each Holder, for
so long as any Transfer Restricted Securities remain outstanding, to make
available to any Holder or beneficial owner of Transfer Restricted Securities in
connection with any sale thereof and any prospective purchaser of such Transfer
Restricted Securities from such Holder or beneficial owner, the information
required by Rule 144A(d)(4) under the Securities Act in order to permit resales
of such Transfer Restricted Securities pursuant to Rule 144A.

SECTION 10. PARTICIPATION IN UNDERWRITTEN REGISTRATIONS

         No Holder may participate in any Underwritten Registration hereunder
unless such Holder (a) agrees to sell such Holder's Transfer Restricted
Securities on the basis provided in any underwriting arrangements approved by
the Persons entitled hereunder to approve such arrangements and (b) completes
and executes all reasonable questionnaires, powers of attorney, indemnities,
underwriting agreements, lock-up letters and other documents required under the
terms of such underwriting arrangements.

SECTION 11. SELECTION OF UNDERWRITERS

         The Holders of Transfer Restricted Securities covered by the Shelf
Registration Statement who desire to do so may sell such Transfer Restricted
Securities in an Underwritten Offering. In any such Underwritten Offering, the
investment banker or investment bankers and manager or managers that will
administer the offering will be selected by the Holders of a majority in
aggregate principal amount of the Transfer Restricted Securities included in
such offering; provided, that such investment bankers and managers must be
reasonably satisfactory to the Company.

SECTION 12. MISCELLANEOUS

         (a) Remedies. The Company and the Guarantors each hereby agree that
monetary damages would not be adequate compensation for any loss incurred by
reason of a breach by it of the provisions of this Agreement and hereby agree to
waive the defense in any action for specific performance that a remedy at law
would be adequate.

         (b) No Inconsistent Agreements. The Company will not, and will cause
the Guarantors not to, on or after the date of this Agreement enter into any
agreement with respect to its securities that is inconsistent with the rights
granted to the Holders in this Agreement or otherwise conflicts with the
provisions hereof. Neither the Company nor the Guarantors have entered into any
agreement granting any registration rights with respect to the Securities to any
Person. The rights granted to the Holders hereunder do not in any way conflict
with and are not inconsistent with the rights granted to the holders of the
Company's or the Guarantors' securities under any agreement in effect on the
date hereof.

         (c) Adjustments Affecting the Securities. The Company will not take any
action, or permit any change to occur, with respect to the Securities that would
materially and adversely affect the ability of the Holders to Consummate any
Exchange Offer.

         (d) Amendments and Waivers. The provisions of this Agreement may not be
amended, modified or supplemented, and waivers or consents to or departures from
the provisions hereof may not be given unless the Company has obtained the
written consent of Holders of a majority of the outstanding principal amount of
Transfer Restricted Securities (excluding Transfer Restricted Securities held by
the Company or its Affiliates).

                                       15

<PAGE>

Notwithstanding the foregoing, a waiver or consent to departure from the
provisions hereof that relates exclusively to the rights of Holders whose
securities are being tendered pursuant to the Exchange Offer and that does not
affect directly or indirectly the rights of other Holders whose securities are
not being tendered pursuant to such Exchange Offer may be given by the Holders
of a majority of the outstanding principal amount of Transfer Restricted
Securities being tendered or registered; provided that, with respect to any
matter that directly or indirectly affects the rights of any Initial Purchaser
hereunder, the Company shall obtain the written consent of each such Initial
Purchaser with respect to which such amendment, qualification, supplement,
waiver, consent or departure is to be effective.

         (e) Notices. All notices and other communications provided for or
permitted hereunder shall be made in writing by hand-delivery, first-class mail
(registered or certified, return receipt requested), telex, telecopier, or air
courier guaranteeing overnight delivery:

             (i) if to a Holder, at the address set forth on the records of the
Registrar under the Indenture, with a copy to the Registrar under the Indenture;
and

             (ii) if to the Company:

                            National Nephrology Associates, Inc.
                            230 Great Circle Road, Suite 218
                            Nashville, Tennessee 37228
                            Facsimile: 615-312-5206
                            Attention: Leif Murphy

                  With a copy to:

                            J.W. Childs Associates, L.P.
                            111 Huntington Avenue
                            Suite 2900
                            Boston, MA 02199
                            Facsimile: (617) 753-1101
                            Attention: Edward D. Yun

                  and to:

                            Kaye Scholer LLP
                            425 Park Avenue
                            New York, NY 10022
                            Facsimile 212-836-8689
                            Attention: Adam H. Golden, Esq.

         All such notices and communications shall be deemed to have been duly
given: at the time delivered by hand, if personally delivered; five business
days after being deposited in the mail, postage prepaid, if mailed; when
answered back, if telexed; when receipt acknowledged, if telecopied; and on the
next business day, if timely delivered to an air courier guaranteeing overnight
delivery.

         Copies of all such notices, demands or other communications shall be
concurrently delivered by the Person giving the same to the Trustee at the
address specified in the Indenture.

         (f) Successors and Assigns. This Agreement shall inure to the benefit
of and be binding upon the successors and assigns of each of the parties,
including without limitation and without the need for an express

                                       16
<PAGE>

assignment, subsequent Holders of Transfer Restricted Securities; provided,
however, that this Agreement shall not inure to the benefit of or be binding
upon a successor or assign of a Holder unless and to the extent such successor
or assign acquired Transfer Restricted Securities from such Holder.

         (g) Counterparts. This Agreement may be executed in any number of
counterparts and by the parties hereto in separate counterparts, each of which
when so executed shall be deemed to be an original and all of which taken
together shall constitute one and the same agreement.

         (h) Headings. The headings in this Agreement are for convenience of
reference only and shall not limit or otherwise affect the meaning hereof.

         (i) GOVERNING LAW. THIS AGREEMENT SHALL BE GOVERNED BY AND CONSTRUED IN
ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK, WITHOUT REGARD TO THE
CONFLICT OF LAW RULES THEREOF.

         (j) Severability. In the event that any one or more of the provisions
contained herein, or the application thereof in any circumstance, is held
invalid, illegal or unenforceable, the validity, legality and enforceability of
any such provision in every other respect and of the remaining provisions
contained herein shall not be affected or impaired thereby.

         (k) Entire Agreement. This Agreement together with the Purchase
Agreement, the Indenture, the Securities and any related documents, is intended
by the parties as a final expression of their agreement and intended to be a
complete and exclusive statement of the agreement and understanding of the
parties hereto in respect of the subject matter contained herein. There are no
restrictions, promises, warranties or undertakings, other than those set forth
or referred to herein with respect to the registration rights granted by the
Company with respect to the Transfer Restricted Securities. This Agreement
supersedes all prior agreements and understandings between the parties with
respect to such subject matter.

                                       17
<PAGE>

         IN WITNESS WHEREOF, the parties have executed this Agreement as of the
date first written above.

                             NATIONAL NEPHROLOGY ASSOCIATES, INC., a Delaware
                                 corporation

                             By:
                                 ---------------------------------------------
                                 Name:  Michael N. Cannizzaro
                                 Title: Chairman and Chief Executive Officer

                             NNA OF OKLAHOMA, INC., a Nevada corporation
                             NNA OF GEORGIA, INC., a Delaware corporation
                             NNA OF ALABAMA, INC., an Alabama corporation
                             NNA MANAGEMENT COMPANY OF KENTUCKY, INC., a
                                 Kentucky corporation
                             NATIONAL NEPHROLOGY ASSOCIATES MANAGEMENT
                                 COMPANY OF TEXAS, INC., a Texas corporation
                             NNA OF NEVADA, INC., a Nevada corporation
                             NATIONAL NEPHROLOGY ASSOCIATES CREDIT CORPORATION,
                                 a Tennessee corporation
                             NNA OF TOLEDO, INC., an Ohio corporation
                             NNA OF RHODE ISLAND, INC., a Rhode Island
                                 corporation
                             NNA TRANSPORTATION SERVICES CORPORATION, a
                                 Tennessee corporation
                             NNA PROPERTIES OF TENNESSEE, INC., a Tennessee
                                 corporation
                             NNA PROPERTIES OF KENTUCKY, INC., a Kentucky
                                 corporation
                             NNA PROPERTIES OF NEW JERSEY, INC., a New Jersey
                                 corporation
                             NNA MANAGEMENT COMPANY OF LOUISIANA, INC., a
                                 Louisiana corporation
                             RENEX CORP., a Florida corporation
                             RENEX MANAGEMENT SERVICES, INC., a Florida
                                 corporation
                             DIALYSIS SERVICES OF ATLANTA, INC., a Georgia
                                 corporation
                             RENEX DIALYSIS CLINIC OF PENN HILLS, INC., a
                                 Pennsylvania corporation
                             RENEX DIALYSIS CLINIC OF SHALER, INC., a
                                 Pennsylvania corporation
                             RENEX DIALYSIS CLINIC OF DOYLESTOWN, INC., a
                                 Pennsylvania corporation
                             RENEX DIALYSIS CLINIC OF AMESBURY, INC., a
                                 Massachusetts corporation
                             RENEX DIALYSIS CLINIC OF NORTH ANDOVER, INC., a
                                 Massachusetts corporation

                                       18
<PAGE>

                             RENEX DIALYSIS CLINIC OF SOUTH GEORGIA, INC., a
                                 Georgia corporation
                             RENEX DIALYSIS CLINIC OF CREVE COUER, INC., a
                                 Missouri corporation
                             RENEX DIALYSIS CLINIC OF ST. LOUIS, INC., a
                                 Missouri corporation
                             RENEX DIALYSIS CLINIC OF BRIDGETON, INC., a
                                 Missouri corporation
                             RENEX DIALYSIS CLINIC OF UNION, INC., a Missouri
                                 corporation
                             RENEX DIALYSIS HOMECARE OF GREATER ST. LOUIS, INC.,
                                 a Missouri corporation
                             RENEX DIALYSIS CLINIC OF MAPLEWOOD, INC., a
                                 Missouri corporation
                             RENEX DIALYSIS CLINIC OF UNIVERSITY CITY, INC., a
                                 Missouri corporation
                             RENEX DIALYSIS FACILITIES, INC., a Mississippi
                                 corporation
                             RENEX DIALYSIS CLINIC OF BLOOMFIELD, INC., a New
                                 Jersey corporation
                             RENEX DIALYSIS CLINIC OF ORANGE, INC., a New Jersey
                                 corporation
                             RENEX DIALYSIS CLINIC OF PHILADELPHIA, INC., a
                                 Pennsylvania corporation
                             RENEX DIALYSIS CLINIC OF PITTSBURGH, INC., a
                                 Pennsylvania corporation
                             RENEX DIALYSIS CLINIC OF WOODBURY, INC., a New
                                 Jersey corporation
                             RENEX DIALYSIS CLINIC OF TAMPA, INC., a Florida
                                 corporation
                             DIALYSIS ASSOCIATES, LLC, a Tennessee limited
                                 liability company
                             By: National Nephrology Associates, Inc., a
                                 Delaware corporation, as sole member
                             DIALYSIS ASSOCIATES MEDICAL SUPPLY, LLC, a
                                 Tennessee limited liability company
                             By: National Nephrology Associates, Inc., a
                                 Delaware corporation, as sole member
                             NNA-SAINT BARNABAS, L.L.C., a New Jersey limited
                                 liability company
                             By: Renex Dialysis Clinic of Woodbury, Inc., a
                                 Delaware corporation, as sole member
                             NNA SAINT BARNABAS - NEWARK, L.L.C., a New Jersey
                                 limited liability company
                             By: NNA - Saint Barnabas, L.L.C., a New Jersey
                                 limited liability company, as sole member
                             NNA OF OKLAHOMA, L.L.C., an Oklahoma limited
                                 liability company
                             By: NNA of Oklahoma, Inc., a Nevada corporation,
                                 as sole member
                             NNA OF LOUISIANA, LLC, a Louisiana limited
                                 liability company
                             By: NNA Management Company of Louisiana, Inc., as
                                 sole member
                             DOYLESTOWN ACUTE RENAL SERVICES, L.L.C., a
                                 Pennsylvania limited liability company

                                       19
<PAGE>

                             By: Renex Dialysis Clinic of Doylestown, Inc., a
                                 Pennsylvania corporation, as sole member
                             NNA OF NEWARK, L.L.C., a New Jersey limited
                                 liability company
                             By: Renex Dialysis Clinic of Woodbury, Inc., a New
                                 Jersey corporation, as sole member
                             NATIONAL NEPHROLOGY ASSOCIATES OF TEXAS, L.P., a
                                 Texas limited partnership
                             By: National Nephrology Associates Management
                                 Company of Texas, Inc., a Texas corporation,
                                 as its general partner

                             By:
                                 ----------------------------------------------
                                 Name:  Michael N. Cannizzaro
                                 Title: Chairman and Chief Executive Officer

                                       20
<PAGE>

The foregoing Registration Rights Agreement is hereby
confirmed and accepted as of the date first above written.

BANC OF AMERICA SECURITIES LLC,
J.P. MORGAN SECURITIES INC.
RBC DOMINION SECURITIES CORPORATION
HARRIS NESBITT CORP.

BY: BANC OF AMERICA SECURITIES LLC

By:
    --------------------------------------------
    Name:     Bruce R. Thompson
    Title:    Managing Director

                                       21
<PAGE>

                                                                      APPENDIX I

                                   GUARANTORS

                NNA of Oklahoma, Inc.
                NNA of Georgia, Inc.
                NNA of Alabama, Inc.
                NNA Management Company of Kentucky, Inc.
                National Nephrology Associates Management Company of Texas,
                Inc.
                NNA of Nevada, Inc.
                National Nephrology Associates Credit Corporation
                NNA of Toledo, Inc.
                NNA of Rhode Island, Inc.
                NNA Transportation Services Corporation
                NNA Properties of Tennessee, Inc.
                NNA Properties of Kentucky, Inc.
                NNA Properties of New Jersey, Inc.
                NNA Management Company of Louisiana, Inc.
                Renex Corp.
                Renex Management Services, Inc.
                Dialysis Services of Atlanta, Inc.
                Renex Dialysis Clinic of Penn Hills, Inc.
                Renex Dialysis Clinic of Shaler, Inc.
                Renex Dialysis Clinic of Doylestown, Inc.
                Renex Dialysis Clinic of Amesbury, Inc.
                Renex Dialysis Clinic of North Andover, Inc.
                Renex Dialysis Clinic of South Georgia, Inc.
                Renex Dialysis Clinic of Creve Coeur, Inc.
                Renex Dialysis Clinic of St. Louis, Inc.
                Renex Dialysis Clinic of Union, Inc.
                Renex Dialysis Clinic of Bridgeton, Inc.
                Renex Dialysis Homecare of Greater St. Louis, Inc.
                Renex Dialysis Clinic of Maplewood, Inc.
                Renex Dialysis Clinic of University City, Inc.
                Renex Dialysis Facilities, Inc.
                Renex Dialysis Clinic of Bloomfield, Inc.
                Renex Dialysis Clinic of Orange, Inc.
                Renex Dialysis Clinic of Philadelphia, Inc.
                Renex Dialysis Clinic of Pittsburgh, Inc.
                Renex Dialysis Clinic of Woodbury, Inc.
                Renex Dialysis Clinic of Tampa, Inc.
                Dialysis Associates, LLC
                Dialysis Associates Medical Supply, LLC
                NNA-Saint Barnabas, L.L.C.
                NNA-Saint Barnabas-Newark, L.L.C.

                                       22
<PAGE>

                NNA of Oklahoma, L.L.C.
                NNA of Louisiana, LLC
                Doylestown Acute Renal Services, L.L.C.
                NNA of Newark, L.L.C.
                National Nephrology Associates of Texas L.P.

                                       23<PAGE>
                                                                     EXHIBIT 4.4

                                                                  EXECUTION COPY

                      National Nephrology Associates, Inc.

                                       and

                           The Guarantors named herein

                                  $160,000,000

                      9% Senior Subordinated Notes due 2011

                               Purchase Agreement

                             dated October 16, 2003

                         Banc of America Securities LLC

                           J.P. Morgan Securities Inc.

                       RBC Dominion Securities Corporation

                              Harris Nesbitt Corp.

<PAGE>

                                Table of Contents

<TABLE>
<S>                                                                                                    <C>
SECTION 1.        Representations and Warranties.........................................................2
   (a)   No Registration Required........................................................................2
   (b)   No Integration of Offerings or General Solicitation.............................................3
   (c)   Eligibility for Resale under Rule 144A..........................................................3
   (d)   The Offering Memorandum and the Preliminary Offering Memorandum.................................3
   (e)   The Purchase Agreement..........................................................................4
   (f)   The Registration Rights Agreement and DTC Agreement.............................................4
   (g)   Authorization of the Securities and the Exchange Securities.....................................4
   (h)   Authorization of the Indenture..................................................................5
   (i)   Description of the Securities and the Indenture.................................................5
   (j)   No Material Adverse Change......................................................................5
   (k)   Independent Accountants.........................................................................6
   (l)   Preparation of the Financial Statements.........................................................6
   (m)   Incorporation and Good Standing of the Company and its Subsidiaries.............................6
   (n)   Capitalization and Other Capital Stock Matters..................................................7
   (o)   Non-Contravention of Existing Instruments; No Further Authorizations or Approvals Required......7
   (p)   No Material Actions or Proceedings..............................................................8
   (q)   Intellectual Property Rights....................................................................9
   (r)   All Necessary Permits, etc......................................................................9
   (s)   Medicare/Medicaid Participation.................................................................9
   (t)   Other Healthcare Regulatory Matters............................................................10
   (u)   Title to Properties............................................................................11
   (v)   Tax Law Compliance.............................................................................12
   (w)   Company Not an "Investment Company"............................................................12
   (x)   Insurance......................................................................................12
   (y)   No Price Stabilization or Manipulation.........................................................12
   (z)   Solvency.......................................................................................12
   (aa)  No Unlawful Contributions or Other Payments....................................................13
   (bb)  MD&A...........................................................................................13
   (cc)  Company's Accounting System....................................................................13
   (dd)  Compliance with Environmental Laws.............................................................14
   (ee)  ERISA Compliance...............................................................................14
   (ff)  Guarantor Subsidiaries.........................................................................15
   (gg)  Credit Agreement...............................................................................15
   (hh)  Compliance with Regulation S...................................................................15
   (ii)  Taxes; Fees....................................................................................15
   (jj)  No Labor Disputes..............................................................................15
   (kk)  Minute Books and Records.......................................................................16
SECTION 2.        Purchase, Sale and Delivery of the Securities.........................................16
   (a)   The Securities.................................................................................16
   (b)   The Closing Date...............................................................................16
   (c)   Delivery of the Securities.....................................................................17
   (d)   Delivery of Offering Memorandum to the Initial Purchasers......................................17
   (e)   Initial Purchasers as Qualified Institutional Buyers...........................................17
SECTION 3.        Additional Covenants..................................................................17
   (a)   Initial Purchasers' Review of Proposed Amendments and Supplements..............................17
   (b)   Additional Information, Amendments and Supplements to the Offering Memorandum and Other
         Securities Act Matters.........................................................................18
</TABLE>

