Document:

<PAGE>

                                                               Exhibit 4(a)

            INDENTURE dated as of March 1, 1995 between National Medical
Enterprises, Inc., a Nevada corporation (the "COMPANY"), and The Bank of New
York, as trustee (the "TRUSTEE").

            The Company and the Trustee agree as follows for the benefit of each
other and for the equal and ratable benefit of the Holders of the 9 5/8% Senior
Notes due 2002 (the "SECURITIES"):

                                   ARTICLE 1
                         DEFINITIONS AND INCORPORATION
                                 BY REFERENCE

SECTION 1.01.    DEFINITIONS.

            "ACQUIRED DEBT" means, with respect to any specified Person, (i)
Indebtedness of any other Person existing at the time such other Person is
merged with or into or became a Subsidiary of such specified Person, including,
without limitation, Indebtedness incurred in connection with, or in
contemplation of, such other Person merging with or into or becoming a
Subsidiary of such specified Person, and (ii) Indebtedness secured by a Lien
encumbering any asset acquired by such specified Person.

            "AFFILIATE" of any specified Person means any other Person
directly or indirectly controlling or controlled by or under direct or indirect
common control with such specified Person.  For purposes of this definition,
"control" (including, with correlative meanings, the terms "controlling,"
"controlled by" and "under common control with"), as used with respect to any
Person, shall mean the possession, directly or indirectly, of the power to
direct or cause the direction of the management or policies of such Person,
whether through the ownership of voting securities, by agreement or otherwise;
PROVIDED that beneficial ownership of 10% or more of the voting securities of
a Person shall be deemed to be control.

            "AGENT" means any Registrar, Paying Agent or co-registrar.

            "ASSET SALE" means (i) the sale, lease, conveyance or other
disposition of any assets (including, without limitation, by way of a sale and
leaseback) other than in the ordinary course of business consistent with past
practices (PROVIDED that the sale, lease, conveyance or other disposition of
all or substantially all of the assets of the Company and its Subsidiaries taken
as a whole shall be governed by Section 3.13 and/or Article 4 hereof and not by
Section 3.10 hereof), and (ii) the issuance or sale by the Company or any of its
Subsidiaries of Equity Interests of any of the Company's Subsidiaries, in the
case of either clause (i) or (ii), whether in a single transaction or a series
of related transactions (a) that have a fair market value in excess of $25.0
million or (b) for net proceeds in excess of $25.0 million.  Notwithstanding the
foregoing:  (a) a transfer of assets by the Company to a Subsidiary or by a
Subsidiary to the Company or to another Subsidiary, (b) an issuance of Equity
Interests by a Subsidiary to the Company or to another Subsidiary, (c) a
Restricted Payment that is permitted by Section 3.07 hereof and (d) a Hospital
Swap shall not be deemed to be an Asset Sale.

<PAGE>

            "BOARD OF DIRECTORS" means the Board of Directors of the Company
or any authorized committee thereof.

            "BUSINESS DAY" means any day other than a Legal Holiday.

            "CAPITAL LEASE" means, at the time any determination thereof is to
be made, any lease of property, real or personal, in respect of which the
present value of the minimum rental commitment would be capitalized on a balance
sheet of the lessee in accordance with GAAP.

            "CAPITAL LEASE OBLIGATION" means, at the time any determination
thereof is to be made, the amount of the liability in respect of a Capital Lease
that would at such time be required to be capitalized on a balance sheet in
accordance with GAAP.

            "CAPITAL STOCK" means (i) in the case of a corporation, corporate
stock, (ii) in the case of an association or business entity, any and all
shares, interests, participations, rights or other equivalents (however
designated) of corporate stock, (iii) in the case of a partnership, partnership
interests (whether general or limited) and (iv) any other interest or
participation that confers on a Person the right to receive a share of the
profits and losses of, or distributions of assets of, the issuing Person.

            "CHANGE OF CONTROL" means the occurrence of any of the following:
(i) the sale, lease, transfer, conveyance or other disposition, in one or a
series of related transactions, of all or substantially all of the assets of the
Company and its Subsidiaries taken as a whole to any Person or group (as such
term is used in Sections 13(d)(3) and 14(d)(2) of the Exchange Act), other than
to a Person or group who, prior to such transaction, held a majority of the
voting power of the voting stock of the Company, (ii) the acquisition by any
Person or group, as defined above, of a direct or indirect interest in more than
50% of the voting power of the voting stock of the Company, by way of merger,
consolidation or otherwise, or (iii) the first day on which a majority of the
members of the Board of Directors of the Company are not Continuing Directors.

            "CHANGE OF CONTROL TRIGGERING EVENT" means the occurrence of both
a Change of Control and a Rating Decline.

            "COMMISSION" means the Securities and Exchange Commission.

            "COMPANY" means National Medical Enterprises, Inc., as obligor
under the Securities, unless and until a successor replaces National Medical
Enterprises, Inc., in accordance with Article 4 hereof and thereafter includes
such successor.

            "CONSOLIDATED CASH FLOW" means, with respect to any Person for any
period, the Consolidated Net Income of such Person for such period PLUS (i) an
amount equal to any extraordinary loss of such Person PLUS any net loss
realized in connection with an Asset Sale (to the extent such losses were
deducted in computing such Consolidated Net Income), PLUS (ii) provision for
taxes based on income or profits of such Person and its Subsidiaries for such
period, to the extent such provision for taxes was included in computing such
Consolidated Net

                                        2
<PAGE>

Income, PLUS (iii) the Fixed Charges of such Person and its Subsidiaries for
such period, to the extent that such Fixed Charges were deducted in computing
such Consolidated Net Income, PLUS (iv) depreciation and amortization
(including amortization of goodwill and other intangibles but excluding
amortization of prepaid cash expenses that were paid in a prior period) of such
Person and its Subsidiaries for such period to the extent that such depreciation
and amortization were deducted in computing such Consolidated Net Income, in
each case, on a consolidated basis and determined in accordance with GAAP.
Notwithstanding the foregoing, the provision for taxes on the income or profits
of, and the depreciation and amortization of, a Subsidiary of the referent
Person shall be added to Consolidated Net Income to compute Consolidated Cash
Flow only to the extent (and in same proportion) that the Net Income of such
Subsidiary was included in calculating the Consolidated Net Income of such
Person and only if a corresponding amount would be permitted at the date of
determination to be dividended to the Company by such Subsidiary without prior
approval (that has not been obtained), pursuant to the terms of its charter and
all agreements, instruments, judgments, decrees, orders, statutes, rules and
governmental regulations applicable to that Subsidiary or its stockholders.

            "CONSOLIDATED NET INCOME" means, with respect to any Person for
any period, the aggregate of the Net Income of such Person and its Subsidiaries
for such period, on a consolidated basis, determined in accordance with GAAP but
excluding any one-time charge or expense incurred in order to consummate the
Refinancing; PROVIDED that (i) the Net Income of any Person that is not a
Subsidiary or that is accounted for by the equity method of accounting shall be
included only to the extent of the amount of dividends or distributions paid in
cash to the referent Person or a Wholly Owned Subsidiary thereof, (ii) the Net
Income of any Subsidiary shall be excluded to the extent that the declaration or
payment of dividends or similar distributions by that Subsidiary of that Net
Income is not at the date of determination permitted without any prior
governmental approval (that has not been obtained) or, directly or indirectly,
by operation of the terms of its charter or any agreement, instrument, judgment,
decree, order, statute, rule or governmental regulation applicable to that
Subsidiary or its stockholders, (iii) the Net Income of any Person acquired in a
pooling of interests transaction for any period prior to the date of such
acquisition shall be excluded and (iv) the cumulative effect of a change in
accounting principles shall be excluded.

            "CONSOLIDATED NET WORTH" means, with respect to any Person as of
any date, the sum of (i) the consolidated equity of the common stockholders of
such Person and its consolidated Subsidiaries as of such date PLUS (ii) the
respective amounts reported on such Person's balance sheet as of such date with
respect to any series of preferred stock (other than Disqualified Stock), LESS
all write-ups (other than write-ups resulting from foreign currency translations
and write-ups of tangible assets of a going concern business made in accordance
with GAAP as a result of the acquisition of such business) subsequent to the
date hereof in the book value of any asset owned by such Person or a
consolidated Subsidiary of such Person, and excluding the cumulative effect of a
change in accounting principles, all as determined in accordance with GAAP.

            "CONTINUING DIRECTORS" means, as of any date of determination, any
member of the Board of Directors of the Company who (i) was a member of such
Board of Directors on the date hereof or (ii) was nominated for election or
elected to such Board of Directors with the

                                        3
<PAGE>

approval of a majority of the Continuing Directors who were members of such
Board at the time of such nomination or election.

            "CORPORATE TRUST OFFICE OF THE TRUSTEE" shall be at the address of
the Trustee specified in Section 9.02 hereof or such other address as to which
the Trustee may give notice to the Company.

            "DEFAULT" means any event that is or with the passage of time or
the giving of notice or both would be an Event of Default.

            "DISQUALIFIED STOCK" means any Capital Stock that, by its terms
(or by the terms of any security into which it is convertible or for which it is
exchangeable), or upon the happening of any event, matures or is mandatorily
redeemable, pursuant to a sinking fund obligation or otherwise, or redeemable at
the option of the Holder thereof, in whole or in part, on or prior to September
1, 2002.

            "EQUITY INTERESTS" means Capital Stock and all warrants, options
or other rights to acquire Capital Stock (but excluding any debt security that
is convertible into, or exchangeable for, Capital Stock).

            "EXCHANGE ACT" means the Securities Exchange Act of 1934, as
amended.

            "EXISTING INDEBTEDNESS" means Indebtedness of the Company and its
Subsidiaries (other than Indebtedness under the New Credit Facility) in
existence on the date hereof, until such amounts are repaid, including all
reimbursement obligations with respect to letters of credit outstanding as of
the date hereof (other than letters of credit issued pursuant to the New Credit
Facility).

            "FIXED CHARGE COVERAGE RATIO" means with respect to any Person for
any period, the ratio of the Consolidated Cash Flow of such Person for such
period to the Fixed Charges of such Person for such period; PROVIDED, HOWEVER,
that in the event that the Company or any of its Subsidiaries incurs, assumes,
Guarantees or redeems any Indebtedness (other than revolving credit borrowings)
or issues preferred stock subsequent to the commencement of the period for which
the Fixed Charge Coverage Ratio is being calculated but prior to the date on
which the event for which the calculation of the Fixed Charge Coverage Ratio is
made (the "CALCULATION DATE"), then the Fixed Charge Coverage Ratio shall be
calculated giving pro forma effect to such incurrence, assumption, Guarantee or
redemption of Indebtedness, or such issuance or redemption of preferred stock,
as if the same had occurred at the beginning of the applicable four-quarter
reference period; and PROVIDED FURTHER that for purposes of making the
computation referred to above, (i) acquisitions that have been made by the
Company or any of its Subsidiaries, including through mergers or consolidations
and including any related financing transactions, during the four-quarter
reference period or subsequent to such reference period and on or prior to the
Calculation Date shall be deemed to have occurred on the first day of the
four-quarter reference period, and (ii) the Consolidated Cash Flow and Fixed
Charges attributable to discontinued operations, as determined in accordance
with GAAP, and operations or businesses disposed of prior to the Calculation
Date, shall be excluded.

                                        4
<PAGE>

            "FIXED CHARGES" means, with respect to any Person for any period,
the sum of (i) the consolidated interest expense of such Person and its
Subsidiaries for such period, whether paid or accrued (including, without
limitation, amortization of original issue discount, non-cash interest payments,
the interest component of any deferred payment obligations, the interest
component of all payments associated with Capital Lease Obligations,
commissions, discounts and other fees and charges incurred in respect of letters
of credit or bankers' acceptance financings, and net payments (if any) pursuant
to Hedging Obligations) and (ii) the consolidated interest expense of such
Person and its Subsidiaries that was capitalized during such period, and (iii)
any interest expense on Indebtedness of another Person that is Guaranteed by
such Person or one of its Subsidiaries or secured by a Lien on assets of such
Person or one of its Subsidiaries (whether or not such Guarantee or Lien is
called upon) and (iv) the product of (a) all cash dividend payments (and
non-cash dividend payments in the case of a Person that is a Subsidiary) on any
series of preferred stock of such Person, TIMES (b) a fraction, the numerator
of which is one and the denominator of which is one minus the then current
combined federal, state and local statutory tax rate of such Person, expressed
as a decimal, in each case, on a consolidated basis and in accordance with GAAP.

            "GAAP" means generally accepted accounting principles set forth in
the opinions and pronouncements of the Accounting Principles Board of the
American Institute of Certified Public Accountants and statements and
pronouncements of the Financial Accounting Standards Board or in such other
statements by such other entity as have been approved by a significant segment
of the accounting profession, as in effect from time to time.

            "GOVERNMENT SECURITIES" means direct obligations of, or
obligations guaranteed by, the United States of America for the payment of which
guarantee or obligations the full faith and credit of the United States is
pledged.

            "GUARANTEE" means a guarantee (other than by endorsement of
negotiable instruments for collection in the ordinary course of business),
direct or indirect, in any manner (including, without limitation, letters of
credit and reimbursement agreements in respect thereof), of all or any part of
any Indebtedness.

            "HEDGING OBLIGATIONS" means, with respect to any Person, the
obligations of such Person under (i) interest rate swap agreements, interest
rate cap agreements and interest rate collar agreements, (ii) foreign exchange
contracts or currency swap agreements and (iii) other agreements or arrangements
designed to protect such Person against fluctuations in interest rates or
currency values.

            "HOLDER" means a Person in whose name a Security is registered.

            "HOSPITAL" means a hospital, outpatient clinic, long-term care
facility or other facility that is used or useful in the provision of healthcare
services.

            "HOSPITAL SWAP" means an exchange of assets by the Company or a
Subsidiary of the Company for one or more Hospitals and/or one or more Related
Businesses or for the

                                        5
<PAGE>

Capital Stock of any Person owning one or more Hospitals and/or one or more
Related Businesses.

            "INDEBTEDNESS" means with respect to any Person, any indebtedness
of such Person, whether or not contingent, in respect of borrowed money or
evidenced by bonds, notes, debentures or similar instruments or letters of
credit (or reimbursement agreements in respect thereof) or banker's acceptances
or representing Capital Lease Obligations or the balance deferred and unpaid of
the purchase price of any property or representing any Hedging Obligations,
except any such balance that constitutes an accrued expense or trade payable, if
and to the extent any of the foregoing indebtedness (other than letters of
credit and Hedging Obligations) would appear as a liability upon a balance sheet
of such Person prepared in accordance with GAAP, as well as all indebtedness of
others secured by a Lien on any asset of such Person (whether or not such
indebtedness is assumed by such Person) and, to the extent not otherwise
included, the Guarantee by such Person of any indebtedness of any other Person.

            "INDENTURE" means this Indenture, as amended or supplemented from
time to time.

            "INTERNATIONAL SUBSIDIARIES" means International-NME, Inc., NME
(Australia) Pty. Limited, and National Medical Enterprises Corp., and each of
such Person's respective Subsidiaries.

            "INVESTMENT GRADE" means a rating of BBB- or higher by S&P or Baa3
or higher by Moody's or the equivalent of such ratings by S&P or Moody's.  In
the event that the Company shall select any other Rating Agency, the equivalent
of such ratings by such Rating Agency shall be used.

            "INVESTMENTS" means, with respect to any Person, all investments
by such Person in other Persons (including Affiliates) in the form of direct or
indirect loans (including Guarantees of Indebtedness or other obligations),
advances or capital contributions, purchases or other acquisitions for
consideration of Indebtedness, Equity Interests or other securities and all
other items that are or would be classified as investments on a balance sheet
prepared in accordance with GAAP; PROVIDED that an acquisition of assets,
Equity Interests or other securities by the Company for consideration consisting
of common equity securities of the Company shall not be deemed to be an
Investment.

            "LIEN" means, with respect to any asset, any mortgage, lien,
pledge, charge, security interest or encumbrance of any kind in respect of such
asset given to secure Indebtedness, whether or not filed, recorded or otherwise
perfected under applicable law (including any conditional sale or other title
retention agreement, any lease in the nature thereof, any option or other
agreement to sell or give a security interest in and any filing of or agreement
to give any financing statement under the Uniform Commercial Code (or equivalent
statutes) of any jurisdiction with respect to any such lien, pledge, charge or
security interest).

            "METROCREST LETTER OF CREDIT FACILITY" means that certain letter
of credit facility, dated as of February 28, 1995, by and among the Company and
Morgan Guaranty Trust Company of New York and the other banks that are party
thereto, in an aggregate principal amount of $91.35 million.

                                        6
<PAGE>

            "MOODY'S" means Moody's Investors Services, Inc. and its
successors.

            "NET INCOME" means, with respect to any Person, the net income
(loss) of such Person, determined in accordance with GAAP and before any
reduction in respect of preferred stock dividends, excluding, however, (i) any
gain (but not loss), together with any related provision for taxes on such gain
(but not loss), realized in connection with (a) any Asset Sale (including,
without limitation, dispositions pursuant to sale and leaseback transactions) or
(b) the disposition of any securities by such Person or any of its Subsidiaries
or the extinguishment of any Indebtedness of such Person or any of its
Subsidiaries and (ii) any extraordinary or nonrecurring gain (but not loss),
together with any related provision for taxes on such extraordinary or
nonrecurring gain (but not loss).

            "NET PROCEEDS" means the aggregate cash proceeds received by the
Company or any of its Subsidiaries in respect of any Asset Sale (including,
without limitation, any cash received upon the sale or other disposition of any
permitted Non-Cash Consideration received in any Asset Sale), net of the direct
costs relating to such Asset Sale (including, without limitation, legal,
accounting and investment banking fees and sales commissions) and any other
expenses incurred or to be incurred by the Company or a Subsidiary as a direct
result of the sale of such assets (including, without limitation, severance,
relocation, lease termination and other similar expenses), taxes actually paid
or payable as a result thereof, amounts required to be applied to the repayment
of Indebtedness (other than Senior Term Debt or Senior Revolving Debt) secured
by a Lien on the asset or assets that were the subject of such Asset Sale and
any reserve for adjustment in respect of the sale price of such asset or assets
established in accordance with GAAP.

            "NEW CREDIT FACILITY" means that certain Credit Agreement, dated
as of February 28, 1995, by and among the Company and Morgan Guaranty Trust
Company of New York and the other banks that are party thereto, providing for
$1.8 billion in aggregate principal amount of Senior Term Debt and up to $500.0
million in aggregate principal amount of Senior Revolving Debt, including any
related notes, collateral documents, instruments and agreements executed in
connection therewith, and in each case as amended, modified, extended, renewed,
refunded, replaced or refinanced, in whole or in part, from time to time.

            "NON-CASH CONSIDERATION" means any non-cash consideration received
by the Company or a Subsidiary of the Company in connection with an Asset Sale
and any non-cash consideration received by the Company or any of its
Subsidiaries upon disposition thereof.

            "NON-RECOURSE DEBT" means Indebtedness of an International
Subsidiary (i) as to which neither the Company nor any of its Subsidiaries
(other than the International Subsidiaries) (a) provides credit support of any
kind (including any undertaking, agreement or instrument that would constitute
Indebtedness of the Company or any of its Subsidiaries), or (b) is directly or
indirectly liable (as a guarantor or otherwise) and (ii) no default with respect
to which (including any rights that the holders thereof may have to take
enforcement action against an International Subsidiary) would permit (upon
notice, lapse of time or both) any holder of any other Indebtedness of the
Company or any of its Subsidiaries (other than the International Subsidiaries)
to declare a default on such other Indebtedness or cause the payment thereof to
be accelerated

                                        7
<PAGE>

or payable prior to its stated maturity (except any such provisions set forth in
Existing Indebtedness until the same is repaid or refinanced).

            "OBLIGATIONS" means any principal, interest, penalties, fees,
indemnifications, reimbursements, damages and other liabilities payable under
the documentation governing any Indebtedness.

            "OFFICERS" means the Chairman of the Board, the Chief Executive
Officer, the President, the Chief Operating Officer, the Chief Financial
Officer, the Treasurer, any Assistant Treasurer, the Controller, the Secretary
and any Vice President of the Company or any Subsidiary, as the case may be.

            "OFFICERS' CERTIFICATE" means a certificate signed by two
Officers, one of whom must be the principal executive officer, principal
financial officer or principal accounting officer of the Company.

            "OPINION OF COUNSEL" means an opinion from legal counsel who is
reasonably acceptable to the Trustee.  The counsel may be an employee of or
counsel to the Company, any Subsidiary or the Trustee.

            "PAYMENT DEFAULT" means any failure to pay any scheduled
installment of interest or principal on any Indebtedness within the grace period
provided for such payment in the documentation governing such Indebtedness.

            "PERFORMANCE INVESTMENT PLAN" means the 1989 Performance
Investment Plan adopted by the Company's Board of Directors on March 10, 1989.

            "PERMITTED COLLATERAL" means, collectively, (i) all Capital Stock
and other Equity Interests of the Company's present and future direct
Subsidiaries, (ii) all intercompany Indebtedness owed to the Company and (iii)
all Capital Stock and other Equity Interests in Westminster Health Care Holdings
PLC owned by the Company or its Subsidiaries.

            "PERMITTED LIENS" means (i) Liens on Permitted Collateral securing
Senior Term Debt of the Company under the New Credit Facility in an aggregate
principal amount at any time outstanding not to exceed an amount equal to $1.8
billion less the aggregate amount of all repayments, optional or mandatory, of
the principal of any Senior Term Debt (other than repayments that are
immediately reborrowed) that have been made since the date hereof; (ii) Liens on
Permitted Collateral securing Senior Revolving Debt and letters of credit of the
Company incurred pursuant to the New Credit Facility in an aggregate principal
amount at any time outstanding (with letters of credit being deemed to have a
principal amount equal to the maximum potential reimbursement obligation of the
Company with respect thereto) not to exceed an amount equal to $500.0 million
less the aggregate amount of all Net Proceeds of Asset Sales applied to
permanently reduce commitments with respect to such Indebtedness pursuant to
Section 3.10 hereof since the date hereof; (iii) Liens in favor of the Company;
(iv) Liens on property of a Person existing at the time such Person is merged
into or consolidated with the Company or any Subsidiary of the Company or
becomes a Subsidiary of the Company; PROVIDED

                                        8
<PAGE>

that such Liens were in existence prior to the contemplation of such merger,
consolidation or acquisition and do not extend to any assets other than those of
the Person merged into or consolidated with the Company or that becomes a
Subsidiary of the Company; (v) Liens on property existing at the time of
acquisition thereof by the Company or any Subsidiary of the Company, PROVIDED
that such Liens were in existence prior to the contemplation of such
acquisition; (vi) Liens to secure the performance of statutory obligations,
surety or appeal bonds, performance bonds or other obligations of a like nature
incurred in the ordinary course of business; (vii) Liens existing on the date
hereof, including, without limitation, Liens on Permitted Collateral securing
reimbursement obligations under the Metrocrest Letter of Credit Facility; (viii)
Liens for taxes, assessments or governmental charges or claims that are not yet
delinquent or that are being contested in good faith by appropriate proceedings
promptly instituted and diligently concluded; PROVIDED that any reserve or
other appropriate provision as shall be required in conformity with GAAP shall
have been made therefor; (ix) other Liens on assets of the Company or any
Subsidiary of the Company securing Indebtedness that is permitted by the terms
hereof to be outstanding having an aggregate principal amount at any one time
outstanding not to exceed 10% of the Stockholders' Equity of the Company; and
(x) Liens to secure Permitted Refinancing Indebtedness incurred to refinance
Indebtedness that was secured by a Lien permitted hereunder and that was
incurred in accordance with the provisions hereof; PROVIDED that such Liens do
not extend to or cover any property or assets of the Company or any Subsidiary
other than assets or property securing the Indebtedness so refinanced.

            "PERMITTED REFINANCING INDEBTEDNESS" means any Indebtedness of the
Company or any of its Subsidiaries issued in exchange for, or the net proceeds
of which are used solely to extend, refinance, renew, replace, defease or
refund, other Indebtedness of the Company or any of its Subsidiaries; PROVIDED
that, except in the case of Indebtedness of the Company issued in exchange for,
or the net proceeds of which are used solely to extend, refinance, renew,
replace, defease or refund, Indebtedness of a Subsidiary of the Company:  (i)
the principal amount of such Permitted Refinancing Indebtedness does not exceed
the principal amount of the Indebtedness so extended, refinanced, renewed,
replaced, defeased or refunded (plus the amount of any premiums paid and
reasonable expenses incurred in connection therewith); (ii) such Permitted
Refinancing Indebtedness has a final maturity date later than the final maturity
date of, and has a Weighted Average Life to Maturity equal to or greater than
the Weighted Average Life to Maturity of, the Indebtedness being extended,
refinanced, renewed, replaced, defeased or refunded; (iii) if the Indebtedness
being extended, refinanced, renewed, replaced, defeased or refunded is
subordinated in right of payment to the Securities, such Permitted Refinancing
Indebtedness has a final maturity date later than the final maturity date of,
and is subordinated in right of payment to, the Securities on terms at least as
favorable to the Holders of Securities as those contained in the documentation
governing the Indebtedness being extended, refinanced, renewed, replaced,
defeased or refunded; and (iv) such Indebtedness is incurred either by the
Company or by the Subsidiary who is the obligor on the Indebtedness being
extended, refinanced, renewed, replaced, defeased or refunded.

            "PERSON" means any individual, corporation, partnership, joint
venture, association, joint-stock company, trust or unincorporated organization
(including any subdivision or ongoing business of any such entity or
substantially all of the assets of any such entity, subdivision or business).

                                        9
<PAGE>

            "PHYSICIAN JOINT VENTURE DISTRIBUTIONS" means distributions made
by the Company or any of its Subsidiaries to any physician, pharmacist or other
allied healthcare professional in connection with the unwinding, liquidation or
other termination of any joint venture or similar arrangement between any such
Person and the Company or any of its Subsidiaries.

            "PHYSICIAN SUPPORT OBLIGATIONS" means any obligation or Guarantee
incurred in the ordinary course of business by the Company or a Subsidiary of
the Company in connection with any advance, loan or payment to, or on behalf of
or for the benefit of any physician, pharmacist or other allied healthcare
professional for the purpose of recruiting, redirecting or retaining the
physician, pharmacist or other allied healthcare professional to provide service
to patients in the service area of any Hospital or Related Business owned or
operated by the Company or any of its Subsidiaries; EXCLUDING, HOWEVER,
compensation for services provided by physicians, pharmacists or other allied
healthcare professionals to any Hospital or Related Business owned or operated
by the Company or any of its Subsidiaries.

            "QUALIFIED EQUITY INTERESTS" shall mean all Equity Interests of
the Company other than Disqualified Stock of the Company.

            "RATING AGENCIES" means (i) S&P and (ii) Moody's or (iii) if S&P
or Moody's or both shall not make a rating of the Securities publicly available,
a nationally recognized securities rating agency or agencies, as the case may
be, selected by the Company, shall be substituted for S&P or Moody's or both, as
the case may be.

            "RATING CATEGORY" means (i) with respect to S&P, any of the
following categories:  BB, B, CCC, CC, C and D (or equivalent successor
categories); (ii) with respect to Moody's, any of the following categories:  Ba,
B, Caa, Ca, C and D (or equivalent successor categories); and (iii) the
equivalent of any such category of S&P or Moody's used by another Rating Agency.
In determining whether the rating of the Securities has decreased by one or more
gradations, gradations within Rating Categories (+ and - for S&P, 1, 2 and 3 for
Moody's; or the equivalent gradations for another Rating Agency) shall be taken
into account (E.G., with respect to S&P, a decline in a rating from BB+ to BB,
as well as from BB- to B+, shall constitute a decrease of one gradation).

            "RATING DATE" means the date which is 90 days prior to the earlier
of (i) a Change of Control and (ii) the first public notice of the occurrence of
a Change of Control or of the intention by the Company to effect a Change of
Control.

            "RATING DECLINE" means the occurrence on or within 90 days after
the date of the first public notice of the occurrence of a Change of Control or
of the intention by the Company to effect a Change of Control (which period
shall be extended so long as the rating of the Securities is under publicly
announced consideration for possible downgrade by any of the Rating Agencies)
of:  (a) in the event the Securities are rated by either Moody's or S&P on the
Rating Date as Investment Grade, a decrease in the rating of the Securities by
both Rating Agencies to a rating that is below Investment Grade, or (b) in the
event the Securities are rated below Investment Grade by both Rating Agencies on
the Rating Date, a decrease in the rating of the

                                        10
<PAGE>

Securities by either Rating Agency by one or more gradations (including
gradations within Rating Categories as well as between Rating Categories).

            "REFINANCING" has the meaning ascribed to it in the prospectus
dated February 21, 1995 relating to the Securities.

            "RELATED BUSINESS" means a healthcare business affiliated or
associated with a Hospital or any business related or ancillary to the provision
of healthcare services or the operation of a Hospital.

            "RESPONSIBLE OFFICER" when used with respect to the Trustee, means
any officer within the corporate trust department of the Trustee (or any
successor group of the Trustee) or any other officer of the Trustee customarily
performing functions similar to those performed by any of the above designated
officers and also means, with respect to a particular corporate trust matter,
any other officer to whom such matter is referred because of his knowledge of
and familiarity with the particular subject.

            "RESTRICTED INVESTMENT" means an Investment in any of the
International Subsidiaries.

            "SECURITIES" means the securities described above, issued under
this Indenture.

            "SECURITIES ACT" means the Securities Act of 1933, as amended.

            "SENIOR REVOLVING DEBT" means revolving credit loans outstanding
from time to time under the New Credit Facility.

            "SENIOR SUBORDINATED ASSET SALE OFFER" means the offer to purchase
Senior Subordinated Notes made by the Company to holders of Senior Subordinated
Notes under Section 4.10 of the Senior Subordinated Note Indenture.

            "SENIOR SUBORDINATED NOTES" means the 10-1/8% Senior Subordinated
Notes due 2005 of the Company in an aggregate principal amount of $900.0
million, issued pursuant to the Senior Subordinated Note Indenture.

            "SENIOR SUBORDINATED NOTE INDENTURE" means the Indenture dated as
of March 1, 1995 between the Company and The Bank of New York, as trustee, as
amended or supplemented from time to time, under which the Senior Subordinated
Notes were issued.

            "SENIOR TERM DEBT" means term loans outstanding from time to time
under the New Credit Facility.

            "SIGNIFICANT SUBSIDIARY" means any Subsidiary that would be a
"significant subsidiary" as defined in Article 1, Rule 1-02 of Regulation S-X,
promulgated pursuant to the Securities Act, as such Regulation is in effect on
the date hereof.

                                        11
<PAGE>

            "S&P" means Standard & Poor's Corporation and its successors.

            "SPECIFIED ASSETS" means the Company's and its Subsidiaries'
interest in The Hillhaven Corporation and Westminster Healthcare Holdings PLC
owned as of the date hereof and the Capital Stock and assets of the
International Subsidiaries.

            "STOCKHOLDERS' EQUITY" means, with respect to any Person as of any
date, the stockholders' equity of such Person determined in accordance with GAAP
as of the date of the most recent available internal financial statements of
such Person, and calculated on a pro forma basis to give effect to any
acquisition or disposition by such Person consummated or to be consummated since
the date of such financial statements and on or prior to the date of such
calculation.

            "SUBSIDIARY" means, with respect to any Person, (i) any
corporation, association or other business entity of which more than 50% of the
total voting power of shares of Capital Stock entitled (without regard to the
occurrence of any contingency) to vote in the election of directors, managers or
trustees thereof is at the time owned or controlled, directly or indirectly, by
such Person or one or more of the other Subsidiaries of that Person (or a
combination thereof) and (ii) any partnership (a) the sole general partner or
the managing general partner of which is such Person or a Subsidiary of such
Person or (b) the only general partners of which are such Person or of one or
more Subsidiaries of such Person (or any combination thereof); PROVIDED that
no International Subsidiary shall be deemed to be a "Subsidiary" for any purpose
hereunder for so long as such International Subsidiary:  (a) has no Indebtedness
other than Existing Indebtedness and Non-Recourse Debt; (b) is not a party to
any agreement, contract, arrangement or understanding with the Company or any of
its other Subsidiaries (other than International Subsidiaries) except any such
agreement, contract, arrangement or understanding that (i) was in effect on the
date hereof, or (ii) meets the requirements of Section 3.11 hereof; (c) is a
Person with respect to which neither the Company nor any of its Subsidiaries
(other than International Subsidiaries) has any direct or indirect obligation
(x) to subscribe for additional Equity Interests or (y) to maintain or preserve
such Person's financial condition or to cause such Person to achieve any
specified level of operating results except, in each case, any such obligation
in existence on the date hereof or created pursuant to the terms of any
Investment permitted by Section 3.07 hereof; and (d) has not Guaranteed or
otherwise directly or indirectly provided credit support for any Indebtedness of
the Company or any of its Subsidiaries (other than International Subsidiaries).
If, at any time, any International Subsidiary would fail to meet the foregoing
requirements, it shall thereafter be deemed to be a Subsidiary for all purposes
of this Indenture and any Indebtedness of such International Subsidiary shall be
deemed to be incurred by a Subsidiary of the Company as of such date (and, if
such Indebtedness is not permitted to be incurred as of such date under Section
3.09 hereof, the Company shall be in default of such covenant).

             "TIA" means the Trust Indenture Act of 1939, as amended (15 U.S.C.
Section 77aaa-77bbbb) as in effect on the date on which this Indenture is
qualified under the TIA, except as provided in Section 8.03 hereof.

            "TRANSFER RESTRICTION" means, with respect to the Company's
Subsidiaries, any encumbrance or restriction on the ability of any Subsidiary to
(i)(a) pay dividends or make any

                                        12
<PAGE>

other distributions to the Company or any of its Subsidiaries (1) on its Capital
Stock or (2) with respect to any other interest or participation in, or measured
by, its profits, or (b) pay any Indebtedness owed to the Company or any of its
Subsidiaries, (ii) make loans or advances to the Company or any of its
Subsidiaries, or (iii) transfer any of its properties or assets to the Company
or any of its Subsidiaries.

            "TRUSTEE" means the party named as such above until a successor
replaces it in accordance with the applicable provisions of this Indenture and
thereafter means the successor serving hereunder.

            "WEIGHTED AVERAGE LIFE TO MATURITY" means, when applied to any
Indebtedness at any date, the number of years obtained by dividing (i) the sum
of the products obtained by multiplying (a) the amount of each then remaining
installment, sinking fund, serial maturity or other required payments of
principal, including payment at final maturity, in respect thereof, by (b) the
number of years (calculated to the nearest one-twelfth) that will elapse between
such date and the making of such payment, by (ii) the then outstanding principal
amount of such Indebtedness.

            "WHOLLY OWNED SUBSIDIARY" of any Person means a Subsidiary of such
Person all of the outstanding Capital Stock or other ownership interests of
which (other than directors' qualifying shares) shall at the time be owned by
such Person or by one or more Wholly Owned Subsidiaries of such Person or by
such Person and one or more Wholly Owned Subsidiaries of such Person.

SECTION 1.02.    OTHER DEFINITIONS.
                                                      DEFINED IN
       TERM                                            SECTION
       ----                                            -------

      "Affiliate Transaction".....................     3.11
      "Bankruptcy Law"............................     5.01
      "Change of Control Offer"...................     3.13
      "Change of Control Payment".................     3.13
      "Change of Control Payment Date"............     3.13
      "Commencement Date".........................     2.15
      "Covenant Defeasance".......................     7.03
      "Custodian".................................     5.01
      "Event of Default"..........................     5.01
      "Excess Proceeds"...........................     3.10
      "incur".....................................     3.09
      "Legal Defeasance"..........................     7.02
      "Legal Holiday".............................     9.07
      "Notice of Default".........................     5.01
      "Offer Amount"..............................     2.15
      "Offer Period"..............................     2.15
      "Paying Agent"..............................     2.03
      "Purchase Date".............................     2.15

                                       13

<PAGE>

      "Purchase Price"............................     3.10
      "Registrar".................................     2.03
      "Restricted Payments".......................     3.07
      "Senior Asset Sale Offer"...................     3.10

SECTION 1.03.    INCORPORATION BY REFERENCE OF TIA.

            Whenever this Indenture refers to a provision of the TIA, the
provision is incorporated by reference in and made a part of this Indenture.

            The following TIA terms used in this Indenture have the following
meanings:

            "INDENTURE SECURITIES" means the Securities;

            "INDENTURE SECURITY HOLDER" means a Holder;

            "INDENTURE TO BE QUALIFIED" means this Indenture;

            "INDENTURE TRUSTEE" or "INSTITUTIONAL TRUSTEE" means the
Trustee;

            "OBLIGOR" on the Securities means the Company and any successor
obligor upon the Securities.

            All other terms used in this Indenture that are defined by the TIA,
defined by TIA reference to another statute or defined by the Commission rule
under the TIA have the meanings so assigned to them.

SECTION 1.04.    RULES OF CONSTRUCTION.

            Unless the context otherwise requires:

            (1)   a term has the meaning assigned to it;

            (2)   an accounting term not otherwise defined has the meaning
      assigned to it in accordance with GAAP;

            (3)   "or" is not exclusive;

            (4)   words in the singular include the plural, and in the plural
      include the singular; and

            (5)   provisions apply to successive events and transactions.

                                        14
<PAGE>

                                   ARTICLE 2
                 THE SECURITIES; OFFER TO PURCHASE PROCEDURES

SECTION 2.01.    FORM AND DATING.

            The Securities and the Trustee's certificate of authentication shall
be substantially in the form of Exhibit A hereto, the terms of which are
incorporated in and made a part of this Indenture.  The Securities may have
notations, legends or endorsements approved as to form by the Company and
required by law, stock exchange rule, agreements to which the Company is subject
or usage.  Each Security shall be dated the date of its authentication.  The
Securities shall be issuable only in registered form, without coupons, in
denominations of $1,000 and integral multiples thereof.

SECTION 2.02.    EXECUTION AND AUTHENTICATION.

            An Officer of the Company shall sign the Securities for the Company
by manual or facsimile signature.  The Company's seal shall be reproduced on the
Securities and may be in facsimile form.

            If an Officer whose signature is on a Security no longer holds that
office at the time the Security is authenticated, the Security shall
nevertheless be valid.

            A Security shall not be valid until authenticated by the manual
signature of the Trustee.  The signature of the Trustee shall be conclusive
evidence that the Security has been authenticated under this Indenture.  The
form of Trustee's certificate of authentication to be borne by the Securities
shall be substantially as set forth in Exhibit A hereto.

            The Trustee shall, upon a written order of the Company signed by two
Officers of the Company, authenticate Securities for original issue up to the
aggregate principal amount stated in paragraph 4 of the Securities.  The
aggregate principal amount of Securities outstanding at any time shall not
exceed the amount set forth herein except as provided in Section 2.07 hereof.

            The Trustee may appoint an authenticating agent acceptable to the
Company to authenticate Securities.  Unless limited by the terms of such
appointment, an authenticating agent may authenticate Securities whenever the
Trustee may do so.  Each reference in this Indenture to authentication by the
Trustee includes authentication by such agent.  An authenticating agent has the
same rights as an Agent to deal with the Company or an Affiliate of the Company.

SECTION 2.03.    REGISTRAR AND PAYING AGENT.

            The Company shall maintain (i) an office or agency where Securities
may be presented for registration of transfer or for exchange (including any
co-registrar, the "REGISTRAR") and (ii) an office or agency where Securities
may be presented for payment (the "PAYING AGENT").  The Registrar shall keep a
register of the Securities and of their transfer and exchange.  The Company may
appoint one or more co-registrars and one or more additional paying agents.  The
term "Paying Agent" includes any additional paying agent.  The Company may
change any

                                        15
<PAGE>

Paying Agent, Registrar or co-registrar without prior notice to any Holder.  The
Company shall notify the Trustee and the Trustee shall notify the Holders of the
name and address of any Agent not a party to this Indenture. If the Company
fails to appoint or maintain another entity as Registrar or Paying Agent, the
Trustee shall act as such.  The Company or any of its Subsidiaries may act as
Paying Agent, Registrar or co-registrar.  The Company shall enter into an
appropriate agency agreement with any Agent not a party to this Indenture, which
shall incorporate the provisions of the TIA.  The agreement shall implement the
provisions of this Indenture that relate to such Agent.  The Company shall
notify the Trustee of the name and address of any such Agent.  If the Company
fails to maintain a Registrar or Paying Agent, or fails to give the foregoing
notice, the Trustee shall act as such, and shall be entitled to appropriate
compensation in accordance with Section 6.07 hereof.

            The Company initially appoints the Trustee as Registrar, Paying
Agent and agent for service of notices and demands in connection with the
Securities.

SECTION 2.04.    PAYING AGENT TO HOLD MONEY IN TRUST.

            On or prior to the due date of principal of, premium, if any, and
interest on any Securities, the Company shall deposit with the Trustee or the
Paying Agent money sufficient to pay such principal, premium, if any, and
interest becoming due.  The Company shall require each Paying Agent other than
the Trustee to agree in writing that the Paying Agent shall hold in trust for
the benefit of the Holders or the Trustee all money held by the Paying Agent for
the payment of principal of, premium, if any, and interest on the Securities,
and shall notify the Trustee of any Default by the Company in making any such
payment.  While any such Default continues, the Trustee may require a Paying
Agent to pay all money held by it to the Trustee.  The Company at any time may
require a Paying Agent to pay all money held by it to the Trustee.  Upon payment
over to the Trustee, the Paying Agent (if other than the Company) shall have no
further liability for the money delivered to the Trustee.  If the Company acts
as Paying Agent, it shall segregate and hold in a separate trust fund for the
benefit of the Holders all money held by it as Paying Agent.

SECTION 2.05.    HOLDER LISTS.

            The Trustee shall preserve in as current a form as is reasonably
practicable the most recent list available to it of the names and addresses of
Section  Holders and shall otherwise comply with TIA Section 312(a).  If the
Registrar, the Company shall furnish to the Trustee at least seven Business Days
before each interest payment date and at such other times as the Trustee may
request in writing a list in such form and as of such date as the Trustee may
reasonably require of the names and addresses of Holders, including the
aggregate principal amount of the Securities held by each thereof, and the
Company shall otherwise comply with TIA Section 312(a).

SECTION 2.06.    TRANSFER AND EXCHANGE.

            When Securities are presented to the Registrar with a request to
register the transfer or to exchange them for an equal principal amount of
Securities of other denominations, the Registrar shall register the transfer or
make the exchange if its requirements for such trans-

                                       16

<PAGE>

actions are met; PROVIDED, HOWEVER, that any Security presented or surrendered
for registration of transfer or exchange shall be duly endorsed or accompanied
by a written instruction of transfer in form satisfactory to the Registrar and
the Trustee duly executed by the Holder thereof or by his attorney duly
authorized in writing.  To permit registrations of transfer and exchanges, the
Company shall issue and the Trustee shall authenticate Securities at the
Registrar's request, subject to such rules as the Trustee may reasonably
require.

            Neither the Company nor the Registrar shall be required to register
the transfer or exchange of a Security between the record date and the next
succeeding interest payment date.
            No service charge shall be made to any Holder for any registration
of transfer or exchange (except as otherwise expressly permitted herein), but
the Company may require payment of a sum sufficient to cover any transfer tax or
similar governmental charge payable in connection therewith (other than such
transfer tax or similar governmental charge payable upon exchanges pursuant to
Sections 2.10 or 8.05 hereof, which shall be paid by the Company).

            Prior to due presentment for registration of transfer of any
Security, the Trustee, any Agent and the Company may deem and treat the Person
in whose name any Security is registered as the absolute owner of such Security
for the purpose of receiving payment of principal of, premium, if any, and
interest on such Security and for all other purposes whatsoever, whether or not
such Security is overdue, and neither the Trustee, any Agent nor the Company
shall be affected by notice to the contrary.

SECTION 2.07.    REPLACEMENT SECURITIES.

            If any mutilated Security is surrendered to the Trustee or the
Company, or the Trustee receives evidence to its satisfaction of the
destruction, loss or theft of any Security, the Company shall issue and the
Trustee, upon the written order of the Company signed by two Officers of the
Company, shall authenticate a replacement Security if the Trustee's requirements
for replacements of Securities are met.  If required by the Trustee or the
Company, an indemnity bond must be supplied by the Holder that is sufficient in
the judgment of the Trustee and the Company to protect the Company, the Trustee,
any Agent and any authenticating agent from any loss which any of them may
suffer if a Security is replaced.  Each of the Company and the Trustee may
charge for its expenses in replacing a Security.

            Every replacement Security is an additional obligation of the
Company.

SECTION 2.08.    OUTSTANDING SECURITIES.

            The Securities outstanding at any time are all the Securities
authenticated by the Trustee except for those cancelled by it, those delivered
to it for cancellation and those described in this Section as not outstanding.

            If a Security is replaced pursuant to Section 2.07 hereof, it ceases
to be outstanding unless the Trustee receives proof satisfactory to it that the
replaced Security is held by a bona fide purchaser.

                                       17
<PAGE>

            If the principal amount of any Security is considered paid under
Section 3.01 hereof, it ceases to be outstanding and interest on it ceases to
accrue.

            Subject to Section 2.09 hereof, a Security does not cease to be
outstanding because the Company or an Affiliate of the Company holds the
Security.

SECTION 2.09.    TREASURY SECURITIES.

            In determining whether the Holders of the required principal amount
of Securities then outstanding have concurred in any demand, direction, waiver
or consent, Securities owned by the Company or any Affiliate of the Company
shall be considered as though not outstanding, except that for purposes of
determining whether the Trustee shall be protected in relying on any such
demand, direction, waiver or consent, only Securities that a Responsible Officer
actually knows to be so owned shall be so considered.  Notwithstanding the
foregoing, Securities that are to be acquired by the Company or an Affiliate of
the Company pursuant to an exchange offer, tender offer or other agreement shall
not be deemed to be owned by the Company or an Affiliate of the Company until
legal title to such Securities passes to the Company or such Affiliate, as the
case may be.

SECTION 2.10.    TEMPORARY SECURITIES.

            Until definitive Securities are ready for delivery, the Company may
prepare and the Trustee, upon receipt of the written order of the Company signed
by two Officers of the Company, shall authenticate temporary Securities.
Temporary Securities shall be substantially in the form of definitive Securities
but may have variations that the Company and the Trustee consider appropriate
for temporary Securities.  Without unreasonable delay, the Company shall prepare
and the Trustee, upon receipt of the written order of the Company signed by two
Officers of the Company, shall authenticate definitive Securities in exchange
for temporary Securities.  Until such exchange, temporary Securities shall be
entitled to the same rights, benefits and privileges as definitive Securities.

SECTION 2.11.    CANCELLATION.

            The Company at any time may deliver Securities to the Trustee for
cancellation.  The Registrar and Paying Agent shall forward to the Trustee any
Securities surrendered to them for registration of transfer, exchange or
payment.  The Trustee shall cancel all Securities surrendered for registration
of transfer, exchange, payment, replacement or cancellation and shall return
such cancelled Securities to the Company.  The Company may not issue new
Securities to replace Securities that it has paid or that have been delivered to
the Trustee for cancellation.

SECTION 2.12.    DEFAULTED INTEREST.

            If the Company defaults in a payment of interest on the Securities,
it shall pay the defaulted interest in any lawful manner plus, to the extent
lawful, interest payable on the defaulted interest, to the Persons who are
Holders on a subsequent special record date, which date shall be at the earliest
practicable date but in all events at least five Business Days prior to

                                       18
<PAGE>

the related payment date, in each case at the rate provided in the Securities
and in Section 3.01 hereof.  The Company shall, with the consent of the Trustee,
fix or cause to be fixed each such special record date and payment date.  At
least 15 days before the special record date, the Company (or the Trustee, in
the name of and at the expense of the Company) shall mail to Holders a notice
that states the special record date, the related payment date and the amount of
such interest to be paid.

