Document:

EXHIBIT 10.15

                            ASSET PURCHASE AGREEMENT

                                  BY AND AMONG

                      MACNEAL HEALTH SERVICES CORPORATION,

                   THE MACNEAL MEMORIAL HOSPITAL ASSOCIATION,

                           MACNEAL HEALTH FOUNDATION,

                             VHS OF ILLINOIS, INC.

                                      AND

                         VANGUARD HEALTH SYSTEMS, INC.

                          DATED AS OF OCTOBER 4, 1999

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                               LIST OF SCHEDULES

Note: Certain of the Schedules have not been completed by the Parties as of the
Effective Date (i.e., those Schedules marked below with an asterisk) but shall
be appended hereto after the Effective Date in accordance with Section 11.01.
All Draft Schedules are to be initially prepared by Sellers, except Schedules
2.01(f), 2.04(k), 4.07, 5.03 and 7.13, which are to be prepared by Buyer.

*Schedule A.................................................Subsidiary Contracts
Schedule B....................................Subsidiary Intellectual Properties
Schedule 1.02...............................................Knowledge of Sellers
Schedule 2.01(a)....................................List of Seller Real Property
Schedule 2.01(b)................................List of Seller Personal Property
Schedule 2.01(d).............................................Other Seller Assets
*Schedule 2.01(f)..............................................Assumed Contracts
*Schedule 2.01(g)...................................List of Permits and Licenses
Schedule 2.01(h)..........................List of Seller Intellectual Properties
*Schedule 2.01(j).....................................List of Seller Investments
*Schedule 2.02(g)...........................Assets Contributed to the Foundation
Schedule 2.02(h)......................................Seller Retained Properties
*Schedule 2.03.......................................Certain Assumed Liabilities
*Schedule 2.04(k).............................................Excluded Contracts
Schedule 3.02.......................Powers; Consents; Absence of Conflicts, Etc.
Schedule 3.04(a)...............Subsidiaries, Investments and Third Party Options
*Schedule 3.04(b).....................Certain Information About the Subsidiaries
*Schedule 3.05...................................Legal and Regulatory Compliance
Schedule 3.06...............................................Financial Statements
*Schedule 3.07...........................................Undisclosed Liabilities
*Schedule 3.08.................................................Recent Activities
*Schedule 3.10..............................List of Subsidiary Personal Property
Schedule 3.11(i).................Permitted Seller Personal Property Encumbrances
*Schedule 3.11(ii)...........Permitted Subsidiary Personal Property Encumbrances
Schedule 3.12(a)(i)............................Certain Real Property Matters - 1
*Schedule 3.12(a)(ii)..........................Certain Real Property Matters - 2
*Schedule 3.12(a)(iii).........................Certain Real Property Matters - 3
Schedule 3.12(d)...............................Certain Real Property Matters - 4
*Schedule 3.12(i)..............................Certain Real Property Matters - 5
Schedule 3.13(a).......................................Environmental Matters - 1
Schedule 3.13(b).......................................Environmental Matters - 2
Schedule 3.13(c).......................................Environmental Matters - 3
Schedule 3.13(d).......................................Environmental Matters - 4
*Schedule 3.14...........Seller Intellectual Properties, Computer Software, Etc.
Schedule 3.15..........................................................Insurance
*Schedule 3.16..............................................Permits and Licenses
Schedule 3.17.........................Government Payment Programs; Accreditation
*Schedule 3.18............................................Terms of the Contracts

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Schedule 3.19........................................Certain Contractual Matters
Schedule 3.21...................................Employees and Employee Relations
Schedule 3.22.............................................Employee Benefit Plans
*Schedule 3.23........................................Litigation and Proceedings
*Schedule 3.24.............................................................Taxes
Schedule 3.25......................................................Medical Staff
Schedule 3.26......................................................Special Funds
Schedule 3.30...............................Operation of the Hospital Businesses
Schedule 4.07......................................Vanguard Financial Statements
Schedule 5.03.....................................Buyer's Employee Benefit Plans
Schedule 5.16....................................Sellers' Indigent Care Policies
Schedule 5.21...........................................Restricted Seller Assets

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                            ASSET PURCHASE AGREEMENT

         THIS ASSET PURCHASE AGREEMENT, made and entered into effective as of
October 4, 1999, is by and among MACNEAL HEALTH SERVICES CORPORATION, an
Illinois not-for-profit corporation ("MHSC"), THE MACNEAL MEMORIAL HOSPITAL
ASSOCIATION, an Illinois not-for-profit corporation ("MacNeal Hospital") (each
individually a "Seller" and collectively the "Sellers"), MACNEAL HEALTH
FOUNDATION, an Illinois not-for-profit corporation (the "Foundation"), VHS OF
ILLINOIS, INC., a Delaware corporation ("Buyer"), and VANGUARD HEALTH SYSTEMS,
INC., a Delaware corporation ("Vanguard").

                              W I T N E S S E T H

         As more particularly described herein, this Agreement provides for the
sale by Sellers to Buyer of substantially all of the assets, real, personal and
mixed, tangible and intangible, owned by Sellers, including the following
Hospital Businesses:

     (1)  MacNeal Hospital, a community hospital located in Berwyn, Illinois
          with 427 licensed acute care beds and 40 licensed skilled nursing
          beds;

     (2)  MacNeal Primary Care Network, a network of primary care physicians
          and facilities;

     (3)  Genesis Clinical Laboratory, a clinical and anatomic pathology
          laboratory; and

     (4)  MacNeal OccHealth Services, an occupational medicine provider.

In addition, this Agreement provides for the sale by Sellers to Buyer of all of
the ownership interests held by Sellers in the following Hospital Businesses:

     (5)  MacNeal Management Services, Inc., (and its partially or wholly-owned
          subsidiaries MacNeal Health Providers, The 6300 West Roosevelt
          Partnership (limited partnership interest), Primary Care Physician
          Center, LLC, MacNeal Renal Lifeline Services and Midwest Claims
          Processing, Inc.);

     (6)  Azron, Inc.;

     (7)  MacNeal/CCP Joint Venture;

     (8)  Berwyn Magnetic Resonance Center, LLC;

     (9)  BHS Digestive Disease Associates (a/k/a Gastro and Liver Specialists
          Joint Venture);

     (10) The 6300 West Roosevelt Partnership (general partnership interest);
          and

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     (11) MacNeal/Daly/Shaw Joint Venture.

         NOW, THEREFORE, for and in consideration of the premises, and the
agreements, covenants, representations and warranties hereinafter set forth,
and other good and valuable consideration, the receipt and adequacy of which
are forever acknowledged and confessed, the Parties, intending to be legally
bound, agree as follows:

   1.   DEFINITIONS AND REFERENCES

     1.01. Definitions: As used in this Agreement, and unless the context
requires a different meaning, the following terms have the meanings given:

                  Accounts Receivable: all accounts receivable of Sellers,
         accrued and unaccrued, including Government Payment Program
         receivables, but excluding all Cost Report settlement receivables and
         amounts due from Affiliates;

                  Adjusted EBITDA: Sellers' earnings before interest, income
         Taxes, depreciation and amortization of the fiscal year ended
         September 30, 1999, prepared in accordance with generally accepted
         accounting principles consistently applied by Sellers, adjusted by
         adding back the following non-recurring transaction-related expenses
         in conjunction with the 1999 fiscal year end close: (i) legal,
         accounting, investment banking and other expenses, (ii) appraisals,
         surveys and other real estate matters, (iii) environmental reports,
         (iv) bank fees, (v) expensed bonuses and related payroll taxes, (vi)
         success and retention bonuses and related payroll Taxes, (vii) due
         diligence costs, (viii) change of control payments and related payroll
         Taxes under employment Contracts, and (ix) acceleration of
         non-qualified deferred compensation expenses and related payroll
         Taxes;

                  ADR: defined in Section 10.03;

                  Affiliate: any Person that, directly or indirectly through
         one or more intermediaries, controls, is controlled by, or is under
         common control with another Person and includes the power to direct or
         cause the direction of the management and policies of a Person,
         whether through the ownership of securities, election or appointment
         of directors, by Contract or otherwise (excluding, in the case of
         Sellers, the Foundation, RMHP Corporation, the RML Partnership and MH
         Insurance Company);

                  Affiliated Group: any affiliated group within the meaning of
         section 1504 of the Code or any similar group defined under a similar
         provision of state, local or foreign law;

                  Agreement: this Asset Purchase Agreement and all Exhibits and
         Schedules attached hereto, as amended, consolidated, supplemented,
         novated or replaced by the Parties from time to time;

                  Alternative Proposal: defined in Section 5.07;

                  Articles: articles of the Agreement;

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                  Assets: the Seller Assets and the Subsidiary Assets;

                  Assumed Contracts: the Seller Contracts listed or described
         on Schedule 2.01(g) and the Immaterial Contracts to which any Seller
         is a party;

                  Assumed Liabilities: (i) current liabilities in Net Working
         Capital, (ii) vacation, holiday and sick leave accumulations of the
         Hired Employees, and related Taxes thereon, (iii) all obligations of
         Sellers arising on or after the Closing Date with respect to any
         period commencing on the Closing Date under the Assumed Contracts,
         (iv) Affiliate Contracts described on Schedule A and Immaterial
         Contracts to which any Subsidiary is a Party, but excluding the
         Excluded Contracts, and (v) the other liabilities and obligations, if
         any, described on Schedule 2.03;

                  Audited Financial Statements: the audited balance sheets of
         MacNeal Hospital and MHP as of September 30, 1998 and 1997, and the
         audited statements of operations, changes in net assets and cash flows
         of MacNeal Hospital and MHP for the fiscal years then ended, together
         with the notes thereto and the report thereon of Arthur Andersen LLP,
         independent certified public accountants;

                  Authorized Individuals: defined in Section 10.02;

                  Buyer: VHS of Illinois, Inc., a Delaware corporation;

                  Buyer's Indemnified Persons: Buyer, Vanguard, and Buyer's and
         Vanguard's stockholders, Affiliates, successors and assigns, and their
         respective stockholders, partners, Affiliates, directors, trustees,
         officers, employees, agents and representatives;

                  Cash Portion of the Purchase Price: defined in Section
         2.05(d);

                  Claim Notice: written notification of a Third Party Claim by
         an Indemnified Party to an Indemnifying Party under Article 9,
         including a Revenue Agent's Report, Statutory Notice of Deficiency,
         Notice of Proposed Assessment, or any other official written notice
         from a Taxing authority that Taxes are due or that a Tax audit will be
         conducted;

                  Closing: defined in Section 8.01;

                  Closing Balance Sheets: the unaudited combined balance sheets
         of MHSC as of the close of business on the day immediately prior to
         the Closing Date;

                  Closing Date: the date as of which the Closing occurs;

                  Closing Documents: all instruments, agreements, certificates
         or other documents executed or delivered by any Party to another Party
         at Closing;

                  Code: the Internal Revenue Code of 1986, as amended;

                  Common Shares: defined in Section 2.05(d);

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                  Common Stock: the common stock, $.01 par value, of Vanguard;

                  Contracts: the Seller Contracts and the Affiliate Contracts;

                  Controlled Group: with respect to any Seller, a group
         consisting of each trade or business (whether or not incorporated)
         which, together with such Seller, would be deemed a "single employer"
         within the meaning of subsections (b), (c), (m) or (o) of section 414
         of the Code;

                  Cost Reports: all cost and other reports filed pursuant to
         the requirements of the Government Payment Programs for payment or
         reimbursement of amounts due from them;

                  Defined Benefit Plan: defined in section 3(35) of ERISA;

                  Draft Schedules: defined in Section 11.01;

                  Effective Date: the date as of which this Agreement was
         entered into by the Parties, as set forth on the first page of this
         Agreement;

                  Employee Benefit Plan: any (1) nonqualified deferred
         compensation or retirement plan or arrangement which is an Employee
         Pension Benefit Plan, (2) qualified defined contribution retirement
         plan or arrangement which is an Employee Pension Benefit Plan
         (including any Multiemployer Plan), (3) qualified defined benefit
         retirement plan or arrangement which is an Employee Pension Benefit
         Plan (including any Multiemployer Plan), or (4) Employee Welfare
         Benefit Plan or material fringe benefit plan or program;

                  Employee Pension Benefit Plan: defined in section 3(2) of
         ERISA;

                  Employee Welfare Benefit Plan: defined in section 3(1) of
         ERISA;

                  Encumbrances: liabilities, levies, claims, charges,
         assessments, mortgages, security interests, liens, pledges,
         conditional sales agreements, title retention contracts, leases,
         subleases, rights of first refusal, options to purchase, restrictions
         and other encumbrances, and agreements or commitments to create or
         suffer any of the foregoing;

                  Environmental Claim: any written notice (or oral notice
         reduced to writing by any Seller) alleging potential liability
         (including potential liability for investigatory costs, cleanup costs,
         Governmental Authority response costs, natural resource damages,
         property damages, personal injuries, or penalties) arising out of,
         based on or resulting from the presence, or release into the
         environment, of any Materials of Environmental Concern at any
         location, whether or not owned by Sellers;

                  Environmental Laws: any and all Legal Requirements relating
         to pollution or protection of human health or the environment
         (including ground water, land surface or subsurface strata), including
         Legal Requirements relating to emissions, discharges, releases or
         threatened releases of Materials of Environmental Concern, or
         otherwise relating to the

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         manufacture, processing, distribution, use, treatment, storage,
         disposal, transport, recycling, reporting or handling of Materials of
         Environmental Concern;

                  ERISA: the Employee Retirement Income Security Act of 1974,
         as amended;

                  ERISA Fiduciary: defined in section 3(21) of ERISA;

                  Escrow Agent: a financial institution acceptable to the
         Parties;

                  Excluded Contracts: the Affiliate Contracts and the other
         Contracts, if any, listed or described on Schedule 2.04(k);

                  Excluded Liabilities: any and all liabilities of any Seller
         or Subsidiary other than the Assumed Liabilities, whether known or
         unknown, fixed or contingent, recorded or unrecorded, and whether
         arising prior to or after Closing;

                  Excluded Seller Assets: defined in Section 2.02;

                  Final Schedules: defined in Section 11.01;

                  Financial Statements: the Audited Financial Statements, MHSC
         Financial Statements, Interim Financial Statements, Interim Closing
         Balance Sheets, Closing Balance Sheets, and the financial statements
         described in Section 5.04(b);

                  Foundation: MacNeal Health Foundation, an Illinois
         not-for-profit corporation;

                  Governmental Authorities: all agencies, authorities, bodies,
         boards, commissions, courts, instrumentalities, legislatures and
         offices of any nature whatsoever of any federal, state, county,
         district, municipal, city, foreign or other government or
         quasi-government unit or political subdivision;

                  Government Payment Programs: federal and state Medicare,
         Medicaid and CHAMPUS programs, and similar or successor programs with
         or for the benefit of Governmental Authorities;

                  Hill-Burton Act: the Public Health Service Act, 42 U.S.C.
         291, et. seq.;

                  Hired Employees: those employees of the Hospital Businesses
         who accept Buyer's offer of employment as of the Closing Date and
         those employees of the Hospital Businesses employed by Buyer under
         written Assumed Contracts;

                  Hospital: MacNeal Hospital, a 467-bed hospital owned and
         operated by MacNeal Hospital and located in Berwyn, Illinois;

                  Hospital Businesses: all businesses owned, leased, managed or
         otherwise operated or conducted by Sellers and the Subsidiaries and
         comprising or used in the operation or management of the business of
         the Hospital, and all other businesses (including outpatient

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         facilities, professional corporations, medical office buildings and
         parking facilities) owned, managed or leased by Sellers or the
         Subsidiaries, other than RMHP Corporation, the RML Partnership, and MH
         Insurance Company;

                  HSR Act: the Hart-Scott-Rodino Antitrust Improvements Act of
         1976, as amended;

                  Immaterial Contracts: Contracts that (i) require the future
         payment by any Seller or Subsidiary of $25,000 or less or the future
         performance by any Seller or Subsidiary of services having a value of
         $25,000 or less, or (ii) are terminable by any Seller or Subsidiary at
         any time without cause upon notice of 90 days or less and that require
         during the period prior to termination the payment of $25,000 or less
         or the future performance of services having a value of $25,000 or
         less, provided that, notwithstanding the foregoing, Immaterial
         Contracts shall not include any Contracts described in paragraphs (a)
         through (h) of Section 3.18;

                  Indemnified Party: any Person entitled to indemnification
         under Article 9;

                  Indemnifying Party: any Person obligated to indemnify another
         Person under Article 9;

                  Indemnity Notice: written notification of a claim for
         indemnity under Article 9, other than a Third Party Claim, made by an
         Indemnified Party to an Indemnifying Party pursuant to Section
         9.05(b);

                  Initiating Party: defined in Section 10.02;

                  Intellectual Properties: Seller Intellectual Properties and
         Subsidiary Intellectual Properties;

                  Interim Closing Balance Sheets: the unaudited individual and
         combined balance sheets of the Hospital Businesses as of the most
         recent month end available prior to the Closing Date;

                  Interim Financial Statements: the unaudited combined balance
         sheets of MHSC as of June 30, 1999, and the unaudited combined
         statements of revenue and expense, cash flow, funded depreciation
         investments, loan compliance and operating statistics report for the
         nine month period ended June 30, 1999;

                  Investments: Sellers' ownership interests in MacNeal/CCP
         Joint Venture, an Illinois general partnership, Berwyn Magnetic
         Resonance Center, LLC, an Illinois limited liability company, and
         shares of capital stock of any corporation other than the
         Subsidiaries, interests in other partnerships or limited liability
         companies, other equity or debt instruments in any other Person, and
         proceeds from the sale after June 30, 1999 of any of the foregoing;

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                  Legal Requirements: with respect to any Person, all statutes,
         ordinances, by-laws, codes, rules, regulations, restrictions, orders,
         judgments, orders, writs, injunctions, decrees, determinations or
         awards of any Governmental Authority having jurisdiction over such
         Person or any of such Person's assets or businesses;

                  Losses: any and all damages, claims, costs, losses (including
         any diminution in value but excluding any diminution in value of the
         investment of one Indemnified Person in another Indemnified Person),
         liabilities, expenses or obligations (including Taxes, interest,
         penalties, court costs, costs of preparation and investigation, and
         attorneys', accountants' and other professional advisors' fees and
         expenses);

                  MacNeal Hospital: The MacNeal Memorial Hospital Association,
         an Illinois not-for-profit corporation;

                  Material Adverse Effect: whether individually or in the
         aggregate, a material adverse effect on the business, assets,
         liabilities, results of operations or financial condition of Sellers
         and the Subsidiaries, taken as a whole;

                  Materials of Environmental Concern: chemicals, pollutants,
         contaminants, wastes (including medical waste), toxic substances,
         petroleum and petroleum products, including hazardous wastes under the
         Resource, Conservation and Recovery Act, 42 U.S.C. ss. 6903 et seq.,
         hazardous substances under the Comprehensive Environmental Response,
         Compensation and Liability Act of 1980, 42 U.S.C. 9601 et seq.,
         asbestos, polychlorinated biphenyls and urea formaldehyde, and
         low-level nuclear materials, special nuclear materials or
         nuclear-byproduct materials, all within the meaning of the Atomic
         Energy Act of 1954 as amended, and any rules, regulations or policies
         promulgated thereunder;

                  MHP: MacNeal Health Providers, an Illinois corporation;

                  MHSC: MacNeal Health Services Corporation, an Illinois
         not-for-profit corporation;

                  MHSC Financial Statements: the unaudited combined balance
         sheets of MHSC as of September 30, 1998 and 1997 and the unaudited
         combined statements of revenue and expenses, cash flows, funded
         depreciation investments, loan compliance and operating statistics
         report;

                  Multiemployer Plan: defined in section 3(37) of ERISA or
         section 4001(a)(3) of ERISA;

                  Multiple Employer Plan: an Employee Pension Benefit Plan
         which is not a Multiemployer Plan and for which a Person who is not a
         member of a Controlled Group that includes any Seller is or has been a
         contributing sponsor;

                  Net Working Capital: the difference between (i) "cash" of MHP
         only, "patient accounts receivable, net of allowances", "receivables
         from affiliates - current portion", "other receivables", "inventories,
         at cost" and usable "prepaid expenses", and (ii) "accounts

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         payable" and "accrued liabilities", but excluding from such
         calculation any Excluded Seller Assets and Excluded Liabilities;

                  Neutral: defined in Section 13.04;

                  Notice Period: defined in Section 9.05(a)(i);

                  Other Plan: any Contract, program or arrangement which
         provides cash or non-cash benefits or perquisites to current or former
         employees of any Seller, but which is not an Employee Benefit Plan;

                  Party: any party to this Agreement, its successors and
         assigns;

                  Party in Interest: a "party in interest" as defined in
         section 3(14) of ERISA, and a "disqualified person" as defined in the
         Code;

                  PBGC: the Pension Benefit Guaranty Corporation;

                  Permitted Personal Property Encumbrances: those Encumbrances
         described in Schedule 3.11 that Buyer elects to assume or take title
         to the Assets subject to at Closing;

                  Permitted Real Property Encumbrances: those Encumbrances
         described in Schedule 3.12 that Buyer elects to assume or take title
         to the Real Property subject to at Closing, including utility
         easements and other customary covenants and restrictions of record
         that do not adversely affect the ownership of the Real Property or the
         conduct of the Hospital Businesses;

                  Person: any individual, company, body corporate, association,
         partnership, firm, joint venture, trust, trustee or Governmental
         Authority;

                  Prohibited Transaction: defined in section 406 of ERISA and
         section 4975 of the Code;

                  Purchase Price: defined in Section 2.05;

                  Purchase Price Adjustment: defined in Section 2.05;

                  Real Property: Seller Real Property and Subsidiary Real
         Property;

                  Reportable Event: defined in section 4043 of ERISA;

                  Responding Party: defined in Section 10.02;

                  Restricted Area: defined in Section 5.08(a);

                  RML Partnership: RML Health Providers, L.P., an Illinois
         limited partnership;

                  Sections: sections of the Agreement;

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                  Securities Act: the Securities Act of 1933, as amended from
         time to time;

                  Seller Assets: all assets, real, personal and mixed, tangible
         and intangible, owned or leased by any Seller and employed in the
         operation of the Hospital Businesses of such Seller as of the
         Effective Date, and arising or acquired between the Effective Date and
         the Closing Date, excluding assets disposed of by Sellers pursuant to
         Section 5.02(e);

                  Seller Contracts: all commitments, contracts, leases,
         licenses, agreements and understandings, written or oral, relating to
         the Seller Assets or the operation of the Hospital Businesses to which
         any Seller is a party or by which it or any of the Seller Assets are
         bound, including agreements with payers, physicians and other
         providers, agreements with health maintenance organizations,
         independent practice associations, preferred provider organizations
         and other managed care plans and alternative delivery systems, joint
         venture and partnership agreements, management, employment, retention
         and severance agreements, vendor agreements, real and personal
         property leases and schedules, maintenance agreements and schedules,
         agreements with municipalities and labor organizations, and bonds,
         mortgages and other loan agreements;

                  Seller Intellectual Properties: all marks, names, trademarks,
         service marks, patents, patent rights, assumed names, logos,
         copyrights, trade secrets and similar intangibles (including variants
         of and applications for the foregoing) used in connection with the
         ownership and operation of the Hospital Business by Sellers as of the
         Effective Date, but not including the name "MacNeal Health
         Foundation";

                  Seller Real Property: all real property owned (legally or
         beneficially) by Sellers and used in the conduct of the Hospital
         Businesses, as more particularly described on Schedule 2.01(a),
         together with all buildings, improvements and fixtures thereon and all
         appurtenances and rights thereto, but excluding the Seller Real
         Property described on Schedule 2.02(h);

                  Sellers: MHSC and MacNeal Hospital;

                  Sellers' Indemnified Persons: Sellers and Sellers' members,
         stockholders, Affiliates, successors and assigns, and their respective
         members, directors, trustees, officers, employees, agents and
         representatives;

                  Shareholders Agreement: the Shareholders Agreement dated as
         of June 1, 1998 among Vanguard and all of its shareholders, which
         includes, without limitation, provisions (i) restricting the sale or
         other disposition of any currently outstanding Common Stock, (e.g.
         rights of first refusal) and (ii) granting customary demand and
         piggy-back registration rights to all current Vanguard shareholders.

                  Signing Schedules: defined in Section 11.01;

                  Submission Date: defined in Section 10.03;

                  Subsidiaries: MacNeal Management Services, Inc., an Illinois
         corporation, Azron, Inc., a California corporation, The 6300 West
         Roosevelt Partnership, an Illinois limited

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         partnership, Primary Care Physicians Center LLC, an Illinois limited
         liability company, Midwest Claims Processing, Inc., an Illinois
         corporation, MacNeal Health Providers, Inc., an Illinois corporation,
         MacNeal Renal Lifeline Services, an Illinois general partnership, BHS
         Digestive Disease Associates, an Illinois general partnership, and
         MacNeal/Daly/Shaw Joint Venture, an Illinois general partnership; -

                  Subsidiary Assets: all assets, real, personal and mixed,
         tangible and intangible, owned or leased by any Subsidiary and
         employed in the operation of the Hospital Businesses of such
         Subsidiaries as of the Effective Date, and arising or acquired between
         the Effective Date and the Closing Date, excluding assets disposed of
         by the Subsidiaries pursuant to Section 5.02(e);

                  Subsidiary Contracts: all commitments, contracts, leases,
         licenses, agreements and understandings, written or oral, relating to
         the Subsidiary Assets or the operation of the Hospital Businesses to
         which any Subsidiary is a party or by which it or any of the
         Subsidiary Assets are bound, including agreements with payers,
         physicians and other providers, agreements with health maintenance
         organizations, independent practice associations, preferred provider
         organizations and other managed care plans and alternative delivery
         systems, joint venture and partnership agreements, management,
         employment, retention and severance agreements, vendor agreements,
         real and personal property leases and schedules, maintenance
         agreements and schedules, agreements with municipalities and labor
         organizations, and bonds, mortgages and other loan agreements;

                  Subsidiary Intellectual Properties: all marks, names,
         trademarks, service marks, patents, patent rights, assumed names,
         logos, copyrights, trade secrets and similar intangibles (including
         variants of and applications for the foregoing) used in connection
         with the ownership and operation of the Hospital Business by the
         Subsidiaries as of the Effective Date, but not including the name
         "MacNeal Health Foundation", including those Intellectual Properties
         listed or described on Schedule B;

                  Subsidiary Real Property: all real property owned (legally or
         beneficially) by the Subsidiaries and used in the conduct of the
         Hospital Businesses, as more particularly described on Schedule
         2.01(a), together with all buildings, improvements and fixtures
         thereon and all appurtenances and rights thereto;

                  Surviving Shareholders Agreement: the Surviving Shareholders
         Agreement dated as of June 1, 1998 hereof among Vanguard and all of
         Vanguard's shareholders which Agreement becomes effective upon
         termination of the Shareholders Agreement and which includes, without
         limitation, provisions (i) restricting the sale or other disposition
         of certain Common Stock and (ii) granting customary demand and
         piggy-back registration rights to all current Vanguard shareholders;

                  Tax: any income, unrelated business income, gross receipts,
         license, payroll, employment, excise, severance, stamp, occupation,
         privilege, premium, windfall profits,

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         environmental (including taxes under section 59A of the Code), customs
         duties, capital stock, franchise, profits, withholding, social
         security, unemployment, disability, real property, personal property,
         stamp, sales, use, transfer, registration, escheat, unclaimed
         property, value added, alternative or add-on minimum, estimated or
         other tax, assessment, charge, levy or fee of any kind whatsoever,
         including payments or services in lieu of Taxes, interest or penalties
         on and additions to all of the foregoing, which are due or alleged to
         be due to any Governmental Authority, whether disputed or not;

                  Tax Return: any return, declaration, report, claim for
         refund, information return or statement, including schedules and
         attachments thereto and amendments, relating to Taxes;

                  Third Party Claim: defined in Section 9.05(a)(i);

                  Vanguard: Vanguard Health Systems, Inc., a Delaware
         corporation;

                  Vanguard Audited Financial Statements: the audited
         consolidated balance sheet of Vanguard and its subsidiaries as of June
         30, 1999, the audited consolidated statement of operations, the
         audited consolidated statement of stockholders' equity, and the
         audited consolidated statement of cash flows for the fiscal year then
         ended, together with the notes thereto and the report thereon of Ernst
         & Young, LLP, independent certified public accountants;

                  Vanguard Financial Statements: the Vanguard Audited Financial
         Statements and the Vanguard Interim Financial Statements; and

                  Vanguard Interim Financial Statements: the consolidated
         balance sheet, consolidated statement of operations and consolidated
         statement of cash flows of Vanguard and its subsidiaries as of and for
         the one month ended July 31, 1999.

         1.02. Certain References. As used in this Agreement, and unless the
context requires otherwise:

                           (a) references to "include" or "including" mean
                  including without limitation;

                           (b) references to "partners" include general and
                  limited partners of partnerships and members of limited
                  liability companies;

                           (c) references to "partnerships" include general and
                  limited partnerships, joint ventures and limited liability
                  companies;

                           (d) references to any document are references to
                  that document as amended, consolidated, supplemented, novated
                  or replaced by the parties thereto from time to time;

                                      11
<PAGE>

                           (e) references to any law are references to that law
                  as amended, consolidated, supplemented or replaced from time
                  to time and all rules and regulations promulgated thereunder;

                           (f) references to time are references to central
                  time;

                           (g) references in this Agreement to the "knowledge"
                  of Sellers or variants thereof (including "best knowledge")
                  mean the actual knowledge of each of the Persons whose names
                  or titles are set forth in Schedule 1.02, after due inquiry
                  by Sellers of such Persons, but no further inquiry by such
                  Persons;

                           (h) the gender of all words includes the masculine,
                  feminine and neuter, and the number of all words includes the
                  singular and plural; and

                           (i) the Table of Contents, the division of this
                  Agreement into Articles and Sections, and the use of captions
                  and headings in connection therewith are solely for
                  convenience and shall have no legal effect in construing the
                  provisions of this Agreement.