                                       i

<PAGE>
<TABLE>
<S>                                                                                                    <C>
   (c)   Copies of the Offering Memorandum..............................................................18
   (d)   Blue Sky Compliance............................................................................18
   (e)   The Depositary.................................................................................19
   (f)   Additional Issuer Information..................................................................19
   (g)   Agreement Not To Offer or Sell Additional Securities...........................................19
   (h)   No Integration of Offerings or General Solicitation............................................19
   (i)   Legended Securities............................................................................20
   (j)   PORTAL.........................................................................................20
SECTION 4.        Payment of Expenses...................................................................20
SECTION 5.        Conditions of the Obligations of the Initial Purchasers...............................21
   (a)   Accountants' Comfort Letter....................................................................21
   (b)   No Material Adverse Change or Ratings Agency Change............................................21
   (c)   Opinion of Counsel for the Company.............................................................21
   (d)   Credit Agreement Opinion.......................................................................21
   (e)   Opinion of Counsel for the Initial Purchasers..................................................22
   (f)   Officers' Certificate..........................................................................22
   (g)   Chief Financial Officer's Certificate..........................................................22
   (h)   Bring-down Comfort Letter......................................................................22
   (i)   PORTAL Listing.................................................................................22
   (j)   Other Agreements...............................................................................23
   (k)   Credit Agreement...............................................................................23
   (l)   Additional Documents...........................................................................23
SECTION 6.        Reimbursement of Initial Purchasers' Expenses.........................................23
SECTION 7.        Offer, Sale and Resale Procedures.....................................................24
SECTION 8.        Indemnification.......................................................................25
   (a)   Indemnification of the Initial Purchasers......................................................25
   (b)   Indemnification of the Company and their Guarantors and their Directors and Officers...........26
   (c)   Notifications and Other Indemnification Procedures.............................................27
   (d)   Settlements....................................................................................27
SECTION 9.        Contribution..........................................................................28
SECTION 10.       Termination of this Agreement.........................................................29
SECTION 11.       Representations and Indemnities to Survive Delivery...................................29
SECTION 12.       Notices...............................................................................30
SECTION 13.       Successors............................................................................31
SECTION 14.       Partial Unenforceability..............................................................31
SECTION 15.       Governing Law Provisions..............................................................31
   (a)   Consent to Jurisdiction........................................................................31
SECTION 16.       Default of One or More of the Several Initial Purchasers..............................31
SECTION 17.       Tax Disclosure........................................................................32
SECTION 18.       General Provisions....................................................................32

SCHEDULE A -    Initial Purchasers
EXHIBIT A -     List of Subsidiaries
EXHIBIT B-1 -   Form of Opinion of Kaye Scholer LLP
EXHIBIT B-2 -   Form of Opinion of Baker, Donelson, Bearman, Caldwell & Berkowitz
PC ANNEX I -    Resale Pursuant to Regulation S or Rule 144A
</TABLE>

                                       ii
<PAGE>

                               Purchase Agreement

                                                                October 16, 2003

BANC OF AMERICA SECURITIES LLC
J.P. MORGAN SECURITIES INC.
RBC DOMINION SECURITIES CORPORATION
HARRIS NESBITT CORP.

   As Initial Purchasers
c/o BANC OF AMERICA SECURITIES LLC
9 West 57th Street
New York, New York 10019

Ladies and Gentlemen:

         Introductory. National Nephrology Associates, Inc., a Delaware
corporation (the "Company"), proposes to issue and sell to Banc of America
Securities LLC, J.P. Morgan Securities Inc., RBC Dominion Securities Corporation
and Harris Nesbitt Corp. (collectively, the "Initial Purchasers"), acting
severally and not jointly, the respective amounts set forth in Schedule A of a
$160,000,000 aggregate principal amount of the Company's 9% Senior Subordinated
Notes due 2011 (the "Notes").

         The Notes will be issued pursuant to an indenture, to be dated as of
October 22, 2003 (the "Indenture"), among the Company, the Guarantors (as
defined below) and Wells Fargo Bank Minnesota, N.A., as trustee (the "Trustee").
Notes issued in book-entry form will be issued in the name of Cede & Co., as
nominee of The Depository Trust Company (the "Depositary") pursuant to a DTC
letter of representations, to be dated as of the Closing Date (as defined in
Section 2) (the "DTC Agreement"), among the Company, the Guarantors, the Trustee
and the Depositary.

         The holders of the Notes will be entitled to the benefits of a
registration rights agreement, to be dated as of October 22, 2003 (the
"Registration Rights Agreement"), among the Company, the Guarantors and the
Initial Purchasers, pursuant to which the Company and the Guarantors will agree
to file, within 180 days of the Closing Date, a registration statement with the
Commission registering the Exchange Securities (as defined below) under the
Securities Act.

         The payment of principal, premium and Liquidated Damages (as defined in
the Indenture), if any, and interest on the Notes and the Exchange Notes (as
defined below) will be fully and unconditionally guaranteed on a senior
subordinated unsecured basis, jointly and severally by (i) all of the wholly
owned subsidiaries of the Company and (ii) any wholly owned subsidiary of the
Company formed or acquired after the Closing Date or any other subsidiary that
executes an additional guarantee in accordance with the terms of the Indenture,
and their respective successors and assigns (collectively, the "Guarantors"),
pursuant to their guarantees (the "Guarantees"). The Notes and the Guarantees
attached thereto are herein collectively referred to as the "Securities"; and
the Exchange Notes and the Guarantees attached thereto are herein collectively
referred to as the "Exchange Securities."

<PAGE>

         At or prior to the Closing Date, the Company will enter into a new
senior secured credit facility, consisting of a $75 million five-year revolving
credit facility, with a syndicate of lenders led by Bank of America, N.A.,
substantially as described in the Offering Memorandum and as set forth in a
credit agreement, to be dated as of the Closing Date, between the Company, the
Guarantors, Bank of America, N.A. as administrative agent, L/C issuer and swing
line lender, the lender parties named therein and Banc of America Securities LLC
as sole lead arranger and sole book manager, together with any collateral and
other ancillary documents related thereto (the "Credit Agreement"). As more
specifically provided for in the Credit Agreement, it is a condition to the
closing of the Credit Agreement that the Company shall have received at least
$160 million in gross cash proceeds from the issuance and sale of the
Securities. The Company will use the net proceeds from the issuance and sale of
the Securities, along with borrowing under the Credit Agreement, to, among other
things, repay borrowings under the Company's existing credit facility.

         The Company and the Guarantors understand that the Initial Purchasers
propose to make an offering of the Securities on the terms and in the manner set
forth herein and in the Offering Memorandum (as defined below) and agree that
the Initial Purchasers may resell, subject to the conditions set forth herein,
all or a portion of the Securities to purchasers (the "Subsequent Purchasers")
at any time after the date of this Agreement. The Securities are to be offered
and sold to or through the Initial Purchasers without being registered with the
Securities and Exchange Commission (the "Commission") under the Securities Act
of 1933, as amended (the "Securities Act," which term, as used herein, includes
the rules and regulations of the Commission promulgated thereunder), in reliance
upon exemptions therefrom. The terms of the Securities and the Indenture will
require that investors who acquire Securities expressly agree that Securities
may only be resold or otherwise transferred, after the date hereof, if such
Securities are registered for sale under the Securities Act or if an exemption
from the registration requirements of the Securities Act is available (including
the exemptions afforded by Rule 144A ("Rule 144A") or Regulation S ("Regulation
S") thereunder).

         The Company and the Guarantors have prepared and delivered to each
Initial Purchaser copies of a Preliminary Offering Memorandum, dated October 6,
2003 (the "Preliminary Offering Memorandum"), and have prepared and will deliver
to each Initial Purchaser, copies of the Offering Memorandum, dated October 16,
2003, describing the terms of the Securities, each for use by such Initial
Purchaser in connection with its solicitation of offers to purchase the
Securities. As used herein, the "Offering Memorandum" shall mean, with respect
to any date or time referred to in this Agreement, the Company's Offering
Memorandum, dated October 16, 2003, including amendments or supplements thereto
and any exhibits thereto, in the most recent form that has been prepared and
delivered by the Company and the Guarantors to the Initial Purchasers in
connection with their solicitation of offers to purchase Securities.

         The Company and the Guarantors hereby confirm their respective
agreements with the Initial Purchasers as follows:

SECTION 1. Representations and Warranties. Each of the Company and the
Guarantors, jointly and severally, hereby represents, warrants and covenants to
each Initial Purchaser as follows:

         (a) No Registration Required. Subject to compliance by the Initial
         Purchasers with the representations and warranties set forth in Section
         2 hereof and with the procedures set forth in Section 7 hereof, it is
         not

                                       2
<PAGE>

         necessary in connection with the issuance and sale of the Securities to
         the Initial Purchasers and the offer, sale and delivery of the
         Securities to each Subsequent Purchaser in the manner contemplated by
         this Agreement and the Offering Memorandum to register the Securities
         under the Securities Act or, until such time as the Exchange Securities
         are issued pursuant to an effective registration statement, to qualify
         the Indenture under the Trust Indenture Act of 1939 (the "Trust
         Indenture Act," which term, as used herein, includes the rules and
         regulations of the Commission promulgated thereunder).

         (b) No Integration of Offerings or General Solicitation. The Company
         has not, and none of the Company's subsidiaries or Affiliates (as such
         term is defined in Rule 501 under the Securities Act (each, an
         "Affiliate")) have, directly or indirectly, solicited any offer to buy
         or offered to sell, and will not, directly or indirectly, solicit any
         offer to buy or offer to sell, in the United States or to any United
         States citizen or resident, any security which is or would be
         integrated with the sale of the Securities in a manner that would
         require the Securities to be registered under the Securities Act. None
         of the Company, the Guarantors, any of their subsidiaries or
         Affiliates, or any person acting on its or any of their behalf (other
         than the Initial Purchasers, as to whom the Company and the Guarantors
         make no representation, warranty or covenant) has engaged or will
         engage, in connection with the offering of the Securities, in any form
         of general solicitation or general advertising within the meaning of
         Rule 502 under the Securities Act. With respect to those Securities
         sold in reliance upon Regulation S, (i) none of the Company, the
         Guarantors, any of their subsidiaries or Affiliates or any person
         acting on its or any of their behalf (other than the Initial
         Purchasers, as to whom the Company and the Guarantors make no
         representation, warranty or covenant) has engaged or will engage in any
         directed selling efforts within the meaning of Regulation S and (ii)
         each of the Company, the Guarantors, any of their subsidiaries or
         Affiliates and any person acting on its or their behalf (other than the
         Initial Purchasers, as to whom the Company and the Guarantors make no
         representation, warranty or covenant) has complied and will comply with
         the offering restrictions set forth in Regulation S.

         (c) Eligibility for Resale under Rule 144A. The Securities are eligible
         for resale pursuant to Rule 144A and will not be, at the Closing Date,
         of the same class as securities listed on a national securities
         exchange registered under Section 6 of the Exchange Act or quoted in a
         U.S. automated interdealer quotation system.

         (d) The Offering Memorandum and the Preliminary Offering Memorandum.
         Each of the Offering Memorandum and Preliminary Offering Memorandum
         does not, and at the Closing Date the Offering Memorandum will not,
         include an untrue statement of a material fact or omit to state a
         material fact necessary in order to make the statements therein, in the
         light of the circumstances under which they were made, not misleading;
         provided that this representation, warranty and agreement shall not
         apply to statements in or omissions from the Offering Memorandum made
         in reliance upon and in conformity with information furnished to the
         Company or any Guarantor in writing by the Initial Purchasers expressly
         for use in the Offering Memorandum. Each of the Preliminary Offering
         Memorandum and the Offering Memorandum, as of its date, contains all
         the information specified in, and meeting the requirements of, Rule
         144A. Neither the

                                       3
<PAGE>

         Company nor any of the Guarantors have distributed, and the Company and
         the Guarantors will not distribute, prior to the later of the Closing
         Date and the completion of the Initial Purchasers' distribution of the
         Securities, any offering material in connection with the offering and
         sale of the Securities other than the Preliminary Offering Memorandum
         or the Offering Memorandum.

         (e) The Purchase Agreement. This Agreement has been duly authorized,
         executed and delivered by, and is a valid and binding agreement of, the
         Company and each of the Guarantors, enforceable in accordance with its
         terms, except as rights to indemnification and contribution hereunder
         may be limited by applicable law or against public policy and subject
         to bankruptcy, insolvency, fraudulent conveyance, reorganization,
         moratorium or other laws of general applicability relating to or
         affecting the rights and remedies of creditors or by general principles
         of equity (whether considered in a proceeding at law or in equity).

         (f) The Registration Rights Agreement and DTC Agreement. The
         Registration Rights Agreement has been duly authorized by the Company
         and each of the Guarantors and, at the Closing Date, will be duly
         executed and delivered by, and will be a valid and binding agreement
         of, the Company and each of the Guarantors, enforceable in accordance
         with its terms, except as rights to indemnification and contribution
         thereunder may be limited by applicable law or against public policy
         and subject to bankruptcy, insolvency, fraudulent conveyance,
         reorganization, moratorium or other laws of general applicability
         relating to or affecting the rights and remedies of creditors or by
         general principles of equity (whether considered in a proceeding at law
         or in equity). At the Closing Date, the DTC Agreement will be duly
         authorized, executed and delivered by, and will be a valid and binding
         agreement of, the Company, enforceable in accordance with its terms,
         subject to bankruptcy, insolvency, fraudulent conveyance,
         reorganization, moratorium or other laws of general applicability
         relating to or affecting the rights and remedies of creditors or by
         general principles of equity (whether considered in a proceeding at law
         or in equity). Pursuant to the Registration Rights Agreement, the
         Company and the Guarantors each will agree to file with the Commission,
         under the circumstances set forth therein, (i) a registration statement
         under the Securities Act relating to another series of debt securities
         of the Company with terms substantially identical to the Notes (the
         "Exchange Notes") to be offered in exchange for the Notes (the
         "Exchange Offer") and (ii) to the extent required by the Registration
         Rights Agreement, a shelf registration statement pursuant to Rule 415
         of the Securities Act relating to the resale by certain holders of the
         Notes, and in each case, to use its reasonable best efforts to cause
         such registration statements to be declared effective.

         (g) Authorization of the Securities and the Exchange Securities. (i)
         The Notes to be purchased by the Initial Purchasers from the Company
         are in the form contemplated by the Indenture, have been duly
         authorized for issuance and sale pursuant to this Agreement and the
         Indenture and, at the Closing Date, will have been duly executed by the
         Company and, when authenticated in the manner provided for in the
         Indenture and delivered against payment of the purchase price therefor,
         will constitute valid and binding obligations of the Company,
         enforceable in accordance with their terms, subject to bankruptcy,
         insolvency, fraudulent conveyance, reorganization, moratorium or other
         laws of general applicability relating to or affecting the rights and
         remedies of creditors or by general principles of equity (whether
         considered in a

                                       4

<PAGE>

         proceeding at law or in equity) and will be entitled to the benefits of
         the Indenture. (ii) The Exchange Notes have been duly and validly
         authorized for issuance by the Company, and when issued and
         authenticated in accordance with the terms of the Indenture, the
         Registration Rights Agreement and the Exchange Offer, will constitute
         valid and binding obligations of the Company, enforceable against the
         Company in accordance with their terms, subject to bankruptcy,
         insolvency, fraudulent conveyance, reorganization, moratorium or other
         laws of general applicability relating to or affecting the rights and
         remedies of creditors or by general principles of equity (whether
         considered in a proceeding at law or in equity) and will be entitled to
         the benefits of the Indenture. (iii) The Guarantees of the Notes are in
         the form contemplated by the Indenture, have been duly authorized for
         issuance and sale pursuant to this Agreement and the Indenture and, at
         the Closing Date, will have been duly executed by each of the
         Guarantors and, when the Notes have been authenticated in the manner
         provided for in the Indenture and delivered against payment of the
         purchase price therefor, will constitute valid and binding agreements
         of the Guarantors, enforceable in accordance with their terms, subject
         to bankruptcy, insolvency, fraudulent conveyance, reorganization,
         moratorium or other laws of general applicability relating to or
         affecting the rights and remedies of creditors or by general principles
         of equity (whether considered in a proceeding at law or in equity) and
         will be entitled to the benefits of the Indenture. (iv) The Guarantees
         of the Exchange Notes will be in the form contemplated by the
         Indenture, will have been duly authorized for issuance and sale
         pursuant to the Indenture and when issued and authenticated in
         accordance with the terms of the Indenture, will constitute valid and
         binding agreements of the Guarantors, enforceable in accordance with
         their terms, subject to bankruptcy, insolvency, fraudulent conveyance,
         reorganization, moratorium or other laws of general applicability
         relating to or affecting the rights and remedies of creditors or by
         general principles of equity (whether considered in a proceeding at law
         or in equity) and will be entitled to the benefits of the Indenture.

         (h) Authorization of the Indenture. The Indenture has been duly
         authorized by the Company and each of the Guarantors and, at the
         Closing Date, will have been duly executed and delivered by the Company
         and each of the Guarantors and will constitute a valid and binding
         agreement of the Company and each of the Guarantors, enforceable
         against the Company and each of the Guarantors in accordance with its
         terms, except as the enforcement thereof may be limited by bankruptcy,
         insolvency, fraudulent conveyance, reorganization, moratorium or other
         similar laws relating to or affecting the rights and remedies of
         creditors or by general equitable principles (whether considered in a
         proceeding at law or in equity).

         (i) Description of the Securities and the Indenture. The Notes, the
         Guarantees of the Notes and the Indenture conform, or will conform, in
         all material respects to the respective statements relating thereto
         contained in the Offering Memorandum. The Exchange Notes and the
         Guarantees of the Exchange Notes will conform in all material respects
         to the respective statements relating thereto contained in the Offering
         Memorandum and the registration statement relating to the Exchange
         Securities at the time such registration statement becomes effective.

         (j) No Material Adverse Change. Except as otherwise disclosed in the
         Offering Memorandum, subsequent to the

                                       5
<PAGE>

         respective dates as of which information is given in the Offering
         Memorandum: (i) there has been no material adverse change in the
         condition, financial or otherwise, or in the earnings, business,
         operations or prospects, whether or not arising from transactions in
         the ordinary course of business, of the Company and its subsidiaries,
         considered as one entity (any such change is called a "Material Adverse
         Change"); (ii) the Company and its subsidiaries, considered as one
         entity, have not incurred any material liability or obligation (in any
         such case, other than with respect to any fees payable in connection
         with the offering of the Securities), indirect, direct or contingent,
         not in the ordinary course of business nor entered into any material
         transaction or agreement not in the ordinary course of business; and
         (iii) except for the accrual of dividends on the Company's Series C
         Preferred Stock, there has been no dividend or distribution of any kind
         declared, paid or made by the Company or, except for dividends paid to
         the Company or other subsidiaries, any of its subsidiaries on any class
         of capital stock or repurchase or redemption by the Company or any of
         its subsidiaries of any class of capital stock.