SECTION 2.13.    RECORD DATE.

            The record date for purposes of determining the identity of Holders
entitled to vote or consent to any action by vote or consent authorized or
Trustee is not the permitted under this Indenture shall be determined as
316(c).

SECTION 2.14.    CUSIP NUMBER.

            The Company in issuing the Securities may use a "CUSIP" number, and
if it does so, the Trustee shall use the CUSIP number in notices to Holders;
PROVIDED that any such notice may state that no representation is made as to
the correctness or accuracy of the CUSIP number printed in the notice or on the
Securities and that reliance may be placed only on the other identification
numbers printed on the Securities.  The Company shall promptly notify the
Trustee of any change in the CUSIP number.

SECTION 2.15.    OFFER TO PURCHASE BY APPLICATION OF EXCESS PROCEEDS.

            In the event that the Company shall commence a Senior Asset Sale
Offer pursuant to Section 3.10 hereof, it shall follow the procedures specified
below.

            No later than the date on which the aggregate amount of Excess
Proceeds exceeds $25.0 million, the Company shall notify the Trustee of such
Senior Asset Sale Offer and provide the Trustee with an Officers' Certificate
setting forth, in addition to the information to be included therein pursuant to
Section 3.10 hereof, the calculations used in determining the amount of Net
Proceeds to be applied to the purchase of Securities.  The Company shall
commence or cause to be commenced the Senior Asset Sale Offer on a date no later
than 10 Business Days after such notice (the "COMMENCEMENT DATE").

            The Senior Asset Sale Offer shall remain open for at least 20
Business Days after the Commencement Date relating to such Senior Asset Sale
Offer and shall remain open for no more than such 20 Business Days, except to
the extent required by applicable law (as so extended, the "OFFER PERIOD").
No later than one Business Day after the termination of the Offer Period (the
"PURCHASE DATE"), the Company shall purchase the principal amount (the "OFFER
Amount") of Securities required to be purchased in such Senior Asset Sale Offer
pursuant to Section 3.10 hereof or, if less than the Offer Amount has been
tendered, all Securities tendered in response to the Senior Asset Sale Offer, in
each case for an amount in cash equal to the Purchase Price.

            If the Purchase Date is on or after an interest payment record date
and on or before the related interest payment date, any accrued interest shall
be paid to the Person in

                                       19
<PAGE>

whose name a Security is registered at the close of business on such record
date, and no additional interest shall be payable to Holders who tender
Securities pursuant to the Senior Asset Sale Offer.

            On the Commencement Date of any Senior Asset Sale Offer, the Company
shall send, or at the Company's request the Trustee shall send, by first class
mail, a notice to each of the Holders at their last registered address, with a
copy to the Trustee and the Paying Agent, offering to repurchase the Securities
held by such Holder pursuant to the procedure specified in such notice.  Such
notice, which shall govern the terms of the Senior Asset Sale Offer, shall
contain all instructions and materials necessary to enable the Holders to tender
Securities pursuant to the Senior Asset Sale Offer and shall state:

                  (1)   that the Senior Asset Sale Offer is being made pursuant
                        to this Section 2.15 and Section 3.10 hereof and the
                        length of time the Senior Asset Sale Offer shall remain
                        open;

                  (2)   the Offer Amount, the Purchase Price and the Purchase
                        Date;

                  (3)   that any Security not tendered or accepted for payment
                        shall continue to accrue interest;

                  (4)   that, unless the Company defaults in the payment of the
                        Purchase Price, any Security accepted for payment
                        pursuant to the Senior Asset Sale Offer shall cease to
                        accrue interest after the Purchase Date;

                  (5)   that Holders electing to have a Security purchased
                        pursuant to any Senior Asset Sale Offer shall be
                        required to surrender the Security, with the form
                        entitled "Option of Holder to Elect Purchase" on the
                        reverse of the Security completed, to the Company, a
                        depositary, if appointed by the Company, or a Paying
                        Agent at the address specified in the notice prior to
                        the close of business on the Business Day next preceding
                        the Purchase Date;

                  (6)   that Holders shall be entitled to withdraw their
                        election if the Company, depositary or Paying Agent, as
                        the case may be, receives, not later than the close of
                        business on the Business Day next preceding the
                        termination of the Offer Period, a facsimile
                        transmission or letter setting forth the name of the
                        Holder, the principal amount of the Security the Holder
                        delivered for purchase and a statement that such Holder
                        is withdrawing his election to have such Security
                        purchased;

                  (7)   that, if the aggregate principal amount of Securities
                        surrendered by Holders exceeds the Offer Amount, the
                        Trustee shall select the Securities to be purchased on a
                        PRO RATA basis (with such adjustments as may be deemed
                        appropriate by the Trustee so that

                                        20
<PAGE>

                        only Securities in denominations of $1,000, or integral
                        multiples thereof, shall be purchased);

                  (8)   that Holders whose Securities were purchased only in
                        part shall be issued new Securities equal in principal
                        amount to the unpurchased portion of the Securities
                        surrendered; and

                  (9)   the circumstances and relevant facts regarding such
                        Asset Sale and any other information that would be
                        material to a decision as to whether to tender a
                        Security pursuant to the Senior Asset Sale Offer.

            On the Purchase Date, the Company shall, to the extent lawful, (i)
accept for payment, on a PRO RATA basis to the extent necessary, an aggregate
principal amount equal to the Offer Amount of Securities tendered pursuant to
the Senior Asset Sale Offer, or if less than the Offer Amount has been tendered,
all Securities or portion thereof so tendered, (ii) deposit with the Paying
Agent an amount equal to the Purchase Price in respect of all Securities or
portions thereof so tendered and (iii) deliver or cause to be delivered to the
Trustee the Securities so accepted together with an Officers' Certificate
stating the aggregate principal amount of Securities or portions thereof being
purchased by the Company.  The Paying Agent shall promptly mail to each Holder
of Securities so tendered payment in an amount equal to the Purchase Price for
such Securities and the Trustee shall promptly authenticate and mail (or cause
to be transferred by book entry) a new Security to such Holder equal in
principal amount to any unpurchased portion of the Securities surrendered, if
any; PROVIDED that each such new Security shall be in a principal amount of
$1,000 or an integral multiple thereof.  The Company shall publicly announce the
results of the Senior Asset Sale Offer on or as soon as practicable after the
Purchase Date.

            The Company shall comply with the requirements of Rule 14e-1 under
the Exchange Act and any other securities laws and regulations thereunder to the
extent such laws and regulations are applicable in connection with the purchase
of Securities as a result of the Senior Asset Sale Offer.

                                   ARTICLE 3
                                   COVENANTS

SECTION 3.01.    PAYMENT OF SECURITIES.

            The Company shall pay or cause to be paid the principal of, premium,
if any, and interest on the Securities on the dates and in the manner provided
in this Indenture and the Securities.  Principal, premium, if any, and interest
shall be considered paid on the date due if the Paying Agent, if other than the
Company or a Subsidiary of the Company, holds as of 10:00 a.m. Eastern Time on
the due date money deposited by the Company in immediately available funds and
designated for and sufficient to pay all principal, premium, if any, and
interest then due.  Such Paying Agent shall return to the Company, no later than
five days following the date

                                        21

<PAGE>

of payment, any money (including accrued interest) that exceeds such amount of
principal, premium, if any, and interest to be paid on the Securities.

            The Company shall pay interest (including post-petition interest in
any proceeding under any Bankruptcy Law) on overdue principal at the rate equal
to 1% per annum in excess of the interest rate then applicable to the Securities
to the extent lawful.  In addition, it shall pay interest (including
post-petition interest in any proceeding under any Bankruptcy Law) on overdue
installments of interest (without regard to any applicable grace period) at the
same rate to the extent lawful.

SECTION 3.02.    MAINTENANCE OF OFFICE OR AGENCY.

            The Company shall maintain in the Borough of Manhattan, the City of
New York, an office or agency (which may be an office of the Trustee or an
affiliate of the Trustee, Registrar or co-registrar) where Securities may be
surrendered for registration of transfer or exchange and where notices and
demands to or upon the Company in respect of the Securities and this Indenture
may be served.  The Company shall give prompt written notice to the Trustee of
the location, and any change in the location, of such office or agency.  If at
any time the Company shall fail to maintain any such required office or agency
or shall fail to furnish the Trustee with the address thereof, such
presentations, surrenders, notices and demands may be made or served at the
Corporate Trust Office of the Trustee.

            The Company may also from time to time designate one or more other
offices or agencies where the Securities may be presented or surrendered for any
or all such purposes and may from time to time rescind such designations;
PROVIDED, HOWEVER, that no such designation or rescission shall in any
manner relieve the Company of its obligation to maintain an office or agency in
the Borough of Manhattan, the City of New York for such purposes.  The Company
shall give prompt written notice to the Trustee of any such designation or
rescission and of any change in the location of any such other office or agency.

            The Company hereby designates The Bank of New York, 101 Barclay
Street, 21 West, New York, New York 10286 as one such office or agency of the
Company in accordance with Section 2.03 hereof.

SECTION 3.03.    COMMISSION REPORTS.

            (i)   So long as any of the Securities remain outstanding, the
Company shall provide to the Trustee within 15 days after the filing thereof
with the Commission copies of the annual reports and of the information,
documents and other reports (or copies of such portions of any of the foregoing
as the Commission may by rules and regulations prescribe) that the Company is
required to file with the Commission pursuant to Section 13 or 15(d) of the
Exchange Act.  All obligors on the Securities shall comply with the provisions
provided for in TIA Section  of TIA Section 314(a).  Notwithstanding that the
reporting requirements of Section 13 or 15(d) of the Exchange Act or otherwise
report on an annual and quarterly basis on forms provided for such annual and
quarterly reporting pursuant to rules and regulations promulgated by the
Commission, the Company shall file with the Commission and provide to the
Trustee (a) within 90 days after the end of each fiscal year, annual reports on
Form 10-K (or any

                                        22
<PAGE>

successor or comparable form) containing the information required to be
contained therein (or required in such successor or comparable form), including
a "MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF
Operations" and a report thereon by the Company's certified public accountants;
(b) within 45 days after the end of each of the first three fiscal quarters of
each fiscal year, reports on Form 10-Q (or any successor or comparable form)
containing the information required to be contained therein (or required in any
successor or comparable form), including a "MANAGEMENT'S DISCUSSION AND
Analysis of Financial Condition and Results of Operations"; and (c) promptly
from time to time after the occurrence of an event required to be therein
reported, such other reports on Form 8-K (or any successor or comparable form)
containing the information required to be contained therein (or required in any
successor or comparable form); PROVIDED, HOWEVER, that the Company shall not
be in default of the provisions of this Section 3.03(i) for any failure to file
reports with the Commission solely by the refusal of the Commission to accept
the same for filing.  Each of the financial statements contained in such reports
shall be prepared in accordance with GAAP.

            (ii)  The Trustee, at the Company's expense, shall promptly mail
copies of all such annual reports, information, documents and other reports
provided to the Trustee pursuant to Section 3.03(i) hereof to the Holders at
their addresses appearing in the register of Securities maintained by the
Registrar.

            (iii) Whether or not required by the rules and regulations of the
Commission, the Company shall file a copy of all such information and reports
with the Commission for public availability and make such information available
to securities analysts and prospective investors upon request.

            (iv)  The Company shall provide the Trustee with a sufficient number
of copies of all reports and other documents and information that the Trustee
may be required to deliver to the Holders under this Section 3.03.

            (v)   Delivery of such reports, information and documents to the
Trustee is for informational purposes only and the Trustee's receipt of such
shall not constitute constructive notice of any information contained therein or
determinable from information contained therein, including the Company's
compliance with any of its covenants hereunder (as to which the Trustee is
entitled to rely exclusively on Officers' Certificates).

SECTION 3.04.    COMPLIANCE CERTIFICATE.

            (i)   The Company shall deliver to the Trustee, within 120 days
after the end of each fiscal year, an Officers' Certificate stating that a
review of the activities of the Company and its Subsidiaries during the
preceding fiscal year has been made under the supervision of the signing
Officers with a view to determining whether each has kept, observed, performed
and fulfilled its obligations under this Indenture, and further stating, as to
each such Officer signing such certificate, that to the best of his or her
knowledge each entity has kept, observed, performed and fulfilled each and every
covenant contained in this Indenture and is not in default in the performance or
observance of any of the terms, provisions and conditions of this Indenture (or,
if a Default or Event of Default shall have occurred, describing all such
Defaults or Events of Default of which he or she may have knowledge and what
action each is taking or proposes

                                        23
<PAGE>

to take with respect thereto), all without regard to periods of grace or notice
requirements, and that to the best of his or her knowledge no event has occurred
and remains in existence by reason of which payments on account of the principal
of or interest, if any, on the Securities is prohibited or if such event has
occurred, a description of the event and what action each is taking or proposes
to take with respect thereto.

            (ii)  So long as not contrary to the then current recommendations of
the American Institute of Certified Public Accountants, the year-end financial
statements delivered pursuant to Section 3.03 above shall be accompanied by a
written statement of the Company's certified independent public accountants (who
shall be a firm of established national reputation) that in making the
examination necessary for certification of such financial statements nothing has
come to their attention which would lead them to believe that the Company or any
Subsidiary of the Company has violated any provisions of Article 3 or of Article
4 of this Indenture or, if any such violation has occurred, specifying the
nature and period of existence thereof, it being understood that such
accountants shall not be liable directly or indirectly to any Person for any
failure to obtain knowledge of any such violation.

            (iii)  The Company shall, so long as any of the Securities are
outstanding, deliver to the Trustee, forthwith upon any Officer becoming aware
of (a) any Default or Event of Default or (b) any event of default under any
other mortgage, indenture or instrument referred to in Section 5.01(v) hereof,
an Officers' Certificate specifying such Default, Event of Default or event of
default and what action the Company is taking or proposes to take with respect
thereto.

SECTION 3.05.    TAXES.

            The Company shall pay, and shall cause each of its Subsidiaries to
pay, prior to delinquency, all material taxes, assessments, and governmental
levies except (i) as contested in good faith by appropriate proceedings and with
respect to which appropriate reserves have been taken in accordance with GAAP or
(ii) where the failure to effect such payment is not adverse in any material
respect to the Holders.

SECTION 3.06.    STAY, EXTENSION AND USURY LAWS.

            The Company covenants (to the extent that it may lawfully do so)
that it shall not at any time insist upon, plead, or in any manner whatsoever
claim or take the benefit or advantage of, any stay, extension or usury law
wherever enacted, now or at any time hereafter in force, that may affect the
covenants or the performance of this Indenture; and the Company (to the extent
that it may lawfully do so) hereby expressly waives all benefit or advantage of
any such law, and covenants that it shall not, by resort to any such law,
hinder, delay or impede the execution of any power herein granted to the
Trustee, but shall suffer and permit the execution of every such power as though
no such law has been enacted.

SECTION 3.07.    LIMITATIONS ON RESTRICTED PAYMENTS.

            The Company shall not, and shall not permit any of its Subsidiaries
to, directly or indirectly:  (i) declare or pay any dividend or make any
distribution on account of the

                                        24
<PAGE>

Company's or any of its Subsidiaries' Equity Interests (other than (w) Physician
Joint Venture Distributions, (x) dividends or distributions payable in Qualified
Equity Interests of the Company, (y) dividends or distributions payable to the
Company or any Subsidiary of the Company and (z) dividends or distributions by
any Subsidiary of the Company payable to all holders of a class of Equity
Interests of such Subsidiary on a PRO RATA basis); (ii) purchase, redeem or
otherwise acquire or retire for value any Equity Interests of the Company; (iii)
make any principal payment on, or purchase, redeem, defease or otherwise acquire
or retire for value any Indebtedness that is subordinated to the Securities,
except at the original final maturity date thereof or pursuant to the
Refinancing; or (iv) make any Restricted Investment (all such payments and other
actions set forth in clauses (i) through (iv) above being collectively referred
to as "RESTRICTED PAYMENTS"), unless, at the time of and after giving effect
to such Restricted Payment (the amount of any such Restricted Payment, if other
than cash, shall be the fair market value (as conclusively evidenced by a
resolution of the Board of Directors set forth in an Officers' Certificate
delivered to the Trustee within 60 days prior to the date of such Restricted
Payment) of the asset(s) proposed to be transferred by the Company or such
Subsidiary, as the case may be, pursuant to such Restricted Payment):

            (a)   no Default or Event of Default shall have occurred and be
                  continuing or would occur as a consequence thereof; and

            (b)   the Company would, at the time of such Restricted Payment and
                  after giving pro forma effect thereto as if such Restricted
                  Payment had been made at the beginning of the most recently
                  ended four full fiscal quarter period for which internal
                  financial statements are available immediately preceding the
                  date of such Restricted Payment, have been permitted to incur
                  at least $1.00 of additional Indebtedness pursuant to the
                  Fixed Charge Coverage Ratio test set forth in the first
                  paragraph of Section 3.09 hereof; and

            (c)   such Restricted Payment, together with the aggregate of all
                  other Restricted Payments (excluding Restricted Payments
                  permitted by clauses (ii), (iii), (iv) and (v) of the next
                  succeeding paragraph) made by the Company and its Subsidiaries
                  after the date hereof, is less than the sum of (1) 50% of the
                  Consolidated Net Income of the Company for the period (taken
                  as one accounting period) from the beginning of the first
                  fiscal quarter commencing after the date hereof to the end of
                  the Company's most recently ended fiscal quarter for which
                  internal financial statements are available at the time of
                  such Restricted Payment (or, if such Consolidated Net Income
                  for such period is a deficit, less 100% of such deficit),
                  PLUS (2) 100% of the aggregate net cash proceeds received by
                  the Company from the issue or sale (other than to a Subsidiary
                  of the Company) since the date hereof of Qualified Equity
                  Interests of the Company or of debt securities of the Company
                  or any of its Subsidiaries that have been converted into or
                  exchanged for such Qualified Equity Interests of the Company,
                  PLUS (3) $20.0 million.

                                        25
<PAGE>

            If no Default or Event of Default has occurred and is continuing or
would occur as a consequence thereof, the foregoing provisions shall not
prohibit:

            (i)   the payment of any dividend within 60 days after the date of
                  declaration thereof, if at said date of declaration such
                  payment would have complied with the provisions hereof;

            (ii)  the payment of cash dividends on any series of Disqualified
                  Stock issued after the date hereof in an aggregate amount not
                  to exceed the cash received by the Company since the date
                  hereof upon issuance of such Disqualified Stock;

            (iii) the repurchase of the Performance Investment Plan investment
                  options from the holders thereof;

            (iv)  the redemption, repurchase, retirement or other acquisition of
                  any Equity Interests of the Company or any Subsidiary in
                  exchange for, or out of the net cash proceeds of, the
                  substantially concurrent sale (other than to a Subsidiary of
                  the Company) of Qualified Equity Interests of the Company;
                  PROVIDED that the amount of any such net cash proceeds that
                  are utilized for any such redemption, repurchase, retirement
                  or other acquisition shall be excluded from clause (c)(2) of
                  the preceding paragraph;

            (v)   the defeasance, redemption or repurchase of subordinated
                  Indebtedness with the net cash proceeds from an incurrence of
                  Permitted Refinancing Indebtedness or in exchange for or out
                  of the net cash proceeds from the substantially concurrent
                  sale (other than to a Subsidiary of the Company) of Qualified
                  Equity Interests of the Company; PROVIDED that the amount of
                  any such net cash proceeds that are utilized for any such
                  redemption, repurchase, retirement or other acquisition shall
                  be excluded from clause (c)(2) of the preceding paragraph;

            (vi)  the repurchase, redemption or other acquisition or retirement
                  for value of any Equity Interests of the Company or any
                  Subsidiary of the Company held by any member of the Company's
                  (or any of its Subsidiaries') management pursuant to any
                  management equity subscription agreement or stock option
                  agreement; PROVIDED that the aggregate price paid for all
                  such repurchased, redeemed, acquired or retired Equity
                  Interests shall not exceed $5.0 million in any twelve-month
                  period; and

            (vii) the making and consummation of (A) a Senior Subordinated Asset
                  Sale Offer in accordance with the provisions of the Senior
                  Subordinated Note Indenture with any Excess Proceeds that
                  remain after consummation of a Senior Asset Sale Offer, within
                  120 days of the consummation of such Senior Asset Sale Offer,
                  or (B) a Change of Control Offer with respect to the Senior
                  Subordinated Notes in accordance with the provisions of the
                  Senior Subordinated Note Indenture.

                                        26
<PAGE>

            Not later than the date of making any Restricted Payment, the
Company shall deliver to the Trustee an Officers' Certificate stating that such
Restricted Payment is permitted and setting forth the basis upon which the
calculations required by this covenant were computed.

SECTION 3.08.    LIMITATIONS ON DIVIDEND AND OTHER PAYMENT RESTRICTIONS
                  AFFECTING SUBSIDIARIES.

            The Company shall not, and shall not permit any of its Subsidiaries
to, directly or indirectly, create or otherwise cause or suffer to exist or
become effective any consensual Transfer Restriction, except for such Transfer
Restrictions existing under or by reason of:

            (a)   Existing Indebtedness as in effect on the date hereof,

            (b)   this Indenture,

            (c)   applicable law,

            (d)   any instrument governing Indebtedness or Capital Stock of a
                  Person acquired by the Company or any of its Subsidiaries as
                  in effect at the time of such acquisition (except to the
                  extent such Indebtedness was incurred in connection with or in
                  contemplation of such acquisition or in violation of Section
                  3.09 hereof), which encumbrance or restriction is not
                  applicable to any Person, or the properties or assets of any
                  Person, other than the Person, or the property or assets of
                  the Person, so acquired, PROVIDED that the Consolidated Cash
                  Flow of such Person shall not be taken into account in
                  determining whether such acquisition was permitted by the
                  terms hereof except to the extent that such Consolidated Cash
                  Flow would be permitted to be dividends to the Company without
                  the prior consent or approval of any third party,

            (e)   customary non-assignment provisions in leases entered into in
                  the ordinary course of business,

            (f)   purchase money obligations for property acquired in the
                  ordinary course of business that impose restrictions on the
                  ability of any of the Company's Subsidiaries to transfer the
                  property so acquired to the Company or any of its
                  Subsidiaries,

            (g)   Permitted Refinancing Indebtedness, PROVIDED that the
                  restrictions contained in the agreements governing such
                  Permitted Refinancing Indebtedness are no more restrictive
                  than those contained in the agreements governing the
                  Indebtedness being refinanced, or

            (h)   the New Credit Facility and related documentation as the same
                  is in effect on the date hereof and as amended or replaced
                  from time to time, PROVIDED that no such amendment or
                  replacement is more restrictive as to

                                        27
<PAGE>

                  Transfer Restrictions than the New Credit Facility and related
                  documentation as in effect on the date hereof.

SECTION 3.09.    LIMITATIONS ON INCURRENCE OF INDEBTEDNESS AND ISSUANCE OF
                  PREFERRED STOCK

            The Company shall not, and shall not permit any of its Subsidiaries
to, directly or indirectly, create, incur, issue, assume, Guarantee or otherwise
become directly or indirectly liable, contingently or otherwise, with respect to
(collectively, "INCUR") after the date hereof any Indebtedness (including
Acquired Debt), and the Company shall not issue any Disqualified Stock and shall
not permit any of its Subsidiaries to issue any shares of preferred stock;
PROVIDED, HOWEVER, that the Company may incur Indebtedness (including
Acquired Debt) and the Company may issue shares of Disqualified Stock if the
Fixed Charge Coverage Ratio for the Company's most recently ended four full
fiscal quarters for which internal financial statements are available
immediately preceding the date on which such additional Indebtedness is incurred
or such Disqualified Stock is issued would have been at least (x) 2.25 to 1 if
such incurrence or issuance occurs on or before March 31, 1996, or (y) 2.5 to 1
if such incurrence or issuance occurs at any time thereafter, in each case
determined on a pro forma basis (including a pro forma application of the net
proceeds therefrom), as if the additional Indebtedness had been incurred or the
Disqualified Stock had been issued, as the case may be, at the beginning of such
four-quarter period.  Indebtedness consisting of reimbursement obligations in
respect of a letter of credit shall be deemed to be incurred when the letter of
credit is first issued.  The Company shall not permit any of the International
Subsidiaries to incur any Indebtedness other than Non-Recourse Debt.

            The foregoing provisions shall not apply to:

            (a)   the incurrence by the Company of Senior Term Debt pursuant to
                  the New Credit Facility in an aggregate principal amount at
                  any time outstanding not to exceed an amount equal to $1.8
                  billion less the aggregate amount of all repayments, optional
                  or mandatory, of the principal of any Senior Term Debt (other
                  than repayments that are immediately reborrowed) that have
                  been made since the date hereof;

            (b)   the incurrence by the Company of Senior Revolving Debt and
                  letters of credit pursuant to the New Credit Facility in an
                  aggregate principal amount at any time outstanding (with
                  letters of credit being deemed to have a principal amount
                  equal to the maximum potential reimbursement obligation of the
                  Company with respect thereto) not to exceed an amount equal to
                  $500.0 million less the aggregate amount of all Net Proceeds
                  of Asset Sales applied to permanently reduce the commitments
                  with respect to such Indebtedness pursuant to Section 3.10
                  hereof;

            (c)   the incurrence by the Company of Indebtedness represented by
                  the Securities;

            (d)   the incurrence by the Company and its Subsidiaries of the
                  Existing Indebtedness;

                                        28
<PAGE>

            (e)   the incurrence by the Company or any of its Subsidiaries of
                  Permitted Refinancing Indebtedness in exchange for, or the net
                  proceeds of which are used to extend, refinance, renew,
                  replace, defease, or refund, Indebtedness that was permitted
                  by this Indenture to be incurred (including, without
                  limitation, Existing Indebtedness);

            (f)   the incurrence by the Company of Hedging Obligations that are
                  incurred for the purpose of fixing or hedging interest rate or
                  currency risk with respect to any fixed or floating rate
                  Indebtedness that is permitted by the terms hereof to be
                  outstanding or any receivable or liability the payment of
                  which is determined by reference to a foreign currency;
                  PROVIDED that the notional principal amount of any such
                  Hedging Obligation does not exceed the principal amount of the
                  Indebtedness to which such Hedging Obligation relates;

            (g)   the incurrence by the Company or any of its Subsidiaries of
                  Physician Support Obligations;

            (h)   the incurrence by the Company or any of its Subsidiaries of
                  intercompany Indebtedness between or among the Company and any
                  of its Subsidiaries;

            (i)   the incurrence by the Company or any of its Subsidiaries of
                  Indebtedness represented by performance bonds, standby letters
                  of credit or appeal bonds, in each case to the extent incurred
                  in the ordinary course of business of the Company or such
                  Subsidiary;

            (j)   the incurrence by any Subsidiary of the Company of
                  Indebtedness, the aggregate principal amount of which,
                  together with all other Indebtedness of the Company's
                  Subsidiaries at the time outstanding (excluding the Existing
                  Indebtedness until repaid or refinanced and excluding
                  Physician Support Obligations), does not exceed the greater of
                  (1) 10% of the Company's Stockholders' Equity as of the date
                  of incurrence or (2) $10.0 million; PROVIDED that, in the
                  case of clause (1) only, the Fixed Charge Coverage Ratio for
                  the Company's most recently ended four full fiscal quarters
                  for which internal financial statements are available
                  immediately preceding the date on which such Indebtedness is
                  incurred would have been at least (x) 2.25 to 1 if such
                  incurrence occurs on or before March 31, 1996, or (y) 2.5 to 1
                  if such incurrence occurs at any time thereafter, in each case
                  determined on a pro forma basis (including a pro forma
                  application of the net proceeds therefrom), as if such
                  Indebtedness had been incurred at the beginning of such
                  four-quarter period; and

            (k)   the incurrence by the Company of Indebtedness (in addition to
                  Indebtedness permitted by any other clause of this paragraph)
                  in an aggregate principal amount at any time outstanding not
                  to exceed $250.0 million.

                                        29
<PAGE>

SECTION 3.10.    ASSET SALES.

            The Company shall not, and shall not permit any of its Subsidiaries
to consummate an Asset Sale, unless (i) the Company (or the Subsidiary as the
case may be) receives consideration at the time of such Asset Sale at least
equal to the fair market value (as conclusively determined by a resolution of
the Board of Directors set forth in an Officers' Certificate delivered to the
Trustee) of the assets or Equity Interests issued or sold or otherwise disposed
of and (ii) except in the case of a sale of Specified Assets, at least 80% of
the consideration therefor received by the Company or such Subsidiary is in the
form of cash; PROVIDED, HOWEVER, that for purposes of this provision, (x) the
amount of (A) any liabilities (as shown on the Company's or such Subsidiary's
most recent balance sheet or in the notes thereto), of the Company or any
Subsidiary (other than, in the case of an Asset Sale by the Company, liabilities
that are by their terms subordinated to the Securities) that are assumed by the
transferee of any such assets and (B) any securities or other obligations
received by the Company or any such Subsidiary from such transferee that are
immediately converted by the Company or such Subsidiary into cash (or as to
which the Company or such Subsidiary has received at or prior to the
consummation of the Asset Sale a commitment (which may be subject to customary
conditions) from a nationally recognized investment, merchant or commercial bank
to convert into cash within 90 days of the consummation of such Asset Sale and
which are thereafter actually converted into cash within such 90-day period)
shall be deemed to be cash (but shall not be deemed to be Net Proceeds for
purposes of the following provisions until reduced to cash); and (y) the fair
market value of any Non-Cash Consideration received by the Company or a
Subsidiary in any Asset Sale shall be deemed to be cash (but shall not be deemed
to be Net Proceeds for purposes of the following provisions until reduced to
cash) to the extent that the aggregate fair market value (as conclusively
determined by a resolution of the Board of Directors set forth in an Officers'
Certificate delivered to the Trustee) of all Non-Cash Consideration (measured at
the time received and without giving effect to any subsequent changes in value)
held by the Company immediately after consummation of such Asset Sale does not
exceed 10% of the Company's Stockholders' Equity as of the date of such
consummation.

            Within 365 days after the receipt of any Net Proceeds from an Asset
Sale, the Company may apply such Net Proceeds (i) to purchase one or more
Hospitals or Related Businesses and/or a controlling interest in the Capital
Stock of a Person owning one or more Hospitals and/or one or more Related
Businesses, (ii) to make a capital expenditure or to acquire other tangible
assets, in each case, that are used or useful in any business in which the
Company is permitted to be engaged pursuant to Section 3.15 hereof, (iii) to
permanently reduce Senior Term Debt or Existing Indebtedness of a Subsidiary or
(iv) to permanently reduce Senior Revolving Debt (and to correspondingly reduce
commitments with respect thereto), except that up to an aggregate of $200.0
million of Net Proceeds from Asset Sales may be applied after the date hereof to
reduce Senior Revolving Debt without a corresponding reduction in commitments
with respect thereto.  Pending the final application of any such Net Proceeds,
the Company may temporarily reduce Senior Revolving Debt or otherwise invest
such Net Proceeds in any manner that is not prohibited by the terms hereof.  Any
Net Proceeds from Asset Sales that are not so invested or applied shall be
deemed to constitute "Excess Proceeds."  When the aggregate amount of Excess
Proceeds exceeds $25.0 million, the Company shall make an offer to all Holders
of Securities and holders of any other Indebtedness of the Company ranking on a
parity with the Securities from time to time outstanding with similar provisions
requiring the Company

                                        30
<PAGE>

to make an offer to purchase or to redeem such Indebtedness with the proceeds
from any asset sales, PRO RATA in proportion to the respective principal
amounts of the Securities and such other Indebtedness then outstanding (a
"SENIOR ASSET SALE OFFER") to purchase the maximum principal amount of
Securities and such other Indebtedness that may be purchased out of the Excess
Proceeds, at an offer price in cash equal to 100% of the principal amount
thereof plus accrued and unpaid interest thereon, if any, to the date of
purchase (the "PURCHASE PRICE"), in accordance with the procedures set forth
in Section 2.15 hereof.  To the extent that the aggregate amount of Securities
and such other Indebtedness tendered pursuant to a Senior Asset Sale Offer is
less than the Excess Proceeds, the Company may use any remaining Excess Proceeds
for general corporate purposes, including an offer to purchase Senior
Subordinated Notes pursuant to Section 4.10 of the Senior Subordinated Note
Indenture.  If the aggregate principal amount of Securities and such other
Indebtedness surrendered by holders pursuant to a Senior Asset Sale Offer
exceeds the amount of Excess Proceeds, the Securities and such other
Indebtedness shall be purchased on a PRO RATA basis.  Upon completion of a
Senior Asset Sale Offer, the amount of Excess Proceeds shall be reset at zero.

SECTION 3.11.    LIMITATIONS ON TRANSACTIONS WITH AFFILIATES.

            The Company shall not, and shall not permit any of its Subsidiaries
to, sell, lease, transfer or otherwise dispose of any of its properties or
assets to, or purchase any property or assets from, or enter into or make any
contract, agreement, understanding, loan, advance or Guarantee with, or for the
benefit of, any Affiliate (each of the foregoing, an "AFFILIATE TRANSACTION")
unless (i) such Affiliate Transaction is on terms that are no less favorable to
the Company or the relevant Subsidiary than those that could have been obtained
in a comparable transaction by the Company or such Subsidiary with an unrelated
Person and (ii) the Company delivers to the Trustee (a) with respect to any
Affiliate Transaction involving aggregate consideration in excess of $5.0
million, a resolution of the Board of Directors set forth in an Officers'
Certificate certifying that such Affiliate Transaction complies with clause (i)
above and that such Affiliate Transaction was approved by a majority of the
disinterested members of the Board of Directors and (b) with respect to any
Affiliate Transaction involving aggregate consideration in excess of $15.0
million, an opinion as to the fairness of such Affiliate Transaction to the
Company or such Subsidiary from a financial point of view issued by an
investment banking firm of national standing; PROVIDED that (x) transactions
or payments pursuant to any employment arrangements or employee or director
benefit plans entered into by the Company or any of its Subsidiaries in the
ordinary course of business and consistent with the past practice of the Company
or such Subsidiary, (y) transactions between or among the Company and/or its
Subsidiaries and (z) transactions permitted under Section 3.07 hereof, in each
case, shall not be deemed to be Affiliate Transactions.

                                        31
<PAGE>

SECTION 3.12.    LIMITATIONS ON LIENS.

            The Company shall not, and shall not permit any of its Subsidiaries
to, directly or indirectly create, incur, assume or suffer to exist any Lien
(except Permitted Liens) on any asset now owned or hereafter acquired, or any
income or profits therefrom or assign or convey any right to receive income
therefrom unless all payments due hereunder and under the Securities are secured
on an equal and ratable basis with the Obligations so secured until such time as
such Obligations are no longer secured by a Lien.

SECTION 3.13.    CHANGE OF CONTROL.

            Upon the occurrence of a Change of Control Triggering Event, each
Holder of Securities shall have the right to require the Company to repurchase
all or any part (equal to $1,000 or an integral multiple thereof) of such
Holder's Securities pursuant to the offer described below (the "CHANGE OF
CONTROL OFFER") at an offer price in cash equal to 101% of the aggregate
principal amount thereof plus accrued and unpaid interest, if any, thereon to
the date of purchase (the "CHANGE OF CONTROL PAYMENT") on a date that is not
more than 90 days after the occurrence of such Change of Control Triggering
Event (the "CHANGE OF CONTROL PAYMENT DATE").

            Within 30 days following any Change of Control Triggering Event, the
Company shall mail, or at the Company's request the Trustee shall mail, a notice
of a Change of Control to each Holder (at its last registered address with a
copy to the Trustee and the Paying Agent) offering to repurchase the Securities
held by such Holder pursuant to the procedure specified in such notice.  The
Change of Control Offer shall remain open from the time of mailing until the
close of business on the Business Day next preceding the Change of Control
Payment Date.  The notice, which shall govern the terms of the Change of Control
Offer, shall contain all instructions and materials necessary to enable the
Holders to tender Securities pursuant to the Change of Control Offer and shall
state:

            (1)   that the Change of Control Offer is being made pursuant to
                  this Section 3.13 and that all Securities tendered will be
                  accepted for payment;

            (2)   the Change of Control Payment and the Change of Control
                  Payment Date, which date shall be no earlier than 30 days nor
                  later than 60 days from the date such notice is mailed;

            (3)   that any Security not tendered will continue to accrue
                  interest in accordance with the terms of this Indenture;

            (4)   that, unless the Company defaults in the payment of the Change
                  of Control Payment, all Securities accepted for payment
                  pursuant to the Change of Control Offer will cease to accrue
                  interest after the Change of Control Payment Date;

            (5)   that Holders electing to have a Security purchased pursuant to
                  any Change of Control Offer will be required to surrender the
                  Security, with the form

                                        32

<PAGE>

                  entitled "Option of Holder to Elect Purchase" on the reverse
                  of the Security completed, to the Company, a depositary, if
                  appointed by the Company, or a Paying Agent at the address
                  specified in the notice prior to the close of business on the
                  Business Day next preceding the Change of Control Payment
                  Date;

            (6)   that Holders will be entitled to withdraw their election if
                  the Company, depositary or Paying Agent, as the case may be,
                  receives, not later than the close of business on the Business
                  Day next preceding the Change of Control Payment Date, a
                  facsimile transmission or letter setting forth the name of the
                  Holder, the principal amount of the Security the Holder
                  delivered for purchase, and a statement that such Holder is
                  withdrawing his election to have such Security purchased;

            (7)   that Holders whose Securities are being purchased only in part
                  will be issued new Securities equal in principal amount to the
                  unpurchased portion of the Securities surrendered, which
                  unpurchased portion must be equal to $1,000 in principal
                  amount or an integral multiple thereof; and

            (8)   the circumstances and relevant facts regarding such Change of
                  Control (including, but not limited to, information with
                  respect to PRO FORMA historical financial information after
                  giving effect to such Change of Control, information regarding
                  the Person or Persons acquiring control and such Person's or
                  Persons' business plans going forward) and any other
                  information that would be material to a decision as to whether
                  to tender a Security pursuant to the Change of Control Offer.

            On the Change of Control Payment Date, the Company shall, to the
extent lawful, (i) accept for payment all Securities or portions thereof
properly tendered and not withdrawn pursuant to the Change of Control Offer,
(ii) deposit with the Paying Agent an amount equal to the Change of Control
Payment in respect of all Securities or portions thereof so tendered and (iii)
deliver or cause to be delivered to the Trustee the Securities so accepted
together with an Officers' Certificate stating the aggregate principal amount of
Securities or portions thereof being purchased by the Company.  The Paying Agent
shall promptly mail to each Holder of Securities so tendered the Change of
Control Payment for such Securities, and the Trustee shall promptly authenticate
and mail (or cause to be transferred by book entry) to each Holder a new
Security equal in principal amount to any unpurchased portion of the Securities
surrendered, if any; PROVIDED that each such new Security shall be in a
principal amount of $1,000 or an integral multiple thereof.  The Company shall
publicly announce the results of the Change of Control Offer on or as soon as
practicable after the Change of Control Payment Date.

            The Company shall comply with the requirements of Rule 14e-1 under
the Exchange Act and any other securities laws and regulations thereunder to the
extent such laws and regulations are applicable in connection with the
repurchase of Securities as a result of a Change of Control.

                                        33

<PAGE>

SECTION 3.14.    CORPORATE EXISTENCE.

            Subject to Section 3.13 and Article 4 hereof, the Company shall do
or cause to be done all things necessary to preserve and keep in full force and
effect (i) its corporate existence, and the corporate, partnership or other
existence of each of its Subsidiaries, in accordance with the respective
organizational documents (as the same may be amended from time to time) of each
Subsidiary and (ii) the rights (charter and statutory), licenses and franchises
of the Company and its Subsidiaries; PROVIDED, HOWEVER, that the Company
shall not be required to preserve any such right, license or franchise, or the
corporate, partnership or other existence of any of its Subsidiaries, if the
Board of Directors shall determine that the preservation thereof is no longer
desirable in the conduct of the business of the Company and its Subsidiaries,
taken as a whole, and that the loss thereof is not adverse in any material
respect to the Holders.

SECTION 3.15.    LINE OF BUSINESS

            The Company shall not, and shall not permit any of its Subsidiaries
to, engage to any material extent in any business other than the ownership,
operation and management of Hospitals and Related Businesses.

SECTION 3.16.    LIMITATIONS ON ISSUANCES OF GUARANTEES OF INDEBTEDNESS BY
                  Subsidiaries

            The Company shall not permit any Subsidiary, directly or indirectly,
to Guarantee or secure the payment of any other Indebtedness of the Company or
any of its Subsidiaries (except Indebtedness of a Subsidiary of such Subsidiary
or Physician Support Obligations) unless such Subsidiary simultaneously executes
and delivers a supplemental indenture to this Indenture, in substantially the
form attached hereto as Exhibit B, providing for the Guarantee of the payment of
the Securities by such Subsidiary, which Guarantee shall be senior to or PARI
PASSU with such Subsidiary's Guarantee of or pledge to secure such other
Indebtedness.  Any such Guarantee by a Subsidiary of the Securities shall
provide by its terms that it shall be automatically and unconditionally released
and discharged upon the sale or other disposition, by way of merger or
otherwise, to any Person not an Affiliate of the Company, of all of the
Company's stock in, or all or substantially all the assets of, such Subsidiary,
which sale or other disposition is made in compliance with, and the Net Proceeds
therefrom are applied in accordance with, the applicable provisions hereof.  The
foregoing provisions shall not be applicable to any one or more Guarantees of up
to $10.0 million in aggregate principal amount of Indebtedness of the Company at
any time outstanding.

SECTION 3.17.    NO AMENDMENT TO SUBORDINATION PROVISIONS OF SENIOR
                  Subordinated Note Indenture

            The Company shall not amend, modify or alter the Senior Subordinated
Note Indenture in any way that would (i) increase the principal of, advance the
final maturity date of or shorten the Weighted Average Life to Maturity of any
Senior Subordinated Notes such that the final maturity date of the Senior
Subordinated Notes is earlier than the 91st day following the final maturity
date of the Securities or (ii) amend the provisions of Article 10 of the Senior

                                        33
<PAGE>

Subordinated Indenture (which relates to subordination) or any of the defined
terms used therein in a manner that would be adverse to the Holders of the
Securities.

                                   ARTICLE 4
                                  SUCCESSORS

SECTION 4.01.    LIMITATIONS ON MERGERS, CONSOLIDATIONS OR SALES OF ASSETS

            The Company may not consolidate or merge with or into (whether or
not the Company is the surviving corporation), or sell, assign, transfer, lease,
convey or otherwise dispose of all or substantially all of its properties or
assets in one or more related transactions, to another corporation, Person or
entity unless:

            (i)   the Company is the surviving corporation or the entity or the
                  Person formed by or surviving any such consolidation or merger
                  (if other than the Company) or to which such sale, assignment,
                  transfer, lease, conveyance or other disposition shall have
                  been made is a corporation organized or existing under the
                  laws of the United States, any state thereof or the District
                  of Columbia;

            (ii)  the entity or Person formed by or surviving any such
                  consolidation or merger (if other than the Company) or the
                  entity or Person to which such sale, assignment, transfer,
                  lease, conveyance or other disposition shall have been made
                  assumes all the Obligations of the Company under this
                  Indenture and the Securities pursuant to a supplemental
                  indenture in a form reasonably satisfactory to the Trustee;

            (iii) immediately after such transaction no Default or Event of
                  Default exists; and

            (iv)  the Company or the entity or Person formed by or surviving any
                  such consolidation or merger (if other than the Company), or
                  to which such sale, assignment, transfer, lease, conveyance or
                  other disposition shall have been made (A) shall have
                  Consolidated Net Worth immediately after the transaction equal
                  to or greater than the Consolidated Net Worth of the Company
                  immediately preceding the transaction and (B) shall, at the
                  time of such transaction and after giving pro forma effect
                  thereto as if such transaction had occurred at the beginning
                  of the applicable four-quarter period, be permitted to incur
                  at least $1.00 of additional Indebtedness pursuant to the
                  Fixed Charge Coverage Ratio test set forth in the first
                  paragraph of Section 3.09 hereof.

            The Company shall deliver to the Trustee prior to the consummation
of the proposed transaction an Officers' Certificate to the foregoing effect and
an Opinion of Counsel, covering clauses (i) through (iv) above, stating that the
proposed transaction and such

                                       35
<PAGE>

supplemental indenture comply with this Indenture.  The Trustee shall be
entitled to conclusively rely upon such Officers' Certificate and Opinion of
Counsel.

            SECTION 4.02.    SUCCESSOR CORPORATION SUBSTITUTED.

            Upon any consolidation or merger, or any sale, assignment, transfer,
lease, conveyance or other disposition of all or substantially all of the assets
of the Company in accordance with Section 4.01 hereof, the successor corporation
formed by such consolidation or into or with which the Company is merged or to
which such sale, assignment, transfer, lease, conveyance or other disposition is
made shall succeed to, and be substituted for (so that from and after the date
of such consolidation, merger, sale, assignment, transfer, lease, conveyance or
other disposition, the provisions of this Indenture referring to the "Company"
shall refer instead to the successor corporation), and may exercise every right
and power of, the Company under this Indenture with the same effect as if such
successor Person has been named as the Company, herein.

                                   ARTICLE 5
                             DEFAULTS AND REMEDIES

SECTION 5.01.    EVENTS OF DEFAULT.

            Each of the following constitutes an "EVENT OF DEFAULT":

                  (i)   default for 30 days in the payment when due of interest
                        on the Securities;

                  (ii)  default in payment when due of the principal of or
                        premium, if any, on the Securities at maturity or
                        otherwise;

                  (iii) failure by the Company to comply with the provisions of
                        Sections 3.07, 3.09, 3.10, or 3.13 hereof;

                  (iv)  failure by the Company to comply with any other covenant
                        or agreement in the Indenture or the Securities for the
                        period and after the notice specified below;

                  (v)   any default that occurs under any mortgage, indenture or
                        instrument under which there may be issued or by which
                        there may be secured or evidenced any Indebtedness for
                        money borrowed by the Company or any of its Significant
                        Subsidiaries (or the payment of which is Guaranteed by
                        the Company or any of its Significant Subsidiaries),
                        whether such Indebtedness or Guarantee exists on the
                        date hereof or is created after the date hereof, which
                        default (a) constitutes a Payment Default or (b) results
                        in the acceleration of such Indebtedness prior to its
                        express maturity and, in each case, the principal amount
                        of any such Indebtedness,

                                        36

<PAGE>

                        together with the principal amount of any other such
                        Indebtedness under which there has been a Payment
                        Default or that has been so accelerated, aggregates
                        $25.0 million or more;

                  (vi)  failure by the Company or any of its Significant
                        Subsidiaries to pay a final judgment or final judgments
                        aggregating in excess of $25.0 million entered by a
                        court or courts of competent jurisdiction against the
                        Company or any of its Significant Subsidiaries if such
                        final judgment or judgments remain unpaid or
                        undischarged for a period (during which execution shall
                        not be effectively stayed) of 60 days after their entry;

                  (vii) the Company or any Significant Subsidiary thereof
                        pursuant to or within the meaning of any Bankruptcy Law:

                     (a)      commences a voluntary case,

                     (b)      consents to the entry of an order for relief
                              against it in an involuntary case in which it is
                              the debtor,

                     (c)      consents to the appointment of a Custodian of it
                              or for all or substantially all of its property,

                     (d)      makes a general assignment for the benefit of its
                              creditors, or

                     (e)      admits in writing its inability generally to pay
                              its debts as the same become due; and

                 (viii) a court of competent jurisdiction enters an order or
                        decree under any Bankruptcy Law that:

                     (a)      is for relief against the Company or any
                              Significant Subsidiary thereof in an involuntary
                              case in which it is the debtor,

                     (b)      appoints a Custodian of the Company or any
                              Significant Subsidiary thereof or for all or
                              substantially all of the property of the Company
                              or any Significant Subsidiary thereof, or

                     (c)      orders the liquidation of the Company or any
                              Significant Subsidiary thereof,

                  and the order or decree remains unstayed and in effect for 60
            days.