        2.       SALE OF SELLER ASSETS AND RELATED MATTERS

         2.01. Sale of Seller Assets. Subject to the terms and conditions of
this Agreement, at Closing Sellers shall sell, assign, convey, transfer and
deliver to Buyer, or cause to be sold, assigned, conveyed, transferred and
delivered to Buyer, and Buyer shall purchase the Seller Assets, free and clear
of all Encumbrances other than the Permitted Real Property Encumbrances and the
Permitted Personal Property Encumbrances, including the following:

                           (a) the Seller Real Property described in Schedule
                  2.01(a) and all claims to and interests in other real
                  property, recorded or unrecorded used or to be used in the
                  conduct of the Hospital Businesses;

                           (b) all major, minor or other equipment (including
                  medical and computer equipment, vehicles, furniture and
                  furnishings and other tangible personal properties owned by
                  Sellers and used in the conduct of the Hospital Businesses,
                  including those listed in Schedule 2.01(b);

                           (c) all current assets of Sellers included in Net
                  Working Capital;

                           (d) such other current assets of Sellers on the
                  Closing Balance Sheets, if any, as are identified on Schedule
                  2.01(d);

                           (e) all financial, patient, medical staff, personnel
                  and other records of Sellers (including equipment records,
                  medical/administrative libraries, medical records, documents,
                  catalogs, books, records, files and operating manuals);

                                      12

<PAGE>

                           (f) Seller's right, title and interest in the
                  Assumed Contracts listed or described on Schedule 2.01(f) and
                  the other Immaterial Contracts to which any Seller is a
                  party;

                           (g) all licenses, permits and other approvals
                  (including pending approvals) of Governmental Authorities, to
                  the extent assignable, relating to the ownership, development
                  and operation of the Hospital Businesses, including the
                  licenses and permits described on Schedule 2.01(g);

                           (h) all Seller Intellectual Properties and all
                  software, hardware, application programs and similar systems
                  licensed for use in the Hospital Businesses, including those
                  described in Schedule 2.01(h);

                           (i) all property, real, personal or mixed, tangible
                  or intangible, arising or acquired between the Effective Date
                  and the Closing Date owned or leased by Sellers, other than
                  the Excluded Seller Assets;

                           (j) Sellers' right, title and interest in and to the
                  Subsidiaries, and the other Investments relating to the
                  Hospital Businesses described on Schedule 2.01(j);

                           (k) all insurance proceeds (including applicable
                  deductibles, copayments or self insured requirements) arising
                  in connection with damage to the Assets occurring prior to
                  the Closing Date, to the extent not expended for the repair
                  or restoration of the Assets;

                           (l) general intangibles of the Hospital Businesses,
                  including goodwill of Sellers and the names "MacNeal",
                  "MacNeal Hospital", MacNeal Health Network" and "MacNeal
                  Health Providers";

                           (m) claims of Sellers against third parties relating
                  to the Seller Assets, choate or inchoate, known or unknown,
                  contingent or otherwise, but excluding such claims relating
                  to Excluded Liabilities; and

                           (n) all proceeds of the foregoing and all other
                  property of every kind, character or description, tangible
                  and intangible, known or unknown, owned or leased by Sellers,
                  wherever located and whether or not reflected on the
                  Financial Statements or similar to the properties described
                  above.

         2.02. Excluded Seller Assets. Notwithstanding the generality of
Section 2.01, the following assets (the "Excluded Seller Assets") are not a
part of the sale and purchase contemplated by this Agreement and are excluded
from the Seller Assets:

                           (a) any records of the Hospital which by law Sellers
                  are required to retain in their possession;

                                      13

<PAGE>

                           (b) all cash, cash equivalents (other than the cash
                  and cash equivalents of MHP and cash described in Section
                  5.21), funds held by trustee (including funds held in
                  self-insurance trusts), and cost report settlements;

                           (c) inventory and supplies disposed of or exhausted
                  after the Effective Date and prior to the Closing Date in the
                  ordinary course of the Hospital Businesses, and Seller Assets
                  transferred or disposed of in accordance with Section
                  5.02(e);

                           (d) Cost Report settlement receivables, and all
                  appeals and appeal rights relating thereto;

                           (e) all funds held by trustees pursuant to bond
                  indentures of Sellers;

                           (f) all membership, ownership or investment
                  interests of any Seller in any other Seller, in the
                  Foundation and, subject to Section 2.05(h), in the RML
                  Partnership;

                           (g) all assets and properties to be contributed by
                  Sellers to the Foundation, which are listed or described on
                  Schedule 2.02(g);

                           (h) the real estate and improvements, if any,
                  described on Schedule 2.02(h);

                           (i) any asset that would revert to Seller or a
                  Subsidiary as employer upon the termination of any Employee
                  Benefit Plan, including assets representing a surplus or
                  overfunding of any Employee Benefit Plan;

                           (j) all claims, rights, interests and proceeds with
                  respect to refunds of Taxes (including property taxes) with
                  respect to periods ending on or prior to the Closing Date,
                  and the right to pursue appeals of same;

                           (k) all restricted assets listed on Schedule 5.21;
                  and

                           (l) any other assets identified in this Agreement as
                  Excluded Seller Assets or excluded by mutual written
                  agreement of the Parties.

         2.03. Assumed Liabilities. As of the Closing Date, Buyer shall assume
the Assumed Liabilities.

         2.04. Excluded Liabilities. The Parties acknowledge and agree that the
sale to Buyer of the Subsidiary Assets has been structured for the benefit of
Sellers as a sale of Sellers' direct or indirect ownership interests in the
Subsidiaries, that by operation of law as a result of such sale Buyer will
assume liabilities of the Subsidiaries which the Parties do not intend for
Buyer to assume or be responsible and that, as among the Parties, such
liabilities shall not constitute Assumed Liabilities but shall be Excluded
Liabilities. Under no circumstance shall Buyer assume or be obligated to pay,
and none of the Seller Assets or Subsidiary Assets shall be or become liable
for or

                                      14

<PAGE>

subject to any of the Excluded Liabilities, including the following, which
shall be, become and remain liabilities of Sellers:

                           (a) all liabilities accrued on the Closing Balance
                  Sheets other than those included in Net Working Capital;

                           (b) liabilities or obligations of Sellers or the
                  Subsidiaries for Taxes in respect of periods ending on or
                  prior to the Closing Date or resulting from the consummation
                  of the transactions contemplated herein;

                           (c) liabilities or obligations associated with any
                  Excluded Seller Assets arising with respect to or otherwise
                  attributable to any Excluded Seller Assets;

                           (d) the outstanding principal amount of, any accrued
                  but unpaid interest on, or expenses arising with respect to
                  any and all indebtedness of Sellers or the Subsidiaries for
                  borrowed money;

                           (e) liabilities or obligations arising under any
                  Assumed Contract before the Closing Date or resulting from
                  any breach or default by any Seller or Subsidiary prior to
                  the Closing Date of any Assumed Contracts or other Assumed
                  Liabilities, liabilities arising out of the assignment to
                  Buyer at Closing of any Assumed Contract, and liabilities
                  arising under any Contracts not assumed by Buyer;

                           (f) liabilities or obligations arising out of or in
                  connection with claims, litigation or proceedings described
                  in Schedule 3.23, and claims, litigation and proceedings
                  (whether instituted prior to or after Closing) for acts or
                  omissions which allegedly occurred prior to the Closing Date,
                  including litigation and other actions related to all peer
                  review activities at the Hospital Businesses prior to the
                  Closing Date;

                           (g) liabilities or obligations under the Hill-Burton
                  Act or other restricted grant or loan programs;

                           (h) except to the extent included in Net Working
                  Capital on the Closing Balance Sheets and assumed by Buyer
                  with a Purchase Price credit pursuant to Section 2.05(c),
                  liabilities or obligations to Sellers' employees, Employee
                  Benefit Plans, the Internal Revenue Service, PBGC or any
                  other Governmental Authority, arising from or relating to
                  periods prior to Closing (whether or not triggered by the
                  transactions contemplated by this Agreement), including
                  liabilities or obligations arising under any Employee Benefit
                  Plan, EEOC claim, unfair labor practice, and wage and hour
                  practice;

                           (i) Cost Report settlement payables relating to all
                  Cost Report periods ending on or before the Closing Date;

                                      15
<PAGE>

                           (j) penalties, fines, settlements, interest, costs
                  and expenses arising out of or incurred as a result of any
                  actual or alleged violation by any Seller of any Legal
                  Requirement; and

                           (k) the Excluded Contracts listed on Schedule
                  2.04(k).

         2.05. Purchase Price; Purchase Price Adjustment.

                           (a) Subject to the terms and conditions of this
                  Agreement, in reliance upon the representations, warranties
                  and covenants of Sellers herein set forth, and as
                  consideration for the sale and purchase of the Assets, at
                  Closing, Buyer shall assume the Assumed Liabilities and shall
                  tender to Sellers as the purchase price (the "Purchase
                  Price") Two Hundred Nine Million, Nine Hundred Ninety Nine
                  Thousand, Five Hundred Thirty Six and Four/100 Dollars
                  ($209,999,536.04), provided that if the Adjusted EBITDA for
                  the fiscal year ending September 30, 1999 is less than
                  $23,000,000, then Sellers and the Foundation shall pay Buyer
                  the amount determined as follows: (i) $23,000,000 minus the
                  Adjusted EBITDA for the fiscal year ending September 30,
                  1999, times (ii) seven.

                           (b) [Intentionally Omitted]

                           (c) No more than five business days prior to the
                  Closing Date, Buyer and Sellers shall agree on the value of
                  prepaid expenses and "other current assets" in Net Working
                  Capital in respect of which Buyer will receive an economic
                  benefit.

                           (d) Buyer shall pay to Sellers and the Foundation at
                  Closing an amount (the "Cash Portion of the Purchase Price")
                  equal to the Purchase Price minus (i) the net book value as
                  of the Closing Date of any long-term indebtedness or
                  capitalized lease obligations of Sellers (including the
                  current portions thereof) that Buyer may agree to assume at
                  Closing, and (ii) all vacation, holiday and sick leave
                  accumulations of the Hired Employees, and related Taxes
                  thereon to the extent not included in Net Working Capital
                  which liabilities will be assumed by Buyer at Closing and
                  (iii) $9,999,536.04, payable in shares of Common Stock of
                  Vanguard (valued by Buyer at the same price per share as is
                  paid by Vanguard's shareholders in connection with the
                  Closing) (the "Common Shares").

                           (e) The Purchase Price shall be calculated by Buyer
                  and Sellers at Closing from the relevant entries in the
                  Interim Closing Balance Sheets (as adjusted to reflect the
                  matters discussed in Section 2.05(c)) and estimates of fees,
                  expenses and other items as of the Closing Date. If the Net
                  Working Capital on the Interim Closing Balance Sheets is less
                  than $26,527,000, Sellers shall deliver to Buyer cash in an
                  amount equal to the difference between $26,527,000 and the
                  Net Working Capital on the Interim Closing Balance Sheets. If
                  the Net Working Capital on the Interim Closing Balance Sheets
                  is greater than $26,527,000, Buyer shall deliver to Sellers
                  cash in an amount equal to the difference between the Net
                  Working Capital on the Interim Closing Balance Sheets and
                  $26,527,000. Within 60 days after the Closing Date, Sellers
                  will deliver to Buyer the Closing Balance Sheets, prepared in

                                      16
<PAGE>

                  accordance with generally accepted accounting principles
                  consistently applied and including the balance sheets of the
                  Hospital Businesses owned by Sellers, and the Net Working
                  Capital shall be recalculated to reflect the difference
                  between the Net Working Capital on the Interim Closing
                  Balance Sheets and on the Closing Balance Sheets (the
                  "Purchase Price Adjustment"), provided that such
                  recalculation shall be dollar-for-dollar in the differences
                  between such balance sheets and no consideration in the
                  recalculations shall be given to the fact that under
                  generally accepted accounting principles consistently applied
                  a materiality standard applies to such Financial Statements.
                  If Buyer disputes any entry in the Closing Balance Sheets
                  relevant to the calculation of the Purchase Price Adjustment,
                  and/or disputes the value of the inventory and supplies, and
                  such dispute is not resolved to the mutual satisfaction of
                  Sellers and Buyer within 90 days after the Closing Date,
                  Sellers and Buyer each shall have the right to require that
                  such dispute be submitted to Ernst & Young, or to such other
                  certified public accounting firm as Sellers and Buyer may
                  then mutually agree upon in writing, in either case acting as
                  experts and not as arbitrators to resolve the computation or
                  verification of the disputed Closing Balance Sheets entries
                  in accordance with the provisions of this Agreement and
                  otherwise where applicable in accordance with generally
                  accepted accounting principles applied on a consistent basis.
                  The fees and expenses of any such submission to an accounting
                  firm shall be split 50/50 between Sellers and Buyer.

                           (f) The Common Shares issuable as part of the
                  Purchase Price shall be issued at Closing to the Foundation
                  and Buyer shall issue and deliver a stock certificate at
                  Closing to the Foundation evidencing its ownership of the
                  Common Shares, subject to the legends required by the
                  Shareholders Agreement and Surviving Shareholders Agreement.
                  The Cash Portion of the Purchase Price payment required by
                  this Section shall be paid as follows: (i) $100,000,000 shall
                  be paid to the Foundation by wire transfer of immediately
                  available funds; and (ii) the balance of the Purchase Price
                  shall be paid by wire transfer of immediately available funds
                  to an account or accounts designated by Sellers, and the
                  Parties shall execute such receipts or other acknowledgments
                  as are reasonably necessary to evidence payment of the
                  Purchase Price. Sellers shall pay Buyer, or Buyer shall pay
                  Sellers, as the case may be, the Purchase Price Adjustment,
                  if any, within five business days after its determination.

         2.06. Prorations. At Closing, and to the extent not included in Net
Working Capital, Buyer and Sellers shall prorate real estate and personal
property lease payments, real estate and personal property Taxes and other
assessments, and all other income and expenses (including utilities) with
respect to the Hospital Businesses which are normally prorated upon a sale of
assets of a going concern, provided that if, as a result of the transactions
contemplated by this Agreement, Sellers become liable for real estate or
personal property Taxes for which Sellers otherwise would be exempt, such Taxes
shall not be prorated but shall be paid by Buyer. If any payment in lieu of
Taxes made by Sellers prior to Closing is credited against real estate Taxes
for which Buyer will be liable, the amount of such credit will be paid to
Sellers upon its receipt by Buyer.

   3.   REPRESENTATIONS AND WARRANTIES OF SELLERS

                                      17
<PAGE>

         Each Seller makes the following representations and warranties to
Buyer and Vanguard on and as of the Effective Date, subject to the Schedules
attached hereto and incorporated by reference herein. Each Seller shall be
deemed to make such representations and warranties again at and as of the
Closing Date:

         3.01. Organization. Each Seller is duly organized and validly existing
in good standing under the laws of the State in which it is incorporated. None
of the Sellers is licensed, qualified or admitted to do business in any
jurisdiction other than the State in which it is incorporated in which the
ownership, use or leasing of any of their respective assets or properties, or
the conduct or nature of their respective businesses, makes such licensing,
qualification or admission necessary.

         3.02. Powers; Consents; Absence of Conflicts, Etc. Each of the Sellers
has the requisite power and authority to conduct its businesses as now being
conducted, to enter into this Agreement and to perform its obligations
hereunder (the board of directors of each of the Sellers having approved their
execution of this Agreement and the sale of the Seller Assets to Buyer
hereunder) and, except as described in Schedule 3.02, the execution, delivery
and performance by each of the Sellers of this Agreement and the Closing
Documents and the consummation of the transactions contemplated herein:

                  (a) are within such Seller's corporate powers, are not in
         contravention of any material Legal Requirement or of the terms of its
         articles of incorporation, bylaws and other governing documents, if
         any, as amended to date, and have been duly authorized by all
         appropriate corporate and member action;

                  (b) do not conflict with, result in any breach or
         contravention of, or permit the acceleration of the maturity of, any
         material liabilities of any Seller or Subsidiary (other than Excluded
         Liabilities), and do not create or permit the creation of any
         Encumbrance on or affecting any of the Assets;

                  (c) do not violate any Legal Requirement to which any of the
         Sellers or the Assets may be subject (including any bulk transfer or
         similar law); and

                  (d) do not conflict with or result in a material breach or
         violation of any Contract to which any Seller or Subsidiary is a party
         or by which it is bound (other than Excluded Liabilities).

         3.03. Binding Agreement. This Agreement and each of the Closing
Documents to which each of the Sellers is or becomes a party are (or upon
execution will be), assuming due and valid execution by Buyer, valid and
legally binding obligations of such Seller, enforceable against such Seller in
accordance with the respective terms hereof or thereof, except as
enforceability may be restricted, limited or delayed by applicable bankruptcy
or other laws affecting creditors' rights generally and except as
enforceability may be subject to general principles of equity.

         3.04. Subsidiaries and Third Party Rights.

                                      18

<PAGE>

                  (a) Except as described in Schedules 3.04(a) and 3.04(b), no
         Affiliate of any Seller conducts any Hospital Businesses, Sellers have
         no subsidiaries or equity interests in any Persons that conduct any
         Hospital Businesses, and none of the Foundation, RMHP Corporation and
         the RML Partnership conduct, or own or control any assets used in the
         conduct of, the Hospital Businesses. Except for the Investments and
         the other instruments described on Schedule 2.01(j), Sellers hold no
         Investments that are recorded as assets of the Hospital Businesses.
         There are no Contracts with, or rights of, any Person to acquire,
         directly or indirectly, any material Assets, or any interest therein.

                  (b) Each of the Subsidiaries that is a corporation is duly
         organized, validly existing and in good standing under the laws of the
         State of Illinois. Each of the Subsidiaries that is a limited
         liability company is duly organized, validly existing and in good
         standing under the laws of the State of Illinois. Each of the
         Subsidiaries that is a general or limited partnership is duly
         organized, validly existing and in good standing under the laws of the
         State of Illinois. All shares of capital stock or other beneficial
         interests of each of the Subsidiaries are owned beneficially and of
         record by Sellers or another Subsidiary, as specified in Schedule
         3.04(b). Each of the Subsidiaries is duly licensed, qualified or
         admitted to do business and is in good standing in the jurisdictions
         specified in Schedule 3.04(b) and such jurisdictions are the only
         jurisdictions in which the ownership, use or leasing of such Person's
         assets or properties, or the conduct or nature of its business, makes
         such licensing, qualification or admission necessary. The information
         concerning each Subsidiary set forth on Schedule 3.04(b) is complete
         and accurate in all respects. Complete and genuine copies of the
         articles or certificate of incorporation, bylaws and all other
         agreements, instruments and documents relating to the creation and
         governance of each of the Subsidiaries have been provided to Buyer.

                  (c) The minute books and other similar records each of the
         Subsidiaries have been made available to Buyer prior to the Effective
         Date and contain a true, correct and complete record of all action
         taken at all meetings, and by all written consents in lieu of
         meetings, of the stockholders, the board of directors and committees
         of the board of directors of such Person. The stock transfer ledgers
         and other similar records of each of the Subsidiaries have been made
         available to Buyer, are true, correct and complete, and accurately
         reflect all transactions in the capital stock of such Person.

                  (d) All outstanding shares of capital stock of each of the
         Subsidiaries that are corporations are duly authorized, validly
         issued, outstanding, fully paid and non-assessable. Sellers own the
         shares beneficially and of record, free and clear of all Encumbrances.
         Sellers have full voting power over the shares, subject to no proxy,
         shareholders' agreement, voting trust or other agreement relating to
         the voting of any of the shares.

                  (e) Except as described on Schedule 2.01(g), there are no
         outstanding securities, rights, subscriptions, warrants, calls,
         options, "phantom" stock rights or (except for this Agreement) other
         Contracts of any kind that give any Person (other than a Seller prior
         to Closing) the right to (i) purchase or otherwise receive or be
         issued any shares of capital stock of any Subsidiary or any security
         or liability of any kind convertible into or exchangeable for any such
         shares of any Subsidiary, (ii) receive any benefits or rights similar
         to any rights

                                      19
<PAGE>

         enjoyed by or accruing to the holder of shares of capital stock of any
         Subsidiary, or (iii) participate in the equity, income or election of
         directors or officers of any Subsidiary. Other than this Agreement and
         except as described on Schedule 2.01(g), there is no Contract between
         any Seller and any Person with respect to the disposition of the
         shares of any Subsidiary.

         3.05. Legal and Regulatory Compliance. Except as described in Schedule
3.05, each Seller and each Subsidiary is in compliance with all Legal
Requirements, and has timely filed all reports, data and other information
required to be filed with Governmental Authorities, except where a failure to
be in compliance or file timely would not have a Material Adverse Effect.
Except as described on Schedule 3.05, no Seller and no Subsidiary has received
notice from any Person of any proceeding or investigation by Governmental
Authorities alleging or based upon a violation of any Legal Requirements that
(i) is currently pending or (ii) if not currently pending, would not otherwise
have a Material Adverse Effect. To the knowledge of Sellers, no Seller and no
Subsidiary is threatened by any Person with, any proceeding or investigation by
Governmental Authorities alleging a violation of any Legal Requirements.

         3.06. Financial Statements. Attached as Schedule 3.06 are copies of
the Audited Financial Statements, the MHSC Financial Statements, and the
Interim Financial Statements. The Financial Statements fairly present the
financial condition and results of operations of the Hospital Businesses as of
the respective dates thereof and for the periods therein referred to, all in
accordance with generally accepted accounting principles, subject, in the case
of the Interim Financial Statements and Closing Balance Sheets, to normal
recurring year-end adjustments (the effect of which will not, individually or
in the aggregate, be materially adverse) and the absence of notes (which, if
presented, would not differ materially from those included in the Audited
Financial Statements); and the Financial Statements reflect the consistent
application of such accounting principles throughout the periods involved. All
Subsidiaries other than MMSI are accounted for by Sellers in the Financial
Statements using the equity method (as such term is defined by generally
accepted accounting principles).

         3.07. Undisclosed Liabilities. To the knowledge of Sellers, Schedule
3.07 contains an accurate description of all material liabilities of Sellers
and the Subsidiaries not included in the Audited Financial Statements, whether
accrued, absolute, contingent or otherwise, except (i) liabilities incurred in
the ordinary course of business since the date of the Audited Financial
Statements and (ii) other liabilities disclosed in the Schedules.

         3.08. Recent Activities. Except as described in Schedule 3.08 since
June 30, 1999:

                  (a) no material adverse change has occurred in the financial
         condition, assets, liabilities (contingent or otherwise), working
         capital reserves, income or prospects of the Hospital Businesses,
         taken as a whole;

                  (b) no material damage, destruction or loss (whether or not
         covered by insurance) has occurred affecting the Assets;

                                      20
<PAGE>

                  (c) except in the ordinary course of the Hospital Businesses
         in accordance with existing Hospital personnel policies or otherwise
         disclosed on Schedule 3.18, no Seller or Subsidiary has increased or
         agreed to increase the compensation payable to any of the employees or
         agents of the Hospital Businesses or made or agreed to make any bonus
         or severance payment to any of the employees or agents of the Hospital
         Businesses, and no Seller or Subsidiary has employed any additional
         management personnel in respect of the Hospital Businesses;

                  (d) no labor dispute, enactment of state or local law,
         promulgation of state or local regulation, or other event or condition
         has occurred materially adversely affecting any of the Hospital
         Businesses;

                  (e) no Seller or Subsidiary has sold, assigned, transferred,
         distributed or otherwise disposed of any of the Assets, except in the
         ordinary course of the Hospital Businesses;

                  (f) no Encumbrance has been imposed on any of the Assets;

                  (g) no Seller or Subsidiary has canceled or waived any rights
         in respect of the Assets, except in the ordinary course of the
         Hospital Businesses;

                  (h) there has been no change in any accounting method, policy
         or practice of any Seller or Subsidiary with respect to the Hospital
         Businesses;

                  (i) other than compensation paid in the ordinary course of
         employment, no Seller or Subsidiary has paid any amount to, sold any
         Assets to, or entered into any Contract with, any officer, director,
         trustee, shareholder, partner or member of any Seller or Subsidiary,
         or any Affiliate of any such Person or of any Seller or Subsidiary;

                  (j) no Seller or Subsidiary has paid or agreed to pay to any
         Person damages, fines, penalties or other amounts in respect of actual
         or alleged violation of any Legal Requirement;

                  (k) no Seller or Subsidiary has terminated, amended or
         otherwise modified any Employee Benefit Plan or Other Plan, except for
         amendments required to comply with applicable Legal Requirements; and

                  (l) no Seller or Subsidiary has entered into or agreed to
         enter into any transaction outside the ordinary course of the Hospital
         Businesses which may cause a liability or obligation in excess of
         $10,000.

          3.09.    Accounts Receivable; Inventory.

                                      21
<PAGE>

                  (a) The Accounts Receivable, to the extent uncollected, are
         valid and existing and represent monies due for goods sold and
         delivered and services performed in bona fide commercial transactions
         and are not subject to any Encumbrances; there are no refunds,
         discounts or setoffs payable or assessable with respect to the
         Accounts Receivable not reflected in the Financial Statements.

                  (b) All Assets consisting of inventory and supplies are
         carried at cost on a first-in, first-out basis and are properly stated
         in the Audited Financial Statements as of the dates thereof. All items
         of inventory and supplies on hand consist of items of a quality usable
         or saleable in the ordinary course of business, except for those items
         which are obsolete, below standard quality or in the process of repair
         and for which adequate reserves have been provided in the Financial
         Statements. The quantities of all inventory and supplies are
         reasonable and justified under the normal operations of the Hospital
         Businesses.

         3.10. Equipment. Schedule 2.01(b) is a depreciation schedule as of the
date set forth therein that, to Sellers' best knowledge, takes into
consideration all the equipment associated with, or constituting any part of,
the Seller Assets. Schedule 3.10 is a depreciation schedule as of the date set
forth therein that, to Sellers' best knowledge, takes into consideration all
the equipment associated with, or constituting any part of, the Subsidiary
Assets. Since June 30, 1999, no Seller or Subsidiary has sold or otherwise
disposed of any equipment of the Hospital Businesses having an original cost in
excess of $5,000 except with a comparable replacement thereof. To Sellers'
knowledge, all equipment used in the operations of the Hospital Businesses,
whether reflected in the Financial Statements or otherwise, is well maintained
and in good operating condition, except for reasonable wear and tear. All
medical and leased equipment has been maintained in accordance with
manufacturer and lessor requirements, and maintenance logs or journals have
been maintained in the ordinary course of business at all times.

         3.11. Title to Personal Property. Sellers own and hold good and valid
title or leasehold title to all Seller Assets other than the Seller Real
Property, free and clear of any Encumbrances other than the Encumbrances
described in Schedule 3.11(i) and the Subsidiaries own and hold, and at Closing
will own and hold, good and valid title or leasehold title to all Subsidiary
Assets other than the Subsidiary Real Property, free and clear of any
Encumbrances other than the Encumbrances described in Schedule 3.11(ii). At
Closing Sellers will convey to Buyer good and valid title to all Seller Assets
other than the Seller Real Property, free and clear of any Encumbrances other
than the Permitted Personal Property Encumbrances.

         3.12. Real Property.

                  (a) Sellers own fee simple or leasehold title (as the case
         may be) to the Real Property described in Schedule 2.01(a), together
         with all buildings, improvements and fixtures thereon and all
         appurtenances and rights thereto, free and clear of any Encumbrances
         other than the Encumbrances described in Schedule 3.12(a)(i).
         Subsidiaries own fee simple or leasehold title (as the case may be) to
         the Real Property described in Schedule 3.12(a)(ii), together with all
         buildings, improvements and fixtures thereon and all appurtenances and
         rights thereto, free and

                                      22

<PAGE>

         clear of any Encumbrances other than the Encumbrances described in
         Schedule 3.12(a)(iii).

                  (b) The Real Property comprises all of the real property
         owned or leased by Sellers and the Subsidiaries which is associated
         with or employed in the operation of the Hospital Businesses.

                  (c) At Closing Sellers will convey to Buyer good and
         marketable fee simple or leasehold title (as the case may be) to the
         Seller Real Property, free and clear of any Encumbrances other than
         the Permitted Real Property Encumbrances.

                  (d) Except as described on Schedule 3.12(d), to Sellers'
         knowledge, the buildings standing on the Real Property are in a state
         of good condition and repair, are structurally sound, and in need of
         no maintenance or repairs except for ordinary, routine maintenance.

                  (e) No Seller or Subsidiary has received notice of
         condemnation or similar proceeding relating to the Real Property or
         any part thereof.

                  (f) To Sellers' knowledge, no part of the Real Property
         contains, is located within or abuts any flood plain, navigable water
         or other body of water, tideland, wetland, marshland or any other area
         which is subject to special State, federal or municipal regulation,
         control or protection.

                  (g) Except for those tenants in possession of the Real
         Property under Contracts described in Schedule 3.18, there are no
         Persons in possession of, or claiming any possession, adverse or not,
         to or other interest in, any portion of the Real Property other than
         Sellers or the Subsidiaries, whether as lessees, tenants at
         sufferance, trespassers or otherwise.

                  (h) No tenant is entitled to any rebate, concession, or free
         rent, other than as reflected in the Contract with such tenant; no
         commitments have been made to any Tenant for repairs or improvements
         other than for normal repairs and maintenance in the future or
         improvements required under Contracts with tenants; and no rents due
         under any of the Contracts with tenants have been assigned or
         hypothecated to, or encumbered by, any Person.

                  (i) Except as set forth on Schedule 3.12(i), all painting,
         repairs, alterations and other work required to be performed by
         Sellers and the Subsidiaries as landlord under each of the Contracts
         with tenants, and all other material obligations of Sellers and the
         Subsidiaries as landlord required to be performed thereunder, have
         been performed in all material respects.

                  (j) To Sellers' knowledge, all essential utilities (including
         water, sewer, gas, electricity and telephone service) are available to
         the Real Property, as currently developed by Sellers and the
         Subsidiaries, and, to Sellers' knowledge, there are no

                                      23

<PAGE>

         conditions existing which could result in the termination or reduction
         of the current access from the Real Property to existing roadways.

         3.13. Environmental Matters.

                  (a) To Sellers' knowledge and except as described on Schedule
         3.13(a), the Hospital Businesses are in compliance in all material
         respects with Environmental Laws. Except as described on Schedule
         3.13(a), no Seller or Subsidiary has received any written
         communication (or reduced to writing any oral communication) from any
         Person alleging that, with respect to the conduct of the Hospital
         Businesses, any Seller or Subsidiary is not in material compliance
         with Environmental Laws. Each Seller and Subsidiary has all material
         permits, licenses and approvals required under applicable
         Environmental Laws to own the properties of the Hospital Businesses
         and to conduct the Hospital Businesses thereon. All licenses, permits
         and other authorizations of Governmental Authorities currently held by
         Sellers and the Subsidiaries related to the Hospital Businesses
         pursuant to the Environmental Laws are identified in Schedule 2.01(g).

                  (b) With respect to the Hospital Businesses and except as
         described on Schedule 3.13(b), there is no Environmental Claim pending
         or to Sellers' knowledge threatened against any Person with respect to
         the Hospital Businesses, which liability has been retained or assumed
         by any Seller or Subsidiary either contractually or by operation of
         law.