         (k) Independent Accountants. KPMG LLP, who have expressed their opinion
         with respect to the financial statements (which term as used in this
         Agreement includes the related notes thereto) included in the Offering
         Memorandum, are independent public or certified public accountants
         within the meaning of Regulation S-X under the Securities Act and the
         Exchange Act.

         (l) Preparation of the Financial Statements. The financial statements,
         together with the related schedules and notes, included in the Offering
         Memorandum present fairly, in all material respects, the consolidated
         financial position of the Company and its subsidiaries as of and at the
         dates indicated and the results of their operations and cash flows for
         the periods specified, subject, in the case of interim financial
         statements, to year-end adjustments. Such financial statements have
         been prepared in conformity with generally accepted accounting
         principles as applied in the United States of America, applied on a
         consistent basis throughout the periods involved, except as may be
         expressly stated in the related notes thereto. The financial statements
         included in the Offering Memorandum comply as to form with the
         requirements applicable to registration statements on Form S-1 under
         the Securities Act. The financial data set forth in the Offering
         Memorandum under the captions "Offering Memorandum Summary--Summary
         Financial Data" and "Selected Consolidated Financial Data" present
         fairly the historical financial information set forth therein on a
         basis consistent with that of the audited and unaudited financial
         statements contained in the Offering Memorandum. No pro forma financial
         statements would be required by Regulation S-X under the Securities Act
         to be included in the Offering Memorandum if the Offering Memorandum
         were a registration statement on Form S-1 under the Securities Act.

         (m) Incorporation and Good Standing of the Company and its
         Subsidiaries. Each of the Company and its subsidiaries has been duly
         incorporated or formed and is validly existing as a corporation,
         partnership or limited liability company in good standing under the
         laws of the jurisdiction of its incorporation or formation and has
         corporate power and authority to own, lease and operate its properties
         and to conduct its business as described in the Offering Memorandum
         and, in the case of the Company and

                                       6
<PAGE>

         the Guarantors, to enter into and perform its obligations under each of
         this Agreement, the Registration Rights Agreement, the DTC Agreement,
         the Securities, the Exchange Securities, the Indenture and the Credit
         Agreement to which it is a party. Each of the Company and each
         subsidiary is duly qualified as a foreign corporation, partnership or
         limited liability company, as applicable, to transact business and is
         in good standing in each jurisdiction in which such qualification is
         required, whether by reason of the ownership or leasing of property or
         the conduct of business, except for such jurisdictions where the
         failure to so qualify or to be in good standing would not, individually
         or in the aggregate, result in a Material Adverse Change.

         (n) Capitalization and Other Capital Stock Matters. At June 30, 2003,
         on a consolidated basis, after giving pro forma effect to the issuance
         and sale of the Securities pursuant hereto, the application of the net
         proceeds therefrom and the closing of the Credit Agreement, the Company
         would have an authorized and outstanding capitalization as set forth in
         the Offering Memorandum under the caption "Capitalization" (other than
         for subsequent issuances of capital stock, if any, pursuant to employee
         benefit plans described in the Offering Memorandum or upon exercise or
         conversion of outstanding options or convertible securities described
         in the Offering Memorandum). All of the outstanding shares of capital
         stock of the Company have been duly authorized and validly issued, are
         fully paid and nonassessable and have been issued in compliance with
         federal and state securities laws. None of the outstanding shares of
         Common Stock were issued in violation of any preemptive rights, rights
         of first refusal or other similar rights to subscribe for or purchase
         securities of the Company. There are no authorized or outstanding debt
         securities convertible into or exchangeable or exercisable for any
         capital stock of the Company or any of its subsidiaries other than
         those accurately described in the Offering Memorandum. The description
         of the Company's stock option plan, and the options or other rights
         granted thereunder, set forth in the Offering Memorandum accurately and
         fairly describes such plans. All of the issued and outstanding capital
         stock or limited liability company interests of each subsidiary has
         been duly authorized and validly issued, is fully paid and
         nonassessable and, to the extent owned by the Company, directly or
         through subsidiaries, free and clear of any security interest,
         mortgage, pledge, lien, encumbrance or claim. The Company does not own
         or control, directly or indirectly, any corporation, association or
         other entity other than the subsidiaries listed in Exhibit A hereto.

         (o) Non-Contravention of Existing Instruments; No Further
         Authorizations or Approvals Required. Neither the Company nor any of
         its subsidiaries is in violation of its charter or by-laws or is in
         default (or, with the giving of notice or lapse of time, would be in
         default) ("Default") under any indenture, mortgage, loan or credit
         agreement, note, contract, franchise, lease, license or other
         instrument to which the Company or any of its subsidiaries is a party
         or by which it or any of them may be bound or to which any of the
         property or assets of the Company or any of its subsidiaries is subject
         (each, an "Existing Instrument"), except for such Defaults as would
         not, individually or in the aggregate, result in a Material Adverse
         Change and except for Defaults that have been waived or suspended in
         writing and disclosed in the Offering Memorandum. The execution,
         delivery and performance of this Agreement, the Registration Rights
         Agreement, the Credit Agreement and the Indenture by the Company and
         each Guarantor party thereto, the Company's execution, delivery and
         performance of the DTC Agreement and the issuance and delivery of the
         Securities or the Exchange Securities, and consummation of

                                       7
<PAGE>

         the transactions contemplated hereby and thereby and by the Offering
         Memorandum (i) will not result in any violation of the provisions of
         the charter, by-laws, partnership agreement, operating agreement or
         other similar constitutive document of the Company or any subsidiary,
         (ii) will not conflict with or constitute a breach of, or Default or a
         Debt Repayment Triggering Event (as defined below) under, or result in
         the creation or imposition of any lien, charge or encumbrance upon any
         property or assets of the Company or any of its subsidiaries pursuant
         to, or require the consent of any other party to, any Existing
         Instrument, except for such conflicts, breaches, Defaults, liens,
         charges or encumbrances as would not, individually or in the aggregate,
         result in a Material Adverse Change, and (iii) will not result in any
         violation of any law, administrative regulation or administrative or
         court decree applicable to the Company or any subsidiary. No consent,
         approval, authorization or other order of, or registration or filing
         with, any court or other governmental or regulatory authority or
         agency, is required for the Company's or any Guarantor's execution,
         delivery and performance of this Agreement, the Registration Rights
         Agreement, the DTC Agreement, the Credit Agreement or the Indenture, to
         which it is a party, or the issuance and delivery of the Securities or
         the Exchange Securities, or consummation of the transactions
         contemplated hereby and thereby and by the Offering Memorandum, except
         such as have been obtained or made by the Company or the Guarantors and
         are in full force and effect under the Securities Act, applicable state
         securities or blue sky laws and except such as may be required by
         federal and state securities laws with respect to the Company's and the
         Guarantors' obligations under the Registration Rights Agreement and
         issuance of the Exchange Securities and the Guarantees thereof. As used
         herein, a "Debt Repayment Triggering Event" means any event or
         condition which gives, or with the giving of notice or lapse of time
         would give, the holder of any note, debenture or other evidence of
         indebtedness (or any person acting on such holder's behalf) the right
         to require the repurchase, redemption or repayment of all or a portion
         of such indebtedness by the Company or any of its subsidiaries.

         (p) No Material Actions or Proceedings. Except as otherwise disclosed
         in the Offering Memorandum, to the Company's or any Guarantor's
         knowledge, there are no legal or governmental actions, suits,
         investigations or proceedings pending or threatened against or
         affecting the Company or any of its subsidiaries, or the officers,
         directors, employees or agents (as defined in 42 C.F.R. Part 420
         Subpart C and 42 C.F.R. Section 1001.1001(a)(2)) of the Company or any
         of its subsidiaries, which has as the subject thereof any property
         owned or leased by, the Company or any of its subsidiaries, where in
         any such case there is a reasonable possibility that such action, suit
         or proceeding might be determined adversely to the Company or such
         subsidiary and any such action, suit, investigation or proceeding, if
         so determined adversely, would reasonably be expected to result in a
         Material Adverse Change or materially and adversely affect the
         consummation of the transactions contemplated by this Agreement,
         including, without limitation, any such action, suit, investigation or
         proceeding pursuant to federal or state laws or regulations (i)
         prohibiting the payment or receipt of remuneration for patient
         referrals, (ii) prohibiting the filing of false claims, (iii)
         prescribing conditions of participation for certification by the
         Medicare and Medicaid programs and any other federal or state
         healthcare program or (iv) providing for coverage and reimbursement
         under Medicare, Medicaid and any other federal or state healthcare
         program.

                                       8
<PAGE>

         (q) Intellectual Property Rights. The Company and its subsidiaries own,
         possess or license sufficient trademarks, trade names, patent rights,
         copyrights, licenses, approvals, trade secrets and other similar rights
         (collectively, "Intellectual Property Rights") reasonably necessary to
         conduct their businesses as now conducted; and the expected expiration
         of any of such Intellectual Property Rights would not result in a
         Material Adverse Change. Neither the Company nor any of its
         subsidiaries has received any notice of infringement or conflict with
         asserted Intellectual Property Rights of others, which infringement or
         conflict, if the subject of an unfavorable decision, ruling or filing
         would result in a Material Adverse Change. Neither the Company nor any
         of its subsidiaries is in default under the terms of any license or
         similar agreement related to any Intellectual Property Rights necessary
         to conduct their business as now conducted or contemplated except as
         would not result in a Material Adverse Change.

         (r) All Necessary Permits, etc. The Company and each subsidiary possess
         such valid and current certificates, authorizations, qualifications,
         licenses, permits, consents or approvals (including certificates of
         need, licenses, pharmacy licenses, Medicare and Medicaid provider
         agreements, accreditations and other similar documentation, or
         approvals of any local health departments) issued by the appropriate
         municipal, state, federal or foreign regulatory agencies or bodies
         necessary to conduct their respective businesses as now conducted
         except as would not result in a Material Adverse Change, and neither
         the Company nor any subsidiary has received any notice of proceedings
         relating to the revocation or modification of, or non-compliance with,
         any such certificate, authorization or permit which, individually or in
         the aggregate, if the subject of an unfavorable decision, ruling or
         finding, would not reasonably be expected to result in a Material
         Adverse Change.

         (s) Medicare/Medicaid Participation. To the knowledge of the Company
         and each subsidiary, none of the Company, any of its subsidiaries, any
         existing or designated officers or directors of the Company or the
         respective subsidiary, any agent (as defined in 42 C.F.R. Section
         1001.1001(a)(2)) acting on behalf of the Company, or managing employee
         (as defined in SSA Section 1126(b) or any regulations promulgated
         thereunder) acting on behalf of the Company: (1) has had a material
         civil monetary penalty assessed against it under Section 1128A of the
         SSA or any regulations promulgated thereunder; (2) has been excluded
         from participation under the Medicare program or a federal or state
         healthcare program; or (3) has been convicted (as that term in defined
         in 42 C.F.R. Section 1001.2) of any of the following categories of
         offenses as described in SSA Section 1128(a) and (b)(1), (2), (3) or
         any regulations promulgated thereunder: (i) criminal offenses relating
         to the delivery of an item or service under Medicare or any federal or
         state healthcare program; (ii) criminal offenses under federal or state
         law relating to patient neglect or abuse in connection with the
         delivery of a healthcare item or service; criminal offenses under
         federal or state law relating to fraud, theft, embezzlement, breach of
         fiduciary responsibility, or other financial misconduct in connection
         with the delivery of a healthcare item or service or with respect to
         any act or omission in a program operated by or financed in whole or in
         part by any federal, state or local governmental agency; (iii) federal
         or state laws relating to the interference with or obstruction of any
         investigation into any criminal offense described above in this
         paragraph; or (iv) criminal offenses under federal or state law
         relating to the unlawful manufacture, distribution, prescription or
         dispensing of a controlled substance. The Company, a subsidiary, or an
         entity owned in whole or in part

                                       9

<PAGE>

         by the Company or a subsidiary has a Medicare provider number, and
         materially meets all applicable Medicare conditions of participation,
         in each locale, as applicable, in which the Company, such subsidiary or
         such entity bills directly to Medicare for services furnished by the
         Company, such subsidiary or such entity. The Company, a subsidiary, or
         an entity owned in whole or in part by the Company or a subsidiary has
         a Medicaid provider number, and a participating provider agreement, and
         materially satisfies all applicable Medicaid conditions of coverage, in
         each state, as applicable, in which the Company, such subsidiary, or
         such other entity bills directly to such state's Medicaid agency for
         services provided by the Company, such subsidiary, or such other entity
         for Medicaid patients.

                  The Company, the Guarantors and their officers and directors,
         and persons who provide professional services under agreements with the
         Company and the employees of the subsidiaries of the Company have not,
         on behalf of the Company, knowingly and willfully, except where,
         individually or in the aggregate, it would not reasonably be expected
         to result in a Material Adverse Change: (i) made or caused to be made a
         false statement or representation of a material fact in any application
         for any benefit or payment; (ii) made or caused to be made any false
         statement or representation of a material fact for use in determining
         rights to any benefit or payment; (iii) presented or caused to be
         presented a claim for reimbursement under Medicare, Medicaid or other
         federal or state healthcare program that is (A) for an item or service
         that the person presenting or causing to be presented knows or should
         know was not provided as claimed, or (B) for an item or service and the
         person presenting knows or should know that the claim is false or
         fraudulent; (iv) failed to disclose knowledge of the occurrence of any
         event affecting the initial or continued right of a claimant to any
         benefit or payment on its own behalf or on behalf of another, with
         intent to fraudulently secure such benefit or payment in a greater
         amount or quantity than is due or when no such benefit or payment is
         authorized if such event results in an improper benefit to the Company;
         or (v) made or caused to be made or induced or sought to induce the
         making of any false statement or representation (or knowingly and
         willfully omitted to state a fact required to be stated therein or
         necessary to make the statements contained therein not misleading) of a
         material fact with respect to (a) the conditions or operations of a
         facility in order that the facility may qualify for Medicare, Medicaid
         or other federal or state healthcare program certification, or (b)
         information required to be provided under Section 1124A of the Social
         Security Act (42 U.S.C. Section 1320a-3a).

                  To the knowledge of the Company and the Guarantors, there are
         no Medicare or Medicaid recoupment or recoupments of any other
         third-party payor being sought, threatened, requested or claimed
         against the Company or any Subsidiary that could reasonably be expected
         to result in a Material Adverse Change.

         (t) Other Healthcare Regulatory Matters. To the knowledge of the
         Company and each Guarantor, except as otherwise described in the
         Offering Memorandum, none of (i) the Company, any of its subsidiaries,
         or the officers, directors, employees, or agents (as defined in 42
         C.F.R. Part 420 Subpart C and 42 C.F.R. Section 1001.1001(a)(2)) of the
         Company or any of its subsidiaries, or (ii) any entity which the
         Company or any of its subsidiaries manages ("Managed Entity") has (and
         with respect to the officers, directors, agents and employees of the
         Company or any of its subsidiaries or any employee of any Managed
         Entity as described above, only as to any activity during their
         employment or association with the Company, any subsidiary of the
         Company or any Managed Entity) (A) been charged with, or has been or is
         being

                                       10

<PAGE>

         investigated with respect to, any activity that materially contravenes
         or could materially contravene or constitutes or could constitute a
         material violation of any Healthcare Law (defined below), or (B)
         knowingly and willfully engaged in any activity that materially
         contravenes or constitutes a material violation of any Healthcare Law
         during their employment or association with the Company, any
         subsidiary, or any Managed Entity, which could reasonably be expected
         to result in a Material Adverse Change. To the knowledge of the Company
         and each Guarantor, no person who has a direct or indirect ownership
         interest of 5% or more (as those terms are defined in 42 C.F.R. Part
         420 Subpart C and 42 C.F.R. Section 1001.1001(a)(2)) in the Company or
         any subsidiary, has been charged with, or has been or is being
         investigated with respect to, any activity involving the Company or any
         subsidiary that materially contravenes or could materially contravene
         or constitutes or could constitute a material violation of any
         Healthcare Law except as described in the Offering Memorandum. To the
         knowledge of the Company and each Guarantor and except as described in
         the Offering Memorandum, none of the officers, directors and agents of
         any Managed Entity has been charged with, or has (A) been or is being
         investigated with respect to, any activity during their employment or
         association with any Managed Entity that materially contravenes or
         could materially contravene or constitutes or could constitute a
         material violation of any Healthcare Law, or (B) engaged in any
         activity during their employment or association with the Company, any
         subsidiary or any Managed Entity that materially contravenes or
         constitutes a material violation of any Healthcare Law. To the
         knowledge of the Company and each Guarantor and except as described in
         the Offering Memorandum, no person who has a direct or indirect
         ownership interest of 5% or more (as those terms are defined in 42
         C.F.R. Part 420 Subpart C and 42 C.F.R. Section 1001.1001(a)(2)) in a
         Managed Entity has been charged with, or has been or is being
         investigated with respect to, any activity in connection with the
         Managed Entity that materially contravenes or could materially
         contravene or constitutes or could constitute a material violation of
         any Healthcare Law. "Healthcare Law" means the following laws or
         regulations relating to the regulation of the healthcare industry or to
         payment for services rendered by healthcare providers: (i) Sections
         1877, 1128, 1128A or 1128B of the Social Security Act ("SSA"); (ii) any
         prohibition on the making of any false statement or misrepresentation
         of material facts to any governmental agency that administers a federal
         or state healthcare program (including, but not limited to, Medicare,
         Medicaid, and the federal Civilian Health and Medical Plan of the
         Uniformed Services); (iii) the licensure, certification or registration
         requirements of healthcare facilities, services or equipment; (iv) any
         state certificate of need or similar law governing the establishment of
         healthcare facilities or services or the making of healthcare capital
         expenditures; (v) any state law relating to fee-splitting or the
         corporate practice of medicine; (vi) any state physician self-referral
         prohibition or state anti-kickback law; (vii) any criminal offense
         relating to the delivery of, or claim for payment for, a healthcare
         item or service under any federal or state healthcare program; (viii)
         any federal or state law relating to the interference with or
         obstruction of any investigation into any criminal offense; and (ix)
         any criminal offense under federal or state law relating to the
         unlawful distribution, prescription or dispensing of a controlled
         substance.

         (u) Title to Properties. The Company and each of its subsidiaries has
         good and marketable title to all the properties and assets reflected as
         owned in the financial statements referred to in Section 1(l) above (or
         elsewhere in the Offering Memorandum), in each case free and clear of
         any security interests, mortgages, liens, encumbrances, equities,
         claims and other defects, except as would not reasonably expected to
         result in a Material Adverse Change.

                                       11
<PAGE>

         The real property, improvements, equipment and personal property held
         under lease by the Company or any subsidiary are held under valid and
         enforceable leases, with such exceptions as would not reasonably be
         expected to result in a Material Adverse Change.