                                        37

<PAGE>

            The term "BANKRUPTCY LAW" means title 11, U.S. Code or any similar
federal or state law for the relief of debtors.  The term "CUSTODIAN" means
any receiver, trustee, assignee, liquidator or similar official under any
Bankruptcy Law.

            A Default under clause (iv) is not an Event of Default until the
Trustee notifies the Company in writing, or the Holders of at least 25% in
principal amount of the then outstanding Securities notify the Company and the
Trustee in writing, of the Default and the Company does not cure the Default
within 60 days after receipt of such notice.  The written notice must specify
the Default, demand that it be remedied and state that the notice is a "NOTICE
OF DEFAULT."

SECTION 5.02.    ACCELERATION.

            If any Event of Default (other than an Event of Default specified in
clause (vii) or (viii) of Section 5.01 hereof) occurs and is continuing, the
Trustee by notice to the Company, or the Holders of at least 25% in aggregate
principal amount of the then outstanding Securities by written notice to the
Company and the Trustee, may declare the unpaid principal of, premium, if any,
and any accrued and unpaid interest on all the Securities to be due and payable
immediately.  Upon such declaration the principal, premium, if any, and interest
shall be due and payable immediately.  If an Event of Default specified in
clause (vii) or (viii) of Section 5.01 hereof occurs with respect to the Company
or any Significant Subsidiary thereof such an amount shall IPSO FACTO become
and be immediately due and payable without further action or notice on the part
of the Trustee or any Holder.

            If an Event of Default occurs under this Indenture prior to the
maturity of the Securities by reason of any willful action (or inaction) taken
(or not taken) by or on behalf of the Company with the intention of avoiding the
prohibition on redemption of such Securities prior to the date of maturity, then
a premium with respect thereto (expressed as a percentage of the amount that
would otherwise be due but for the provisions of this sentence) shall become and
be immediately due and payable to the extent permitted by law upon the
acceleration of such Securities if such Event of Default occurs during the
twelve-month period beginning on March 1 of the years set forth below:

                  YEAR                           PERCENTAGE
                  ----                           ----------

                  1995..............................  109.625%
                  1996..............................  108.342%
                  1997..............................  107.058%
                  1998..............................  105.775%
                  1999..............................  104.492%
                  2000..............................  103.208%
                  2001..............................  101.925%
                  2002..............................  100.642%

            Any determination regarding the primary purpose of any such action
or inaction, as the case may be, shall be made by and set forth in a resolution
of the Board of Directors (including the concurrence of a majority of the
independent directors of the Company then

                                        38

<PAGE>

serving) delivered to the Trustee after consideration of the business reasons
for such action or inaction, other than the avoidance of payment of such premium
or prohibition on redemption.  In the absence of fraud, each such determination
shall be final and binding upon the Holders of Securities.  Subject to Section
6.01 hereof, the Trustee shall be entitled to rely on the determination set
forth in any such resolutions delivered to the Trustee.

SECTION 5.03.    OTHER REMEDIES.

            If an Event of Default occurs and is continuing, the Trustee may
pursue any available remedy to collect the payment of principal or interest on
the Securities or to enforce the performance of any provision of the Securities
or this Indenture.

            The Trustee may maintain a proceeding even if it does not possess
any of the Securities or does not produce any of them in the proceeding.  A
delay or omission by the Trustee or any Holder in exercising any right or remedy
accruing upon an Event of Default shall not impair the right or remedy or
constitute a waiver of or acquiescence in the Event of Default.  All remedies
are cumulative to the extent permitted by law.

SECTION 5.04.    WAIVER OF PAST DEFAULTS.

            The Holders of not less than a majority in aggregate principal
amount of the Securities then outstanding by written notice to the Trustee may
on behalf of the Holders of all of the Securities waive any existing Default or
Event of Default and its consequences under this Indenture except a continuing
Default or Event of Default in the payment of the principal of, premium, if any,
or interest on any Security.  Upon any such waiver, such Default shall cease to
exist, and any Event of Default arising therefrom shall be deemed to have been
cured for every purpose of this Indenture; but no such waiver shall extend to
any subsequent or other Default or impair any right consequent thereon.

SECTION 5.05.    CONTROL BY MAJORITY.

            Holders of a majority in principal amount of the then outstanding
Securities may direct the time, method and place of conducting any proceeding
for any remedy available to the Trustee or exercising any trust or power
conferred on it.  However, the Trustee may refuse to follow any direction that
conflicts with law or this Indenture that the Trustee determines may be unduly
prejudicial to the rights of other Holders or that may involve the Trustee in
personal liability.  The Trustee may take any other action which it deems proper
which is not inconsistent with any such direction.

SECTION 5.06.    LIMITATION ON SUITS.

            A Holder may pursue a remedy with respect to this Indenture or the
Securities only if:

            (i)   the Holder gives to the Trustee written notice of a continuing
                  Event of Default;

                                        39

<PAGE>

            (ii)  the Holders of at least 25% in principal amount of the then
                  outstanding Securities make a written request to the Trustee
                  to pursue the remedy;

            (iii) such Holder or Holders offer and, if requested, provide to the
                  Trustee indemnity satisfactory to the Trustee against any
                  loss, liability or expense;

            (iv)  the Trustee does not comply with the request within 60 days
                  after receipt of the request and the offer and, if requested,
                  the provision of indemnity; and

            (v)   during such 60-day period the Holders of a majority in
                  principal amount of the then outstanding Securities do not
                  give the Trustee a direction inconsistent with the request.

A Holder may not use this Indenture to prejudice the rights of another Holder or
to obtain a preference or priority over another Holder.

SECTION 5.07.    RIGHTS OF HOLDERS TO RECEIVE PAYMENT.

            Notwithstanding any other provision of this Indenture, the right of
any Holder to receive payment of principal, premium, if any, and interest on the
Security, on or after the respective due dates expressed in the Security, or to
bring suit for the enforcement of any such payment on or after such respective
dates, shall not be impaired or affected without the consent of the Holder.

SECTION 5.08.    COLLECTION SUIT BY TRUSTEE.

            If an Event of Default specified in Section 5.01(i) or (ii) hereof
occurs and is continuing, the Trustee is authorized to recover judgment in its
own name and as trustee of an express trust against the Company or any other
obligor for the whole amount of principal, premium, if any, and interest
remaining unpaid on the Securities and interest on overdue principal and, to the
extent lawful, interest and such further amount as shall be sufficient to cover
amounts due the Trustee under Section 6.07 hereof, including the costs and
expenses of collection, including the reasonable compensation, expenses,
disbursements and advances of the Trustee, its agents and counsel.

SECTION 5.09.    TRUSTEE MAY FILE PROOFS OF CLAIM.

            The Trustee is authorized to file such proofs of claim and other
papers or documents as may be necessary or advisable in order to have the claims
of the Trustee (including any claim for the reasonable compensation, expenses,
disbursements and advances of the Trustee, its agents and counsel) and the
Holders allowed in any judicial proceedings relative to the Company (or any
other obligor upon the Securities), its creditors or its property and shall be
entitled and empowered to collect, receive and distribute any money or other
property payable or deliverable on any such claims and any custodian in any such
judicial proceeding is hereby authorized by each Holder to make such payments to
the Trustee, and in the event that the Trustee shall consent to the making of
such payments directly to the Holders, to pay to the

                                        40

<PAGE>

Trustee any amount due to it for the reasonable compensation, expenses,
disbursements and advances of the Trustee, its agents and counsel, and any other
amounts due the Trustee under Section 6.07 hereof.  To the extent that the
payment of any such compensation, expenses, disbursements and advances of the
Trustee, its agents and counsel, and any other amounts due the Trustee under
Section 6.07 hereof out of the estate in any such proceeding, shall be denied
for any reason, payment of the same shall be secured by a Lien on, and shall be
paid out of, any and all distributions, dividends, money, securities and other
properties which the Holders may be entitled to receive in such proceeding
whether in liquidation or under any plan of reorganization or arrangement or
otherwise.  Nothing herein contained shall be deemed to authorize the Trustee to
authorize or consent to or accept or adopt on behalf of any Holder any plan of
reorganization, arrangement, adjustment or composition affecting the Securities
or the rights of any Holder thereof, or to authorize the Trustee to vote in
respect of the claim of any Holder in any such proceeding.

SECTION 5.10.    PRIORITIES.

            If the Trustee collects any money pursuant to this Article, it shall
pay out the money in the following order:

            First:  to the Trustee, its agents and attorneys for amounts due
under Section 6.07, including payment of all compensation, expense and
liabilities incurred, and all advances made, by the Trustee and the costs and
expenses of collection;

            Second:  to Holders for amounts due and unpaid on the Securities for
principal, premium, if any, and interest, ratably, without preference or
priority of any kind, according to the amounts due and payable on the Securities
for principal, premium, if any and interest, respectively; and

            Third:  to the Company or to such party as a court of competent
jurisdiction shall direct.

            The Trustee may fix a record date and payment date for any payment
to Holders pursuant to this Section 5.10 upon five Business Days prior notice to
the Company.

SECTION 5.11.    UNDERTAKING FOR COSTS.

            In any suit for the enforcement of any right or remedy under this
Indenture or in any suit against the Trustee for any action taken or omitted by
it as a Trustee, a court in its discretion may require the filing by any party
litigant in the suit of an undertaking to pay the costs of the suit, and the
court in its discretion may assess reasonable costs, including reasonable
attorneys' fees and expenses, against any party litigant in the suit, having due
regard to the merits and good faith of the claims or defenses made by the party
litigant.  This Section does not apply to a suit by the Trustee, a suit by a
Holder pursuant to Section 5.07 hereof, or a suit by Holders of more than 10% in
principal amount of the then outstanding Securities.

                                        41

<PAGE>

                                   ARTICLE 6
                                    TRUSTEE

SECTION 6.01.    DUTIES OF TRUSTEE.

            (i)   If an Event of Default has occurred and is continuing, the
Trustee shall exercise such of the rights and powers vested in it by this
Indenture, and use the same degree of care and skill in their exercise, as a
prudent man would exercise or use under the circumstances in the conduct of his
own affairs.

            (ii)  Except during the continuance of an Event of Default known to
the Trustee:

            (a)   the duties of the Trustee shall be determined solely by the
                  express provisions of this Indenture or the TIA and the
                  Trustee need perform only those duties that are specifically
                  set forth in this Indenture or the TIA and no others, and no
                  implied covenants or obligations shall be read into this
                  Indenture against the Trustee, and

            (b)   in the absence of bad faith on its part, the Trustee may
                  conclusively rely, as to the truth of the statements and the
                  correctness of the opinions expressed therein, upon
                  certificates or opinions furnished to the Trustee and
                  conforming to the requirements of this Indenture.  However, in
                  the case of any such certificates or opinions which by any
                  provisions hereof are required to be furnished to the Trustee,
                  the Trustee shall examine the certificates and opinions to
                  determine whether or not they conform to the requirements of
                  this Indenture.

            (iii) The Trustee may not be relieved from liabilities for its own
                  negligent action, its own negligent failure to act, or its own
                  willful misconduct,
except that:

                  (a)   this paragraph does not limit the effect of paragraph
                        (ii) of this Section;

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

                  (c)   the Trustee shall not be liable with respect to any
                        action it takes or omits to take in good faith in
                        accordance with a direction received by it pursuant to
                        Section 5.05 hereof.

            (iv)  Whether or not therein expressly so provided every provision
of this Indenture that in any way relates to the Trustee is subject to
paragraphs (i), (ii), and (iii) of this Section.

                                        42

<PAGE>

            (v)   No provision of this Indenture shall require the Trustee to
expend or risk its own funds or incur any liability.  The Trustee may refuse to
perform any duty or exercise any right or power unless it receives security and
indemnity satisfactory to it against any loss, liability or expense.

            (vi)  The Trustee shall not be liable for interest on any money
received by it except as the Trustee may agree in writing with the Company.
Absent written instruction from the Company, the Trustee shall not be required
to invest any such money.  Money held in trust by the Trustee need not be
segregated from other funds except to the extent required by law.

            (vii) The Trustee shall not be deemed to have knowledge of any
matter unless such matter is actually known to a Responsible Officer.

SECTION 6.02.    RIGHTS OF TRUSTEE.

            (i)   The Trustee may conclusively rely upon any document believed
by it to be genuine and to have been signed or presented by the proper Person.
The Trustee need not investigate any fact or matter stated in the document.

            (ii)  Before the Trustee acts or refrains from acting, it may
require an Officers' Certificate or an Opinion of Counsel or both.  The Trustee
shall not be liable for any action it takes or omits to take in good faith in
reliance on such Officers' Certificate or Opinion of Counsel.  The Trustee may
consult with counsel and the written advice of such counsel or any Opinion of
Counsel shall be full and complete authorization and protection from liability
in respect of any action taken, suffered or omitted by it hereunder in good
faith and in reliance thereon.

            (iii) The Trustee may act through its attorneys and agents and shall
not be responsible for the misconduct or negligence of any agent appointed with
due care.

            (iv)  The Trustee shall not be liable for any action it takes or
omits to take in good faith which it believes to be authorized or within its
rights or powers conferred upon it by this Indenture.  A permissive right
granted to the Trustee hereunder shall not be deemed an obligation to act.

            (v)   Unless otherwise specifically provided in this Indenture, any
demand, request, direction or notice from the Company shall be sufficient if
signed by an Officer of the Company.

SECTION 6.03.    INDIVIDUAL RIGHTS OF TRUSTEE.

            The Trustee in its individual or any other capacity may become the
owner or pledgee of Securities and may otherwise deal with the Company or any
Affiliate of the Company with the same rights it would have if it were not
Trustee.  Any Agent may do the same with like rights.  However, the Trustee is
subject to Sections 6.10 and 6.11 hereof.

                                        43

<PAGE>

SECTION 6.04.    TRUSTEE'S DISCLAIMER.

            The Trustee shall not be responsible for and makes no representation
as to the validity or adequacy of this Indenture or the Securities, nor shall it
be accountable for the Company's use of the proceeds from the Securities or any
money paid to the Company or upon the Company's direction under any provision of
this Indenture, nor shall it be responsible for the use or application of any
money received by any Paying Agent other than the Trustee, nor shall it be
responsible for any statement or recital herein or any statement in the
Securities or any other document in connection with the sale of the Securities
or pursuant to this Indenture other than its certificate of authentication.

SECTION 6.05.    NOTICE OF DEFAULTS.

            If a Default or Event of Default occurs and is continuing and if it
is known to the Trustee, the Trustee shall mail to Holders a notice of the
Default or Event of Default within 90 days after it occurs.  Except in the case
of a Default or Event of Default in payment on any Security, the Trustee may
withhold the notice if and so long as a committee of its Responsible Officers in
good faith determines that withholding the notice is in the interests of the
Holders.

SECTION 6.06.    REPORTS BY TRUSTEE TO HOLDERS.

            Within 60 days after each December 31 beginning with the December 31
following the date hereof, the Trustee shall mail to the Holders a brief report
Company may not be subject to the dated as of such reporting date that complies
with TIA Section 313(a) (but if no event described in TIA Section 313(a) has
reporting date, no report need be transmitted).  The Trustee also shall comply
with TIA Section 313(b).  The Trustee shall also transmit by mail all reports as
required by TIA Section 313(c).

            A copy of each report at the time of its mailing to the Holders
shall be mailed to the Company and filed with the Commission and each stock
exchange on which the Securities are listed.  The Company shall promptly notify
the Trustee when the Securities are listed on any stock exchange.

SECTION 6.07.    COMPENSATION AND INDEMNITY.

            The Company shall pay to the Trustee from time to time such
compensation for its acceptance of this Indenture and services hereunder as the
Company and Trustee shall agree in writing.  The Trustee's compensation shall
not be limited by any law on compensation of a trustee of an express trust.  The
Company shall reimburse the Trustee promptly upon request for all reasonable
disbursements, advances and expenses incurred or made by it in addition to the
compensation for its services.  Such expenses shall include the reasonable
compensation, disbursements and expenses of the Trustee's agents and counsel.

            The Company shall indemnify the Trustee against any and all losses,
liabilities, damages, claims or expenses incurred by it arising out of or in
connection with the acceptance of its duties and the administration of the
trusts under this Indenture, except as set forth below.  The Trustee shall
notify the Company promptly of any claim for which it may seek indemnity.

                                        44

<PAGE>

Failure by the Trustee to so notify the Company shall not relieve the Company of
its obligations hereunder.  The Company shall defend the claim and the Trustee
shall cooperate in the defense.  The Trustee may have separate counsel and the
Company shall pay the reasonable fees and expenses of such counsel.  The Company
need not pay for any settlement made without its consent, which consent shall
not be unreasonably withheld.

            The obligations of the Company under this Section 6.07 shall survive
the satisfaction and discharge of this Indenture.

            The Company need not reimburse any expense or indemnify against any
loss or liability incurred by the Trustee through its own negligence or bad
faith.

            To secure the Company's payment obligations in this Section, the
Trustee shall have a Lien prior to the Securities on all money or property held
or collected by the Trustee, except that held in trust to pay principal and
interest on particular Securities.  Such Lien shall survive the satisfaction and
discharge of this Indenture.

            When the Trustee incurs expenses or renders services after an Event
of Default specified in Section 5.01(vii) or (viii) hereof occurs, the expenses
and the compensation for the services (including the fees and expenses of its
agents and counsel) are intended to constitute expenses of administration under
any Bankruptcy Law.

SECTION 6.08.    REPLACEMENT OF TRUSTEE.

            A resignation or removal of the Trustee and appointment of a
successor Trustee shall become effective only upon the successor Trustee's
acceptance of appointment as provided in this Section.

            The Trustee may resign in writing at any time and be discharged from
the trust hereby created by so notifying the Company.  The Holders of a majority
in principal amount of the then outstanding Securities may remove the Trustee by
so notifying the Trustee and the Company in writing.  The Company may remove the
Trustee if:

            (1)   the Trustee fails to comply with Section 6.10 hereof;

            (2)   the Trustee is adjudged a bankrupt or an insolvent or an order
      for relief is entered with respect to the Trustee under any Bankruptcy
      Law;

            (3)   a Custodian or public officer takes charge of the Trustee or
      its property; or

            (4)   the Trustee becomes incapable of acting.

            If the Trustee resigns or is removed or if a vacancy exists in the
office of Trustee for any reason, the Company shall promptly appoint a successor
Trustee.  Within one year after the successor Trustee takes office, the Holders
of a majority in principal amount of the then

                                        45

<PAGE>

outstanding Securities may appoint a successor Trustee to replace the successor
Trustee appointed by the Company.

            If a successor Trustee does not take office within 60 days after the
retiring Trustee resigns or is removed, the retiring Trustee, the Company, or
the Holders of at least 10% in principal amount of the then outstanding
Securities may petition any court of competent jurisdiction for the appointment
of a successor Trustee.

            If the Trustee after written request by any Holder who has been a
Holder for at least six months fails to comply with Section 6.10 hereof, such
Holder may petition any court of competent jurisdiction for the removal of the
Trustee and the appointment of a successor Trustee.

            A successor Trustee shall deliver a written acceptance of its
appointment to the retiring Trustee and to the Company.  Thereupon, the
resignation or removal of the retiring Trustee shall become effective, and the
successor Trustee shall have all the rights, powers and duties of the Trustee
under this Indenture.  The successor Trustee shall mail a notice of its
succession to Holders.  The retiring Trustee shall promptly transfer all
property held by it as Trustee to the successor Trustee, provided all sums owing
to the Trustee hereunder have been paid and subject to the Lien provided for in
Section 6.07 hereof.  Notwithstanding replacement of the Trustee pursuant to
this Section 6.08, the Company's obligations under Section 6.07 hereof shall
continue for the benefit of the retiring Trustee.

SECTION 6.09.    SUCCESSOR TRUSTEE OR AGENT BY MERGER, ETC.

            If the Trustee or any Agent consolidates, merges or converts into,
or transfers all or substantially all of its corporate trust business to,
another corporation, the successor corporation without any further act shall be
the successor Trustee or Agent.

SECTION 6.10.    ELIGIBILITY; DISQUALIFICATION.

            There shall at all times be a Trustee hereunder which shall be a
corporation organized and doing business under the laws of the United States of
America or of any state thereof authorized under such laws to exercise corporate
trustee power, shall be subject to supervision or examination by federal or
state authority and shall have a combined capital and surplus of at least $100.0
million as set forth in its most recent published annual report of condition.

            This Indenture shall always have a Trustee who satisfies the
occurred within the twelve months preceding the requirements of TIA Section
310(b).

SECTION 6.11.    PREFERENTIAL COLLECTION OF CLAIMS AGAINST COMPANY.

            The Trustee is subject to TIA Section 311(a), excluding any creditor
310(a)(1), (2) and (5).  The Trustee is subject to TIA Section  relationship
shall be subject to TIA Section 311(a) to the extent indicated therein.

                                        46

<PAGE>

                                  ARTICLE 7
                            DISCHARGE OF INDENTURE

SECTION 7.01.    DEFEASANCE AND DISCHARGE OF THIS INDENTURE AND THE
                  Securities.

            The Company may, at the option of its Board of Directors evidenced
by a resolution set forth in an Officers' Certificate, at any time, with respect
to the Securities, elect to have either Section 7.02 or 7.03 hereof be applied
to all outstanding Securities upon compliance with the conditions set forth
below in this Article 7.

SECTION 7.02.    LEGAL DEFEASANCE AND DISCHARGE.

            Upon the Company's exercise under Section 7.01 hereof of the option
applicable to this Section 7.02, the Company shall be deemed to have been
discharged from its obligations with respect to all outstanding Securities on
the date the conditions set forth below are satisfied (hereinafter, "LEGAL
DEFEASANCE").  For this purpose, such Legal Defeasance means that the Company
shall be deemed to have paid and discharged the entire Indebtedness represented
by the outstanding Securities, which shall thereafter be deemed to be
"outstanding" only for the purposes of Section 7.05 hereof and the other
Sections of this Indenture referred to in clauses (i) and (ii) of this Section
7.02, and to have satisfied all its other obligations under such Securities and
this Indenture (and the Trustee, on demand of and at the expense of the Company,
shall execute proper instruments acknowledging the same), except for the
following provisions which shall survive until otherwise terminated or
discharged hereunder:  (i) the rights of Holders of outstanding Securities to
receive solely from the trust fund described in Section 7.04 hereof, and as more
fully set forth in such Section, payments in respect of the principal of,
premium, if any, and interest on such Securities when such payments are due,
(ii) the Company's obligations with respect to such Securities under Sections
2.04, 2.06, 2.07, 2.10 and 3.02 hereof, (iii) the rights, powers, trusts, duties
and immunities of the Trustee hereunder, including, without limitation, the
Trustee's rights under Section 6.07 hereof, and the Company's obligations in
connection therewith and (iv) this Article 7.  Subject to compliance with this
Article 7, the Company may exercise its option under this Section 7.02
notwithstanding the prior exercise of its option under Section 7.03 hereof with
respect to the Securities.

SECTION 7.03.    COVENANT DEFEASANCE.

            Upon the Company's exercise under Section 7.01 hereof of the option
applicable to this Section 7.03, the Company shall be released from its
obligations under the covenants contained in Sections 2.15, 3.07, 3.08, 3.09,
3.10, 3.11, 3.12, 3.13, 3.15, 3.16 and 3.17 and Article 4 hereof with respect to
the outstanding Securities on and after the date the conditions set forth below
are satisfied (hereinafter, "COVENANT DEFEASANCE"), and the Securities shall
thereafter be deemed not "outstanding" for the purposes of any direction,
waiver, consent or declaration or act of Holders (and the consequences of any
thereof) in connection with such covenants, but shall continue to be deemed
"outstanding" for all other purposes hereunder (it being understood that such
Securities shall not be deemed outstanding for accounting purposes).  For this
purpose, such Covenant Defeasance means that, with respect to the outstanding
Securities, the Company may omit to comply with and shall have no liability in
respect of any term, condition or limitation set forth in any such covenant,
whether directly or indirectly, by

                                        47

<PAGE>

reason of any reference elsewhere herein to any such covenant or by reason of
any reference in any such covenant to any other provision herein or in any other
document and such omission to comply shall not constitute a Default or an Event
of Default under Section 5.01(iii) hereof, but, except as specified above, the
remainder of this Indenture and such Securities shall be unaffected thereby.  In
addition, upon the Company's exercise under Section 7.01 hereof of the option
applicable to this Section 7.03, Sections 5.01(iv) through 5.01(vi) hereof shall
not constitute Events of Default.

SECTION 7.04.    CONDITIONS TO LEGAL OR COVENANT DEFEASANCE.

            The following shall be the conditions to application of either
Section 7.02 or Section 7.03 hereof to the outstanding Securities:

            (i)   The Company shall irrevocably have deposited or caused to be
      deposited with the Trustee (or another trustee satisfying the requirements
      of Section 6.10 who shall agree to comply with the provisions of this
      Article 7 applicable to it) as trust funds in trust for the purpose of
      making the following payments, specifically pledged as security for, and
      dedicated solely to, the benefit of the Holders of such Securities, (a)
      cash in U.S. Dollars in an amount, or (b) non-callable Government
      Securities that through the scheduled payment of principal and interest in
      respect thereof in accordance with their terms will provide, not later
      than one day before the due date of any payment, cash in U.S. Dollars in
      an amount, or (c) a combination thereof, in such amounts as will be
      sufficient, in the opinion of a nationally recognized firm of independent
      public accountants expressed in a written certification thereof delivered
      to the Trustee, to pay and discharge and which shall be applied by the
      Trustee (or other qualifying trustee) to pay and discharge the principal
      of, premium, if any, and interest on such outstanding Securities on the
      stated maturity date of such principal or installment of principal,
      premium, if any, or interest.

            (ii)  In the case of an election under Section 7.02 hereof, the
      Company shall have delivered to the Trustee an Opinion of Counsel in the
      United States confirming that (a) the Company has received from, or there
      has been published by, the Internal Revenue Service a ruling or (b) since
      the date hereof, there has been a change in the applicable federal income
      tax law, in either case to the effect that, and based thereon such Opinion
      of Counsel shall confirm that, the Holders of the outstanding Securities
      will not recognize income, gain or loss for federal income tax purposes as
      a result of such Legal Defeasance and will be subject to federal income
      tax on the same amounts, in the same manner and at the same times as would
      have been the case if such Legal Defeasance had not occurred.

            (iii) In the case of an election under Section 7.03 hereof, the
      Company shall have delivered to the Trustee an Opinion of Counsel in the
      United States confirming that the Holders of the outstanding Securities
      will not recognize income, gain or loss for federal income tax purposes as
      a result of such Covenant Defeasance and will be subject to federal income
      tax on the same amounts, in the same manner and at the same times as would
      have been the case if such Covenant Defeasance had not occurred.

                                        48

<PAGE>

            (iv)  No Default or Event of Default with respect to the Securities
      shall have occurred and be continuing on the date of such deposit (other
      than a Default or Event of Default resulting from the borrowing of funds
      to be applied to such deposit) or, insofar as Section 5.01(vii) or
      5.01(viii) hereof is concerned, at any time in the period ending on the
      91st day after the date of such deposit (it being understood that this
      condition shall not be deemed satisfied until the expiration of such
      period).

            (v)   Such Legal Defeasance or Covenant Defeasance shall not result
      in a breach or violation of, or constitute a default under any material
      agreement or instrument (other than this Indenture) to which the Company
      or any of its Subsidiaries is a party or by which the Company or any of
      its Subsidiaries is bound (other than a breach, violation or default
      resulting from the borrowing of funds to be applied to such deposit).

            (vi)  The Company shall have delivered to the Trustee an Opinion of
      Counsel to the effect that after the 91st day following the deposit, the
      trust funds will not be subject to the effect of any applicable
      bankruptcy, insolvency, reorganization or similar laws affecting
      creditors' rights generally.

            (vii)  The Company shall have delivered to the Trustee an Officers'
      Certificate stating that the deposit made by the Company pursuant to its
      election under Section 7.02 or 7.03 hereof was not made by the Company
      with the intent of preferring the Holders of the Securities over the other
      creditors of the Company with the intent of defeating, hindering, delaying
      or defrauding creditors of the Company or others.

            (viii) The Company shall have delivered to the Trustee an Officers'
      Certificate and an Opinion of Counsel in the United States, each stating
      that all conditions precedent provided for relating to either the Legal
      Defeasance under Section 7.02 hereof or the Covenant Defeasance under
      Section 7.03 hereof (as the case may be) have been complied with as
      contemplated by this Section 7.04.

SECTION 7.05.    DEPOSITED MONEY AND GOVERNMENT SECURITIES TO BE HELD IN TRUST;
                  OTHER MISCELLANEOUS PROVISIONS.

            Subject to Section 7.06 hereof, all money and non-callable
Government Securities (including the proceeds thereof) deposited with the
Trustee (or other qualifying trustee, collectively for purposes of this Section
7.05, the "Trustee") pursuant to Section 7.04 hereof in respect of the
outstanding Securities shall be held in trust and applied by the Trustee, in
accordance with the provisions of such Securities and this Indenture, to the
payment, either directly or through any Paying Agent (including the Company
acting as Paying Agent) as the Trustee may determine, to the Holders of such
Securities of all sums due and to become due thereon in respect of principal,
premium, if any, and interest, but such money need not be segregated from other
funds except to the extent required by law.

            The Company shall pay and indemnify the Trustee against any tax, fee
or other charge imposed on or assessed against the cash or non-callable
Government Securities deposited pursuant to Section 7.04 hereof or the principal
and interest received in respect thereof other

                                        49

<PAGE>

than any such tax, fee or other charge which by law is for the account of the
Holders of the outstanding Securities.

            Anything in this Article 7 to the contrary notwithstanding, the
Trustee shall deliver or pay to the Company from time to time upon the Company's
request any money or non-callable Government Securities held by it as provided
in Section 7.04 hereof which, in the opinion of a nationally recognized firm of
independent public accountants expressed in a written certification thereof
delivered to the Trustee (which may be the opinion delivered under Section
7.04(i) hereof), are in excess of the amount thereof which would then be
required to be deposited to effect an equivalent Legal Defeasance or Covenant
Defeasance.

SECTION 7.06.    REPAYMENT TO COMPANY.

            Any money deposited with the Trustee or any Paying Agent, or then
held by the Company, in trust for the payment of the principal of, premium, if
any, or interest on any Security and remaining unclaimed for two years after
such principal, and premium, if any, or interest has become due and payable
shall be paid to the Company on its written request or (if then held by the
Company) shall be discharged from such trust; and the Holder of such Security
shall thereafter, as an unsecured general creditor, look only to the Company for
payment thereof, and all liability of the Trustee or such Paying Agent with
respect to such trust money, and all liability of the Company as trustee
thereof, shall thereupon cease; PROVIDED, HOWEVER, that the Trustee or such
Paying Agent, before being required to make any such repayment, may at the
expense of the Company cause to be published once, in the NEW YORK TIMES and
THE WALL STREET JOURNAL (national edition), notice that such money remains
unclaimed and that, after a date specified therein, which shall not be less than
30 days from the date of such notification or publication, any unclaimed balance
of such money then remaining will be repaid to the Company.

SECTION 7.07.    REINSTATEMENT.

            If the Trustee or Paying Agent is unable to apply any U.S. Dollars
or non-callable Government Securities in accordance with Section 7.02 or 7.03
hereof, as the case may be, by reason of any order or judgment of any court or
governmental authority enjoining, restraining or otherwise prohibiting such
application, then the Company's obligations under this Indenture and the
Securities shall be revived and reinstated as though no deposit had occurred
pursuant to Section 7.02 or 7.03 hereof until such time as the Trustee or Paying
Agent is permitted to apply all such money in accordance with Section 7.02 or
7.03 hereof, as the case may be; PROVIDED, HOWEVER, that, if the Company makes
any payment of principal of, premium, if any, or interest on any Security
following the reinstatement of its obligations, the Company shall be subrogated
to the rights of the Holders of such Security to receive such payment from the
money held by the Trustee or Paying Agent.

                                        50

<PAGE>

                                  ARTICLE 8
                       AMENDMENT, SUPPLEMENT AND WAIVER

SECTION 8.01.    WITHOUT CONSENT OF HOLDERS.

            The Company and the Trustee may amend or supplement this Indenture
or the Securities without the consent of any Holder:

            (i)         to cure any ambiguity, defect or inconsistency;

            (ii)        to provide for uncertificated Securities in addition to
                        or in place of certificated Securities;

            (iii)       to provide for any supplemental indenture required
                        pursuant to Section 3.16 hereof;

            (iv)        to provide for the assumption of the Company's
                        obligations to the Holders of the Securities in the case
                        of a merger, consolidation or sale of assets pursuant to
                        Article 4 hereof;

            (v)         to make any change that would provide any additional
                        rights or benefits to the Holders of the Securities or
                        that does not adversely affect the legal rights
                        hereunder of any such Holder; or

            (vi)        to comply with requirements of the Commission in order
                        to effect or maintain the qualification of this
                        Indenture under the TIA.

            Upon the request of the Company accompanied by a resolution of its
Board of Directors authorizing the execution of any such supplemental indenture,
and upon receipt by the Trustee of the documents described in Section 8.06
hereof, the Trustee shall join with the Company in the execution of any
supplemental indenture authorized or permitted by the terms of this Indenture
and to make any further appropriate agreements and stipulations which may be
therein contained, but the Trustee shall not be obligated to enter into such
supplemental indenture which affects its own rights, duties or immunities under
this Indenture or otherwise.

SECTION 8.02.    WITH CONSENT OF HOLDERS.

            Except as provided in the next succeeding paragraphs, this Indenture
or the Securities may be amended or supplemented with the consent of the Holders
of at least a majority in principal amount of the Securities then outstanding
(including consents obtained in connection with a tender offer or exchange offer
for such Securities), and any existing default or compliance with any provision
of this Indenture or the Securities may be waived with the consent of the
Holders of a majority in principal amount of the then outstanding Securities
(including consents obtained in connection with a tender offer or exchange offer
for such Securities).

                                        51

<PAGE>

            Upon the request of the Company accompanied by a resolution of its
Board of Directors authorizing the execution of any such supplemental indenture,
and upon the filing with the Trustee of evidence satisfactory to the Trustee of
the consent of the Holders as aforesaid, and upon receipt by the Trustee of the
documents described in Section 8.06 hereof, the Trustee shall join with the
Company in the execution of such supplemental indenture unless such supplemental
indenture affects the Trustee's own rights, duties or immunities under this
Indenture or otherwise, in which case the Trustee may in its discretion, but
shall not be obligated to, enter into such supplemental indenture.

            It shall not be necessary for the consent of the Holders under this
Section 8.02 to approve the particular form of any proposed amendment or waiver,
but it shall be sufficient if such consent approves the substance thereof.

            After an amendment, supplement or waiver under this Section becomes
effective, the Company shall mail to the Holders affected thereby a notice
briefly describing the amendment, supplement or waiver.  Any failure of the
Company to mail such notice, or any defect therein, shall not, however, in any
way impair or affect the validity of any such supplemental indenture or waiver.
Subject to Sections 5.04 and 5.07 hereof, the Holders of a majority in aggregate
principal amount of the Securities then outstanding may waive compliance in a
particular instance by the Company with any provision of this Indenture or the
Securities.  Without the consent of each Holder affected, however, an amendment
or waiver may not (with respect to any Security held by a non-consenting
Holder):

         (i)      reduce the principal amount of Securities whose Holders must
                  consent to an amendment, supplement or waiver;

        (ii)      reduce the principal of or change the fixed maturity of any
                  Security;

       (iii)      reduce the rate of or change the time for payment of interest
                  on any Security;

        (iv)      waive a Default or Event of Default in the payment of
                  principal of or premium, if any, or interest on the Securities
                  (except a rescission of acceleration of the Securities by the
                  Holders of at least a majority in aggregate principal amount
                  thereof and a waiver of the payment default that resulted from
                  such acceleration);

         (v)      make any Security payable in money other than that stated in
                  the Securities;

        (vi)      make any change in Section 5.04 or 5.07 hereof; or

       (vii)      make any change in this sentence of this Section 8.02.

                                        52

<PAGE>

SECTION 8.03.    COMPLIANCE WITH TIA.

            Every amendment to this Indenture or the Securities shall be set
forth in a supplemental indenture that complies with the TIA as then in effect.

SECTION 8.04.    REVOCATION AND EFFECT OF CONSENTS.

            Until an amendment or waiver becomes effective, a consent to it by a
Holder is a continuing consent by the Holder and every subsequent Holder of a
Security or portion of a Security that evidences the same debt as the consenting
Holder's Security, even if notation of the consent is not made on any Security.
However, any such Holder or subsequent Holder may revoke the consent as to its
Security if the Trustee receives written notice of revocation before the date
the waiver or amendment becomes effective.  An amendment or waiver becomes
effective in accordance with its terms and thereafter binds every Holder.

            The Company may, but shall not be obligated to, fix a record date
for determining which Holders must consent to such amendment or waiver.  If the
Company fixes a record date, the record date shall be fixed at (i) the later of
30 days prior to the first solicitation of such consent or the date of the most
recent list of Holders furnished to the Trustee prior to such solicitation
pursuant to Section 2.05 hereof or (ii) such other date as the Company shall
designate.

SECTION 8.05.    NOTATION ON OR EXCHANGE OF SECURITIES.

            The Trustee may place an appropriate notation about an amendment or
waiver on any Security thereafter authenticated.  The Company in exchange for
all Securities may issue and the Trustee shall authenticate new Securities that
reflect the amendment or waiver.

            Failure to make the appropriate notation or issue a new Security
shall not affect the validity and effect of such amendment or waiver.

SECTION 8.06.    TRUSTEE TO SIGN AMENDMENTS, ETC.

            The Trustee shall sign any amendment or supplemental indenture
authorized pursuant to this Article 8 if the amendment does not adversely affect
the rights, duties, liabilities or immunities of the Trustee.  If it does, the
Trustee may, but need not, sign it.  In signing or refusing to sign such
amendment or supplemental indenture, the Trustee shall be entitled to receive
and, subject to Section 6.01, shall be fully protected in relying upon, an
Officers' Certificate and an Opinion of Counsel as conclusive evidence that such
amendment or Supplemental Indenture is authorized or permitted by this
Indenture, that it is not inconsistent herewith, and that it shall be valid and
binding upon the Company in accordance with its terms.  The Company may not sign
an amendment or supplemental indenture until the Board of Directors approves it.

                                        53

<PAGE>

                                   ARTICLE 9
                                 MISCELLANEOUS

SECTION 9.01.    TIA CONTROLS.

            If any provision of this Indenture limits, qualifies or conflicts
with the duties imposed by TIA Section 318(c), the imposed duties shall control.

SECTION 9.02.    NOTICES.

            Any notice or communication by the Company or the Trustee to the
other is duly given if in writing and delivered in person or mailed by first
class mail (registered or certified, return receipt requested), telex,
telecopier or overnight air courier guaranteeing next day delivery, to the
other's address:

            If to the Company:

            National Medical Enterprises, Inc.
            2700 Colorado Avenue
            Santa Monica, California  90404
            Telecopier No.:  (310) 998-6700
            Attention:  Treasurer

            With a copy to:

            Skadden, Arps, Slate, Meagher & Flom
            300 South Grand Avenue, Suite 3400
            Los Angeles, California  90071
            Telecopier No.:  (213) 687-5600
            Attention:  Thomas C. Janson, Jr.

            If to the Trustee:

            The Bank of New York
            101 Barclay Street, 21 West
            New York, New York  10286
            Telecopier No.: (212) 815-5915
            Attention:  Corporate Trust Trustee Administration

            The Company or the Trustee, by notice to the others may designate
additional or different addresses for subsequent notices or communications.

            All notices and communications (other than those sent to Holders)
shall be deemed to have been duly given:  at the time delivered by hand, if
personally delivered; five Business Days after being deposited in the mail,
postage prepaid, if mailed; when answered back, if

                                        54

<PAGE>

telexed; when receipt acknowledged, if telecopied; and the next Business Day
after timely delivery to the courier, if sent by overnight air courier
guaranteeing next day delivery.

            Unless otherwise set forth above, any notice or communication to a
Holder shall be mailed by first class mail, certified or registered, return
receipt requested, or by overnight air courier guaranteeing next day delivery to
its address shown on the register kept by the Registrar.  Any notice or
listed in TIA Section 311(b).  A Trustee who has resigned or been removed
to the extent required by the TIA.  Failure to mail a notice or communication to
a Holder or any defect in it shall not affect its sufficiency with respect to
other Holders.

            If a notice or communication is mailed in the manner provided above
within the time prescribed, it is duly given, whether or not the addressee
receives it.

            If the Company mails a notice or communication to Holders, it shall
mail a copy to the Trustee and each Agent at the same time.

SECTION 9.03.    COMMUNICATION BY HOLDERS WITH OTHER HOLDERS.

communication shall also be so mailed to any Person described in TIA Section
with respect to their rights under this Indenture or the Securities.  The
Company, the Trustee, the Registrar and anyone else shall have the protection of
TIA Section 312(c).

SECTION 9.04.    CERTIFICATE AND OPINION AS TO CONDITIONS PRECEDENT.

            Upon any request or application by the Company to the Trustee to
take any action under this Indenture, the Company shall furnish to the Trustee:

            (1)   an Officers' Certificate (which shall include the statements
      set forth in Section 9.05 hereof) stating that, in the opinion of the
      signers, all conditions precedent and covenants, if any, provided for in
      this Indenture relating to the proposed action have been satisfied; and

            (2)   an Opinion of Counsel (which shall include the statements set
      forth in Section 9.05 hereof) stating that, in the opinion of such
      counsel, all such conditions precedent and covenants have been satisfied.

SECTION 9.05.    STATEMENTS REQUIRED IN CERTIFICATE OR OPINION.

            Each certificate or opinion with respect to compliance with a
condition or covenant provided for in this Indenture (other than a certificate
provided pursuant to TIA Section 314(a)(4)) shall include:

            (1)   a statement that the person making such certificate or opinion
      has read such covenant or condition;

                                        55

<PAGE>

            (2)   a brief statement as to the nature and scope of the
      examination or investigation upon which the statements or opinions
      contained in such certificate or opinion are based;

            (3)   a statement that, in the opinion of such person, he has made
      such examination or investigation as is necessary to enable him to express
      an informed opinion as to whether or not such covenant or condition has
      been satisfied; and

            (4)   a statement as to whether or not, in the opinion of such
      person, such condition or covenant has been satisfied; PROVIDED,
      HOWEVER, that with respect to matters of fact, an Opinion of Counsel may
      rely on an Officers' Certificate or certificates of public officials.

SECTION 9.06.    RULES BY TRUSTEE AND AGENTS.

            The Trustee may make reasonable rules for action by or at a meeting
of Holders.  The Registrar or Paying Agent may make reasonable rules and set
reasonable requirements for its functions.

SECTION 9.07.    LEGAL HOLIDAYS.

            A "LEGAL HOLIDAY" is a Saturday, a Sunday or a day on which
banking institutions in The City of New York or at a place of payment are
authorized or obligated by law, regulation or executive order to remain closed.
If a payment date is a Legal Holiday at a place of payment, payment may be made
at that place on the next succeeding day that is not a Legal Holiday, and no
interest shall accrue for the intervening period.

SECTION 9.08.    NO PERSONAL LIABILITY OF DIRECTORS, OFFICERS, EMPLOYEES AND
                  Shareholders

            No director, officer, employee, incorporator or shareholder of the
Company, as such, shall have any liability for any obligations of the Company
under the Securities, the Indenture or for any claim based on, in respect of, or
by reason of, such obligations or their creation.  Each Holder of the Securities
by accepting a Security waives and releases all such liability.  The waiver and
release are part of the consideration for issuance of the Securities.  Such
waiver may not be effective to waive liabilities under the federal securities
laws and it is the view of the Commission that such a waiver is against public
policy.

SECTION 9.09.    DUPLICATE ORIGINALS.

            The parties may sign any number of copies of this Indenture.  One
signed copy is enough to prove this Indenture.

                                        56

<PAGE>

SECTION 9.10.    GOVERNING LAW.

            The internal law of the State of New York, shall govern and be used
to construe this Indenture and the Securities, without regard to the conflict of
laws provisions thereof.

SECTION 9.11.    NO ADVERSE INTERPRETATION OF OTHER AGREEMENTS.

            This Indenture may not be used to interpret another indenture, loan
or debt agreement of the Company or its Subsidiaries.  Any such indenture, loan
or debt agreement may not be used to interpret this Indenture.

SECTION 9.12.    SUCCESSORS.

            All agreements of the Company in this Indenture and the Securities
shall bind its successors.  All agreements of the Trustee in this Indenture
shall bind its successor.

SECTION 9.13.    SEVERABILITY.

            In case any provision in this Indenture or in the Securities shall
be invalid, illegal or unenforceable, the validity, legality and enforceability
of the remaining provisions shall not in any way be affected or impaired
thereby, it being intended that all of the provisions hereof shall be
enforceable to the full extent permitted by law.

SECTION 9.14.    COUNTERPART ORIGINALS.

            The parties may sign any number of copies of this Indenture.  Each
signed copy shall be an original, but all of them together represent the same
agreement.

SECTION 9.15.    TABLE OF CONTENTS, HEADINGS, ETC.

            The Table of Contents, Cross-Reference Table and Headings of the
Articles and Sections of this Indenture have been inserted for convenience of
reference only, are not to be considered a part of this Indenture and shall in
no way modify or restrict any of the terms or provisions hereof.

                                        57

<PAGE>

                                  SIGNATURES

Dated as of _______________         NATIONAL MEDICAL ENTERPRISES, INC.

                                    By:
                                       -------------------------------------
                                        Name:  Terence P. McMullen
                                        Title:   Senior Vice President
Attest:

----------------------------  (SEAL)
  Richard B. Silver

Dated as of _______________         THE BANK OF NEW YORK, as Trustee

                                    By:
                                       -------------------------------------
                                    Name:
                                    Title:

Attest:

---------------------------  (SEAL)

                                        58

<PAGE>

                                                                     EXHIBIT A
                              (Face of Security)

                                9-5/8% Senior Note
                             due September 1, 2002
CUSIP:
No.                                                      $____________

                      NATIONAL MEDICAL ENTERPRISES, INC.

promises to pay to

_________________________________________________________________________

or its registered assigns, the principal sum of ________________________________

Dollars on September 1, 2002.

Interest Payment Dates:  March 1 and September 1, commencing September 1, 1995.

Record Dates:  February 15 and August 15 (whether or not a Business Day).

NATIONAL MEDICAL ENTERPRISES, INC.

By: _________________________

                                        A-1

<PAGE>

Dated:  __________, ____

(SEAL)

Trustee's Certificate of Authentication:

This is one of the Securities referred
to in the within-mentioned Indenture:

The Bank of New York, as Trustee

By: ___________________________
      Authorized Signatory

                                        A-2

<PAGE>

                              (Back of Security)

                                9 5/8% SENIOR NOTE
                             due September 1, 2002

            Capitalized terms used herein have the meanings assigned to them in
the Indenture (as defined below) unless otherwise indicated.

            1.  INTEREST.  National Medical Enterprises, Inc., a Nevada
corporation (the "COMPANY"), promises to pay interest on the principal amount
of this Security at the rate and in the manner specified below.