                  (c) To Sellers' knowledge and except as described on Schedule
         3.13(c), no actions, activities, circumstances, conditions, events or
         incidents, including the release, emission, discharge or disposal of
         any Materials of Environmental Concern, have occurred at the Hospital
         Businesses that could form the basis of any Environmental Claim
         against any Person whose liability for any Environmental Claim any
         Seller or Subsidiary has or may have retained or assumed either
         contractually or by operation of law.

                  (d) Without in any way limiting the generality of the
         foregoing, (i) all on-site and off-site locations where Sellers store,
         dispose or arrange for the disposal of Materials of Environmental
         Concern for the Hospital Businesses are identified in Schedule
         3.13(d), (ii) all Contracts dealing with the removal, storage,
         disposal and handling of Materials of Environmental Concern of the
         Hospital Businesses are listed in Schedule 3.18, and (iii) all
         underground storage tanks, and the capacity and contents of such
         tanks, located on the Real Property are identified in Schedule
         3.13(d).

         3.14. Intellectual Properties, Computer Software, etc.

                                      24

<PAGE>

                  (a) Except as described in Schedule 3.14 and except for
         customary licensing and maintenance fees payable under the Contracts,
         Sellers and the Subsidiaries have the right to use, free and clear of
         any royalty or other payment obligations, claims of infringement or
         other liens, (i) all Intellectual Properties used or needed by Sellers
         and/or the Subsidiaries in the conduct of the Hospital Businesses, and
         (ii) all software, hardware application programs and similar systems
         owned by or licensed under Contracts to Sellers and/or the
         Subsidiaries and used in the conduct of the Hospital Businesses; and
         no Seller or Subsidiary is in conflict with or in violation or
         infringement of, nor has any Seller or Subsidiary received a notice
         alleging any conflict with or violation or infringement of, any rights
         of any other Person with respect to any such Intellectual Properties
         or software, hardware, application programs or similar systems. To
         Sellers' knowledge, no other Person is in conflict with or in
         violation or infringement of any Seller's or Subsidiary's rights in
         such Intellectual Properties or software, hardware, application
         programs or similar systems. Except as set forth in Schedule 3.14 and
         except for customary licensing and maintenance fees payable under the
         Contracts, subsequent to the Closing and without further action or the
         payment of additional fees, royalties or other compensation to any
         Person, Buyer will be entitled to unrestricted use of all Intellectual
         Properties, software, hardware, application programs and similar
         systems currently used in the Hospital Businesses.

                  (b) Sellers make no representation or warranty, whether
         implied or express, regarding the year 2000 compliance of any
         software, hardware, application programs or similar systems used in
         the conduct of the Hospital Businesses. Sellers have developed a plan
         to determine whether and the extent to which Sellers' and the
         Subsidiaries' software, hardware, application programs and similar
         systems used in the conduct of the Hospital Businesses are year 2000
         compliant and, pursuant to such plan, have conducted an assessment and
         inventory of all material year 2000 compliant and non-compliant
         software, hardware, application programs and similar systems
         (including clinical and non-clinical applications of Sellers and the
         Subsidiaries and programs, applications and systems of third party
         vendors with which Sellers' and the Subsidiaries' systems are
         interfaced). Action plans to implement year 2000 compliant software,
         hardware, application programs and similar systems have been prepared,
         and Sellers have budgeted for implementation of such recommendations
         and action plans in such a manner that will resolve all critical
         non-compliant applications in a timely manner so as not to disrupt
         patient care and financial and business office accounting. Sellers
         have delivered to Buyer complete and genuine copies of Sellers' plan,
         recommendation of the information steering committee and action plans
         relating to year 2000 compliance.

         3.15. Insurance. Schedule 3.15 lists all insurance arrangements,
including self-insurance, in place for the benefit of the Assets and the
conduct of the Hospital Businesses. With respect to third party insurance,
Schedule 3.15 sets forth the name of each insurer, whether such insurer is an
Affiliate of any Seller, and the number, coverage, limits, term and premium for
each policy of insurance purchased or held by Sellers and the Subsidiaries
covering the ownership and operation of the Assets and the Hospital Businesses.
All of such policies are now and until Closing

                                      25
<PAGE>

will remain valid, outstanding, in full force and effect, and enforceable with
no premium arrearages. No insurance carrier has canceled or reduced, or given
notice of its intention to cancel or reduce, any insurance coverage with
respect to the Hospital Businesses, and, to Sellers' knowledge, there exist no
grounds to cancel or avoid any such policies or the coverage provided thereby.
True and correct copies of all such policies and any endorsements thereto have
been delivered to Buyer.

         3.16. Permits and Licenses. Schedule 2.01(g) contains an accurate list
and summary description of all material licenses, permits, franchises and
certificates of need (including applications therefor) owned or held by Sellers
and the Subsidiaries relating to the ownership, development or operations of
the Hospital Businesses and the Assets, all of which, to Sellers' knowledge,
are in good standing and not subject to meritorious challenge. The Hospital is
duly licensed as an acute care hospital by the appropriate state agencies, and
all ancillary departments operated by the Hospital that are required to be
separately licensed are duly licensed by the appropriate state agencies. Except
as described Schedule 3.16, the Hospital Businesses are in compliance with such
licensing requirements, except to the extent noncompliance would not have a
Material Adverse Effect. There are no provisions in or Contracts relating to
any such licenses, permits and certificates of need (including applications
therefor) which would preclude or limit Buyer from operating the Hospital
Businesses as currently operated and using all the beds of the Hospital as they
are currently classified. Sellers have delivered to Buyer complete and genuine
copies of the latest licensure, survey and/or fire marshal reports of the
Hospital Businesses and plans of correction or responses thereto. All material
violations set forth in such reports, if any, have been or by Closing will be
corrected by such Seller at its expense. Sellers and the Subsidiaries have
complied in all material respects with the requirements and conditions of all
certificates of need (including applications therefor, non-review letters and
implemented and unimplemented CONs if not lapsed and unexpired). To Sellers'
knowledge, each unimplemented Certificate of Need (which is designated as such
in Schedule 2.01(h)) is valid and in good standing and is not subject to
meritorious challenge, and all related progress and similar reports required to
be filed have been filed. To Sellers' knowledge, each implemented Certificate
of Need has been implemented in accordance with its terms.

         3.17. Government Payment Programs; Accreditation. The Hospital is
qualified for participation in, and has current and valid provider Contracts
with, the Government Payment Programs and/or their fiscal intermediaries or
paying agents and comply in all material respects with the conditions of
participation therein. The Hospital is entitled to payment under the Government
Payment Programs for services rendered to qualified beneficiaries and has
received all approvals or qualifications necessary for capital reimbursement on
its Seller Assets. The Cost Reports were filed when due for all Cost Report
periods through September 30, 1998. The Cost Reports have been audited and
Notices of Program Reimbursement issued for all Cost Report periods through
September 30, 1996. All amounts shown as due from Sellers in the Cost Reports
were remitted with such reports and all amounts shown in the Notices of Program
Reimbursement as due have been paid. Except to the extent liabilities and
contractual adjustments of the Hospital under the Government Payment Programs
have been properly reflected and adequately reserved in the Financial
Statements, to the knowledge of Sellers, the Hospital Businesses have not
received or intentionally or recklessly submitted any claim for payment in
excess of the amount provided by law or applicable Seller Contract and no
Seller or Subsidiary has received notice of any dispute or claim by any
Governmental Authority, fiscal intermediary or other Person regarding the
Government

                                      26
<PAGE>

Payment Programs or Sellers' participation therein relating to the
Hospital. The Hospital is duly accredited with no contingencies by the
accrediting organizations named on Schedule 3.17 for the periods specified
thereon. Sellers have delivered to Buyer complete and genuine copies of the
most recent accreditation survey reports, deficiency lists, statements of
deficiency, plans of correction and similar materials. Sellers have taken or
are taking all reasonable steps to correct all material deficiencies noted
therein.

         3.18. Agreements and Commitments. Schedule A and Schedule 3.18 sets
forth certain information regarding the Contracts, including the Contracts
described below that relate to the Hospital Businesses. Sellers have made
available for review or have delivered to Buyer complete and genuine copies of
the Contracts. Except for Contracts described on Schedule A and Schedule 3.18:

                  (a) there are no Contracts affecting the ownership or use of,
         title to or interest in any Real Property;

                  (b) there are no Contracts with referral sources to any of
         the Hospital Businesses and no Contracts between any Seller or
         Subsidiary and any physician or physician group who is (or whose
         members are) employees of Sellers or any Subsidiary or members of the
         medical staff of any of the Hospital Businesses;

                  (c) there are no Contracts relating to information and data
         processing systems, hardware and software utilized in connection with
         the Hospital Businesses;

                  (d) there are no collective bargaining agreements or other
         Contracts with Hospital labor unions or other employee representatives
         or groups;

                  (e) there are no Contracts with directors, trustees,
         shareholders, partners, Affiliates, officers or other individual
         employees of any Seller or Subsidiary relating to the Hospital
         Businesses;

                  (f) there are no requirements or exclusive Contracts or
         Contracts prohibiting or limiting competition or the conduct of any
         lawful business by the Hospital Businesses between any Seller or
         Subsidiary and any Person;

                  (g) there are no Contracts providing for payments based in
         any manner on the revenues, purchases or profits of the Hospital
         Businesses or any part thereof; and

                  (h) there are no Contracts other than Immaterial Contracts.

         3.19. The Assumed Contracts. Except as described in Schedule 3.19:

                  (a) the Assumed Contracts constitute lawful, valid and
         legally binding obligations of the parties thereto and are enforceable
         in accordance with their terms, except as would not have a Material
         Adverse Effect;

                                      27
<PAGE>

                  (b) each Assumed Contract is in full force and effect and
         constitutes the entire agreement by and between the parties thereto,
         except as would not have a Material Adverse Effect;

                  (c) in all material respects, all obligations required to be
         performed under the Assumed Contracts by the parties thereto on or
         prior to the Effective Date have been performed, and no event has
         occurred or failed to occur which constitutes, or with the giving of
         notice, the lapse of time or both would constitute, a default by any
         Seller under the Assumed Contracts, except as would not have a
         Material Adverse Effect;

                  (d) no Assumed Contract prohibits or requires the consent of
         any Person to the assignment to and assumption by Buyer of the Assumed
         Contract;

                  (e) no Assumed Contract will prohibit competition or restrict
         the ability of Buyer to engage in any lawful business after Closing
         (including ambulatory surgery centers and home health services); and

                  (f) the assignment of any Assumed Contract to and assumption
         of such Assumed Contract by Buyer will not give a third party the
         right to terminate such Assumed Contract, or result in any penalty or
         premium to, or adverse change in the rights, remedies, benefits and
         obligations of, any Seller or Subsidiary.

         3.20. [Intentionally Omitted]

         3.21. Employees and Employee Relations.

                  (a) Schedule 3.21 sets forth (i) a complete list (as of the
         date set forth therein) of names and positions of all full-time and
         part-time non-physician employees of Sellers and the Subsidiaries
         employed in the operation of the Hospital Businesses, and (ii) a
         separate complete list (as of the date set forth therein) of names of
         all full-time and part-time physician employees of Sellers and the
         Subsidiaries (indicating in both lists whether each employee is
         part-time or full-time, whether such employee is employed under
         written Contract, and, if such employee is not actively at work, the
         reason therefor). Schedule 3.21 also sets forth the name of each
         employee whose employment was terminated during the 90 day period
         ending on the Effective Date and the reason for such termination.

                  (b) To Sellers' knowledge, Sellers' and the Subsidiaries'
         relations with their employees are good. There is no pending or, to
         Sellers' knowledge, threatened employee strike, work stoppage or
         slowdown, labor dispute or unfair labor practices at the Hospital
         Businesses. No employees of any Seller are represented by, or have
         made demand for recognition of, a labor union or employee
         organization, and to Sellers' knowledge no other union organizing or
         collective bargaining activities by or with respect to any employees
         of any Seller are taking place.

                                      28

<PAGE>

                  (c) Except to the extent included in Net Working Capital or
         as otherwise described in Schedule 3.18 or Schedule 3.21, no present
         or former employee of the Hospital or the Hospital Businesses has or
         will have as a result of the consummation of the transactions
         contemplated by this Agreement any claim against Buyer on the account
         of or for (i) overtime pay, (ii) wages, salary, bonuses or amounts due
         under any Employee Benefit Plan or Other Plan, or (iii) sick pay,
         severance pay, claim for unlawful discharge, holiday or vacation pay
         or paid or personal time off.

         3.22. Employee Benefit Plans.

                  (a) Schedule 3.22 contains a summary description of each
         Employee Benefit Plan and Other Plan that any Seller or any member of
         the Controlled Group that includes any Seller maintains or to which it
         contributes (including employee elective deferrals). Since January 1,
         1999 and except as described in Schedule 3.18 and Schedule 3.22, no
         Seller or Subsidiary has instituted any new Employee Benefit Plan or
         Other Plan for the benefit of any of their respective employees.

                  (b) Each Employee Benefit Plan (and related trust, insurance
         contract or fund) complies in all material respects with applicable
         Legal Requirements, and has been administered in all material respects
         in accordance with applicable Legal Requirements. All required reports
         and descriptions (including Form 5500 Annual Reports, Summary Annual
         Reports, and Summary Plan Descriptions) have been filed or distributed
         appropriately with respect to each Employee Benefit Plan. Sellers have
         made available or delivered to Buyer complete and genuine copies of
         the plan documents and summary plan descriptions, most recent
         determination letters received from the Internal Revenue Service, most
         recent Form 5500 Annual Report, and all related trust, insurance and
         funding Contracts which implement each Employee Benefit Plan. Since
         January 1, 1993, no Employee Benefit Plan has been audited by any
         Governmental Authority and no notice that such an audit will or may be
         conducted has been received by any Seller or Subsidiary.

                  (c) Each Employee Pension Benefit Plan intended to satisfy
         the requirements of a qualified plan under section 401(a) of the Code
         has received a favorable determination letter from the Internal
         Revenue Service reflecting compliance at least through the
         requirements imposed by the Tax Reform Act of 1986. All contributions
         (including employer contributions and employee salary reduction
         contributions) to each Employee Pension Benefit Plan that are required
         to be paid have been paid, and all Seller contributions in respect of
         periods ending the day prior to the Closing Date will be accrued on
         the Closing Balance Sheets. The market value of all assets under each
         Employee Pension Benefit Plan and the present value of all vested and
         unvested liabilities thereunder have been determined as of a date not
         less than six months prior to the Effective Date and, with respect to
         each such Employee Pension Benefit Plan, as of such date of
         determination the market value of such assets equals the present value
         of all vested and unvested liabilities thereunder.

                                      29

<PAGE>

                  (d) To Sellers' knowledge, the requirements of Part 6 of
         Subtitle B to Title I of ERISA and of section 4980B of the Code have
         been met with respect to each Employee Welfare Benefit Plan; all
         premiums or other payments for all periods ending on or before the
         Closing Date have been paid with respect to each Employee Welfare
         Benefit Plan.

                  (e) To Sellers' knowledge, there have been no Prohibited
         Transactions with respect to any Employee Benefit Plan that would
         subject any Seller or any member of the Controlled Group that includes
         any Seller to any liability; no ERISA Fiduciary has any material
         liability for breach of fiduciary duty or any other failure to act or
         comply in connection with the administration or investment of the
         assets of any Employee Benefit Plan; no action, suit, proceeding,
         hearing or investigation with respect to the administration or the
         investment of the assets of any Employee Benefit Plan (other than
         routine claims for benefits) is pending or to Sellers' knowledge
         threatened; and to Sellers' knowledge there exists no basis for any
         such action, suit, proceeding, hearing or investigation.

                  (f) No Employee Benefit Plan is a Defined Benefit Plan.

                  (g) No Seller, and no member of the Controlled Group that
         includes any Seller, contributes to, ever has contributed to, or ever
         has been required to contribute to any Multiple Employer Plan or any
         Multiemployer Plan or has any liability (including withdrawal
         liability) under any Multiple Employer Plan or any Multiemployer Plan.
         No Seller, and no member of the Controlled Group that includes any
         Seller, maintains or contributes, ever has maintained or contributed,
         or ever has been required to maintain or contribute to any Employee
         Welfare Benefit Plan providing medical, health or life insurance or
         other welfare-type benefits for current or future retired or
         terminated employees, their spouses or their dependents (other than in
         accordance with section 4980B of the Code).

         3.23. Litigation and Proceedings. Schedule 3.23 contains an accurate
list and summary description of all claims, actions, suits, litigation,
arbitration, mediations, investigations and other proceedings pending against
or otherwise affecting any Seller or Subsidiary with respect to the Hospital
Businesses or the Assets and, in the case of uninsured matters, Schedule 3.23
also sets forth the reserves therefor included in the Financial Statements.
Except as described in Schedule 3.23, all such litigation, arbitration,
mediations and other proceedings are fully insured (except for applicable
deductibles) and no insurer has issued a "reservation of rights" letter or
otherwise qualified its obligation to insure and defend Sellers or any
Subsidiary against losses arising therefrom. Except as described in Schedule
3.23, (i) there are no claims, actions, suits, litigation, arbitration,
mediations, investigations or other proceedings pending, affecting or to
Sellers' knowledge threatened against any Seller or Subsidiary with respect to
the Hospital Businesses or the Assets, (ii) there are no claims, actions,
suits, litigation, arbitration, mediations, investigations or other proceedings
pending, affecting or to Sellers' knowledge threatened against any Seller or
Subsidiary which might have an adverse effect on the Hospital Businesses or the
Assets, and (iii) to Sellers' knowledge, there exist no facts that might form
the basis of any such claim, action, suit, litigation, arbitration, mediation,
investigation or other proceeding.

                                      30
<PAGE>

         3.24. Taxes.

                  (a) Each Seller and each Subsidiary has filed all Tax Returns
         required to be filed by or on behalf of such entity, all such Tax
         Returns are correct and complete in all material respects, and Sellers
         or the Subsidiaries, as applicable, have duly paid or made provision
         in the Financial Statements for the payment of all Taxes; no claim has
         ever been made by a Governmental Authority in a jurisdiction where any
         Seller or Subsidiary does not file Tax Returns that it is or may be
         subject to Tax by that jurisdiction; and there are no Encumbrances on
         any Assets that arose in connection with any failure (or alleged
         failure) to pay any Tax.

                  (b) Except as described on Schedule 3.24, each Seller and
         Subsidiary has withheld proper and accurate amounts from its
         employees' compensation in full and complete compliance with all
         withholding and similar provisions of the Code and any and all other
         applicable Legal Requirements, and has withheld and paid, or caused to
         be withheld and paid, all Taxes on monies paid by Sellers and the
         Subsidiaries to independent contractors, creditors and other Persons
         for which withholding or payment is required by law.

                  (c) To Sellers' knowledge, no Governmental Authority intends
         to assess any additional Taxes for any period for which Tax Returns
         have been filed. Except as set forth on Schedule 3.24, there is no
         dispute or claim concerning any Tax liability of Sellers or the
         Subsidiaries either claimed or raised by any Governmental Authority in
         writing, or as to which any Seller or Subsidiary has notice or
         knowledge based upon personal contact with any agent of such
         authority; Schedule 3.24 lists all federal, state, local and foreign
         income Tax Returns filed with respect to Sellers and the Subsidiaries
         for the last three complete fiscal years and for the current
         year-to-date, and indicates those Tax Returns that have been audited
         and those that currently are the subject of audit or that have not
         been audited.

                  (d) There is not currently in effect any waiver of a statute
         of limitations in respect of Taxes by any Seller or Subsidiary or any
         Contract to extend the time with respect to a Tax assessment or
         deficiency.

                  (e) No Seller or Subsidiary is a party to any Tax allocation
         or sharing Contract; no Seller or Subsidiary is or has been a member
         of an Affiliated Group filing a consolidated federal income Tax
         Return.

                  (f) MHSC and MacNeal Hospital are corporations exempt from
         federal and state income taxation, and each has received favorable
         letters of determination from the Internal Revenue Service and the
         State of Illinois regarding such Tax status.

                  (g) Except as described on Schedule 3.24, no Seller or
         Subsidiary has or may have any liability for the Taxes of any Person
         other than Sellers and the Subsidiaries under Internal Revenue Service
         regulation 1.1502-6 (or any similar

                                      31
<PAGE>

         provision of state, local, or foreign law), as a transferee or
         successor, by Contract or otherwise.

         3.25. Medical Staff; Physician Relations. Sellers have delivered to
Buyer complete and genuine copies of the bylaws, policies, rules and
regulations of the medical staff and medical executive committees of the
Hospitals and the other Hospital Businesses. Schedule 3.25 sets forth (a) the
name and age of each member of the medical staff of the Hospital Businesses
(active, associate, consulting, courtesy or other); (b) the degree (M.D., D.O.,
etc), title, specialty and Board Certification, if any, of each Hospital
medical staff member, (c) the names of Hospital medical staff members (current
and former) in respect of whom any Seller has made a report to the National
Practitioners Data Bank during the last three years, and (d) the number of
current medical staff members of the Hospital in respect of whom any committee
of the medical staff has recommended adverse action which is not yet final.
Except as set forth on Schedule 3.25, there are no pending or to Sellers'
knowledge threatened disputes with Hospital medical staff members or applicants
or allied health professionals and all appeal periods in respect of any medical
staff member or applicant against whom an adverse action has been taken have
expired. Except as set forth on Schedule 3.25, to Sellers' knowledge, no member
of the medical staff of the Hospital has been excluded from participation in
any Government Payment Program. Sellers and the Subsidiaries have made no
request for payment from any Government Payment Program in respect of
healthcare services furnished by or directed or proscribed by a physician who
at such time was excluded from participation in such Government Payment
Program.

         3.26. Special Funds. Except as described in Schedule 3.26, none of the
Assets are subject to any Encumbrance in respect of funds received by any
Person for the purchase, improvement or use of any of the Assets or the conduct
of the Hospital Businesses under restricted or conditioned grants or donations,
including monies received under the Hill-Burton Act.

         3.27. Brokers and Finders. No Seller nor any Subsidiary has engaged
any finder or broker in connection with the transactions contemplated
hereunder, except that MHSC has engaged Cain Brothers & Company, LLC to act as
MHSC's independent financial advisor in connection with the transactions
contemplated by this Agreement.

         3.28. Payments. No Seller or Subsidiary has, directly or indirectly,
paid or delivered or agreed to pay or deliver any fee, commission or other sum
of money or item of property, however characterized, to any Person which is in
any manner related to the Assets or the Hospital Businesses in violation of any
Legal Requirement. No Seller or Subsidiary, nor any officer, director or
trustee of any Seller or Subsidiary has received or, as a result of the
consummation of the transaction contemplated by this Agreement, will receive
any rebate, kickback or other improper or illegal payment from any Person with
whom Sellers or the Subsidiaries conduct or have conducted any of the Hospital
Businesses.

         3.29. Solvency. No Seller immediately after Closing will be rendered
insolvent or otherwise unable to pay its debts as they become due; no Seller
has any intention of filing in any court pursuant to any statute either of the
United States or of any state a petition in bankruptcy or insolvency or for
reorganization or for the appointment of a receiver or trustee of all or any
portion of such Seller's property; and, to Sellers' knowledge, no other Person
has filed or threatened to file such

                                      32

<PAGE>

a petition against any Seller. No Subsidiary is insolvent or otherwise unable
to pay its debts as they become due; no Subsidiary has any intention of filing
in any court pursuant to any statute either of the United States or of any
state a petition in bankruptcy or insolvency or for reorganization or for the
appointment of a receiver or trustee of all or any portion of such Subsidiary's
property; and, to Sellers' knowledge, no other Person has filed or threatened
to file such a petition against any Subsidiary.

         3.30. Operation of the Hospital Businesses. The Assets constitute all
assets, properties, goodwill and businesses necessary to operate the Hospital
Businesses in all material respects in the manner in which they have been
operated since June 30, 1999. Schedule 3.30 sets forth a list of the 20 largest
non-governmental payors of the Hospital Businesses, determined on the basis of
revenues from services provided for the fiscal year ended September 30, 1999.
Except as set forth in Schedule 3.30, none of the non-governmental payors in
Schedule 3.30 has terminated or materially curtailed its business relationship
with or materially reduced reimbursement rates to the Hospital and no Seller
has received any notice to the effect that any such non-governmental payor
intends to terminate or materially curtail its business relationship with or
materially reduce reimbursement rates to the Hospital. There is no
non-governmental payor the loss of which would have a Material Adverse Effect,
other than those set forth on Schedule 3.30.

         3.31. Full Disclosure. This Agreement and the Schedules and other
documents and information described in this Agreement as having been delivered
or otherwise made available to Buyer do not and will not contain any untrue
statement of a material fact or omit to state any material fact necessary to
make the statements made therein not misleading.

         3.32. Private Placement.

                  (a) The Foundation understands that (i) the offering and sale
         of the Common Shares is intended to be exempt from registration under
         the Securities Act pursuant to Section 4(2) of the Securities Act and
         (ii) there is no existing public or other market for the Common Shares
         and there can be no assurance that the Foundation will be able to sell
         or dispose of the Common Shares.

                  (b) The Foundation represents that the Common Shares to be
         acquired by the Foundation at the Closing are being acquired for its
         own account and without a current view to the public distribution of
         such Common Shares or any interest therein.

                  (c) The Foundation are or at Closing will be each an
         "Accredited Investor" as such term is defined in Regulation D under
         the Securities Act. The Foundation has sufficient knowledge and
         experience in financial and business matters so as to be capable of
         evaluating the merits and risks of its investment in the Common Shares
         and the Foundation is capable of bearing the economic risks of such
         investment, including a complete loss of the investment in the Common
         Shares.

                                      33
<PAGE>

                  (d) The Foundation has been furnished with and carefully read
         a copy of this Agreement and has been given the opportunity to ask
         questions of, and receive answers from, Vanguard concerning the terms
         and conditions of the Common Shares and other related matters. The
         Foundation further represents and warrants to Vanguard that Vanguard
         has made available to the Foundation or its agents all documents and
         information relating to an investment in the Common Shares requested
         by or on behalf of the Foundation.

                  (e) The office of the Foundation in which the investment
         decision was made is located in Berwyn, Illinois.

         4. REPRESENTATIONS AND WARRANTIES OF BUYER AND VANGUARD

         Buyer and Vanguard make the following representations and warranties
to Sellers and the Foundation on and as of the Effective Date and shall be
deemed to make them again at and as of the Closing Date. Buyer and Vanguard
represent and warrant to Sellers and the Foundation as follows:

         4.01. Organization. Buyer is a corporation duly organized and validly
existing in good standing under the laws of the State of Delaware and by
Closing will be qualified to do business in the State of Illinois. Vanguard is
a corporation duly organized and validly existing in good standing under the
laws of the State of Delaware.

         4.02. Corporate Powers; Consents; Absence of Conflicts, Etc. Each of
Buyer and Vanguard has the requisite power and authority to conduct its
business as now being conducted, to enter into this Agreement, and to perform
its obligations hereunder (the board of directors of each of Vanguard and the
Buyer having approved their execution of this Agreement and the purchase of the
Seller Assets by Buyer). The execution, delivery and performance by Buyer and
Vanguard of this Agreement and the consummation of the transactions
contemplated herein by each of them:

                  (a) are within their corporate powers and are not in
         contravention of the terms of their articles or certificates of
         incorporation and bylaws, as amended to date, and have been approved
         by all requisite corporate action;

                  (b) do not conflict with or result in any breach or
         contravention of, any material agreement to which either Buyer or
         Vanguard is a party or by which it is bound, except that consummation
         of the transactions contemplated by this Agreement requires the
         consent of Vanguard's lenders under the terms of its principal credit
         agreement and the consent of Morgan Stanley Capital Partners III, L.P.
         and Morgan Stanley Dean Witter Capital Partners IV, L.P. pursuant to
         section 4.02(a) of the Shareholders Agreement; and

                  (c) do not violate any Legal Requirement to which Buyer or
         Vanguard may be subject.

         4.03. Binding Agreement. This Agreement and each of the Closing
Documents to which Buyer or Vanguard is or becomes a party are (or upon
execution will be), assuming due and

                                      34

<PAGE>

valid execution by Sellers and the Foundation, valid and legally binding
obligations of Buyer and Vanguard, respectively, enforceable against each of
them in accordance with the respective terms hereof and thereof, except as
enforceability against them may be restricted, limited or delayed by applicable
bankruptcy or other laws affecting creditors' rights generally and except as
enforceability may be subject to general principles of equity.

         4.04. Brokers and Finders. Neither Buyer, nor any Affiliate of Buyer
(including Vanguard), has engaged any finder or broker in connection with the
transactions contemplated hereunder.

         4.05. Common Shares. The Common Shares issued to the Sellers, when
issued and delivered in accordance with the terms of this Agreement and
transferred to the Foundation, will be duly authorized, validly issued, fully
paid, and nonassessable and free of all preemptive rights, liens, voting or
transfer restrictions and encumbrances, except as may be provided under federal
or state securities laws, the Shareholders Agreement and the Surviving
Shareholders Agreement.

         4.06. Offering Valid. The offer, sale and issuance of the Common
Shares will be exempt from the registration requirements of the Securities Act,
and will have been registered or qualified (or are exempt from registration and
qualification) under the registration, permit or qualification requirements of
all applicable state securities laws.

         4.07. Vanguard Financial Statements. Attached as Schedule 4.07 are
copies of the Vanguard Audited Financial Statements and the Vanguard Interim
Financial Statements. The Vanguard Financial Statements are true, complete and
accurate and fairly present the financial condition and results of operations
of Vanguard and its subsidiaries as of the respective dates thereof and for the
periods therein referred to, all in accordance with generally accepted
accounting principles, subject in the case of the Vanguard Interim Financial
Statements, to normal recurring year-end adjustments (the effect of which will
not, individually or in the aggregate, be materially adverse) and the absence
of notes (which, if presented, would not differ materially from those included
in the Vanguard Audited Financial Statements); and the Vanguard Financial
Statements reflect the consistent application of such accounting principles
throughout the periods involved.

         4.08. Capitalization. As of the date hereof, the authorized capital
stock of Vanguard consists of 350,000 shares of Common Stock and 100,000 shares
of preferred stock, par value $0.01 per share. As of the date hereof, 71,252
shares of Common Stock are outstanding and no shares of preferred stock are
outstanding, and warrants or options exercisable for 29,410 shares of Common
Stock are outstanding.

         4.09. Vanguard's Management Experience. Vanguard's management has
substantial experience in the management and operation of hospital businesses.
Vanguard has delivered to Sellers indications of interest from institutional
investors regarding Vanguard's ability to finance the consummation of the
transactions described in this Agreement. As of the Effective Date, Vanguard
has no reason to believe that such financing will not be forthcoming at Closing
in sufficient amounts to finance the Purchase Price.