         (v) Tax Law Compliance. The Company and its subsidiaries have filed all
         material federal, state and foreign income and franchise tax returns
         required to have been filed and have paid all taxes shown on such
         returns as due and payable and, if due and payable, any related or
         similar assessment, fine or penalty levied against any of them. The
         Company and each Guarantor have made adequate charges, accruals and
         reserves in accordance with generally accepted accounting principles
         applied in the United States in the applicable financial statements
         referred to in Section 1(l) above in respect of all federal, state and
         foreign income and franchise taxes for all periods as to which the tax
         liability of the Company or any of its subsidiaries has not been
         finally determined except when such failure would not reasonably be
         expected to result in a Material Adverse Change.

         (w) Company Not an "Investment Company". The Company has been advised
         of the rules and requirements under the Investment Company Act of 1940,
         as amended (the "Investment Company Act"). The Company is not, and
         after receipt of payment for the Securities will not be, an "investment
         company" within the meaning of Investment Company Act and will conduct
         its business in a manner so that it will not become subject to the
         Investment Company Act.

         (x) Insurance. Each of the Company and its subsidiaries are insured by
         recognized, financially sound institutions (or are self-insured at
         prudent levels) with policies in such amounts and with such deductibles
         and policy limits and covering such risks as are generally deemed
         adequate and customary for their businesses including, but not limited
         to, policies covering professional liability and malpractice. The
         Company has no reason to believe that it or any subsidiary will not be
         able (i) to renew its existing insurance coverage as and when such
         policies expire or (ii) to obtain adequate and comparable coverage as
         may be necessary or appropriate to conduct its business as now
         conducted and at a cost that would not result in a Material Adverse
         Change.

         (y) No Price Stabilization or Manipulation. None of the Company, the
         Guarantors or any of their respective Affiliates has taken or will
         take, directly or indirectly, any action designed to or that might be
         reasonably expected to cause or result in stabilization or manipulation
         of the price of any security of the Company to facilitate the sale or
         resale of the Securities.

         (z) Solvency. The Company and each of the Guarantors is (except to the
         extent the Company and/or such Guarantors may be deemed insolvent by
         reason of a default under its existing credit facility), and
         immediately after the Closing Date will be, Solvent. As used herein,
         the term "Solvent" means, with respect to the Company or any Guarantor
         on a particular date, that on such date (i) the fair market value of
         the assets of the Company or such Guarantor, as the case may be, is
         greater than the total amount of liabilities (including

                                       12
<PAGE>

         contingent liabilities) of the Company or such Guarantor, as the case
         may be, (ii) the present fair salable value of the assets of the
         Company or such Guarantor, as the case may be, is greater than the
         amount that will be required to pay the probable liabilities of the
         Company or such Guarantor, as the case may be, on its debts as they
         become absolute and matured, (iii) the Company or such Guarantor, as
         the case may be, is able to realize upon its assets and pay its debts
         and other liabilities, including contingent obligations, as they
         mature, (iv) the Company or such Guarantor, as the case may be, does
         not intend to, and does not believe that it will, incur debts or
         liabilities beyond such entity's ability to realize upon its assets and
         pay its debts and other liabilities, including contingent obligations,
         as they mature in their ordinary course, and (v) the Company or such
         Guarantor, as the case may be, does not have unreasonably small
         capital.

         (aa) No Unlawful Contributions or Other Payments. Neither the Company
         nor any of its subsidiaries nor, to the best of the Company's and the
         Guarantors' knowledge, any employee or agent of the Company or any
         subsidiary, has made any contribution or other payment to any official
         of, or candidate for, any federal, state or foreign office in violation
         of any law or of the character necessary to be disclosed in the
         Offering Memorandum in order to make the statements therein not
         misleading.

         (bb) MD&A. There are no transactions, arrangements or other
         relationships, including but not limited to off balance sheet
         transactions, which would be required to be included in the Offering
         Memorandum by Item 303 of Regulation S-K under the Securities Act if
         the issuance of the Securities were being registered under the
         Securities Act, which are not so described in the Offering Memorandum.

         (cc) Company's Accounting System. The Company on a consolidated basis,
         and each of the Company's subsidiaries, maintain a system of accounting
         controls sufficient to provide reasonable assurances that (i)
         transactions are executed in accordance with management's general or
         specific authorization; (ii) transactions are recorded as necessary to
         permit preparation of financial statements in conformity with generally
         accepted accounting principles applied in the United States and to
         maintain accountability for assets; (iii) access to assets is permitted
         only in accordance with management's general or specific authorization;
         (iv) the recorded accountability for assets is compared with existing
         assets at reasonable intervals and appropriate action is taken with
         respect to any differences; (v) material information relating to the
         Company and its consolidated subsidiaries is promptly made known to the
         officers responsible for establishing and maintaining the system of
         internal control over financial reporting; and (vi) any significant
         deficiencies or material weaknesses in the design or operation of
         internal control over financial reporting which are reasonably likely
         to materially and adversely affect the Company's ability to record,
         process, summarize and report financial information, and any fraud
         whether or not material that involves management or other employees who
         have a significant role in the Company's internal control over
         financial reporting, are adequately and promptly disclosed to the
         Company's independent auditors and the audit committee of the Company's
         board of directors.

                                       13
<PAGE>

         (dd) Compliance with Environmental Laws. Except as would not,
         individually or in the aggregate, result in a Material Adverse Change
         (i) the Company and each of its subsidiaries have all permits,
         authorizations and approvals required under any Environmental Laws (as
         defined below) and are in compliance with their requirements, (ii)
         neither the Company nor any of its subsidiaries is in violation of any
         federal, state, local or foreign law or regulation relating to
         pollution or protection of human health or the environment (including,
         without limitation, ambient air, surface water, groundwater, land
         surface or subsurface strata) or wildlife, including without
         limitation, laws and regulations relating to emissions, discharges,
         releases or threatened releases of chemicals, pollutants, contaminants,
         wastes, toxic substances, hazardous substances, petroleum and petroleum
         products (collectively, "Materials of Environmental Concern"), or
         otherwise relating to the manufacture, processing, distribution, use,
         treatment, storage, disposal, transport or handling of Materials of
         Environmental Concern (collectively, "Environmental Laws"), which
         violation includes, but is not limited to, noncompliance with any
         permits or other governmental authorizations required for the operation
         of the business of the Company or its subsidiaries under applicable
         Environmental Laws, or noncompliance with the terms and conditions
         thereof, nor has the Company or any of its subsidiaries received any
         written communication, whether from a governmental authority, citizens
         group, employee or otherwise, that alleges that the Company or any of
         its subsidiaries is in violation of any Environmental Law; (iii) there
         is no claim, action or cause of action filed with a court or
         governmental authority, no investigation with respect to which the
         Company has received written notice, and no written notice by any
         person or entity alleging potential liability for investigatory costs,
         cleanup costs, governmental responses costs, natural resources damages,
         property damages, personal injuries, attorneys' fees or penalties
         arising out of, based on or resulting from the presence, or release
         into the environment, of any Material of Environmental Concern at any
         location owned, leased or operated by the Company or any of its
         subsidiaries, now or in the past (collectively, "Environmental
         Claims"), pending or, to the best of the Company's or any Guarantors'
         knowledge, threatened against the Company or any of its subsidiaries or
         any person or entity whose liability for any Environmental Claim the
         Company or any of its subsidiaries has retained or assumed either
         contractually or by operation of law; and (iv) to the Company's and the
         Guarantors knowledge, there are no past or present actions, activities,
         circumstances, conditions, events or incidents, including, without
         limitation, the release, emission, discharge, presence or disposal of
         any Material of Environmental Concern, that reasonably could result in
         a violation of any Environmental Law or form the basis of a potential
         Environmental Claim against the Company or any of its subsidiaries or
         against any person or entity whose liability for any Environmental
         Claim the Company or any of its subsidiaries has retained or assumed
         either contractually or by operation of law.

         (ee) ERISA Compliance. The Company and its subsidiaries and any
         "employee benefit plan" (as defined under the Employee Retirement
         Income Security Act of 1974, as amended, and the regulations and
         published interpretations thereunder (collectively, "ERISA"))
         established or maintained by the Company, its subsidiaries or their
         "ERISA Affiliates" (as defined below) are in compliance in all respects
         with ERISA, except where any non-compliance would not result reasonably
         be expected to result in a Material Adverse Change. "ERISA Affiliate"
         means, with respect to the Company or a subsidiary, any member of any
         group of organizations described in Sections 414(b), (c), (m) or (o) of
         the Internal Revenue Code of 1986, as amended, and the regulations and
         published interpretations thereunder (the "Code") of which the Company
         or such subsidiary is a member. No "reportable event" (as defined under
         ERISA) has occurred or is reasonably expected to occur with respect to

                                       14
<PAGE>

         any "employee benefit plan" established or maintained by the Company,
         its subsidiaries or any of their ERISA Affiliates. No "employee benefit
         plan" established or maintained by the Company, its subsidiaries or any
         of their ERISA Affiliates, if such "employee benefit plan" were
         terminated, would have any "amount of unfunded benefit liabilities" (as
         defined under ERISA). Neither the Company, its subsidiaries nor any of
         their ERISA Affiliates has incurred or reasonably expects to incur any
         liability under Title IV of ERISA with respect to termination of, or
         withdrawal from, any "employee benefit plan" or (ii) Sections 412,
         4971, 4975 or 4980B of the Code. Each "employee benefit plan"
         established or maintained by the Company, its subsidiaries or any of
         their ERISA Affiliates that is intended to be qualified under Section
         401 of the Code is so qualified and nothing has occurred, whether by
         action or failure to act, which would cause the loss of such
         qualification.

         (ff) Guarantor Subsidiaries. All of the wholly owned subsidiaries of
         the Company are Guarantors.

         (gg) Credit Agreement. The Credit Agreement has been duly and validly
         authorized by the Company and the guarantors thereto and, when duly
         executed and delivered by the Company and the guarantors thereto, will
         be the valid and legally binding obligation of the Company and the
         guarantors thereto, enforceable in accordance with its terms, except as
         the enforcement thereof may be limited by bankruptcy, insolvency,
         reorganization, moratorium or other similar laws relating to or
         affecting the rights and remedies of creditors or by general equitable
         principles.

         (hh) Compliance with Regulation S. The Company, the Guarantors and
         their respective subsidiaries and Affiliates and all authorized persons
         acting on their behalf (other than the Initial Purchasers, as to whom
         the Company and the Guarantors make no representation, warranty or
         covenant) have complied with and will comply with the offering
         restrictions requirements of Regulation S in connection with the
         offering of the Securities outside the United States and, in connection
         therewith, the Offering Memorandum will contain the disclosure required
         by Rule 902. The Securities sold in reliance on Regulation S will be
         represented upon issuance by a temporary global security that may not
         be exchanged for definitive securities until the expiration of the
         40-day restricted period referred to in Rule 903 of the Securities Act
         and only upon certification of beneficial ownership of such Securities
         by non-U.S. persons or U.S. persons who purchased such Securities in
         transactions that were exempt from the registration requirements of the
         Securities Act.

         (ii) Taxes; Fees. There are no stamp or other issuance or transfer
         taxes or duties or other similar fees or charges required to be paid in
         connection with the execution and delivery of this Agreement or the
         issuance or sale by the Company of the Securities.

         (jj) No Labor Disputes. As of the date hereof, (i) there is no unfair
         labor practice complaint pending against the Company or any of its
         subsidiaries or, to the knowledge of the Company, threatened

                                       15
<PAGE>

         against any of them, before the National Labor Relations Board or any
         state or local labor relations board, and no significant grievance or
         significant arbitration proceeding arising out of or under any
         collective bargaining agreement is so pending against the Company or
         any of its subsidiaries or, to the knowledge of the Company, threatened
         against any of them, (ii) there is no material strike, labor dispute,
         slowdown or stoppage pending against the Company or any of its
         subsidiaries or, to the knowledge of the Company, threatened against
         the Company and (iii) the Company is not aware of any existing,
         threatened or imminent labor disturbance by the employees of any of its
         principal customers, suppliers, manufacturers or contractors, in the
         case of (i), (ii) or (iii), which would reasonably likely result in a
         Material Adverse Change.

         (kk) Minute Books and Records. The minute books and records of meetings
         of the Company's stockholders, board of directors and committees
         thereof, as furnished to Fried, Frank, Harris, Shriver & Jacobson,
         counsel for the Initial Purchasers, for the purpose of examination in
         connection with the preparation of the Offering Memorandum, are the
         original minute books and records or are true, correct and complete
         copies thereof, and such minute books and records represent
         descriptions which are accurate in all material respects of the
         business actually transacted at such meetings since December 12, 2000,
         with respect to the Company. Other than meetings or consents or actions
         of the board of directors or any committees thereof or meetings or
         consents or actions of the stockholders of the Company that are
         evidenced by minutes or written consents attached to the secretary's
         certificate to be delivered on the Closing Date to the Initial
         Purchasers, no other meetings or consents or actions of the board of
         directors or any committees thereof or meetings or consents or actions
         of the stockholders of the Company have been convened or made, as
         applicable, since August 1, 2003, and there have been no material
         changes, additions or alterations in said minute books or records.

             Any certificate signed by an officer of the Company or any
    Guarantor and delivered to the Initial Purchasers or to counsel for the
    Initial Purchasers pursuant to this Agreement shall be deemed to be a
    representation and warranty by the Company or such Guarantor to each Initial
    Purchaser as to the matters set forth therein.

SECTION 2. Purchase, Sale and Delivery of the Securities.

         (a) The Securities. The Company and the Guarantors agree to issue and
         sell to the several Initial Purchasers, severally and not jointly, all
         of the Securities upon the terms herein set forth. On the basis of the
         representations, warranties and agreements of the Company and the
         Guarantors herein contained, and upon the terms but subject to the
         conditions herein set forth, the Initial Purchasers agree, severally
         and not jointly, to purchase from the Company and the Guarantors the
         aggregate principal amount of Securities set forth opposite their names
         on Schedule A, at a purchase price of 97.421875% of the principal
         amount thereof payable on the Closing Date.

         (b) The Closing Date. Delivery of certificates for the Securities in
         definitive form to be purchased by the Initial Purchasers and payment
         therefor shall be made at the offices of Fried, Frank, Harris, Shriver
         & Jacobson, One New York Plaza, New York, New York 10004 (or such other

                                       16
<PAGE>

         place as may be agreed to by the Company and Banc of America Securities
         LLC) at 9:00 a.m. New York City time, on October 22, 2003 or such other
         time and date as Banc of America Securities LLC shall designate by
         notice to the Company (the time and date of such closing are called the
         "Closing Date"). The Company hereby acknowledges that circumstances
         under which the Initial Purchasers may provide notice to postpone the
         Closing Date as originally scheduled include, but are in no way limited
         to, any determination by the Company or the Initial Purchasers to
         recirculate to investors copies of an amended or supplemented Offering
         Memorandum or a delay as contemplated by the provisions of Section 16.

         (c) Delivery of the Securities. The Company shall deliver, or cause to
         be delivered, to Banc of America Securities LLC for the accounts of the
         Initial Purchasers certificates for the Notes and the Guarantees at the
         Closing Date against the irrevocable release of a wire transfer of
         immediately available funds for the amount of the purchase price
         therefor. The certificates for the Notes shall be in such denominations
         and registered in the name of Cede & Co., as nominee of the Depository,
         pursuant to the DTC Agreement, and shall be made available for
         inspection on the business day preceding the Closing Date at a location
         in New York City, as Banc of America Securities LLC may designate. Time
         shall be of the essence, and delivery at the time and place specified
         in this Agreement is a further condition to the obligations of the
         Initial Purchasers.

         (d) Delivery of Offering Memorandum to the Initial Purchasers. Not
         later than 12:00 p.m. New York City time on the second business day
         following the date of this Agreement, the Company shall deliver or
         cause to be delivered copies of the Offering Memorandum in such
         quantities and at such places as the Initial Purchasers shall
         reasonably request.

         (e) Initial Purchasers as Qualified Institutional Buyers. Each Initial
         Purchaser severally and not jointly represents and warrants to, and
         agrees with, the Company that (i) it is a "qualified institutional
         buyer" within the meaning of Rule 144A (a "Qualified Institutional
         Buyer") and an "accredited investor" within the meaning of Rule 501
         under the Securities Act (an "Accredited Investor") and (ii) with
         respect to those securities sold in reliance on Regulation S: (A) it
         has not engaged and will not engage in any direct selling efforts
         within the meaning of Regulation S; and (B) it has complied and will
         comply with the offering restrictions requirements of Regulation S.

SECTION 3. Additional Covenants. Each of the Company and the Guarantors, jointly
and severally, further covenant and agree with each Initial Purchaser as
follows:

         (a) Initial Purchasers' Review of Proposed Amendments and Supplements.
         Prior to amending or supplementing the Offering Memorandum, the Company
         and the Guarantors shall furnish to the Initial Purchasers for review a
         copy of each such proposed amendment or supplement, and the Company and
         the Guarantors shall not use any such

                                       17

<PAGE>

         proposed amendment or supplement to which any Initial Purchaser
         reasonably objects in writing within three business days (with advice
         from its independent counsel).

         (b) Additional Information, Amendments and Supplements to the Offering
         Memorandum and Other Securities Act Matters. Prior to the completion of
         the placement of the Securities by the Initial Purchasers with the
         Subsequent Purchasers, the Company and the Guarantors will immediately
         notify each Initial Purchaser, and confirm such notice in writing, of
         (x) any filing made by the Company or any Guarantor with any securities
         exchange or any other securities regulatory body in the United States
         or any other jurisdiction or (y) any press release issued by the
         Company or any Guarantor. If, prior to the completion of the placement
         of the Securities by the Initial Purchasers with the Subsequent
         Purchasers, any event shall occur or condition exist as a result of
         which it is necessary to amend or supplement the Offering Memorandum in
         order to make the statements therein, in the light of the circumstances
         when the Offering Memorandum is delivered to a purchaser, not
         misleading, or if in the reasonable opinion of the Initial Purchasers
         or counsel for the Initial Purchasers it is otherwise necessary to
         amend or supplement the Offering Memorandum to comply with law, the
         Company and the Guarantors agree to promptly prepare (subject to
         Section 3 hereof), and furnish at its own expense to the Initial
         Purchasers, amendments or supplements to the Offering Memorandum so
         that the statements in the Offering Memorandum as so amended or
         supplemented will not, in the light of the circumstances when the
         Offering Memorandum is delivered to a purchaser, be misleading or so
         that the Offering Memorandum, as amended or supplemented, will comply
         with law.

                  The Company and the Guarantors hereby expressly acknowledge
         that the indemnification and contribution provisions of Sections 8 and
         9 hereof are specifically applicable and relate to each offering
         memorandum, registration statement, prospectus, amendment or supplement
         referred to in this Section 3.

         (c) Copies of the Offering Memorandum. The Company agrees to furnish
         the Initial Purchasers, without charge, as many copies of the Offering
         Memorandum and any amendments and supplements thereto as they shall
         have reasonably requested prior to or at the time of the original
         printing of the Offering Memorandum or any amendment or supplement
         thereto.