            The Company shall pay interest in cash on the principal amount of
this Security at the rate per annum of 9/ /%.  The Company shall pay interest
semiannually in arrears on March 1 and September 1 of each year, commencing
September 1, 1995 to Holders of record on the immediately preceding February 15
and August 15, respectively, or if any such date of payment is not a Business
Day on the next succeeding Business Day (each an "INTEREST PAYMENT DATE").

            Interest shall be computed on the basis of a 360-day year comprised
of twelve 30-day months.  Interest shall accrue from the most recent date to
which interest has been paid or, if no interest has been paid, from the date of
the original issuance of the Securities.  To the extent lawful, the Company
shall pay interest on overdue principal at the rate of 1% per annum in excess of
the interest rate then applicable to the Securities; it shall pay interest on
overdue installments of interest (without regard to any applicable grace
periods) at the same rate to the extent lawful.

            2.  METHOD OF PAYMENT.  The Company shall pay interest on the
Securities (except defaulted interest) to the Persons who are registered Holders
of Securities at the close of business on the record date next preceding the
Interest Payment Date, even if such Securities are cancelled after such record
date and on or before such Interest Payment Date.  The Holder hereof must
surrender this Security to a Paying Agent to collect principal payments.  The
Company shall pay principal and interest in money of the United States that at
the time of payment is legal tender for payment of public and private debts.
Principal, premium, if any, and interest shall be payable at the office or
agency of the Company maintained for such purpose within the City and State of
New York or, at the option of the Company, payment of interest may be made by
check mailed to the Holder's registered address.  Notwithstanding the foregoing,
all payments with respect to Securities the Holders of which have given wire
transfer instructions, on or before the relevant record date, to the Paying
Agent shall be made by wire transfer of immediately available funds to the
accounts specified by such Holders.

            3.  PAYING AGENT AND REGISTRAR.  Initially, the Trustee shall act
as Paying Agent and Registrar.  The Company may change any Paying Agent or
Registrar or co-registrar without prior notice to any Holder.  The Company and
any of its Subsidiaries may act in any such capacity.

                                        A-3

<PAGE>

            4.  INDENTURE.  The Company issued the Securities under an
Indenture, dated as of March 1, 1995 (the "INDENTURE"), between the Company
and the Trustee.  The terms of the Securities include those stated in the
Indenture and those made part of the Indenture by reference to the Trust
Indenture Act of 1939, as amended (15 U.S. Code Sections 77aaa-77bbbb) (the
"TIA") as in effect on the date of the Indenture. The Securities are subject to
all such terms, and Holders are referred to the Indenture and such act for a
statement of such terms.  The terms of the Indenture shall govern any
inconsistencies between the Indenture and the Securities.  The Securities are
unsecured general obligations of the Company.  The Securities are limited to
$300,000,000 in aggregate principal amount.

            5.  MANDATORY REDEMPTION.  Subject to the Company's obligation to
make an offer to repurchase Securities under certain circumstances pursuant to
Sections 3.10 and 3.13 of the Indenture (as described in paragraph 6 below), the
Company shall have no mandatory redemption or sinking fund obligations with
respect to the Securities.

            6.  REPURCHASE AT OPTION OF HOLDER.  (i)  If there is a Change of
Control Triggering Event, the Company shall offer to repurchase on the Change of
Control Payment Date all outstanding Securities at 101% of the aggregate
principal amount thereof plus accrued and unpaid interest thereon to the Change
of Control Payment Date.  Holders that are subject to an offer to purchase shall
receive a Change of Control Offer from the Company prior to any related Change
of Control Payment Date and may elect to have such Securities purchased by
completing the form entitled "Option of Holder to Elect Purchase" appearing
below.

            (ii)  If the Company or a Subsidiary consummates an Asset Sale,
within 365 days after the receipt of any Net Proceeds from such Asset Sale, the
Company may apply such Net Proceeds (a) to purchase one or more Hospitals or
Related Businesses and/or a controlling interest in the Capital Stock of a
Person owning one or more Hospitals and/or one or more Related Businesses, (b)
to make a capital expenditure or to acquire other tangible assets, in each case,
that are used or useful in any business in which the Company is permitted to be
engaged pursuant to Section 3.15 of the Indenture, (c) to permanently reduce
Senior Term Debt or Existing Indebtedness of a Subsidiary or (d) to permanently
reduce Senior Revolving Debt (and to correspondingly reduce commitments with
respect thereto), except that up to an aggregate of $200.0 million of Net
Proceeds from Asset Sales may be applied after the date of the Indenture to
reduce Senior Revolving Debt without a corresponding reduction in commitments
with respect thereto.  Pending the final application of any such Net Proceeds,
the Company may temporarily reduce Senior Revolving Debt or otherwise invest
such Net Proceeds in any manner that is not prohibited by the Indenture.  Any
Net Proceeds from any Asset Sale that are not so invested or applied shall be
deemed to constitute "EXCESS PROCEEDS."  When the aggregate amount of Excess
Proceeds exceeds $25.0 million, the Company shall make an offer to all Holders
of Securities and holders of any other Indebtedness of the Company ranking on a
parity with the Securities from time to time outstanding with similar provisions
requiring the Company to make an offer to purchase or to redeem such
Indebtedness with the proceeds from any asset sales, PRO RATA in proportion to
the respective principal amounts of the Securities and such other Indebtedness
then outstanding (a "SENIOR ASSET SALE OFFER") to purchase the maximum
principal amount of Securities and such other Indebtedness that may be purchased
out of the Excess Proceeds, at an offer price in cash in an amount equal to 100%
of the principal amount thereof plus accrued and unpaid interest thereon, if
any, to the date of purchase in accordance with the terms of the

                                        A-4

<PAGE>

Indenture.  To the extent that the aggregate amount of Securities and such other
Indebtedness tendered pursuant to a Senior Asset Sale Offer is less than the
Excess Proceeds, the Company may use any remaining Excess Proceeds for general
corporate purposes, including an offer to purchase Senior Subordinated Notes
pursuant to Section 4.10 of the Senior Subordinated Note Indenture.  If the
aggregate principal amount of Securities and such other Indebtedness surrendered
by holders pursuant to a Senior Asset Sale Offer exceeds the amount of Excess
Proceeds, the Securities and such other Indebtedness shall be purchased on a
PRO RATA basis.  Holders that are the subject of an offer to purchase shall
receive a Senior Asset Sale Offer from the Company prior to any related purchase
date and may elect to have such Securities purchased by completing the form
entitled "Option of Holder to Elect Purchase" appearing below.

            7.  DENOMINATIONS, TRANSFER, EXCHANGE.  The Securities are in
registered form without coupons, and in denominations of $1,000 and integral
multiples of $1,000.  The transfer of Securities may be registered and
Securities may be exchanged as provided in the Indenture.  The Registrar and the
Trustee may require a Holder, among other things, to furnish appropriate
endorsements and transfer documents and to pay any taxes and fees required by
law or permitted by the Indenture.  The Registrar need not exchange or register
the transfer of any Securities between a record date and the corresponding
Interest Payment Date.

            8.  PERSONS DEEMED OWNERS.  Prior to due presentment to the
Trustee for registration of the transfer of this Security, the Trustee, any
Agent and the Company may deem and treat the Person in whose name this Security
is registered as its absolute owner for the purpose of receiving payment of
principal of, premium, if any, and interest on this Security and for all other
purposes whatsoever, whether or not this Security is overdue, and neither the
Trustee, any Agent nor the Company shall be affected by notice to the contrary.
The registered Holder of a Security shall be treated as its owner for all
purposes.

            9.  AMENDMENT, SUPPLEMENT AND WAIVERS.  Except as provided in the
next succeeding paragraphs, the Indenture or the Securities may be amended or
supplemented with the consent of the Holders of at least a majority in principal
amount of the Securities then outstanding (including consents obtained in
connection with a tender offer or exchange offer for Securities) and any
existing default or compliance with any provision of the Indenture or the
Securities may be waived with the consent of the Holders of a majority in
principal amount of the then outstanding Securities (including consents obtained
in connection with a tender offer or exchange offer for Securities).

            Without the consent of each Holder affected, an amendment or waiver
may not (with respect to any Security held by a non-consenting Holder of
Securities):  (i) reduce the principal amount of Securities whose Holders must
consent to an amendment, supplement or waiver, (ii) reduce the principal of or
change the fixed maturity of any Security, (iii) reduce the rate of or change
the time for payment of interest on any Security, (iv) waive a Default or Event
of Default in the payment of principal of or premium, if any, or interest on the
Securities, (except a rescission of acceleration of the Securities by the
Holders of at least a majority in aggregate principal amount thereof and a
waiver of the payment default that resulted from such acceleration), (v) make
any Security payable in money other than that stated in the Securities, (vi)
make any change in the provisions of the Indenture relating to waivers of past
Defaults or the rights of Holders of Securities to receive payments of principal
of or premium, if any, or

                                        A-5

<PAGE>

interest on the Securities or (vii) make any change in the foregoing amendment
and waiver provisions.

            Notwithstanding the foregoing, without the consent of any Holder of
Securities, the Company and the Trustee may amend or supplement the Indenture or
the Securities to cure any ambiguity, defect or inconsistency, to provide for
uncertificated Securities in addition to or in place of certificated Securities,
to provide for any supplemental indenture required pursuant to Section 3.16 of
the Indenture, to provide for the assumption of the Company's obligations to
Holders of the Securities in the case of a merger, consolidation or sale of
assets, to make any change that would provide any additional rights or benefits
to the Holders of the Securities or that does not adversely affect the legal
rights under the Indenture of any such Holder, or to comply with requirements of
the Securities and Exchange Commission (the "COMMISSION") in order to effect
or maintain the qualification of the Indenture under the TIA.

            10.  DEFAULTS AND REMEDIES.  Events of Default under the Indenture
include:  (i) a default for 30 days in the payment when due of interest on the
Securities; (ii) a default in payment when due of the principal of or premium,
if any, on the Securities, at maturity or otherwise; (iii) a failure by the
Company to comply with the provisions described under the covenants "Limitations
on Restricted Payments," "Limitations on Incurrence of Indebtedness and Issuance
of Preferred Stock," "Asset Sales," and "Change of Control;" (iv) a failure by
the Company for 60 days after notice to comply with any of its other agreements
in the Indenture or the Securities; (v) any default that occurs under any
mortgage, indenture or instrument under which there may be issued or by which
there may be secured or evidenced any Indebtedness for money borrowed by the
Company or any of its Significant Subsidiaries (or the payment of which is
Guaranteed by the Company or any of its Significant Subsidiaries) whether such
Indebtedness or Guarantee exists on the date of the Indenture, or is created
after the date of the Indenture, which default (a) constitutes a Payment Default
or (b) results in the acceleration of such Indebtedness prior to its express
maturity and, in each case, the principal amount of any such Indebtedness,
together with the principal amount of any other such Indebtedness under which
there has been a Payment Default or that has been so accelerated, aggregates
$25.0 million or more; (vi) failure by the Company or any of its Significant
Subsidiaries to pay a final judgment or final judgments aggregating in excess of
$25.0 million entered by a court or courts or competent jurisdiction against the
Company or any of its Significant Subsidiaries if such final judgment or
judgments remain unpaid or undischarged for a period (during which execution
shall not be effectively stayed) of 60 days after their entry; and (vii) certain
events of bankruptcy or insolvency with respect to the Company or any of its
Significant Subsidiaries. If any Event of Default occurs and is continuing, the
Trustee or the Holders of at least 25% in aggregate principal amount of the then
outstanding Securities by written notice to the Company and the Trustee, may
declare all the Securities to be due and payable immediately (plus, in the case
of an Event of Default that is the result of willful actions (or inactions) by
or on behalf of the Company intended to avoid prohibitions on redemptions of the
Securities contained in the Indenture or the Securities, an amount of premium
applicable pursuant to the Indenture).  Notwithstanding the foregoing, in the
case of an Event of Default arising from certain events of bankruptcy or
insolvency with respect to the Company or any of its Significant Subsidiaries,
all outstanding Securities shall become due and payable without further action
or notice.  Holders of the Securities may not enforce the Indenture or the
Securities except as provided in the Indenture.  Subject to certain limitation,
Holders of a majority in principal amount of the

                                        A-6

<PAGE>

then outstanding Securities may direct the Trustee in its exercise of any trust
or power.  The Trustee may withhold from Holders of the Securities notice of any
continuing Default or Event of Default (except a Default or Event of Default
relating to the payment of principal or interest) if it determines that
withholding notice is in such Holders' interest.

            The Holders of not less than a majority in aggregate principal
amount of the Securities then outstanding by written notice to the Trustee may
on behalf of the Holders of all of the Securities waive any existing Default or
Event of Default and its consequences under the Indenture except a continuing
Default or Event of Default in the payment of interest or premium on, or the
principal of, the Securities.

            The Company is required to deliver to the Trustee annually a
statement regarding compliance with the Indenture, and the Company is required
upon becoming aware of any Default or Event of Default, to deliver to the
Trustee a statement specifying such Default or Event of Default.

            The above description of Events of Default and remedies is qualified
by reference, and subject in its entirety, to the more complete description
thereof contained in the Indenture.

            11.  RESTRICTIVE COVENANTS.  The Indenture imposes certain
limitations on the ability of the Company and its Subsidiaries to incur
additional indebtedness and issue preferred stock, pay dividends or make other
distributions, repurchase Equity Interests or subordinated indebtedness, create
certain liens, enter into certain transactions with affiliates, sell assets of
the Company or its Subsidiaries, issue or sell Equity Interests of the Company's
Subsidiaries, issue Guarantees of Indebtedness by the Company's Subsidiaries and
enter into certain mergers and consolidations.

            12.  TRUSTEE DEALINGS WITH COMPANY.  The Trustee under the
Indenture, in its individual or any other capacity, may make loans to, accept
deposits from, and perform services for the Company or its Affiliates, and may
otherwise deal with the Company or its Affiliates, as if it were not Trustee.

            13.  NO PERSONAL LIABILITY OF DIRECTORS, OFFICERS, EMPLOYEES AND
Shareholders.  No director, officer, employee, incorporator or shareholder of
the Company, as such, shall have any liability for any obligations of the
Company under the Securities, the Indenture or for any claim based on, in
respect of, or by reason of, such obligations or their creation.  Each Holder by
accepting a Security waives and releases all such liability.  The waiver and
release are part of the consideration for the issuance of the Securities.  Such
waiver may not be effective to waive liabilities under the federal securities
laws and it is the view of the Commission that such a waiver is against public
policy.

            14.  AUTHENTICATION.  This Security shall not be valid until
authenticated by the manual signature of the Trustee or an authenticating agent.

            15.  ABBREVIATIONS.  Customary abbreviations may be used in the
name of a Holder or an assignee, such as:  TEN COM (= tenants in common), TEN
ENT (= tenants by

                                        A-7

<PAGE>

the entireties), JT TEN (= joint tenants with right of survivorship and not as
tenants in common), CUST (= Custodian), and U/G/M/A (= Uniform Gifts to Minors
Act).

            16.  CUSIP NUMBERS.  Pursuant to a recommendation promulgated by
the Committee on Uniform Security Identification Procedures, the Company has
caused CUSIP numbers to be printed on the Securities and has directed the
Trustee to use CUSIP numbers as a convenience to Holders.  No representation is
made as to the accuracy of such numbers either as printed on the Securities and
reliance may be placed only on the other identification numbers placed thereon.

            The Company will furnish to any Holder upon written request and
without charge a copy of the Indenture.  Request may be made to:

            National Medical Enterprises, Inc.
            2700 Colorado Avenue
            Santa Monica, California  90404
            Attention:  Treasurer

                                        A-8

<PAGE>

                                ASSIGNMENT FORM

      To assign this Security, fill in the form below:  For value received (i)
or (we) hereby sell, assign and transfer this Security to

_______________________________________________________________________________
                 (Insert assignee's soc. sec. or tax I.D. no.)

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________
             (Print or type assignee's name, address and zip code)

and do hereby irrevocably constitute and appoint_______________________________
Attorney to transfer this Security on the books of the Company with full power
of substitution in the premises.

_______________________________________________________________________________

Date:  ______________

                                  Your Signature:_______________________________
                                  (Sign exactly as your name appears on the face
of this Security)

Signature Guarantee.*

__________

*Participant in a recognized Signature Guarantee Medallion Program (or other
signature guarantor acceptable to the Trustee).

                                        A-9

<PAGE>

                      OPTION OF HOLDER TO ELECT PURCHASE

      If you want to elect to have all or any part of this Security purchased by
the Company pursuant to Section 3.10 or Section 3.13 of the Indenture, check the
appropriate box:

        / / Section 3.10                                 / / Section 3.13
           (Asset Sale)                                      (Change of Control)

      If you want to have only part of the Security purchased by the Company
pursuant to Section 3.10 or Section 3.13 of the Indenture, state the amount you
elect to have purchased:

$ _______________

Date:____________

                                  Your Signature:_______________________________
                                  (Sign exactly as your name appears on the face
                                   of this Security)

Signature Guarantee.*

__________

*Participant in a recognized Signature Guarantee Medallion Program (or other
signature guarantor acceptable to the Trustee).

                                        A-10

<PAGE>

                                                                EXECUTION COPY
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------

                      NATIONAL MEDICAL ENTERPRISES, INC.

                   ___________________________________________

                                 $300,000,000

                           9/ /% SENIOR NOTES due 2002

                   ___________________________________________

                           _________________________

                                   INDENTURE

                           Dated as of March 1, 1995
                           _________________________

                           _________________________

                             THE BANK OF NEW YORK
                           _________________________

                                  as Trustee

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

<PAGE>

                     CROSS-REFERENCE TABLE*

TRUST INDENTURE
  ACT SECTION                                   INDENTURE SECTION
----------------                                -----------------

310 (a)(1)............................................       6.10
   (a)(2).............................................       6.10
   (a)(3).............................................       N.A.
   (a)(4).............................................       N.A.
   (a)(5).............................................       6.10
   (b) ............................................... 6.08; 6.10
   (c) ...............................................       N.A.
311 (a) ..............................................       6.11
   (b) ...............................................       6.11
   (c) ...............................................       N.A.
312 (a)...............................................       2.05
   (b)................................................       9.03
   (c) ...............................................       9.03
313 (a) ..............................................       6.06
   (b)(1) ............................................       N.A.
   (b)(2) ............................................       6.06
   (c) ...............................................  6.06; 9.02
   (d)................................................       6.06
314 (a) .............................................. 3.03; 9.02
   (b) ...............................................       N.A.
   (c)(1).............................................       9.04
   (c)(2).............................................       9.04
   (c)(3).............................................       N.A.
   (d)................................................       N.A.
   (e)  ..............................................       9.05
   (f)................................................       N.A.
315 (a)...............................................6.01(iii)(b)
   (b)................................................ 6.05; 9.02
   (c)  ..............................................    6.01(i)
   (d)................................................  6.01(iii)
   (e)................................................       5.11
316 (a)(last sentence) ...............................       2.09
   (a)(1)(a)..........................................       5.05
   (a)(1)(b) .........................................       5.04
   (a)(2).............................................       N.A.
   (b) ...............................................       5.07
   (c) ...............................................  2.13; 8.04
317 (a)(1) ...........................................       5.08
   (a)(2).............................................       5.09
   (b) ...............................................       2.04
318 (a)...............................................       9.01
   (b)................................................       N.A.
   (c)................................................       9.01

N.A. means not applicable.
____________________________
*THIS CROSS-REFERENCE TABLE IS NOT PART OF THE INDENTURE.

<PAGE>

                         TABLE OF CONTENTS

                                                              Page

                             ARTICLE 1
                   DEFINITIONS AND INCORPORATION
                           BY REFERENCE

      Section 1.01. Definitions................................  1
      Section 1.02. Other Definitions.......................... 13
      Section 1.03. Incorporation by Reference of TIA.......... 14
      Section 1.04. Rules of Construction...................... 14

                             ARTICLE 2
           THE SECURITIES; OFFER TO PURCHASE PROCEDURES

      Section 2.01. Form and Dating............................ 15
      Section 2.02. Execution and Authentication............... 15
      Section 2.03. Registrar and Paying Agent................. 15
      Section 2.04. Paying Agent to Hold Money in Trust........ 16
      Section 2.05. Holder Lists............................... 16
      Section 2.06. Transfer and Exchange...................... 16
      Section 2.07. Replacement Securities..................... 17
      Section 2.08. Outstanding Securities..................... 17
      Section 2.09. Treasury Securities........................ 18
      Section 2.10. Temporary Securities....................... 18
      Section 2.11. Cancellation............................... 18
      Section 2.12. Defaulted Interest......................... 18
      Section 2.13. Record Date................................ 19
      Section 2.14. CUSIP Number............................... 19
      Section 2.15. Offer to Purchase By Application of Excess
                    Proceeds....................................19

                             ARTICLE 3
                             COVENANTS

      Section 3.01. Payment of Securities...................... 21
      Section 3.02. Maintenance of Office or Agency............ 22
      Section 3.03. Commission Reports......................... 22
      Section 3.04. Compliance Certificate..................... 23
      Section 3.05. Taxes...................................... 24
      Section 3.06. Stay, Extension and Usury Laws............. 24
      Section 3.07. Limitations on Restricted Payments......... 24
      Section 3.08. Limitations on Dividend and Other Payment
                    Restrictions Affecting Subsidiaries........ 27
      Section 3.09. Limitations on Incurrence of Indebtedness
                    and Issuance of Preferred Stock............ 28

                                        i

<PAGE>

                                                              Page

      Section 3.10. Asset Sales................................ 30
      Section 3.11. Limitations on Transactions with Affiliates 31
      Section 3.12. Limitations on Liens....................... 32
      Section 3.13. Change of Control.......................... 32
      Section 3.14. Corporate Existence........................ 34
      Section 3.15. Line of Business........................... 34
      Section 3.16. Limitations on Issuances of Guarantees of
                    Indebtedness by Subsidiaries............... 34
      Section 3.17. No Amendment to Subordination Provisions of
                    Senior Subordinated Note Indenture......... 34

                             ARTICLE 4
                            SUCCESSORS

      Section 4.01. Limitations On Mergers, Consolidations or
                    Sales of Assets............................ 35
      Section 4.02. Successor Corporation Substituted.......... 36

                             ARTICLE 5
                       DEFAULTS AND REMEDIES

      Section 5.01. Events of Default.......................... 36
      Section 5.02. Acceleration............................... 38
      Section 5.03. Other Remedies............................. 39
      Section 5.04. Waiver of Past Defaults.................... 39
      Section 5.05. Control by Majority........................ 39
      Section 5.06. Limitation on Suits........................ 39
      Section 5.07. Rights of Holders to Receive Payment....... 40
      Section 5.08. Collection Suit by Trustee................. 40
      Section 5.09. Trustee May File Proofs of Claim........... 40
      Section 5.10. Priorities................................. 41
      Section 5.11. Undertaking for Costs...................... 41

                             ARTICLE 6
                              TRUSTEE

      Section 6.01. Duties of Trustee.......................... 42
      Section 6.02. Rights of Trustee.......................... 43
      Section 6.03. Individual Rights of Trustee............... 43
      Section 6.04. Trustee's Disclaimer....................... 44
      Section 6.05. Notice of Defaults......................... 44
      Section 6.06. Reports by Trustee to Holders.............. 44
      Section 6.07. Compensation and Indemnity................. 44
      Section 6.08. Replacement of Trustee..................... 45
      Section 6.09. Successor Trustee or Agent by Merger, etc.. 46

                                        ii

<PAGE>

                                                              Page

      Section 6.10. Eligibility; Disqualification.............. 46
      Section 6.11. Preferential Collection of Claims Against
                    Company.................................... 46

                            ARTICLE 7
                      DISCHARGE OF INDENTURE

      Section 7.01. Defeasance and Discharge of this Indenture
                    and the Securities......................... 47
      Section 7.02. Legal Defeasance and Discharge............. 47
      Section 7.03. Covenant Defeasance........................ 47
      Section 7.04. Conditions to Legal or Covenant Defeasance. 48
      Section 7.05. Deposited Money and Government Securities
                    to be Held in Trust; Other Miscellaneous
                    Provisions................................. 49
      Section 7.06. Repayment to Company....................... 50
      Section 7.07. Reinstatement.............................. 50

                            ARTICLE 8
                 AMENDMENT, SUPPLEMENT AND WAIVER

      Section 8.01. Without Consent of Holders................. 51
      Section 8.02. With Consent of Holders.................... 51
      Section 8.03. Compliance with TIA........................ 53
      Section 8.04. Revocation and Effect of Consents.......... 53
      Section 8.05. Notation on or Exchange of Securities...... 53
      Section 8.06. Trustee to Sign Amendments, etc............ 53

                             ARTICLE 9
                           MISCELLANEOUS

      Section 9.01. TIA Controls............................... 54
      Section 9.02. Notices.................................... 54
      Section 9.03. Communication by Holders with Other Holders 55
      Section 9.04. Certificate and Opinion as to Conditions
                    Precedent.................................. 55
      Section 9.05. Statements Required in Certificate or
                    Opinion.................................... 55
      Section 9.06. Rules by Trustee and Agents................ 56
      Section 9.07. Legal Holidays............................. 56
      Section 9.08. No Personal Liability of Directors,
                    Officer Employees Shareholders............. 56
      Section 9.09. Duplicate Originals........................ 56
      Section 9.10. Governing Law.............................. 57
      Section 9.11. No Adverse Interpretation of Other
                    Agreements................................. 57
      Section 9.12. Successors................................. 57
      Section 9.13. Severability............................... 57

                                        iii

<PAGE>

                                                              Page

      Section 9.14. Counterpart Originals...................... 57
      Section 9.15. Table of Contents, Headings, etc........... 57

EXHIBITS

      Exhibit A     FORM OF SECURITY............................ A
      Exhibit B     FORM OF SUPPLEMENTAL INDENTURE.............. B

                                        iv

<PAGE>

                                                                     EXHIBIT B

                       FORM OF SUPPLEMENTAL INDENTURE

      SUPPLEMENTAL INDENTURE (this "Supplemental Indenture"), dated as of
________________, between __________________ (the "Guarantor"), a subsidiary of
National Medical Enterprises, Inc. (or its successor), a Nevada corporation (the
"Company"), and The Bank of New York, as trustee under the indenture referred to
below (the "Trustee").

                              W I T N E S S E T H

      WHEREAS, the Company has heretofore executed and delivered to the Trustee
an indenture (the "Indenture"), dated as of March 1, 1995, providing for the
issuance of an aggregate principal amount of $300,000,000 of 9-5/8% Senior Notes
due 2002 (the "Securities");

      WHEREAS, Section 3.16 of the Indenture provides that under certain
circumstances the Company is required to cause the Guarantor to execute and
deliver to the Trustee a supplemental indenture pursuant to which the Guarantor
shall guarantee the payment of the Securities pursuant to a Guarantee on the
terms and conditions set forth herein; and

      WHEREAS, pursuant to Section 8.01 of the Indenture, the Trustee is
authorized to execute and deliver this Supplemental Indenture.

      NOW THEREFORE, in consideration of the foregoing and for other good and
valuable consideration, the receipt of which is hereby acknowledged, the
Guarantor and the Trustee mutually covenant and agree for the equal and ratable
benefit of the holders of the Securities as follows:

      1.    CAPITALIZED TERMS.  Capitalized terms used herein without definition
shall have the meanings assigned to them in the Indenture.

      2.    AGREEMENT TO GUARANTEE.  The Guarantor hereby unconditionally
guarantees to each Holder of a Security authenticated and delivered by the
Trustee and to the Trustee and its successors and assigns, irrespective of the
validity and enforceability of the Indenture, the Securities or the Obligations
of the Company hereunder and thereunder, that: (a) the principal of, premium, if
any, and interest on the Securities will be promptly paid in full when due,
whether at maturity, by acceleration, redemption or otherwise, and interest on
the overdue principal, premium, if any, and (to the extent permitted by law)
interest on any interest on the Securities and all other payment Obligations of
the Company to the Holders or the Trustee hereunder or thereunder will be
promptly paid in full, all in accordance with the terms hereof and thereof; and
(b) in case of any extension of time of payment or renewal of any Securities or
any of such other payment Obligations, that same will be promptly paid in full
when due or performed in accordance with the terms of the extension or renewal,
whether at stated maturity,

                                        B-1

<PAGE>

by acceleration, redemption or otherwise.  Failing payment when due of any
amount so guaranteed for whatever reason the Guarantor shall be obligated to pay
the same immediately.  An Event of Default under the Indenture or the Securities
shall constitute an event of default under this Guarantee, and shall entitle the
Holders of Securities to accelerate the Obligations of the Guarantor hereunder
in the same manner and to the same extent as the Obligations of the Company.
The Guarantor hereby agrees that its Obligations hereunder shall be
unconditional, irrespective of the validity, regularity or enforceability of the
Securities or the Indenture, the absence of any action to enforce the same, any
waiver or consent by any Holder of the Securities with respect to any provisions
hereof or thereof, the recovery of any judgment against the Company, any action
to enforce the same or any other circumstance which might otherwise constitute a
legal or equitable discharge or defense of the Guarantor.  The Guarantor hereby
waives diligence, presentment, demand of payment, filing of claims with a court
in the event of insolvency or bankruptcy of the Company, any right to require a
proceeding first against the Company, protest, notice and all demands whatsoever
and covenant that this Guarantee will not be discharged except by complete
performance of the Obligations contained in the Securities and the Indenture.
If any Holder or the Trustee is required by any court or otherwise to return to
the Company, the Guarantor, or any Custodian, Trustee, liquidator or other
similar official acting in relation to either the Company or the Guarantor, any
amount paid by either to the Trustee or such Holder, this Guarantee, to the
extent theretofore discharged, shall be reinstated in full force and effect.
The Guarantor agrees that it shall not be entitled to, and hereby waives, any
right of subrogation in relation to the Holders in respect of any Obligations
guaranteed hereby.  The Guarantor further agrees that, as between the Guarantor,
on one hand, and the Holders and the Trustee, on the other hand, (x) the
maturity of the Obligations guaranteed hereby may be accelerated as provided in
Article 5 of the Indenture for the purposes of this Guarantee, notwithstanding
any stay, injunction or other prohibition preventing such acceleration in
respect of the Obligations guaranteed hereby, and (y) in the event of any
declaration of acceleration of such Obligations as provided in Article 5 of the
Indenture, such Obligations (whether or not due and payable) shall forthwith
become due and payable by the Guarantor for the purpose of this Guarantee.

      3.    EXECUTION AND DELIVERY OF GUARANTEE.  To evidence its Guarantee set
forth in Section 2, the Guarantor hereby agrees that a notation of such
Guarantee substantially in the form of EXHIBIT A shall be endorsed by an
officer of such Guarantor on each Security authenticated and delivered by the
Trustee and that this Supplemental Indenture shall be executed on behalf of such
Guarantor, by manual or facsimile signature, by its President or one of its Vice
Presidents.

            The Guarantor hereby agrees that its Guarantee set forth in Section
2 shall remain in full force and effect notwithstanding any failure to endorse
on each Security a notation of such Guarantee.

            If an Officer whose signature is on this Supplemental Indenture or
on the Guarantee no longer holds that office at the time the Trustee
authenticates the Security on which a Guarantee is endorsed, the Guarantee shall
be valid nevertheless.

                                        B-2

<PAGE>

            The delivery of any Security by the Trustee, after the
authentication thereof hereunder, shall constitute due delivery of the Guarantee
set forth in this Indenture on behalf of the Guarantors.

      4.    GUARANTORS MAY CONSOLIDATE, ETC. ON CERTAIN TERMS.

            (a)   Except as set forth in Articles 3 and 4 of the Indenture,
nothing contained in this Supplemental Indenture or in the Securities shall
prevent any consolidation or merger of the Guarantor with or into the Company or
any Subsidiary of the Company that has executed and delivered a supplemental
indenture substantially in the form hereof or shall prevent any sale or
conveyance of the property of the Guarantor as an entirety or substantially as
an entirety, to the Company or any such Subsidiary of the Company.

            (b)   Except as provided in Section 4(a) hereof or in a transaction
referred to in Section 5 hereof, the Guarantor shall not consolidate with or
merge with or into, or sell, assign, transfer, lease, convey or otherwise
dispose of all or substantially all of its assets to, another Person unless (1)
either (x) the Guarantor shall be the surviving Person of such merger or
consolidation or (y) the surviving Person or transferee is a corporation,
partnership or trust organized and existing under the laws of the United States,
any state thereof or the District of Columbia and such surviving Person or
transferee shall expressly assume all the obligations of the Guarantor under
this Guarantee and the Indenture pursuant to a supplemental indenture
substantially in the form  hereof; (2) immediately after giving effect to such
transaction (including the incurrence of any Indebtedness incurred or
anticipated to be incurred in connection with such transaction) no Default or
Event of Default shall have occurred and be continuing; and (3) the Company has
delivered to the Trustee an Officers' Certificate and Opinion of Counsel, each
stating that such consolidation, merger or transfer complies with the Indenture,
that the surviving Person agrees to be bound thereby, and that all conditions
precedent in the Indenture relating to such transaction have been satisfied.
For purposes of the foregoing, the transfer (by lease, assignment, sale or
otherwise, in a single transaction or series of related transactions) of all or
substantially all of the properties and assets of one or more Subsidiaries of
the Guarantor, the Capital Stock of which constitutes all or substantially all
of the properties and assets of the Guarantor, shall be deemed to be the
transfer of all or substantially all of the properties and assets of the
Guarantor.

            Upon any consolidation or merger, or any sale, assignment, transfer,
lease, conveyance or other disposition of all or substantially all of the assets
of the Guarantor in accordance with this Section 4(b) hereof, the successor
corporation shall succeed to and be substituted for the Guarantor with the same
effect as if it had been named herein as a Guarantor.  Such successor
corporation thereupon may cause to be signed any or all of the Guarantees to be
endorsed upon all of the Securities issuable hereunder which theretofore shall
not have been signed by the Company and delivered to the Trustee.  All
Guarantees so issued shall in all respects have the same legal rank and benefit
under the Indenture as the Guarantees theretofore and thereafter issued in
accordance with the terms of the Indenture as though all of such Guarantees had
been issued at the date of the execution hereof.

                                        B-3

<PAGE>

      5.    RELEASES FOLLOWING SALE OF ASSETS.  Concurrently with any sale,
lease, conveyance or other disposition (by merger, consolidation or otherwise)
of assets of the Guarantor (including, if applicable, disposition of all of the
Capital Stock of the Guarantor), any Liens in favor of the Trustee in the assets
sold, leased, conveyed or otherwise disposed of shall be released; PROVIDED
that in the event of an Asset Sale, such Asset Sale is effected, and the Net
Proceeds therefrom are applied, in accordance with Section 3.10 of the
Indenture.  If the assets sold, leased, conveyed or otherwise disposed of (by
merger, consolidation or otherwise) include all or substantially all of the
assets of the Guarantor or all of the Capital Stock of the Guarantor in each
case, in compliance with the terms of the Indenture, then the Guarantor shall be
automatically and unconditionally released from and relieved of its Obligations
under its Guarantee; PROVIDED that in the event of an Asset Sale, such Asset
Sale is effected, and the Net Proceeds therefrom are applied, in accordance with
Section 3.10 of the Indenture.  Upon delivery by the Company to the Trustee of
an Officers' Certificate to the effect that such sale, lease, conveyance or
other disposition was made by the Company in accordance with the provisions of
the Indenture, including without limitation of Section 3.10 thereof, if
applicable, the Trustee shall execute any documents reasonably required in order
to evidence the release of the Guarantor from its Obligations under its
Guarantee.

            Nothing herein shall relieve the Company from its obligation to
apply the proceeds of any Asset Sale as provided in Section 3.10 of the
Indenture.

      6.    LIMITATION ON GUARANTOR LIABILITY.  For purposes hereof, the
Guarantor's liability will be that amount from time to time equal to the
aggregate liability of the Guarantor hereunder, but shall be limited to the
lesser of (i) the aggregate amount of the Obligations of the Company under the
Securities and the Indenture and (ii) the amount, if any, which would not have
(a) rendered the Guarantor "insolvent" (as such term is defined in the federal
Bankruptcy Law and in the Debtor and Creditor Law of the State of New York) or
(b) left it with unreasonably small capital at the time its Guarantee of the
Securities was entered into, after giving effect to the incurrence of existing
Indebtedness immediately prior to such time; PROVIDED that it shall be a
presumption in any lawsuit or other proceeding in which the Guarantor is a party
that the amount guaranteed pursuant to its Guarantee is the amount set forth in
clause (i) above unless any creditor, or representative of creditors of the
Guarantor, or debtor in possession or trustee in bankruptcy of the Guarantor,
otherwise proves in such a lawsuit that the aggregate liability of the Guarantor
is limited to the amount set forth in clause (ii).  In making any determination
as to the solvency or sufficiency of capital of the Guarantor in accordance with
the previous sentence, the right of the Guarantor to contribution from other
Subsidiaries of the Company that have executed and delivered a supplemental
indenture substantially in the form hereof and any other rights the Guarantor
may have, contractual or otherwise, shall be taken into account.

      7.    "TRUSTEE" TO INCLUDE PAYING AGENT.  In case at any time any Paying
Agent other than the Trustee shall have been appointed by the Company and be
then acting under the Indenture, the term "Trustee" as used in this Supplemental
Indenture shall in each case (unless the context shall otherwise require) be
construed as extending to and including such Paying Agent within its meaning as
fully and for all intents and purposes as if such Paying Agent were named in
this Supplemental Indenture in place of the Trustee.

                                        B-4

<PAGE>

      8.    NO RECOURSE AGAINST OTHERS.  No director, officer, employee,
incorporator or stockholder of the Guarantor, as such, shall have any liability
for any obligations of the Company or the Guarantor under the Securities, any
Guarantees, the Indenture or this Supplemental Indenture or for any claim based
on, in respect of, or by reason of, such obligations or their creation.  Each
Holder of the Securities by accepting a Security waives and releases all such
liability.  The waiver and release are part of the consideration for issuance of
the Securities.  Such waiver may not be effective to waive liabilities under the
federal securities laws and it is the view of the Commission that such a waiver
is against public policy.

      9.    NEW YORK LAW TO GOVERN.  The internal law of the State of New York
shall govern and be used to construe this Supplemental Indenture.

      10.   COUNTERPARTS.  The parties may sign any number of copies of this
Supplemental Indenture.  Each signed copy shall be an original, but all of them
together represent the same agreement.

      11.   EFFECT OF HEADINGS.  The Section headings herein are for convenience
only and shall not affect the construction hereof.

IN WITNESS WHEREOF, the parties hereto have caused this Supplemental Indenture
to be duly executed and attested, all as of the date first above written.

Dated:  _________________ ___, ____

[Guarantor]

By:  ______________________________
Name:
Title:

The Bank of New York,
      as Trustee

By:  ______________________________
Name:
Title:

                                       B-5

<PAGE>

                      EXHIBIT A TO SUPPLEMENTAL INDENTURE

                                   GUARANTEE

            The Guarantor hereby unconditionally guarantees to each Holder of a
Security authenticated and delivered by the Trustee and to the Trustee and its
successors and assigns, irrespective of the validity and enforceability of the
Indenture, the Securities or the Obligations of the Company to the Holders or
the Trustee under the Securities or under the Indenture, that: (a) the principal
of, and premium, if any, and interest on the Securities will be promptly paid in
full when due, whether at maturity, by acceleration, redemption or otherwise,
and interest on overdue principal, premium, if any, and (to the extent permitted
by law) interest on any interest on the Securities and all other payment
Obligations of the Company to the Holders or the Trustee under the Indenture or
under the Securities will be promptly paid in full, all in accordance with the
terms thereof; and (b) in case of any extension of time of payment or renewal of
any Securities or any of such other payment Obligations, the same will be
promptly paid in full when due in accordance with the terms of the extension or
renewal, whether at stated maturity, by acceleration, redemption  or otherwise.
Failing payment when due of any amount so guaranteed, for whatever reason, the
Guarantor shall be obligated to pay the same immediately.

            The obligations of the Guarantor to the Holders of Securities and to
the Trustee pursuant to this Guarantee and the Indenture are expressly set forth
in a Supplemental Indenture, dated as of _________ __, ____ to the Indenture,
and reference is hereby made to the Indenture, as supplemented, for the precise
terms of this Guarantee.

            This is a continuing Guarantee and shall remain in full force and
effect and shall be binding upon the Guarantor and its respective successors and
assigns to the extent set forth in the Indenture until full and final payment of
all of the Company's Obligations under the Securities and the Indenture and
shall inure to the benefit of the successors and assigns of the Trustee and the
Holders of Securities and, in the event of any transfer or assignment of rights
by any Holder of Securities or the Trustee, the rights and privileges herein
conferred upon that party shall automatically extend to and be vested in such
transferee or assignee, all subject to the terms and conditions hereof.  This a
Guarantee of payment and not a guarantee of collection.

            This Guarantee shall not be valid or obligatory for any purpose
until the certificate of authentication on the Security upon which this
Guarantee is noted shall have been executed by the Trustee under the Indenture
by the manual signature of one of its authorized signatories.

            For purposes hereof, the Guarantor's liability will be that amount
from time to time equal to the aggregate liability of the Guarantor hereunder,
but shall be limited to the lesser of (i) the aggregate amount of the
Obligations of the Company under the Securities and the Indenture and (ii) the
amount, if any, which would not have (a) rendered the Guarantor "insolvent" (as
such term is defined in the federal Bankruptcy Law and in the Debtor and
Creditor Law of the State of New York) or (b) left it with unreasonably small
capital at the time its Guarantee of the Securities was entered into, after
giving effect to the incurrence of existing

                                       B-6

<PAGE>

Indebtedness immediately prior to such time; PROVIDED that it shall be a
presumption in any lawsuit or other proceeding in which the Guarantor is a party
that the amount guaranteed pursuant to its Guarantee is the amount set forth in
clause (i) above unless any creditor, or representative of creditors of the
Guarantor, or debtor in possession or trustee in bankruptcy of the Guarantor,
otherwise proves in such a lawsuit that the aggregate liability of the Guarantor
is limited to the amount set forth in clause (ii).  The Indenture provides that,
in making any determination as to the solvency or sufficiency of capital of a
Guarantor in accordance with the previous sentence, the right of the Guarantor
to contribution from other Subsidiaries of the Company that have become
Guarantors and any other rights the Guarantor may have, contractual or
otherwise, shall be taken into account.

            Capitalized terms used herein have the same meanings given in the
Indenture unless otherwise indicated.

                                    [GUARANTOR]

                                    By:_________________________
                                        Name:
                                        Title:

                                     B-7<PAGE>

                                                                  Exhibit 4(d)

            INDENTURE dated as of March 1, 1995 between National Medical
Enterprises, Inc., a Nevada corporation (the "COMPANY"), and The Bank of New
York, as trustee (the "TRUSTEE").

            The Company and the Trustee agree as follows for the benefit of each
other and for the equal and ratable benefit of the Holders of the 10 1/8% Senior
Subordinated Notes due 2005 (the "SECURITIES"):

                                   ARTICLE 1
                         DEFINITIONS AND INCORPORATION
                                 BY REFERENCE

SECTION 1.01.    DEFINITIONS.

            "ACQUIRED DEBT" means, with respect to any specified Person, (i)
Indebtedness of any other Person existing at the time such other Person is
merged with or into or became a Subsidiary of such specified Person, including,
without limitation, Indebtedness incurred in connection with, or in
contemplation of, such other Person merging with or into or becoming a
Subsidiary of such specified Person, and (ii) Indebtedness secured by a Lien
encumbering any asset acquired by such specified Person.

            "AFFILIATE" of any specified Person means any other Person
directly or indirectly controlling or controlled by or under direct or indirect
common control with such specified Person.  For purposes of this definition,
"control" (including, with correlative meanings, the terms "controlling,"
"controlled by" and "under common control with"), as used with respect to any
Person, shall mean the possession, directly or indirectly, of the power to
direct or cause the direction of the management or policies of such Person,
whether through the ownership of voting securities, by agreement or otherwise;
PROVIDED that beneficial ownership of 10% or more of the voting securities of
a Person shall be deemed to be control.

            "AGENT" means any Registrar, Paying Agent or co-registrar.

            "ASSET SALE" means (i) the sale, lease, conveyance or other
disposition of any assets (including, without limitation, by way of a sale and
leaseback) other than in the ordinary course of business consistent with past
practices (PROVIDED that the sale, lease, conveyance or other disposition of
all or substantially all of the assets of the Company and its Subsidiaries taken
as a whole shall be governed by Section 4.13 and/or Article 5 hereof and not by
Section 4.10 hereof), and (ii) the issuance or sale by the Company or any of its
Subsidiaries of Equity Interests of any of the Company's Subsidiaries, in the
case of either clause (i) or (ii), whether in a single transaction or a series
of related transactions (a) that have a fair market value in excess of $25.0
million or (b) for net proceeds in excess of $25.0 million.  Notwithstanding the
foregoing:  (a) a transfer of assets by the Company to a Subsidiary or by a
Subsidiary to the Company or to another Subsidiary, (b) an issuance of Equity
Interests by a Subsidiary to the Company or to another Subsidiary, (c) a
Restricted Payment that is permitted by Section 4.07 hereof and (d) a Hospital
Swap shall not be deemed to be an Asset Sale.

<PAGE>

            "BOARD OF DIRECTORS" means the Board of Directors of the Company
or any authorized committee thereof.

            "BUSINESS DAY" means any day other than a Legal Holiday.

            "CAPITAL LEASE" means, at the time any determination thereof is to
be made, any lease of property, real or personal, in respect of which the
present value of the minimum rental commitment would be capitalized on a balance
sheet of the lessee in accordance with GAAP.

            "CAPITAL LEASE OBLIGATION" means, at the time any determination
thereof is to be made, the amount of the liability in respect of a Capital Lease
that would at such time be required to be capitalized on a balance sheet in
accordance with GAAP.

            "CAPITAL STOCK" means (i) in the case of a corporation, corporate
stock, (ii) in the case of an association or business entity, any and all
shares, interests, participations, rights or other equivalents (however
designated) of corporate stock, (iii) in the case of a partnership, partnership
interests (whether general or limited) and (iv) any other interest or
participation that confers on a Person the right to receive a share of the
profits and losses of, or distributions of assets of, the issuing Person.

            "CHANGE OF CONTROL" means the occurrence of any of the following:
(i) the sale, lease, transfer, conveyance or other disposition, in one or a
series of related transactions, of all or substantially all of the assets of the
Company and its Subsidiaries taken as a whole to any Person or group (as such
term is used in Sections 13(d)(3) and 14(d)(2) of the Exchange Act), other than
to a Person or group who, prior to such transaction, held a majority of the
voting power of the voting stock of the Company, (ii) the acquisition by any
Person or group, as defined above, of a direct or indirect interest in more than
50% of the voting power of the voting stock of the Company, by way of merger,
consolidation or otherwise, or (iii) the first day on which a majority of the
members of the Board of Directors of the Company are not Continuing Directors.

            "CHANGE OF CONTROL TRIGGERING EVENT" means the occurrence of both
a Change of Control and a Rating Decline.

            "COMMISSION" means the Securities and Exchange Commission.

            "COMPANY" means National Medical Enterprises, Inc., as obligor
under the Securities, unless and until a successor replaces National Medical
Enterprises, Inc., in accordance with Article 5 hereof and thereafter includes
such successor.