         5. COVENANTS AND AGREEMENTS OF THE PARTIES

                                      35

<PAGE>

         5.01. Operations. From the Effective Date until the Closing Date and
except as otherwise expressly provided in this Agreement or agreed to in
writing by Buyer, Sellers will and will cause the Subsidiaries to:

                  (a) carry on the Hospital Businesses in substantially the
         same manner as they have heretofore and not make any material change
         in personnel, operations, finances, accounting policies, or real or
         personal property of the Hospital Businesses;

                  (b) maintain all material Assets in as good working order and
         condition as at present, ordinary wear and tear excepted and make all
         normal and planned capital expenditures related to the Assets and/or
         the Hospital Businesses;

                  (c) use commercially reasonable efforts to perform when due
         all Legal Requirements and obligations under Contracts relating to or
         affecting the Hospital Businesses, except where the failure to perform
         such Legal Requirements and Contract obligations shall not have a
         Material Adverse Effect;

                  (d) take all commercially reasonable actions necessary and
         appropriate to deliver to Buyer title to the Seller Assets free and
         clear of all Encumbrances (except for the Permitted Real Property
         Encumbrances and the Permitted Personal Property Encumbrances), to
         ensure that title to the Subsidiary Assets is free and clear of all
         Encumbrances (except for the Permitted Real Property Encumbrances and
         the Permitted Personal Property Encumbrances) at Closing, and to
         obtain appropriate releases, consents, estoppels, certificates,
         opinions and other instruments as Buyer may reasonably request;

                  (e) use commercially reasonable efforts to keep in full force
         and effect present insurance policies or other comparable insurance
         benefiting the Assets and the conduct of the Hospital Businesses and
         maintain sufficient liquid reserves reasonably estimated to be
         sufficient to meet all deductible, self-insurance and copayment
         requirements of such policies;

                  (f) use commercially reasonable efforts to maintain and
         preserve their business organizations and operations intact; retain
         the present employees at the Hospital Businesses (subject to the right
         of Sellers and the Subsidiaries to discharge any employee in the
         ordinary course of the Hospital Businesses); maintain their
         relationships with physicians, suppliers, patients and other Persons
         doing business with Sellers at the Hospital Businesses; and take such
         actions as are reasonably necessary and achievable to cause the
         smooth, efficient and successful transition to Buyer of the Hospital
         Businesses at Closing;

                  (g) permit and allow reasonable access by Buyer to discuss
         and make offers of post-Closing employment with any of Sellers'
         personnel working at any of the Hospital Businesses, to advertise for
         post-Closing employment at the Hospital Businesses after consultation
         with Sellers, and to establish relationships with physicians, payors
         and other Persons having business relations with Sellers and the

                                      36

<PAGE>

         Subsidiaries in respect of the Hospital Businesses, provided that any
         Contract offered or entered into by Buyer or its Affiliates with any
         such Person shall be contingent upon the Closing.

         5.02. Negative Covenants. From the Effective Date until the Closing
Date and except as otherwise expressly provided in this Agreement or agreed to
by Buyer in writing, Sellers will not and will cause the Subsidiaries not to:

                  (a) amend or terminate any Assumed Contract, or enter into
         any Contract except Immaterial Contracts entered into, terminated or
         amended in the ordinary course of the Hospital Businesses consistent
         with past practices;

                  (b) make offers to any employees of the Hospital Businesses
         for employment with any Person after Closing;

                  (c) increase compensation payable or to become payable to,
         make a bonus or severance payment to, or otherwise enter into one or
         more bonus or severance Contracts with, any employee or agent of any
         of the Hospital Businesses except in the ordinary course of the
         Hospital Businesses consistent with past practices in accordance with
         existing personnel policies;

                  (d) create, assume or permit to exist any new Encumbrance
         upon any of the Assets other than in the ordinary course of the
         Hospital Businesses consistent with past practices;

                  (e) sell, assign, transfer, distribute or otherwise transfer
         or dispose of any item of property, plant or equipment of any Seller
         or Subsidiary having an original cost in excess of $5,000 except in
         the ordinary course of the Hospital Businesses consistent with past
         practices with comparable replacement thereof;

                  (f) take any action outside the ordinary course of the
         Hospital Businesses, other than to make a cash donation of up to
         $1,000,000 to the Foundation;

                  (g) create, incur, assume, guarantee or otherwise become
         liable for any liability, or agree to do any of the foregoing, except
         in the ordinary course of the Hospital Businesses consistent with past
         practices;

                  (h) cancel, forgive, release, discharge or waive any
         receivable or any similar Asset or right with respect to the Hospital
         Businesses, or agree to do any of the foregoing, except in the
         ordinary course of the Hospital Businesses consistent with past
         practices;

                  (i) change any accounting method, policy or practice or
         reduce any reserves in the Financial Statements;

                                      37
<PAGE>

                  (j) terminate, amend or otherwise modify any Employee Benefit
         Plan or Other Plan, except for amendments required to comply with this
         Agreement or applicable Legal Requirements; or

                  (k) amend or agree to amend the articles or certificate of
         incorporation or bylaws of any Seller or Subsidiary or otherwise take
         any action relating to any liquidation or dissolution of any Seller or
         Subsidiary.

         5.03. Employee Matters.

                  (a) Subject to the exclusions set forth in this Section, and
         in reliance upon the representations and warranties of Sellers in
         Sections 3.21 and 3.22, Buyer will offer, or cause its Affiliates to
         offer, to employ as of the Closing Date all active employees of
         Sellers employed at the Hospital Businesses immediately prior to
         Closing, including employees on approved or legally required
         short-term leaves of absence but not including employees on long term
         leaves of absence, on substantially the same terms and conditions
         (i.e., salaries, wages, job duties, titles and responsibilities)
         applicable to such employees on the Effective Date. In addition, the
         Employee Benefit Plans offered to the Hired Employees by Buyer will be
         the same as those generally provided to employees at other hospitals
         operated by Vanguard's Affiliates. A summary description of Buyer's
         Employee Benefit Plan is attached hereto as Schedule 5.03. Sellers
         acknowledge that all employment offers are subject to the satisfactory
         completion by Buyer of its customary employee background checks.
         Employees employed under written Contracts will not be offered
         employment pursuant to this Section, but employment of such employees
         shall be governed by the terms of the Assumed Contracts, if any,
         relating to such employees.

                  (b) Nothing contained in this Section or elsewhere in this
         Agreement shall be deemed to limit or otherwise affect in any manner
         the right of Buyer or any Affiliate of Buyer to terminate at will the
         employment of any Hired Employee (except as otherwise provided in
         Assumed Contracts with such employees), or to change individual
         features or plans in the employment compensation and benefits package
         of the Hired Employees.

                  (c) At Closing, Sellers shall deliver to Buyer a list as of
         Closing setting forth the name of each employee of the Hospital
         Businesses whose employment was terminated during the 90 day period
         ending on the Closing Date and the reason for such termination. In
         reliance upon this list and in reliance upon the representations and
         warranties of Sellers in Section 3.21, Buyer shall indemnify, defend
         and hold harmless Sellers and the Foundation from any liability under
         the WARN Act arising from Buyer's termination after Closing of any
         Hired Employee or arising from Buyer's failure to offer employment to
         the employees of the Hospital Businesses in accordance with Section
         5.03(a).

                  (d) With respect to the Hired Employees and their eligible
         dependents, Buyer will waive, or cause to be waived, the "pre-existing
         condition" exclusions

                                      38

<PAGE>

         under Buyer's applicable Employee Welfare Benefit Plan for the Hired
         Employees, subject to the pre-existing coverage limitations provided
         by Sellers' Employee Welfare Benefit Plan as of the Closing Date.
         Buyer shall give all Hired Employees credit for their vacation,
         holiday and sick pay to the extent the same constitute Assumed
         Liabilities. Buyer shall give all Hired Employees credit after Closing
         for their years of service with Sellers for the purpose of determining
         how much vacation, holiday and sick pay the Hired Employees are
         entitled to under the applicable Employee Welfare Benefit Plan of
         Buyer and for purposes of determining eligibility to participate and
         vesting percentages in Buyer's Employee Pension Benefit Plans, subject
         to the limitations provided under the Employee Pension Benefit Plans
         of Sellers as of the Closing Date. Buyer will not assume or otherwise
         become liable for (i) the Employee Welfare Plans of Sellers or any
         Subsidiary, (ii) obligations of Sellers under the Consolidated Omnibus
         Budget Reconciliation Act, (iii) payment of health care expenses of
         Hired Employees and their beneficiaries who are in a continuum of care
         on the Closing Date, or (iv) other obligations to former or currently
         retired employees, and Buyer will not make any contributions to the
         pension plans of Sellers or any Subsidiary.

                  (e) As of the Closing Date, Sellers shall terminate the
         participation of all Hired Employees and all employees of the
         Subsidiaries in any Employee Pension Benefit Plan of Sellers, and
         provide for distributions consistent with the terms of the applicable
         plans, ERISA and the Code. As soon as practicable after Closing (but
         in any event prior to December 31 of the year in which the Closing
         occurs), Sellers shall provide Buyer with all necessary payroll
         records for the calendar year in which the Closing occurs so that
         Buyer may furnish a Form W-2 to all Hired Employees disclosing all
         wages and other compensation paid to them (and amounts withheld
         therefrom) by Sellers and Buyer in the calendar year.

                  (f) Between the Effective Date and Closing and after
         consultation with Sellers, Buyer may run newspaper advertisements in
         the name of any of the Hospital Businesses to recruit employees for
         and in the name of any of the Hospital Businesses, such employment to
         commence as of the Closing or any time thereafter.

         5.04. Access to and Provision of Additional Information.

                  (a) From the Effective Date until the Closing Date, Sellers
         shall, and shall cause the Subsidiaries to, (i) provide to Buyer full
         and complete access to and the right to inspect the Assets, books and
         records of Sellers and the Subsidiaries relating to the Hospital
         Businesses, (ii) provide to Buyer full and complete access to any of
         the employees and medical staff members providing services at or for
         the Hospital Businesses, (iii) advise Buyer of material developments
         concerning the Hospital Businesses, and (iv) furnish to Buyer such
         additional financial, operating and other data and information
         (including auditors' workpapers) regarding the Hospital Businesses as
         Buyer may from time to time reasonably request, without regard to
         where such information may be located.

                                      39
<PAGE>

                  (b) Sellers will deliver to Buyer complete and genuine copies
         of:

                           (i) within 20 days following the end of each
                  calendar month prior to the Closing Date, the unaudited
                  balance sheet and the related unaudited statements of income
                  and cash flows of the Hospital Businesses for each such month
                  then ended and for the year-to-date then ended, consolidating
                  and consolidated financial statements of the Hospital
                  Businesses,

                           (ii) promptly after prepared, any other financial
                  statements or reports prepared by or for management relating
                  to the Hospital Businesses, together with any notes thereto,

                           (iii) promptly after prepared and no later than ten
                  days before the Closing Date, the audited balance sheets of
                  MHSC as of September 30, 1999, and the audited consolidated
                  statements of operations, changes in net assets and cash
                  flows of MHSC for the fiscal years ended September 30, 1999
                  and 1998, together with the notes thereto and the report
                  thereon of Arthur Andersen LLP, independent certified public
                  accountants, and

                           (iv) promptly after prepared and no later than
                  October 14, 1999, the audited balance sheets of MHSC as of
                  September 30, 1998, and the audited consolidated statements
                  of operations, changes in net assets and cash flows of MHSC
                  for the fiscal year ended September 30, 1998, together with
                  the notes thereto and the report thereon of Arthur Andersen
                  LLP, independent certified public accountants.

                  (c) From the Effective Date until the Closing Date, Sellers
         shall cause their and the Subsidiaries' respective officers and
         employees and medical staff members to confer with one or more
         representatives of Buyer and to answer Buyer's questions regarding
         matters relating to the conduct of the Hospital Businesses and the
         status of transactions contemplated by this Agreement. Sellers shall
         notify Buyer in writing of any material changes in the operations,
         financial condition or prospects of the Hospital Businesses and of any
         investigations, hearings or adjudicatory proceedings (or
         communications indicating that the same may be contemplated) of any
         Person and shall keep Buyer reasonably informed of such matters.

         5.05. Post-Closing Maintenance of and Access to Information.

                  (a) The Parties acknowledge that after Closing each Party may
         need access to information or documents in the control or possession
         of another Party for the purposes of concluding the transactions
         herein contemplated, preparing Tax Returns or conducting Tax audits,
         complying with the Government Payment Programs and other Legal
         Requirements, and prosecuting or defending third party claims.
         Accordingly, each Party shall keep, preserve and maintain in the
         ordinary

                                      40
<PAGE>

         course of business, and as required by Legal Requirements and relevant
         insurance carriers, all books, records (including patient medical
         records), documents and other information in the possession or control
         of such Party and relevant to the foregoing purposes at least until
         the expiration of any applicable statute of limitations or extensions
         thereof.

                  (b) Each Party shall cooperate fully with, and make available
         for inspection and copying by, the other Party, its employees, agents,
         counsel and accountants and/or Governmental Authorities, upon written
         request and at the expense of the requesting Party, such books,
         records documents and other information to the extent reasonably
         necessary to facilitate the foregoing purposes. In addition, each
         Party shall cooperate with, and shall permit and use its best efforts
         to cause its respective former and present directors, officers and
         employees to cooperate with, the other Party on and after Closing in
         furnishing information, evidence, testimony and other assistance in
         connection with any action, proceeding, arrangement or dispute of any
         nature with respect to the subject matters of this Agreement.

                  (c) Sellers shall be entitled to remove from the Hospital
         Businesses, at Sellers' sole risk and expense, any patient or other
         records that relate to events or periods prior to Closing for purposes
         of pending litigation involving matters to which such records refer,
         as certified in writing prior to removal by counsel retained by
         Sellers in connection with such litigation. Any records so removed
         from the Hospital shall be promptly returned to Buyer following their
         use by Sellers. Sellers shall be responsible for obtaining consents or
         approvals, if any, required to remove and gain access to such records.

                  (d) The exercise by any Party of any right of access granted
         herein shall not materially interfere with the business operations of
         the other Party.

         5.06. Governmental Authority Approvals; Consents to Assignment.

                  (a) From the Effective Date until the Closing Date, each
         Seller and Buyer shall (i) promptly apply for and use its reasonable
         best efforts to obtain prior to Closing all consents, approvals,
         authorizations and clearances of Governmental Authorities required of
         it to consummate the transactions contemplated hereby, (ii) provide
         such information and communications to Governmental Authorities as the
         other Party or such Persons may reasonably request, and (iii) assist
         and cooperate with other Parties to obtain all consents, licenses,
         permits, approvals, authorizations and clearances of Governmental
         Authorities that the other Parties reasonably deem necessary or
         appropriate, and to prepare any document or other information
         reasonably required of it by any such Persons to consummate the
         transactions contemplated herein, provided that, notwithstanding the
         foregoing, no Party shall have any obligation under such provisions
         (x) to pay any cash amounts to Governmental Authorities other than
         filing fees, or (y) to agree to divest assets or limit the operations
         of its businesses.

                                      41
<PAGE>

                  (b) From the Effective Date until the Closing Date, each of
         the Parties shall file, if and to the extent required by law, all
         reports or other documents required or requested by Governmental
         Authorities under the HSR Act concerning the transactions contemplated
         hereby, and comply promptly with any requests by the Governmental
         Authorities for additional information concerning such transactions,
         so that the waiting period specified in the HSR Act will expire as
         soon as reasonably possible after the Effective Date. Each of the
         Parties shall furnish to the other Parties such information as the
         other Parties reasonably require to perform their obligations under
         the HSR Act and shall exchange drafts of the relevant portions of each
         other's report forms prior to filing.

                  (c) From the Effective Date until the Closing Date, each of
         the Parties shall file all reports or other documents reasonably
         requested by the Attorney General of the State of Illinois concerning
         the transactions contemplated by this Agreement, and shall cooperate
         with any and all requests by the Attorney General for additional
         information concerning such transactions.

                  (d) From the Effective Date, each Seller shall promptly apply
         for and use its commercially reasonable efforts to obtain prior to
         Closing all consents required to assign at Closing the Assumed
         Contracts to Buyer and the Excluded Contract to Sellers.

         5.07. Alternative Proposals. From the Effective Date until the Closing
of the transactions contemplated by, or termination of, this Agreement, Sellers
agree (a) that none of them shall, and they shall direct and use their best
efforts to cause the Subsidiaries and the officers, directors, employees,
agents and representatives of Sellers and the Subsidiaries (including, without
limitation, any investment banker, attorney or accountant retained by any
Seller) not to, initiate, solicit or encourage, directly or indirectly, any
inquiries or the making or implementation of any proposal or offer (including,
without limitation, any proposal or offer to its board of directors) with
respect to a merger, acquisition, consolidation or similar transaction
involving, or any purchase of all or any significant portion of the assets or
equity or membership interests of, Sellers or any of the Subsidiaries (any such
proposal or offer being hereinafter referred to as an "Alternative Proposal")
or engage in any negotiations concerning, or provide any confidential
information or data to, or have any discussions with, any person relating to an
Alternative Proposal, or otherwise facilitate any effort or attempt to make or
implement an Alternative Proposal; (b) that Sellers will immediately cease and
cause to be terminated any existing activities, discussions or negotiations
with any Persons conducted heretofore with respect to any of the foregoing, and
it will take the necessary steps to inform the individuals or entities referred
to above of the obligations undertaken in this Section; and (c) that Sellers
will notify Buyer immediately if any such inquiries or proposals are received
by, any such information is requested from, or any such negotiations or
discussions are sought to be initiated or continued with, any Seller; provided
that nothing contained in this Section shall prohibit the board of directors or
trustees of any Seller from (i) furnishing information to or entering into
discussions or negotiations with, any Person that makes an unsolicited bona
fide proposal to acquire Sellers or the Subsidiaries pursuant to a merger,
consolidation, share exchange, purchase of a substantial portion of assets,
business combination or other similar transactions, if, and only to the extent
that, (A) the relevant board of directors or trustees determines in good faith
that such action is required for the

                                      42
<PAGE>

board to comply with its fiduciary duties imposed by law, (B) prior to
furnishing such information to, or entering into discussions or negotiations
with, such Person, Sellers provide written notice to Buyer and Vanguard to the
effect that it is furnishing information to, or entering into discussions or
negotiations with, such Person, and (C) subject to any confidentiality
agreement with such Person (which Sellers determined in good faith was required
to be executed in order for its board to comply with fiduciary duties imposed
by law), Sellers keep Buyer and Vanguard informed of the status (not the terms)
of any discussions or negotiations. Nothing in this Section shall (x) permit
Sellers to terminate this Agreement (except as specifically provided in Article
8), (y) permit Sellers to enter into any agreement with respect to an
Alternative Proposal during the term of this Agreement (it being agreed that
during the term of this Agreement, Sellers shall not enter into any agreement
with any Person that provides for or in any way facilitates, an Alternative
Proposal (other than a confidentiality agreement in customary form), or (z)
affect any other obligation of Sellers under this Agreement.

         5.08. Noncompetition.

                  (a) For a period of five years from and after the Closing
         Date, no Seller nor any Affiliate of Sellers shall, directly or
         indirectly (including by affiliation or "virtual merger" with another
         Person), in any capacity:

                           (i) own, lease, manage, operate, control,
                  participate in the management or control of, be employed by,
                  or maintain or continue any interest whatsoever in any
                  enterprise engaged in the business of providing any
                  healthcare goods or services offered by the Hospital
                  Businesses immediately prior to Closing, including hospitals
                  and outpatient or diagnostic procedures, within a 25-mile
                  radius of the Hospital (the "Restricted Area"); or

                           (ii) employ or solicit the employment of any Hired
                  Employee other than through public of general advertisements
                  or solicitations unless (X) such employee resigns voluntarily
                  (without any solicitation from any Seller or any of its
                  Affiliates), (Y) Buyer consents in writing to such employment
                  or solicitation, or (Z) such employee is terminated by Buyer
                  after the Closing Date; or

                           (iii) induce, cause or attempt to induce or cause
                  any Person (including any physician employee or medical staff
                  member) to replace or terminate any Contract for the
                  provision or arrangement of health care services from the
                  Hospital with products or services of any other Person at any
                  time after the Closing Date.

                  Notwithstanding the foregoing, MacNeal Hospital shall not be
         prohibited from owning its interests in the RML Partnership (provided
         that the RML Partnership does not engage in any business in violation
         of this Section beyond that business engaged in by the Partnership as
         of the Effective Date), and Foundation shall not be prohibited from
         (i) owning and operating any Excluded Seller Assets, (ii) owning the
         Common Shares and any other equity ownership interest in Vanguard or
         any sucessor thereto,

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<PAGE>

         (iii) owning up to three percent of any equity interest in any
         publicly traded company, (iv) providing charitable gifts and grants
         that, in the Foundation's sole discretion, are consistent with its
         charitable purposes and mission, or (v) owning, operating or otherwise
         sponsoring free care health clinics or clinics to provide health care
         services to indigent or underserved populations in the community,
         provided that, for five years from and after the Closing Date, Buyer
         shall have a 30 day right of first refusal to provide any such health
         care service, and any professional or technical personnel, ancillary
         services and other necessary resources for any health care service
         that the Foundation wishes to own, operate or sponsor within the
         Restricted Area on terms and conditions that are qualitatively and
         quantitatively no less favorable to the Foundation than those
         available from other Persons.

                  (c) Sellers acknowledge that any remedy at law for any breach
         of this Section would be inadequate and consent to the granting by any
         court of an injunction or other equitable relief, without the
         necessity of actual monetary loss being proved, in order that a breach
         or threatened breach of this Section may be effectively enjoined.

         5.09. Use of Names. From and after Closing, Sellers shall not use the
names "MacNeal", "MacNeal Hospital", "MacNeal Health Network", and "MacNeal
Health Providers", or any variation of the foregoing in the conduct of their
businesses, except as may be necessary to wind up their corporate affairs and
except that the Foundation may continue to conduct its business under its
current name after Closing. Within 30 days after Closing, Sellers shall change
their corporate names to names not including "MacNeal" or variations thereof.

         5.10. Allocation of Purchase Price. Sellers and Buyer agree that the
Purchase Price shall be allocated among the Seller Assets as the Parties may
mutually determine consistent with section 1060 of the Code in accordance with
their fair market values as determined by Real Estate Valuation Corporation (or
other mutually acceptable firm) pursuant to an appraisal to be conducted within
30 days following the Closing Date, and such allocation shall be binding upon
the Parties for all applicable federal, state, local and foreign Tax purposes.
Sellers and Buyer covenant to report gain or loss or cost basis, as the case
may be, in a manner consistent with such allocation on all Tax Returns filed by
any of them after Closing and not to voluntarily take any inconsistent position
therewith in any administrative or judicial proceeding relating to such
returns. Sellers and Buyer shall exchange mutually acceptable and completed
Internal Revenue Service Forms 8594 (including supplemental forms, if
required), which they shall use to report the transaction contemplated
hereunder to the Internal Revenue Service in accordance with such allocation.
Buyer and Seller shall bear one-half of the cost of Real Estate Valuation
Corporation's appraisal.

         5.11. Further Acts and Assurances. At any time and from time to time
at and after the Closing, upon request of Buyer, each Seller shall do, execute,
acknowledge and deliver, or cause to be done, executed, acknowledged and
delivered, such further acts, deeds, assignments, transfers, conveyances,
powers of attorney, confirmations and assurances as Buyer may reasonably
request to more effectively convey, assign and transfer to and vest in Buyer,
its successors and assigns, full legal right, title and interest in and actual
possession of the Seller Assets and the Hospital Businesses, to confirm such
Seller's capacity and ability to perform its post-Closing covenants and

                                      44

<PAGE>

agreements under this Agreement and the Closing Documents, and to generally
carry out the purposes and intent of this Agreement. Each Seller shall also
furnish Buyer with such information and documents in its possession or under
its control, or which Seller can execute or cause to be executed, as will
enable Buyer to prosecute any and all petitions, applications, claims and
demands relating to or constituting a part of the Seller Assets and Hospital
Businesses.

         5.12. Casualty. If prior to the Closing Date any part of one or more
of the Hospital Businesses is destroyed or damaged by fire, theft, vandalism or
other cause or casualty and, as a result thereof, any material part of the
Hospital is rendered prior to the Closing Date unsuitable for its primary
intended use, Buyer may terminate this Agreement in its entirety without
penalty. Otherwise, Buyer may elect at its option to (i) reduce the Purchase
Price by the fair market value of the Seller Assets destroyed or damaged
(determined as of the date immediately prior to the destruction or damage) or,
if greater, by the estimated cost to restore, repair or replace such Seller
Assets, in which event Sellers shall retain all right, title and interest in
and to insurance proceeds payable on account of such destruction or damage, or
(ii) agree to consummate the transaction notwithstanding such destruction or
damage, in which event Sellers shall pay, transfer and assign to Buyer at
Closing the proceeds (or the right to receive the proceeds) of, plus any
deductibles or copayments required under, the applicable insurance policy. In
the absence of an agreement among the Parties, any reduction in Purchase Price
pursuant to this Section shall be determined by an MAI appraiser mutually
selected and paid equally by Sellers, on the one hand, and Buyer, on the other
hand.

         5.13. Transition Services and Patients. If Buyer receives any cost
report settlement amounts from the Government Payment Programs for discharges
occurring prior to the Closing Date, Buyer shall promptly tender same to
Sellers. If Sellers receive any cost report settlement amounts from the
Government Payment Programs for discharges occurring on or after the Closing
Date, Sellers shall promptly tender same to Buyer. Each Party shall be entitled
to receive from the Government Payment Programs cost reimbursement settlements
(including capital costs, indirect medical education and disproportionate
share) for those patients discharged by a Party at the time such Party owned
the Hospital based upon the Cost Report filed by such Party.

         5.14. Sellers' Cost Reports. Sellers will prepare and timely file all
Cost Reports required to be filed after Closing for periods ending on or prior
to the Closing Date, including any terminating Cost Report required as a result
of the consummation of the transactions described herein. If a terminating Cost
Report is required to be filed by Sellers, the Purchase Price shall be
allocated for such purposes consistent with the allocation for Tax purposes
described in Section 5.10. Buyer will forward to Sellers any and all
correspondence, remittances and demands relating to Sellers' Cost Reports
within five business days after receipt by Buyer. Sellers shall retain all
rights to Sellers' Cost Reports, including any payables resulting from or
reserves relating to the Cost Reports and the right to appeal any Medicare
determinations relating to the Cost Reports.

         5.15. Hospital Board of Trustees. Following the Closing Buyer will
appoint a Board of Trustees for the Hospital composed of the Hospital's Chief
Executive Officer and equal numbers of physicians on the Hospital's medical
staff and community representatives, all in accordance with Buyer's standard
policy. Subject to applicable Legal Requirements, the Board of Trustees will be
responsible for medical staff credentialing, quality assurance and
accreditation of the

                                      45

<PAGE>

Hospital, in accordance with Buyer's model Board of Trustee Bylaws. The Board
of Trustees will be comprised of between five and 15 members appointed for
terms of three years on a staggered basis to provide continuity of leadership.
Prior to Closing, the Parties shall agree on the Persons who will be named by
Buyer as the initial Board of Trustees of the Hospital.

         5.16. Indigent Care. Buyer accepts the responsibility to treat
indigent patients in the service area of the Hospital and will comply with all
applicable federal and state laws and regulations governing such matters. To
this end, Buyer shall maintain for not less than five years after Closing
Sellers' policies for the treatment of indigent patients at the Hospital as
described on Schedule 5.16, subject to changes in governmental policy, such as
implementation of universal healthcare insurance or similar governmental
programs. Buyer shall use commercially reasonable efforts to become and remain
a provider to the federal Medicare/Medicaid programs and similar state
programs.

         5.17. Costs and Expenses.

                  (a) Except as otherwise expressly set forth in this
         Agreement, all expenses of the preparation of this Agreement and of
         the purchase of the Assets set forth herein, including counsel,
         accounting, brokerage and investment advisor fees and disbursements,
         shall be borne by the respective Party incurring such expenses,
         whether or not such transactions are consummated. Sellers shall be
         responsible for paying all fees and expenses of Cain Brothers &
         Company LLC as MHSC's independent financial advisor, in connection
         with the transactions contemplated by this Agreement.

                  (b) Sellers shall pay all sales and use Taxes arising out of
         the transfer of the Seller Assets, the cost of Buyer's owner's title
         insurance policies described in Section 7.07, the cost of removing
         Encumbrances that are not Permitted Real Property Encumbrances or
         Permitted Personal Property Encumbrances, and documentary or other
         Taxes or fees on the transfer of Sellers' interests in the
         Subsidiaries. Buyer shall pay the HSR Act filing fee, the Certificate
         of Exemption filing fee, and the cost of Buyer's land title surveys of
         the Real Property, and the cost of all environmental, engineering and
         other professional studies undertaken by Buyer. Real estate transfer
         Taxes in respect of the Seller Real Property shall be paid one-half by
         Sellers and one-half by Buyer.

                  (c) In the event either Party elects to incur legal fees or
         expenses to enforce or interpret any provision of this Agreement, the
         prevailing Party will be entitled to recover such legal fees and
         expenses, including attorney's fees, costs and necessary
         disbursements, in addition to any other relief to which such Party
         shall be entitled.

         5.18. Insurance Ratings. From the Effective Date until the Closing
Date, Sellers will take all actions reasonably requested by Buyer to enable
Buyer to succeed to the Workers' Compensation and Unemployment Insurance
ratings, insurance policies, deposits and other interests of Sellers and the
Hospital Businesses for insurance or other purposes. Buyer shall not be
obligated

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<PAGE>

to succeed to any such rating, insurance policy, deposit or other interest,
except as it may elect to do so.

         5.19. Fulfillment of Conditions. Each Party will execute and deliver
at Closing each Closing Document that such Party is required by this Agreement
to execute and deliver as a condition to Closing, and will take all
commercially reasonable steps necessary or desirable and proceed diligently and
in good faith to satisfy each other condition to the obligations of the Parties
contained in this Agreement, to the extent that satisfaction of such condition
is within the control of such Party.

         5.20. Release of Encumbrances. Sellers shall cause all Encumbrances
other than the Permitted Real Property Encumbrances and the Permitted Personal
Property Encumbrances to be released and discharged at or prior to Closing,
including Encumbrances of Sellers' tax-exempt bond indebtedness, if any, and in
connection therewith may direct Buyer to pay to the bond trustee or such other
Person as the Parties may agree at Closing all or any part of the Cash Portion
of the Purchase Price sufficient in amount to release or discharge such
Encumbrances.