         (d) Blue Sky Compliance. The Company and the Guarantors shall cooperate
         with the Initial Purchasers and counsel for the Initial Purchasers to
         qualify or register the Securities for sale under (or obtain exemptions
         from the application of) the Blue Sky or state securities laws of those
         jurisdictions designated by the Initial Purchasers, shall comply with
         such laws and shall continue such qualifications, registrations and
         exemptions in effect so long as required for the distribution of the
         Securities. The Company and each of the Guarantors shall not be
         required to qualify as a foreign corporation or to take any action that
         would subject it to general service of process in any such jurisdiction
         where it is not presently qualified or where it would be subject to
         taxation as a foreign corporation. The Company and the Guarantors will
         advise the Initial Purchasers promptly of the suspension of the
         qualification or registration of (or any such exemption relating to)
         the Securities for offering, sale or trading in any jurisdiction or any
         initiation or threat of any proceeding

                                       18
<PAGE>

         for any such purpose, and in the event of the issuance of any order
         suspending such qualification, registration or exemption, the Company
         shall use its reasonable best efforts to obtain the withdrawal thereof
         at the earliest possible moment.

         (e) The Depositary. The Company will cooperate with the Initial
         Purchasers and use its reasonable best efforts to permit the Securities
         to be eligible for clearance and settlement through the facilities of
         the Depositary.

         (f) Additional Issuer Information. The Company and the Guarantors agree
         that, for so long as Securities (but not the Exchange Securities)
         remain outstanding, they will furnish to holders and beneficial owners
         of Securities and to securities analysts and prospective purchasers of
         Securities, upon their request, the information (together with the
         documents referred to in the second sentence of this paragraph, the
         "Additional Issuer Information") required to be delivered pursuant to
         Rule 144A(d)(4) under the Securities Act.

         (g) Agreement Not To Offer or Sell Additional Securities. During the
         period of 180 days following the date of the Offering Memorandum, the
         Company and each of the Guarantors will not, without the prior written
         consent of Banc of America Securities LLC (which consent may be
         withheld at the sole discretion of Banc of America Securities LLC),
         directly or indirectly, sell, offer, contract or grant any option to
         sell, pledge, transfer or establish an open "put equivalent position"
         within the meaning of Rule 16a-1 under the Exchange Act, or otherwise
         dispose of or transfer, or announce the offering of, or file any
         registration statement under the Securities Act in respect of, any debt
         securities of the Company or securities exchangeable for or convertible
         into debt securities of the Company, in each case pursuant to an
         offering registered under the Securities Act, an offering under Rule
         144A or any other private placement transaction utilizing a placement
         agent (other than as contemplated by this Agreement and to register the
         Exchange Securities).

         (h) No Integration of Offerings or General Solicitation. The Company
         agrees that it will not and will cause its Affiliates and subsidiaries
         not to make any offer or sale of securities of the Company or any of
         its subsidiaries of any class if, as a result of the doctrine of
         "integration" referred to in Rule 502 under the Securities Act, such
         offer or sale would render invalid (for the purpose of (i) the sale of
         the Securities by the Company to the Initial Purchasers, (ii) the
         resale of the Securities by the Initial Purchasers to Subsequent
         Purchasers or (iii) the resale of the Securities by such Subsequent
         Purchasers to others) the exemption from the registration requirements
         of the Securities Act provided by Section 4 thereof or by Rule 144A or
         by Regulation S thereunder or otherwise. Neither the Company, the
         Guarantors, nor any of their respective subsidiaries or Affiliates, or
         any person acting on its or any of their behalf (other than the Initial
         Purchasers, as to whom the Company and the Guarantors make no
         representation, warranty or covenant) will engage, in connection with
         the offering of the Securities, in any form of general solicitation or
         general advertising within the meaning of Rule 502 under the Securities
         Act. With respect to those Securities sold in reliance upon Regulation
         S, (i) none of the Company, the Guarantors, any of their subsidiaries
         or Affiliates or any person acting on its or any of their behalf (other
         than the Initial Purchasers, as to

                                       19
<PAGE>

         whom the Company and the Guarantors make no representation, warranty or
         covenant) will engage in any directed selling efforts within the
         meaning of Regulation S and (ii) each of the Company, the Guarantors,
         any of their subsidiaries or Affiliates and any person acting on its or
         their behalf (other than the Initial Purchasers, as to whom the Company
         and the Guarantors make no representation, warranty or covenant) will
         comply with the offering restrictions set forth in Regulation S.

         (i) Legended Securities. Each certificate for a Note will bear a legend
         substantially similar to the legend contained in "Notice to Investors"
         in the Offering Memorandum for the time period and upon the other terms
         stated in the Offering Memorandum.

         (j) PORTAL. The Company will use its reasonable best efforts to cause
         such Notes to be eligible for the National Association of Securities
         Dealers, Inc. PORTAL market (the "PORTAL market").

        Banc of America Securities LLC, on behalf of the several Initial
Purchasers, may, in its sole discretion, waive in writing the performance by the
Company or Guarantors of any one or more of the foregoing covenants or extend
the time for their performance.

SECTION 4. Payment of Expenses. The Company and the Guarantors agree to pay all
costs, fees and expenses incurred in connection with the performance of its
obligations hereunder and in connection with the transactions contemplated
hereby, including without limitation (i) all necessary issue, transfer and other
stamp taxes in connection with the issuance and sale of the Securities to the
Initial Purchasers, (ii) all fees and expenses of the Company's and the
Guarantors' counsel, independent public or certified public accountants and
other advisors, (iii) all costs and expenses incurred in connection with the
preparation, printing, filing, shipping and distribution of each preliminary
Offering Memorandum and the Offering Memorandum (including financial statements
and exhibits), and all amendments and supplements thereto (iv) all filing fees,
attorneys' fees and expenses incurred by the Company or the Initial Purchasers
in connection with qualifying or registering (or obtaining exemptions from the
qualification or registration of) all or any part of the Securities for offer
and sale under the Blue Sky laws and, if requested by the Initial Purchasers,
preparing and printing a "Blue Sky Survey" or memorandum, and any supplements
thereto, advising the Initial Purchasers of such qualifications, registrations
and exemptions, such fees and expenses under this clause (iv) not to exceed
$20,000, (v) the fees and expenses of the Trustee, including the fees and
disbursements of counsel for the Trustee in connection with the Indenture, the
Securities and the Exchange Securities, (vi) any fees payable in connection with
the rating of the Securities or the Exchange Securities with the ratings
agencies and the listing of the Securities with the PORTAL market, and (vii) all
fees and expenses (including reasonable fees and expenses of counsel) of the
Company and the Guarantors in connection with approval of the Securities by DTC
for "book-entry" transfer, and the performance by the Company and the Guarantors
of their respective other obligations under this Agreement. Except as provided
in this Section 4, Section 6, Section 8 and Section 9 hereof, the Initial
Purchasers shall pay their own expenses, including fees and disbursements for
their counsel, and shall be responsible for all expenses associated with the
road show for the marketing of the Securities, including, without limitation,
any expenses associated with lodging or transportation.

                                       20
<PAGE>

SECTION 5. Conditions of the Obligations of the Initial Purchasers. The
obligations of the several Initial Purchasers to purchase and pay for the
Securities as provided herein on the Closing Date shall be subject to the
accuracy of the representations and warranties on the part of the Company and
each of the Guarantors set forth in Section 1 hereof as of the date hereof and
as of the Closing Date as though then made and to the timely performance by the
Company and each of the Guarantors of their respective covenants and other
obligations hereunder, and to each of the following additional conditions:

         (a) Accountants' Comfort Letter. On the date hereof, the Initial
         Purchasers shall have received from KPMG LLP, independent public or
         certified public accountants for the Company, a letter dated the date
         hereof addressed to the Initial Purchasers, in form and substance
         satisfactory to the Initial Purchasers, containing statements and
         information of the type ordinarily included in accountant's "comfort
         letters" to Initial Purchasers, delivered according to Statement of
         Auditing Standards Nos. 72 and 76 (or any successor bulletins), with
         respect to the audited and unaudited financial statements and certain
         financial information contained in the Offering Memorandum.

         (b) No Material Adverse Change or Ratings Agency Change. For the period
         from and after the date of this Agreement and prior to the Closing
         Date:

                  (i) in the reasonable judgment of the Initial Purchasers there
shall not have occurred any Material Adverse Change; and

                  (ii) the Securities shall be rated at least B3 by Moody's
Investors Service, Inc. ("Moody's") and B- by Standard & Poor's Rating Services,
a division of McGraw Hill, Inc. ("S&P"), in each case with a stable outlook, or
there shall not have occurred any downgrading or the giving of any notice of any
intended or potential downgrading, or of any review for a possible change that
does not indicate the direction of the possible change, in each case to a rating
of the Securities by Moody's or S&P below B3 or B-, respectively.

         (c) Opinion of Counsel for the Company. On the Closing Date the Initial
         Purchasers shall have received an opinion of Kaye Scholer LLP and an
         opinion of Baker, Donelson, Bearman, Caldwell & Berkowitz, PC, each
         counsel for the Company, each dated as of such Closing Date, in
         substantially the forms attached as Exhibit B-1 and Exhibit B-2,
         respectively.

         (d) Credit Agreement Opinion. On the Closing Date the Initial
         Purchasers shall have received a reliance letter from Kaye Scholer LLP
         and a reliance letter from Baker, Donelson, Bearman, Caldwell &
         Berkowitz, PC, each counsel for the Company with respect to the Credit
         Agreement, each dated as of such Closing Date, authorizing the Initial
         Purchasers to rely upon the opinions of each of such counsel,
         respectively, each dated as of the Closing Date, in each case addressed
         and delivered to Bank of America, N.A., as administrative agent under
         the Credit Agreement, with the same force and effect as if the Initial
         Purchasers were named as addressees of each such opinion.

                                       21
<PAGE>

         (e) Opinion of Counsel for the Initial Purchasers. On the Closing Date
         the Initial Purchasers shall have received an opinion of Fried, Frank,
         Harris, Shriver & Jacobson, counsel for the Initial Purchasers, dated
         as of such Closing Date, with respect to such matters as may be
         reasonably requested by the Initial Purchasers.

         (f) Officers' Certificate. On the Closing Date the Initial Purchasers
         shall have received a written certificate executed by the Chairman of
         the Board, Chief Executive Officer or President of the Company and the
         Chief Financial Officer or Chief Accounting Officer of the Company,
         dated as of the Closing Date, to the effect that:

                  (i) for the period from and after the date of this Agreement
and prior to the Closing Date there has not occurred any Material Adverse
Change;

                  (ii) the representations, warranties and covenants of the
Company and the Guarantors, as the case may be, set forth in Section 1 of this
Agreement are true and correct with the same force and effect as though
expressly made on and as of the Closing Date; and

                  (iii) the Company and the Guarantors have complied with all
the agreements and satisfied all the conditions on their part to be performed or
satisfied at or prior to the Closing Date.

         (g) Chief Financial Officer's Certificate. On the Closing Date the
         Initial Purchasers shall have received a written certificate executed
         by the Chief Financial Officer of the Company, dated as of the Closing
         Date, to the effect that the statements contained in the Preliminary
         Offering Memorandum and the Offering Memorandum, as applicable, under
         the section "Management's Discussion and Analysis of Financial
         Condition and Results of Operations - Recent Developments" with respect
         to the Company's net revenue and income from operations for the quarter
         ended September 30, 2003 are, to his knowledge, consistent with the
         Company's current expectations in all material respects as of the
         Closing Date.

         (h) Bring-down Comfort Letter. On the Closing Date the Initial
         Purchasers shall have received from KPMG LLP, independent public or
         certified public accountants for the Company, a letter dated such date,
         in form and substance satisfactory to the Initial Purchasers, to the
         effect that they reaffirm the statements made in the letter furnished
         by them pursuant to subsection (a)(i) of this Section 5, except that
         the specified date referred to therein for the carrying out of
         procedures shall be no more than three business days prior to the
         Closing Date.

         (i) PORTAL Listing. At the Closing Date the Notes shall have been
         designated for trading on the PORTAL market.

                                       22
<PAGE>

         (j) Other Agreements. The Company and the Guarantors shall have entered
         into the Registration Rights Agreement and the Indenture and the
         Initial Purchasers shall have received executed counterparts thereof.

         (k) Credit Agreement. At the Closing Date and upon consummation of the
         transactions contemplated hereby, (i) the Company and the Guarantors
         shall have duly authorized, executed and delivered the Credit
         Agreement, (ii) upon execution and delivery thereof by the lenders
         thereunder, the Credit Agreement shall constitute a valid and legally
         binding obligation of the Company and each of the Guarantors,
         enforceable against the Company and each of the Guarantors in
         accordance with its terms, except as the enforcement thereof may be
         limited by bankruptcy, insolvency, reorganization, moratorium or other
         similar laws relating to or affecting the rights and remedies of
         creditors or by general equitable principles, (iii) no default shall
         have occurred or be continuing under the Credit Agreement, (iv) as
         described in the Offering Memorandum, the Company shall be prepared to
         (A) repay all outstanding indebtedness under the Company's existing
         credit facility and (B) pay the redemption price of approximately $11.4
         million, plus accrued and unpaid dividends, for the Company's series C
         preferred stock which was issued to an affiliate of J.W. Childs Equity
         Partners II, L.P., and (v) the Company and the Guarantors shall have
         received all consents necessary, as required by the Credit Agreement,
         to the issuance and sale of the Securities and the consummation of the
         transactions contemplated hereby, in each case in a form and substance
         reasonably satisfactory to the Initial Purchasers and counsel for the
         Initial Purchasers. The Company and the Guarantors shall have entered
         into and the Initial Purchasers shall have received executed
         counterparts thereof.

         (l) Additional Documents. On or before the Closing Date, the Initial
         Purchasers and counsel for the Initial Purchasers shall have received
         such information, documents and opinions as they may reasonably require
         for the purposes of enabling them to pass upon the issuance and sale of
         the Securities as contemplated herein, or in order to evidence the
         accuracy of any of the representations and warranties, or the
         satisfaction of any of the conditions or agreements, herein contained.

                  If any condition specified in this Section 5 is not satisfied
when and as required to be satisfied, this Agreement may be terminated by the
Initial Purchasers by notice to the Company and the Guarantors at any time on or
prior to the Closing Date, which termination shall be without liability on the
part of any party to any other party, except that Section 4, Section 6, Section
8 and Section 9 shall at all times be effective and shall survive such
termination.

SECTION 6. Reimbursement of Initial Purchasers' Expenses. If the sale to the
Initial Purchasers of the Securities on the Closing Date is not consummated
because of any refusal, inability or failure on the part of the Company or any
of the Guarantors to perform in all material respects any agreement herein or to
comply in all material respects with any provision hereof, the Company agrees to
reimburse the Initial Purchasers (or such Initial Purchasers as have terminated
this Agreement with respect to themselves), severally, upon demand for all
out-of-pocket costs and expenses that shall have been reasonably incurred by the
Initial Purchasers in connection with the proposed purchase and the offering and
sale of the Securities, including but not limited to reasonable fees and
disbursements of counsel, printing

                                       23
<PAGE>

expenses, travel expenses, expenses associated with the road show for the
marketing of the Securities, postage, facsimile and telephone charges.

SECTION 7. Offer, Sale and Resale Procedures. Each of the Initial Purchasers, on
the one hand, and the Company and each of the Guarantors, on the other hand,
hereby establish and agree to observe the following procedures in connection
with the offer and sale of the Securities:

                  (A) Offers and sales of the Securities will be made only by
the Initial Purchasers or Affiliates thereof qualified to do so in the
jurisdictions in which such offers or sales are made. Each such offer or sale
shall only be made to persons whom the offeror or seller reasonably believes to
be qualified institutional buyers (as defined in Rule 144A under the Securities
Act) or non-U.S. persons outside the United States to whom the offeror or seller
reasonably believes offers and sales of the Securities may be made in reliance
upon Regulation S under the Securities Act, upon the terms and conditions set
forth in Annex I hereto, which Annex I is hereby expressly made a part hereof.

                  (B) No general solicitation or general advertising (within the
meaning of Rule 502 under the Securities Act) will be used in the United States
in connection with the offering of the Securities.

                  (C) Upon original issuance by the Company, and until such time
as the same is no longer required under the applicable requirements of the
Securities Act, the Notes (and all securities issued in exchange therefor or in
substitution thereof, other than the Exchange Securities) shall bear the
following legend:

                  "THE SECURITY (OR ITS PREDECESSOR) EVIDENCED HEREBY WAS
                  ORIGINALLY ISSUED IN A TRANSACTION EXEMPT FROM REGISTRATION
                  UNDER SECTION 5 OF THE UNITED STATES SECURITIES ACT OF 1933
                  (THE "SECURITIES ACT"), AND THE SECURITY EVIDENCED HEREBY MAY
                  NOT BE OFFERED, SOLD OR OTHERWISE TRANSFERRED IN THE ABSENCE
                  OF SUCH REGISTRATION OR AN APPLICABLE EXEMPTION THEREFROM.
                  EACH PURCHASER OF THE SECURITY EVIDENCED HEREBY IS HEREBY
                  NOTIFIED THAT THE SELLER MAY BE RELYING ON THE EXEMPTION FROM
                  THE PROVISIONS OF SECTION 5 OF THE SECURITIES ACT PROVIDED BY
                  RULE 144A THEREUNDER. THE HOLDER OF THE SECURITY EVIDENCED
                  HEREBY AGREES FOR THE BENEFIT OF THE COMPANY THAT SUCH
                  SECURITY MAY BE RESOLD, PLEDGED OR OTHERWISE TRANSFERRED, ONLY
                  TO A PERSON WHOM THE SELLER REASONABLY BELIEVES IS A QUALIFIED
                  INSTITUTIONAL BUYER (AS DEFINED IN RULE 144A UNDER THE
                  SECURITIES ACT) IN A TRANSACTION MEETING THE REQUIREMENTS OF
                  RULE 144A, PURCHASING FOR ITS OWN ACCOUNT OR FOR THE ACCOUNT
                  OF A QUALIFIED INSTITUTIONAL BUYER IN A TRANSACTION MEETING
                  THE REQUIREMENTS OF RULE 144A UNDER THE SECURITIES ACT,
                  OUTSIDE THE UNITED STATES TO A FOREIGN PERSON IN A TRANSACTION
                  MEETING THE REQUIREMENTS OF RULE 903 OR RULE 904 OF REGULATION
                  S UNDER THE SECURITIES ACT, PURSUANT TO AN EXEMPTION FROM
                  REGISTRATION UNDER THE SECURITIES ACT PROVIDED BY RULE 144
                  THEREUNDER (IF APPLICABLE) OR IN ACCORDANCE WITH ANOTHER
                  EXEMPTION FROM THE

                                       24
<PAGE>

                  REGISTRATION REQUIREMENTS OF THE SECURITIES ACT (AND BASED
                  UPON AN OPINION OF COUNSEL IF THE COMPANY SO REQUESTS), TO THE
                  COMPANY OR PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT
                  AND, IN EACH CASE, IN ACCORDANCE WITH ANY APPLICABLE
                  SECURITIES LAWS OF ANY STATE OF THE UNITED STATES OR ANY OTHER
                  APPLICABLE JURISDICTION AND THE HOLDER WILL, AND EACH
                  SUBSEQUENT HOLDER IS REQUIRED TO, NOTIFY ANY PURCHASER OF THE
                  SECURITY EVIDENCED HEREBY OF THE RESALE RESTRICTIONS SET FORTH
                  ABOVE. NO REPRESENTATION CAN BE MADE AS TO THE AVAILABILITY OF
                  THE EXEMPTION PROVIDED BY RULE 144 FOR RESALE OF THE SECURITY
                  EVIDENCED HEREBY."