            "CONSOLIDATED CASH FLOW" means, with respect to any Person for any
period, the Consolidated Net Income of such Person for such period PLUS (i) an
amount equal to any extraordinary loss of such Person PLUS any net loss
realized in connection with an Asset Sale (to the extent such losses were
deducted in computing such Consolidated Net Income), PLUS (ii) provision for
taxes based on income or profits of such Person and its Subsidiaries for such
period, to the extent such provision for taxes was included in computing such
Consolidated Net

                                        2

<PAGE>

Income, PLUS (iii) the Fixed Charges of such Person and its Subsidiaries for
such period, to the extent that such Fixed Charges were deducted in computing
such Consolidated Net Income, PLUS (iv) depreciation and amortization
(including amortization of goodwill and other intangibles but excluding
amortization of prepaid cash expenses that were paid in a prior period) of such
Person and its Subsidiaries for such period to the extent that such depreciation
and amortization were deducted in computing such Consolidated Net Income, in
each case, on a consolidated basis and determined in accordance with GAAP.
Notwithstanding the foregoing, the provision for taxes on the income or profits
of, and the depreciation and amortization of, a Subsidiary of the referent
Person shall be added to Consolidated Net Income to compute Consolidated Cash
Flow only to the extent (and in same proportion) that the Net Income of such
Subsidiary was included in calculating the Consolidated Net Income of such
Person and only if a corresponding amount would be permitted at the date of
determination to be dividended to the Company by such Subsidiary without prior
approval (that has not been obtained), pursuant to the terms of its charter and
all agreements, instruments, judgments, decrees, orders, statutes, rules and
governmental regulations applicable to that Subsidiary or its stockholders.

            "CONSOLIDATED NET INCOME" means, with respect to any Person for
any period, the aggregate of the Net Income of such Person and its Subsidiaries
for such period, on a consolidated basis, determined in accordance with GAAP but
excluding any one-time charge or expense incurred in order to consummate the
Refinancing; PROVIDED that (i) the Net Income of any Person that is not a
Subsidiary or that is accounted for by the equity method of accounting shall be
included only to the extent of the amount of dividends or distributions paid in
cash to the referent Person or a Wholly Owned Subsidiary thereof, (ii) the Net
Income of any Subsidiary shall be excluded to the extent that the declaration or
payment of dividends or similar distributions by that Subsidiary of that Net
Income is not at the date of determination permitted without any prior
governmental approval (that has not been obtained) or, directly or indirectly,
by operation of the terms of its charter or any agreement, instrument, judgment,
decree, order, statute, rule or governmental regulation applicable to that
Subsidiary or its stockholders, (iii) the Net Income of any Person acquired in a
pooling of interests transaction for any period prior to the date of such
acquisition shall be excluded and (iv) the cumulative effect of a change in
accounting principles shall be excluded.

            "CONSOLIDATED NET WORTH" means, with respect to any Person as of
any date, the sum of (i) the consolidated equity of the common stockholders of
such Person and its consolidated Subsidiaries as of such date PLUS (ii) the
respective amounts reported on such Person's balance sheet as of such date with
respect to any series of preferred stock (other than Disqualified Stock), LESS
all write-ups (other than write-ups resulting from foreign currency translations
and write-ups of tangible assets of a going concern business made in accordance
with GAAP as a result of the acquisition of such business) subsequent to the
date hereof in the book value of any asset owned by such Person or a
consolidated Subsidiary of such Person, and excluding the cumulative effect of a
change in accounting principles, all as determined in accordance with GAAP.

            "CONTINUING DIRECTORS" means, as of any date of determination, any
member of the Board of Directors of the Company who (i) was a member of such
Board of Directors on the date hereof or (ii) was nominated for election or
elected to such Board of Directors with the

                                        3

<PAGE>

approval of a majority of the Continuing Directors who were members of such
Board at the time of such nomination or election.

            "CORPORATE TRUST OFFICE OF THE TRUSTEE" shall be at the address of
the Trustee specified in Section 11.02 hereof or such other address as to which
the Trustee may give notice to the Company.

            "DEFAULT" means any event that is or with the passage of time or
the giving of notice or both would be an Event of Default.

            "DISQUALIFIED STOCK" means any Capital Stock that, by its terms
(or by the terms of any security into which it is convertible or for which it is
exchangeable), or upon the happening of any event, matures or is mandatorily
redeemable, pursuant to a sinking fund obligation or otherwise, or redeemable at
the option of the Holder thereof, in whole or in part, on or prior to March 1,
2005.

            "EQUITY INTERESTS" means Capital Stock and all warrants, options
or other rights to acquire Capital Stock (but excluding any debt security that
is convertible into, or exchangeable for, Capital Stock).

            "EXCHANGE ACT" means the Securities Exchange Act of 1934, as
amended.

            "EXISTING INDEBTEDNESS" means Indebtedness of the Company and its
Subsidiaries (other than Indebtedness under the New Credit Facility) in
existence on the date hereof, until such amounts are repaid, including all
reimbursement obligations with respect to letters of credit outstanding as of
the date hereof (other than letters of credit issued pursuant to the New Credit
Facility).

            "FIXED CHARGE COVERAGE RATIO" means with respect to any Person for
any period, the ratio of the Consolidated Cash Flow of such Person for such
period to the Fixed Charges of such Person for such period; PROVIDED, HOWEVER,
that in the event that the Company or any of its Subsidiaries incurs, assumes,
Guarantees or redeems any Indebtedness (other than revolving credit borrowings)
or issues preferred stock subsequent to the commencement of the period for which
the Fixed Charge Coverage Ratio is being calculated but prior to the date on
which the event for which the calculation of the Fixed Charge Coverage Ratio is
made (the "CALCULATION DATE"), then the Fixed Charge Coverage Ratio shall be
calculated giving pro forma effect to such incurrence, assumption, Guarantee or
redemption of Indebtedness, or such issuance or redemption of preferred stock,
as if the same had occurred at the beginning of the applicable four-quarter
reference period; and PROVIDED FURTHER that for purposes of making the
computation referred to above, (i) acquisitions that have been made by the
Company or any of its Subsidiaries, including through mergers or consolidations
and including any related financing transactions, during the four-quarter
reference period or subsequent to such reference period and on or prior to the
Calculation Date shall be deemed to have occurred on the first day of the
four-quarter reference period, and (ii) the Consolidated Cash Flow and Fixed
Charges attributable to discontinued operations, as determined in accordance
with GAAP, and operations or businesses disposed of prior to the Calculation
Date, shall be excluded.

                                        4

<PAGE>

            "FIXED CHARGES" means, with respect to any Person for any period,
the sum of (i) the consolidated interest expense of such Person and its
Subsidiaries for such period, whether paid or accrued (including, without
limitation, amortization of original issue discount, non-cash interest payments,
the interest component of any deferred payment obligations, the interest
component of all payments associated with Capital Lease Obligations,
commissions, discounts and other fees and charges incurred in respect of letters
of credit or bankers' acceptance financings, and net payments (if any) pursuant
to Hedging Obligations) and (ii) the consolidated interest expense of such
Person and its Subsidiaries that was capitalized during such period, and (iii)
any interest expense on Indebtedness of another Person that is Guaranteed by
such Person or one of its Subsidiaries or secured by a Lien on assets of such
Person or one of its Subsidiaries (whether or not such Guarantee or Lien is
called upon) and (iv) the product of (a) all cash dividend payments (and
non-cash dividend payments in the case of a Person that is a Subsidiary) on any
series of preferred stock of such Person, TIMES (b) a fraction, the numerator
of which is one and the denominator of which is one minus the then current
combined federal, state and local statutory tax rate of such Person, expressed
as a decimal, in each case, on a consolidated basis and in accordance with GAAP.

            "GAAP" means generally accepted accounting principles set forth in
the opinions and pronouncements of the Accounting Principles Board of the
American Institute of Certified Public Accountants and statements and
pronouncements of the Financial Accounting Standards Board or in such other
statements by such other entity as have been approved by a significant segment
of the accounting profession, as in effect from time to time.

            "GOVERNMENT SECURITIES" means direct obligations of, or
obligations guaranteed by, the United States of America for the payment of which
guarantee or obligations the full faith and credit of the United States is
pledged.

            "GUARANTEE" means a guarantee (other than by endorsement of
negotiable instruments for collection in the ordinary course of business),
direct or indirect, in any manner (including, without limitation, letters of
credit and reimbursement agreements in respect thereof), of all or any part of
any Indebtedness.

            "HEDGING OBLIGATIONS" means, with respect to any Person, the
obligations of such Person under (i) interest rate swap agreements, interest
rate cap agreements and interest rate collar agreements, (ii) foreign exchange
contracts or currency swap agreements and (iii) other agreements or arrangements
designed to protect such Person against fluctuations in interest rates or
currency values.

            "HOLDER" means a Person in whose name a Security is registered.

            "HOSPITAL" means a hospital, outpatient clinic, long-term care
facility or other facility that is used or useful in the provision of healthcare
services.

            "HOSPITAL SWAP" means an exchange of assets by the Company or a
Subsidiary of the Company for one or more Hospitals and/or one or more Related
Businesses or for the

                                        5

<PAGE>

Capital Stock of any Person owning one or more Hospitals and/or one or more
Related Businesses.

            "INDEBTEDNESS" means with respect to any Person, any indebtedness
of such Person, whether or not contingent, in respect of borrowed money or
evidenced by bonds, notes, debentures or similar instruments or letters of
credit (or reimbursement agreements in respect thereof) or banker's acceptances
or representing Capital Lease Obligations or the balance deferred and unpaid of
the purchase price of any property or representing any Hedging Obligations,
except any such balance that constitutes an accrued expense or trade payable, if
and to the extent any of the foregoing indebtedness (other than letters of
credit and Hedging Obligations) would appear as a liability upon a balance sheet
of such Person prepared in accordance with GAAP, as well as all indebtedness of
others secured by a Lien on any asset of such Person (whether or not such
indebtedness is assumed by such Person) and, to the extent not otherwise
included, the Guarantee by such Person of any indebtedness of any other Person.

            "INDENTURE" means this Indenture, as amended or supplemented from
time to time.

            "INTERNATIONAL SUBSIDIARIES" means International-NME, Inc., NME
(Australia) Pty. Limited, and National Medical Enterprises Corp., and each of
such Person's respective Subsidiaries.

            "INVESTMENT GRADE" means a rating of BBB- or higher by S&P or Baa3
or higher by Moody's or the equivalent of such ratings by S&P or Moody's.  In
the event that the Company shall select any other Rating Agency, the equivalent
of such ratings by such Rating Agency shall be used.

            "INVESTMENTS" means, with respect to any Person, all investments
by such Person in other Persons (including Affiliates) in the form of direct or
indirect loans (including Guarantees of Indebtedness or other obligations),
advances or capital contributions, purchases or other acquisitions for
consideration of Indebtedness, Equity Interests or other securities and all
other items that are or would be classified as investments on a balance sheet
prepared in accordance with GAAP; PROVIDED that an acquisition of assets,
Equity Interests or other securities by the Company for consideration consisting
of common equity securities of the Company shall not be deemed to be an
Investment.

            "LIEN" means, with respect to any asset, any mortgage, lien,
pledge, charge, security interest or encumbrance of any kind in respect of such
asset given to secure Indebtedness, whether or not filed, recorded or otherwise
perfected under applicable law (including any conditional sale or other title
retention agreement, any lease in the nature thereof, any option or other
agreement to sell or give a security interest in and any filing of or agreement
to give any financing statement under the Uniform Commercial Code (or equivalent
statutes) of any jurisdiction with respect to any such lien, pledge, charge or
security interest).

            "METROCREST LETTER OF CREDIT FACILITY" means that certain letter
of credit facility, dated as of February 28, 1995, by and among the Company and
Morgan Guaranty Trust Company of New York and the other banks that are party
thereto, in an aggregate principal amount of $91.35 million.

                                        6

<PAGE>

            "MOODY'S" means Moody's Investors Services, Inc. and its
successors.

            "NET INCOME" means, with respect to any Person, the net income
(loss) of such Person, determined in accordance with GAAP and before any
reduction in respect of preferred stock dividends, excluding, however, (i) any
gain (but not loss), together with any related provision for taxes on such gain
(but not loss), realized in connection with (a) any Asset Sale (including,
without limitation, dispositions pursuant to sale and leaseback transactions) or
(b) the disposition of any securities by such Person or any of its Subsidiaries
or the extinguishment of any Indebtedness of such Person or any of its
Subsidiaries, and (ii) any extraordinary or nonrecurring gain (but not loss),
together with any related provision for taxes on such extraordinary or
nonrecurring gain (but not loss).

            "NET PROCEEDS" means the aggregate cash proceeds received by the
Company or any of its Subsidiaries in respect of any Asset Sale (including,
without limitation, any cash received upon the sale or other disposition of any
permitted Non-Cash Consideration received in any Asset Sale), net of the direct
costs relating to such Asset Sale (including, without limitation, legal,
accounting and investment banking fees and sales commissions) and any other
expenses incurred or to be incurred by the Company or a Subsidiary as a direct
result of the sale of such assets (including, without limitation, severance,
relocation, lease termination and other similar expenses), taxes actually paid
or payable as a result thereof, amounts required to be applied to the repayment
of Indebtedness (other than Senior Term Debt or Senior Revolving Debt) secured
by a Lien on the asset or assets that were the subject of such Asset Sale and
any reserve for adjustment in respect of the sale price of such asset or assets
established in accordance with GAAP.

            "NEW CREDIT FACILITY" means that certain Credit Agreement, dated
as of February 28, 1995, by and among the Company and Morgan Guaranty Trust
Company of New York and the other banks that are party thereto, providing for
$1.8 billion in aggregate principal amount of Senior Term Debt and up to $500.0
million in aggregate principal amount of Senior Revolving Debt, including any
related notes, collateral documents, instruments and agreements executed in
connection therewith, and in each case as amended, modified, extended, renewed,
refunded, replaced or refinanced, in whole or in part, from time to time.

            "NON-CASH CONSIDERATION" means any non-cash consideration received
by the Company or a Subsidiary of the Company in connection with an Asset Sale
and any non-cash consideration received by the Company or any of its
Subsidiaries upon disposition thereof.

            "NON-RECOURSE DEBT" means Indebtedness of an International
Subsidiary (i) as to which neither the Company nor any of its Subsidiaries
(other than the International Subsidiaries) (a) provides credit support of any
kind (including any undertaking, agreement or instrument that would constitute
Indebtedness of the Company or any of its Subsidiaries), or (b) is directly or
indirectly liable (as a guarantor or otherwise) and (ii) no default with respect
to which (including any rights that the holders thereof may have to take
enforcement action against an International Subsidiary) would permit (upon
notice, lapse of time or both) any holder of any other Indebtedness of the
Company or any of its Subsidiaries (other than the International Subsidiaries)
to declare a default on such other Indebtedness or cause the payment thereof to
be accelerated

                                        7

<PAGE>

or payable prior to its stated maturity (except any such provisions set forth in
Existing Indebtedness until the same is repaid or refinanced).

            "OBLIGATIONS" means any principal, interest, penalties, fees,
indemnifications, reimbursements, damages and other liabilities payable under
the documentation governing any Indebtedness.

            "OFFICERS" means the Chairman of the Board, the Chief Executive
Officer, the President, the Chief Operating Officer, the Chief Financial
Officer, the Treasurer, any Assistant Treasurer, the Controller, the Secretary
and any Vice President of the Company or any Subsidiary, as the case may be.

            "OFFICERS' CERTIFICATE" means a certificate signed by two
Officers, one of whom must be the principal executive officer, principal
financial officer or principal accounting officer of the Company.

            "OPINION OF COUNSEL" means an opinion from legal counsel who is
reasonably acceptable to the Trustee.  The counsel may be an employee of or
counsel to the Company, any Subsidiary or the Trustee.

            "PERFORMANCE INVESTMENT PLAN" means the 1989 Performance
Investment Plan adopted by the Company's Board of Directors on March 10, 1989.

            "PERMITTED COLLATERAL" means, collectively, (i) all Capital Stock
and other Equity Interests of the Company's present and future direct
Subsidiaries, (ii) all intercompany Indebtedness owed to the Company and (iii)
all Capital Stock and other Equity Interests in Westminster Health Care Holdings
PLC owned by the Company or its Subsidiaries.

            "PERMITTED LIENS" means (i) Liens on Permitted Collateral securing
Senior Term Debt of the Company under the New Credit Facility in an aggregate
principal amount at any time outstanding not to exceed an amount equal to $1.8
billion less the aggregate amount of all repayments, optional or mandatory, of
the principal of any Senior Term Debt (other than repayments that are
immediately reborrowed) that have been made since the date hereof; (ii) Liens on
Permitted Collateral securing Senior Revolving Debt and letters of credit of the
Company incurred pursuant to the New Credit Facility in an aggregate principal
amount at any time outstanding (with letters of credit being deemed to have a
principal amount equal to the maximum potential reimbursement obligation of the
Company with respect thereto) not to exceed an amount equal to $500.0 million
less the aggregate amount of all Net Proceeds of Asset Sales applied to
permanently reduce commitments with respect to such Indebtedness pursuant to
Section 4.10 hereof since the date hereof; (iii) Liens in favor of the Company;
(iv) Liens on property of a Person existing at the time such Person is merged
into or consolidated with the Company or any Subsidiary of the Company or
becomes a Subsidiary of the Company; PROVIDED that such Liens were in
existence prior to the contemplation of such merger, consolidation or
acquisition and do not extend to any assets other than those of the Person
merged into or consolidated with the Company or that becomes a Subsidiary of the
Company; (v) Liens on property existing at the time of acquisition thereof by
the Company or any Subsidiary of the

                                        8

<PAGE>

Company, PROVIDED that such Liens were in existence prior to the contemplation
of such acquisition; (vi) Liens to secure the performance of statutory
obligations, surety or appeal bonds, performance bonds or other obligations of a
like nature incurred in the ordinary course of business; (vii) Liens existing on
the date hereof, including, without limitation, Liens on Permitted Collateral
securing reimbursement obligations under the Metrocrest Letter of Credit
Facility; (viii) Liens for taxes, assessments or governmental charges or claims
that are not yet delinquent or that are being contested in good faith by
appropriate proceedings promptly instituted and diligently concluded; PROVIDED
that any reserve or other appropriate provision as shall be required in
conformity with GAAP shall have been made therefor; (ix) other Liens on assets
of the Company or any Subsidiary of the Company securing Indebtedness that is
permitted by the terms hereof to be outstanding having an aggregate principal
amount at any one time outstanding not to exceed 10% of the Stockholders' Equity
of the Company; and (x) Liens to secure Permitted Refinancing Indebtedness
incurred to refinance Indebtedness that was secured by a Lien permitted
hereunder and that was incurred in accordance with the provisions hereof;
PROVIDED that such Liens do not extend to or cover any property or assets of
the Company or any Subsidiary other than assets or property securing the
Indebtedness so refinanced.

            "PERMITTED REFINANCING INDEBTEDNESS" means any Indebtedness of the
Company or any of its Subsidiaries issued in exchange for, or the net proceeds
of which are used solely to extend, refinance, renew, replace, defease or
refund, other Indebtedness of the Company or any of its Subsidiaries; PROVIDED
that, except in the case of Indebtedness of the Company issued in exchange for,
or the net proceeds of which are used solely to extend, refinance, renew,
replace, defease or refund, Indebtedness of a Subsidiary of the Company:  (i)
the principal amount of such Permitted Refinancing Indebtedness does not exceed
the principal amount of the Indebtedness so extended, refinanced, renewed,
replaced, defeased or refunded (plus the amount of any premiums paid and
reasonable expenses incurred in connection therewith); (ii) such Permitted
Refinancing Indebtedness has a final maturity date later than the final maturity
date of, and has a Weighted Average Life to Maturity equal to or greater than
the Weighted Average Life to Maturity of, the Indebtedness being extended,
refinanced, renewed, replaced, defeased or refunded; (iii) if the Indebtedness
being extended, refinanced, renewed, replaced, defeased or refunded is
subordinated in right of payment to the Securities, such Permitted Refinancing
Indebtedness has a final maturity date later than the final maturity date of,
and is subordinated in right of payment to, the Securities on terms at least as
favorable to the Holders of Securities as those contained in the documentation
governing the Indebtedness being extended, refinanced, renewed, replaced,
defeased or refunded; and (iv) such Indebtedness is incurred either by the
Company or by the Subsidiary who is the obligor on the Indebtedness being
extended, refinanced, renewed, replaced, defeased or refunded.

            "PERSON" means any individual, corporation, partnership, joint
venture, association, joint-stock company, trust or unincorporated organization
(including any subdivision or ongoing business of any such entity or
substantially all of the assets of any such entity, subdivision or business).

            "PHYSICIAN JOINT VENTURE DISTRIBUTIONS" means distributions made
by the Company or any of its Subsidiaries to any physician, pharmacist or other
allied healthcare professional in connection with the unwinding, liquidation or
other termination of any joint venture or similar arrangement between any such
Person and the Company or any of its Subsidiaries.

                                        9

<PAGE>

            "PHYSICIAN SUPPORT OBLIGATIONS" means any obligation or Guarantee
incurred in the ordinary course of business by the Company or a Subsidiary of
the Company in connection with any advance, loan or payment to, or on behalf of
or for the benefit of any physician, pharmacist or other allied healthcare
professional for the purpose of recruiting, redirecting or retaining the
physician, pharmacist or other allied healthcare professional to provide service
to patients in the service area of any Hospital or Related Business owned or
operated by the Company or any of its Subsidiaries; EXCLUDING, HOWEVER,
compensation for services provided by physicians, pharmacists or other allied
healthcare professionals to any Hospital or Related Business owned or operated
by the Company or any of its Subsidiaries.

            "QUALIFIED EQUITY INTERESTS" shall mean all Equity Interests of
the Company other than Disqualified Stock of the Company.

            "RATING AGENCIES" means (i) S&P and (ii) Moody's or (iii) if S&P
or Moody's or both shall not make a rating of the Securities publicly available,
a nationally recognized securities rating agency or agencies, as the case may
be, selected by the Company, shall be substituted for S&P or Moody's or both, as
the case may be.

            "RATING CATEGORY" means (i) with respect to S&P, any of the
following categories:  BB, B, CCC, CC, C and D (or equivalent successor
categories); (ii) with respect to Moody's, any of the following categories:  Ba,
B, Caa, Ca, C and D (or equivalent successor categories); and (iii) the
equivalent of any such category of S&P or Moody's used by another Rating Agency.
In determining whether the rating of the Securities has decreased by one or more
gradations, gradations within Rating Categories (+ and - for S&P, 1, 2 and 3 for
Moody's; or the equivalent gradations for another Rating Agency) shall be taken
into account (E.G., with respect to S&P, a decline in a rating from BB+ to BB,
as well as from BB- to B+, shall constitute a decrease of one gradation).

            "RATING DATE" means the date which is 90 days prior to the earlier
of (i) a Change of Control and (ii) the first public notice of the occurrence of
a Change of Control or of the intention by the Company to effect a Change of
Control.

            "RATING DECLINE" means the occurrence on or within 90 days after
the date of the first public notice of the occurrence of a Change of Control or
of the intention by the Company to effect a Change of Control (which period
shall be extended so long as the rating of the Securities is under publicly
announced consideration for possible downgrade by any of the Rating Agencies)
of:  (a) in the event the Securities are rated by either Moody's or S&P on the
Rating Date as Investment Grade, a decrease in the rating of the Securities by
both Rating Agencies to a rating that is below Investment Grade, or (b) in the
event the Securities are rated below Investment Grade by both Rating Agencies on
the Rating Date, a decrease in the rating of the Securities by either Rating
Agency by one or more gradations (including gradations within Rating Categories
as well as between Rating Categories).

            "REFINANCING" has the meaning ascribed to it in the prospectus
dated February 21, 1995 relating to the Securities.

                                       10

<PAGE>

            "RELATED BUSINESS" means a healthcare business affiliated or
associated with a Hospital or any business related or ancillary to the provision
of healthcare services or the operation of a Hospital.

            "RESPONSIBLE OFFICER" when used with respect to the Trustee, means
any officer within the corporate trust department of the Trustee (or any
successor group of the Trustee) or any other officer of the Trustee customarily
performing functions similar to those performed by any of the above designated
officers and also means, with respect to a particular corporate trust matter,
any other officer to whom such matter is referred because of his knowledge of
and familiarity with the particular subject.

            "RESTRICTED INVESTMENT" means an Investment in any of the
International Subsidiaries.

            "SECURITIES" means the securities described above, issued under
this Indenture.

            "SECURITIES ACT" means the Securities Act of 1933, as amended.

            "SENIOR ASSET SALE OFFER" means the offer to purchase Senior Notes
made by the Company to holders of Senior Notes under Section 3.10 of the Senior
Note Indenture.

            "SENIOR NOTES" means the 9 5/8% Senior Notes due 2002 of the Company
in an aggregate principal amount of $300.0 million, issued pursuant to the
Senior Note Indenture.

            "SENIOR NOTE INDENTURE" means the Indenture dated as of March 1,
1995 between the Company and The Bank of New York, as trustee, as amended or
supplemented from time to time, under which the Senior Notes were issued.

            "SENIOR REVOLVING DEBT" means revolving credit loans outstanding
from time to time under the New Credit Facility.

            "SENIOR TERM DEBT" means term loans outstanding from time to time
under the New Credit Facility.

            "SIGNIFICANT SUBSIDIARY" means any Subsidiary that would be a
"significant subsidiary" as defined in Article 1, Rule 1-02 of Regulation S-X,
promulgated pursuant to the Securities Act, as such Regulation is in effect on
the date hereof.

            "S&P" means Standard & Poor's Corporation and its successors.

            "SPECIFIED ASSETS" means the Company's and its Subsidiaries'
interest in The Hillhaven Corporation and Westminster Healthcare Holdings PLC
owned as of the date hereof and the Capital Stock and assets of the
International Subsidiaries.

            "STOCKHOLDERS' EQUITY" means, with respect to any Person as of any
date, the stockholders' equity of such Person determined in accordance with GAAP
as of the date of the

                                       11

<PAGE>

most recent available internal financial statements of such Person, and
calculated on a pro forma basis to give effect to any acquisition or disposition
by such Person consummated or to be consummated since the date of such financial
statements and on or prior to the date of such calculation.

            "SUBSIDIARY" means, with respect to any Person, (i) any
corporation, association or other business entity of which more than 50% of the
total voting power of shares of Capital Stock entitled (without regard to the
occurrence of any contingency) to vote in the election of directors, managers or
trustees thereof is at the time owned or controlled, directly or indirectly, by
such Person or one or more of the other Subsidiaries of that Person (or a
combination thereof) and (ii) any partnership (a) the sole general partner or
the managing general partner of which is such Person or a Subsidiary of such
Person or (b) the only general partners of which are such Person or of one or
more Subsidiaries of such Person (or any combination thereof); PROVIDED that
no International Subsidiary shall be deemed to be a "Subsidiary" for any purpose
hereunder for so long as such International Subsidiary:  (a) has no Indebtedness
other than Existing Indebtedness and Non-Recourse Debt; (b) is not a party to
any agreement, contract, arrangement or understanding with the Company or any of
its other Subsidiaries (other than International Subsidiaries) except any such
agreement, contract, arrangement or understanding that (i) was in effect on the
date hereof, or (ii) meets the requirements of Section 4.11 hereof; (c) is a
Person with respect to which neither the Company nor any of its Subsidiaries
(other than International Subsidiaries) has any direct or indirect obligation
(x) to subscribe for additional Equity Interests or (y) to maintain or preserve
such Person's financial condition or to cause such Person to achieve any
specified level of operating results except, in each case, any such obligation
in existence on the date hereof or created pursuant to the terms of any
Investment permitted by Section 4.07 hereof; and (d) has not Guaranteed or
otherwise directly or indirectly provided credit support for any Indebtedness of
the Company or any of its Subsidiaries (other than International Subsidiaries).
If, at any time, any International Subsidiary would fail to meet the foregoing
requirements, it shall thereafter be deemed to be a Subsidiary for all purposes
of this Indenture and any Indebtedness of such International Subsidiary shall be
deemed to be incurred by a Subsidiary of the Company as of such date (and, if
such Indebtedness is not permitted to be incurred as of such date under Section
4.09 hereof, the Company shall be in default of such covenant).

             "TIA" means the Trust Indenture Act of 1939, as amended (15 U.S.C.
77aaa-77bbbb) as in effect on the date on which this Indenture is qualified
under the TIA, except as provided in Section 9.03 hereof.

            "TRANSFER RESTRICTION" means, with respect to the Company's
Subsidiaries, any encumbrance or restriction on the ability of any Subsidiary to
(i)(a) pay dividends or make any other distributions to the Company or any of
its Subsidiaries (1) on its Capital Stock or (2) with respect to any other
interest or participation in, or measured by, its profits, or (b) pay any
Indebtedness owed to the Company or any of its Subsidiaries, (ii) make loans or
advances to the Company or any of its Subsidiaries, or (iii) transfer any of its
properties or assets to the Company or any of its Subsidiaries.

                                       12

<PAGE>

            "TRUSTEE" means the party named as such above until a successor
replaces it in accordance with the applicable provisions of this Indenture and
thereafter means the successor serving hereunder.

            "WEIGHTED AVERAGE LIFE TO MATURITY" means, when applied to any
Indebtedness at any date, the number of years obtained by dividing (i) the sum
of the products obtained by multiplying (a) the amount of each then remaining
installment, sinking fund, serial maturity or other required payments of
principal, including payment at final maturity, in respect thereof, by (b) the
number of years (calculated to the nearest one-twelfth) that will elapse between
such date and the making of such payment, by (ii) the then outstanding principal
amount of such Indebtedness.

            "WHOLLY OWNED SUBSIDIARY" of any Person means a Subsidiary of such
Person all of the outstanding Capital Stock or other ownership interests of
which (other than directors' qualifying shares) shall at the time be owned by
such Person or by one or more Wholly Owned Subsidiaries of such Person or by
such Person and one or more Wholly Owned Subsidiaries of such Person.

SECTION 1.02.    OTHER DEFINITIONS.
                                                      DEFINED IN
       TERM                                            SECTION
       ----                                            -------

      "Affiliate Transaction".....................     4.11
      "Bankruptcy Law"............................     6.01
      "Change of Control Offer"...................     4.13
      "Change of Control Payment".................     4.13
      "Change of Control Payment Date"............     4.13
      "Commencement Date".........................     3.09
      "Covenant Defeasance".......................     8.03
      "Custodian".................................     6.01
      "Designated Senior Debt"....................    10.02
      "Event of Default"..........................     6.01
      "Excess Proceeds"...........................
4.10
      "incur".....................................     4.09
      "Legal Defeasance"..........................     8.02
      "Legal Holiday".............................    11.07
      "Notice of Default".........................     6.01
      "Offer Amount"..............................     3.09
      "Offer Period"..............................     3.09
      "Paying Agent"..............................     2.03
      "Payment Blockage Notice"...................    10.04
      "Purchase Date".............................     3.09
      "Purchase Price"............................     4.10
      "Registrar".................................     2.03
      "Representative"............................    10.02
      "Restricted Payments".......................     4.07

                                       13

<PAGE>

      "Senior Debt"...............................    10.02
      "Senior Subordinated Asset Sale Offer"......     4.10

SECTION 1.03.    INCORPORATION BY REFERENCE OF TIA.

            Whenever this Indenture refers to a provision of the TIA, the
provision is incorporated by reference in and made a part of this Indenture.

            The following TIA terms used in this Indenture have the following
meanings:

            "INDENTURE SECURITIES" means the Securities;

            "INDENTURE SECURITY HOLDER" means a Holder;

            "INDENTURE TO BE QUALIFIED" means this Indenture;

            "INDENTURE TRUSTEE" or "INSTITUTIONAL TRUSTEE" means the
Trustee;

            "OBLIGOR" on the Securities means the Company and any successor
obligor upon the Securities.

            All other terms used in this Indenture that are defined by the TIA,
defined by TIA reference to another statute or defined by the Commission rule
under the TIA have the meanings so assigned to them.

SECTION 1.04.    RULES OF CONSTRUCTION.

            Unless the context otherwise requires:

            (1)   a term has the meaning assigned to it;

            (2)   an accounting term not otherwise defined has the meaning
      assigned to it in accordance with GAAP;

            (3)   "or" is not exclusive;

            (4)   words in the singular include the plural, and in the plural
      include the singular; and

            (5)   provisions apply to successive events and transactions.

                                       14

<PAGE>

                                   ARTICLE 2
                                THE SECURITIES

SECTION 2.01.    FORM AND DATING.

            The Securities and the Trustee's certificate of authentication shall
be substantially in the form of Exhibit A hereto, the terms of which are
incorporated in and made a part of this Indenture.  The Securities may have
notations, legends or endorsements approved as to form by the Company and
required by law, stock exchange rule, agreements to which the Company is subject
or usage.  Each Security shall be dated the date of its authentication.  The
Securities shall be issuable only in registered form, without coupons, in
denominations of $1,000 and integral multiples thereof.

SECTION 2.02.    EXECUTION AND AUTHENTICATION.

            An Officer of the Company shall sign the Securities for the Company
by manual or facsimile signature.  The Company's seal shall be reproduced on the
Securities and may be in facsimile form.

            If an Officer whose signature is on a Security no longer holds that
office at the time the Security is authenticated, the Security shall
nevertheless be valid.

            A Security shall not be valid until authenticated by the manual
signature of the Trustee.  The signature of the Trustee shall be conclusive
evidence that the Security has been authenticated under this Indenture.  The
form of Trustee's certificate of authentication to be borne by the Securities
shall be substantially as set forth in Exhibit A hereto.

            The Trustee shall, upon a written order of the Company signed by two
Officers of the Company, authenticate Securities for original issue up to the
aggregate principal amount stated in paragraph 4 of the Securities.  The
aggregate principal amount of Securities outstanding at any time shall not
exceed the amount set forth herein except as provided in Section 2.07 hereof.

            The Trustee may appoint an authenticating agent acceptable to the
Company to authenticate Securities.  Unless limited by the terms of such
appointment, an authenticating agent may authenticate Securities whenever the
Trustee may do so.  Each reference in this Indenture to authentication by the
Trustee includes authentication by such agent.  An authenticating agent has the
same rights as an Agent to deal with the Company or an Affiliate of the Company.

SECTION 2.03.    REGISTRAR AND PAYING AGENT.

            The Company shall maintain (i) an office or agency where Securities
may be presented for registration of transfer or for exchange (including any
co-registrar, the "REGISTRAR") and (ii) an office or agency where Securities
may be presented for payment (the "PAYING AGENT").  The Registrar shall keep a
register of the Securities and of their transfer and exchange.  The Company may
appoint one or more co-registrars and one or more additional paying agents.  The
term "Paying Agent" includes any additional paying agent.  The Company may
change any

                                       15

<PAGE>

Paying Agent, Registrar or co-registrar without prior notice to any Holder.  The
Company shall notify the Trustee and the Trustee shall notify the Holders of the
name and address of any Agent not a party to this Indenture. If the Company
fails to appoint or maintain another entity as Registrar or Paying Agent, the
Trustee shall act as such.  The Company or any of its Subsidiaries may act as
Paying Agent, Registrar or co-registrar.  The Company shall enter into an
appropriate agency agreement with any Agent not a party to this Indenture, which
shall incorporate the provisions of the TIA.  The agreement shall implement the
provisions of this Indenture that relate to such Agent.  The Company shall
notify the Trustee of the name and address of any such Agent.  If the Company
fails to maintain a Registrar or Paying Agent, or fails to give the foregoing
notice, the Trustee shall act as such, and shall be entitled to appropriate
compensation in accordance with Section 7.07 hereof.

            The Company initially appoints the Trustee as Registrar, Paying
Agent and agent for service of notices and demands in connection with the
Securities.

SECTION 2.04.    PAYING AGENT TO HOLD MONEY IN TRUST.

            On or prior to the due date of principal of, premium, if any, and
interest on any Securities, the Company shall deposit with the Trustee or the
Paying Agent money sufficient to pay such principal, premium, if any, and
interest becoming due.  The Company shall require each Paying Agent other than
the Trustee to agree in writing that the Paying Agent shall hold in trust for
the benefit of the Holders or the Trustee all money held by the Paying Agent for
the payment of principal of, premium, if any, and interest on the Securities,
and shall notify the Trustee of any Default by the Company in making any such
payment.  While any such Default continues, the Trustee may require a Paying
Agent to pay all money held by it to the Trustee.  The Company at any time may
require a Paying Agent to pay all money held by it to the Trustee.  Upon payment
over to the Trustee, the Paying Agent (if other than the Company) shall have no
further liability for the money delivered to the Trustee.  If the Company acts
as Paying Agent, it shall segregate and hold in a separate trust fund for the
benefit of the Holders all money held by it as Paying Agent.

SECTION 2.05.    HOLDER LISTS.

            The Trustee shall preserve in as current a form as is reasonably
practicable the most recent list available to it of the names and addresses of
Section  Holders and shall otherwise comply with TIA Section 312(a).  If the
Registrar, the Company shall furnish to the Trustee at least seven Business Days
before each interest payment date and at such other times as the Trustee may
request in writing a list in such form and as of such date as the Trustee may
reasonably require of the names and addresses of Holders, including the
aggregate principal amount of the Securities held by each thereof, and the
Company shall otherwise comply with TIA Section 312(a).

SECTION 2.06.    TRANSFER AND EXCHANGE.

            When Securities are presented to the Registrar with a request to
register the transfer or to exchange them for an equal principal amount of
Securities of other denominations, the Registrar shall register the transfer or
make the exchange if its requirements for such trans-

                                       16

<PAGE>

actions are met; PROVIDED, HOWEVER, that any Security presented or surrendered
for registration of transfer or exchange shall be duly endorsed or accompanied
by a written instruction of transfer in form satisfactory to the Registrar and
the Trustee duly executed by the Holder thereof or by his attorney duly
authorized in writing.  To permit registrations of transfer and exchanges, the
Company shall issue and the Trustee shall authenticate Securities at the
Registrar's request, subject to such rules as the Trustee may reasonably
require.

            Neither the Company nor the Registrar shall be required to (i)
issue, register the transfer of or exchange Securities during a period beginning
at the opening of business on a Business Day 15 days before the day of any
selection of Securities for redemption under Section 3.02 hereof and ending at
the close of business on the day of selection, (ii) register the transfer of or
exchange any Security so selected for redemption in whole or in part, except the
unredeemed portion of any Security being redeemed in part or (iii) register the
transfer or exchange of a Security between the record date and the next
succeeding interest payment date.

            No service charge shall be made to any Holder for any registration
of transfer or exchange (except as otherwise expressly permitted herein), but
the Company may require payment of a sum sufficient to cover any transfer tax or
similar governmental charge payable in connection therewith (other than such
transfer tax or similar governmental charge payable upon exchanges pursuant to
Sections 2.10 or 9.05 hereof, which shall be paid by the Company).

            Prior to due presentment for registration of transfer of any
Security, the Trustee, any Agent and the Company may deem and treat the Person
in whose name any Security is registered as the absolute owner of such Security
for the purpose of receiving payment of principal of, premium, if any, and
interest on such Security and for all other purposes whatsoever, whether or not
such Security is overdue, and neither the Trustee, any Agent nor the Company
shall be affected by notice to the contrary.

SECTION 2.07.    REPLACEMENT SECURITIES.

            If any mutilated Security is surrendered to the Trustee or the
Company, or the Trustee receives evidence to its satisfaction of the
destruction, loss or theft of any Security, the Company shall issue and the
Trustee, upon the written order of the Company signed by two Officers of the
Company, shall authenticate a replacement Security if the Trustee's requirements
for replacements of Securities are met.  If required by the Trustee or the
Company, an indemnity bond must be supplied by the Holder that is sufficient in
the judgment of the Trustee and the Company to protect the Company, the Trustee,
any Agent and any authenticating agent from any loss which any of them may
suffer if a Security is replaced.  Each of the Company and the Trustee may
charge for its expenses in replacing a Security.

            Every replacement Security is an additional obligation of the
Company.

SECTION 2.08.    OUTSTANDING SECURITIES.

            The Securities outstanding at any time are all the Securities
authenticated by the Trustee except for those cancelled by it, those delivered
to it for cancellation and those described in this Section as not outstanding.

                                       17

<PAGE>

            If a Security is replaced pursuant to Section 2.07 hereof, it ceases
to be outstanding unless the Trustee receives proof satisfactory to it that the
replaced Security is held by a bona fide purchaser.

            If the principal amount of any Security is considered paid under
Section 4.01 hereof, it ceases to be outstanding and interest on it ceases to
accrue.

            Subject to Section 2.09 hereof, a Security does not cease to be
outstanding because the Company or an Affiliate of the Company holds the
Security.

SECTION 2.09.    TREASURY SECURITIES.

            In determining whether the Holders of the required principal amount
of Securities then outstanding have concurred in any demand, direction, waiver
or consent, Securities owned by the Company or any Affiliate of the Company
shall be considered as though not outstanding, except that for purposes of
determining whether the Trustee shall be protected in relying on any such
demand, direction, waiver or consent, only Securities that a Responsible Officer
actually knows to be so owned shall be so considered.  Notwithstanding the
foregoing, Securities that are to be acquired by the Company or an Affiliate of
the Company pursuant to an exchange offer, tender offer or other agreement shall
not be deemed to be owned by the Company or an Affiliate of the Company until
legal title to such Securities passes to the Company or such Affiliate, as the
case may be.

SECTION 2.10.    TEMPORARY SECURITIES.

            Until definitive Securities are ready for delivery, the Company may
prepare and the Trustee, upon receipt of the written order of the Company signed
by two Officers of the Company, shall authenticate temporary Securities.
Temporary Securities shall be substantially in the form of definitive Securities
but may have variations that the Company and the Trustee consider appropriate
for temporary Securities.  Without unreasonable delay, the Company shall prepare
and the Trustee, upon receipt of the written order of the Company signed by two
Officers of the Company, shall authenticate definitive Securities in exchange
for temporary Securities.  Until such exchange, temporary Securities shall be
entitled to the same rights, benefits and privileges as definitive Securities.

SECTION 2.11.    CANCELLATION.

            The Company at any time may deliver Securities to the Trustee for
cancellation.  The Registrar and Paying Agent shall forward to the Trustee any
Securities surrendered to them for registration of transfer, exchange or
payment.  The Trustee shall cancel all Securities surrendered for registration
of transfer, exchange, payment, replacement or cancellation and shall return
such cancelled Securities to the Company.  The Company may not issue new
Securities to replace Securities that it has paid or that have been delivered to
the Trustee for cancellation.

                                       18

<PAGE>

SECTION 2.12.    DEFAULTED INTEREST.

            If the Company defaults in a payment of interest on the Securities,
it shall pay the defaulted interest in any lawful manner plus, to the extent
lawful, interest payable on the defaulted interest, to the Persons who are
Holders on a subsequent special record date, which date shall be at the earliest
practicable date but in all events at least five Business Days prior to the
related payment date, in each case at the rate provided in the Securities and in
Section 4.01 hereof.  The Company shall, with the consent of the Trustee, fix or
cause to be fixed each such special record date and payment date.  At least 15
days before the special record date, the Company (or the Trustee, in the name of
and at the expense of the Company) shall mail to Holders a notice that states
the special record date, the related payment date and the amount of such
interest to be paid.

SECTION 2.13.    RECORD DATE.

            The record date for purposes of determining the identity of Holders
entitled to vote or consent to any action by vote or consent authorized or
Trustee is not the permitted under this Indenture shall be determined as
provided for in TIA Section 316(c).

SECTION 2.14.    CUSIP NUMBER.

            The Company in issuing the Securities may use a "CUSIP" number, and
if it does so, the Trustee shall use the CUSIP number in notices to Holders;
PROVIDED that any such notice may state that no representation is made as to
the correctness or accuracy of the CUSIP number printed in the notice or on the
Securities and that reliance may be placed only on the other identification
numbers printed on the Securities.  The Company shall promptly notify the
Trustee of any change in the CUSIP number.

                                   ARTICLE 3
                                  REDEMPTION

SECTION 3.01.    NOTICES TO TRUSTEE.

            If the Company elects to redeem Securities pursuant to the optional
redemption provisions of Section 3.07 hereof, it shall furnish to the Trustee,
at least 45 days but not more than 60 days before a redemption date, an
Officers' Certificate setting forth (i) the Section of this Indenture pursuant
to which the redemption shall occur, (ii) the redemption date, (iii) the
principal amount of Securities to be redeemed and (iv) the redemption price.

            If the Company is required to make an offer to purchase Securities
pursuant to the provisions of Section 4.10 or 4.13 hereof, it shall furnish to
the Trustee an Officers' Certificate setting forth (i) the Section of this
Indenture pursuant to which the purchase shall occur, (ii) the purchase date,
(iii) the principal amount of Securities to be purchased, (iv) the purchase
price and (v) a statement to the effect that (a) the Company or one of its
Subsidiaries has effected an Asset Sale and the conditions set forth in Section
4.10 hereof have been satisfied

                                       19

<PAGE>

or (b) a Change of Control has occurred and the conditions set forth in Section
4.13 hereof have been satisfied, as applicable.

SECTION 3.02.    SELECTION OF SECURITIES TO BE REDEEMED.

            If less than all of the Securities are to be redeemed at any time,
the Trustee shall select the Securities to be redeemed among the Holders in
compliance with the requirements of the principal national securities exchange,
if any, on which the Securities are then listed, or, if the Securities are not
so listed, on a PRO RATA basis, by lot or by such method the Trustee shall
deem fair and appropriate; PROVIDED that Securities with a principal amount of
$1,000 shall not be redeemed in part.

            The Trustee shall promptly notify the Company in writing of the
Securities selected for redemption and, in the case of any Security selected for
partial redemption, the principal amount thereof to be redeemed.  Securities and
portions of them selected shall be in amounts of $1,000 or whole multiples of
$1,000; except that if all of the Securities of a Holder are to be redeemed, the
entire outstanding amount of Securities held by such Holder, even if not a
multiple of $1,000, shall be redeemed.  Except as provided in the preceding
sentence, provisions of this Indenture that apply to Securities called for
redemption also apply to portions of Securities called for redemption.

            In the event the Company is required to make an offer to purchase
Securities pursuant to Sections 3.09 and 4.10 hereof and the amount of the
Excess Proceeds from the Asset Sale are not evenly divisible by $1,000, the
Trustee shall promptly refund to the Company any remaining Excess Proceeds.

SECTION 3.03.    NOTICE OF REDEMPTION.

            Subject to the provisions of Section 3.09 hereof, at least 30 days
but not more than 60 days before a redemption date, the Company shall mail or
cause to be mailed by first class mail a notice of redemption to each Holder of
Securities to be redeemed at its registered address.

            The notice shall identify the Securities to be redeemed and shall
state:

            (1)   the redemption date;

            (2)   the redemption price;

            (3)   if any Security is being redeemed in part, the portion of the
                  principal amount of such Security to be redeemed and that,
                  after the redemption date upon surrender of such Security, a
                  new Security or Securities in principal amount equal to the
                  unredeemed portion shall be issued;

            (4)   the name and address of the Paying Agent;

                                       20

<PAGE>

            (5)   that Securities called for redemption must be surrendered to
                  the Paying Agent to collect the redemption price;

            (6)   that, unless the Company defaults in making such redemption
                  payment, interest on Securities called for redemption ceases
                  to accrue on and after the redemption date;

            (7)   the paragraph of the Securities and/or Section of this
                  Indenture pursuant to which the Securities called for
                  redemption are being redeemed; and

            (8)   that no representation is made as to the correctness or
                  accuracy of the CUSIP number, if any, listed in such notice or
                  printed on the Securities.

            At the Company's request, the Trustee shall give the notice of
redemption in the Company's name and at its expense; PROVIDED, HOWEVER, that
the Company shall have delivered to the Trustee, at least 40 days prior to the
redemption date, unless the Trustee shall agree to a shorter period, an
Officers' Certificate requesting that the Trustee give such notice and setting
forth the information to be stated in such notice as provided in the preceding
paragraph.  The notice mailed in the manner herein provided shall be
conclusively presumed to have been duly given whether or not the Holder receives
such notice.  In any case, failure to give such notice by mail or any defect in
the notice to the Holder of any Security shall not affect the validity of the
proceeding for the redemption of any other Security.

SECTION 3.04.    EFFECT OF NOTICE OF REDEMPTION.