         5.21. Restricted Assets. Buyer acknowledges that Sellers are retaining
as Excluded Seller Assets certain monies or other restricted assets that are
required by the donors thereof to be spent at the Hospital Businesses. Schedule
5.21 sets forth a description of the restricted assets and the Hospital uses to
which they must be applied. Buyer will take such actions after Closing
reasonably necessary to comply with the conditions of such grants upon payment
by Sellers of the funds therefor. Possession and/or control of any cash held by
Sellers in trust for or for the benefit of other Persons (e.g., tenant security
deposits and medical staff dues) shall not be retained by Sellers but shall be
delivered to Buyer.

         5.22. Tail Insurance. From the Closing Date or except as otherwise
agreed by Buyer at Closing, Sellers will maintain self-insurance in amounts
that provide substantially the same liability protections to the Parties as
would arise under occurrence-based insurance policies purchased by Sellers to
cover acts and omissions prior to Closing of Sellers and each physician
employee of Sellers (or for which Sellers otherwise have an obligation to
provide such insurance), provided that Sellers may, at their option, engage in
a loss portfolio transfer for some or all of such risks with one or more
insurers licensed to conduct business in the State, in which event Sellers
shall require such insurers to expressly name Buyer's Indemnified Persons as
beneficiaries thereof.

         5.23. Teaching Mission of the Hospital. For not less than five years
after Closing, Buyer shall use commercially reasonable efforts to continue the
teaching mission of the Hospital in substantially the same manner as had been
conducted by Sellers immediately prior to Closing, and to that end will use
commercially reasonable efforts to continue the residency teaching programs
currently operated at the Hospital.

         5.24. Hospital Services and Programs. For not less than five years
after Closing, Buyer will use commercially reasonable efforts to continue and
maintain the healthcare programs and services provided by the Hospital as of
the Effective Date.

         5.25. RML Partnership.

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<PAGE>

                  (a) The management agreement dated June 1, 1997 between MMSI
         and the RML Partnership is and at Closing will be an Assumed Contract.
         Between the Effective Date and Closing, Sellers shall use their
         respective best efforts to cause the RML Partnership to amend the RMP
         Partnership management agreement at or prior to Closing to extend the
         term of such Contract to a term ending not less than five years after
         Closing. If the term of such Contract is not extended at or prior to
         Closing, Buyer and Sellers shall continue to use commercially
         reasonable efforts after Closing to extend the term of the Contract.
         Sellers shall cooperate in all reasonable efforts to solicit and
         obtain the consent of the RML Partnership and its partners to the
         extension of the Contract, shall execute such consents, approvals or
         other instruments reasonably necessary to evidence the amendment of
         the Contract and Sellers' support and approval thereof, and, subject
         to MMSI's fiduciary duties, shall vote for extension of the management
         agreement and generally support and be an advocate of Buyer in its
         capacity as manager.

                  (b) MacNeal Hospital owns and shall retain a limited
         partnership interest in the Partnership and an equity interest in RMHP
         Corporation, the general partner of the Partnership. Upon each event
         of (i) a distribution of cash or other properties in respect of
         Sellers' interest in the RML Partnership made to Sellers by the
         Partnership after June 30, 1999, or a payment of dividends or return
         of capital made by the Partnership to Sellers, including
         distributions, dividends or returns of capital following or in
         connection with the sale of all or substantially all of the assets of
         the Partnership or (ii) a sale of Sellers' interest in the Partnership
         and in the general partner of the Partnership, Sellers shall pay to
         Buyer an amount equal to the amount distributed, paid or otherwise
         received by Sellers from each such event. Such payment shall be made
         within two business days after receipt of such property.

         5.26. Medical Staff Membership. Promptly after Closing, Buyer shall
grant to each member of the Hospital's medical staff immediately prior to
Closing medical staff privileges and medical staff status identical to the
privileges and status held by such physician prior to Closing.

         6. CONDITIONS PRECEDENT TO OBLIGATIONS OF SELLERS

         The obligations of Sellers hereunder are subject to the satisfaction
on or prior to the Closing Date of the following conditions unless waived in
writing by Sellers:

         6.01. Representations and Warranties; Covenants.

                  (a) Each of the representations and warranties of Buyer and
         Vanguard contained in this Agreement shall be true and correct on and
         as of the Effective Date; each of the representations and warranties
         of Buyer and Vanguard contained in this Agreement that are qualified
         as to materiality shall be true and correct on and as of the Closing
         Date; and each of the other representations and warranties of Buyer
         and Vanguard contained in this Agreement shall be true and correct in
         all material respects on and as of the Closing Date.

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<PAGE>

                  (b) Each and all of the terms, covenants and agreements to be
         complied with or performed by Buyer or Vanguard on or before the
         Closing Date shall have been complied with and performed, including
         the obligations of Buyer in Section 8.03.

         6.02. Adverse Action or Proceeding. No action or proceeding before any
Governmental Authority shall have been instituted or threatened to restrain or
prohibit the transactions herein contemplated, and no Governmental Authority
shall have taken any other action or made any request of Sellers or Buyer as a
result of which Sellers reasonably and in good faith deem it inadvisable to
proceed with the transactions hereunder; and there shall not be in effect any
order restraining, enjoining or otherwise preventing consummation of the sale
of the Assets and other transactions contemplated hereunder.

         6.03. Pre-Closing Confirmations. Sellers shall have obtained
documentation or other evidence reasonably satisfactory to Sellers that Sellers
have received or will receive all consents, approvals, authorizations and
clearances of Governmental Authorities required of it to consummate the
transactions contemplated hereby, and that all applicable waiting periods under
the HSR Act have expired.

         6.04. Extraordinary Events. Neither Buyer nor Vanguard shall (a) be in
receivership or dissolution, (b) have made any assignment for the benefit of
creditors, (c) have admitted in writing its inability to pay its debts as they
mature, (d) have been adjudicated a bankrupt, (e) have filed a petition in
voluntary bankruptcy, a petition or answer seeking reorganization, or an
arrangement with creditors under the federal bankruptcy law or any other
similar law or statute of the United States or any state, nor shall any such
petition have been filed against Buyer or Vanguard, or (f) have entered into
any Contract to do or permit the doing of any of the foregoing on or after the
Closing Date.

         6.05. Opinion of Buyer's Counsel. Sellers shall have received an
opinion from counsel to Buyer (who may be in-house counsel) dated as of the
Closing Date and addressed to Sellers, in form and substance reasonably
satisfactory to Sellers, to substantially the following effect:

                  (a) Each of Buyer and Vanguard is a corporation duly
         incorporated and validly existing in good standing under the laws of
         the State of its incorporation with full corporate power to carry on
         its business as it is now being conducted. Each of Buyer and Vanguard
         has full power and authority to execute and deliver this Agreement and
         each of the Closing Documents to which it is a party and to perform
         its obligations therein. All corporate proceedings required to be
         taken by Buyer or Vanguard to authorize the execution and delivery of
         this Agreement and each of the Closing Documents to which it is a
         party and to authorize the performance of its obligations therein,
         have all been duly and properly taken.

                  (b) The execution, delivery and performance by Buyer and
         Vanguard of this Agreement and each of the Closing Documents to which
         it is a party does not violate any provision of its articles of
         incorporation, bylaws, or of any indenture or other material Contract
         to which Buyer or Vanguard is a party and of which counsel has
         knowledge.

                                      49

<PAGE>

                  (c) This Agreement and each of the Closing Documents to which
         it is a party constitutes a valid and binding obligation of Buyer and
         Vanguard, enforceable against Buyer and Vanguard in accordance with
         its terms, subject, as to enforcement of remedies, to (i) applicable
         bankruptcy, reorganization, insolvency, moratorium or other laws
         affecting creditors' rights generally from time to time in effect,
         (ii) limitations on the enforcement of equitable remedies, and (iii)
         such other qualifications as counsel to the Parties may mutually agree
         upon.

                  (d) To such counsel's knowledge, the consummation of the
         transactions described in this Agreement will not result in a
         violation, breach or default by Buyer or Vanguard under any material
         Legal Requirements.

                  (e) The Common Shares issued and delivered to the Foundation
         at Closing were duly authorized and issued and represent fully-paid,
         nonassessable shares of Common Stock free of all transfer restrictions
         except those imposed by applicable Legal Requirements and under the
         Shareholders Agreement and Surviving Shareholders Agreement.

                  (f) Assuming due and valid execution by the Foundation of the
         Shareholders Agreement and the Surviving Shareholders Agreement, the
         Foundation shall be entitled to all of the rights and privileges (but
         subject to the limitations and conditions) of a "Holder" (as defined
         therein) under each such agreement.

In rendering such opinion, such counsel may rely upon certificates of
governmental officials and may place reasonable reliance upon certificates of
officers of Buyer or Vanguard.

         6.06. Delivery of Closing Documents. Buyer shall have delivered at
Closing (to the Person or Persons designated therein) the Closing Documents
required by, and otherwise have fully complied with, the provisions of Section
8.03.

         6.07. Leases. MHSC and Buyer shall have entered into one or more
master leases of the real property and improvements described on Schedule
2.02(h) for a term of 20 years and an annual rent during the first year of the
lease term of $1,207,000 (subject to adjustment during the lease term based on
changes in the consumer price index) and otherwise on terms and conditions
acceptable to MHSC. The master lease shall be assignable by MHSC. All current
leases in such properties shall be assigned to Buyer as subleases and
subordinated to the master lease(s) and Buyer shall have a right of first
refusal to purchase the properties during the term of the master lease.

         7. CONDITIONS PRECEDENT TO OBLIGATIONS OF BUYER

         The obligations of Buyer hereunder are subject to the satisfaction on
or prior to the Closing Date of the following conditions, unless waived in
writing by Buyer:

         7.01. Representations and Warranties; Covenants.

                  (a) Each of the representations and warranties of Sellers
         contained in this Agreement shall be true and correct on and as of the
         Effective Date; each of the

                                      50

<PAGE>

         representations and warranties of Sellers contained in this Agreement
         that are qualified as to materiality shall be true and correct on and
         as of the Closing Date; and each of the other representations and
         warranties of Sellers contained in this Agreement shall be true and
         correct in all material respects on and as of the Closing Date.

                  (b) Each and all of the terms, covenants and agreements to be
         complied with or performed by Sellers on or before the Closing Date
         shall have been complied with and performed, including the obligations
         of Sellers and the Foundation in Section 8.02.

         7.02. Adverse Action or Proceeding. No action or proceeding before any
Governmental Authority shall have been instituted or threatened to restrain or
prohibit the transactions herein contemplated, and no Governmental Authority
shall have taken any other action or made any request of Sellers or Buyer as a
result of which Buyer reasonably and in good faith deems it inadvisable to
proceed with the transactions hereunder; and there shall not be in effect any
order restraining, enjoining or otherwise preventing consummation of the sale
of the Assets and other transactions contemplated hereunder.

         7.03. Pre-Closing Confirmations and Contractual Consents. Buyer shall
have obtained documentation or other evidence reasonably satisfactory to Buyer
that:

                  (a) Sellers and Buyer have received all consents, permits,
         approvals, authorizations and clearances of Governmental Authorities
         required to consummate the transactions herein contemplated;

                  (b) Buyer has received confirmation from the Illinois
         Department of Health and other applicable licensure agencies that upon
         Closing all licenses required by law to operate the Hospital
         Businesses will be transferred to or issued in the name of Buyer;

                  (c) Buyer has obtained reasonable assurances that
         certification of the operation by Buyer of the Hospital Businesses by
         all Government Payment Programs as to which reimbursement has been
         historically a part of the Hospital Businesses will be effective as of
         the Closing Date and that Buyer may participate in and receive
         reimbursement from such programs effective as of the Closing Date;

                  (d) subject to Section 7.13, Sellers have obtained consents
         to assignment of substantially all Assumed Contracts (other than
         Immaterial Contracts) for which such consents are required; and

                  (e) Sellers or the Subsidiaries have obtained such consents
         and approvals as may be legally or contractually required for Buyer to
         succeed to the ownership interests of Sellers in the Subsidiaries; and

                  (f) all applicable waiting periods under the HSR Act have
         expired.

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<PAGE>

         7.04. No Material Adverse Change. Since June 30, 1999, no material
adverse change in the Assets or results of operations, financial condition or
prospects for future operations of the Hospital Businesses, taken as a whole,
shall have occurred. Accrual of non-recurring transaction-related expenses (as
described in the definition of Adjusted EBITDA) shall not constitute a material
adverse change within the meaning of this Section.

7.05 Extraordinary Events. No Seller or Subsidiary shall (a) be in receivership
or dissolution, (b) have made any assignment for the benefit of creditors, (c)
have admitted in writing its inability to pay its debts as they mature, (d)
have been adjudicated a bankrupt, (e) have filed a petition in voluntary
bankruptcy, a petition or answer seeking reorganization, or an arrangement with
creditors under the federal bankruptcy law or any other similar law or statute
of the United States or any state, nor shall any such petition have been filed
against any of them, or (f) have entered into any Contract to do or permit the
doing of any of the foregoing on or after the Closing Date.

         7.06 Environmental and Structural Reports. Buyer shall have received
environmental and structural reports with respect to the Hospital Businesses
prepared by Persons acceptable to Buyer and the scope, findings and conclusions
of such reports shall be reasonably satisfactory to Buyer.

         7.07 Title Insurance Policies and Surveys. Buyer shall have received:

                  (a) commitments from a title insurance company or companies
         designated by Buyer to issue as of the Closing Date one or more ALTA
         extended coverage owner's title insurance policies for the Seller Real
         Property, in amounts acceptable to Buyer, in form reasonably
         satisfactory to Buyer and with such endorsements as Buyer may
         reasonably require; and

                  (b) evidence that the Subsidiaries have title insurance for
         the Subsidiary Real Property in amounts and forms reasonably
         satisfactory to Buyer, with such endorsements as Buyer may reasonably
         require to evidence the release of any Encumbrances that are not
         Permitted Real Property Encumbrances;

                  (c) ALTA surveys of the Real Property and improvements
         thereon, in form satisfactory to Buyer and the title insurance
         company, from an engineering firm designated by Buyer and certified to
         Buyer, the title insurance company and such other Persons as Buyer may
         designate.

         7.08 Opinion of Sellers' Counsel. Buyer shall have received an opinion
from counsel to Sellers (who may be in-house counsel) dated as of the Closing
Date and addressed to Buyer, in form and substance reasonably satisfactory to
Buyer, to substantially the following effect;

                  (a) Each Seller is a not-for-profit corporation duly
         incorporated and validly existing in good standing under the laws of
         the State of Illinois with full corporate power to carry on its
         business as it is now being conducted. Each Seller has full power and
         authority to execute and deliver this Agreement and each of the

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<PAGE>

         Closing Documents to which it is a party and to perform its
         obligations therein. All corporate proceedings required to be taken by
         each Seller to authorize the execution and delivery of this Agreement
         and each of the Closing Documents to which it is a party and to
         authorize the performance of its obligations therein, have all been
         duly and properly taken.

                  (b) Each Subsidiary that is a corporation is duly
         incorporated and validly existing in good standing under the laws of
         the State of Illinois with full corporate power to carry on its
         business as it is now being conducted. Each Subsidiary that is a
         limited liability company is duly organized and validly existing in
         good standing under the laws of the State of Illinois with full
         company power to carry on its business as it is now being conducted.
         Each Subsidiary that is a general partnership, limited partnership or
         joint venture is duly organized and validly existing in good standing
         under the laws of the State of Illinois with full partnership power to
         carry on its business as it is now being conducted.

                  (c) The execution, delivery and performance of this Agreement
         and each of the Closing Documents to which it is a party does not
         violate any provision of its articles of incorporation or bylaws, or
         of any indenture or other Contract to which such Seller is a party and
         of which such counsel has knowledge.

                  (d) This Agreement and each of the Closing Documents to which
         it is a party constitutes a valid and binding obligation of such
         Person, enforceable against such Seller in accordance with its terms,
         subject, as to enforcement of remedies, to (a) applicable bankruptcy,
         reorganization, insolvency, moratorium or other laws affecting
         creditors' rights generally from time to time in effect, (b)
         limitations on the enforcement of equitable remedies and (c) such
         other qualifcations as counsel to the Parties may mutually agree upon.

                  (e) To such counsel's knowledge, the consummation of the
         transactions described in the Agreement will not result in a
         violation, breach or default by any Seller under any material Legal
         Requirements.

In rendering such opinion, such counsel may rely upon certificates of
governmental officials and may place reasonable reliance upon certificates of
officers of Sellers.

         7.09 Lien Searches. Sellers shall have delivered to Buyer UCC lien,
litigation and tax searches showing all Encumbrances on the Assets, accompanied
by fully executed UCC or other releases or conveyances relating to all
Encumbrances that are not Permitted Real Property Encumbrances or Permitted
Personal Property Encumbrances.

         7.10 Hill-Burton Facilities. There shall be no Encumbrance on or
affecting any of the Assets or Hospital Businesses relating to or arising out
of the Hill-Burton Act.

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         7.11 Delivery of Closing Documents. Sellers shall have delivered at
Closing (to the Person or Persons designated therein) the Closing Documents
required by, and otherwise have fully complied with, the provisions of Section
8.02.

         7.12 [Intentionally Omitted]

         7.13 Managed Care Contracts. Buyer shall have determined that:

                  (a) The managed care Contracts between Sellers and the payors
         listed on Schedule 3.30 will either be assigned to Buyer or
         re-executed with Buyer on terms and conditions that neither result in
         decreased reimbursement to Buyer nor have other material provisions
         unreasonable as to Buyer; and

                  (b) None of the managed care Contracts to be assigned to or
         re-executed with Buyer shall have restrictive covenants prohibiting
         Buyer from negotiating with existing or future health plans for any
         products or services.

         7.15. Shareholders Agreements. The Foundation shall have become a
party to the existing Shareholders Agreement and Surviving Shareholders
Agreement.

         7.16. Leases. MHSC and Buyer shall have entered into one or more
master leases of the real property and improvements described on Schedule
2.02(h) for a term of 20 years and an annual rent during the first year of the
lease term of $1,207,000 (subject to adjustment during the lease term based on
changes in the consumer price index) and otherwise on terms and conditions
acceptable to Buyer. All current leases in such properties shall be assigned to
Buyer as subleases and subordinated to the master lease(s) and Buyer shall have
a right of first refusal to purchase the properties during the term of the
master lease.

         8. CLOSING; TERMINATION OF AGREEMENT

         8.01. Closing.

                  (a) Consummation of the sale and purchase of the Hospital
         Businesses and the other transactions contemplated by and described in
         this Agreement (the "Closing") shall take place at the office of
         McDermott, Will & Emery, 227 West Monroe Street, Suite 4400, Chicago,
         Illinois, at 10:00 a.m. on the later of (i) the first business day
         following satisfaction or waiver of the conditions set forth in
         Articles 6 and 7, and (ii) January 3, 2000, or at such time or place
         as the Parties may mutually agree. Unless otherwise agreed in writing
         by the Parties at Closing, the Closing shall be effective for
         accounting purposes as of 12:01 a.m. on January 1, 2000 if the
         transaction closes on or before January 15, 2000.

                  (b) At the Closing, Buyer may designate one or more
         Affiliates to take title to the Seller Assets for regulatory or other
         reasons and references to instruments or agreements to be executed and
         delivered to or by Buyer in this Agreement at Closing shall apply to
         each such designee with respect to the Assets acquired by it. Buyer
         shall notify Sellers prior to Closing of the names of such designees
         and, from

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<PAGE>

         and after Closing, the rights, privileges and benefits of this
         Agreement applicable to Buyer shall benefit each such designee,
         subject to the terms, covenants and conditions of this Agreement, with
         respect to the Seller Assets acquired by it.

         8.02. Action of Sellers and the Foundation at Closing. At the Closing
and unless otherwise waived in writing by Buyer, Sellers and the Foundation
shall deliver:

                  (a) to Buyer deeds containing special warranties of title,
         fully executed by Sellers in recordable form, conveying to Buyer good
         and marketable fee title to the Seller Real Property, free and clear
         of all Encumbrances other than the Permitted Real Property
         Encumbrances;

                  (b) to Buyer bills of sale and assignment, fully executed by
         Sellers, in form and substance acceptable to Buyer, conveying to Buyer
         good and valid title to all Seller Assets other than the Real
         Property, free and clear of all Encumbrances other than the Permitted
         Personal Property Encumbrances;

                  (c) to Buyer assignments, fully executed by Sellers, in form
         and substance acceptable to Buyer, conveying to Buyer Sellers'
         interests in the Assumed Contracts;

                  (d) to Buyer a liability assumption and indemnification
         agreement, fully executed by Sellers, in form and substance acceptable
         to Buyer, pursuant to which Sellers shall assume and agree to pay and
         be responsible for, the Excluded Contracts and all liabilities of the
         Subsidiaries except the Assumed Liabilities;

                  (e) to Buyer stock certificates, duly endorsed for transfer
         to Buyer and with all stamps or evidence of other documentary and
         transfer taxes affixed, and certificates or other appropriate
         instruments of transfer of the ownership interests in the
         Subsidiaries, duly endorsed for transfer to Buyer, as appropriate;

                  (f) to Vanguard the certificate evidencing the Shares issued
         by Vanguard to MacNeal Hospital at Closing, duly endorsed for transfer
         to the Foundation and with all stamps or evidence of other documentary
         and transfer taxes affixed;

                  (g) to Vanguard a joinder to (or amended and restated
         versions of) the Shareholders Agreement and the Surviving Shareholders
         Agreement, duly executed by the Foundation;

                  (h) the original minute books and transfer ledgers of the
         Subsidiaries;

                  (i) written resignations of the directors and officers of (or
         persons holding comparable positions in) the Subsidiaries effective on
         and as of the Closing;

                  (j) to Buyer copies of resolutions duly adopted by the board
         of directors or trustees of each Seller and the Foundation and, if
         required, the Subsidiaries and members of each Seller, authorizing and
         approving the execution and delivery of this Agreement and the Closing
         Documents and the consummation of the transactions

                                      55
<PAGE>

         contemplated hereby, certified as true and in full force and effect as
         of the Closing Date by the appropriate officers of such Seller;

                  (k) to Buyer certificates of the duly authorized President or
         Vice President of each Seller and the Foundation certifying
         respectively that each of the representations and warranties of such
         Seller and the Foundation contained in this Agreement that is
         qualified as to materiality is true and correct on and as of the
         Closing Date, that each of the other representations and warranties of
         each Seller and the Foundation contained in this Agreement is true and
         correct in all material respects on and as of the Closing Date, and
         that each and all of the terms, covenants and agreements to be
         complied with or performed by such Seller and the Foundation on or
         before the Closing Date have been complied with and performed;

                  (l) to Buyer certificates of incumbency for the respective
         officers of each Seller and the Foundation executing the Agreement and
         the Closing Documents, dated as of the Closing Date;

                  (m) to Buyer certificates of existence and good standing from
         the state or states in which each Seller, the Foundation and each
         Subsidiary is incorporated or organized, each dated the most recent
         practical date prior to Closing; and

                  (n) to Buyer such other Closing Documents as Buyer reasonably
         deems necessary to effect the transactions contemplated hereby.

         8.03. Action of Buyer at Closing. At the Closing and unless otherwise
waived in writing by Sellers, Buyer shall deliver:

                  (a) to Sellers that part of the Cash Portion of the Purchase
         Price payable to Sellers in accordance with Section 2.05(f) and a
         certificate evidencing the Common Shares issued in the name of MacNeal
         Hospital;

                  (b) to the Foundation that part of the Cash Portion of the
         Purchase Price payable to the Foundation in accordance with Section
         2.05(f) and a certificate evidencing the Common Shares issued in the
         name of the Foundation;

                  (c) to Sellers an assumption agreement, fully executed by
         Buyer, in form and substance acceptable to Sellers, pursuant to which
         Buyer shall assume the future payment and performance of the Assumed
         Liabilities;

                  (d) to the Foundation a joinder to (or amended and restated
         versions of) the Shareholders Agreement and the Surviving Shareholders
         Agreement, duly executed by Vanguard and all necessary Holders (as
         defined therein);

                  (e) to Sellers and the Foundation copies of resolutions duly
         adopted by the boards of directors of Buyer and Vanguard authorizing
         and approving the execution and delivery of this Agreement by Buyer
         and Vanguard and the Closing Documents and the consummation of the
         transactions contemplated hereby, certified

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<PAGE>

         as true and in full force and effect as of the Closing Date by
         appropriate officers of Buyer and Vanguard:

                  (f) to Sellers and the Foundation certificates of the duly
         authorized President or a Vice President of Buyer certifying that each
         of the representations and warranties of Buyer contained in this
         Agreement that is qualified as to materiality is true and correct on
         and as of the Closing Date, that each of the other representations and
         warranties of Buyer contained in this Agreement is true and correct in
         all material respects on and as of the Closing Date, and that each and
         all of the terms, covenants and agreements to be complied with or
         performed by Buyer on or before the Closing Date have been complied
         with and performed;

                  (g) to Sellers and the Foundation certificates of incumbency
         for the officers of Buyer and Vanguard executing this Agreement and
         the Closing Documents, dated as of the Closing Date;

                  (h) to Sellers and the Foundation certificates of existence
         and good standing of Buyer from the state in which it is incorporated,
         dated the most recent practical date prior to Closing; and

                  (i) to Sellers and the Foundation such other Closing
         Documents as Sellers reasonably deem necessary to effect the
         transactions contemplated hereby.

         8.04. Termination Prior to Closing.

                  (a) Notwithstanding anything herein to the contrary, this
         Agreement may be terminated, and the transactions contemplated by this
         Agreement abandoned, upon notice by the terminating Party to the other
         Parties:

                           (i) at any time before the Closing, by mutual
                  consent of Buyer and Sellers;

                           (ii) by Buyer in accordance with Section 5.12;

                           (iii) at any time before the Closing, by Buyer on
                  the one hand, or Sellers on the other hand, in the event of a
                  breach of this Agreement by the non-terminating Party which
                  is not cured by such breaching Party by the earlier of 30
                  days after receipt of written notice specifying the alleged
                  breach and June 30, 2000, or if the satisfaction of any
                  condition to such Party's obligations under this Agreement
                  becomes impossible or impracticable with the use of
                  commercially reasonable efforts and the failure of such
                  condition to be satisfied is not caused by a breach by the
                  terminating Party;

                           (iv) by Sellers or Buyer, if Buyer does not have
                  sufficient funds available to pay the Purchase Price on the
                  date set for Closing pursuant to Section 8.01(a);

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<PAGE>

                           (v) by Sellers if, as a result of an Alternative
                  Proposal received by any Seller from a Person other than
                  Buyer or any of its Affiliates, the board of directors or
                  trustees of any Seller determines in good faith that its
                  fiduciary obligations under applicable law require that such
                  Alternative Proposal be accepted; provided that (i) the board
                  of directors or trustees of such Seller shall have determined
                  in good faith, after considering applicable provisions of
                  state law and after giving effect to all concessions, if any,
                  which have been offered by the Buyer pursuant to clause (ii)
                  of this paragraph, on the basis of oral or written advice of
                  outside counsel, that such action is required by its
                  fiduciary obligations under applicable law, and (ii) prior to
                  any such termination, such Seller shall, and shall cause its
                  financial and legal advisors to, negotiate with Buyer to make
                  such adjustments in the terms and conditions of this
                  Agreement as would enable Buyer to proceed with the
                  transactions contemplated hereby;

                           (vi) at any time prior to the close of business on
                  October 20, 1999 by Buyer if Buyer has not obtained by such
                  time the written consent of Morgan Stanley Capital Partners
                  III, L.P. and Morgan Stanley Dean Witter Capital Partners IV,
                  L.P. pursuant to section 4.02(a) of the Shareholders
                  Agreement to the transactions contemplated by this Agreement;

                           (vii) at any time after June 30, 2000 by Sellers if
                  the transactions contemplated by this Agreement have not been
                  consummated on or before such date and such failure to
                  consummate is not caused by a breach of this Agreement by
                  Sellers;

                           (viii) at any time after June 30, 2000 by Buyer if
                  the transactions contemplated by this Agreement have not been
                  consummated on or before such date and such failure to
                  consummate is not caused by a breach of this Agreement by
                  Buyer;

                           (ix) by Buyer if, since June 30, 1999, a material
                  adverse change in the Assets or results of operations,
                  financial condition or prospects for future operations of the
                  Hospital Businesses, taken as a whole, has occurred; or

                           (x) by Sellers or Buyer in accordance with Section
                  11.01(c).

                  (b) If this Agreement is validly terminated pursuant to this
         Section, this Agreement will be null and void, and there will be no
         liability on the part of any Party (or any of their respective
         officers, directors, trustees, employees, agents, consultants or other
         representatives) except as expressly provided otherwise in Section
         8.05 and except that, upon termination of this Agreement pursuant to
         subparagraphs (iii), (vii) or (viii) above, Sellers will remain liable
         to Buyer and Buyer will remain liable to Sellers for any breach of
         their respective obligations under Section 5.19 existing at the time
         of such termination, and each Party may seek such remedies or damages
         against the other with respect to any such breach as are

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<PAGE>

         provided in this Agreement or as are otherwise available at law or in
         equity. No termination shall be effective pursuant to Section
         8.04(a)(iv) or 8.04(a)(v) unless concurrently with such termination,
         the termination fee is paid in full by the applicable party in
         accordance with the provisions of Section 8.05.

         8.05. Effect of Termination.

                  (a) If this Agreement is terminated by Sellers or Buyer
         pursuant to Section 8.04(a)(iv), then Buyer shall pay to Sellers a
         termination fee of $10 million. If this Agreement is terminated by --
         Sellers pursuant to Section 8.04(a)(v), Sellers shall pay to Buyer a
         termination fee of $10 million. Each termination fee payable under
         this Section shall be payable in cash.

                  (b) The Parties acknowledge and agree that the agreements
         contained in this Section are an integral part of the transaction
         contemplated by the Agreement and constitute liquidated damages and
         not a penalty. If one Party fails to promptly pay to the other any fee
         due under Section 8.05(a), the defaulting Party shall pay the costs
         and expenses (including legal fees and expenses) in connection with
         any action, including the filing of any lawsuit or other legal action,
         taken to collect payment, together with interest as provided in
         Section 11.16 from the date such fee was required to be paid.