Following the sale of the Securities by the Initial Purchasers to Subsequent
Purchasers pursuant to the terms hereof, the Initial Purchasers shall not be
liable or responsible to the Company or any Guarantor for any losses, damages or
liabilities suffered or incurred by the Company or any Guarantor, including any
losses, damages or liabilities under the Securities Act, arising from or
relating to any resale or transfer of any Security.

SECTION 8. Indemnification.

         (a) Indemnification of the Initial Purchasers. The Company and each
         Guarantor, jointly and severally, agree to indemnify and hold harmless
         each Initial Purchaser, its directors, officers and employees, and each
         person, if any, who controls any Initial Purchaser within the meaning
         of the Securities Act and the Exchange Act against any loss, claim,
         damage, liability or expense, as incurred, to which such Initial
         Purchaser or such controlling person may become subject, under the
         Securities Act, the Exchange Act or other federal or state statutory
         law or regulation, or at common law or otherwise (including in
         settlement of any litigation, if such settlement is effected with the
         written consent of the Company), insofar as such loss, claim, damage,
         liability or expense (or actions in respect thereof as contemplated
         below) arises out of or is based (i) upon any untrue statement or
         alleged untrue statement of a material fact contained in the
         Preliminary Offering Memorandum or the Offering Memorandum (or any
         amendment or supplement thereto), or the omission or alleged omission
         therefrom of a material fact necessary in order to make the statements
         therein, in the light of the circumstances under which they were made,
         not misleading; or (ii) in whole or in part upon any inaccuracy in the
         representations and warranties of the Company or any Guarantor
         contained herein; or (iii) in whole or in part upon any failure of the
         Company or any Guarantor to perform its obligations hereunder or under
         law; or (iv) any act or failure to act or any alleged act or failure to
         act by any Initial Purchaser in connection with, or relating in any
         manner to, the offering contemplated hereby, and which is included as
         part of or referred to in any loss, claim, damage, liability or action
         arising out of or based upon any matter covered by clause (i) above to
         the extent such loss, claim, damage, liability or expense is not
         covered in clauses (i) through (iii) (subject to the limitation set
         forth below), provided that the Company and the Guarantors shall not be
         liable under this clause (iv) to the extent that a court of competent
         jurisdiction shall have determined by a final judgment that such loss,
         claim, damage, liability or action resulted directly from any such acts
         or failures to act undertaken or omitted to be taken by such Initial
         Purchaser through its gross negligence or willful misconduct; and to
         reimburse each Initial Purchaser and each such controlling person for
         any and all expenses (including the reasonable fees and disbursements
         of counsel chosen by Banc of America

                                       25
<PAGE>

         Securities LLC) as such expenses are reasonably incurred by such
         Initial Purchaser or such controlling person in connection with
         investigating, defending, settling, compromising or paying any such
         loss, claim, damage, liability, expense or action; provided, however,
         that the foregoing indemnity agreement shall not apply to any loss,
         claim, damage, liability or expense to the extent, but only to the
         extent, arising out of or based upon any untrue statement or alleged
         untrue statement or omission or alleged omission made in reliance upon
         and in conformity with written information furnished to the Company or
         any Guarantor by the Initial Purchasers expressly for use in any
         Preliminary Offering Memorandum or the Offering Memorandum (or any
         amendment or supplement thereto). The indemnity agreement set forth in
         this Section 8 shall be in addition to any liabilities that the Company
         and each of the Guarantors may otherwise have.

         (b) Indemnification of the Company and their Guarantors and their
         Directors and Officers. Each Initial Purchaser agrees, severally and
         not jointly, to indemnify and hold harmless the Company, the Guarantors
         and each of their directors, officers and employees and each person, if
         any, who controls the Company within the meaning of the Securities Act
         or the Exchange Act, against any loss, claim, damage, liability or
         expense, as incurred, to which the Company, any Guarantor or any such
         director, officer or employee or controlling person may become subject,
         under the Securities Act, the Exchange Act, or other federal or state
         statutory law or regulation, or at common law or otherwise (including
         in settlement of any litigation, if such settlement is effected with
         the written consent of such Initial Purchaser), insofar as such loss,
         claim, damage, liability or expense (or actions in respect thereof as
         contemplated below) arises out of or is based upon any untrue or
         alleged untrue statement of a material fact contained in any
         Preliminary Offering Memorandum or the Offering Memorandum (or any
         amendment or supplement thereto), or arises out of or is based upon the
         omission or alleged omission to state therein a material fact required
         to be stated therein or necessary in order to make the statements
         therein in light of the circumstances under which they were made not
         misleading, in each case to the extent, but only to the extent, that
         such untrue statement or alleged untrue statement or omission or
         alleged omission was made in any Preliminary Offering Memorandum or the
         Offering Memorandum (or any amendment or supplement thereto), in
         reliance upon and in conformity with written information furnished to
         the Company and the Guarantors by the Initial Purchasers expressly for
         use therein; and to reimburse the Company and the Guarantors, or any
         such director, officer or employee or controlling person for any and
         all expenses (including reasonable fees and disbursements of counsel)
         as such expenses are reasonably incurred by the Company or the
         Guarantors, or any such director or controlling person in connection
         with investigating, defending, settling, compromising or paying any
         such loss, claim, damage, liability, expense or action. The Company and
         the Guarantors hereby acknowledge that the only information that the
         Initial Purchasers have furnished (prior to the date hereof) to the
         Company expressly for use in the Preliminary Offering Memorandum or the
         Offering Memorandum (or any amendment or supplement thereto) are the
         statements set forth in (A) the first sentence of the sixth full
         paragraph on introductory page ii of the Offering Memorandum, (B) the
         second sentence of the second paragraph under the caption "Risk Factors
         - No public trading market for the Notes exists and the Notes contain
         restrictions on transfer." in the Offering Memorandum and (C) the
         second sentence of the second paragraph, the first and second sentences
         of the fourth paragraph, the fourth sentence of the sixth paragraph,
         the eighth paragraph and the eleventh paragraph under the caption "Plan
         of Distribution" in the Offering Memorandum; and the Initial Purchasers
         confirm that such

                                       26
<PAGE>

         statements are correct. The indemnity agreement set forth in this
         Section 8 shall be in addition to any liabilities that each Initial
         Purchaser may otherwise have.

         (c) Notifications and Other Indemnification Procedures. Promptly after
         receipt by an indemnified party under this Section 8 of notice of the
         commencement of any action, such indemnified party will, if a claim in
         respect thereof is to be made against an indemnifying party under this
         Section 8, notify the indemnifying party in writing of the commencement
         thereof, but the omission so to notify the indemnifying party will not
         relieve it from any liability which it may have to any indemnified
         party for contribution or otherwise than under the indemnity agreement
         contained in this Section 8 or to the extent it is not materially
         prejudiced as a proximate result of such failure. In case any such
         action is brought against any indemnified party and such indemnified
         party seeks or intends to seek indemnity from an indemnifying party,
         the indemnifying party will be entitled to participate in and, to the
         extent that it shall elect, jointly with all other indemnifying parties
         similarly notified, by written notice delivered to the indemnified
         party promptly after receiving the aforesaid notice from such
         indemnified party, to assume the defense thereof with counsel
         reasonably satisfactory to such indemnified party; provided, however,
         if the defendants in any such action include both the indemnified party
         and the indemnifying party and the indemnified party shall have
         reasonably concluded that a conflict may arise between the positions of
         the indemnifying party and the indemnified party in conducting the
         defense of any such action or that there may be legal defenses
         available to it and/or other indemnified parties which are different
         from or additional to those available to the indemnifying party, the
         indemnified party or parties shall have the right to select separate
         counsel to assume such legal defenses and to otherwise participate in
         the defense of such action on behalf of such indemnified party or
         parties. Upon receipt of notice from the indemnifying party to such
         indemnified party of such indemnifying party's election so to assume
         the defense of such action and approval by the indemnified party of
         counsel, the indemnifying party will not be liable to such indemnified
         party under this Section 8 for any legal or other expenses subsequently
         incurred by such indemnified party in connection with the defense
         thereof (other than the reasonable costs of investigation) unless (i)
         the indemnified party shall have employed separate counsel in
         accordance with the proviso to the next preceding sentence (it being
         understood, however, that the indemnifying party shall not be liable
         for the expenses of more than one separate counsel (together with local
         counsel), approved by the indemnifying party (Banc of America
         Securities LLC in the case of Section 8(b)), representing the
         indemnified parties who are parties to such action) or (ii) the
         indemnifying party shall not have employed counsel reasonably
         satisfactory to the indemnified party to represent the indemnified
         party within a reasonable time after notice of commencement of the
         action, in each of which cases the fees and expenses of counsel shall
         be at the expense of the indemnifying party.

         (d) Settlements. The indemnifying party under this Section 8 shall not
         be liable for any settlement of any proceeding effected without its
         written consent, but if settled with such consent or if there be a
         final non-appealable judgment for the plaintiff, the indemnifying party
         agrees to indemnify the indemnified party against any loss, claim,
         damage, liability or expense by reason of such settlement or judgment.
         Notwithstanding the foregoing sentence, if at any time an indemnified
         party shall have requested an indemnifying party to reimburse the
         indemnified party for fees and expenses of counsel as contemplated by
         Section 8 hereof,

                                       27
<PAGE>

         the indemnifying party agrees that it shall be liable for any
         settlement of any proceeding effected without its written consent if
         (i) such settlement is entered into more than 30 days after receipt by
         such indemnifying party of the aforesaid request and (ii) such
         indemnifying party shall not have reimbursed the indemnified party in
         accordance with such request prior to the date of such settlement;
         provided, however, that the indemnifying party shall not be liable for
         any reimbursement to the indemnified party for fees and expenses of
         counsel pursuant to this sentence to the extent, and only for so long
         as, the indemnifying party is contesting such reimbursement in good
         faith. No indemnifying party shall, without the prior written consent
         of the indemnified party, effect any settlement, compromise or consent
         to the entry of judgment in any pending or threatened action, suit or
         proceeding in respect of which any indemnified party is or could have
         been a party and indemnity was or could have been sought hereunder by
         such indemnified party, unless such settlement, compromise or consent
         includes an unconditional release of such indemnified party from all
         liability on claims that are the subject matter of such action, suit or
         proceeding and does not include any statement as to or any admission of
         fault, culpability or failure to act by or on behalf of any indemnified
         party.

SECTION 9. Contribution.

                  If the indemnification provided for in Section 8 is for any
reason held to be unavailable to or otherwise insufficient to hold harmless an
indemnified party in respect of any losses, claims, damages, liabilities or
expenses referred to therein, then each indemnifying party shall contribute to
the aggregate amount paid or payable by such indemnified party, as incurred, as
a result of any losses, claims, damages, liabilities or expenses referred to
therein (i) in such proportion as is appropriate to reflect the relative
benefits received by the Company and the Guarantors, on the one hand, and the
Initial Purchasers, on the other hand, from the offering of the Securities
pursuant to this Agreement or (ii) if the allocation provided by clause (i)
above is not permitted by applicable law, in such proportion as is appropriate
to reflect not only the relative benefits referred to in clause (i) above but
also the relative fault of the Company and the Guarantors, on the one hand, and
the Initial Purchasers, on the other hand, in connection with the statements or
omissions or inaccuracies in the representations and warranties herein which
resulted in such losses, claims, damages, liabilities or expenses, as well as
any other relevant equitable considerations. The relative benefits received by
the Company and the Guarantors, on the one hand, and the Initial Purchasers, on
the other hand, in connection with the offering of the Securities pursuant to
this Agreement shall be deemed to be in the same respective proportions as the
total net proceeds from the offering of the Securities pursuant to this
Agreement (before deducting expenses) received by the Company and the
Guarantors, and the total discount received by the Initial Purchasers bear to
the aggregate initial offering price of the Securities. The relative fault of
the Company or any Guarantor, on the one hand, and the Initial Purchasers, on
the other hand, shall be determined by reference to, among other things, whether
any such untrue or alleged untrue statement of a material fact or omission or
alleged omission to state a material fact or any such inaccurate or alleged
inaccurate representation or warranty relates to information supplied by the
Company or any Guarantor, on the one hand, or the Initial Purchasers, on the
other hand, and the parties' relative intent, knowledge, access to information
and opportunity to correct or prevent such statement or omission.

                  The amount paid or payable by a party as a result of the
losses, claims, damages, liabilities and expenses referred to above shall be
deemed to include, subject to the limitations set forth in Section 8, any legal
or other fees or expenses reasonably incurred by such party in connection with
investigating or defending any action or claim. The provisions set forth in
Section 8 with respect to notice of commencement of any action shall apply if a
claim for contribution is to be made under this Section 9; provided, however,
that no additional notice shall

                                       28
<PAGE>

be required with respect to any action for which notice has been given under
Section 8 for purposes of indemnification.

                  The Company, the Guarantors and the Initial Purchasers agree
that it would not be just and equitable if contribution pursuant to this Section
9 were determined by pro rata allocation (even if the Initial Purchasers were
treated as one entity for such purpose) or by any other method of allocation
which does not take account of the equitable considerations referred to in this
Section 9.

                  Notwithstanding the provisions of this Section 9, no Initial
Purchaser shall be required to contribute any amount in excess of the discount
received by such Initial Purchaser in connection with the Securities distributed
by it. No person guilty of fraudulent misrepresentation (within the meaning of
Section 11 of the Securities Act) shall be entitled to contribution from any
person who was not guilty of such fraudulent misrepresentation. The Initial
Purchasers' obligations to contribute pursuant to this Section 9 are several,
and not joint, in proportion to their respective commitments as set forth
opposite their names in Schedule A. For purposes of this Section 9, each
director, officer and employee of an Initial Purchaser and each person, if any,
who controls an Initial Purchaser within the meaning of the Securities Act and
the Exchange Act shall have the same rights to contribution as such Initial
Purchaser, and each director, officer and employee of the Company and each of
the Guarantors and each person, if any, who controls the Company or any of the
Guarantors within the meaning of the Securities Act and the Exchange Act shall
have the same rights to contribution as the Company.

SECTION 10. Termination of this Agreement. Prior to the Closing Date, this
Agreement may be terminated by the Initial Purchasers by notice given to the
Company if at any time (i) trading in securities generally on either the Nasdaq
Stock Market or the New York Stock Exchange shall have been suspended or
materially limited, or minimum or maximum prices shall have been generally
established on any of such stock exchanges by the Commission or the NASD; (ii) a
general banking moratorium shall have been declared by any of federal or New
York authorities; (iii) there shall have occurred any outbreak or escalation of
national or international hostilities or any crisis or calamity, or any change
in the United States or international financial markets, or any substantial
change or development involving a prospective substantial change in United
States' or international political, financial or economic conditions, all as in
the judgment of the Initial Purchasers is material and adverse and makes it
impracticable or inadvisable to proceed with the offering or delivery of the
Securities in the manner and on the terms described in the Offering Memorandum
or to enforce contracts for the sale of securities; (iv) in the reasonable
judgment of the Initial Purchasers there shall have occurred any Material
Adverse Change; or (v) the Company shall have sustained a loss by strike, fire,
flood, earthquake, accident or other calamity of such character as in the
reasonable judgment of the Initial Purchasers may interfere materially with the
conduct of the business and operations of the Company and the Guarantors, taken
as a whole, regardless of whether or not such loss shall have been insured. Any
termination pursuant to this Section 10 shall be without liability on the part
of (i) the Company to any Initial Purchaser, except that the Company shall be
obligated to reimburse the expenses of the Initial Purchasers pursuant to
Section 4 hereof, (ii) any Initial Purchaser to the Company or any Guarantor, or
(iii) of any party hereto to any other party except that the provisions of
Section 8 and Section 9 shall at all times be effective and shall survive such
termination.

SECTION 11. Representations and Indemnities to Survive Delivery. The respective
indemnities, agreements, representations, warranties and other

                                       29

<PAGE>

statements of the Company and each of the Guarantors, of their respective
officers and of the several Initial Purchasers set forth in or made pursuant to
this Agreement will remain in full force and effect, regardless of any
investigation made by or on behalf of any Initial Purchaser or the Company or
any of the Guarantors or any of its or their partners, officers or directors or
any controlling person, as the case may be, and will survive delivery of and
payment for the Securities sold hereunder and any termination of this Agreement.

SECTION 12. Notices. All communications hereunder shall be in writing and shall
be mailed, hand delivered or telecopied and confirmed to the parties hereto as
follows:

If to the Initial Purchasers:

         Banc of America Securities LLC
         9 West 57th Street
         New York, NY  10019

         Facsimile: (212) 847-6441
         Attention: Bruce Thompson

   with a copy to:

         Fried, Frank, Harris, Shriver & Jacobson
         One New York Plaza
         New York, New York 10004

         Facsimile: (212) 859-4000
         Attention: Valerie Ford Jacob, Esq.

If to the Company or any of the Guarantors:

         National Nephrology Associates, Inc.
         230 Great Circle Road
         Suite 218
         Nashville, Tennessee 37228

         Facsimile: (615) 312-5206
         Attention: Leif Murphy

   with a copies to:

         J.W. Childs Associates, L.P.
         111 Huntington Avenue
         Suite 2900
         Boston, MA 02199
         Facsimile: (617) 753-1101
         Attention: Edward D. Yun

and to:

                                       30
<PAGE>

         Kaye Scholer LLP
         425 Park Avenue
         New York, NY 10022
         Facsimile: 212-836-8689
         Attention: Adam H. Golden, Esq.

Any party hereto may change the address for receipt of communications by giving
written notice to the others.

SECTION 13. Successors. This Agreement will inure to the benefit of and be
binding upon the parties hereto, including any substitute Initial Purchasers
pursuant to Section 16 hereof, and to the benefit of the employees, officers and
directors and controlling persons referred to in Section 8 and Section 9, and in
each case their respective successors, and no other person will have any right
or obligation hereunder. The term "successors" shall not include any purchaser
of the Securities as such from any of the Initial Purchasers merely by reason of
such purchase.