            Once notice of redemption is mailed in accordance with Section 3.03
hereof, Securities called for redemption become due and payable on the
redemption date at the redemption price plus accrued and unpaid interest, if
any, to such date.

SECTION 3.05.    DEPOSIT OF REDEMPTION PRICE.

            One Business Day prior to the redemption date, the Company shall
deposit with the Trustee or with the Paying Agent money sufficient to pay the
redemption price of, and accrued interest on, all Securities to be redeemed on
that date.  The Trustee or the Paying Agent shall promptly return to the Company
any money deposited with the Trustee or the Paying Agent by the Company in
excess of the amounts necessary to pay the redemption price of (including any
applicable premium), and accrued interest on, all Securities to be redeemed.

            On and after the redemption date, interest ceases to accrue on the
Securities or the portions of Securities called for redemption.  If a Security
is redeemed on or after an interest record date but on or prior to the related
interest payment date, then any accrued and unpaid interest shall be paid to the
Person in whose name such Security was registered at the close of business on
such record date.  If any Security called for redemption shall not be so paid
upon surrender for redemption because of the failure of the Company to comply
with the preceding paragraph, interest shall be paid on the unpaid principal,
from the redemption date until such principal is paid, and to the extent lawful
on any interest not paid on such unpaid principal, in each case at the rate
provided in the Securities and in Section 4.01 hereof.

                                       21

<PAGE>

SECTION 3.06.    SECURITIES REDEEMED IN PART.

            Upon surrender of a Security that is redeemed in part, the Company
shall issue and the Trustee shall authenticate for the Holder at the expense of
the Company a new Security equal in principal amount to the unredeemed portion
of the Security surrendered.

SECTION 3.07.    OPTIONAL REDEMPTION.

            On or after March 1, 2000, the Company may redeem all or any portion
of the Securities at the redemption prices (expressed as a percentage of the
principal amount thereof), as set forth in the immediately succeeding paragraph,
plus accrued and unpaid interest, if any, to the redemption date.

            The redemption price (expressed as a percentage of the principal
amount) shall be as follows, if the Securities are redeemed during the
twelve-month period beginning on March 1 of the following years:

            YEAR                                               PERCENTAGE
            ----                                               ----------

            2000............................................   105.063%
            2001............................................   103.375%
            2002............................................   101.688%
            2003 and thereafter.............................   100.000%

SECTION 3.08.    MANDATORY REDEMPTION.

            Subject to the Company's obligation to make an offer to repurchase
Securities under certain circumstances pursuant to Sections 4.10 and 4.13
hereof, the Company shall have no mandatory redemption or sinking fund
obligations with respect to the Securities.

SECTION 3.09.    OFFER TO PURCHASE BY APPLICATION OF EXCESS PROCEEDS.

            In the event that the Company shall commence a Senior Subordinated
Asset Sale Offer pursuant to Section 4.10 hereof, it shall follow the procedures
specified below.

            No later than the date on which the aggregate amount of Excess
Proceeds exceeds $25.0 million, the Company shall notify the Trustee of such
Senior Subordinated Asset Sale Offer and provide the Trustee with an Officers'
Certificate setting forth, in addition to the information to be included therein
pursuant to Section 4.10 hereof, the calculations used in determining the amount
of Net Proceeds to be applied to the purchase of Securities.  The Company shall
commence or cause to be commenced the Senior Subordinated Asset Sale Offer on a
date no later than 10 Business Days after such notice (the "COMMENCEMENT
DATE").

            The Senior Subordinated Asset Sale Offer shall remain open for at
least 20 Business Days after the Commencement Date relating to such Senior
Subordinated Asset Sale Offer and shall remain open for no more than such 20
Business Days, except to the extent

                                       22

<PAGE>

required by applicable law (as so extended, the "OFFER PERIOD").  No later
than one Business Day after the termination of the Offer Period (the "PURCHASE
Date"), the Company shall purchase the principal amount (the "OFFER AMOUNT")
of Securities required to be purchased in such Senior Subordinated Asset Sale
Offer pursuant to Section 4.10 hereof or, if less than the Offer Amount has been
tendered, all Securities tendered in response to the Senior Subordinated Asset
Sale Offer, in each case for an amount in cash equal to the Purchase Price.

            If the Purchase Date is on or after an interest payment record date
and on or before the related interest payment date, any accrued interest shall
be paid to the Person in whose name a Security is registered at the close of
business on such record date, and no additional interest shall be payable to
Holders who tender Securities pursuant to the Senior Subordinated Asset Sale
Offer.

            On the Commencement Date of any Senior Subordinated Asset Sale
Offer, the Company shall send, or at the Company's request the Trustee shall
send, by first class mail, a notice to each of the Holders at their last
registered address, with a copy to the Trustee and the Paying Agent, offering to
repurchase the Securities held by such Holder pursuant to the procedure
specified in such notice.  Such notice, which shall govern the terms of the
Senior Subordinated Asset Sale Offer, shall contain all instructions and
materials necessary to enable the Holders to tender Securities pursuant to the
Senior Subordinated Asset Sale Offer and shall state:

                  (1)   that the Senior Subordinated Asset Sale Offer is being
                        made pursuant to this Section 3.09 and Section 4.10
                        hereof and the length of time the Senior Subordinated
                        Asset Sale Offer shall remain open;

                  (2)   the Offer Amount, the Purchase Price and the Purchase
                        Date;

                  (3)   that any Security not tendered or accepted for payment
                        shall continue to accrue interest;

                  (4)   that, unless the Company defaults in the payment of the
                        Purchase Price, any Security accepted for payment
                        pursuant to the Senior Subordinated Asset Sale Offer
                        shall cease to accrue interest after the Purchase Date;

                  (5)   that Holders electing to have a Security purchased
                        pursuant to any Senior Subordinated Asset Sale Offer
                        shall be required to surrender the Security, with the
                        form entitled "Option of Holder to Elect Purchase" on
                        the reverse of the Security completed, to the Company, a
                        depositary, if appointed by the Company, or a Paying
                        Agent at the address specified in the notice prior to
                        the close of business on the Business Day next preceding
                        the Purchase Date;

                  (6)   that Holders shall be entitled to withdraw their
                        election if the Company, depositary or Paying Agent, as
                        the case may be,

                                       23

<PAGE>

                        receives, not later than the close of business on the
                        Business Day next preceding the termination of the Offer
                        Period, a facsimile transmission or letter setting forth
                        the name of the Holder, the principal amount of the
                        Security the Holder delivered for purchase and a
                        statement that such Holder is withdrawing his election
                        to have such Security purchased;

                  (7)   that, if the aggregate principal amount of Securities
                        surrendered by Holders exceeds the Offer Amount, the
                        Trustee shall select the Securities to be purchased on a
                        PRO RATA basis (with such adjustments as may be deemed
                        appropriate by the Trustee so that only Securities in
                        denominations of $1,000, or integral multiples thereof,
                        shall be purchased);

                  (8)   that Holders whose Securities were purchased only in
                        part shall be issued new Securities equal in principal
                        amount to the unpurchased portion of the Securities
                        surrendered; and

                  (9)   the circumstances and relevant facts regarding such
                        Asset Sale and any other information that would be
                        material to a decision as to whether to tender a
                        Security pursuant to the Senior Subordinated Asset Sale
                        Offer.

            On the Purchase Date, the Company shall, to the extent lawful, (i)
accept for payment, on a PRO RATA basis to the extent necessary, an aggregate
principal amount equal to the Offer Amount of Securities tendered pursuant to
the Senior Subordinated Asset Sale Offer, or if less than the Offer Amount has
been tendered, all Securities or portion thereof so tendered, (ii) deposit with
the Paying Agent an amount equal to the Purchase Price in respect of all
Securities or portions thereof so tendered and (iii) deliver or cause to be
delivered to the Trustee the Securities so accepted together with an Officers'
Certificate stating the aggregate principal amount of Securities or portions
thereof being purchased by the Company.  The Paying Agent shall promptly mail to
each Holder of Securities so tendered payment in an amount equal to the Purchase
Price for such Securities and the Trustee shall promptly authenticate and mail
or deliver (or cause to be transferred by book entry) a new Security to such
Holder equal in principal amount to any unpurchased portion of the Securities
surrendered, if any; provided that each such new Security shall be in a
principal amount of $1,000 or an integral multiple thereof.  The Company shall
publicly announce the results of the Senior Subordinated Asset Sale Offer on or
as soon as practicable after the Purchase Date.

            The Company shall comply with the requirements of Rule 14e-1 under
the Exchange Act and any other securities laws and regulations thereunder to the
extent such laws and regulations are applicable in connection with the purchase
of Securities as a result of the Senior Subordinated Asset Sale Offer.

                                       24

<PAGE>

                                   ARTICLE 4
                                   COVENANTS

SECTION 4.01.    PAYMENT OF SECURITIES.

            The Company shall pay or cause to be paid the principal of, premium,
if any, and interest on the Securities on the dates and in the manner provided
in this Indenture and the Securities.  Principal, premium, if any, and interest
shall be considered paid on the date due if the Paying Agent, if other than the
Company or a Subsidiary of the Company, holds as of 10:00 a.m. Eastern Time on
the due date money deposited by the Company in immediately available funds and
designated for and sufficient to pay all principal, premium, if any, and
interest then due.  Such Paying Agent shall return to the Company, no later than
five days following the date of payment, any money (including accrued interest)
that exceeds such amount of principal, premium, if any, and interest to be paid
on the Securities.

            The Company shall pay interest (including post-petition interest in
any proceeding under any Bankruptcy Law) on overdue principal at the rate equal
to 1% per annum in excess of the interest rate then applicable to the Securities
to the extent lawful.  In addition, it shall pay interest (including
post-petition interest in any proceeding under any Bankruptcy Law) on overdue
installments of interest (without regard to any applicable grace period) at the
same rate to the extent lawful.

SECTION 4.02.    MAINTENANCE OF OFFICE OR AGENCY.

            The Company shall maintain in the Borough of Manhattan, the City of
New York, an office or agency (which may be an office of the Trustee or an
affiliate of the Trustee, Registrar or co-registrar) where Securities may be
surrendered for registration of transfer or exchange and where notices and
demands to or upon the Company in respect of the Securities and this Indenture
may be served.  The Company shall give prompt written notice to the Trustee of
the location, and any change in the location, of such office or agency.  If at
any time the Company shall fail to maintain any such required office or agency
or shall fail to furnish the Trustee with the address thereof, such
presentations, surrenders, notices and demands may be made or served at the
Corporate Trust Office of the Trustee.

            The Company may also from time to time designate one or more other
offices or agencies where the Securities may be presented or surrendered for any
or all such purposes and may from time to time rescind such designations;
PROVIDED, HOWEVER, that no such designation or rescission shall in any
manner relieve the Company of its obligation to maintain an office or agency in
the Borough of Manhattan, the City of New York for such purposes.  The Company
shall give prompt written notice to the Trustee of any such designation or
rescission and of any change in the location of any such other office or agency.

            The Company hereby designates The Bank of New York, 101 Barclay
Street, 21 West, New York, New York 10286 as one such office or agency of the
Company in accordance with Section 2.03 hereof.

                                       25

<PAGE>

SECTION 4.03.    COMMISSION REPORTS.

            (i)   So long as any of the Securities remain outstanding, the
Company shall provide to the Trustee within 15 days after the filing thereof
with the Commission copies of the annual reports and of the information,
documents and other reports (or copies of such portions of any of the foregoing
as the Commission may by rules and regulations prescribe) that the Company is
required to file with the Commission pursuant to Section 13 or 15(d) of the
Exchange Act.  All obligors on the Securities shall comply with the provisions
provided for in TIA Section  of TIA Section 314(a).  Notwithstanding that the
reporting requirements of Section 13 or 15(d) of the Exchange Act or otherwise
report on an annual and quarterly basis on forms provided for such annual and
quarterly reporting pursuant to rules and regulations promulgated by the
Commission, the Company shall file with the Commission and provide to the
Trustee (a) within 90 days after the end of each fiscal year, annual reports on
Form 10-K (or any successor or comparable form) containing the information
required to be contained therein (or required in such successor or comparable
form), including a "MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION
AND RESULTS OF OPERATIONS" and a report thereon by the Company's certified
public accountants; (b) within 45 days after the end of each of the first three
fiscal quarters of each fiscal year, reports on Form 10-Q (or any successor or
comparable form) containing the information required to be contained therein (or
required in any successor or comparable form) including a "MANAGEMENT'S
DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS"; and
(c) promptly from time to time after the occurrence of an event required to be
therein reported, such other reports on Form 8-K (or any successor or comparable
form) containing the information required to be contained therein (or required
in any successor or comparable form); PROVIDED, HOWEVER, that the Company
shall not be in default of the provisions of this Section 4.03(i) for any
failure to file reports with the Commission solely by the refusal of the
Commission to accept the same for filing.  Each of the financial statements
contained in such reports shall be prepared in accordance with GAAP.

            (ii)  The Trustee, at the Company's expense, shall promptly mail
copies of all such annual reports, information, documents and other reports
provided to the Trustee pursuant to Section 4.03(i) hereof to the Holders at
their addresses appearing in the register of Securities maintained by the
Registrar.

            (iii) Whether or not required by the rules and regulations of the
Commission, the Company shall file a copy of all such information and reports
with the Commission for public availability and make such information available
to securities analysts and prospective investors upon request.

            (iv)  The Company shall provide the Trustee with a sufficient number
of copies of all reports and other documents and information that the Trustee
may be required to deliver to the Holders under this Section 4.03.

            (v)   Delivery of such reports, information and documents to the
Trustee is for informational purposes only and the Trustee's receipt of such
shall not constitute constructive notice of any information contained therein or
determinable from information contained therein, including the Company's
compliance with any of its covenants hereunder (as to which the Trustee is
entitled to rely exclusively on Officers' Certificates).

                                       26

<PAGE>

SECTION 4.04.    COMPLIANCE CERTIFICATE.

            (i)   The Company shall deliver to the Trustee, within 120 days
after the end of each fiscal year, an Officers' Certificate stating that a
review of the activities of the Company and its Subsidiaries during the
preceding fiscal year has been made under the supervision of the signing
Officers with a view to determining whether each has kept, observed, performed
and fulfilled its obligations under this Indenture, and further stating, as to
each such Officer signing such certificate, that to the best of his or her
knowledge each entity has kept, observed, performed and fulfilled each and every
covenant contained in this Indenture and is not in default in the performance or
observance of any of the terms, provisions and conditions of this Indenture (or,
if a Default or Event of Default shall have occurred, describing all such
Defaults or Events of Default of which he or she may have knowledge and what
action each is taking or proposes to take with respect thereto), all without
regard to periods of grace or notice requirements, and that to the best of his
or her knowledge no event has occurred and remains in existence by reason of
which payments on account of the principal of or interest, if any, on the
Securities is prohibited or if such event has occurred, a description of the
event and what action each is taking or proposes to take with respect thereto.

            (ii)  So long as not contrary to the then current recommendations of
the American Institute of Certified Public Accountants, the year-end financial
statements delivered pursuant to Section 4.03 above shall be accompanied by a
written statement of the Company's certified independent public accountants (who
shall be a firm of established national reputation) that in making the
examination necessary for certification of such financial statements nothing has
come to their attention which would lead them to believe that the Company or any
Subsidiary of the Company has violated any provisions of Article 4 or of Article
5 of this Indenture or, if any such violation has occurred, specifying the
nature and period of existence thereof, it being understood that such
accountants shall not be liable directly or indirectly to any Person for any
failure to obtain knowledge of any such violation.

            (iii)  The Company shall, so long as any of the Securities are
outstanding, deliver to the Trustee, forthwith upon any Officer becoming aware
of (a) any Default or Event of Default or (b) any event of default under any
other mortgage, indenture or instrument referred to in Section 6.01(v) hereof,
an Officers' Certificate specifying such Default, Event of Default or event of
default and what action the Company is taking or proposes to take with respect
thereto.

SECTION 4.05.    TAXES.

            The Company shall pay, and shall cause each of its Subsidiaries to
pay, prior to delinquency, all material taxes, assessments, and governmental
levies except (i) as contested in good faith by appropriate proceedings and with
respect to which appropriate reserves have been taken in accordance with GAAP or
(ii) where the failure to effect such payment is not adverse in any material
respect to the Holders.

                                       27

<PAGE>

SECTION 4.06.    STAY, EXTENSION AND USURY LAWS.

            The Company covenants (to the extent that it may lawfully do so)
that it shall not at any time insist upon, plead, or in any manner whatsoever
claim or take the benefit or advantage of, any stay, extension or usury law
wherever enacted, now or at any time hereafter in force, that may affect the
covenants or the performance of this Indenture; and the Company (to the extent
that it may lawfully do so) hereby expressly waives all benefit or advantage of
any such law, and covenants that it shall not, by resort to any such law,
hinder, delay or impede the execution of any power herein granted to the
Trustee, but shall suffer and permit the execution of every such power as though
no such law has been enacted.

SECTION 4.07.    LIMITATIONS ON RESTRICTED PAYMENTS.

            The Company shall not, and shall not permit any of its Subsidiaries
to, directly or indirectly:  (i) declare or pay any dividend or make any
distribution on account of the Company's or any of its Subsidiaries' Equity
Interests (other than (w) Physician Joint Venture Distributions, (x) dividends
or distributions payable in Qualified Equity Interests of the Company, (y)
dividends or distributions payable to the Company or any Subsidiary of the
Company and (z) dividends or distributions by any Subsidiary of the Company
payable to all holders of a class of Equity Interests of such Subsidiary on a
PRO RATA basis); (ii) purchase, redeem or otherwise acquire or retire for
value any Equity Interests of the Company; (iii) make any principal payment on,
or purchase, redeem, defease or otherwise acquire or retire for value any
Indebtedness that is subordinated to the Securities, except at the original
final maturity date thereof or pursuant to the Refinancing; or (iv) make any
Restricted Investment (all such payments and other actions set forth in clauses
(i) through (iv) above being collectively referred to as "RESTRICTED
PAYMENTS"), unless, at the time of and after giving effect to such Restricted
Payment (the amount of any such Restricted Payment, if other than cash, shall be
the fair market value (as conclusively evidenced by a resolution of the Board of
Directors set forth in an Officers' Certificate delivered to the Trustee within
60 days prior to the date of such Restricted Payment) of the asset(s) proposed
to be transferred by the Company or such Subsidiary, as the case may be,
pursuant to such Restricted Payment):

            (a)   no Default or Event of Default shall have occurred and be
                  continuing or would occur as a consequence thereof; and

            (b)   the Company would, at the time of such Restricted Payment and
                  after giving pro forma effect thereto as if such Restricted
                  Payment had been made at the beginning of the most recently
                  ended four full fiscal quarter period for which internal
                  financial statements are available immediately preceding the
                  date of such Restricted Payment, have been permitted to incur
                  at least $1.00 of additional Indebtedness pursuant to the
                  Fixed Charge Coverage Ratio test set forth in the first
                  paragraph of Section 4.09 hereof; and

            (c)   such Restricted Payment, together with the aggregate of all
                  other Restricted Payments (excluding Restricted Payments
                  permitted by clauses (ii), (iii), (iv) and (v) of the next
                  succeeding paragraph) made by the

                                       28

<PAGE>

                  Company and its Subsidiaries after the date hereof, is less
                  than the sum of (1) 50% of the Consolidated Net Income of the
                  Company for the period (taken as one accounting period) from
                  the beginning of the first fiscal quarter commencing after the
                  date hereof to the end of the Company's most recently ended
                  fiscal quarter for which internal financial statements are
                  available at the time of such Restricted Payment (or, if such
                  Consolidated Net Income for such period is a deficit, less
                  100% of such deficit), PLUS (2) 100% of the aggregate net
                  cash proceeds received by the Company from the issue or sale
                  (other than to a Subsidiary of the Company) since the date
                  hereof of Qualified Equity Interests of the Company or debt
                  securities of the Company or any of its Subsidiaries that have
                  been converted into or exchanged for such Qualified Equity
                  Interests of the Company, PLUS (3) $20.0 million.

            If no Default or Event of Default has occurred and is continuing or
would occur as a consequence thereof, the foregoing provisions shall not
prohibit:

            (i)   the payment of any dividend within 60 days after the date of
                  declaration thereof, if at said date of declaration such
                  payment would have complied with the provisions hereof;

            (ii)  the payment of cash dividends on any series of Disqualified
                  Stock issued after the date hereof in an aggregate amount not
                  to exceed the cash received by the Company since the date
                  hereof upon issuance of such Disqualified Stock;

            (iii) the repurchase of the Performance Investment Plan investment
                  options from the holders thereof;

            (iv)  the redemption, repurchase, retirement or other acquisition of
                  any Equity Interests of the Company or any Subsidiary in
                  exchange for, or out of the net cash proceeds of, the
                  substantially concurrent sale (other than to a Subsidiary of
                  the Company) of Qualified Equity Interests of the Company;
                  PROVIDED that the amount of any such net cash proceeds that
                  are utilized for any such redemption, repurchase, retirement
                  or other acquisition shall be excluded from clause (c)(2) of
                  the preceding paragraph;

            (v)   the defeasance, redemption or repurchase of subordinated
                  Indebtedness with the net cash proceeds from an incurrence of
                  Permitted Refinancing Indebtedness or in exchange for or out
                  of the net cash proceeds from the substantially concurrent
                  sale (other than to a Subsidiary of the Company) of Qualified
                  Equity Interests of the Company; PROVIDED that the amount of
                  any such net cash proceeds that are utilized for any such
                  redemption, repurchase, retirement or other acquisition shall
                  be excluded from clause (c)(2) of the preceding paragraph;

                                       29

<PAGE>

            (vi)  the repurchase, redemption or other acquisition or retirement
                  for value of any Equity Interests of the Company or any
                  Subsidiary of the Company held by any member of the Company's
                  (or any of its Subsidiaries') management pursuant to any
                  management equity subscription agreement or stock option
                  agreement; PROVIDED that the aggregate price paid for all
                  such repurchased, redeemed, acquired or retired Equity
                  Interests shall not exceed $5.0 million in any twelve-month
                  period; and

            (vii) the making and consummation of (a) a Senior Subordinated Asset
                  Sale Offer in accordance with the provisions of this Indenture
                  with any Excess Proceeds that remain after consummation of a
                  Senior Asset Sale Offer, within 120 days of the consummation
                  of such Senior Asset Sale Offer, or (b) a Change of Control
                  Offer with respect to the Securities in accordance with the
                  provisions of this Indenture.

            Not later than the date of making any Restricted Payment, the
Company shall deliver to the Trustee an Officers' Certificate stating that such
Restricted Payment is permitted and setting forth the basis upon which the
calculations required by this covenant were computed.

SECTION 4.08.    LIMITATIONS ON DIVIDEND AND OTHER PAYMENT RESTRICTIONS
                  AFFECTING SUBSIDIARIES.

            The Company shall not, and shall not permit any of its Subsidiaries
to, directly or indirectly, create or otherwise cause or suffer to exist or
become effective any consensual Transfer Restriction, except for such Transfer
Restrictions existing under or by reason of:

            (a)   Existing Indebtedness as in effect on the date hereof,

            (b)   this Indenture,

            (c)   applicable law,

            (d)   any instrument governing Indebtedness or Capital Stock of a
                  Person acquired by the Company or any of its Subsidiaries as
                  in effect at the time of such acquisition (except to the
                  extent such Indebtedness was incurred in connection with or in
                  contemplation of such acquisition or in violation of Section
                  4.09 hereof), which encumbrance or restriction is not
                  applicable to any Person, or the properties or assets of any
                  Person, other than the Person, or the property or assets of
                  the Person, so acquired, PROVIDED that the Consolidated Cash
                  Flow of such Person shall not be taken into account in
                  determining whether such acquisition was permitted by the
                  terms hereof except to the extent that such Consolidated Cash
                  Flow would be permitted to be dividends to the Company without
                  the prior consent or approval of any third party,

            (e)   customary non-assignment provisions in leases entered into in
                  the ordinary course of business,

                                       30

<PAGE>

            (f)   purchase money obligations for property acquired in the
                  ordinary course of business that impose restrictions on the
                  ability of any of the Company's Subsidiaries to transfer the
                  property so acquired to the Company or any of its
                  Subsidiaries,

            (g)   Permitted Refinancing Indebtedness, PROVIDED that the
                  restrictions contained in the agreements governing such
                  Permitted Refinancing Indebtedness are no more restrictive
                  than those contained in the agreements governing the
                  Indebtedness being refinanced, or

            (h)   the New Credit Facility and related documentation as the same
                  is in effect on the date hereof and as amended or replaced
                  from time to time, provided that no such amendment or
                  replacement is more restrictive as to Transfer Restrictions
                  than the New Credit Facility and related documentation as in
                  effect on the date hereof.

SECTION 4.09.    LIMITATIONS ON INCURRENCE OF INDEBTEDNESS AND ISSUANCE OF
                 PREFERRED STOCK

            The Company shall not, and shall not permit any of its Subsidiaries
to, directly or indirectly, create, incur, issue, assume, Guarantee or otherwise
become directly or indirectly liable, contingently or otherwise, with respect to
(collectively, "INCUR") after the date hereof any Indebtedness (including
Acquired Debt), and the Company shall not issue any Disqualified Stock and shall
not permit any of its Subsidiaries to issue any shares of preferred stock;
PROVIDED, HOWEVER, that the Company may incur Indebtedness (including
Acquired Debt) and the Company may issue shares of Disqualified Stock if the
Fixed Charge Coverage Ratio for the Company's most recently ended four full
fiscal quarters for which internal financial statements are available
immediately preceding the date on which such additional Indebtedness is incurred
or such Disqualified Stock is issued would have been at least (x) 2.25 to 1 if
such incurrence or issuance occurs on or before March 31, 1996, or (y) 2.5 to 1
if such incurrence or issuance occurs at any time thereafter, in each case
determined on a pro forma basis (including a pro forma application of the net
proceeds therefrom), as if the additional Indebtedness had been incurred or the
Disqualified Stock had been issued, as the case may be, at the beginning of such
four-quarter period.  Indebtedness consisting of reimbursement obligations in
respect of a letter of credit shall be deemed to be incurred when the letter
of credit is first issued.  The Company shall not permit any of the
International Subsidiaries to incur any Indebtedness other than Non-Recourse
Debt.

            The foregoing provisions shall not apply to:

            (a)   the incurrence by the Company of Senior Term Debt pursuant to
                  the New Credit Facility in an aggregate principal amount at
                  any time outstanding not to exceed an amount equal to $1.8
                  billion less the aggregate amount of all repayments, optional
                  or mandatory, of the principal of any Senior Term Debt (other
                  than repayments that are immediately reborrowed) that have
                  been made since the date hereof;

                                       31

<PAGE>

            (b)   the incurrence by the Company of Senior Revolving Debt and
                  letters of credit pursuant to the New Credit Facility in an
                  aggregate principal amount at any time outstanding (with
                  letters of credit being deemed to have a principal amount
                  equal to the maximum potential reimbursement obligation of the
                  Company with respect thereto) not to exceed an amount equal to
                  $500.0 million less the aggregate amount of all Net Proceeds
                  of Asset Sales applied to permanently reduce the commitments
                  with respect to such Indebtedness pursuant to Section 4.10
                  hereof;

            (c)   the incurrence by the Company of Indebtedness represented by
                  the Securities;

            (d)   the incurrence by the Company and its Subsidiaries of the
                  Existing Indebtedness;

            (e)   the incurrence by the Company or any of its Subsidiaries of
                  Permitted Refinancing Indebtedness in exchange for, or the net
                  proceeds of which are used to extend, refinance, renew,
                  replace, defease, or refund, Indebtedness that was permitted
                  by this Indenture to be incurred (including, without
                  limitation, Existing Indebtedness);

            (f)   the incurrence by the Company of Hedging Obligations that are
                  incurred for the purpose of fixing or hedging interest rate or
                  currency risk with respect to any fixed or floating rate
                  Indebtedness that is permitted by the terms hereof to be
                  outstanding or any receivable or liability the payments of
                  which is determined by reference to a foreign currency;
                  PROVIDED that the notional principal amount of any such
                  Hedging Obligation does not exceed the principal amount of the
                  Indebtedness to which such Hedging Obligation relates;

            (g)   the incurrence by the Company or any of its Subsidiaries of
                  Physician Support Obligations;

            (h)   the incurrence by the Company or any of its Subsidiaries of
                  intercompany Indebtedness between or among the Company and any
                  of its Subsidiaries;

            (i)   the incurrence by the Company or any of its Subsidiaries of
                  Indebtedness represented by performance bonds, standby letters
                  of credit or appeal bonds, in each case to the extent incurred
                  in the ordinary course of business of the Company or such
                  Subsidiary;

            (j)   the incurrence by any Subsidiary of the Company of
                  Indebtedness, the aggregate principal amount of which,
                  together with all other Indebtedness of the Company's
                  Subsidiaries at the time outstanding (excluding the Existing
                  Indebtedness until repaid or refinanced and excluding
                  Physician Support Obligations), does not exceed the greater of
                  (1) 10% of the Company's Stockholders' Equity as of the date
                  of incurrence or (2) $10.0

                                       32

<PAGE>

                  million; PROVIDED that, in the case of clause (1) only, the
                  Fixed Charge Coverage Ratio for the Company's most recently
                  ended four full fiscal quarters for which internal financial
                  statements are available immediately preceding the date on
                  which such Indebtedness is incurred would have been at least
                  (x) 2.25 to 1 if such incurrence occurs on or before March 31,
                  1996, or (y) 2.5 to 1 if such incurrence occurs at any time
                  thereafter, in each case determined on a pro forma basis
                  (including a pro forma application of the net proceeds
                  therefrom), as if such Indebtedness had been incurred at the
                  beginning of such four-quarter period; and

            (k)   the incurrence by the Company of Indebtedness (in addition to
                  Indebtedness permitted by any other clause of this paragraph)
                  in an aggregate principal amount at any time outstanding not
                  to exceed $250.0 million.

SECTION 4.10.    ASSET SALES.

            The Company shall not, and shall not permit any of its Subsidiaries
to consummate an Asset Sale, unless (i) the Company (or the Subsidiary as the
case may be) receives consideration at the time of such Asset Sale at least
equal to the fair market value (as conclusively determined by a resolution of
the Board of Directors set forth in an Officers' Certificate delivered to the
Trustee) of the assets or Equity Interests issued or sold or otherwise disposed
of and (ii) except in the case of a sale of Specified Assets, at least 80% of
the consideration therefor received by the Company or such Subsidiary is in the
form of cash; PROVIDED, HOWEVER, that for purposes of this provision, (x) the
amount of (a) any liabilities (as shown on the Company's or such Subsidiary's
most recent balance sheet or in the notes thereto), of the Company or any
Subsidiary (other than, in the case of an Asset Sale by the Company, liabilities
that are by their terms subordinated to the Securities that are assumed by the
transferee of any such assets and (b) any securities or other obligations
received by the Company or any such Subsidiary from such transferee that are
immediately converted by the Company or such Subsidiary into cash (or as to
which the Company or such Subsidiary has received at or prior to the
consummation of the Asset Sale a commitment (which may be subject to customary
conditions) from a nationally recognized investment, merchant or commercial bank
to convert into cash within 90 days of the consummation of such Asset Sale and
which are thereafter actually converted into cash within such 90-day period)
shall be deemed to be cash (but shall not be deemed to be Net Proceeds for
purposes of the following provisions until reduced to cash); and (y) the fair
market value of any Non-Cash Consideration received by the Company or a
Subsidiary in any Asset Sale shall be deemed to be cash (but shall not be deemed
to be Net Proceeds for purposes of the following provisions until reduced to
cash) to the extent that the aggregate fair market value (as conclusively
determined by a resolution of the Board of Directors set forth in an Officers'
Certificate delivered to the Trustee) of all Non-Cash Consideration (measured at
the time received and without giving effect to any subsequent changes in value)
held by the Company immediately after consummation of such Asset Sale does not
exceed 10% of the Company's Stockholders' Equity as of the date of such
consummation.

            Within 465 days after the receipt of any Net Proceeds from an Asset
Sale, the Company may apply such Net Proceeds (i) to purchase one or more
Hospitals or Related

                                       33

<PAGE>

Businesses and/or a controlling interest in the Capital Stock of a Person owning
one or more Hospitals and/or one or more Related Businesses, (ii) to make a
capital expenditure or to acquire other tangible assets, in each case, that are
used or useful in any business in which the Company is permitted to be engaged
pursuant to Section 4.15 hereof, (iii) to permanently reduce Senior Term Debt or
Existing Indebtedness of a Subsidiary, (iv) to permanently reduce Senior
Revolving Debt (and to correspondingly reduce commitments with respect thereto),
except that up to an aggregate of $200.0 million of Net Proceeds from Asset
Sales may be applied after the date hereof to reduce Senior Revolving Debt
without a corresponding reduction in commitments with respect thereto, or (v) to
repurchase Senior Notes or redeem or repurchase other Senior Debt.  Pending the
final application of any such Net Proceeds, the Company may temporarily reduce
Senior Revolving Debt or otherwise invest such Net Proceeds in any manner that
is not prohibited by the terms hereof.  Any Net Proceeds from Asset Sales that
are not so invested or applied shall be deemed to constitute "Excess
Proceeds."  When the aggregate amount of Excess Proceeds exceeds $25.0 million,
the Company shall make an offer to all Holders of Securities (a "SENIOR
SUBORDINATED ASSET SALE OFFER") to purchase the maximum principal amount of
Securities that may be purchased out of the Excess Proceeds, at an offer price
in cash equal to 100% of the principal amount thereof plus accrued and unpaid
interest thereon, if any, to the date of purchase (the "PURCHASE PRICE"), in
accordance with the procedures set forth in Section 3.09 hereof.  To the extent
that the aggregate amount of Securities tendered pursuant to a Senior
Subordinated Asset Sale Offer is less than the Excess Proceeds, the Company may
use any remaining Excess Proceeds for general corporate purposes.  If the
aggregate principal amount of Securities surrendered by holders pursuant to a
Senior Subordinated Asset Sale Offer exceeds the amount of Excess Proceeds, the
Securities shall be purchased on a PRO RATA basis. Upon completion of a Senior
Subordinated Asset Sale Offer, the amount of Excess Proceeds shall be reset at
zero.

SECTION 4.11.    LIMITATIONS ON TRANSACTIONS WITH AFFILIATES.

            The Company shall not, and shall not permit any of its Subsidiaries
to, sell, lease, transfer or otherwise dispose of any of its properties or
assets to, or purchase any property or assets from, or enter into or make any
contract, agreement, understanding, loan, advance or Guarantee with, or for the
benefit of, any Affiliate (each of the foregoing, an "AFFILIATE TRANSACTION")
unless (i) such Affiliate Transaction is on terms that are no less favorable to
the Company or the relevant Subsidiary than those that could have been obtained
in a comparable transaction by the Company or such Subsidiary with an unrelated
Person and (ii) the Company delivers to the Trustee (a) with respect to any
Affiliate Transaction involving aggregate consideration in excess of $5.0
million, a resolution of the Board of Directors set forth in an Officers'
Certificate certifying that such Affiliate Transaction complies with clause (i)
above and that such Affiliate Transaction was approved by a majority of the
disinterested members of the Board of Directors and (b) with respect to any
Affiliate Transaction involving aggregate consideration in excess of $15.0
million, an opinion as to the fairness of such Affiliate Transaction to the
Company or such Subsidiary from a financial point of view issued by an
investment banking firm of national standing; PROVIDED that (x) transactions
or payments pursuant to any employment arrangements or employee or director
benefit plans entered into by the Company or any of its Subsidiaries in the
ordinary course of business and consistent with the past practice of the Company
or such Subsidiary, (y) transactions between or among the

                                       34

<PAGE>

Company and/or its Subsidiaries and (z) transactions permitted under Section
4.07 hereof, in each case, shall not be deemed to be Affiliate Transactions.

SECTION 4.12.    LIMITATIONS ON LIENS.

            The Company shall not, and shall not permit any of its Subsidiaries
to, directly or indirectly create, incur, assume or suffer to exist any Lien to
secure Indebtedness that is PARI PASSU with or subordinated in right of
payment to the Securities (except Permitted Liens) on any asset now owned or
hereafter acquired, or any income or profits therefrom or assign or convey any
right to receive income therefrom unless all payments due hereunder and under
the Securities are secured on an equal and ratable basis with the Obligations so
secured until such time as such Obligations are no longer secured by a Lien.

SECTION 4.13.    CHANGE OF CONTROL.

            Upon the occurrence of a Change of Control Triggering Event, each
Holder of Securities shall have the right to require the Company to repurchase
all or any part (equal to $1,000 or an integral multiple thereof) of such
Holder's Securities pursuant to the offer described below (the "CHANGE OF
CONTROL OFFER") at an offer price in cash equal to 101% of the aggregate
principal amount thereof plus accrued and unpaid interest, if any, thereon to
the date of purchase (the "CHANGE OF CONTROL PAYMENT") on a date that is not
more than 90 days after the occurrence of such Change of Control Triggering
Event (the "CHANGE OF CONTROL PAYMENT DATE").

            Within 30 days following any Change of Control Triggering Event, the
Company shall mail, or at the Company's request the Trustee shall mail, a notice
of a Change of Control to each Holder (at its last registered address with a
copy to the Trustee and the Paying Agent) offering to repurchase the Securities
held by such Holder pursuant to the procedure specified in such notice.  The
Change of Control Offer shall remain open from the time of mailing until the
close of business on the Business Day next preceding the Change of Control
Payment Date.  The notice, which shall govern the terms of the Change of Control
Offer, shall contain all instructions and materials necessary to enable the
Holders to tender Securities pursuant to the Change of Control Offer and shall
state:

            (1)   that the Change of Control Offer is being made pursuant to
                  this Section 4.13 and that all Securities tendered will be
                  accepted for payment;

            (2)   the Change of Control Payment and the Change of Control
                  Payment Date, which date shall be no earlier than 30 days nor
                  later than 60 days from the date such notice is mailed;

            (3)   that any Security not tendered will continue to accrue
                  interest in accordance with the terms of this Indenture;

            (4)   that, unless the Company defaults in the payment of the Change
                  of Control Payment, all Securities accepted for payment
                  pursuant to the

                                       35

<PAGE>

                  Change of Control Offer will cease to accrue interest after
                  the Change of Control Payment Date;

            (5)   that Holders electing to have a Security purchased pursuant to
                  any Change of Control Offer will be required to surrender the
                  Security, with the form entitled "Option of Holder to Elect
                  Purchase" on the reverse of the Security completed, to the
                  Company, a depositary, if appointed by the Company, or a
                  Paying Agent at the address specified in the notice prior to
                  the close of business on the Business Day next preceding the
                  Change of Control Payment Date;

            (6)   that Holders will be entitled to withdraw their election if
                  the Company, depositary or Paying Agent, as the case may be,
                  receives, not later than the close of business on the Business
                  Day next preceding the Change of Control Payment Date, a
                  facsimile transmission or letter setting forth the name of the
                  Holder, the principal amount of the Security the Holder
                  delivered for purchase, and a statement that such Holder is
                  withdrawing his election to have such Security purchased;

            (7)   that Holders whose Securities are being purchased only in part
                  will be issued new Securities equal in principal amount to the
                  unpurchased portion of the Securities surrendered, which
                  unpurchased portion must be equal to $1,000 in principal
                  amount or an integral multiple thereof; and

            (8)   the circumstances and relevant facts regarding such Change of
                  Control (including, but not limited to, information with
                  respect to PRO FORMA historical financial information after
                  giving effect to such Change of Control, information regarding
                  the Person or Persons acquiring control and such Person's or
                  Persons' business plans going forward) and any other
                  information that would be material to a decision as to whether
                  to tender a Security pursuant to the Change of Control Offer.

            On the Change of Control Payment Date, the Company shall, to the
extent lawful, (i) accept for payment all Securities or portions thereof
properly tendered and not withdrawn pursuant to the Change of Control Offer,
(ii) deposit with the Paying Agent an amount equal to the Change of Control
Payment in respect of all Securities or portions thereof so tendered and (iii)
deliver or cause to be delivered to the Trustee the Securities so accepted
together with an Officers' Certificate stating the aggregate principal amount of
Securities or portions thereof being purchased by the Company.  The Paying Agent
shall promptly mail to each Holder of Securities so tendered the Change of
Control Payment for such Securities, and the Trustee shall promptly authenticate
and mail (or cause to be transferred by book entry) to each Holder a new
Security equal in principal amount to any unpurchased portion of the Securities
surrendered, if any; PROVIDED that each such new Security shall be in a
principal amount of $1,000 or an integral multiple thereof.

            Prior to complying with the provisions of this Section 4.13, but in
any event within 90 days following a Change of Control Triggering Event, the
Company shall either repay

                                       36

<PAGE>

all outstanding Senior Debt or obtain the requisite consents, if any, under all
agreements governing outstanding Senior Debt to permit the repurchase of
Securities required by this Section 4.13.

            The Company shall publicly announce the results of the Change of
Control Offer on or as soon as practicable after the Change of Control Payment
Date.

            The Company shall comply with the requirements of Rule 14e-1 under
the Exchange Act and any other securities laws and regulations thereunder to the
extent such laws and regulations are applicable in connection with the
repurchase of Securities as a result of a Change of Control.

SECTION 4.14.    CORPORATE EXISTENCE.

            Subject to Section 4.13 and Article 5 hereof, the Company shall do
or cause to be done all things necessary to preserve and keep in full force and
effect (i) its corporate existence, and the corporate, partnership or other
existence of each of its Subsidiaries, in accordance with the respective
organizational documents (as the same may be amended from time to time) of each
Subsidiary and (ii) the rights (charter and statutory), licenses and franchises
of the Company and its Subsidiaries; PROVIDED, HOWEVER, that the Company
shall not be required to preserve any such right, license or franchise, or the
corporate, partnership or other existence of any of its Subsidiaries, if the
Board of Directors shall determine that the preservation thereof is no longer
desirable in the conduct of the business of the Company and its Subsidiaries,
taken as a whole, and that the loss thereof is not adverse in any material
respect to the Holders.

SECTION 4.15.    LINE OF BUSINESS.

            The Company shall not, and shall not permit any of its Subsidiaries
to, engage to any material extent in any business other than the ownership,
operation and management of Hospitals and Related Businesses.

SECTION 4.16.    LIMITATIONS ON ISSUANCES OF GUARANTEES OF INDEBTEDNESS BY
                 SUBSIDIARIES.

            The Company shall not permit any Subsidiary, directly or indirectly,
to Guarantee or secure the payment of any other Indebtedness of the Company or
any of its Subsidiaries (except Indebtedness of a Subsidiary of such Subsidiary
or Physician Support Obligations) unless such Subsidiary simultaneously executes
and delivers a supplemental indenture to this Indenture, in substantially the
form attached hereto as Exhibit B, providing for the Guarantee of the payment of
the Securities by such Subsidiary, which Guarantee shall be subordinated to
such Subsidiary's Guarantee of or pledge to secure such other Indebtedness to
the same extent as the Securities are subordinated to such other Indebtedness
under this Indenture.  Any such Guarantee by a Subsidiary of the Securities
shall provide by its terms that it shall be automatically and unconditionally
released and discharged upon the sale or other disposition, by way of merger or
otherwise, to any Person not an Affiliate of the Company, of all of the
Company's stock in, or all or substantially all the assets of, such Subsidiary,
which sale or other disposition is made in compliance with, and the Net Proceeds
therefrom are applied in accordance with, the

                                       37

<PAGE>

applicable provisions hereof.  The foregoing provisions shall not be applicable
to any one or more Guarantees of up to $10.0 million in aggregate principal
amount of Indebtedness of the Company at any time outstanding.

SECTION 4.17.    NO SENIOR SUBORDINATED DEBT.

            The Company shall not incur any Indebtedness that is subordinate or
junior in right of payment to any Senior Debt and senior in any respect in right
of payment to the Securities.

                                   ARTICLE 5
                                  SUCCESSORS

SECTION 5.01.    LIMITATIONS ON MERGERS, CONSOLIDATIONS OR SALES OF ASSETS.

            The Company may not consolidate or merge with or into (whether or
not the Company is the surviving corporation), or sell, assign, transfer, lease,
convey or otherwise dispose of all or substantially all of its properties or
assets in one or more related transactions to another corporation, Person or
entity unless:

            (i)   the Company is the surviving corporation or the entity or the
                  Person formed by or surviving any such consolidation or merger
                  (if other than the Company) or to which such sale, assignment,
                  transfer, lease, conveyance or other disposition shall have
                  been made is a corporation organized or existing under the
                  laws of the United States, any state thereof or the District
                  of Columbia;

            (ii)  the entity or Person formed by or surviving any such
                  consolidation or merger (if other than the Company) or the
                  entity or Person to which such sale, assignment, transfer,
                  lease, conveyance or other disposition shall have been made
                  assumes all the Obligations of the Company under this
                  Indenture and the Securities pursuant to a supplemental
                  indenture in a form reasonably satisfactory to the Trustee;

            (iii) immediately after such transaction no Default or Event of
                  Default exists; and

            (iv)  the Company or the entity or Person formed by or surviving any
                  such consolidation or merger (if other than the Company), or
                  to which such sale, assignment, transfer, lease, conveyance or
                  other disposition shall have been made (a) shall have
                  Consolidated Net Worth immediately after the transaction equal
                  to or greater than the Consolidated Net Worth of the Company
                  immediately preceding the transaction and (b) shall, at the
                  time of such transaction and after giving pro forma effect
                  thereto as if such transaction had occurred at the beginning
                  of the applicable four-quarter period, be permitted to incur
                  at least $1.00 of additional Indebtedness

                                             38

<PAGE>

                  pursuant to the Fixed Charge Coverage Ratio test set forth in
                  the first paragraph of Section 4.09 hereof.

            The Company shall deliver to the Trustee prior to the consummation
of the proposed transaction an Officers' Certificate to the foregoing effect and
an Opinion of Counsel, covering clauses (i) through (iv) above, stating that the
proposed transaction and such supplemental indenture comply with this Indenture.
The Trustee shall be entitled to conclusively rely upon such Officers'
Certificate and Opinion of Counsel.

SECTION 5.02.    SUCCESSOR CORPORATION SUBSTITUTED.

            Upon any consolidation or merger, or any sale, assignment, transfer,
lease, conveyance or other disposition of all or substantially all of the assets
of the Company in accordance with Section 5.01 hereof, the successor corporation
formed by such consolidation or into or with which the Company is merged or to
which such sale, assignment, transfer, lease, conveyance or other disposition is
made shall succeed to, and be substituted for (so that from and after the date
of such consolidation, merger, sale, assignment, transfer, lease, conveyance or
other disposition, the provisions of this Indenture referring to the "Company"
shall refer instead to the successor corporation), and may exercise every right
and power of, the Company under this Indenture with the same effect as if such
successor Person has been named as the Company, herein.

                                   ARTICLE 6
                             DEFAULTS AND REMEDIES

SECTION 6.01.    EVENTS OF DEFAULT.