         9. INDEMNIFICATION

         9.01. Indemnification by Sellers. Subject to and to the extent
provided in this Article, from and after the Closing, Sellers shall jointly and
severally indemnify, defend and hold harmless Buyer's Indemnified Persons, and
each of them, from and against any Losses incurred or suffered by Buyer's
Indemnified Persons, directly or indirectly, as a result of or arising from:

                  (a) any inaccuracy of any representation or warranty of any
         Seller, whether or not Buyer's Indemnified Persons relied thereon or
         had knowledge thereof, provided that in determining whether there has
         been any such inaccuracy, any qualification as to materiality included
         in any representation or warranty shall not be taken into account;

                  (b) the nonfulfillment of any covenant, agreement or other
         obligation of any Seller set forth in this Agreement or in any other
         agreement or instrument delivered by any Seller pursuant to this
         Agreement; and

                  (c) the Excluded Liabilities.

         9.02. Sellers' Limitations. Sellers shall have no liability under
Section 9.01 and no claim under Section 9.01 shall:

                  (a) accrue to any of Buyer's Indemnified Persons against
         Sellers under Section 9.01(a) unless and until the total liability of
         Sellers in respect of claims arising under Section 9.01(a) exceeds
         $500,000 in the aggregate, provided that (i) in

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<PAGE>

         no event shall Sellers' indemnification obligations under Section
         9.01(a) exceed $100,000,000, and (ii) there shall be no minimum Loss
         requirement, and liability of Sellers shall arise from and after $1.00
         of Losses, in respect of Losses resulting from any Seller's
         intentional misrepresentation or fraud; and

                  (b) be made unless notice thereof shall have been given by or
         on behalf of any of Buyer's Indemnified Persons to Sellers in the
         manner provided in Section 9.05.

         9.03. Indemnification by Buyer. Subject to and to the extent provided
in this Article, from and after the Closing Date, Buyer shall indemnify, defend
and hold harmless Sellers' Indemnified Persons, and each of them, from and
against any Losses incurred or suffered by Sellers' Indemnified Persons,
directly or indirectly, as a result of or arising from:

                  (a) the inaccuracy in any representation or warranty of
         Buyer, whether or not Seller's Indemnified Persons relied thereon or
         had knowledge thereof, provided that in determining whether there has
         been any such inaccuracy, any qualification as to materiality included
         in any representation or warranty shall not be taken into account;

                  (b) the nonfulfillment of any covenant, agreement or other
         obligation of Buyer set forth in this Agreement or in any other
         agreement or instrument delivered by Buyer pursuant to this Agreement;
         and

                  (c) the Assumed Liabilities.

         9.04. Buyer's Limitations. Buyer shall have no liability under Section
9.03 and no claim under Section 9.03 shall:

                  (a) accrue to any of Sellers' Indemnified Persons against
         Buyer under Section 9.03(a) unless and until the total liability of
         Buyer in respect of claims arising under Section 9.03(a) exceeds
         $500,000 in the aggregate, provided that (i) in no event shall Buyer's
         indemnification obligations under Section 9.03(a) exceed $100,000,000,
         and (ii) there shall be no minimum Loss requirement, and liability of
         Buyer shall arise from and after $1.00 of Losses, in respect of Losses
         resulting from Buyer's intentional misrepresentation or fraud; and

                  (b) be made unless notice thereof shall have been given by or
         on behalf of any of Sellers' Indemnified Persons to Buyer in the
         manner provided in Section 9.05.

         9.05. Notice and Procedure. All claims for indemnification by any
Indemnified Party against an Indemnifying Party under this Article shall be
asserted and resolved as follows:

                  (a)(i) If any claim or demand for which an Indemnifying Party
         would be liable for Losses to an Indemnified Party is alleged or
         asserted by a Person other than any Buyer's Indemnified Person or any
         Sellers' Indemnified Person (a "Third Party Claim"), the Indemnified
         Party shall deliver a Claim Notice with reasonable

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<PAGE>

         promptness to the Indemnifying Party, together with a copy of all
         papers served, if any, and specifying the nature of and alleged basis
         for the Third Party Claim and, to the extent then feasible, the
         alleged amount or the estimated amount of the Third Party Claim. If
         the Indemnified Party fails to deliver the Claim Notice to the
         Indemnifying Party within 30 days after the Indemnified Party receives
         notice of such Third Party Claim, or within 15 days after receipt by
         the Indemnified Party of a complaint, petition, arbitration demand or
         other written notice of the institution of formal legal action, the
         Indemnifying Party will not be obligated to indemnify the Indemnified
         Party with respect to such Third Party Claim if and only to the extent
         that the Indemnifying Party's ability to defend the Third Party Claim
         has been materially prejudiced by such failure. The Indemnifying Party
         will notify the Indemnified Party within 20 days after receipt of the
         Claim Notice, or within five days in the case of a Claim Notice
         describing or including a complaint, petition, arbitration demand or
         other written notice of the institution of formal legal action, (in
         either case, the "Notice Period") whether the Indemnifying Party
         intends, at the sole cost and expense of the Indemnifying Party, to
         defend the Indemnified Party against the Third Party Claim. The
         assumption by the Indemnifying Party of the defense of the Third Party
         Claim constitutes an admission by the Indemnifying Party that the
         claim is one for which the Indemnifying Party is ultimately liable
         under this Article.

                  (ii) If the Indemnifying Party notifies the Indemnified Party
         within the Notice Period that the Indemnifying Party intends to defend
         the Indemnified Party against the Third Party Claim, then the
         Indemnifying Party will have the right to defend, at its sole cost and
         expense, the Third Party Claim by all appropriate proceedings, which
         proceedings will be diligently prosecuted by the Indemnifying Party to
         a final conclusion or settled at the discretion of the Indemnifying
         Party (with the consent of the Indemnified Party, which consent shall
         not be unreasonably withheld). The Indemnifying Party will have full
         control of such defense and proceedings; provided that the Indemnified
         Party may file during the pendency of such Third Party Claim, at the
         sole cost and expense of the Indemnified Party, any motion, answer or
         other pleading that the Indemnified Party may deem necessary or
         appropriate to protect its interests and not irrevocably prejudicial
         to the Indemnifying Party (it being understood and agreed that, except
         as provided in Section 9.05(a)(iii), if an Indemnified Party takes any
         such action that is irrevocably prejudicial and conclusively causes a
         final adjudication that is materially adverse to the Indemnifying
         Party, the Indemnifying Party will be relieved of its obligations
         hereunder with respect to that portion of the Third Party Claim
         prejudiced by the Indemnified Party's action); and provided further
         that, if requested by the Indemnifying Party, the Indemnified Party
         shall cooperate, at the sole cost and expense of the Indemnifying
         Party, with the Indemnifying Party and its counsel in contesting any
         Third Party Claim that the Indemnifying Party elects to contest or, if
         appropriate in the judgment of the Indemnified Party and related to
         the Third Party Claim, in making any counterclaim or cross-claim
         against any Person (other than the Indemnified Party). The Indemnified
         Party may participate in, but not control, any defense or settlement
         of any Third Party Claim assumed by the Indemnifying Party pursuant to
         this Section

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<PAGE>

         9.05(a)(ii) and, except as provided in the preceding sentence, the
         Indemnified Party will bear its own costs and expenses with respect to
         such participation. Notwithstanding the foregoing, the Indemnifying
         Party may not assume the defense of the Third Party Claim on behalf of
         the Indemnified Party if (1) the Persons against whom the claim is
         made, or any impleaded Persons, include both the Indemnifying Party
         and any Indemnified Party, and (2) representation of both such Persons
         by the same counsel would be inappropriate due to actual or potential
         differing interests between them, in which case any Indemnified Party
         shall have the right to defend the Third Party Claim on its own behalf
         and to employ counsel at the expense of the Indemnifying Party.

                  (iii) If the Indemnifying Party fails to notify the
         Indemnified Party within the Notice Period that the Indemnifying Party
         intends to defend the Indemnified Party against the Third Party Claim,
         or if the Indemnifying Party gives such notice but fails to diligently
         prosecute or settle the Third Party Claim, or if the Indemnifying
         Party fails to give any notice whatsoever within the Notice Period,
         then the Indemnified Party will have the right (but not the
         obligation) to defend, at the sole cost and expense of the
         Indemnifying Party, the Third Party Claim by all appropriate
         proceedings, which proceedings will be diligently prosecuted by the
         Indemnified Party to a final conclusion or settled at the discretion
         of the Indemnified Party. The Indemnified Party will have full control
         of such defense and proceedings, including any compromise or
         settlement thereof; provided that, if requested by the Indemnified
         Party, the Indemnifying Party shall cooperate, at the sole cost and
         expense of the Indemnifying Party, with the Indemnified Party and its
         counsel in contesting the Third Party Claim which the Indemnified
         Party is contesting, or, if appropriate and related to the Third Party
         Claim in question, in making any counterclaim or cross claim against
         any Person (other than the Indemnifying Party).

                  (iv) Notwithstanding the foregoing provisions of Section
         9.05(a)(iii), if the Indemnifying Party notifies the Indemnified Party
         within the Notice Period that the Indemnifying Party disputes its
         obligation to indemnify the Indemnified Party against the Third Party
         Claim, and if such dispute is resolved pursuant to Section 9.05(c) or
         Article 10 in favor of the Indemnifying Party, the Indemnifying Party
         will not be required to bear the costs and expenses of the Indemnified
         Party's defense pursuant to Section 9.05(a)(iii) or of the
         Indemnifying Party's participation therein at the Indemnified Party's
         request, and the Indemnified Party will reimburse the Indemnifying
         Party in full for all such costs and expenses. Except as otherwise
         specifically provided in Section 9.05(a)(iii), the Indemnifying Party
         may participate in, but not control, any defense or settlement
         controlled by the Indemnified Party pursuant to Section 9.05(a)(iii),
         but the Indemnifying Party will bear its own costs and expenses with
         respect thereto if such participation is not at the request of the
         Indemnified Party.

                  (b) In the event any Indemnified Party should have a claim
         against any Indemnifying Party that is not a Third Party Claim, the
         Indemnified Party shall deliver an Indemnity Notice with reasonable
         promptness to the Indemnifying Party

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<PAGE>

         specifying the nature of and specific basis for the claim and, to the
         extent then feasible, the amount or the estimated amount of the claim.
         The failure by any Indemnified Party to give timely notice referred to
         in the preceding sentence shall not impair such Person's rights
         hereunder except to the extent that an Indemnifying Party demonstrates
         that it has been materially prejudiced thereby. If the Indemnifying
         Party does not notify the Indemnified Party within ten days following
         its receipt of the Indemnity Notice that the Indemnifying Party
         disputes its obligation to indemnify the Indemnified Party hereunder,
         the claim will be conclusively deemed a liability of the Indemnifying
         Party hereunder.

                  (c) If the Indemnifying Party timely disputes its liability
         with respect to a claim described in a Claim Notice or an Indemnity
         Notice, the Indemnifying Party and the Indemnified Party shall proceed
         promptly and in good faith to negotiate a resolution of such dispute
         within 60 days following receipt of the Claim Notice or Indemnity
         Notice and, if such dispute is not resolved through negotiations
         during such 60-day period, it shall be resolved pursuant to the
         provisions of Article 10.

                  (d) The Indemnifying Party shall pay the amount of any
         liability to the Indemnified Party within 30 days following its
         receipt of a Claim Notice or an Indemnity Notice, or on such later
         date (i) in the case of a Third Party Claim, as the Indemnified Party
         suffers Losses in respect of the Third Party Claim, (ii) in the case
         of an Indemnity Notice in which the amount of the claim is estimated,
         promptly after any Losses in respect of such claim are actually
         incurred by the Indemnified Party, provided that, if the Indemnifying
         Party notifies the Indemnified Party within the Notice Period that the
         Indemnifying Party disputes its obligation to indemnify hereunder and
         such dispute is resolved in favor of the Indemnified Party, the
         Indemnifying Party shall pay the amount of any liability to the
         Indemnified Party upon resolution of such dispute. In the event the
         Indemnified Party is not paid in full for its claim in a timely manner
         after the Indemnifying Party's obligation to indemnify and the amount
         thereof has been determined, the amount due shall bear interest from
         the date that the indemnification amount has been determined until
         paid at the interest rate provided in Section 11.16, and in addition
         to any other rights it may have against the Indemnifying Party, the
         Indemnified Party shall have the right to set-off the unpaid amount of
         such claim against any amounts owed by it to the Indemnifying Party.

                  (e) Any estimated amount of a claim submitted in a Claim
         Notice or an Indemnity Notice shall not be conclusive of the final
         amount of such claim, and the giving of a Claim Notice when an
         Indemnity Notice is properly due, or the giving of an Indemnity Notice
         when a Claim Notice is properly due, shall not impair such Indemnified
         Party's rights hereunder except to the extent that an Indemnifying
         Party demonstrates that it has been materially prejudiced thereby.
         Notice of any claim comprised in part of Third Party Claims and claims
         that are not Third Party Claims may be given pursuant to either
         Section 9.05(a) or 9.05(b).

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<PAGE>

                  (f) Each Indemnified Party shall cooperate in all reasonable
         respects with the Indemnifying Party and its counsel in any matter for
         which a defense is provided hereunder. In the event that an
         Indemnified Party does not so cooperate, which failure to cooperate
         has a material adverse effect on the defense or settlement thereof or
         the enforcement of any rights of contribution that the Indemnifying
         Party has against any Person, the Indemnifying Party shall have no
         further obligation hereunder with respect to such matter.

                  (g) Following indemnification of any Indemnified Party as
         provided for hereunder and payment of any and all indemnifiable Losses
         hereunder, the Indemnifying Party shall be subrogated to all of the
         rights of the Indemnified Party with respect to Persons (other than
         another Indemnified Person) relating to the matter for which
         indemnification has been made.

         9.06. Survival of Representations; Indemnity Periods. Notwithstanding
any right of Buyer (whether or not exercised) to investigate the Hospital
Businesses or any right of any Party (whether or not exercised) to investigate
the accuracy of the representations and warranties of the other Party contained
in this Agreement, Sellers have, on the one hand, and Buyer and Vanguard have,
on the other hand, the right to rely fully upon the representations,
warranties, covenants and agreements of the other contained in this Agreement.
The representations, warranties, covenants and agreements in this Agreement
made by Sellers and Buyer respectively will survive the Closing (a)
indefinitely with respect to matters covered by Sections 2.03, 2.04, 3.01,
4.01, 9.01(c) and 9.03(c), (b) until 60 days after the expiration of all
applicable statutes of limitations (including all periods of extension, whether
automatic or permissive) with respect to matters covered by Sections 3.05,
3.07, 3.13, 3.17, 3.22, 3.23, 3.24, 3.26, 3.27, 3.28 and 3.29, and (c) until
the second anniversary of the Closing Date in the case of all other
representations, warranties, covenants and agreements, except that

                           (i) any representation, warranty, covenant or
                  agreement that would otherwise terminate in accordance with
                  clause (b) or (c) above shall survive if a Claim Notice or an
                  Indemnity Notice shall have been given on or prior to such
                  termination date, until the related claim for indemnification
                  has been satisfied or otherwise resolved as provided in this
                  Article,

                           (ii) in the event of intentional misrepresentation
                  or fraud in the making of any representation or warranty, or
                  intentional, willful or reckless nonfulfillment or breach of
                  any covenant in this Agreement, all representations,
                  warranties, covenants and agreements that are the subject of
                  the intentional misrepresentation, fraud, willful or reckless
                  nonfulfillment or breach, shall survive until 60 days after
                  the expiration of all applicable statutes of limitations
                  (including all periods of extension, whether automatic or
                  permissive) with respect to matters covered thereby,

                           (iii) covenants and agreements to be performed after
                  the Closing Date will survive the Closing for the term
                  specified therein, or, if no term is specified, indefinitely,
                  and

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                           (iv) rights to indemnification under this Article
                  will survive until any claims brought hereunder shall have
                  been satisfied or otherwise resolved as provided herein.

         10. ALTERNATE DISPUTE RESOLUTION

         10.01. Agreement to Use the Procedure. In the event of a dispute
between the Parties arising out of or related to this Agreement and upon mutual
agreement of the Parties to resolve such dispute pursuant to the procedures set
forth in this Article, the Parties shall utilize the procedures specified in
this Article except (i) when otherwise modified by written agreement of the
Parties at the time the dispute arises, (ii) in connection with disputes
relating to the Purchase Price Adjustment, in which event the provisions of
Section 2.05 shall be utilized, (iii) when otherwise expressly provided
elsewhere in this Agreement.

         10.02. Initiation of the Procedure. A Party seeking to utilize these
procedures (the "Initiating Party") shall give written notice to the other
Party or Parties, describing briefly the nature of the dispute and its claim
and identifying an individual with authority to settle the dispute on its
behalf. The Party receiving such notice (the "Responding Party") shall have ten
days within which to designate, in a written notice given to the Initiating
Party, an individual with authority to settle the dispute on its behalf. The
individuals so designated shall be known as the "Authorized Individuals."

         10.03. Unassisted Settlement. The Authorized Individuals shall make
such investigations as they deem appropriate and promptly thereafter (but in no
event later than 15 days from the date the Initiating Party's notice is given)
shall commence discussions concerning resolution of the dispute. If the dispute
has not been resolved within 30 days from the commencement of discussions (such
30th day being the "Submission Date"), it shall be submitted to alternative
dispute resolution (the "ADR") as provided below.

         10.04. Selection of the Neutral. The Parties shall have ten days from
the Submission Date to select a mutually acceptable Person who is not an
Affiliate or employee of any Party to resolve the dispute (the "Neutral"). If
no Neutral has been selected within such time, any Party to the dispute may
request that the American Arbitration Association, the Center for Public
Resources, or another mutually agreed-upon provider of neutral dispute
resolution services, supply within ten days a list of potential Neutrals with
qualifications specified by the Parties. Within five days after receipt of the
list, the Parties shall independently rank the proposed candidates,
simultaneously exchange rankings and select as the Neutral the individual
receiving the highest combined ranking who is available to serve.

         10.05. Time and Place for the ADR. In consultation with the Neutral,
the Parties shall promptly designate a mutually convenient time and place for
the ADR (and unless circumstances require otherwise, such time shall be no
later than 60 days after selection of the Neutral).

         10.06. Exchange of Information. In the event any Party has a
substantial need for information in the possession of the other Party in order
to prepare for the ADR, the Parties shall

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attempt in good faith to agree on procedures for the expeditious exchange of
such information, with the help of the Neutral if necessary.

         10.07. Summary of Views. One week prior to the first scheduled session
of the ADR, each Party shall deliver to the Neutral and to the other Party a
concise written summary of its views on the matter in dispute, such summary not
to exceed ten pages in length.

         10.08. Staffing the ADR. In the ADR, each Party shall be represented
by the Authorized Individual and by up to two counsel (who may be in house
counsel). In addition, each Party may bring such other Persons (the maximum
number of which shall be agreed upon by the Parties in advance) as may be
needed to respond to questions, contribute information and participate in the
negotiations, with the assistance of the Neutral, if necessary.

         10.09. Conduct of the ADR. The Parties, in consultation with the
Neutral, will agree upon a format for the meetings designed to assure that the
Neutral and the Authorized Individuals have an opportunity to hear an oral
presentation of each Party's views on the matter in dispute, and that the
Authorized Individuals attempt to negotiate a resolution of the matter in
dispute, with or without the assistance of counsel or others, but with the
assistance of the Neutral. To this end, the Neutral is authorized to conduct
both joint meetings and separate private caucuses with the Parties. The Neutral
will keep confidential all information learned in private caucus with either
Party unless specifically authorized by such Party to make disclosure of the
information to the other Party.

         10.10. The Neutral's Views. The Neutral shall (a) unless requested not
to do so by the Parties, provide his opinion to the Parties on the probable
outcome should the matter be litigated, and (b) if requested to do so by the
Parties, make one or more recommendations as to the terms of a possible
settlement, upon any conditions imposed by the Parties (including a minimum and
maximum amount). The Neutral shall base his opinions and recommendations on
information then available to the Parties, excluding only such information
disclosed by any Party to the Neutral in confidence but not disclosed to the
other Party or Parties. The opinions and recommendations of the Neutral shall
not be binding on the Parties.

         10.11. Termination of the Procedure. The Parties shall participate in
the ADR to its conclusion (as designated by the Neutral) and not terminate
negotiations concerning resolution of the matters in dispute until at least ten
days thereafter. No Party shall commence a lawsuit or seek other remedies prior
to the conclusion of the 10-day post-ADR negotiation period; provided that
either Party may commence litigation within five days prior to the date after
which the commencement of litigation could be barred by an applicable statute
of limitations or doctrine of laches, or in order to request a temporary
restraining order or preliminary injunction to prevent irreparable harm, in
which event the Parties shall continue nevertheless (unless prohibited by court
order) to participate in the ADR to its conclusion.

         10.12. Fees of the Neutral; Disqualification. The fees of the Neutral
shall be shared equally by the Parties. The Neutral shall be disqualified as a
witness, consultant, expert or counsel for either Party with respect to the
matters in dispute and any litigation or other matters relating thereto.

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         10.13. Confidentiality. The procedures described above are intended to
constitute a compromise negotiation for purposes of the Federal Rules of
Evidence and state rules of evidence. The entire Procedure is confidential, and
no stenographic, visual or audio record shall be made. All conduct, statements,
promises, offers, views and opinions, whether oral or written, made in the
course of the Procedure by any Party, its agents, employees, representatives or
other invitees, and by the Neutral (who will be the Parties' joint agent for
purposes of the Procedure) are confidential and, where appropriate, shall be
deemed to be work product and privileged. Such conduct, statements, promises,
offers, views and opinions shall not be discoverable or admissible for any
purposes, including impeachment, in any litigation or other proceeding
involving the Parties, and shall not be disclosed to anyone not an agent,
employee, expert, witness or representative of any Party; provided that
evidence otherwise discoverable or admissible is not excluded from discovery or
admission as a result of its use in the Procedure.

         11. GENERAL

         11.01. Schedules.

                  (a) The Schedules and all exhibits and documents referred to
         in or attached to this Agreement are integral parts of this Agreement
         as if fully set forth herein and all statements appearing therein
         shall be deemed to be representations. Nothing in the Schedules shall
         be deemed adequate to disclose an exception to a representation or
         warranty made herein unless the Schedule identifies the exception with
         reasonable particularity and, without limiting the generality of the
         foregoing, the mere listing of a document as an exception to any
         representation or warranty shall not be deemed to disclose the
         contents of such document as an exception to any representation or
         warranty, provided that a reference to the contents of one or more
         particular documents in a Schedule as an exception to a representation
         or warranty shall be sufficient to disclose the contents of the
         referenced document for purposes of that representation or warranty
         only. Subject only to the preceding sentence, however, the disclosure
         of information by Sellers in any Schedule shall be incorporated by
         this reference into each other Schedule, where applicable.

                  (b) The parties acknowledge that not all of the Schedules
         anticipated to have been completed by Sellers (the "Signing
         Schedules") as of the Effective Date have been completed by the
         Parties, and no Party shall be in breach of any representation,
         warranty or covenant made in this Agreement by reason of the fact that
         all of the Signing Schedules are not in fact attached to this
         Agreement on the Effective Date. Each Schedule on the List of
         Schedules which is not marked with an asterisk on said List is a
         "Final Schedule", may not change without agreement of the Parties and
         shall not be governed by the provisions of this Section 11.01(b). With
         respect to each missing Signing Schedule:

                           (i) Sellers will prepare or complete a draft of all
                  of Signing Schedules (the "Draft Schedules") to be prepared
                  by Seller and deliver the Draft Schedules to Buyer as soon as
                  possible after the Effective Date, but in any event no later
                  than October 15, 1999, and Buyer will prepare or complete

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                  a draft of all of Signing Schedules (the "Draft Schedules")
                  to be prepared by Buyer and deliver the Draft Schedules to
                  Sellers as soon as possible after receipt of the Draft
                  Schedules prepared by Sellers, but in any event no later than
                  October 18, 1999;

                           (ii) If any Draft Schedule is acceptable to the
                  other Parties, it will thereupon be a "Final Schedule"; and

                           (iii) If Buyer notifies Sellers that a Draft
                  Schedule prepared by Seller is not acceptable, or if Sellers
                  notify Buyer that a Draft Schedule prepared by Buyer is not
                  acceptable, the Parties will attempt promptly to resolve
                  their differences with respect to the Draft Schedule, and if
                  the parties reach a written agreement with respect to the
                  Draft Schedule, the Draft Schedule will be a "Final
                  Schedule".

                  (c) Each Final Schedule shall be deemed to be the
         corresponding Schedule referred to in this Agreement and shall be part
         of this Agreement as fully as if it had been appended hereto on, and
         shall speak as of, the Effective Date. Notwithstanding any other
         provision of this Agreement, if any Draft Schedule is not for any
         reason whatsoever delivered by Sellers to Buyer on or before October
         15, 1999, or delivered by Buyer to Sellers on or before October 18,
         1999, or any Draft Schedule does not for any reason whatsoever become
         a Final Schedule pursuant to the provisions of this Section 11.01 on
         or before the close of business on October 20, 1999, then Buyer (if
         the missing Final Schedule is to be prepared by Sellers) or Seller (if
         the missing Final Schedule is to be prepared by Buyer) shall have the
         absolute right to terminate this Agreement on any date subsequent to
         October 20, 1999. Buyer and Seller shall be under no obligation
         whatsoever to accept any Draft Schedule in the form provided or to
         resolve differences with respect thereto.

         11.02. CON Disclaimer. This Agreement shall not be deemed to be an
acquisition or obligation of a capital expenditure or of funds within the
meaning of the certificate of need laws of the State, until the appropriate
Governmental Authorities shall have granted a certificate of need or other
appropriate approval or determined that no certificate of need or exemption or
other approval is required.

         11.03. Tax and Government Payment Program Effect. None of the Parties
(nor such Parties' counsel or accountants) has made or is making in this
Agreement any representation to any other Party (or such Party's counsel or
accountants) concerning any of the Tax or Government Payment Program effects or
consequences on the other Party of the transactions provided for in this
Agreement. Each Party represents that it has obtained, or may obtain,
independent Tax and Government Payment Program advice with respect thereto and
upon which it, if so obtained, has solely relied.

         11.04. Reproduction of Documents. This Agreement and all documents
relating hereto, including consents, waivers and modifications which may
hereafter be executed, the Closing Documents, financial statements,
certificates and other information previously or hereafter furnished

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to any Party, may be reproduced by any Party by any photographic, microfilm,
electronic or similar process and the Parties may destroy any original
documents so reproduced. The Parties stipulate that any such reproduction shall
be admissible in evidence as the original itself in any judicial, arbitral or
administrative proceeding (whether or not the original is in existence and
whether or not such reproduction was made in the ordinary course of business)
and that any enlargement, facsimile or further reproduction of such
reproduction shall likewise be admissible in evidence.

         11.05. Consented Assignment. Anything contained herein to the contrary
notwithstanding, this Agreement shall not constitute an agreement to assign any
Assumed Contract, claim or other right if the assignment or attempted
assignment thereof without the consent of another Person would (i) constitute a
breach thereof or in any material way affect the rights of any Seller
thereunder, (ii) be ineffective or render the Contract void or voidable, or
(iii) materially affect any Seller's rights thereunder so that Buyer would not
in fact receive all such rights. In any such event, Sellers shall cooperate in
any reasonable arrangement designed to provide for Buyer the benefits under any
such Contract, claim or right, including enforcement of any and all rights of
any Seller against the other Person arising out of the breach or cancellation
by such other Person or otherwise. After Closing, the Parties shall continue to
use commercially reasonable efforts to obtain the consent of the assignment of
such Contract, claim or right.

         11.06. Time of Essence. Time is of the essence in the performance of
this Agreement, provided that, if the day on or by which a notice must or may
be given, or the performance of any Party's obligation is due, is a Saturday,
Sunday or holiday for banks in Chicago, Illinois, then the day on or by which
such notice must or may be given, or that such performance is due, shall
automatically be extended to the first business day thereafter. This Section
may be waived only in a writing expressly referring hereto.

         11.07. Consents, Approvals and Discretion. Except as herein expressly
provided to the contrary, whenever this Agreement requires any consent or
approval to be given by any Party or any Party must or may exercise discretion,
such consent or approval shall not be unreasonably withheld or delayed and such
discretion shall be reasonably exercised.

         11.08. Choice of Law. This Agreement shall be governed by and
construed in accordance with the laws of the State of Illinois without regard
to such State's conflicts of laws rules.

         11.09. Benefit; Assignment. This Agreement shall inure to the benefit
of and be binding upon the Parties and their respective legal representatives,
successors and assigns. No Party may assign this Agreement without the prior
written consent of the other Parties, provided that Buyer may assign this
Agreement, in whole or in part, to any Affiliate of Buyer, and to any other
Person who takes title to all or any portion of the Seller Assets in connection
with Buyer's financing (including a sale/leaseback) of the transactions
described herein so long as Vanguard guarantees the performance of all duties
and obligations of such assignee hereunder in the same manner and to the same
extent provided in Section 12.01.

         11.10. Third Party Beneficiary. The terms and provisions of this
Agreement (including provisions regarding employee and employee benefit
matters) are intended solely for the benefit of the Parties, Buyer's
Indemnified Persons, Sellers' Indemnified Persons, and their

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respective successors and permitted assigns, and are not intended to confer
third-party beneficiary rights upon any other Person. Any reference in this
Agreement to one or more Employee Benefit Plans of Buyer includes provisions,
if any, in such plans permitting their termination or amendment and any
covenant in this Agreement to provide any Employee Benefit Plan shall not be
deemed or construed to limit Buyer's right to terminate or amend such plan of
Buyer in accordance with its terms.

         11.11. Waiver of Breach, Right or Remedy. The waiver by any Party of
any breach or violation by another Party of any provision this Agreement or of
any right or remedy permitted the waiving Party in this Agreement (i) shall not
waive or be construed to waive any subsequent breach or violation of the same
provision (ii) shall not waive or be construed to waive a breach or violation
of any other provision, and (iii) shall be in writing and may not be presumed
or inferred from any Party's conduct. Except as expressly provided otherwise in
this Agreement and except for the obligation of the Parties to first utilize
the ADR procedure in Article 10, no remedy conferred by this Agreement is
intended to be exclusive of any other remedy, and each and every remedy shall
be in addition to every other remedy granted in this Agreement or now or
hereafter existing at law or in equity, by statute or otherwise. The election
of any one or more remedies by a Party shall not constitute a waiver of the
right to pursue other available remedies. In addition to any other rights and
remedies any Party may have at law or in equity for breach of this Agreement,
each Party shall be entitled to seek an injunction to enforce the provisions of
this Agreement.