SECTION 14. Partial Unenforceability. The invalidity or unenforceability of any
Section, paragraph or provision of this Agreement shall not affect the validity
or enforceability of any other Section, paragraph or provision hereof. If any
Section, paragraph or provision of this Agreement is for any reason determined
to be invalid or unenforceable, there shall be deemed to be made such minor
changes (and only such minor changes) as are necessary to make it valid and
enforceable.

SECTION 15. Governing Law Provisions. THIS AGREEMENT SHALL BE GOVERNED BY AND
CONSTRUED IN ACCORDANCE WITH THE INTERNAL LAWS OF THE STATE OF NEW YORK
APPLICABLE TO AGREEMENTS MADE AND TO BE PERFORMED IN SUCH STATE.

         (a) Consent to Jurisdiction. Any legal suit, action or proceeding
         arising out of or based upon this Agreement or the transactions
         contemplated hereby ("Related Proceedings") may be instituted in the
         federal courts of the United States of America located in the City and
         County of New York or the courts of the State of New York in each case
         located in the City and County of New York (collectively, the
         "Specified Courts"), and each party irrevocably submits to the
         exclusive jurisdiction (except for proceedings instituted in regard to
         the enforcement of a judgment of any such court (a "Related Judgment"),
         as to which such jurisdiction is non-exclusive) of such courts in any
         such suit, action or proceeding. Service of any process, summons,
         notice or document by mail to such party's address set forth above
         shall be effective service of process for any suit, action or other
         proceeding brought in any such court. The parties irrevocably and
         unconditionally waive any objection to the laying of venue of any suit,
         action or other proceeding in the Specified Courts and irrevocably and
         unconditionally waive and agree not to plead or claim in any such court
         that any such suit, action or other proceeding brought in any such
         court has been brought in an inconvenient forum.

SECTION 16. Default of One or More of the Several Initial Purchasers. If any one
or more of the several Initial Purchasers shall fail or refuse to

                                       31
<PAGE>

purchase Securities that it or they have agreed to purchase hereunder on the
Closing Date, and the aggregate number of Securities which such defaulting
Initial Purchaser or Initial Purchasers agreed but failed or refused to purchase
does not exceed 10% of the aggregate number of the Securities to be purchased on
such date, the other Initial Purchasers shall be obligated, severally, in the
proportions that the number of Securities set forth opposite their respective
names on Schedule A bears to the aggregate number of Securities set forth
opposite the names of all such non-defaulting Initial Purchasers, or in such
other proportions as may be specified by the Initial Purchasers with the consent
of the non-defaulting Initial Purchasers, to purchase the Securities which such
defaulting Initial Purchaser or Initial Purchasers agreed but failed or refused
to purchase on such date. If any one or more of the Initial Purchasers shall
fail or refuse to purchase Securities and the aggregate number of Securities
with respect to which such default occurs exceeds 10% of the aggregate number of
Securities to be purchased on the Closing Date, and arrangements satisfactory to
the Initial Purchasers and the Company for the purchase of such Securities are
not made within 48 hours after such default, this Agreement shall terminate
without liability of any party to any other party except that the provisions of
Section 4, Section 8 and Section 9 shall at all times be effective and shall
survive such termination. In any such case either the Initial Purchasers or the
Company shall have the right to postpone the Closing Date, as the case may be,
but in no event for longer than seven days in order that the required changes,
if any, to the Offering Memorandum or any other documents or arrangements may be
effected.

                  As used in this Agreement, the term "Initial Purchaser" shall
be deemed to include any person substituted for a defaulting Initial Purchaser
under this Section 10. Notwithstanding anything to the contrary herein, any
action taken under this Section 16, including, without limitation, the
termination of this Agreement, shall not relieve any defaulting Initial
Purchaser from liability in respect of any default of such Initial Purchaser
under this Agreement.

SECTION 17. Tax Disclosure. Notwithstanding anything to the contrary contained
herein, each of the Initial Purchasers, the Company and the Guarantors shall be
permitted to disclose the tax treatment and tax structure of any transaction
contemplated by this Agreement or the Offering Memorandum (including any
materials, opinions or analyses relating to such tax treatment or tax structure,
but without disclosure of identifying information of any person or, except to
the extent relating to such tax structure or tax treatment, any nonpublic
commercial or financial information); provided, however, that if such
transaction is not consummated for any reason, the provisions of this sentence
shall cease to apply with respect to such transaction.

SECTION 18. General Provisions. This Agreement constitutes the entire agreement
of the parties to this Agreement and supersedes all prior written or oral and
all contemporaneous oral agreements, understandings and negotiations with
respect to the subject matter hereof. This Agreement may be executed in two or
more counterparts, each one of which shall be an original, with the same effect
as if the signatures thereto and hereto were upon the same instrument. This
Agreement may not be amended or modified unless in writing by all of the parties
hereto, and no condition herein (express or implied) may be waived unless waived
in writing by each party whom the condition is meant to benefit. The Table of
Contents and the section headings herein are for the convenience of the parties
only and shall not affect the construction or interpretation of this Agreement.

                                       32

<PAGE>

                                                                          518246

                                       33
<PAGE>

         If the foregoing is in accordance with your understanding of our
agreement, kindly sign and return to the Company the enclosed copies hereof,
whereupon this instrument, along with all counterparts hereof, shall become a
binding agreement in accordance with its terms.

                                  Very truly yours,

                                  NATIONAL NEPHROLOGY ASSOCIATES, INC., a
                                  Delaware corporation

                                  By:__________________________

                                  Name:  Michael N. Cannizzaro
                                  Title: Chairman and Chief Executive Officer

                                  NNA OF OKLAHOMA, INC., a Nevada corporation
                                  NNA OF GEORGIA, INC., a Delaware corporation
                                  NNA OF ALABAMA, INC., an Alabama corporation
                                  NNA MANAGEMENT COMPANY OF KENTUCKY, INC., a
                                      Kentucky corporation
                                  NATIONAL NEPHROLOGY ASSOCIATES MANAGEMENT
                                      COMPANY OF TEXAS, INC., a Texas
                                      corporation
                                  NNA OF NEVADA, INC., a Nevada corporation
                                  NATIONAL NEPHROLOGY ASSOCIATES CREDIT
                                      CORPORATION, a Tennessee corporation
                                  NNA OF TOLEDO, INC., an Ohio corporation
                                  NNA OF RHODE ISLAND, INC., a Rhode Island
                                      corporation
                                  NNA TRANSPORTATION SERVICES CORPORATION, a
                                      Tennessee corporation
                                  NNA PROPERTIES OF TENNESSEE, INC., a Tennessee
                                      corporation
                                  NNA PROPERTIES OF KENTUCKY, INC., a Kentucky
                                      corporation
                                  NNA PROPERTIES OF NEW JERSEY, INC., a New
                                      Jersey corporation
                                  NNA MANAGEMENT COMPANY OF LOUISIANA, INC., a
                                      Louisiana corporation
                                  RENEX CORP., a Florida corporation
                                  RENEX MANAGEMENT SERVICES, INC., a Florida
                                      corporation
                                  DIALYSIS SERVICES OF ATLANTA, INC., a Georgia
                                      corporation
                                  RENEX DIALYSIS CLINIC OF PENN HILLS, INC., a
                                      Pennsylvania corporation
                                  RENEX DIALYSIS CLINIC OF SHALER, INC., a
                                      Pennsylvania corporation
                                  RENEX DIALYSIS CLINIC OF DOYLESTOWN, INC., a
                                      Pennsylvania corporation

<PAGE>

                                  RENEX DIALYSIS CLINIC OF AMESBURY, INC., a
                                      Massachusetts corporation
                                  RENEX DIALYSIS CLINIC OF NORTH ANDOVER, INC.,
                                      a Massachusetts corporation
                                  RENEX DIALYSIS CLINIC OF SOUTH GEORGIA, INC.,
                                      a Georgia corporation
                                  RENEX DIALYSIS CLINIC OF CREVE COUER, INC.,
                                      a Missouri corporation
                                  RENEX DIALYSIS CLINIC OF ST. LOUIS, INC., a
                                      Missouri corporation
                                  RENEX DIALYSIS CLINIC OF BRIDGETON, INC., a
                                      Missouri corporation
                                  RENEX DIALYSIS CLINIC OF UNION, INC., a
                                      Missouri corporation
                                  RENEX DIALYSIS HOMECARE OF GREATER ST. LOUIS,
                                      INC., a Missouri corporation
                                  RENEX DIALYSIS CLINIC OF MAPLEWOOD, INC., a
                                      Missouri corporation
                                  RENEX DIALYSIS CLINIC OF UNIVERSITY CITY,
                                      INC., a Missouri corporation
                                  RENEX DIALYSIS FACILITIES, INC., a Mississippi
                                      corporation
                                  RENEX DIALYSIS CLINIC OF BLOOMFIELD, INC., a
                                      New Jersey corporation
                                  RENEX DIALYSIS CLINIC OF ORANGE, INC., a New
                                      Jersey corporation
                                  RENEX DIALYSIS CLINIC OF PHILADELPHIA, INC.,
                                      a Pennsylvania corporation
                                  RENEX DIALYSIS CLINIC OF PITTSBURGH, INC., a
                                      Pennsylvania corporation
                                  RENEX DIALYSIS CLINIC OF WOODBURY, INC., a New
                                      Jersey corporation
                                  RENEX DIALYSIS CLINIC OF TAMPA, INC., a
                                      Florida corporation

                                  DIALYSIS ASSOCIATES, LLC, a Tennessee limited
                                      liability company
                                  By: National Nephrology Associates, Inc., a
                                      Delaware corporation, as sole member

                                  DIALYSIS ASSOCIATES MEDICAL SUPPLY, LLC, a
                                      Tennessee limited liability company
                                  By: National Nephrology Associates, Inc., a
                                      Delaware corporation, as sole member

                                  NNA-SAINT BARNABAS, L.L.C., a New Jersey
                                      limited liability company
                                  By: Renex Dialysis Clinic of Woodbury, Inc.,
                                      a Delaware corporation, as sole member

                                  NNA SAINT BARNABAS - NEWARK, L.L.C., a New
                                      Jersey limited liability company

<PAGE>

                                  By: NNA - Saint Barnabas, L.L.C., a New Jersey
                                      limited liability company, as sole member

                                  NNA OF OKLAHOMA, L.L.C., an Oklahoma limited
                                      liability company
                                  By: NNA of Oklahoma, Inc., a Nevada
                                      corporation, as sole member

                                  NNA OF LOUISIANA, LLC, a Louisiana limited
                                      liability company
                                  By: NNA Management Company of Louisiana, Inc.,
                                      as sole member

                                  DOYLESTOWN ACUTE RENAL SERVICES, L.L.C., a
                                      Pennsylvania limited liability company
                                  By: Renex Dialysis Clinic of Doylestown, Inc.,
                                      a Pennsylvania corporation, as sole member

                                  NNA OF NEWARK, L.L.C., a New Jersey limited
                                      liability company
                                  By: Renex Dialysis Clinic of Woodbury, Inc.,
                                      a New Jersey corporation, as sole member

                                  NATIONAL NEPHROLOGY ASSOCIATES OF TEXAS, L.P.,
                                      a Texas limited partnership
                                  By: National Nephrology Associates Management
                                      Company of Texas, Inc., a Texas
                                      corporation, as its general partner

                                  By:____________________________
                                  Name:  Michael N. Cannizzaro
                                  Title: Chairman and Chief Executive Officer

<PAGE>

         The foregoing Purchase Agreement is hereby confirmed and accepted by
the Initial Purchasers as of the date first above written.

BANC OF AMERICA SECURITIES LLC
J.P. MORGAN SECURITIES INC.
RBC DOMINION SECURITIES CORPORATION
HARRIS NESBITT CORP.

By:  Banc of America Securities LLC

By:__________________________
Name:  Bruce Thompson
Title: Managing Director

<PAGE>
                                   SCHEDULE A

<TABLE>
<CAPTION>
                                                                  AGGREGATE
                                                               PRINCIPAL AMOUNT
                                                                 OF SECURITIES
               INITIAL PURCHASERS                               TO BE PURCHASED
               ------------------                               ---------------
<S>                                                            <C>
Banc of America Securities LLC ...........................       $ 78,000,000
J.P. Morgan Securities Inc................................         39,000,000
RBC Dominion Securities Corporation ......................         39,000,000
Harris Nesbitt Corp.......................................          4,000,000

         Total............................................       $160,000,000
</TABLE>

                                      A-1
<PAGE>

                                                                       EXHIBIT A

              SUBSIDIARIES OF NATIONAL NEPHROLOGY ASSOCIATES, INC.

1.       Dialysis Associates Medical Supply, LLC
2.       Dialysis Associates, LLC
3.       Dialysis Services of Atlanta, Inc.
4.       Doylestown Acute Renal Services, L.L.C.
5.       National Nephrology Associates Credit Corporation
6.       National Nephrology Associates Management Company of Texas, Inc.
7.       National Nephrology Associates of Texas, L.P.
8.       NNA Management Company of Kentucky, Inc.
9.       NNA Management Company of Louisiana, Inc.
10.      NNA of Ada, L.L.C.
11.      NNA of Alabama, Inc.
12.      NNA of East Orange, L.L.C.
13.      NNA of Elizabeth, L.L.C.
14.      NNA of Florida, LLC
15.      NNA of Georgia, Inc.
16.      NNA of Harrison, L.L.C.
17.      NNA of Louisiana, LLC
18.      NNA of Memphis, LLC
19.      NNA of Nevada, Inc.
20.      NNA of Newark, L.L.C.
21.      NNA of Oklahoma, Inc.
22.      NNA of Oklahoma, L.L.C.
23.      NNA of Paducah, LLC
24.      NNA of Rhode Island, Inc.
25.      NNA of Toledo, Inc.
26.      NNA Properties of Kentucky, Inc.
27.      NNA Properties of New Jersey, Inc.
28.      NNA Properties of Tennessee, Inc.
29.      NNA Transportation Services Corporation
30.      Renex Corp.
31.      Renex Dialysis Clinic of Amesbury, Inc.
32.      Renex Dialysis Clinic of Bloomfield, Inc.
33.      Renex Dialysis Clinic of Bridgeton, Inc.
34.      Renex Dialysis Clinic of Creve Couer, Inc.
35.      Renex Dialysis Clinic of Doylestown, Inc.
36.      Renex Dialysis Clinic of Maplewood, Inc.
37.      Renex Dialysis Clinic of North Andover, Inc.
38.      Renex Dialysis Clinic of Orange, Inc.
39.      Renex Dialysis Clinic of Penn Hills, Inc.
40.      Renex Dialysis Clinic of Philadelphia, Inc.
41.      Renex Dialysis Clinic of Pittsburgh, Inc.
42.      Renex Dialysis Clinic of Shaler, Inc.

                                      A-1

<PAGE>

43.      Renex Dialysis Clinic of South Georgia, Inc.
44.      Renex Dialysis Clinic of St. Louis, Inc.
45.      Renex Dialysis Clinic of Tampa, Inc.
46.      Renex Dialysis Clinic of Union, Inc.
47.      Renex Dialysis Clinic of University City, Inc.
48.      Renex Dialysis Clinic of Woodbury, Inc.
49.      Renex Dialysis Facilities, Inc.
50.      Renex Dialysis Homecare of Greater St. Louis, Inc.
51.      Renex Management Services, Inc.
52.      NNA-Saint Barnabas, L.L.C.
53.      NNA-Saint Barnabas-Newark, L.L.C.

                                      A-2
<PAGE>
                                                                     EXHIBIT B-1

                  Form of Opinion of Kaye Scholer LLP to be delivered pursuant
to Section 5(c) of the Purchase Agreement.

         (i) The Company is validly existing as a corporation in good standing
under the laws of the State of Delaware.

         (ii) The Company has the corporate power and authority to own, lease
and operate its properties and to conduct its business as described in the
Offering Memorandum and to enter into and perform its obligations under the
Purchase Agreement, the Registration Rights Agreement, the Indenture, the
Securities, the Exchange Securities and the DTC Agreement.

         (iii) Based solely on certificates of public officials and officers of
the Company, including the organizational documents referred to therein, the
Company is duly qualified as a foreign corporation to transact business and is
in good standing in each of the jurisdictions set forth on Schedule 1 hereto.

         (iv) The description of the Company's stock option plan set forth in
the Offering Memorandum fairly describes in all material respects such plan.

         (v) The issuance and sale of the Notes by the Company will not be
subject to any preemptive right, right of first refusal or other similar right
to subscribe for or purchase securities of the Company arising (i) by operation
of the certificate of incorporation or by-laws of the Company or the General
Corporation Law of the State of Delaware, or (ii) under any agreement of the
Company set forth on Schedule 2 hereto (the "Material Agreements").

         (vi) The Purchase Agreement has been duly authorized, executed and
delivered by, and is a valid and binding agreement of, the Company, enforceable
in accordance with its terms, except as rights to indemnification and
contribution thereunder may be limited by applicable law or against public
policy and subject to bankruptcy, insolvency, fraudulent conveyance,
reorganization, moratorium or other similar laws relating to or affecting the
rights and remedies of creditors and by general principles of equity (regardless
of whether considered in a proceeding at law or in equity).

         (vii) The Registration Rights Agreement has been duly authorized,
executed and delivered by, and is a valid and binding agreement of, the Company,
enforceable in accordance with its terms, except as rights to indemnification
and contribution thereunder may be limited by applicable law or against public
policy and subject to bankruptcy, insolvency, fraudulent conveyance,
reorganization, moratorium or other similar laws relating to or affecting the
rights and remedies of creditors and by general principles of equity (regardless
of whether considered in a proceeding at law or in equity).

         (viii) The DTC Agreement has been duly authorized, executed and
delivered by, and is a valid and binding agreement of the Company, enforceable
in accordance with its terms, subject to bankruptcy, insolvency, fraudulent
conveyance, reorganization, moratorium or other similar laws relating to or
affecting the rights and remedies of creditors and by general principles of
equity (regardless of whether considered in a proceeding at law or in equity).

                                     B-1-1
<PAGE>

         (ix) The Indenture has been duly authorized, executed and delivered by
the Company and (assuming the due authorization, execution and delivery thereof
by the Trustee) constitutes a valid and binding agreement of the Company,
enforceable against the Company in accordance with its terms, except as rights
to indemnification and contribution thereunder may be limited by applicable law
or against public policy and subject to bankruptcy, insolvency, fraudulent
conveyance, reorganization, moratorium or other similar laws relating to or
affecting the rights and remedies of creditors and by general principles of
equity (regardless of whether considered in a proceeding at law or in equity).

         (x) The Notes are in the form contemplated by the Indenture, have been
duly authorized by the Company for issuance and sale pursuant to the Purchase
Agreement and the Indenture and, when executed by the Company and authenticated
by the Trustee in the manner provided in the Indenture (assuming the due
authorization, execution and delivery of the Indenture by the Trustee) and
delivered against payment of the purchase price therefor, will constitute valid
and binding obligations of the Company, enforceable against the Company in
accordance with their terms, subject to bankruptcy, insolvency, fraudulent
conveyance, reorganization, moratorium or other similar laws relating to or
affecting the rights and remedies of creditors and by general principles of
equity (regardless of whether considered in a proceeding at law or in equity).