            Each of the following constitutes an "Event of Default":

            (i)   default for 30 days in the payment when due of interest on the
      Securities, whether or not such payment is prohibited by the provisions of
      Article 10 hereof;

            (ii)  default in payment when due of the principal of or premium, if
      any, on the Securities at maturity, upon redemption or otherwise, whether
      or not such payment is prohibited by the provisions of Article 10 hereof;

            (iii) failure by the Company to comply with the provisions of
      Sections 4.07, 4.09, 4.10 or 4.13 hereof;

            (iv)  failure by the Company to comply with any other covenant or
      agreement in the Indenture or the Securities for the period and after the
      notice specified below;

            (v)   any default that occurs under any mortgage, indenture or
      instrument under which there may be issued or by which there may be
      secured or evidenced any Indebtedness for money borrowed by the Company or
      any of its Significant Subsidiaries (or the payment of which is Guaranteed
      by the Company or any of its Significant

                                       39

<PAGE>

      Subsidiaries), whether such Indebtedness or Guarantee exists on the date
      hereof or is created after the date hereof, which default (a) constitutes
      a failure to pay principal at final maturity or (b) results in the
      acceleration of such Indebtedness prior to its express maturity and, in
      each case, the principal amount of such Indebtedness, together with the
      principal amount of any other Indebtedness that has not been paid at final
      maturity or that has been so accelerated, aggregates $25.0 million or
      more;

            (vi)  failure by the Company or any of its Significant Subsidiaries
      to pay a final judgment or final judgments aggregating in excess of $25.0
      million entered by a court or courts of competent jurisdiction against the
      Company or any of its Significant Subsidiaries if such final judgment or
      judgments remain unpaid or undischarged for a period (during which
      execution shall not be effectively stayed) of 60 days after their entry;

            (vii) the Company or any Significant Subsidiary thereof pursuant to
      or within the meaning of any Bankruptcy Law:

                  (a)   commences a voluntary case,

                  (b)   consents to the entry of an order for relief against it
            in an involuntary case in which it is the debtor,

                  (c)   consents to the appointment of a Custodian of it or for
            all or substantially all of its property,

                  (d)   makes a general assignment for the benefit of its
            creditors, or

                  (e)   admits in writing its inability generally to pay its
            debts as the same become due; and

            (viii) a court of competent jurisdiction enters an order or
       decree under any Bankruptcy Law that:

                  (a)   is for relief against the Company or any Significant
            Subsidiary in an involuntary case in which it is the debtor,

                  (b)   appoints a Custodian of the Company or any Significant
            Subsidiary thereof or for all or substantially all of the property
            of the Company or any Significant Subsidiary thereof, or

                  (c)   orders the liquidation of the Company or any Significant
            Subsidiary thereof,

      and the order or decree remains unstayed and in effect for 60 days.

                                       40

<PAGE>

            The term "BANKRUPTCY LAW" means title 11, U.S. Code or any similar
federal or state law for the relief of debtors.  The term "CUSTODIAN" means
any receiver, trustee, assignee, liquidator or similar official under any
Bankruptcy Law.

            A Default under clause (iv) is not an Event of Default until the
Trustee notifies the Company in writing, or the Holders of at least 25% in
principal amount of the then outstanding Securities notify the Company and the
Trustee in writing, of the Default and the Company does not cure the Default
within 60 days after receipt of such notice.  The written notice must specify
the Default, demand that it be remedied and state that the notice is a "Notice
of Default."

SECTION 6.02.    ACCELERATION.

            If any Event of Default (other than an Event of Default specified in
clause (vii) or (viii) of Section 6.01 hereof) occurs and is continuing, the
Trustee by notice to the Company, or the Holders of at least 25% in aggregate
principal amount of the then outstanding Securities by written notice to the
Company and the Trustee, may declare the unpaid principal of, premium, if any,
and any accrued and unpaid interest on all the Securities to be due and payable
immediately.  Upon such declaration the principal, premium, if any, and interest
shall be due and payable immediately (together with the premium referred to in
Section 6.01 hereof, if applicable). If an Event of Default specified in clause
(vii) or (viii) of Section 6.01 hereof occurs with respect to the Company or any
Significant Subsidiary thereof, such an amount shall IPSO FACTO become and be
immediately due and payable without further action or notice on the part of the
Trustee or any Holder.

            In the case of any Event of Default occurring by reason of any
willful action (or inaction) taken (or not taken) by or on behalf of the Company
with the intention of avoiding payment of the premium that the Company would
have had to pay if the Company then had elected to redeem the Securities
pursuant to Section 3.07 hereof, an equivalent premium shall also become and be
immediately due and payable to the extent permitted by law upon the acceleration
of the Securities.

            If an Event of Default occurs prior to March 1, 2000 by reason of
any willful action (or inaction) taken (or not taken) by or on behalf of the
Company with the intention of avoiding the prohibition on redemption of the
Securities prior to March 1, 2000 pursuant to Section 3.07 hereof, then, a
premium with respect thereto (expressed as a percentage of the amount that would
otherwise be due but for the provisions of this sentence, plus accrued interest,
if any, to the date of payment) shall become and be immediately due and payable
to the extent permitted by law upon the accelerations of such Securities for
each of the years beginning on March 1 of the years set forth below:

                  YEAR              PERCENTAGE
                  ----              ----------

                  1995              110.125%
                  1996              109.113%
                  1997              108.100%

                                       41

<PAGE>

                  1998              107.088%
                  1999              106.075%

            Any determination regarding the primary purpose of any such action
or inaction, as the case may be, shall be made by and set forth in a resolution
of the Board of Directors (including the concurrence of a majority of the
independent directors of the Company then serving) delivered to the Trustee
after consideration of the business reasons for such action or inaction, other
than the avoidance of such prohibition on redemption.  In the absence of fraud,
each such determination shall be final and binding upon the Holders of
Securities.  Subject to Section 7.01 hereof, the Trustee shall be entitled to
rely on the determination set forth in any such resolutions delivered to the
Trustee.

SECTION 6.03.    OTHER REMEDIES.

            If an Event of Default occurs and is continuing, the Trustee may
pursue any available remedy to collect the payment of principal or interest on
the Securities or to enforce the performance of any provision of the Securities
or this Indenture.

            The Trustee may maintain a proceeding even if it does not possess
any of the Securities or does not produce any of them in the proceeding.  A
delay or omission by the Trustee or any Holder in exercising any right or remedy
accruing upon an Event of Default shall not impair the right or remedy or
constitute a waiver of or acquiescence in the Event of Default.  All remedies
are cumulative to the extent permitted by law.

SECTION 6.04.    WAIVER OF PAST DEFAULTS.

            The Holders of not less than a majority in aggregate principal
amount of the Securities then outstanding by written notice to the Trustee may
on behalf of the Holders of all of the Securities waive any existing Default or
Event of Default and its consequences under this Indenture, except a continuing
Default or Event of Default in the payment of the principal of, premium, if any,
or interest on any Security.  Upon any such waiver, such Default shall cease to
exist, and any Event of Default arising therefrom shall be deemed to have been
cured for every purpose of this Indenture; but no such waiver shall extend to
any subsequent or other Default or impair any right consequent thereon.

SECTION 6.05.    CONTROL BY MAJORITY.

            Holders of a majority in principal amount of the then outstanding
Securities may direct the time, method and place of conducting any proceeding
for any remedy available to the Trustee or exercising any trust or power
conferred on it.  However, the Trustee may refuse to follow any direction that
conflicts with law or this Indenture that the Trustee determines may be unduly
prejudicial to the rights of other Holders or that may involve the Trustee in
personal liability.  The Trustee may take any other action which it deems proper
which is not inconsistent with any such direction.

                                       42

<PAGE>

SECTION 6.06.    LIMITATION ON SUITS.

            A Holder may pursue a remedy with respect to this Indenture or the
Securities only if:
            (i)   the Holder gives to the Trustee written notice of a continuing
                  Event of Default;

            (ii)  the Holders of at least 25% in principal amount of the then
                  outstanding Securities make a written request to the Trustee
                  to pursue the remedy;

            (iii) such Holder or Holders offer and, if requested, provide to the
                  Trustee indemnity satisfactory to the Trustee against any
                  loss, liability or expense;

            (iv)  the Trustee does not comply with the request within 60 days
                  after receipt of the request and the offer and, if requested,
                  the provision of indemnity; and

            (v)   during such 60-day period the Holders of a majority in
                  principal amount of the then outstanding Securities do not
                  give the Trustee a direction inconsistent with the request.

A Holder may not use this Indenture to prejudice the rights of another Holder or
to obtain a preference or priority over another Holder.

SECTION 6.07.    RIGHTS OF HOLDERS TO RECEIVE PAYMENT.

            Notwithstanding any other provision of this Indenture, the right of
any Holder to receive payment of principal, premium, if any, and interest on the
Security, on or after the respective due dates expressed in the Security, or to
bring suit for the enforcement of any such payment on or after such respective
dates, shall not be impaired or affected without the consent of the Holder.

SECTION 6.08.    COLLECTION SUIT BY TRUSTEE.

            If an Event of Default specified in Section 5.01(i) or (ii) hereof
occurs and is continuing, the Trustee is authorized to recover judgment in its
own name and as trustee of an express trust against the Company or any other
obligor for the whole amount of principal, premium, if any, and interest
remaining unpaid on the Securities and interest on overdue principal and, to the
extent lawful, interest and such further amount as shall be sufficient to cover
amounts due the Trustee under Section 7.07 hereof, including the costs and
expenses of collection, including the reasonable compensation, expenses,
disbursements and advances of the Trustee, its agents and counsel.

SECTION 6.09.    TRUSTEE MAY FILE PROOFS OF CLAIM.

            The Trustee is authorized to file such proofs of claim and other
papers or documents as may be necessary or advisable in order to have the claims
of the Trustee (including

                                       43

<PAGE>

any claim for the reasonable compensation, expenses, disbursements and advances
of the Trustee, its agents and counsel) and the Holders allowed in any judicial
proceedings relative to the Company (or any other obligor upon the Securities),
its creditors or its property and shall be entitled and empowered to collect,
receive and distribute any money or other property payable or deliverable on any
such claims and any custodian in any such judicial proceeding is hereby
authorized by each Holder to make such payments to the Trustee, and in the event
that the Trustee shall consent to the making of such payments directly to the
Holders, to pay to the Trustee any amount due to it for the reasonable
compensation, expenses, disbursements and advances of the Trustee, its agents
and counsel, and any other amounts due the Trustee under Section 7.07 hereof.
To the extent that the payment of any such compensation, expenses, disbursements
and advances of the Trustee, its agents and counsel, and any other amounts due
the Trustee under Section 7.07 hereof out of the estate in any such proceeding,
shall be denied for any reason, payment of the same shall be secured by a Lien
on, and shall be paid out of, any and all distributions, dividends, money,
securities and other properties which the Holders may be entitled to receive in
such proceeding whether in liquidation or under any plan of reorganization or
arrangement or otherwise.  Nothing herein contained shall be deemed to authorize
the Trustee to authorize or consent to or accept or adopt on behalf of any
Holder any plan of reorganization, arrangement, adjustment or composition
affecting the Securities or the rights of any Holder thereof, or to authorize
the Trustee to vote in respect of the claim of any Holder in any such
proceeding.

SECTION 6.10.    PRIORITIES.

            If the Trustee collects any money pursuant to this Article, it shall
pay out the money in the following order:

            First:  to the Trustee, its agents and attorneys for amounts due
under Section 7.07 hereof, including payment of all compensation, expense and
liabilities incurred, and all advances made, by the Trustee and the costs and
expenses of collection;

            Second:  to Holders for amounts due and unpaid on the Securities for
principal, premium, if any, and interest, ratably, without preference or
priority of any kind, according to the amounts due and payable on the Securities
for principal, premium, if any and interest, respectively; and

            Third:  to the Company or to such party as a court of competent
jurisdiction shall direct.

            The Trustee may fix a record date and payment date for any payment
to Holders pursuant to this Section 6.10 upon five Business Days prior notice to
the Company.

SECTION 6.11.    UNDERTAKING FOR COSTS.

            In any suit for the enforcement of any right or remedy under this
Indenture or in any suit against the Trustee for any action taken or omitted by
it as a Trustee, a court in its discretion may require the filing by any party
litigant in the suit of an undertaking to pay the costs of the suit, and the
court in its discretion may assess reasonable costs, including reasonable

                                       44

<PAGE>

attorneys' fees and expenses, against any party litigant in the suit, having
due regard to the merits and good faith of the claims or defenses made by
the party litigant.  This Section does not apply to a suit by the Trustee, a
suit by a Holder pursuant to Section 6.07 hereof, or a suit by Holders of more
than 10% in principal amount of the then outstanding Securities.

                                   ARTICLE 7
                                    TRUSTEE

SECTION 7.01.    DUTIES OF TRUSTEE.

            (i)   If an Event of Default has occurred and is continuing, the
Trustee shall exercise such of the rights and powers vested in it by this
Indenture, and use the same degree of care and skill in their exercise, as a
prudent man would exercise or use under the circumstances in the conduct of his
own affairs.

            (ii)  Except during the continuance of an Event of Default known to
the Trustee:

                  (a)   the duties of the Trustee shall be determined solely by
                        the express provisions of this Indenture or the TIA and
                        the Trustee need perform only those duties that are
                        specifically set forth in this Indenture or the TIA and
                        no others, and no implied covenants or obligations shall
                        be read into this Indenture against the Trustee, and

                  (b)   in the absence of bad faith on its part, the Trustee may
                        conclusively rely, as to the truth of the statements and
                        the correctness of the opinions expressed therein, upon
                        certificates or opinions furnished to the Trustee and
                        conforming to the requirements of this Indenture.
                        However, in the case of any such certificates or
                        opinions which by any provisions hereof are required to
                        be furnished to the Trustee, the Trustee shall examine
                        the certificates and opinions to determine whether or
                        not they conform to the requirements of this Indenture.

            (iii)  The Trustee may not be relieved from liabilities for its own
negligent action, its own negligent failure to act, or its own willful
misconduct, except that:

                  (a)   this paragraph does not limit the effect of paragraph
                        (ii) of this Section;

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

                                       45

<PAGE>

                  (c)   the Trustee shall not be liable with respect to any
                        action it takes or omits to take in good faith in
                        accordance with a direction received by it pursuant to
                        Section 6.05 hereof.

            (iv)  Whether or not therein expressly so provided every provision
of this Indenture that in any way relates to the Trustee is subject to
paragraphs (i), (ii), and (iii) of this Section.

            (v)   No provision of this Indenture shall require the Trustee to
expend or risk its own funds or incur any liability.  The Trustee may refuse to
perform any duty or exercise any right or power unless it receives security and
indemnity satisfactory to it against any loss, liability or expense.

            (vi)  The Trustee shall not be liable for interest on any money
received by it except as the Trustee may agree in writing with the Company.
Absent written instruction from the Company, the Trustee shall not be required
to invest any such money.  Money held in trust by the Trustee need not be
segregated from other funds except to the extent required by law.

            (vii) The Trustee shall not be deemed to have knowledge of any
matter unless such matter is actually known to a Responsible Officer.

SECTION 7.02.    RIGHTS OF TRUSTEE.

            (i)   The Trustee may conclusively rely upon any document believed
by it to be genuine and to have been signed or presented by the proper Person.
The Trustee need not investigate any fact or matter stated in the document.

            (ii)  Before the Trustee acts or refrains from acting, it may
require an Officers' Certificate or an Opinion of Counsel or both.  The Trustee
shall not be liable for any action it takes or omits to take in good faith in
reliance on such Officers' Certificate or Opinion of Counsel.  The Trustee may
consult with counsel and the written advice of such counsel or any Opinion of
Counsel shall be full and complete authorization and protection from liability
in respect of any action taken, suffered or omitted by it hereunder in good
faith and in reliance thereon.

            (iii) The Trustee may act through its attorneys and agents and shall
not be responsible for the misconduct or negligence of any agent appointed with
due care.

            (iv)  The Trustee shall not be liable for any action it takes or
omits to take in good faith which it believes to be authorized or within its
rights or powers conferred upon it by this Indenture.  A permissive right
granted to the Trustee hereunder shall not be deemed an obligation to act.

            (v)   Unless otherwise specifically provided in this Indenture, any
demand, request, direction or notice from the Company shall be sufficient if
signed by an Officer of the Company.

                                       46

<PAGE>

SECTION 7.03.    INDIVIDUAL RIGHTS OF TRUSTEE.

            The Trustee in its individual or any other capacity may become the
owner or pledgee of Securities and may otherwise deal with the Company or any
Affiliate of the Company with the same rights it would have if it were not
Trustee.  Any Agent may do the same with like rights.  However, the Trustee is
subject to Sections 7.10 and 7.11 hereof.

SECTION 7.04.    TRUSTEE'S DISCLAIMER.

            The Trustee shall not be responsible for and makes no representation
as to the validity or adequacy of this Indenture or the Securities, nor shall it
be accountable for the Company's use of the proceeds from the Securities or any
money paid to the Company or upon the Company's direction under any provision of
this Indenture, nor shall it be responsible for the use or application of any
money received by any Paying Agent other than the Trustee, nor shall it be
responsible for any statement or recital herein or any statement in the
Securities or any other document in connection with the sale of the Securities
or pursuant to this Indenture other than its certificate of authentication.

SECTION 7.05.    NOTICE OF DEFAULTS.

            If a Default or Event of Default occurs and is continuing and if it
is known to the Trustee, the Trustee shall mail to Holders a notice of the
Default or Event of Default within 90 days after it occurs.  Except in the case
of a Default or Event of Default in payment on any Security, the Trustee may
withhold the notice if and so long as a committee of its Responsible Officers in
good faith determines that withholding the notice is in the interests of the
Holders.

SECTION 7.06.    REPORTS BY TRUSTEE TO HOLDERS.

            Within 60 days after each December 31 beginning with the December 31
following the date hereof, the Trustee shall mail to the Holders a brief report
dated as of such report date that complies with TIA Section 313(a) (but if no
event described in TIA Section 313(a) has occurred within the twelve months
preceding the reporting date, no report need be transmitted).  The Trustee also
shall comply with TIA Section 313(b).  The Trustee shall also transmit by mail
all reports as required by TIA Section 313(c).

            A copy of each report at the time of its mailing to the Holders
shall be mailed to the Company and filed with the Commission and each stock
exchange on which the Securities are listed.  The Company shall promptly notify
the Trustee when the Securities are listed on any stock exchange.

SECTION 7.07.    COMPENSATION AND INDEMNITY.

            The Company shall pay to the Trustee from time to time such
compensation for its acceptance of this Indenture and services hereunder as the
Company and Trustee shall agree in writing.  The Trustee's compensation shall
not be limited by any law on compensation of a trustee of an express trust.  The
Company shall reimburse the Trustee promptly upon request for all reasonable
disbursements, advances and expenses incurred or made by it in addition to

                                       47

<PAGE>

the compensation for its services.  Such expenses shall include the reasonable
compensation, disbursements and expenses of the Trustee's agents and counsel.

            The Company shall indemnify the Trustee against any and all losses,
liabilities, damages, claims or expenses incurred by it arising out of or in
connection with the acceptance of its duties and the administration of the
trusts under this Indenture, except as set forth below.  The Trustee shall
notify the Company promptly of any claim for which it may seek indemnity.
Failure by the Trustee to so notify the Company shall not relieve the Company of
its obligations hereunder.  The Company shall defend the claim and the Trustee
shall cooperate in the defense.  The Trustee may have separate counsel and the
Company shall pay the reasonable fees and expenses of such counsel.  The Company
need not pay for any settlement made without its consent, which consent shall
not be unreasonably withheld.

            The obligations of the Company under this Section 7.07 shall survive
the satisfaction and discharge of this Indenture.

            The Company need not reimburse any expense or indemnify against any
loss or liability incurred by the Trustee through its own negligence or bad
faith.

            To secure the Company's payment obligations in this Section, the
Trustee shall have a Lien prior to the Securities on all money or property held
or collected by the Trustee, except that held in trust to pay principal and
interest on particular Securities.  Such Lien shall survive the satisfaction and
discharge of this Indenture.

            When the Trustee incurs expenses or renders services after an Event
of Default specified in Section 6.01(vii) or (viii) hereof occurs, the expenses
and the compensation for the services (including the fees and expenses of its
agents and counsel) are intended to constitute expenses of administration under
any Bankruptcy Law.

SECTION 7.08.    REPLACEMENT OF TRUSTEE.

            A resignation or removal of the Trustee and appointment of a
successor Trustee shall become effective only upon the successor Trustee's
acceptance of appointment as provided in this Section.

            The Trustee may resign in writing at any time and be discharged from
the trust hereby created by so notifying the Company.  The Holders of a majority
in principal amount of the then outstanding Securities may remove the Trustee by
so notifying the Trustee and the Company in writing.  The Company may remove the
Trustee if:

            (1)   the Trustee fails to comply with Section 7.10 hereof;

            (2)   the Trustee is adjudged a bankrupt or an insolvent or an order
      for relief is entered with respect to the Trustee under any Bankruptcy
      Law;

            (3)   a Custodian or public officer takes charge of the Trustee or
      its property; or

                                       48

<PAGE>

            (4)   the Trustee becomes incapable of acting.

            If the Trustee resigns or is removed or if a vacancy exists in the
office of Trustee for any reason, the Company shall promptly appoint a successor
Trustee.  Within one year after the successor Trustee takes office, the Holders
of a majority in principal amount of the then outstanding Securities may appoint
a successor Trustee to replace the successor Trustee appointed by the Company.

            If a successor Trustee does not take office within 60 days after the
retiring Trustee resigns or is removed, the retiring Trustee, the Company, or
the Holders of at least 10% in principal amount of the then outstanding
Securities may petition any court of competent jurisdiction for the appointment
of a successor Trustee.

            If the Trustee after written request by any Holder who has been a
Holder for at least six months fails to comply with Section 7.10 hereof, such
Holder may petition any court of competent jurisdiction for the removal of the
Trustee and the appointment of a successor Trustee.

            A successor Trustee shall deliver a written acceptance of its
appointment to the retiring Trustee and to the Company.  Thereupon, the
resignation or removal of the retiring Trustee shall become effective, and the
successor Trustee shall have all the rights, powers and duties of the Trustee
under this Indenture.  The successor Trustee shall mail a notice of its
succession to Holders.  The retiring Trustee shall promptly transfer all
property held by it as Trustee to the successor Trustee, provided all sums owing
to the Trustee hereunder have been paid and subject to the Lien provided for in
Section 7.07 hereof.  Notwithstanding replacement of the Trustee pursuant to
this Section 7.08, the Company's obligations under Section 7.07 hereof shall
continue for the benefit of the retiring Trustee.

SECTION 7.09.    SUCCESSOR TRUSTEE OR AGENT BY MERGER, ETC.

            If the Trustee or any Agent consolidates, merges or converts into,
or transfers all or substantially all of its corporate trust business to,
another corporation, the successor corporation without any further act shall be
the successor Trustee or Agent.

SECTION 7.10.    ELIGIBILITY; DISQUALIFICATION.

            There shall at all times be a Trustee hereunder which shall be a
corporation organized and doing business under the laws of the United States of
America or of any state thereof authorized under such laws to exercise corporate
trustee power, shall be subject to supervision or examination by federal or
state authority and shall have a combined capital and surplus of at least $100.0
million as set forth in its most recent published annual report of condition.

            This Indenture shall always have a Trustee who satisfies the
requirements of TIA Section 310(a)(1), (2) and (5). The Trustee is subject to
TIA Section 310(b).

                                       49

<PAGE>

SECTION 7.11.    PREFERENTIAL COLLECTION OF CLAIMS AGAINST COMPANY.

            The Trustee is subject to TIA Section 311(a), excluding any creditor
relationship listed in TIA Section 311(b). A Trustee who has resigned or been
removed shall be subject to TIA Section 311(a) to the extent indicated therein.

                                  ARTICLE 8
                            DISCHARGE OF INDENTURE

SECTION 8.01.    DEFEASANCE AND DISCHARGE OF THIS INDENTURE AND THE
                  SECURITIES.

            The Company may, at the option of its Board of Directors evidenced
by a resolution set forth in an Officers' Certificate, at any time, with respect
to the Securities, elect to have either Section 8.02 or 8.03 hereof be applied
to all outstanding Securities upon compliance with the conditions set forth
below in this Article 8.

SECTION 8.02.    LEGAL DEFEASANCE AND DISCHARGE.

            Upon the Company's exercise under Section 8.01 hereof of the option
applicable to this Section 8.02, the Company shall be deemed to have been
discharged from its obligations with respect to all outstanding Securities on
the date the conditions set forth below are satisfied (hereinafter, "LEGAL
DEFEASANCE").  For this purpose, such Legal Defeasance means that the Company
shall be deemed to have paid and discharged the entire Indebtedness represented
by the outstanding Securities, which shall thereafter be deemed to be
"outstanding" only for the purposes of Section 8.05 hereof and the other
Sections of this Indenture referred to in clauses (i) and (ii) of this Section
8.02, and to have satisfied all its other obligations under such Securities and
this Indenture (and the Trustee, on demand of and at the expense of the Company,
shall execute proper instruments acknowledging the same), except for the
following provisions which shall survive until otherwise terminated or
discharged hereunder:  (i) the rights of Holders of outstanding Securities to
receive solely from the trust fund described in Section 8.04 hereof, and as more
fully set forth in such Section, payments in respect of the principal of,
premium, if any, and interest on such Securities when such payments are due,
(ii) the Company's obligations with respect to such Securities under Sections
2.04, 2.06, 2.07, 2.10 and 4.02 hereof, (iii) the rights, powers, trusts, duties
and immunities of the Trustee hereunder, including, without limitation, the
Trustee's rights under Section 7.07 hereof, and the Company's obligations in
connection therewith and (iv) this Article 8.  Subject to compliance with this
Article 8, the Company may exercise its option under this Section 8.02
notwithstanding the prior exercise of its option under Section 8.03 hereof with
respect to the Securities.

SECTION 8.03.    COVENANT DEFEASANCE.

            Upon the Company's exercise under Section 8.01 hereof of the option
applicable to this Section 8.03, the Company shall be released from its
obligations under the covenants contained in Sections 3.09, 4.07, 4.08, 4.09,
4.10, 4.11, 4.12, 4.13, 4.15, 4.16 and 4.17 and Article 5 hereof with respect to
the outstanding Securities on and after the date the conditions set forth below
are satisfied (hereinafter, "COVENANT DEFEASANCE"), and the Securities shall

                                       50

<PAGE>

thereafter be deemed not "outstanding" for the purposes of any direction,
waiver, consent or declaration or act of Holders (and the consequences of any
thereof) in connection with such covenants, but shall continue to be deemed
"outstanding" for all other purposes hereunder (it being understood that such
Securities shall not be deemed outstanding for accounting purposes).  For this
purpose, such Covenant Defeasance means that, with respect to the outstanding
Securities, the Company may omit to comply with and shall have no liability in
respect of any term, condition or limitation set forth in any such covenant,
whether directly or indirectly, by reason of any reference elsewhere herein to
any such covenant or by reason of any reference in any such covenant to any
other provision herein or in any other document and such omission to comply
shall not constitute a Default or an Event of Default under Section 6.01(iii)
hereof, but, except as specified above, the remainder of this Indenture and such
Securities shall be unaffected thereby.  In addition, upon the Company's
exercise under Section 8.01 hereof of the option applicable to this Section
8.03, Sections 6.01(iv) through 6.01(vi) hereof shall not constitute Events of
Default.

SECTION 8.04.    CONDITIONS TO LEGAL OR COVENANT DEFEASANCE.

            The following shall be the conditions to application of either
Section 8.02 or Section 8.03 hereof to the outstanding Securities:

            (i)   The Company shall irrevocably have deposited or caused to be
      deposited with the Trustee (or another trustee satisfying the requirements
      of Section 7.10 hereof who shall agree to comply with the provisions of
      this Article 8 applicable to it) as trust funds in trust for the purpose
      of making the following payments, specifically pledged as security for,
      and dedicated solely to, the benefit of the Holders of such Securities,
      (a) cash in U.S. Dollars in an amount, or (b) non-callable Government
      Securities that through the scheduled payment of principal and interest in
      respect thereof in accordance with their terms will provide, not later
      than one day before the due date of any payment, cash in U.S. Dollars in
      an amount, or (c) a combination thereof, in such amounts as will be
      sufficient, in the opinion of a nationally recognized firm of independent
      public accountants expressed in a written certification thereof delivered
      to the Trustee, to pay and discharge and which shall be applied by the
      Trustee (or other qualifying trustee) to pay and discharge the principal
      of, premium, if any, and interest on the outstanding Securities on the
      stated maturity date of such principal or installment of principal,
      premium, if any, or interest or on the applicable redemption date, as the
      case may be,  and the Company shall specify whether the Securities are
      being defeased to maturity or to a particular redemption date (in which
      case the Company shall issue an irrevocable notice of redemption as of a
      specified date that will be delivered by the Trustee in accordance with
      the redemption provisions of this Indenture).

            (ii)  In the case of an election under Section 8.02 hereof, the
      Company shall have delivered to the Trustee an Opinion of Counsel in the
      United States confirming that (a) the Company has received from, or there
      has been published by, the Internal Revenue Service a ruling or (b) since
      the date hereof, there has been a change in the applicable federal income
      tax law, in either case to the effect that, and based thereon such Opinion
      of Counsel shall confirm that, the Holders of the outstanding Securities
      will not recognize income, gain or loss for federal income tax purposes as
      a result of such Legal

                                       51

<PAGE>

      Defeasance and will be subject to federal income tax on the same amounts,
      in the same manner and at the same times as would have been the case if
      such Legal Defeasance had not occurred.

            (iii) In the case of an election under Section 8.03 hereof, the
      Company shall have delivered to the Trustee an Opinion of Counsel in the
      United States confirming that the Holders of the outstanding Securities
      will not recognize income, gain or loss for federal income tax purposes as
      a result of such Covenant Defeasance and will be subject to federal income
      tax on the same amounts, in the same manner and at the same times as would
      have been the case if such Covenant Defeasance had not occurred.

            (iv)  No Default or Event of Default with respect to the Securities
      shall have occurred and be continuing on the date of such deposit (other
      than a Default or Event of Default resulting from the borrowing of funds
      to be applied to such deposit) or, insofar as Section 6.01(vii) or
      6.01(viii) hereof is concerned, at any time in the period ending on the
      91st day after the date of such deposit (it being understood that this
      condition shall not be deemed satisfied until the expiration of such
      period).

            (v)   Such Legal Defeasance or Covenant Defeasance shall not result
      in a breach or violation of, or constitute a default under any material
      agreement or instrument (other than this Indenture) to which the Company
      or any of its Subsidiaries is a party or by which the Company or any of
      its Subsidiaries is bound (other than a breach, violation or default
      resulting from the borrowing of funds to be applied to such deposit).

            (vi)  The Company shall have delivered to the Trustee an Opinion of
      Counsel to the effect that after the 91st day following the deposit, the
      trust funds will not be subject to the effect of any applicable
      bankruptcy, insolvency, reorganization or similar laws affecting
      creditors' rights generally.

            (vii)  The Company shall have delivered to the Trustee an Officers'
      Certificate stating that the deposit made by the Company pursuant to its
      election under Section 8.02 or 8.03 hereof was not made by the Company
      with the intent of preferring the Holders of the Securities over the other
      creditors of the Company with the intent of defeating, hindering, delaying
      or defrauding creditors of the Company or others.

            (viii)  The Company shall have delivered to the Trustee an Officers'
      Certificate and an Opinion of Counsel in the United States, each stating
      that all conditions precedent provided for relating to either the Legal
      Defeasance under Section 8.02 hereof or the Covenant Defeasance under
      Section 8.03 hereof (as the case may be) have been complied with as
      contemplated by this Section 8.04.

SECTION 8.05.    DEPOSITED MONEY AND GOVERNMENT SECURITIES TO BE HELD IN TRUST;
                 OTHER MISCELLANEOUS PROVISIONS.

            Subject to Section 8.06 hereof, all money and non-callable
Government Securities (including the proceeds thereof) deposited with the
Trustee (or other qualifying trustee, collectively for purposes of this Section
8.05, the "Trustee") pursuant to Section 8.04 in respect

                                       52

<PAGE>

of the outstanding Securities shall be held in trust and applied by the Trustee,
in accordance with the provisions of such Securities and this Indenture, to the
payment, either directly or through any Paying Agent (including the Company
acting as Paying Agent) as the Trustee may determine, to the Holders of such
Securities of all sums due and to become due thereon in respect of principal,
premium, if any, and interest, but such money need not be segregated from other
funds except to the extent required by law.

            The Company shall pay and indemnify the Trustee against any tax, fee
or other charge imposed on or assessed against the cash or non-callable
Government Securities deposited pursuant to Section 8.04 hereof or the principal
and interest received in respect thereof other than any such tax, fee or other
charge which by law is for the account of the Holders of the outstanding
Securities.

            Anything in this Article 8 to the contrary notwithstanding, the
Trustee shall deliver or pay to the Company from time to time upon the Company's
request any money or non-callable Government Securities held by it as provided
in Section 8.04 hereof which, in the opinion of a nationally recognized firm of
independent public accountants expressed in a written certification thereof
delivered to the Trustee (which may be the opinion delivered under Section
8.04(i) hereof), are in excess of the amount thereof which would then be
required to be deposited to effect an equivalent Legal Defeasance or Covenant
Defeasance.

SECTION 8.06.    REPAYMENT TO COMPANY.

            Any money deposited with the Trustee or any Paying Agent, or then
held by the Company, in trust for the payment of the principal of, premium, if
any, or interest on any Security and remaining unclaimed for two years after
such principal, and premium, if any, or interest has become due and payable
shall be paid to the Company on its written request or (if then held by the
Company) shall be discharged from such trust; and the Holder of such Security
shall thereafter, as an unsecured general creditor, look only to the Company for
payment thereof, and all liability of the Trustee or such Paying Agent with
respect to such trust money, and all liability of the Company as trustee
thereof, shall thereupon cease; PROVIDED, HOWEVER, that the Trustee or such
Paying Agent, before being required to make any such repayment, may at the
expense of the Company cause to be published once, in the NEW YORK TIMES and
THE WALL STREET JOURNAL (national edition), notice that such money remains
unclaimed and that, after a date specified therein, which shall not be less than
30 days from the date of such notification or publication, any unclaimed balance
of such money then remaining shall be repaid to the Company.

SECTION 8.07.    REINSTATEMENT.

            If the Trustee or Paying Agent is unable to apply any U.S. Dollars
or non-callable Government Securities in accordance with Section 8.02 or 8.03
hereof, as the case may be, by reason of any order or judgment of any court or
governmental authority enjoining, restraining or otherwise prohibiting such
application, then the Company's obligations under this Indenture and the
Securities shall be revived and reinstated as though no deposit had occurred
pursuant to Section 8.02 or 8.03 hereof until such time as the Trustee or Paying
Agent is permitted to apply all such money in accordance with Section 8.02 or
8.03 hereof, as the case may be; PROVIDED,

                                       53

<PAGE>

HOWEVER, that, if the Company makes any payment of principal of, premium, if
any, or interest on any Security following the reinstatement of its obligations,
the Company shall be subrogated to the rights of the Holders of such Security to
receive such payment from the money held by the Trustee or Paying Agent.

                                  ARTICLE 9
                       AMENDMENT, SUPPLEMENT AND WAIVER

SECTION 9.01.    WITHOUT CONSENT OF HOLDERS.

            The Company and the Trustee may amend or supplement this Indenture
or the Securities without the consent of any Holder:

            (i)         to cure any ambiguity, defect or inconsistency;

            (ii)        to provide for uncertificated Securities in addition to
                        or in place of certificated Securities;

            (iii)       to provide for any supplemental indenture required
                        pursuant to Section 4.16 hereof;

            (iv)        to provide for the assumption of the Company's
                        obligations to the Holders of the Securities in the case
                        of a merger, consolidation or sale of assets pursuant to
                        Article 5 hereof;

            (v)         to make any change that would provide any additional
                        rights or benefits to the Holders of the Securities or
                        that does not adversely affect the legal rights
                        hereunder of any Holder; or

            (vi)        to comply with requirements of the Commission in order
                        to effect or maintain the qualification of this
                        Indenture under the TIA.

            Upon the request of the Company accompanied by a resolution of its
Board of Directors authorizing the execution of any such supplemental indenture,
and upon receipt by the Trustee of the documents described in Section 9.06
hereof, the Trustee shall join with the Company in the execution of any
supplemental indenture authorized or permitted by the terms of this Indenture
and to make any further appropriate agreements and stipulations which may be
therein contained, but the Trustee shall not be obligated to enter into such
supplemental indenture which affects its own rights, duties or immunities under
this Indenture or otherwise.

SECTION 9.02.    WITH CONSENT OF HOLDERS.

            Except as provided in the next succeeding paragraphs, this Indenture
or the Securities may be amended or supplemented with the consent of the Holders
of at least a majority in principal amount of the Securities then outstanding
(including consents obtained in connection with a tender offer or exchange offer
for such Securities), and any existing default

                                       54

<PAGE>

or compliance with any provision of this Indenture or the Securities may be
waived with the consent of the Holders of a majority in principal amount of the
then outstanding Securities (including consents obtained in connection with a
tender offer or exchange offer for such Securities).

            Upon the request of the Company accompanied by a resolution of its
Board of Directors authorizing the execution of any such supplemental indenture,
and upon the filing with the Trustee of evidence satisfactory to the Trustee of
the consent of the Holders as aforesaid, and upon receipt by the Trustee of the
documents described in Section 9.06 hereof, the Trustee shall join with the
Company in the execution of such supplemental indenture unless such supplemental
indenture affects the Trustee's own rights, duties or immunities under this
Indenture or otherwise, in which case the Trustee may in its discretion, but
shall not be obligated to, enter into such supplemental indenture.

            It shall not be necessary for the consent of the Holders under this
Section 9.02 to approve the particular form of any proposed amendment or waiver,
but it shall be sufficient if such consent approves the substance thereof.

            After an amendment, supplement or waiver under this Section becomes
effective, the Company shall mail to the Holders affected thereby a notice
briefly describing the amendment, supplement or waiver.  Any failure of the
Company to mail such notice, or any defect therein, shall not, however, in any
way impair or affect the validity of any such supplemental indenture or waiver.
Subject to Sections 6.04 and 6.07 hereof, the Holders of a majority in aggregate
principal amount of the Securities then outstanding may waive compliance in a
particular instance by the Company with any provision of this Indenture or the
Securities.  Without the consent of each Holder affected, however, an amendment
or waiver may not (with respect to any Security held by a non-consenting
Holder):

         (i)      reduce the principal amount of Securities whose Holders must
                  consent to an amendment, supplement or waiver;

        (ii)      reduce the principal of or change the fixed maturity of any
                  Security or alter the provisions with respect to the
                  redemption of the Securities (other than provisions relating
                  to covenants in Sections 4.10 and 4.13 hereof);

       (iii)      reduce the rate of or change the time for payment of interest
                  on any Security;

        (iv)      waive a Default or Event of Default in the payment of
                  principal of or premium, if any, or interest on the Securities
                  (except a rescission of acceleration of the Securities by the
                  Holders of at least a majority in aggregate principal amount
                  thereof and a waiver of the payment default that resulted from
                  such acceleration);

         (v)      make any Security payable in money other than that stated in
                  the Securities;

                                       55

<PAGE>

        (vi)      make any change in Section 6.04 or 6.07 hereof;

       (vii)      waive a redemption payment with respect to any Security (other
                  than a payment required under Section 4.10 or 4.13 hereof); or

      (viii)      make any change in this sentence of this Section 9.02.

            Notwithstanding the foregoing, any amendment to the provisions of
Article 10 hereof shall require the consent of the Holders of at least 75% in
aggregate principal amount of the Securities then outstanding if such amendment
would adversely affect the rights of the Holders of the Securities.

SECTION 9.03.    COMPLIANCE WITH TIA.

            Every amendment to this Indenture or the Securities shall be set
forth in a supplemental indenture that complies with the TIA as then in effect.

SECTION 9.04.    REVOCATION AND EFFECT OF CONSENTS.

            Until an amendment or waiver becomes effective, a consent to it by a
Holder is a continuing consent by the Holder and every subsequent Holder of a
Security or portion of a Security that evidences the same debt as the consenting
Holder's Security, even if notation of the consent is not made on any Security.
However, any such Holder or subsequent Holder may revoke the consent as to its
Security if the Trustee receives written notice of revocation before the date
the waiver or amendment becomes effective.  An amendment or waiver becomes
effective in accordance with its terms and thereafter binds every Holder.

            The Company may, but shall not be obligated to, fix a record date
for determining which Holders must consent to such amendment or waiver.  If the
Company fixes a record date, the record date shall be fixed at (i) the later of
30 days prior to the first solicitation of such consent or the date of the most
recent list of Holders furnished to the Trustee prior to such solicitation
pursuant to Section 2.05 hereof or (ii) such other date as the Company shall
designate.

SECTION 9.05.    NOTATION ON OR EXCHANGE OF SECURITIES.

            The Trustee may place an appropriate notation about an amendment or
waiver on any Security thereafter authenticated.  The Company in exchange for
all Securities may issue and the Trustee shall authenticate new Securities that
reflect the amendment or waiver.

            Failure to make the appropriate notation or issue a new Security
shall not affect the validity and effect of such amendment or waiver.

SECTION 9.06.    TRUSTEE TO SIGN AMENDMENTS, ETC.

            The Trustee shall sign any amendment or supplemental indenture
authorized pursuant to this Article 9 if the amendment does not adversely affect
the rights, duties, liabilities

                                       56

<PAGE>

or immunities of the Trustee.  If it does, the Trustee may, but need not, sign
it.  In signing or refusing to sign such amendment or supplemental indenture,
the Trustee shall be entitled to receive and, subject to Section 7.01 hereof,
shall be fully protected in relying upon, an Officers' Certificate and an
Opinion of Counsel as conclusive evidence that such amendment or Supplemental
Indenture is authorized or permitted by this Indenture, that it is not
inconsistent herewith, and that it will be valid and binding upon the Company in
accordance with its terms.  The Company may not sign an amendment or
supplemental indenture until the Board of Directors approves it.

                                  ARTICLE 10
                                 SUBORDINATION

SECTION 10.01.   AGREEMENT TO SUBORDINATE.

            The Company agrees, and each Holder by accepting a Security agrees,
that the Indebtedness evidenced by the Security is subordinated in right of
payment, to the extent and in the manner provided in this Article, to the prior
payment in full of all Senior Debt (whether outstanding on the date hereof or
hereafter created, incurred, assumed or Guaranteed), and that the subordination
is for the benefit of the holders of Senior Debt.

SECTION 10.02.   CERTAIN DEFINITIONS.

            "Designated Senior Debt" means (i) so long as any Obligations are
outstanding under the New Credit Facility, such Obligations and (ii) thereafter,
any other Senior Debt permitted hereunder the principal amount of which is
$100.0 million or more and that has been designated by the Company as
"Designated Senior Debt".

            "Representative" means the indenture trustee or other trustee, agent
or representative for any Senior Debt.

            "Senior Debt" means (i) the Senior Term Debt and the Senior
Revolving Debt, (ii) the Senior Notes, (iii) any other Indebtedness that is
permitted to be incurred by the Company under the terms of this Indenture,
unless the instrument under which such Indebtedness is incurred expressly
provides that it is on a parity with or subordinated in right of payment to the
Securities and (iv) all Obligations with respect to any of the foregoing.
Notwithstanding anything to the contrary in the foregoing, Senior Debt shall not
include (w) any liability for federal, state, local or other taxes owed or owing
by the Company, (x) any Indebtedness of the Company to any of its Subsidiaries
or other Affiliates, (y) any trade payables or (z) any Indebtedness that is
incurred in violation of this Indenture.

            A distribution may consist of cash, securities or other property, by
set-off or otherwise.

SECTION 10.03.   LIQUIDATION; DISSOLUTION; BANKRUPTCY.

                                       57

<PAGE>

            Upon any distribution to creditors of the Company in a liquidation
or dissolution of the Company or in a bankruptcy, reorganization, insolvency,
receivership or similar proceeding relating to the Company or its property, an
assignment for the benefit of creditors or any marshalling of the Company's
assets and liabilities, holders of Senior Debt shall be entitled to receive
payment in full of all Obligations due in respect of such Senior Debt (including
interest accruing after the commencement of any such proceeding at the rate
specified in the applicable Senior Debt, whether or not allowed or allowable as
a claim in such proceeding) before the Holders shall be entitled to receive any
payment with respect to the Securities, and until all Obligations with respect
to Senior Debt are paid in full, any distribution to which the Holders would be
entitled shall be made to the holders of Senior Debt (except (a) that Holders
may receive securities that (i) are subordinated at least to the same extent as
the Securities to Senior Debt and any securities issued in exchange for Senior
Debt, (ii) are unsecured (except to the extent the Securities are secured),
(iii) are not Guaranteed by any Subsidiary of the Company (except to the extent
the Securities are so Guaranteed), and (iv) have a Weighted Average Life to
Maturity and final maturity that are not shorter than the Weighted Average Life
to Maturity of the Securities or any securities issued to holders of Senior Debt
under the New Credit Facility pursuant to a plan of reorganization or
readjustment and (b) payments made from the trust described in Section 8.04).

SECTION 10.04.   DEFAULT ON DESIGNATED SENIOR DEBT.

            The Company may not make any payment upon or in respect of the
Securities (except in securities that (i) are subordinated to at least the same
extent as the Securities to Senior Debt and any securities issued in exchange
for Senior Debt, (ii) are unsecured (except to the extent the Securities are
secured), (iii) are not Guaranteed by any Subsidiary of the Company (except to
the extent the Securities are so Guaranteed), and (iv) have a Weighted Average
Life to Maturity and final maturity that are not shorter than the Weighted
Average Life to Maturity of the Securities or any securities issued to Holders
of Senior Debt under the New Credit Facility pursuant to a plan of
reorganization or readjustment or from the trust described in Section 8.04
hereof) if;

            (i)   a default in the payment of the principal of, premium, if any
      or interest on Designated Senior Debt occurs and is continuing beyond any
      applicable period of grace in the agreement, indenture or other document
      governing such Designated Senior Debt; or

            (ii)  any other default occurs and is continuing with respect to
      Designated Senior Debt that permits holders of the Designated Senior Debt
      as to which such default relates to accelerate its maturity and the
      Trustee receives a notice of such default (a "Payment Blockage Notice"),
      for so long as any Obligations are outstanding under the New Credit
      Facility, from the Representative thereunder and, thereafter, from the
      holders or Representative of any Designated Senior Debt.  No new period of
      payment blockage may be commenced within 360 days after the receipt by the
      Trustee of any prior Payment Blockage Notice.  No nonpayment default that
      existed or was continuing on the date of delivery of any Payment Blockage
      Notice to the Trustee shall be, or be made, the basis for a subsequent
      Payment Blockage Notice.

                                       58

<PAGE>

            The Company may and shall resume payments on the Securities:

            (1)   in the case of a payment default, upon the date on which such
default is cured or waived, and

            (2)   in the case of a nonpayment default referred to in Section
      10.04(ii) hereof, the earlier of the date on which such nonpayment default
      is cured or waived or 179 days after the date on which the applicable
      Payment Blockage Notice is received, unless the maturity of any Designated
      Senior Debt has been accelerated.

SECTION 10.05.   ACCELERATION OF SECURITIES.

            If payment of the Securities is accelerated because of an Event of
Default, the Company shall promptly notify holders of Senior Debt of the
acceleration.

SECTION 10.06.   WHEN DISTRIBUTION MUST BE PAID OVER.

            In the event that the Trustee or any Holder receives any payment of
any Obligations with respect to the Securities at a time when the Trustee or
such Holder, as applicable, has actual knowledge that such payment is prohibited
by Section 10.04 hereof, such payment shall be held by the Trustee or such
Holder, in trust for the benefit of, and shall be paid forthwith over and
delivered, upon written request, to, the holders of Senior Debt as their
interests may appear or their Representative under the indenture or other
agreement (if any) pursuant to which such Senior Debt may have been issued, as
their respective interests may appear, for application to the payment of all
Obligations with respect to Senior Debt remaining unpaid to the extent necessary
to pay such Obligations in full in accordance with their terms, after giving
effect to any concurrent payment or distribution to or for the holders of Senior
Debt.