         11.12. Notices. Any notice, demand or communication required,
permitted or desired to be given hereunder shall be deemed effectively given if
given in writing (i) on the date tendered by personal delivery, (ii) on the
date received by facsimile or other electronic means, (iii) on the date
tendered for delivery by nationally recognized overnight courier, or (iv) on
the date tendered for delivery by United States mail, with postage prepaid
thereon, certified or registered mail, return receipt requested, in any event
addressed as follows:

         If to Buyer or Vanguard:           Vanguard Health Systems, Inc.
                                            20 Burton Hills Boulevard, Suite 100
                                            Nashville, Tennessee 37215
                                            Attn: General Counsel
                                            Facsimile:  (615) 665-6197

         If to Sellers:                     MacNeal Health Services Corporation
                                            3249 South Oak Park Avenue
                                            Berwyn, Illinois 60402
                                            Attn:    Chief Executive Officer
                                            Facsimile: (708) 783-3489

         With a copy to:                    McDermott, Will & Emery

                                            2049 Century Park East
                                            Los Angeles, California 90067-3208
                                            Attn:  Douglas M. Mancino, Esq.
                                            Facsimile: (310) 277-4730

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or to such other address or number, and to the attention of such other Person,
as any Party may designate at any time in writing in conformity with this
Section.

         11.13. Misdirected Payments. Sellers shall remit to Buyer with
reasonable promptness any monies received by Sellers constituting or in respect
of the Assets and Assumed Liabilities. Buyer shall remit to Sellers with
reasonable promptness any monies received by Buyer constituting or in respect
of the Excluded Seller Assets and Excluded Liabilities. If any Person
determines that funds previously paid or credited to any Seller or the Hospital
Businesses in respect of services rendered prior to the Closing Date have
resulted in an overpayment or must be repaid, Sellers shall be responsible for
the repayment of said monies (and the defense of such actions). If Buyer
suffers any deduction to or offset or withhold against amounts due Buyer of
funds previously paid or credited to any Seller or the Hospital Businesses in
respect of services rendered prior to the Closing Date, Sellers shall
immediately pay to Buyer the amounts so billed or offset upon demand. Any
amounts due Buyer by Sellers or one of their Affiliates, or due Sellers by
Buyer or its Affiliate, may be offset against monies or other funds held by the
Party entitled to payment.

         11.14. Severability. If any provision of this Agreement is held or
determined to be illegal, invalid or unenforceable under any present or future
law, and if the rights or obligations of any Party under this Agreement will
not be materially and adversely affected thereby: (a) such provision will be
fully severable; (b) this Agreement will be construed and enforced as if such
illegal, invalid or unenforceable provision had never comprised a part of this
Agreement; (c) the remaining provisions of this Agreement will remain in full
force and effect and will not be affected by the illegal, invalid or
unenforceable provision or by its severance from this Agreement; and (d) in
lieu of such illegal, invalid or unenforceable provision, there will be added
automatically as a part of this Agreement a legal, valid and enforceable
provision as similar in terms to such illegal, invalid or unenforceable
provision as may be possible.

         11.15. Entire Agreement; Amendment. This Agreement supersedes all
previous contracts, agreements and understandings and constitutes the entire
agreement of whatsoever kind or nature existing between or among the Parties
representing the within subject matter and no Party shall be entitled to
benefits other than those specified herein. As between or among the Parties,
any oral or written representation, agreement or statement not expressly
incorporated herein, whether given prior to or on the Effective Date, shall be
of no force and effect unless and until made in writing and signed by the
Parties on or after the Effective Date. The representations and warranties set
forth in this Agreement shall survive the Closing and remain in full force and
effect as provided in Article 9, and shall survive the execution and delivery
of all other agreements, instruments or other documents described, referenced
or contemplated herein and shall not be merged herewith or therewith. Each
representation, warranty and covenant contained in this Agreement has
independent significance and if any Party has breached any representation,
warranty or covenant contained herein in any respect, the fact that there
exists another representation, warranty or covenant relating to the same
subject matter (regardless of the relative level of specificity) that such
Party has not breached shall not detract from or mitigate the fact that the
Party is in breach of the first representation, warranty or covenant. This
Agreement may be executed in two or more counterparts, each and all of which
shall be deemed an original and all of which together shall constitute but one
and the same

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instrument. This Agreement may not be amended except in a written instrument
executed the Parties.

         11.16. Interest. Unless otherwise provided herein to the contrary, any
monies required to be paid by any Party to another Party pursuant to this
Agreement shall be due two business days after demand therefor and if not paid
when due shall accrue interest from and after the due date to and including the
date full payment is made at an annual rate equal to the average prime rate of
Citibank, N.A.

         11.17. Drafting. No provision of this Agreement shall be interpreted
for or against any Person on the basis that such Person was the draftsman of
such provision, and no presumption or burden of proof shall arise favoring or
disfavoring any Person by virtue of the authorship of any provision of this
Agreement.

         11.18. Confidentiality; Public Announcements.

                  (a) Except as required by Legal Requirements, Sellers, on the
         one hand, and Buyer and Vanguard, on the other hand, shall keep this
         Agreement and its contents confidential and not disclose the same to
         any Person (except the Parties' attorneys, accountants or other
         professional advisors and except to the applicable Governmental
         Authorities in connection with any required notification or
         application for approval or a license or exemption therefrom) without
         the prior written consent of the other Party. With respect to
         information provided by Sellers to Buyer or Vanguard in connection
         with and relative to this proposed transaction, the executed
         Confidentiality Agreement dated August 13, 1999 in respect of
         confidentiality between Vanguard and Cain Brothers & Company, LLC
         shall remain in effect until Closing.

                  (b) At all times before the Closing, Sellers, on the one
         hand, and Buyer, on the other hand, will consult with the other before
         issuing or making any reports, statements or releases to the public
         with respect to this Agreement or the transactions contemplated hereby
         and will use good faith efforts to obtain the other Party's approval
         of the text of any public report, statement or release to be made on
         behalf of such Party. If either Party is unable to obtain the approval
         of its public report, statement or release from the other Party and
         such report, statement or release is, in the opinion of legal counsel
         to such Party, necessary to discharge such Party's disclosure
         obligations under law, then such Party may make or issue the legally
         required report, statement or release and promptly furnish the other
         Party a copy thereof. Nothing herein shall prohibit any Party from
         responding to questions presented by the press or media without first
         obtaining prior written consent of the other Party.

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         12. GUARANTEES

         12.01. Guarantee of Buyer's Obligations. Vanguard, as principal
obligor and not merely as a surety, hereby unconditionally guarantees full,
punctual and complete performance by Buyer of all of Buyer's obligations under
this Agreement and each of the Closing Documents subject to the terms hereof
and thereof and so undertakes to Sellers that, if and whenever Buyer is in
default, Vanguard will on demand duly and promptly perform or procure the
performance of Buyer's obligations. The foregoing guarantee is a continuing
guarantee and will remain in full force and effect until the obligations of
Buyer under this Agreement have been duly performed or discharged and will
continue to be effective or will be reinstated, as the case may be, if at any
time any sum paid to Sellers must be restored by Sellers upon the bankruptcy,
liquidation or reorganization of Buyer. Vanguard's obligations under this
Section shall not be affected or discharged in any way by any proceeding with
respect to Buyer under any federal or state bankruptcy, insolvency or debtor
relief laws.

         12.02. Guarantee of Sellers' Obligations. The Foundation, as principal
obligor and not merely as a surety, hereby unconditionally guarantees full,
punctual and complete performance by Sellers of each Seller's obligations under
this Agreement and each of the Closing Documents subject to the terms hereof
and thereof and so undertakes to Buyer and Vanguard that, if and whenever any
Seller is in default, the Foundation will on demand duly and promptly perform
or procure the performance of each Seller's obligations. The foregoing
guarantee is a continuing guarantee and will remain in full force and effect
until the obligations of each Seller under this Agreement have been duly
performed or discharged and will continue to be effective or will be
reinstated, as the case may be, if at any time any sum paid to Buyer or
Vanguard must be restored by Buyer or Vanguard upon the bankruptcy, liquidation
or reorganization of any Seller. The Foundation's obligations under this
Section shall not be affected or discharged in any way by any proceeding with
respect to any Seller under any federal or state bankruptcy, insolvency or
debtor relief laws. The Foundation's board of directors has approved the
Foundation's execution of this Agreement and the performance of its obligations
hereunder.

         13. REPRESENTATIONS AND WARRANTIES OF FOUNDATION

         The Foundation hereby represents and warrants to Vanguard as of the
date hereof and on the Closing Date that:

         13.01 Existence and Power. The Foundation is duly organized, validly
existing and in good standing under the laws of the State of Illinois and has
all powers (corporate or otherwise) and all material governmental licenses,
authorizations, permits, consents and approvals required to carry on its
business as now conducted.

         13.02 Authorization. The execution, delivery and performance of this
Agreement and the Closing Documents to which it is a party are within the
powers of the Foundation and this Agreement and the Closing Documents to which
it is a party have been duly authorized by all requisite action on its part.
This Agreement and the Closing Documents to which it is a party have been duly
executed and delivered by the Foundation. This Agreement constitutes and, when

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executed and delivered, the Closing Documents to which it is a party will
constitute, the valid and binding agreements of the Foundation.

         13.03 Governmental Authorization. The execution, delivery and
performance by the Foundation of this Agreement and the Closing Documents to
which it is a party requires no action by or in respect of, or filing with any
governmental body, agency or official, other than compliance with any
applicable requirements of the HSR Act, if the HSR Act is applicable.

         13.04 Non-contravention. The execution, delivery, and performance by
the Foundation of this Agreement and the Closing Documents to which it is a
party does not and will not (i) violate the certificate of incorporation,
bylaws or other constituent documents, if any, of the Foundation as currently
in effect, (ii) assuming compliance with the matters referred to in Section
13.03, violate any applicable law, rule, regulation, judgment, injunction,
order or decree, or (iii) require any consent or other action by any Person
under, or constitute a default under, any material agreement or other
instrument binding upon the Foundation.

         14. RIGHT OF FIRST REFUSAL

         14.01 Sale of Hospital. In the event Buyer receives an offer to
acquire the Hospital within three years after Closing and Buyer wishes to
accept such offer, it shall first provide the Foundation with written notice of
such offer, which shall include the name of the proposed buyer and other
material terms of the offer. The Foundation shall have 30 days from receipt of
such notice in which to elect to match the terms of the offer and to so notify
Buyer in writing; provided that, in the event the offer does not include a
definitive purchase price or if the offeror increases the proposed purchase
price, the 30-day election period shall be extended, if necessary, ten business
days after receipt of the definitive purchase price or any increase from the
offeror in the proposed purchase price, as the case may be. If the offer
includes any non-cash consideration, the Foundation shall be entitled to
substitute cash in an amount equal to the fair market value of such non-cash
consideration. During the election period, Buyer shall be free to negotiate
with one or both of the Foundation and the offeror. Notwithstanding anything to
the contrary herein, Buyer may reject any offer without providing the
Foundation a notice relating to such offer. In the event the Foundation elects
to match the offer, the Foundation shall acquire the Hospital at a Closing to
be held within five business days following the date upon which the last
material regulatory approval required in connection with the sale of the
Hospital is obtained, but in no event more than 120 days after the date the
Foundation elects to purchase the Hospital, subject to reasonable extensions
mutually acceptable to Buyer and the Foundation. In connection with the
purchase, the parties shall execute a definitive agreement to be executed by
the Buyer and the Foundation containing the principal terms set forth in the
offer, but otherwise containing substantially the same terms and conditions as
this Agreement, provided that any representations and warranties of Buyer about
the Hospital shall relate to Buyer's period of ownership only. In the event the
Foundation does not elect to acquire the Hospital, Buyer shall be free to sell
the Hospital to the offeror upon the material terms and conditions set forth in
the offer. If the Hospital has not been sold, transferred or assigned to the
offeror upon the material terms and conditions set forth in the offer within
180 days after the expiration of the Foundation's 30-period to elect to
purchase the Hospital, then the restrictions provided in this Section shall
again become effective with respect to the Hospital.

                                      74
<PAGE>

         IN WITNESS WHEREOF, the Parties have caused this Agreement to be
executed in multiple originals by their duly authorized officers as of the
Effective Date.

MACNEAL HEALTH SERVICES CORPORATION          THE MACNEAL MEMORIAL HOSPITAL
                                             ASSOCIATION

By:      /s/ Luke McGuinness                 By: /s/ Brian J. Lemon
         ----------------------------          ---------------------------------
         Luke McGuinness                       Brian J. Lemon
         President & CEO                       President & CEO

MACNEAL HEALTH FOUNDATION

By:      /s/ Edwin J. Hlavka
         ----------------------------
         Edwin J. Hlavka
         Treasurer and Director

VHS OF ILLINOIS, INC.                        VANGUARD HEALTH SYSTEMS, INC.

By:      /s/ Keith B. Pitts                  By:  /s/ Keith B. Pitts
         ----------------------------          --------------------------------
         Keith B. Pitts                        Keith B. Pitts
         Executive Vice President              Executive Vice President

                                      75EXHIBIT 10.16

                               FIRST AMENDMENT TO

                            ASSET PURCHASE AGREEMENT

     THIS FIRST AMENDMENT TO ASSET PURCHASE AGREEMENT (the "Amendment"), made
and entered into effective as of February 1, 2000, is by and among MACNEAL
HEALTH SERVICES CORPORATION, an Illinois not-for-profit corporation ("MHSC"),
THE MACNEAL MEMORIAL HOSPITAL ASSOCIATION, an Illinois not-for-profit
corporation ("MacNeal Hospital") (each individually a "Seller" and collectively
the "Sellers"), MACNEAL HEALTH FOUNDATION, an Illinois not-for-profit
corporation (the "Foundation"), VHS OF ILLINOIS, INC., a Delaware corporation
("Buyer"), and VANGUARD HEALTH SYSTEMS, INC., a Delaware corporation
("Vanguard").

                              W I T N E S S E T H

     WHEREAS, the Parties entered into an Asset Purchase Agreement dated as of
October 4, 1999 (the "Agreement"), pursuant to which Sellers agreed to sell,
and Buyer agreed to purchase, substantially all of Sellers' assets used in the
conduct of the Healthcare Businesses; and

     WHEREAS, the Parties desire to amend the Agreement;

     NOW, THEREFORE, for and in consideration of the premises, and the
agreements, covenants, representations and warranties hereinafter set forth,
and other good and valuable consideration, the receipt and adequacy of which
are forever acknowledged and confessed, the Parties, intending to be legally
bound, amend the Agreement as follows:

     1. DEFINITIONS AND REFERENCES. Section 1 of the Agreement is amended as
follows:

          1.01. Definitions.

          (a) The definition of "Assumed Contracts" is amended as follows:
     "Assumed Contracts: the Seller Contracts listed or described on Schedule
     2.01(f), the Subsidiary Contracts listed or described on Schedule A, and
     the Immaterial Contracts to which any Seller or Subsidiary is a party, but
     expressly excluding the Excluded Contracts;".

          (b) The term "Common Shares" is hereby deleted and the term
     "Preferred Shares" is inserted in lieu thereof in all places in the
     Agreement.

          (c) The defined term "Common Stock" is deleted and the following is
     inserted in lieu thereof: "Preferred Stock: the preferred stock, $0.01 par
     value per share, of Vanguard, having the rights, designations and
     preferences described in Schedule 1.01 (the "Preferred Stock
     Designations");" and all references in the Agreement to Common Stock shall
     hereafter be references to Preferred Stock.

          (d) The definition of Contracts is amended to read as follows:
     "Contracts: the Seller Contracts and the Subsidiary Contracts;"

<PAGE>

          (e) The definition of "Neutral" is amended to read as follows:
     "Neutral: defined in Section 10.04;".

          (f) The definition of "Subsidiaries" is amended to read as follows:
     "Subsidiaries: MacNeal Management Services, Inc., an Illinois corporation,
     The 6300 West Roosevelt Partnership, an Illinois limited partnership,
     Primary Care Physicians Center LLC, an Illinois limited liability company,
     Midwest Claims Processing, Inc., an Illinois corporation, MacNeal Health
     Providers, Inc., an Illinois corporation, BHS Digestive Disease
     Associates, an Illinois general partnership, and MacNeal/Daly/Shaw Joint
     Venture, an Illinois general partnership;".

     2. Excluded Seller Assets. Section 2.02(f) is amended to read as follows:
"(f) all membership, ownership or investment interests of any Seller in any
other Seller, in the Foundation and, subject to Section 5.25, in the RML
Partnership;"

     3. Purchase Price; Purchase Price Adjustment.

          3.01. Section 2.05 of the Agreement is amended as follows:

          3.02. Clause (iii) of Section 2.05(d) is amended to read as follows:
"(iii) $20,000,000, payable by delivery of 20,000 shares of Vanguard Payable in
Kind Cumulative Redeemable Convertible Preferred Stock (the "Preferred
Shares").

          3.03. The first sentence of Section 2.05(f) of the Agreement is
amended as follows: "The Preferred Shares issuable as part of the Purchase
Price shall be issued at Closing to MacNeal Hospital and Buyer shall issue and
deliver a stock certificate at Closing to MacNeal Hospital evidencing its
ownership of the Preferred Shares."

          3.04. The following new Section 2.05(g) is added to the Agreement:

               (g) The Parties expect that MacNeal Hospital may most likely be
          able to utilize Rule 144 under the Securities Act (such Rule 144 or
          any successor thereto herein called "Rule 144") in its sale or sales
          of the Vanguard common stock obtained upon automatic conversion of
          the Preferred Shares into shares of such common stock (the
          "Foundation Preferred Shares") at any time after the 6-month lock-up
          period expires subsequent to Vanguard's initial public offering (the
          "IPO") of its common stock under the Securities Act (the "Foundation
          Public Sale Period"); and due to the tacking provisions of Rule 144
          (d)(3)(ii) which allows MacNeal Hospital's holding period of the
          MacNeal Hospital Preferred Shares to commence upon the issuance date
          of the Preferred Shares, the Parties expect that MacNeal Hospital's
          sales of the MacNeal Hospital Preferred Shares during the MacNeal
          Hospital Public Sale Period will (I) either be subject to the volume
          limitations set forth under Rule 144(e) which apply to securities
          with a holding period in excess of 1 year but less than 2 years (the
          "Rule 144(e) Period") or (2) not be subject to such volume
          limitations but be unlimited as to amount of securities that may be
          sold under Rule 144(k) ( the "Rule 144(k) Period"). In the event that
          when MacNeal Hospital wishes to sell any of the MacNeal Hospital
          Preferred Shares either (1) MacNeal Hospital is not in the Rule
          144(k) Period or

                                       2
<PAGE>

     (2) MacNeal Hospital cannot sell all of the MacNeal Hospital Preferred
     Shares which it wishes to sell during two consecutive three month periods
     during the Rule 144(e) Period, then Vanguard will on one occasion register
     the MacNeal Hospital Preferred Shares for sale by MacNeal Hospital under
     the Securities Act on Form S-3 (or successor form to such Form S-3) upon
     the written demand of MacNeal Hospital (the "Foundation Demand
     Registration") which Registration Statement on Form S-3 may remain
     effective at the request of MacNeal Hospital for up to 90 days provided
     MacNeal Hospital's demand for MacNeal Hospital Demand Registration may not
     be made until Vanguard qualifies for the use of Form S-3 which
     qualification commences upon the expiration of one year after the IPO.
     Vanguard will pay all expenses of the MacNeal Hospital Demand Registration
     except (1) out of pocket expenses of MacNeal Hospital including expenses
     of MacNeal Hospital's attorneys and other professional advisors in such
     registration and (2) MacNeal Hospital's underwriting fees or discounts or
     brokerage commissions attributable to the sale of the MacNeal Hospital
     Preferred Shares. In addition, the MacNeal Hospital Demand Registration
     shall otherwise be subject to all other applicable registration provisions
     currently in force as to all other current Vanguard shareholders for
     post-IPO registrations of their Vanguard common stock which provisions are
     set forth in Article 3 of the Surviving Shareholders Agreement (as defined
     in the Shareholders Agreement) and which provisions are incorporated by
     reference herein as if fully stated herein.

     4. Subsidiaries; Third Party Rights. The first clause of Section 3.04(e)
is amended to read as follows: "Except as described on Schedule 2.01(j) and
Schedule 3.04(a),...", and the last sentence of Section 3.04(e) is amended to
read as follows: "Other than this Agreement, except for limitations in
governing documents provided to Buyer restricting the transfer of interests in
Subsidiaries that are joint ventures, and except as otherwise described on
Schedule 3.04(a), there is no Contract between any Seller and any Person with
respect to the disposition of the shares of any Subsidiary."

     5. Private Placement. Section 3.32 is amended as follows:

          3.32. Private Placement.

               (a) The Preferred Shares issuable as part of the Purchase Price
          shall be issued at Closing to MacNeal Hospital and Buyer shall issue
          and deliver a stock certificate at Closing to MacNeal Hospital
          evidencing its ownership of the Preferred Shares."

               (b) MacNeal Hospital represents that the Preferred Shares to be
          acquired by the MacNeal Hospital at the Closing are being acquired
          for its own account and without a current view to the public
          distribution of such Preferred Shares or any interest therein.

               (c) MacNeal Hospital is or at Closing will be an "Accredited
          Investor" as such term is defined in Regulation D under the
          Securities Act. MacNeal Hospital has sufficient knowledge and
          experience in financial and business

                                       3
<PAGE>

          matters so as to be capable of evaluating the merits and risks of its
          investment in the Preferred Shares and MacNeal Hospital is capable of
          bearing the economic risks of such investment, including a complete
          loss of the investment in the Preferred Shares.

               (d) MacNeal Hospital has been furnished with and carefully read
          a copy of this Agreement and has been given the opportunity to ask
          questions of, and receive answers from, Vanguard concerning the terms
          and conditions of the Preferred Shares and other related matters.
          MacNeal Hospital further represents and warrants to Vanguard that
          Vanguard has made available to MacNeal Hospital or its agents all
          documents and information relating to an investment in the Preferred
          Shares requested by or on behalf of MacNeal Hospital.

               (e) The office of MacNeal Hospital in which the investment
          decision was made is located in Berwyn, Illinois.

     6. Preferred Shares. Section 4.05 of the Agreement is amended as follows:

          4.05. Preferred Shares. The Preferred Shares issued to MacNeal
Hospital, when issued and delivered in accordance with the terms of this
Agreement, will be duly authorized, validly issued, fully paid, and
nonassessable and free of all preemptive rights, liens, voting or transfer
restrictions and encumbrances, except as may be provided under the Preferred
Stock Designations and federal or state securities laws.

     7. RML Partnership. The first sentence of Section 5.25(b) is amended to
read as follows: "MHSC owns and shall retain a limited partnership interest in
the Partnership and an equity interest in RMHP Corporation, the general partner
of the Partnership."

     8. Day School Program. Article 5 of the Agreement is amended by inserting
the following new section 5.27:

          5.27. Day School Program. MacNeal Hospital operates a nonpublic
special education facility (the "Day School Program") that serves students with
disabilities in accordance with Section 14-7.02 of the Illinois School Code
(105 ILCS 5/14-7.02) and is reimbursed in accordance with the regulations of
the Purchased Care Review Board (23 Ill. Admin. Code 401.10, et. seq., and 89
Ill. Admin. Code 900.110, et. seq.). The Day School Program will continue to be
operated by MacNeal Hospital after Closing for not less than the remainder of
the school year then in effect (including Summer term). From and after Closing,
the Parties will evaluate the alternatives available to them with respect to
the operation of the Day School Program for school years beginning after the
expiration of the current school year. Such alternatives may include the
continued operation of the Day School Program by MacNeal Hospital or the
operation of the Day School Program by the Foundation or by Buyer. With respect
to the conduct of the Day School Program during the remainder of the school
year in effect at Closing, MacNeal Hospital and Buyer shall enter into a
management agreement at Closing in form and substance acceptable to the Parties
pursuant to which Buyer shall manage and provide all personnel, facilities,
services and other items necessary to operate the Day School Program for the
remainder of the school year in all material respects in the same manner as the

                                       4
<PAGE>

Day School Program had been operated by MacNeal Hospital prior to Closing.
Under the management agreement, Buyer shall be responsible for all costs and
expenses associated with operating the Day School Program (including occupancy,
support, administrative and other costs), whether allowable or not by the
Purchased Care Review Board. In consideration for Buyer's management services,
MacNeal Hospital shall pay to Buyer a management fee equal to the positive net
cash flow from operation of the Day School Program (which management fee the
Parties acknowledge may not be an allowable cost). MacNeal Hospital shall
notify the Purchased Care Review Board, if and to the extent required by
applicable regulations, of the execution of the management agreement and the
Parties shall provide such other information that the Purchased Care Review
Board requests in connection therewith. With respect to school years beginning
after the current school year, (i) if the Parties determine that the Day School
Program should be operated by MacNeal Hospital or the Foundation, the Parties
shall enter into another management agreement upon substantially the same terms
and conditions as the management agreement executed at Closing (or such other
terms and conditions as are acceptable to the Parties), and (ii) if the Parties
determine that the Day School Program should be operated by Buyer, MacNeal
Hospital and the Foundation shall assist and cooperate with Buyer in filing
with the Illinois State Board of Education and the Purchased Care Review Board
a timely and complete application for approval of the Day School Program for
the following school year.

     9. Opinion of Buyer's Counsel. Section 6.05(f) is deleted and 6.05(e) is
amended as follows:

          (e) The Preferred Shares issued and delivered to MacNeal Hospital at
     Closing were duly authorized and issued and represent fully-paid,
     nonassessable shares of Preferred Stock free of all transfer restrictions
     except those imposed by applicable Legal Requirements.

     10. Section 7.14. The Parties acknowledge that Section 7.14 is
intentionally omitted from the Agreement.

     11. Shareholders Agreements. Section 7.15 of the Agreement is deleted.

     12. Action of Sellers and the Foundation at Closing. Sections 8.02(f) and
8.02(g) are hereby deleted.

     13. Actions of Buyer at Closing. Section 8.03(d) is deleted and 8.03(b) is
amended as follows:

          (b) to the Foundation that part of the Cash Portion of the Purchase
     Price payable to the Foundation in accordance with Section 2.05(f) and to
     MacNeal Hospital a certificate evidencing the Preferred Shares issued in
     the name of MacNeal Hospital;

     14. Schedules

                                       5
<PAGE>

          14.01. Schedule 1.01. Schedule 1.01 is attached to this Amendment and
incorporated into the Agreement and the list of Schedules included in the
Agreement is amended to include a reference to Schedule 1.01, which Schedule
has been prepared by Buyer.

          14.02. Amended Schedules. Schedule 2.01(f) is amended by adding the
following Contracts to the list of Contracts not being assumed by Buyer:

          108
          271
          272

With respect to the Contract with Raymond Nootens (No. 108), the Net Working
Capital shall be credited with an amount equal to the payments due to Dr.
Nootens for the remainder of the term of the Contract and Sellers shall pay off
the balance of such Contract.

     15. Miscellaneous. Except as expressly amended by this Amendment, the
Agreement shall be and remain in full force and effect without change. All
capitalized terms used in this Amendment that are not otherwise defined herein
shall have the meanings ascribed to such terms in the Agreement. From and after
the date of this Amendment, this Amendment shall be incorporated into and
constitute a part of the Agreement as fully and completely as though originally
a part thereof, and references in this Amendment or the Agreement to the
"Agreement" shall mean the Agreement as amended hereby.

                                       6
<PAGE>

     IN WITNESS WHEREOF, the Parties have caused this Amendment to be executed
in multiple originals by their duly authorized officers as of the date set
forth on the first page hereof.

MACNEAL HEALTH SERVICES CORPORATION          THE MACNEAL MEMORIAL HOSPITAL
                                             ASSOCIATION

By: /s/ Luke McGuiness                       By: /s/ Brian J. Lemon
    -------------------------------------        -------------------------------
    Luke McGuinness                              Brian J. Lemon
    President & CEO                              President & CEO

MACNEAL HEALTH FOUNDATION

By: /s/ Luke McGuiness
    -------------------------------------
Name:   Luke McGuiness
     ------------------------------------
Title:  Director
      -----------------------------------

VHS OF ILLINOIS, INC.                        VANGUARD HEALTH SYSTEMS, INC.

By: /s/ Keith B. Pitts                       By: /s/ Keith B. Pitts
    -------------------------------------        -------------------------------
Name:   Keith B. Pitts                           Name:  Keith B. Pitts
      -----------------------------------             --------------------------
Title:  Executive Vice President                 Title: Executive Vice President
      -----------------------------------              -------------------------

                                       7
<PAGE>

                                 Schedule 1.01

                    CERTIFICATE OF DESIGNATIONS, PREFERENCES
                         AND RIGHTS OF PAYABLE IN KIND
                             CUMULATIVE REDEEMABLE
                          CONVERTIBLE PREFERRED STOCK

                                       of

                         VANGUARD HEALTH SYSTEMS, INC.

             Pursuant to Section 151 of the General Corporation Law
                            of the State of Delaware

     We, the undersigned, Joseph D. Moore, Executive Vice President, and Ronald
Soltman, Secretary, of Vanguard Health Systems, Inc., a Delaware corporation
(hereinafter called the "Corporation"), pursuant to the provisions of Sections
103 and 151 of the General Corporation Law of the State of Delaware, do hereby
make this Certificate of Designations and do hereby state and certify that
pursuant to the authority expressly vested in the Board of Directors of the
Corporation by the Certificate of Incorporation, the Board of Directors duly
adopted the following resolutions:

     RESOLVED, that, pursuant to Article Fourth of the Amended and Restated
Certificate of Incorporation (which authorizes 100,000 shares of preferred
stock, $.01 par value (the "Preferred Stock")), the Board of Directors hereby
fixes the powers, designations, preferences and relative, participating,
optional and other special rights, and the qualifications, limitations and
restrictions, of a series of Preferred Stock.

     RESOLVED, that each share of such series of Preferred Stock shall rank
equally in all respects and shall be subject to the following provisions:

     1. Number and Designation. 20,000 shares of the Preferred Stock of the
Corporation shall be designated as Payable In Kind Cumulative Redeemable
Convertible Preferred Stock (the "PIK Preferred Stock").

     2. Rank. The PIK Preferred Stock shall, with respect to dividend rights
and rights on liquidation, dissolution and winding up, rank prior to all
classes or series of the Corporation's common stock, $.01 par value (the
"Common Stock"). All equity securities of the Corporation to which the PIK
Preferred Stock ranks prior (whether with respect to dividends or upon
liquidation, dissolution, winding up or otherwise), including the Common Stock,
are collectively referred to herein as the "Junior Securities." All equity
securities of the Corporation with which the PIK Preferred Stock ranks on a
parity (whether with respect to dividends or upon liquidation, dissolution
winding up or otherwise) are collectively referred to herein as the "Parity
Securities." All shares of any series of Preferred Stock of the Corporation to
which the PIK Preferred Stock ranks junior (whether with respect to dividends
or upon liquidation, dissolution, winding up or otherwise) are collectively
referred to herein as the "Senior Securities". The

                                       8
<PAGE>

respective definitions of Junior Securities, Parity Securities and Senior
Securities shall also include any rights or options exercisable for or
convertible into any of the Junior Securities, Parity Securities and Senior
Securities, as the case may be. Subject to paragraph (b) of Section 7, the PIK
Preferred Stock shall be subject to the creation of Junior Securities and
Parity Securities.