         (xi) The Exchange Notes have been duly and validly authorized for
issuance by the Company.

         (xii) Each of the Purchase Agreement, Registration Rights Agreement and
Indenture is a valid and binding agreement of the Guarantors, enforceable in
accordance with their respective terms, except as rights to indemnification and
contribution thereunder may be limited by applicable law or against public
policy, and subject to bankruptcy, insolvency, fraudulent conveyance,
reorganization, moratorium or other similar laws relating to or affecting the
rights and remedies of creditors and by general principles of equity (regardless
of whether considered in a proceeding at law or in equity).

         (xiii) The Guarantees of the Notes are in the form contemplated by the
Indenture, and, when the Notes have been executed by the Company and
authenticated by the Trustee in the manner provided for in the Indenture and
delivered against payment of the purchase price therefor, will constitute valid
and binding obligations of the Guarantors, enforceable against the applicable
Guarantors in accordance with their terms, subject to bankruptcy, insolvency,
fraudulent conveyance, reorganization, moratorium or other similar laws relating
to or affecting the rights and remedies of creditors and by general principles
of equity (regardless of whether considered in a proceeding at law or in equity)
and will be entitled to the benefits of the Indenture.

         (xiv) The Notes, the Guarantees of the Notes, the Indenture and the
Registration Rights Agreement conform in all material respects to the
descriptions thereof contained in the Offering Memorandum.

         (xv) The statements in the Offering Memorandum under the captions "Risk
Factors - Risks Relating to Our Debt, Including the Notes," "Management -
Employment Agreements and Executive Compensation," "Management - Benefit Plans -
Stock Option Plans," "Description of Notes," "Certain Federal Income Tax
Considerations" and "Notice to Investors," insofar as such statements constitute
matters of law, summaries of legal matters or legal

                                     B-1-2
<PAGE>

conclusions, have been reviewed by us and fairly present, in all material
respects, the matters referred to therein.

         (xvi) No consent, approval, authorization or other order of, or
registration or filing with, any court or other governmental or regulatory
authority or agency of the federal government of the United States or the State
of New York or any court or other governmental or regulatory authority acting
pursuant to the General Corporation Law of the State of Delaware, is required
for the Company's execution, delivery and performance of the Purchase Agreement,
the Registration Rights Agreement, the DTC Agreement or the Indenture or the
issuance and delivery of the Notes, or consummation of the transactions
contemplated thereby, except as may be required under the Securities Act,
Exchange Act, the Trust Indenture Act and applicable state securities or blue
sky laws.

         (xvii) The execution and delivery of the Purchase Agreement, the
Registration Rights Agreement, the DTC Agreement, the Notes and the Indenture by
the Company and the performance by the Company of its obligations thereunder
(other than performance by the Company of its obligations under the
indemnification and contribution sections of such agreements, as applicable, as
to which we render no opinion) (i) will not result in any violation of the
provisions of the certificate of incorporation of by-laws of the Company; (ii)
will not constitute a breach of, or Default or result in the creation or
imposition of any lien, charge or encumbrance upon any property or assets of the
Company pursuant to, with respect to the Company, any material agreements listed
on Schedule I hereto; and (iii) to the best of our knowledge, will not result in
any violation of any law, statute, rule or administrative regulation of the
federal government of the United States or the State of New York or the General
Corporation Law of the State of Delaware which a lawyer exercising customary
professional diligence would reasonably recognize as being directly applicable
to the Company or any subsidiary with respect to transactions contemplated by
the Purchase Agreement, the Registration Rights Agreement, the Indenture and the
Notes. We express no opinion herein as to the applicability or effect of
Healthcare Laws.

         (xviii) To the best of our knowledge, the execution and delivery of
each of the Purchase Agreement, Registration Rights Agreement, Indenture and the
Guarantees of the Notes by the Guarantors and the performance by the Guarantors
of their obligations thereunder (other than performance by the Guarantors of
their obligations under the indemnification and contribution sections of such
agreements, as applicable, as to which we render no opinion) will not result in
any violation of any law, statute, rule or administrative regulation of the
federal government of the United States or the State of New York or the General
Corporation Law of the State of Delaware which a lawyer exercising customary
professional diligence would reasonably recognize as being directly applicable
to the Guarantors with respect to the transactions contemplated by the Purchase
Agreement, the Registration Rights Agreement, the Indenture and the Guarantees
of the Notes.

         (xix) The Company is not, nor after receipt of payment for the
Securities will it be, an "investment company" requiring it to register under
the Investment Company Act.

         (xx) Assuming the accuracy of the representations, warranties and
covenants of the Company, the Guarantors and the Initial Purchasers contained in
the Purchase Agreement, no registration of the Notes or the Guarantees thereof
under the Securities Act, and no qualification of an indenture under the Trust
Indenture Act with respect thereto, is required in connection with the purchase
of the Securities by the Initial Purchasers or the initial resale of the
Securities by the

                                     B-1-3
<PAGE>

Initial Purchasers to Qualified Institutional Buyers or pursuant to Regulation S
under the Securities Act in the manner contemplated by the Purchase Agreement
and the Offering Memorandum other than any registration or qualification that
may be required in connection with the Exchange Offer contemplated by the
Offering Memorandum or in connection with the Registration Rights Agreement. We
need express no opinion, however, as to when or under what circumstances any
Initial Notes initially sold by the Initial Purchasers may be reoffered or
resold.

         (xxi) To our knowledge, other than as described in the Offering
Memorandum, there are no pending or threatened legal or governmental proceedings
to which the Company is a party that would be required to be described by Item
103 of Regulation S-K under the Securities Act if the issuance of the Securities
were being registered under the Securities Act.

         (xxii) None of the sale, issuance, execution or delivery of the
Securities will contravene Regulation T (12 C.F.R. Part 220), Regulation U (12
C.F.R. Part 221) or Regulation X (12 C.F.R. Part 224) of the Board of Governors
of the Federal Reserve System.

                                     B-1-4
<PAGE>
                                                                      SCHEDULE 1

           Jurisdictions Where the Company is Qualified to do Business
                            as a Foreign Corporation

                                    Tennessee

                                      1-1
<PAGE>

                                                                      SCHEDULE 2

                               Material Agreements

1.       Securityholders Agreement, dated as of December 23, 1998, among the
         Company, J.W. Childs Equity Partners II, L.P. and certain other parties
         thereto, as amended by Amendment No. 1 to Securityholders Agreement,
         dated as of January 22, 1999, Amendment No. 2 to Securityholders
         Agreement, dated as of April 30, 1999, and Amendment No. 3 to
         Securityholders Agreement, dated as of February 8, 2002.

2.       Advisory Services Agreement, dated as of December 23, 1998, among J.W.
         Childs Associates, L.P., Credit Agricole Indosuez and the Company.

3.       Employment Agreement, dated as of December 1, 1998, between the Company
         and Jeffrey L. Hymes.

4.       Employment Agreement, dated as of December 1, 1998, between the Company
         and M. Stephen Harrison.

5.       Employment Agreement, dated as of September 1, 1999, between the
         Company and Leif Murphy.

6.       Epogen Freestanding Dialysis Center Agreement, dated April 1, 1998,
         between Amgen Inc. and the Company, as amended by Amendment No. 1 to
         Agreement, dated January 15, 1999, Amendment No. 2 to Agreement, dated
         January 14, 2000, Amendment No. 3 to Agreement, dated March 15, 2000,
         Amendment No. 4 to Agreement, dated February 9, 2001, Amendment No. 5
         to Agreement, dated October 3, 2001, and Amendment No. 6 to Agreement,
         dated September 26, 2002.

7.       Services Agreement, dated as of August 1, 2000, between the Company and
         IMRAC Corporation.

8.       License and Support Agreement, dated as of August 1, 2000, between the
         Company and IMRAC Corporation.

                                      2-1
<PAGE>

                                                                     EXHIBIT B-2

                  Form of Opinion of Baker, Donelson, Bearman, Caldwell &
Berkowitz, PC to be delivered pursuant to Section 5(c) of the Purchase
Agreement.

         (i) Each Guarantor has been duly incorporated and is validly existing
as a corporation, limited liability company or limited partnership, as
applicable, under the laws of the jurisdiction of its incorporation or
formation, and, based solely on certificates of public officials, is in good
standing, as of the respective date of such applicable certificate, under the
laws of the jurisdiction of its incorporation or formation except for such
jurisdictions where the failure to so qualify or to be in good standing would
not, individually or in the aggregate, result in a Material Adverse Change. Each
Guarantor has the corporate, limited liability or partnership power, as
applicable, and corporate, limited liability or partnership authority, as
applicable, to own, lease and operate its properties and to conduct its business
as described in the Offering Memorandum and to enter into and perform its
obligations under the Purchase Agreement, the Registration Rights Agreement, the
Credit Agreement, the Indenture and the Securities. To our knowledge based
solely on certificates of public officials and officers of each Guarantor, each
Guarantor is, as of the respective dates of the applicable certificates, duly
qualified as a foreign corporation, limited liability company or partnership, as
applicable, to transact business and is in good standing in the respective
jurisdictions set forth in Schedule 1 (attached hereto and incorporated herein
by reference), except for such jurisdictions where the failure to so qualify or
to be in good standing would not, individually or in the aggregate, result in a
Material Adverse Change.

         (ii) All of the issued and outstanding capital stock, limited liability
company or partnership interests of each Guarantor has been duly authorized and
validly issued, is fully paid and non-assessable and is owned by the Company,
directly or through subsidiaries, free and clear of any security interest,
mortgage, pledge, lien or encumbrance, except for a pledge under the Company's
Second Amended and Restated Credit Agreement dated as of February 10, 2000, as
amended.

         (iii) The Guarantees of the Notes and the Exchange Notes have been duly
authorized for issuance and sale pursuant to this Agreement and the Indenture
and, at the Closing Date, will have been duly executed by each of the
Guarantors.

         (iv) The Purchase Agreement has been duly authorized, executed and
delivered by each of the Guarantors.

         (v) The Registration Rights Agreement has been duly authorized,
executed and delivered by each of the Guarantors.

         (vi) The Credit Agreement has been duly authorized, executed and
delivered by each of the Guarantors.

         (vii) The Indenture has been duly authorized, executed and delivered by
each of the Guarantors.

         (viii) To our knowledge: (a) the Company and each Guarantor have such
permits, licenses, franchises, certifications, accreditations and authorizations
(collectively, "Authorizations") from all regulatory or governmental officials,
bodies or tribunals as are necessary to own, lease and operate its respective
properties and to conduct its business in the

                                     B-2-1
<PAGE>

manner described in the Offering Memorandum except as would not reasonably be
expected to result in a Material Adverse Change; (b) the Company and each
Guarantor are eligible to participate in the Medicare and Medicaid programs as
and except to the extent described in the Offering Memorandum; (c) the Company
and each Guarantor has fulfilled and performed all of its material obligations
with respect to such Authorizations or eligibility; and (d) except as disclosed
in the Offering Memorandum, no event has occurred which allows, or after notice
or lapse of time would allow, revocation or termination thereof except where
such revocation or termination would not result in a Material Adverse Change.
The opinion rendered in this paragraph (viii) is limited solely to any federal
or Tennessee Healthcare Laws.

         (ix) No consent, approval, authorization or other order of, or
registration or filing with, any governmental or regulatory authority or agency,
or, to our knowledge, any court, of the United States federal government or the
State of Tennessee, is required for any Guarantor's execution, delivery and
performance of the Purchase Agreement, the Registration Rights Agreement, the
DTC Agreement, or the Indenture, as applicable, or the issuance and delivery of
the Guarantees of the Notes, or consummation of the transactions contemplated
thereby and by the Offering Memorandum, except as would not reasonably be
expected to result in a Material Adverse Change and except for any obligations
relating to the execution and performance of the Credit Agreement and any
documents to be delivered thereunder or as may be required under any Healthcare
Laws or the Securities Act, Exchange Act, the Trust Indenture Act, applicable
state securities or blue sky laws, and all rules and regulations promulgated
under such federal and state laws.

         (x) The performance by the Company (solely with respect to clauses (b)
and (c) below) and each of the Guarantors of its obligations under the Purchase
Agreement, the Registration Rights Agreement, the DTC Agreement, the Notes, the
Guarantees of the Notes and the Indenture, as applicable, (other than
performance by the Company or any Guarantor of their indemnification and
contribution obligations under such agreements and any obligations relating to
the execution and performance of the Credit Agreement and any documents to be
delivered thereunder, as to which we render no opinion) (a) will not result in
any violation of the provisions of the certificate of incorporation, by-laws,
operating agreement or limited partnership agreement of such Guarantor; (b) will
not constitute a breach of, or a default (with or without the giving of notice
or lapse of time) of, or result in the creation or imposition of any lien,
charge or encumbrance upon any property or assets of the Company or any
Guarantor pursuant to, its obligations under any of the agreements listed in
Schedule 2 (attached hereto and incorporated herein by reference), except for
such breaches, defaults, liens, charges or encumbrances that either (y) have
been waived or suspended in writing and disclosed in the Offering Memorandum, or
(z) would not reasonably be expected, individually or in the aggregate, to
result in a Material Adverse Change; or (c) to our knowledge, will not result in
any violation of any federal or Tennessee Healthcare Law. No opinion is given
herein with respect to any financial covenants or ratios found in any of the
agreements listed in Schedule 2 for which the review or interpretation of
financial data is necessary in order to determine compliance.

         (xi) The statements in the Offering Memorandum under the captions "Risk
Factors - Risks Relating to Our Business," "Business - Sources of Revenue -
Medicare Reimbursement," "Business - Sources of Revenue - Medicaid
Reimbursement," "Government Regulation," and "Business - Legal Proceedings,"
insofar as such statements constitute matters of law, summaries of legal matters
or legal conclusions, have been reviewed by us and fairly present, in all
material respects, the matters referred to therein and do not omit a material
fact necessary to make the statements contained therein not misleading.
Notwithstanding the foregoing, we render no

                                     B-2-2
<PAGE>

opinion as to financial statements, notes, schedules or other financial data
derived therefrom, that is included in the Offering Memorandum or any amendments
or supplements thereto.

         (xii) Although we are not counsel of record, to our knowledge, the
litigation styled Tomlin v. National Nephrology Associates, Inc., et al. (Case
No: 01-C-1513) filed in the Circuit Court for Davidson County, Tennessee would
not be required to be described by Item 103 of Regulation S-K under the
Securities Act if the issuance of the Securities were being registered under the
Securities Act.

         In addition, we have participated in conferences with officers and
other representatives of the Company and the Guarantors, representatives of the
independent public or certified public accountants for the Company and with
representatives and counsel of the Initial Purchasers at which the contents of
the Offering Memorandum, and any supplements or amendments thereto, and related
matters were discussed and revised. Because of the inherent limitations in the
independent verification of factual matters, and the character of determinations
involved in the preparation of disclosure documents, we are not passing upon,
and do not assume any responsibility for the accuracy, completeness or fairness
of the statements contained in the Offering Memorandum. However, subject to the
foregoing, on the basis of our participation in the conferences referred to
above and our examination of the documents referred to herein and relying upon
facts provided by representatives of the Company, we advise you that nothing has
come to our attention that the Offering Memorandum, as of its date or at the
Closing Date, contained or contains an untrue statement of a material fact or
omitted or omits to state a material fact necessary in order to make the
statements therein, in the light of the circumstances under which they were
made, not misleading (it being understood that we express no belief as to any
financial statements, notes, schedules or other financial data derived
therefrom, that is included in the Offering Memorandum or any amendments or
supplements thereto).

                                     B-2-3
<PAGE>
                                                                      SCHEDULE 1

 Jurisdictions Where Guarantors are Qualified to do Business as a Foreign Entity

National Nephrology Associates Credit Corporation, a Tennessee corporation, is
qualified to do business in Texas

NNA of Georgia, Inc., a Delaware corporation, is qualified to do business in
Georgia

Renex Dialysis Facilities, Inc., a Mississippi corporation, is qualified to do
business in Louisiana

                                      1-1
<PAGE>
                                                                      SCHEDULE 2

                                   Agreements

1.       Asset Purchase Agreement by and between Company, NNA-Saint Barnabas,
         L.L.C., Saint Barnabas Medical Center, Saint Barnabas Outpatient
         Centers, Newark Beth Israel Medical Center, Inc., Monmouth Medical
         Center, Clara Mass Medical Center, and Saint Barnabas Corporation dated
         August 1, 2003

2.       Medical Director Services Agreements for each location listed on p. 45
         of the Offering Memorandum

                                      2-1
<PAGE>
                                                                         ANNEX I

                  Each Initial Purchaser understands that:

         Such Initial Purchaser agrees that it has not offered or sold and will
not offer or sell the Securities in the United States or to, or for the benefit
or account of, a U.S. Person (other than a distributor), in each case, as
defined in Rule 902 under the Securities Act as part of its distribution at any
time and otherwise until 40 days after the later of the commencement of the
offering of the Securities pursuant hereto and the Closing Date, other than in
accordance with Regulation S of the Securities Act or another exemption from the
registration requirements of the Securities Act. Such Initial Purchaser agrees
that, during such 40-day restricted period, it will not cause any advertisement
with respect to the Securities (including any "tombstone" advertisement) to be
published in any newspaper or periodical or posted in any public place and will
not issue any circular relating to the Securities, except such advertisements as
permitted by and include the statements required by Regulation S.

                  Such Initial Purchaser agrees that, at or prior to
confirmation of a sale of Securities by it to any distributor, dealer or person
receiving a selling concession, fee or other remuneration during the 40-day
restricted period referred to in Rule 903 under the Securities Act, it will send
to such distributor, dealer or person receiving a selling concession, fee or
other remuneration a confirmation or notice to substantially the following
effect:

                  "The Securities covered hereby have not been registered under
         the U.S. Securities Act of 1933, as amended (the "Securities Act"), and
         may not be offered and sold within the United States or to, or for the
         account or benefit of, U.S. persons as part of your distribution at any
         time or otherwise until 40 days after the later of the commencement of
         the Offering and the Closing Date, except in either case in accordance
         with Regulation S under the Securities Act (or Rule 144A or to
         Accredited Institutions in transactions that are exempt from the
         registration requirements of the Securities Act), and in connection
         with any subsequent sale by you of the Notes covered hereby in reliance
         on Regulation S during the period referred to above to any distributor,
         dealer or person receiving a selling concession, fee or other
         remuneration, you must deliver a notice to substantially the foregoing
         effect. Terms used above have the meanings assigned to them in
         Regulation S."

                  Such Initial Purchaser agrees that the Securities offered and
sold in reliance on Regulation S will be represented upon issuance by a global
security that may not be exchanged for definitive securities until the
expiration of the 40-day restricted period referred to in Rule 903 of the
Securities Act and only upon certification of beneficial ownership of such
Securities by non-U.S. persons or U.S. persons who purchased such Securities in
transactions that were exempt from the registration requirements of the
Securities Act.

                                      I-1

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