     3. Dividends. (a) The holders of shares of PIK Preferred Stock shall be
entitled to receive, when, as and if declared by the Board of Directors, out of
funds legally available for the payment of dividends, dividends at the annual
rate of $80.00 per share. Such dividends shall be payable in arrears annually
on March 31 of each year for the fiscal period February 1 through January 31
(unless March 31 in any year is not a business day, in which event on the next
succeeding business day) (each of such dates being a "Dividend Payment Date"
and each such annual period ending on January 31 in each year commencing
January 31, 2001 being a "Dividend Period"). When, as and if declared, such
dividends shall be cumulative from the date of issue, whether or not in any
Dividend Period or Periods there shall be funds of the Corporation legally
available for the payment of such dividends. Each such dividend shall be
payable to the holders of record of shares of the PIK Preferred Stock, as they
appear on the stock records of the Corporation at the close of business on such
record dates, not more than 60 days or less than 10 days preceding the payment
dates thereof, as shall be fixed by the Board of Directors. Accrued and unpaid
dividends for any past Dividend Periods may be declared and paid at any time,
without reference to any Dividend Payment Date, to holders of record on such
date, not more than 45 days preceding the payment date thereof, as may be fixed
by the Board of Directors. Any dividend payments made with respect to PIK
Preferred Stock shall be made in cash; provided that, notwithstanding anything
to the contrary set forth herein, during any Dividend Period prior to the
Dividend Period ending January 31, 2008 (the "Pay in Kind Period"), such
dividend payments may be made, in the sole discretion of the Corporation, in
lieu of the payment in whole or in part of dividends in cash, by issuing
additional fully paid, duly authorized, validly issued and nonassessable shares
of PIK Preferred Stock at the rate of 0.08 shares of PIK Preferred Stock for
each $80.00 of such dividend not paid in cash, and the issuance of such
additional shares shall constitute full payment of such dividend; provided,
further, the Pay in Kind Period shall immediately terminate upon the
Corporation's payment of a cash dividend upon any share of its capital stock.

     (b) The amount of dividends payable for the initial Dividend Period, or
any other period shorter or longer than a full Dividend Period, on the PIK
Preferred Stock shall be computed on the basis of twelve 30-day months and a
360-day year. Holders of shares of PIK Preferred Stock shall not be entitled to
any dividends, whether payable in cash, property or stock, in excess of
cumulative dividends, as herein provided, on the PIK Preferred Stock. No
interest, or sum of money in lieu of interest, shall be payable in respect of
any dividend payment or payments on the PIK Preferred Stock that may be in
arrears.

     (c) Notwithstanding anything contained herein to the contrary, no cash
dividends on shares of PIK Preferred Stock shall be declared by the Board of
Directors or paid or set apart for payment by the Corporation at such time as
the terms and provisions of any financing or working capital agreement of the
Corporation specifically prohibit such declaration, payment or setting apart
for payment or if such declaration, payment or setting apart for payment

                                       9
<PAGE>

would constitute a breach thereof or a default thereunder or if such
declaration, payment or setting apart for payment would, upon the giving of
notice or passage of time or both, constitute such a breach or default;
provided, that subject to applicable law, if any cash dividends are prohibited
in whole or in part during the Pay In Kind Period, the Corporation may, to the
extent payment in cash of such dividends is not made, pay such dividends in
shares of PIK Preferred Stock in accordance with paragraph (a) of this Section
3; and provided, further, that nothing herein contained shall in any way or
under any circumstances be construed or deemed to require the Board of
Directors to declare or the Corporation to pay or set apart for payment any
dividends on shares of the PIK Preferred Stock at any time, whether permitted
by any of such agreements or not.

     (d) So long as any shares of the PIK Preferred Stock are outstanding, no
dividends, except as described in the next succeeding sentence, shall be
declared or paid or set apart for payment on Parity Securities, for any period
unless full cumulative dividends have been or contemporaneously are declared
and paid or declared and a sum sufficient for the payment thereof set apart for
such payment on the PIK Preferred Stock for all Dividend Periods terminating on
or prior to the date of payment of the dividend on such class or series of
Parity Securities. When dividends are not paid in full or a sum sufficient for
such payment is not set apart, as aforesaid, all dividends declared upon shares
of the PIK Preferred Stock and all dividends declared upon any other class or
series of stock ranking on a parity as to dividends and amounts distributable
upon liquidation, dissolution or winding up shall be declared ratably in
proportion to the respective amounts of dividends accumulated and unpaid on the
PIK Preferred Stock and accumulated and unpaid on such Parity Securities. No
interest, or sum of money in lieu of interest, shall be payable in respect of
any dividend payment or payments on the PIK Preferred Stock or any other Parity
Securities which may be in arrears.

     (e)  (i) Holders of shares of the PIK Preferred Stock shall be entitled to
receive the dividends provided for in paragraph (a) of this Section 3 in
preference to and in priority over any dividends upon any of the Junior
Securities.

          (ii) The Corporation shall not declare, pay or set apart for payment
any dividend on any of the Junior Securities or make any payment on account of
or set apart for payment money for a sinking or other similar fund for the
purchase, redemption or other retirement of, any of the Junior Securities or
any warrants, rights, calls or options, exercisable for or convertible into any
of the Junior Securities, or make any distribution in respect thereof, either
directly or indirectly, and whether in cash, obligations or shares of the
Corporation or other property (other than distributions or dividends in Junior
Securities to the holders of Junior Securities), and shall not permit any
corporation or other entity directly or indirectly controlled by the
Corporation to purchase or redeem any of the Junior Securities so long as any
shares of the PIK Preferred Stock are outstanding, unless prior to or
concurrently with such declaration, payment, setting apart for payment,
purchase, redemption or distribution, as the case may be, all accrued and
unpaid dividends on shares of the PIK Preferred Stock not paid on the dates
provided for in paragraph (a) of this Section 3 shall have been or be paid or
set apart for payment.

                                      10
<PAGE>

     (f) Subject to the foregoing provisions of this Section 3 and applicable
law, the Board of Directors may declare and the Corporation may pay or set
apart for payment dividends on any of the Junior Securities or Parity
Securities, may make any payment on account of or set apart for payment money
for a sinking fund or other similar fund for the purchase, redemption or other
retirement of, any of the Junior Securities or Parity Securities or any
warrants, rights, calls or options, exercisable for or convertible into any of
the Junior Securities or Parity Securities, and may make any distribution in
respect thereof, either directly or indirectly, and whether in cash,
obligations or shares of the Corporation or other property, and may purchase or
otherwise redeem any of the Junior Securities or Parity Securities or any
warrants, rights or options exercisable for or convertible into any of the
Junior Securities or Parity Securities, and the holders of the shares of the
PIK Preferred Stock shall not be entitled to share therein.

     4. Liquidation Preference. (a) In the event of any liquidation,
dissolution or winding up of the Corporation, whether voluntary or involuntary,
before any payment or distribution of the assets of the Corporation (whether
capital or surplus) shall be made to or set apart for the holders of Junior
Securities, the holders of the shares of PIK Preferred Stock shall be entitled
to receive $1,000 per share of PIK Preferred Stock plus an amount equal to all
dividends (whether or not earned or declared) accrued and unpaid thereon to the
date of final distribution to such holders; but such holders shall not be
entitled to any further payment. If, upon any liquidation, dissolution or
winding up of the Corporation, the assets of the Corporation, or proceeds
thereof, distributable among the holders of the shares of PIK Preferred Stock
shall be insufficient to pay in full the preferential amount aforesaid and
liquidating payments on any Parity Securities, then such assets, or the
proceeds thereof, shall be distributed among the holders of shares of PIK
Preferred Stock and any such other Parity Securities ratably in accordance with
the respective amounts that would be payable on such shares of PIK Preferred
Stock and any such other stock if all amounts payable thereon were paid in
full. Notwithstanding anything else in this Certificate of Designations, a
liquidation, dissolution or winding up, voluntary or involuntary, of the
Corporation shall not be deemed to have occurred upon (i) the acquisition of
the Corporation by another entity by means of any transaction or series of
related transactions (including, without limitation, any reorganization, merger
or consolidation, whether of the Corporation with or into any other corporation
or corporations or of any other corporation or corporations with or into the
Corporation; or (ii) a sale of all or substantially all of the assets of the
Corporation.

     (b) Subject to the rights of the holders of any Parity Securities, after
payment shall have been made in full to the holders of the PIK Preferred Stock,
as provided in paragraph (a) of this Section 4, any other series or class or
classes of Junior Securities shall, subject to the respective terms and
provisions (if any) applying thereto, be entitled to receive any and all assets
remaining to be paid or distributed, and the holders of the PIK Preferred Stock
shall not be entitled to share therein.

     5. Redemption. (a) To the extent the Corporation shall have funds legally
available for such payment, the Corporation may redeem at its option shares of
PIK Preferred Stock, at any time in whole or from time to time in part, at a
redemption price of $1,000 per share, together with accrued and unpaid
dividends thereon to the date fixed for redemption, without interest.

                                      11
<PAGE>

     (b) To the extent the Corporation shall have funds legally available for
payment, the Corporation shall redeem all outstanding shares of PIK Preferred
Stock upon the earliest to occur of the following dates:

               (i) January 31, 2015;
               (ii) no later than 90 days after there shall have been a Change
          in Control of the Corporation; and
               (iii) no later than 90 days after the Corporation or its
          affiliate shall have sold to a Person not its affiliate all or
          substantially all of the assets of MacNeal Hospital, Berwyn,
          Illinois.

Such shares shall be redeemed at a redemption price of $1,000 per share,
together with accrued and unpaid dividends thereon to the redemption date,
without interest.

     (c) Shares of PIK Preferred Stock which have been issued and reacquired in
any manner, including shares purchased or redeemed, shall (upon compliance with
any applicable provisions of the laws of the State of Delaware) have the status
of authorized and unissued shares of the class of Preferred Stock undesignated
as to series and may be redesignated and reissued as part of any series of the
Preferred Stock; provided, however, that no such issued and reacquired shares
of PIK Preferred Stock shall be reissued or sold as PIK Preferred Stock unless
reissued as a stock or pay in kind dividend on shares of PIK Preferred Stock.

     (d) If the Corporation is unable or shall fail to discharge its obligation
to redeem all outstanding shares of PIK Preferred Stock pursuant to paragraph
(b) of this Section 5 (the "Mandatory Redemption Obligation"), the Mandatory
Redemption Obligation shall be discharged as soon as the Corporation is able to
discharge such Mandatory Redemption Obligation. If and so long as any Mandatory
Redemption Obligation with respect to the PIK Preferred Stock shall not be
fully discharged, the Corporation shall not (i) declare or pay any dividends or
make any distribution on or, directly or indirectly, purchase, redeem or
discharge any mandatory redemption, sinking fund or other similar obligation in
respect of any Parity Securities or any warrants, rights or options exercisable
for or convertible into any of the Parity Securities (except in connection with
a redemption, sinking fund or other similar obligation to be satisfied pro rata
with PIK Preferred Stock) or (ii) declare or pay any dividend or make any
distributions on, or, directly or indirectly, purchase, redeem or satisfy any
such mandatory redemption, sinking fund or other similar obligation in respect
of the Junior Securities or any warrants, rights or options exercisable for or
convertible into any of the Junior Securities.

     (e) Notwithstanding the foregoing provisions of this Section 5, unless the
full cumulative dividends on all outstanding shares of PIK Preferred Stock
shall have been paid or contemporaneously are declared and payable for all past
and current dividend periods, none of the shares of PIK Preferred Stock shall
be redeemed, and no sum shall be set aside for such redemption, unless shares
of PIK Preferred Stock are redeemed pro rata.

                                      12
<PAGE>

     (f) Change in Control. For purposes of this Certificate of Designations, a
Change in Control of the Corporation shall have occurred if:

               (i) any Person (other than (1) the Corporation, any of its
          subsidiaries or any of its stockholders on February 1, 2000 (or any
          affiliate of any such stockholder)), (2) any trustee or other
          fiduciary holding securities under an employee benefit plan of the
          Corporation or any of its subsidiaries, (3) an underwriter
          temporarily holding securities pursuant to an offering of such
          securities, or (4) any corporation owned, directly or indirectly, by
          the stockholders of the Corporation in substantially the same
          proportions as their ownership of the Corporation's common stock)),
          is or becomes the "beneficial owner" (as defined in Rule 13d-3 under
          the Securities Exchange Act of 1934 (the "Exchange Act")), directly
          or indirectly, of securities of the Corporation representing more
          than 50% of the combined voting power of the Corporation's then
          outstanding voting securities;

               (ii) the stockholders of the Corporation approve a merger or
          consolidation of the Corporation with any other corporation, other
          than both (A)(1) a merger or consolidation which would result in the
          voting securities of the Corporation outstanding immediately prior
          thereto continuing to represent (either by remaining outstanding or
          by being converted into voting securities of the surviving or parent
          entity) 50% or more of the combined voting power of the voting
          securities of the Corporation or such surviving or parent entity
          outstanding immediately after such merger or consolidation or (2) a
          merger or consolidation in which no Person acquires 50% or more of
          the combined voting power of the Corporation's then outstanding
          securities; and (B) immediately after the consummation of such merger
          or consolidation described in clause (A)(1) or (A)(2) above (and for
          at least 180 days thereafter) neither the Corporation's Chief
          Executive Officer nor its Chief Financial Officer change from the
          people occupying such positions immediately prior to such merger or
          consolidation except as a result of their death or disability and
          neither of such officers shall have changed prior to such merger or
          consolidation at the direction of a Person who has entered into an
          agreement with the Corporation the consummation of which will
          constitute a Change in Control of the Corporation; or

               (iii) the stockholders of the Corporation approve a plan of
          complete liquidation of the Corporation or an agreement for the sale
          or disposition by the Corporation of all or substantially all of the
          Corporation's assets (or any transaction having a similar effect).

     6. Procedure for Redemption. (a) In the event the Corporation shall redeem
shares of PIK Preferred Stock, notice of such redemption shall be given by
first class mail, postage prepaid, mailed not less than 30 days nor more than
60 days prior to the redemption date, to each holder of record of the shares to
be redeemed at such holder's address as the same appears on the stock register
of the Corporation; provided that neither the failure to give such notice nor
any defect therein shall affect the validity of the giving of notice for the
redemption of any share of

                                      13
<PAGE>

PIK Preferred Stock to be redeemed except as to the holder to whom the
Corporation has failed to give said notice or except as to the holder whose
notice was defective. Each such notice shall state: (i) the redemption date;
(ii) the amount of shares of PIK Preferred Stock that are being redeemed and,
if less than all the shares held by such holder are to be redeemed from such
holder, the number of shares to be redeemed from such holder; (iii) the
redemption price; (iv) the place or places where certificates for such shares
are to be surrendered for payment of the redemption price; and (v) that
dividends on the shares to be redeemed will cease to accrue on such redemption
date. In the event that fewer than all the outstanding shares of PIK Preferred
Stock are to be redeemed, the number of shares to be redeemed shall be
determined by the Board of Directors and the shares to be redeemed shall be
selected by lot or pro rata as may be determined by the Board of Directors,
except that in, any redemption of fewer than all the outstanding shares of PIK
Preferred Stock, the Corporation may redeem all shares held by any holders of a
number of shares not to exceed 100 as may be specified by the Corporation.

     (b) Notice having been mailed as aforesaid, from and after the redemption
date (provided that on or prior to the redemption date the Corporation shall
have irrevocably deposited funds for such redemption in trust for the holders
of PIK Preferred Stock), dividends on the shares of PIK Preferred Stock so
called for redemption shall cease to accrue, and such shares shall no longer be
deemed to be outstanding and shall have the status of authorized but unissued
shares of Preferred Stock, unclassified as to series, and shall not be reissued
as shares of PIK Preferred Stock unless reissued as a stock dividend on shares
of PIK Preferred Stock, and all rights of the holders thereof as stockholders
of the Corporation (except the right to receive from the Corporation the
redemption price) shall cease. Upon surrender in accordance with said notice of
the certificates for any shares so redeemed (properly endorsed or assigned for
transfer, if the Board of Directors of the Corporation shall so require and the
notice shall so state), such share shall be redeemed by the Corporation at the
redemption price. In case fewer than all the shares represented by any such
certificate are redeemed, a new certificate shall be issued representing the
unredeemed shares without cost to the holder thereof.

     7. Voting Rights. (a) The holders of record of shares of PIK Preferred
Stock shall not be entitled to any voting rights except as hereinafter provided
in this paragraph 7 or as otherwise provided by law.

          (b) (i) If at any time or times dividends payable (whether in cash or
shares of PIK Preferred Stock) on PIK Preferred Stock shall be in arrears and
unpaid on an amount equal to two full annual dividends (whether or not
consecutive) or if the Corporation shall have failed to discharge its Mandatory
Redemption Obligation, then the number of directors constituting the Board of
Directors, without further action, shall be increased by two and the holders of
PIK Preferred Stock shall have the exclusive right, voting separately as a
class, to elect the directors of the Corporation to fill such newly created
directorships, the remaining directors to be elected by the other class or
classes of stock entitled to vote therefor, at each meeting of stockholders
held for the purpose of electing directors.

                                      14
<PAGE>

          (ii) Whenever such voting right shall have vested, such right may be
exercised initially either at a special meeting of the holders of PIK Preferred
Stock, called as hereinafter provided, or at any annual meeting of stockholders
held for the purpose of electing directors, and thereafter at such annual
meetings or by the written consent of the holders of PIK Preferred Stock. Such
voting right shall continue until such time as all accrued dividends
accumulated on the PIK Preferred Stock shall have been paid in full, or the
Corporation has fulfilled its Mandatory Redemption Obligation, as the case may
be, at which time such voting right of the holders of PIK Preferred Stock shall
terminate, subject to revesting in the event of each and every subsequent
failure of the Corporation of the character described above.

          (iii) At any time when such voting right shall have vested in the
holders of PIK Preferred Stock and if such right shall not already have been
initially exercised, a proper officer of the Corporation shall, upon the
written request of any holder of record of PIK Preferred Stock then
outstanding, addressed to the Secretary of the Corporation, call a special
meeting of holders of PIK Preferred Stock. Such meeting shall be held at the
earliest practicable date upon the notice required for annual meetings of
stockholders at the place for holding annual meetings of stockholders of the
Corporation or, if none, at a place designated by the Secretary of the
Corporation. If such meeting shall not be called by the proper officer of the
Corporation within 30 days after the personal service of such written request
upon the Secretary of the Corporation, or within 30 days after mailing the same
within the United States, by registered mail, addressed to the Secretary of the
Corporation at its principal office (such mailing to be evidenced by the
registry receipt issued by the postal authorities), then the holders of record
of 10% of the shares of PIK Preferred Stock then outstanding may designate in
writing a holder of PIK Preferred Stock to call such meeting at the expense of
the Corporation, and such meeting may be called by such person so designated
upon the notice required for annual meetings of stockholders and shall be held
at the same place as is elsewhere provided in this paragraph (b)(iii) of this
Section 7. Any holder of PIK Preferred Stock which would be entitled to vote at
such meeting shall have access to the stock books of the Corporation for the
purpose of causing a meeting of holders of PIK Preferred Stock to be called
pursuant to the provisions of this paragraph. Notwithstanding the provisions of
this paragraph, however, no such special meeting shall be called during a
period within 90 days immediately preceding the date fixed for the next annual
meeting of stockholders.

          (iv) At any meeting held for the purpose of electing directors at
which the holders of PIK Preferred Stock shall have the right to elect
directors as provided herein, the presence in person or by proxy of the holders
of at least a majority of the then outstanding shares of PIK Preferred Stock
shall be required and be sufficient to constitute a quorum of such class for
the election of directors by such class. At any such meeting or adjournment
thereof (A) the absence of a quorum of the holders of PIK Preferred Stock shall
not prevent the election of directors other than those to be elected by the
holders of stock of such class and the absence of a quorum or quorums of the
holders of capital stock entitled to elect such other directors shall not
prevent the election of directors to be elected by the holders of PIK Preferred
Stock and (B) in the absence of a quorum of the holders of any class of stock
entitled to vote for the election of directors, a majority of the

                                      15
<PAGE>

holders present in person or by proxy of such class shall have the power to
adjourn the meeting for the elections of directors which the holders of such
class are entitled to elect, from time to time, without notice (except as
required by law) other than announcement at the meeting, until a quorum shall
be present.

          (v) The term of office of all directors elected by the holders of PIK
Preferred Stock pursuant to paragraph (b)(i) of this Section 7 in office at any
time when the aforesaid voting rights are vested in the holders of PIK
Preferred Stock shall terminate upon the election of their successors at any
meeting of holders of PIK Preferred Stock for the purpose of electing
directors. Upon any termination of the aforesaid voting rights in accordance
with paragraph (b)(ii) of this Section 7, the term of office of all directors
elected by the holders of PIK Preferred Stock pursuant to paragraph (b)(i) of
this Section 7 then in office shall thereupon terminate and upon such
termination the number of directors constituting the Board of Directors, shall,
without further action, be reduced by two, subject always to the increase of
the number of directors pursuant to paragraph (b)(i) of this Section 7 in case
of the future right of holders of PIK Preferred Stock to elect directors as
provided herein.

          (vi) In case of any vacancy occurring among the directors so elected,
the remaining director who shall have been so elected may appoint a successor
to hold office for the unexpired term of the director whose place shall be
vacant. If both directors so elected by the holders of PIK Preferred Stock
shall cease to serve as directors before their terms shall expire, the holders
of PIK Preferred Stock then outstanding may, at a special meeting of the
holders called as provided above, elect successors to hold office for the
unexpired terms of such directors whose places shall be vacant.

     (c) Without the written consent of a majority of the outstanding shares of
PIK Preferred Stock or the vote of holders of a majority of the outstanding
shares of PIK Preferred Stock at a meeting of the holders of PIK Preferred
Stock called for such purpose, the Corporation will not authorize the issuance
of any Senior Securities or any securities exchangeable or convertible into any
Senior Securities or amend, alter or repeal any provision of this Certificate
of Designations (by merger or otherwise) so as to materially and adversely
affect the preferences, rights or powers of the PIK Preferred Stock. No other
series of the Corporation's preferred stock shall have the right to vote with
the PIK Preferred Stock as a single class on any matter.

     (d) (i) The creation, authorization or issuance of any shares of any
Junior Securities or Parity Securities, or the creation, authorization or
issuance of any obligation or security convertible into or evidencing the right
to purchase any Junior Securities or Parity Securities, (ii) the creation of
any indebtedness of any kind of the Corporation, or (iii) the increase or
decrease in the amount of authorized capital stock of any class (including the
Preferred Stock, but excluding the PIK Preferred Stock) or any increase,
decrease or change in the par value of any such class other than the Preferred
Stock, shall not require the consent of the holders of PIK Preferred Stock and
shall not be deemed to affect adversely the rights, preferences, privileges and
voting rights of shares of PIK Preferred Stock.

                                      16
<PAGE>

     (e) In exercising the voting rights set forth in this Section 7, each
share of PIK Preferred Stock shall have one vote per share. Except as otherwise
required by applicable law or as set forth herein, the shares of PIK Preferred
Stock shall not have any relative, participating, optional or other special
voting rights and powers and the consent of the holders thereof shall not be
required for the taking of any corporate action.

     8. Reports. So long as any of the PIK Preferred Stock is outstanding, the
Corporation will furnish the holders thereof with the quarterly and annual
financial reports that the Corporation is required to file with the Securities
and Exchange Commission pursuant to Section 13 or Section 15(d) of the
Securities Exchange Act of 1934.

     9. Conversion Rights. The holders of the PIK Preferred Stock shall be
subject to the following with respect to the conversion of the PIK Preferred
Stock into shares of Common Stock (the "Conversion Rights"):

     (a) Automatic Conversion

               (i) Each outstanding share of PIK Preferred Stock shall
          automatically be converted into shares of Common Stock, at the PIK
          Conversion Price (as defined in paragraph (b) below), immediately on
          the same date that the closing occurs in respect of a firmly
          underwritten public offering pursuant to an effective registration
          statement under the Securities Act of 1933, as amended, covering the
          offer and sale of shares of Common Stock for the account of the
          Corporation in which the gross cash proceeds to the Corporation
          (before underwriting discounts, commissions and fees) are not less
          than $50,000,000 (a "Qualifying IPO").

               (ii) Upon the occurrence of a Qualifying IPO, each of the
          outstanding shares of PIK Preferred Stock shall be converted
          automatically into shares of Common Stock without any further action
          by the holders of such shares and whether or not the certificates
          representing such shares are surrendered to the Corporation or its
          transfer agent; provided that the Corporation shall not be obligated
          to issue certificates evidencing the shares of Common Stock issuable
          upon such conversion unless the certificates evidencing such shares
          of PIK Preferred Stock are either delivered to the Corporation or its
          transfer agent as provided below, or the holder notifies the
          Corporation or its transfer agent that such certificates have been
          lost, stolen or destroyed and executes an agreement satisfactory to
          the Corporation to indemnify the Corporation from any loss incurred
          by it in connection with such certificates. Upon the occurrence of
          such automatic conversion of the PIK Preferred Stock, the holders of
          PIK Preferred Stock shall surrender the certificates representing
          such shares at the office of the Corporation or any transfer agent
          for the PIK Preferred Stock. Thereupon, there shall be issued and
          delivered to such holder promptly at such office and in its name as
          shown on such surrendered certificate or certificates, a certificate
          or certificates for the number of shares of Common Stock into which
          the shares of PIK Preferred Stock surrendered were convertible on the
          date on which such automatic conversion occurred.

                                      17
<PAGE>

               (iii) Notwithstanding anything to the contrary set forth herein,
          as a condition to the Corporation's obligation to issue to each
          holder of PIK Preferred a certificate or certificates for the number
          of shares of Common Stock to which such holder is entitled, each such
          holder (by acceptance of any certificate for shares of PIK Preferred
          Stock) agrees to enter into a written agreement not to effect any
          public sale or distribution of any shares of Common Stock issuable to
          such holder, if and to the extent requested by the managing
          underwriter for the Qualifying IPO during the 14 days prior to, and
          during an up to 180-day period beginning on, the effective date of
          the registration statement relating to the Qualifying IPO without the
          written consent of such managing underwriter; provided that each such
          holder has received written notice of such registration at least 5
          business days prior to the anticipated beginning of the 14-day period
          referred to above.

     (b) PIK Conversion Price. The PIK Conversion Price shall be the initial
public offering price for each share of Common Stock in the Qualifying IPO on
the date on which the Corporation's registration statement relating thereto
first becomes effective.

     (c) Mechanics of Conversion. Each holder of PIK Preferred Stock which has
been automatically converted into shares of Common Stock pursuant to this
Section 9 shall surrender the certificate or certificates therefor, duly
endorsed, at the office of the Corporation or any transfer agent for the PIK
Preferred Stock. Thereupon, the Company shall promptly issue and deliver at
such office to such holder a certificate or certificates for the number of
shares of Common Stock to which such holder is entitled and shall promptly pay
in cash or in additional shares of Common Stock, any declared and unpaid
dividends on the shares of PIK Preferred Stock being converted. Such conversion
shall be deemed to have been made at the close of business on the date of the
closing of the Qualifying IPO, and the Person entitled to receive the shares of
Common Stock issuable upon such conversion shall be treated for all purposes as
the record holder of such shares of Common Stock on such date.

     (d) Fractional Shares. At the option of the Corporation, no fractional
shares of Common Stock shall be issued upon conversion of PIK Preferred Stock
and all shares of Common Stock (including fractions thereof) issuable upon
conversion of more than one share of PIK Preferred Stock by a holder thereof
shall be aggregated for purposes of determining whether the conversion would
result in the issuance of any fractional share. If, after the aforementioned
aggregation, the conversion would result in the issuance of any fractional
share, the Corporation may at its option, in lieu of issuing any fractional
share, pay cash equal to the product of such fraction multiplied by the initial
public offering of the Common Stock.

     (e) Reservation of Stock Issuable Upon Conversion. The Corporation shall
at all times reserve and keep available out of its authorized but unissued
shares of Common Stock, solely for the purpose of effecting the conversion of
the shares of the PIK Preferred Stock, such number of its shares of Common
Stock as shall from time to time be sufficient to effect the conversion

                                      18
<PAGE>

of all outstanding shares of the PIK Preferred Stock. If at any time the number
of authorized but unissued shares of Common Stock shall not be sufficient to
effect the conversion of all then outstanding shares of the PIK Preferred
Stock, the Corporation with take such corporate action as may, in the opinion
of its counsel, be necessary to increase its authorized but unissued shares of
Common Stock to such number of shares as shall be sufficient for such purpose.

     (f) Notices. Any notice to a holder of shares of PIK Preferred Stock
pursuant to the provisions of this Section 9 shall be in writing and shall be
deemed effectively given: (i) upon personal delivery to the party to be
notified, (ii) when sent by confirmed facsimile if sent during normal business
hours of the recipient; if not, then on the next business day, (iii) five (5)
days after having been sent by registered or certified mail, return receipt
requested, postage prepaid, or (iv) one (1) day after deposit with a nationally
recognized overnight courier, specifying next day delivery, with written
verification of receipt. All notices shall be addressed to each holder of
record at the address of such holder appearing on the books of the Corporation.

     10. General Provisions. (a) The term "Person" as used herein means any
corporation, limited liability company, partnership, trust, organization,
association, other entity or individual provided notwithstanding the foregoing,
for the purposes only of the provisions of paragraph (f) of Section 5 above,
the term "Person" as used in such paragraph means the definition of the term
"Person" found in Section 3(a)(9) of the Exchange Act.

     (b) The term "outstanding", when used with reference to shares of stock,
shall mean issued shares, excluding shares held by the Corporation or a
subsidiary.

     (c) The headings of the paragraphs, subparagraphs, clauses and subclauses
of this Certificate of Designations are for convenience of reference only and
shall not define, limit or affect any of the provisions hereof.

     IN WITNESS WHEREOF, Vanguard Health Systems, Inc. has caused this
Certificate of Designations to be signed and attested by the undersigned this
31st day of January, 2000.

                                         VANGUARD HEALTH SYSTEMS, INC.

                                         By: /s/ Joseph D. Moore
                                             -----------------------------------
                                             Joseph D. Moore
                                             Executive Vice President

ATTEST:

By: /s/ Ronald P. Soltman
    ------------------------------
Ronald P. Soltman
Secretary

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