            With respect to the holders of Senior Debt, the Trustee undertakes
to perform only such obligations on the part of the Trustee as are specifically
set forth in this Article 10, and no implied covenants or obligations with
respect to the holders of Senior Debt shall be read into this Indenture against
the Trustee.  The Trustee shall not be deemed to owe any fiduciary duty to the
holders of Senior Debt, and shall not be liable to any such holders if the
Trustee shall pay over or distribute to or on behalf of Holders or the Company
or any other Person money or assets to which any holders of Senior Debt shall be
entitled by virtue of this Article 10, except if such payment is made as a
result of the willful misconduct or gross negligence of the Trustee.

SECTION 10.07.   NOTICE BY COMPANY.

            The Company shall promptly notify the Trustee and the Paying Agent
of any facts known to the Company that would cause a payment of any Obligations
with respect to the Securities to violate this Article, but failure to give such
notice shall not affect the subordination of the Securities to the Senior Debt
as provided in this Article.

SECTION 10.08.   SUBROGATION.

                                       59

<PAGE>

            After all Senior Debt is paid in full and until the Securities are
paid in full, Holders shall be subrogated (equally and ratably with all other
Indebtedness pari passu with the Securities) to the rights of holders of Senior
Debt to receive distributions applicable to Senior Debt to the extent that
distributions otherwise payable to the Holders have been applied to the payment
of Senior Debt.  A distribution made under this Article to holders of Senior
Debt that otherwise would have been made to Holders is not, as between the
Company and Holders, a payment by the Company on the Securities.

SECTION 10.09.   RELATIVE RIGHTS.

            This Article defines the relative rights of Holders and holders of
Senior Debt.  Nothing in this Indenture shall:

            (1)   impair, as between the Company and Holders, the obligation of
      the Company, which is absolute and unconditional, to pay principal of and
      interest on the Securities in accordance with their terms;

            (2)   affect the relative rights of Holders and creditors of the
      Company other than their rights in relation to holders of Senior Debt; or

            (3)   prevent the Trustee or any Holder from exercising its
      available remedies upon a Default or Event of Default, subject to the
      rights of holders and owners of Senior Debt to receive distributions and
      payments otherwise payable to Holders.

            If the Company fails because of this Article to pay principal of or
interest on a Security on the due date, the failure is still a Default or Event
of Default.

SECTION 10.10.   SUBORDINATION MAY NOT BE IMPAIRED BY COMPANY.

            No right of any holder of Senior Debt to enforce the subordination
of the Indebtedness evidenced by the Securities shall be impaired by any act or
failure to act by the Company or any Holder or by the failure of the Company or
any Holder to comply with this Indenture.

SECTION 10.11.   DISTRIBUTION OR NOTICE TO REPRESENTATIVE.

            Whenever a distribution is to be made or a notice given to holders
of Senior Debt, the distribution may be made and the notice given to their
Representative.

            Upon any payment or distribution of assets of the Company referred
to in this Article 10, the Trustee and the Holders shall be entitled to rely
upon any order or decree made by any court of competent jurisdiction or upon any
certificate of such Representative or of the liquidating trustee or agent or
other Person making any distribution to the Trustee or to the Holders for the
purpose of ascertaining the Persons entitled to participate in such
distribution, the holders of the Senior Debt and other Indebtedness of the
Company, the amount thereof or payable thereon, the amount or amounts paid or
distributed thereon and all other facts pertinent thereto or to this Article 10.

                                       60

<PAGE>

SECTION 10.12.   RIGHTS OF TRUSTEE AND PAYING AGENT.

            Notwithstanding the provisions of this Article 10 or any other
provision of this Indenture, the Trustee shall not be charged with knowledge of
the existence of any facts that would prohibit the making of any payment or
distribution by the Trustee, and the Trustee and the Paying Agent may continue
to make payments on the Securities, unless the Trustee shall have received at
its Corporate Trust Office at least five Business Days prior to the date of such
payment written notice of facts that would cause the payment of any Obligations
with respect to the Securities to violate this Article 10.  Only the Company or
a Representative may give the notice.  Nothing in this Article 10 shall impair
the claims of, or payments to, the Trustee under or pursuant to Section 7.07
hereof.

            The Trustee in its individual or any other capacity may hold Senior
Debt with the same rights it would have if it were not Trustee.  Any Agent may
do the same with like rights.

SECTION 10.13.   AUTHORIZATION TO EFFECT SUBORDINATION.

            Each Holder of a Security by the Holder's acceptance thereof
authorizes and directs the Trustee on the Holder's behalf to take such action as
may be necessary or appropriate to effectuate the subordination as provided in
this Article 10, and appoints the Trustee to act as the Holder's
attorney-in-fact for any and all such purposes.

SECTION 10.14.   AMENDMENTS.

            The provisions of this Article 10 shall not be amended or modified
without the written consent of the holders of all Senior Debt.

                                  ARTICLE 11
                                 MISCELLANEOUS

SECTION 11.01.   TIA CONTROLS.

            If any provision of this Indenture limits, qualifies or conflicts
with the duties imposed by TIA Section 318(c), the imposed duties shall control.

SECTION 11.02.   NOTICES.

            Any notice or communication by the Company or the Trustee to the
other is duly given if in writing and delivered in person or mailed by first
class mail (registered or certified, return receipt requested), telex,
telecopier or overnight air courier guaranteeing next day delivery, to the
other's address:

                                       61

<PAGE>

            If to the Company:

            National Medical Enterprises, Inc.
            2700 Colorado Avenue
            Santa Monica, California  90404
            Telecopier No.:  (310) 998-6700
            Attention:  Treasurer

            With a copy to:

            Skadden, Arps, Slate, Meagher & Flom
            300 South Grand Avenue, Suite 3400
            Los Angeles, California  90071
            Telecopier No.:  (213) 687-5600
            Attention:  Thomas C. Janson, Jr.

            If to the Trustee:

            The Bank of New York
            101 Barclay Street, 21 West
            New York, New York  10286
            Telecopier No.: (212) 815-5915
            Attention:  Corporate Trust Trustee Administration

            The Company or the Trustee, by notice to the others may designate
additional or different addresses for subsequent notices or communications.

            All notices and communications (other than those sent to Holders)
shall be deemed to have been duly given:  at the time delivered by hand, if
personally delivered; five Business Days after being deposited in the mail,
postage prepaid, if mailed; when answered back, if telexed; when receipt
acknowledged, if telecopied; and the next Business Day after timely delivery to
the courier, if sent by overnight air courier guaranteeing next day delivery.

            Unless otherwise set forth above, any notice or communication to a
Holder shall be mailed by first class mail, certified or registered, return
receipt requested, or by overnight air courier guaranteeing next day delivery to
its address shown on the register kept by the Registrar.  Any notice or
communication shall also be mailed to any Person described in TIA Section
313(c), to the extent required by the TIA.  Failure to mail a notice or
communication to a Holder or any defect in it shall not affect its sufficiency
with respect to other Holders.

            If a notice or communication is mailed in the manner provided above
within the time prescribed, it is duly given, whether or not the addressee
receives it.

            If the Company mails a notice or communication to Holders, it shall
mail a copy to the Trustee and each Agent at the same time.

                                       62

<PAGE>

SECTION 11.03.   COMMUNICATION BY HOLDERS WITH OTHER HOLDERS.

Holders may communicate pursuant to TIA Section 312(b) with other Holders with
respect to their rights under this Indenture or the Securities.  The Company,
the Trustee, the Registrar and anyone else shall have the protection of TIA
Section 312(c).

SECTION 11.04.   CERTIFICATE AND OPINION AS TO CONDITIONS PRECEDENT.

            Upon any request or application by the Company to the Trustee to
take any action under this Indenture, the Company shall furnish to the Trustee:

            (1)   an Officers' Certificate (which shall include the statements
      set forth in Section 11.05 hereof) stating that, in the opinion of the
      signers, all conditions precedent and covenants, if any, provided for in
      this Indenture relating to the proposed action have been satisfied; and

            (2)   an Opinion of Counsel (which shall include the statements set
      forth in Section 11.05 hereof) stating that, in the opinion of such
      counsel, all such conditions precedent and covenants have been satisfied.

SECTION 11.05.   STATEMENTS REQUIRED IN CERTIFICATE OR OPINION.

            Each certificate or opinion with respect to compliance with a
condition or covenant provided for in this Indenture (other than a certificate
provided pursuant to TIA Section 314(a)(4)) shall include:

            (1)   a statement that the person making such certificate or opinion
      has read such covenant or condition;

            (2)   a brief statement as to the nature and scope of the
      examination or investigation upon which the statements or opinions
      contained in such certificate or opinion are based;

            (3)   a statement that, in the opinion of such person, he has made
      such examination or investigation as is necessary to enable him to express
      an informed opinion as to whether or not such covenant or condition has
      been satisfied; and

            (4)   a statement as to whether or not, in the opinion of such
      person, such condition or covenant has been satisfied; PROVIDED,
      HOWEVER, that with respect to matters of fact, an Opinion of Counsel may
      rely on an Officers' Certificate or certificates of public officials.

SECTION 11.06.   RULES BY TRUSTEE AND AGENTS.

            The Trustee may make reasonable rules for action by or at a meeting
of Holders.  The Registrar or Paying Agent may make reasonable rules and set
reasonable requirements for its functions.

                                       63

<PAGE>

SECTION 11.07.   LEGAL HOLIDAYS.

            A "LEGAL HOLIDAY" is a Saturday, a Sunday or a day on which
banking institutions in The City of New York or at a place of payment are
authorized or obligated by law, regulation or executive order to remain closed.
If a payment date is a Legal Holiday at a place of payment, payment may be made
at that place on the next succeeding day that is not a Legal Holiday, and no
interest shall accrue for the intervening period.

SECTION 11.08.   NO PERSONAL LIABILITY OF DIRECTORS, OFFICERS, EMPLOYEES AND
                 SHAREHOLDERS

            No director, officer, employee, incorporator or shareholder of the
Company, as such, shall have any liability for any obligations of the Company
under the Securities, the Indenture or for any claim based on, in respect of, or
by reason of, such obligations or their creation.  Each Holder of the Securities
by accepting a Security waives and releases all such liability.  The waiver and
release are part of the consideration for issuance of the Securities.  Such
waiver may not be effective to waive liabilities under the federal securities
laws and it is the view of the Commission that such a waiver is against public
policy.

SECTION 11.09.   DUPLICATE ORIGINALS.

            The parties may sign any number of copies of this Indenture.  One
signed copy is enough to prove this Indenture.

SECTION 11.10.   GOVERNING LAW.

            The internal law of the State of New York shall govern and be used
to construe this Indenture and the Securities, without regard to the conflict of
laws provisions thereof.

SECTION 11.11.   NO ADVERSE INTERPRETATION OF OTHER AGREEMENTS.

            This Indenture may not be used to interpret another indenture, loan
or debt agreement of the Company or its Subsidiaries.  Any such indenture, loan
or debt agreement may not be used to interpret this Indenture.

SECTION 11.12.   SUCCESSORS.

            All agreements of the Company in this Indenture and the Securities
shall bind its successors.  All agreements of the Trustee in this Indenture
shall bind its successor.

SECTION 11.13.   SEVERABILITY.

            In case any provision in this Indenture or in the Securities shall
be invalid, illegal or unenforceable, the validity, legality and enforceability
of the remaining provisions shall not in any way be affected or impaired
thereby, it being intended that all of the provisions hereof shall be
enforceable to the full extent permitted by law.

                                       64

<PAGE>

SECTION 11.14.   COUNTERPART ORIGINALS.

            The parties may sign any number of copies of this Indenture.  Each
signed copy shall be an original, but all of them together represent the same
agreement.

SECTION 11.15.   TABLE OF CONTENTS, HEADINGS, ETC.

            The Table of Contents, Cross-Reference Table and Headings of the
Articles and Sections of this Indenture have been inserted for convenience of
reference only, are not to be considered a part of this Indenture and shall in
no way modify or restrict any of the terms or provisions hereof.

                                       65

<PAGE>

                                  SIGNATURES

Dated as of _______________         NATIONAL MEDICAL ENTERPRISES, INC.

                                    By:
                                       -------------------------------------
                                        Name:  Terence P. McMullen
                                        Title:   Senior Vice President
Attest:

___________________________  (SEAL)
  Richard B. Silver

Dated as of _______________         THE BANK OF NEW YORK, as Trustee

                                    By:
                                       -------------------------------------
                                    Name:
                                    Title:

Attest:

____________________________   (SEAL)

                                       66

<PAGE>

                                                            EXHIBIT A
                              (Face of Security)

                         10 1/8% Senior Subordinated Note
                               due March 1, 2005
CUSIP:
No.                                                      $____________

                      NATIONAL MEDICAL ENTERPRISES, INC.

promises to pay to

_________________________________________________________________________

or its registered assigns, the principal sum of ________________________________

Dollars on March 1, 2005.

Interest Payment Dates:  March 1 and September 1, commencing September 1, 1995.

Record Dates:  February 15 and August 15 (whether or not a Business Day).

NATIONAL MEDICAL ENTERPRISES, INC.

By: _________________________

<PAGE>

Dated:  __________, ____

(SEAL)

Trustee's Certificate of Authentication:

This is one of the Securities referred
to in the within-mentioned Indenture:

The Bank of New York, as Trustee

By: ___________________________
      Authorized Signatory

                                       A-2

<PAGE>

                              (Back of Security)

                         10 1/8% SENIOR SUBORDINATED NOTE
                               due March 1, 2005

            Capitalized terms used herein have the meanings assigned to them in
the Indenture (as defined below) unless otherwise indicated.

            1.  INTEREST.  National Medical Enterprises, Inc., a Nevada
corporation (the "COMPANY"), promises to pay interest on the principal amount
of this Security at the rate and in the manner specified below.

            The Company shall pay interest in cash on the principal amount of
this Security at the rate per annum of 10 1/8%.  The Company shall pay interest
semiannually in arrears on March 1 and September 1 of each year, commencing
September 1, 1995 to Holders of record on the immediately preceding February 15
and August 15, respectively, or if any such date of payment is not a Business
Day on the next succeeding Business Day (each an "INTEREST PAYMENT DATE").

            Interest shall be computed on the basis of a 360-day year comprised
of twelve 30-day months.  Interest shall accrue from the most recent date to
which interest has been paid or, if no interest has been paid, from the date of
the original issuance of the Securities.  To the extent lawful, the Company
shall pay interest on overdue principal at the rate of 1% per annum in excess of
the interest rate then applicable to the Securities; it shall pay interest on
overdue installments of interest (without regard to any applicable grace
periods) at the same rate to the extent lawful.

            2.  METHOD OF PAYMENT.  The Company shall pay interest on the
Securities (except defaulted interest) to the Persons who are registered Holders
of Securities at the close of business on the record date next preceding the
Interest Payment Date, even if such Securities are cancelled after such record
date and on or before such Interest Payment Date.  The Holder hereof must
surrender this Security to a Paying Agent to collect principal payments.  The
Company shall pay principal and interest in money of the United States that at
the time of payment is legal tender for payment of public and private debts.
Principal, premium, if any, and interest shall be payable at the office or
agency of the Company maintained for such purpose within the City and State of
New York or, at the option of the Company, payment of interest may be made by
check mailed to the Holder's registered address.  Notwithstanding the foregoing,
all payments with respect to Securities the Holders of which have given wire
transfer instructions, on or before the relevant record date, to the Paying
Agent shall be made by wire transfer of immediately available funds to the
accounts specified by such Holders.

            3.  PAYING AGENT AND REGISTRAR.  Initially, the Trustee shall act
as Paying Agent and Registrar.  The Company may change any Paying Agent or
Registrar or co-registrar without prior notice to any Holder.  The Company and
any of its Subsidiaries may act in any such capacity.

                                       A-3

<PAGE>

            4.  INDENTURE.  The Company issued the Securities under an
Indenture, dated as of March 1, 1995 (the "INDENTURE"), between the Company
and the Trustee.  The terms of the Securities include those stated in the
Indenture and those made part of the Indenture by reference to the Trust
Indenture Act of 1939, as amended (15 U.S. Code Sections 77aaa-77bbbb) (the
"TIA") as in effect on the date of the Indenture.  The Securities are subject to
all such terms, and Holders are referred to the Indenture and such act for a
statement of such terms.  The terms of the Indenture shall govern any
inconsistencies between the Indenture and the Securities.  The Securities are
unsecured general obligations of the Company.  The Securities are limited to
$900,000,000 in aggregate principal amount.

            5.  OPTIONAL REDEMPTION.  On or after March 1, 2000, the Company
may redeem all or any portion of the Securities at a redemption price (expressed
as a percentage of the principal amount thereof), as set forth in the
immediately succeeding paragraph, plus accrued and unpaid interest, if any, to
the redemption date.

            The redemption price as a percentage of the principal amount shall
be as follows, if the Securities are redeemed during the twelve-month period
beginning on March 1 of the following years:

            YEAR                                      PERCENTAGE
            ----                                      ----------

            2000....................................  105.063 %
            2001....................................  103.375 %
            2002....................................  101.688 %
            2003 and thereafter.....................  100.000 %

            6.  MANDATORY REDEMPTION.  Subject to the Company's obligation to
make an offer to repurchase Securities under certain circumstances pursuant to
Sections 4.10 and 4.13 of the Indenture (as described in paragraph 7 below), the
Company shall have no mandatory redemption or sinking fund obligations with
respect to the Securities.

            7.  REPURCHASE AT OPTION OF HOLDER.  (i)  If there is a Change of
Control Triggering Event, the Company shall offer to repurchase on the Change of
Control Payment Date all outstanding Securities at 101% of the aggregate
principal amount thereof plus accrued and unpaid interest thereon to the Change
of Control Payment Date.  Holders that are subject to an offer to purchase shall
receive a Change of Control Offer from the Company prior to any related Change
of Control Payment Date and may elect to have such Securities purchased by
completing the form entitled "Option of Holder to Elect Purchase" appearing
below.

            (ii)  If the Company or a Subsidiary consummates an Asset Sale,
within 465 days after the receipt of any Net Proceeds from such Asset Sale, the
Company may apply such Net Proceeds (a) to purchase one or more Hospitals or
Related Businesses and/or a controlling interest in the Capital Stock of a
Person owning one or more Hospitals and/or one or more Related Businesses, (b)
to make a capital expenditure or to acquire other tangible assets, in each case,
that are used or useful in any business in which the Company is permitted to be
engaged pursuant to Section 4.15 of the Indenture, (c) to permanently reduce
Senior Term Debt or Existing Indebtedness of a Subsidiary, (d) to permanently
reduce Senior Revolving Debt (and

                                       A-4

<PAGE>

to correspondingly reduce commitments with respect thereto), except that up to
an aggregate of $200.0 million of Net Proceeds from Asset Sales may be applied
after the date of the Indenture to reduce Senior Revolving Debt without a
corresponding reduction in commitments with respect thereto or (e) to repurchase
Senior Notes or redeem or repurchase other Senior Debt.  Pending the final
application of any such Net Proceeds, the Company may temporarily reduce Senior
Revolving Debt or otherwise invest such Net Proceeds in any manner that is not
prohibited by the Indenture.  Any Net Proceeds from Asset Sales that are not so
invested or applied shall be deemed to constitute "EXCESS PROCEEDS."  When the
aggregate amount of Excess Proceeds exceeds $25.0 million, the Company shall
make an offer to all Holders of Securities (a "SENIOR SUBORDINATED ASSET SALE
OFFER") to purchase the maximum principal amount of Securities that may be
purchased out of the Excess Proceeds, at an offer price in cash in an amount
equal to 100% of the principal amount thereof plus accrued and unpaid interest
thereon, if any, to the date of purchase, in accordance with the terms of the
Indenture.  To the extent that the aggregate amount of Securities tendered
pursuant to a Senior Subordinated Asset Sale Offer is less than the Excess
Proceeds, the Company may use any remaining Excess Proceeds for general
corporate purposes.  If the aggregate principal amount of Securities surrendered
by Holders pursuant to a Senior Subordinated Asset Sale Offer exceeds the amount
of Excess Proceeds, the Securities shall be purchased on a PRO RATA basis.
Holders that are the subject of an offer to purchase shall receive a Senior
Subordinated Asset Sale Offer from the Company prior to any related purchase
date and may elect to have such Securities purchased by completing the form
entitled "Option of Holder to Elect Purchase" appearing below.

            8.  SUBORDINATION.  The Securities are subordinated to Senior Debt
(as defined in the Indenture), which includes any Indebtedness arising under or
in connection with (a) the Senior Notes, (b) the New Credit Facility (but only
to the extent permitted under Section 4.09 of the Indenture), and (c) all other
Indebtedness permitted by the Indenture, unless the instrument under which such
Indebtedness is incurred expressly provides that it is on a parity with or
subordinated in right of payment to the Securities and all Obligations (as
defined in the Indenture) of the Company with respect to any of the foregoing.
To the extent provided in the Indenture, Senior Debt must be paid before the
Securities may be paid.  The Company agrees, and each Holder by accepting a
Security consents and agrees, to the subordination provided in the Indenture and
authorizes the Trustee to give it effect.

            9.  NOTICE OF REDEMPTION.  Notice of redemption shall be mailed at
least 30 days but not more than 60 days before the redemption date to each
Holder of Securities to be redeemed at its registered address.  Securities may
be redeemed in part but only in whole multiples of $1,000, unless all of the
Securities held by a Holder are to be redeemed.  On and after the redemption
date, interest ceases to accrue on Securities or portions of them called for
redemption.

            10.  DENOMINATIONS, TRANSFER, EXCHANGE.  The Securities are in
registered form without coupons, and in denominations of $1,000 and integral
multiples of $1,000.  The transfer of Securities may be registered and
Securities may be exchanged as provided in the Indenture.  The Registrar and the
Trustee may require a Holder, among other things, to furnish appropriate
endorsements and transfer documents and to pay any taxes and fees required by
law or permitted by the Indenture.  The Registrar need not exchange or register
the transfer of any Securities between a record date and the corresponding
Interest Payment Date.

                                       A-5

<PAGE>

            11.  PERSONS DEEMED OWNERS.  Prior to due presentment to the
Trustee for registration of the transfer of this Security, the Trustee, any
Agent and the Company may deem and treat the Person in whose name this Security
is registered as its absolute owner for the purpose of receiving payment of
principal of, premium, if any, and interest on this Security and for all other
purposes whatsoever, whether or not this Security is overdue, and neither the
Trustee, any Agent nor the Company shall be affected by notice to the contrary.
The registered Holder of a Security shall be treated as its owner for all
purposes.

            12.  AMENDMENT, SUPPLEMENT AND WAIVERS.  Except as provided in the
next succeeding paragraphs, the Indenture or the Securities may be amended or
supplemented with the consent of the Holders of at least a majority in principal
amount of the Securities then outstanding (including consents obtained in
connection with a tender offer or exchange offer for Securities) and any
existing default or compliance with any provision of the Indenture or the
Securities may be waived with the consent of the Holders of a majority in
principal amount of the then outstanding Securities (including consents obtained
in connection with a tender offer or exchange offer for Securities).

            Without the consent of each Holder affected, an amendment or waiver
may not (with respect to any Securities held by a non-consenting Holder of
Securities):  (i) reduce the principal amount of Securities whose Holders must
consent to an amendment, supplement or waiver, (ii) reduce the principal of or
change the fixed maturity of any Security or alter the provisions with respect
to the redemption of the Securities (other than provisions relating to covenants
in Sections 4.10 and 4.13 of the Indenture), (iii) reduce the rate of or change
the time for payment of interest on any Security, (iv) waive a Default or Event
of Default in the payment of principal of or premium, if any, or interest on the
Securities, (except a rescission of acceleration of the Securities by the
Holders of at least a majority in aggregate principal amount thereof and a
waiver of the payment default that resulted from such acceleration), (v) make
any Security payable in money other than that stated in the Securities, (vi)
make any change in the provisions of the Indenture relating to waivers of past
Defaults or the rights of Holders of Securities to receive payments of principal
of or premium, if any, or interest on the Securities, (vii) waive a redemption
payment with respect to any Security (other than a payment required under
Section 4.10 or 4.13 of the Indenture) or (viii) make any change in the
foregoing amendment and waiver provisions.

            Any amendment to the provisions of Article 10 of the Indenture shall
require the consent of the Holders of at least 75% in aggregate principal amount
of the Securities then outstanding if such amendment would adversely affect the
rights of the Holders of the Securities.

            Notwithstanding the foregoing, without the consent of any Holder of
Securities, the Company and the Trustee may amend or supplement the Indenture or
the Securities to cure any ambiguity, defect or inconsistency, to provide for
uncertificated Securities in addition to or in place of certificated Securities,
to provide for any supplemental indenture required pursuant to Section 4.16 of
the Indenture, to provide for the assumption of the Company's obligations to
Holders of the Securities in the case of a merger, consolidation or sale of
assets, to make any change that would provide any additional rights or benefits
to the Holders of the Securities or that does not adversely affect the legal
rights under the Indenture of any such Holder, or to

                                       A-6

<PAGE>

comply with requirements of the Securities and Exchange Commission (the
"COMMISSION") in order to effect or maintain the qualification of the
Indenture under the TIA.

            13.  DEFAULTS AND REMEDIES.  Events of Default under the Indenture
include:  (i) a default for 30 days in the payment when due of interest on the
Securities, whether or not such payment is prohibited by the provisions of
Article 10 of the Indenture; (ii) a default in payment when due of the principal
of or premium, if any, on the Securities, at maturity, upon redemption or
otherwise, whether or not such payment is prohibited by the provisions of
Article 10 of the Indenture; (iii) a failure by the Company to comply with the
provisions described under the covenants "Limitations on Restricted Payments,"
"Limitations on Incurrence of Indebtedness and Issuance of Preferred Stock,"
"Asset Sales," and "Change of Control;" (iv) a failure by the Company for 60
days after notice to comply with any of its other agreements in the Indenture or
the Securities; (v) any default that occurs under any mortgage, indenture or
instrument under which there may be issued or by which there may be secured or
evidenced any Indebtedness for money borrowed by the Company or any of its
Significant Subsidiaries (or the payment of which is Guaranteed by the Company
or any of its Significant Subsidiaries) whether such Indebtedness or Guarantee
exists on the date of the Indenture, or is created after the date of the
Indenture, which default (a) constitutes a failure to pay principal at final
maturity or (b) results in the acceleration of such Indebtedness prior to its
express maturity and, in each case, the principal amount of any such
Indebtedness, together with the principal amount of any other such Indebtedness
that has not been paid at final maturity or that has been so accelerated,
aggregates $25.0 million or more; (vi) failure by the Company or any of its
Significant Subsidiaries to pay a final judgment or final judgments aggregating
in excess of $25.0 million entered by a court or courts or competent
jurisdiction against the Company or any of its Significant Subsidiaries if such
final judgment or judgments remain unpaid or undischarged for a period (during
which execution shall not be effectively stayed) of 60 days after their entry;
and (vii) certain events of bankruptcy or insolvency with respect to the Company
or any of its Significant Subsidiaries. If any Event of Default occurs and is
continuing, the Trustee or the Holders of at least 25% in aggregate principal
amount of the then outstanding Securities by written notice to the Company and
the Trustee, may declare all the Securities to be due and payable immediately
(plus, in the case of an Event of Default that is the result of willful actions
(or inactions) by or on behalf of the Company intended to avoid prohibitions on,
or premiums related to, redemptions of the Securities contained in the Indenture
or the Securities, an amount of premium that would have been applicable pursuant
to the Indenture).  Notwithstanding the foregoing, in the case of an Event of
Default arising from certain events of bankruptcy or insolvency with respect to
the Company or any Significant Subsidiary thereof, all outstanding Securities
shall become due and payable without further action or notice.  Holders of the
Securities may not enforce the Indenture or the Securities except as provided in
the Indenture.  Subject to certain limitation, Holders of a majority in
principal amount of the then outstanding Securities may direct the Trustee in
its exercise of any trust or power.  The Trustee may withhold from Holders of
the Securities notice of any continuing Default or Event of Default (except a
Default or Event of Default relating to the payment of principal or interest) if
it determines that withholding notice is in such Holders' interest.

            The Holders of not less than a majority in aggregate principal
amount of the Securities then outstanding by written notice to the Trustee may
on behalf of the Holders of all of the Securities waive any existing Default or
Event of Default and its consequences under the

                                       A-7

<PAGE>

Indenture except a continuing Default or Event of Default in the payment of
interest or premium on, or the principal of, the Securities.

            The Company is required to deliver to the Trustee annually a
statement regarding compliance with the Indenture, and the Company is required
upon becoming aware of any Default or Event of Default, to deliver to the
Trustee a statement specifying such Default or Event of Default.

            The above description of Events of Default and remedies is qualified
by reference, and subject in its entirety, to the more complete description
thereof contained in the Indenture.

            14.  RESTRICTIVE COVENANTS.  The Indenture imposes certain
limitations on the ability of the Company and its Subsidiaries to incur
additional indebtedness and issue preferred stock, pay dividends or make other
distributions, repurchase Equity Interests or subordinated indebtedness, create
certain liens, enter into certain transactions with affiliates, sell assets of
the Company or its Subsidiaries, issue or sell Equity Interests of the Company's
Subsidiaries, issue Guarantees of Indebtedness by the Company's Subsidiaries and
enter into certain mergers and consolidations.

            15.  TRUSTEE DEALINGS WITH COMPANY.  The Trustee under the
Indenture, in its individual or any other capacity, may make loans to, accept
deposits from, and perform services for the Company or its Affiliates, and may
otherwise deal with the Company or its Affiliates, as if it were not Trustee.

            16.  NO PERSONAL LIABILITY OF DIRECTORS, OFFICERS, EMPLOYEES AND
Shareholders.  No director, officer, employee, incorporator or shareholder of
the Company, as such, shall have any liability for any obligations of the
Company under the Securities, the Indenture or for any claim based on, in
respect of, or by reason of, such obligations or their creation.  Each Holder by
accepting a Security waives and releases all such liability.  The waiver and
release are part of the consideration for the issuance of the Securities.  Such
waiver may not be effective to waive liabilities under the federal securities
laws and it is the view of the Commission that such a waiver is against public
policy.

            17.  AUTHENTICATION.  This Security shall not be valid until
authenticated by the manual signature of the Trustee or an authenticating agent.

            18.  ABBREVIATIONS.  Customary abbreviations may be used in the
name of a Holder or an assignee, such as:  TEN COM (= tenants in common), TEN
ENT (= tenants by the entireties), JT TEN (= joint tenants with right of
survivorship and not as tenants in common), CUST (= Custodian), and U/G/M/A (=
Uniform Gifts to Minors Act).

            19.  CUSIP NUMBERS.  Pursuant to a recommendation promulgated by
the Committee on Uniform Security Identification Procedures, the Company has
caused CUSIP numbers to be printed on the Securities and has directed the
Trustee to use CUSIP numbers as a convenience to Holders.  No representation is
made as to the accuracy of such numbers either as printed on the Securities and
reliance may be placed only on the other identification numbers placed thereon.

                                       A-8

<PAGE>

            The Company will furnish to any Holder upon written request and
without charge a copy of the Indenture.  Request may be made to:

            National Medical Enterprises, Inc.
            2700 Colorado Avenue
            Santa Monica, California  90404
            Attention:  Treasurer

                                       A-9

<PAGE>

                                ASSIGNMENT FORM

      To assign this Security, fill in the form below:  For value received, (I)
or (we) hereby sell, assign and transfer this Security to

________________________________________________________________________________
                 (Insert assignee's soc. sec. or tax I.D. no.)

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________
             (Print or type assignee's name, address and zip code)

and do hereby irrevocably constitute and appoint______________________________
Attorney to transfer this Security on the books of the Company with full power
of substitution in the premises.

______________________________________________________________________________

Date:  ______________

                                  Your Signature:______________________________
                                  (Sign exactly as your name appears on the face
                                   of this Security)

Signature Guarantee.*

__________

*Participant in a recognized Signature Guarantee Medallion Program (or other
signature guarantor acceptable to the Trustee).

                                      A-10

<PAGE>

                      OPTION OF HOLDER TO ELECT PURCHASE

      If you want to elect to have all or any part of this Security purchased by
the Company pursuant to Section 4.10 or Section 4.13 of the Indenture, check the
appropriate box:

      / / Section 4.10                                  / / Section 4.13
           (Asset Sale)                                     (Change of Control)

      If you want to have only part of the Security purchased by the Company
pursuant to Section 4.10 or Section 4.13 of the Indenture, state the amount you
elect to have purchased:

$ _______________

Date:____________

                                  Your Signature:______________________________
                                  (Sign exactly as your name appears on the face
                                   of this Security)

Signature Guarantee.*

__________

*Participant in a recognized Signature Guarantee Medallion Program (or other
signature guarantor acceptable to the Trustee).

                                      A-11

<PAGE>

                                                                EXECUTION COPY
________________________________________________________________________________
________________________________________________________________________________

                      NATIONAL MEDICAL ENTERPRISES, INC.

                     ______________________________________

                                 $900,000,000

                    10 1/8% SENIOR SUBORDINATED NOTES due 2005

                      _____________________________________

                            ______________________

                                   INDENTURE

                           Dated as of March 1, 1995
                            ______________________

                    ________________________________________

                             THE BANK OF NEW YORK
                    ________________________________________

                                  as Trustee

________________________________________________________________________________
________________________________________________________________________________

<PAGE>

                     CROSS-REFERENCE TABLE*

TRUST INDENTURE
  ACT SECTION                                   INDENTURE SECTION
---------------                                 -----------------
310 (a)(1)............................................       7.10
   (a)(2).............................................       7.10
   (a)(3).............................................       N.A.
   (a)(4).............................................       N.A.
   (a)(5).............................................       7.10
   (b) ............................................... 7.08; 7.10
   (c) ...............................................       N.A.
311 (a) ..............................................       7.11
   (b) ...............................................       7.11
   (c) ...............................................       N.A.
312 (a)...............................................       2.05
   (b)................................................      11.03
   (c) ...............................................      11.03
313 (a) ..............................................       7.06
   (b)(1) ............................................       N.A.
   (b)(2) ............................................       8.06
   (c) ...............................................7.06; 11.02
   (d)................................................       7.06
314 (a) ..............................................4.03; 11.02
   (b) ...............................................       N.A.
   (c)(1).............................................      11.04
   (c)(2).............................................      11.04
   (c)(3).............................................       N.A.
   (d)................................................       N.A.
   (e)  ..............................................      11.05
   (f)................................................       N.A.
315 (a)...............................................7.01(ii)(b)
   (b)................................................7.05; 11.02
   (c)  ..............................................    7.01(i)
   (d)................................................  7.01(iii)
   (e)................................................       6.11
316 (a)(last sentence) ...............................       2.09
   (a)(1)(a)..........................................       6.05
   (a)(1)(b) .........................................       6.04
   (a)(2).............................................       N.A.
   (b) ...............................................       6.07
   (c) ............................................... 2.13; 8.04
317 (a)(1) ...........................................       6.08
   (a)(2).............................................       6.09
   (b) ...............................................       2.04
318 (a)...............................................      11.01
   (b)................................................       N.A.
   (c)................................................      11.01

N.A. means not applicable.
____________________________
*THIS CROSS-REFERENCE TABLE IS NOT PART OF THE INDENTURE.

<PAGE>

                         TABLE OF CONTENTS

                                                              Page

                             ARTICLE 1
                   DEFINITIONS AND INCORPORATION
                           BY REFERENCE

      Section 1.01. Definitions................................  1
      Section 1.02. Other Definitions.......................... 13
      Section 1.03. Incorporation by Reference of TIA.......... 14
      Section 1.04. Rules of Construction...................... 14

                             ARTICLE 2
                          THE SECURITIES

      Section 2.01. Form and Dating............................ 15
      Section 2.02. Execution and Authentication............... 15
      Section 2.03. Registrar and Paying Agent................. 15
      Section 2.04. Paying Agent to Hold Money in Trust........ 16
      Section 2.05. Holder Lists............................... 16
      Section 2.06. Transfer and Exchange...................... 16
      Section 2.07. Replacement Securities..................... 17
      Section 2.08. Outstanding Securities..................... 17
      Section 2.09. Treasury Securities........................ 18
      Section 2.10. Temporary Securities....................... 18
      Section 2.11. Cancellation............................... 18
      Section 2.12. Defaulted Interest......................... 19
      Section 2.13. Record Date................................ 19
      Section 2.14. CUSIP Number............................... 19

                             ARTICLE 3
                            REDEMPTION

      Section 3.01. Notices to Trustee......................... 19
      Section 3.02. Selection of Securities to Be Redeemed..... 20
      Section 3.03. Notice of Redemption....................... 20
      Section 3.04. Effect of Notice of Redemption............. 21
      Section 3.05. Deposit of Redemption Price................ 21
      Section 3.06. Securities Redeemed in Part................ 22
      Section 3.07. Optional Redemption........................ 22
      Section 3.08. Mandatory Redemption....................... 22
      Section 3.09. Offer to Purchase By Application of Excess
                    Proceeds................................... 22

                                        i

<PAGE>

                                                              Page

                             ARTICLE 4
                             COVENANTS

      Section 4.01. Payment of Securities...................... 25
      Section 4.02. Maintenance of Office or Agency............ 25
      Section 4.03. Commission Reports......................... 26
      Section 4.04. Compliance Certificate..................... 27
      Section 4.05. Taxes...................................... 27
      Section 4.06. Stay, Extension and Usury Laws............. 28
      Section 4.07. Limitations on Restricted Payments......... 28
      Section 4.08. Limitations on Dividend and Other Payment
                    Restrictions Affecting Subsidiaries........ 30
      Section 4.09. Limitations on Incurrence of Indebtedness
                    and Issuance of Preferred Stock............ 31
      Section 4.10. Asset Sales................................ 33
      Section 4.11. Limitations on Transactions with Affiliates 34
      Section 4.12. Limitations on Liens....................... 35
      Section 4.13. Change of Control.......................... 35
      Section 4.14. Corporate Existence........................ 37
      Section 4.15. Line of Business........................... 37
      Section 4.16. Limitations on Issuances of Guarantees of
                    Indebtedness by Subsidiaries............... 37
      Section 4.17. No Senior Subordinated Debt................ 38

                             ARTICLE 5
                            SUCCESSORS

      Section 5.01. Limitations On Mergers, Consolidations or
                    Sales of Assets............................ 38
      Section 5.02. Successor Corporation Substituted.......... 39

                             ARTICLE 6
                       DEFAULTS AND REMEDIES

      Section 6.01. Events of Default.......................... 39
      Section 6.02. Acceleration............................... 41
      Section 6.03. Other Remedies............................. 42
      Section 6.04. Waiver of Past Defaults.................... 42
      Section 6.05. Control by Majority........................ 42
      Section 6.06. Limitation on Suits........................ 43
      Section 6.07. Rights of Holders to Receive Payment....... 43
      Section 6.08. Collection Suit by Trustee................. 43
      Section 6.09. Trustee May File Proofs of Claim........... 44
      Section 6.10. Priorities................................. 44
      Section 6.11. Undertaking for Costs...................... 45

                                       ii

<PAGE>

                                                              Page
                             ARTICLE 7
                              TRUSTEE

      Section 7.01. Duties of Trustee.......................... 45
      Section 7.02. Rights of Trustee.......................... 46
      Section 7.03. Individual Rights of Trustee............... 47
      Section 7.04. Trustee's Disclaimer....................... 47
      Section 7.05. Notice of Defaults......................... 47
      Section 7.06. Reports by Trustee to Holders.............. 47
      Section 7.07. Compensation and Indemnity................. 48
      Section 7.08. Replacement of Trustee..................... 48
      Section 7.09. Successor Trustee or Agent by Merger, etc.. 49
      Section 7.10. Eligibility; Disqualification.............. 49
      Section 7.11. Preferential Collection of Claims Against
                    Company.................................... 50

                            ARTICLE 8
                      DISCHARGE OF INDENTURE

      Section 8.01. Defeasance and Discharge of this Indenture
                    and the Securities......................... 50
      Section 8.02. Legal Defeasance and Discharge............. 50
      Section 8.03. Covenant Defeasance........................ 51
      Section 8.04. Conditions to Legal or Covenant Defeasance. 51
      Section 8.05. Deposited Money and Government Securities
                    to be Held in Trust; Other Miscellaneous
                    Provisions................................. 53
      Section 8.06. Repayment to Company....................... 53
      Section 8.07. Reinstatement.............................. 54

                            ARTICLE 9
                 AMENDMENT, SUPPLEMENT AND WAIVER

      Section 9.01. Without Consent of Holders................. 54
      Section 9.02. With Consent of Holders.................... 55
      Section 9.03. Compliance with TIA........................ 56
      Section 9.04. Revocation and Effect of Consents.......... 56
      Section 9.05. Notation on or Exchange of Securities...... 57
      Section 9.06. Trustee to Sign Amendments, etc............ 57

                            ARTICLE 10
                           SUBORDINATION

      Section 10.01. Agreement to Subordinate.................. 57
      Section 10.02. Certain Definitions....................... 57
      Section 10.03. Liquidation; Dissolution; Bankruptcy...... 58

                                       iii

<PAGE>

                                                              Page

      Section 10.04. Default on Designated Senior Debt......... 58
      Section 10.05. Acceleration of Securities................ 59
      Section 10.06. When Distribution Must Be Paid Over....... 59
      Section 10.07. Notice by Company......................... 60
      Section 10.08. Subrogation............................... 60
      Section 10.09. Relative Rights........................... 60
      Section 10.10. Subordination May Not Be Impaired by
                     Company................................... 60
      Section 10.11. Distribution or Notice to Representative.. 60
      Section 10.12. Rights of Trustee and Paying Agent........ 61
      Section 10.13. Authorization to Effect Subordination..... 61
      Section 10.14. Amendments................................ 61

                            ARTICLE 11
                           MISCELLANEOUS

      Section 11.01. TIA Controls.............................. 61
      Section 11.02. Notices................................... 62
      Section 11.03. Communication by Holders with Other
                     Holders................................... 63
      Section 11.04. Certificate and Opinion as to Conditions
                     Precedent................................. 63
      Section 11.05. Statements Required in Certificate or
                     Opinion................................... 63
      Section 11.06. Rules by Trustee and Agents............... 64
      Section 11.07. Legal Holidays............................ 64
      Section 11.08. No Personal Liability of Directors,
                     Officers, Employees and Shareholders...... 64
      Section 11.09. Duplicate Originals....................... 64
      Section 11.10. Governing Law............................. 64
      Section 11.11. No Adverse Interpretation of Other
                     Agreements................................ 64
      Section 11.12. Successors................................ 64
      Section 11.13. Severability.............................. 65
      Section 11.14. Counterpart Originals..................... 65
      Section 11.15. Table of Contents, Headings, etc.......... 65

EXHIBITS

      Exhibit A     FORM OF SECURITY............................ A
      Exhibit B     FORM OF SUPPLEMENTAL INDENTURE.............. B

                                       iv

<PAGE>

                                                                     EXHIBIT B

                       FORM OF SUPPLEMENTAL INDENTURE

      Supplemental Indenture (this "Supplemental Indenture"), dated as of
________________, between __________________ (the "Guarantor"), a subsidiary of
National Medical Enterprises, Inc. (or its successor), a Nevada corporation (the
"Company"), and The Bank of New York, as trustee under the indenture referred to
below (the "Trustee").

                              W I T N E S S E T H

      WHEREAS, the Company has heretofore executed and delivered to the Trustee
an indenture (the "Indenture"), dated as of March 1, 1995, providing for the
issuance of an aggregate principal amount of $900,000,000 of 10 1/8% Senior
Subordinated Notes due 2005 (the "Securities");

      WHEREAS, Section 4.16 of the Indenture provides that under certain
circumstances the Company is required to cause the Guarantor to execute and
deliver to the Trustee a supplemental indenture pursuant to which the Guarantor
shall guarantee the payment of the Securities pursuant to a Guarantee on the
terms and conditions set forth herein; and

      WHEREAS, pursuant to Section 9.01 of the Indenture, the Trustee is
authorized to execute and deliver this Supplemental Indenture.

      NOW THEREFORE, in consideration of the foregoing and for other good and
valuable consideration, the receipt of which is hereby acknowledged, the
Guarantor and the Trustee mutually covenant and agree for the equal and ratable
benefit of the holders of the Securities as follows:

      1.    CAPITALIZED TERMS.  Capitalized terms used herein without definition
shall have the meanings assigned to them in the Indenture.

      2.    AGREEMENT TO GUARANTEE.  The Guarantor hereby unconditionally
guarantees to each Holder of a Security authenticated and delivered by the
Trustee and to the Trustee and its successors and assigns, irrespective of the
validity and enforceability of the Indenture, the Securities or the Obligations
of the Company hereunder and thereunder, that: (a) the principal of, premium, if
any, and interest on the Securities will be promptly paid in full when due,
whether at maturity, by acceleration, redemption or otherwise, and interest on
the overdue principal, premium, if any, and (to the extent permitted by law)
interest on any interest on the Securities and all other payment Obligations of
the Company to the Holders or the Trustee hereunder or thereunder will be
promptly paid in full, all in accordance with the terms hereof and thereof; and
(b) in case of any extension of time of payment or renewal of any Securities or
any of such other payment Obligations, that same will be promptly paid in full
when due or

                                       B-1

<PAGE>

performed in accordance with the terms of the extension or renewal, whether at
stated maturity, by acceleration, redemption or otherwise.  Failing payment when
due of any amount so guaranteed for whatever reason the Guarantor shall be
obligated to pay the same immediately.  An Event of Default under the Indenture
or the Securities shall constitute an event of default under this Guarantee, and
shall entitle the Holders of Securities to accelerate the Obligations of the
Guarantor hereunder in the same manner and to the same extent as the Obligations
of the Company.  The Guarantor hereby agrees that its Obligations hereunder
shall be unconditional, irrespective of the validity, regularity or
enforceability of the Securities or the Indenture, the absence of any action to
enforce the same, any waiver or consent by any Holder of the Securities with
respect to any provisions hereof or thereof, the recovery of any judgment
against the Company, any action to enforce the same or any other circumstance
which might otherwise constitute a legal or equitable discharge or defense of
the Guarantor.  The Guarantor hereby waives diligence, presentment, demand of
payment, filing of claims with a court in the event of insolvency or bankruptcy
of the Company, any right to require a proceeding first against the Company,
protest, notice and all demands whatsoever and covenant that this Guarantee will
not be discharged except by complete performance of the Obligations contained in
the Securities and the Indenture.  If any Holder or the Trustee is required by
any court or otherwise to return to the Company, the Guarantor, or any
Custodian, Trustee, liquidator or other similar official acting in relation to
either the Company or the Guarantor, any amount paid by either to the Trustee or
such Holder, this Guarantee, to the extent theretofore discharged, shall be
reinstated in full force and effect.  The Guarantor agrees that it shall not be
entitled to, and hereby waives, any right of subrogation in relation to the
Holders in respect of any Obligations guaranteed hereby.  The Guarantor further
agrees that, as between the Guarantor, on one hand, and the Holders and the
Trustee, on the other hand, (x) the maturity of the Obligations guaranteed
hereby may be accelerated as provided in Article 6 of the Indenture for the
purposes of this Guarantee, notwithstanding any stay, injunction or other
prohibition preventing such acceleration in respect of the Obligations
guaranteed hereby, and (y) in the event of any declaration of acceleration of
such Obligations as provided in Article 6 of the Indenture, such Obligations
(whether or not due and payable) shall forthwith become due and payable by the
Guarantor for the purpose of this Guarantee.

      3.    Execution and Delivery of Guarantee.  To evidence its Guarantee set
forth in Section 2, the Guarantor hereby agrees that a notation of such
Guarantee substantially in the form of EXHIBIT A shall be endorsed by an
officer of such Guarantor on each Security authenticated and delivered by the
Trustee and that this Supplemental Indenture shall be executed on behalf of such
Guarantor, by manual or facsimile signature, by its President or one of its Vice
Presidents.

            The Guarantor hereby agrees that its Guarantee set forth in Section
2 shall remain in full force and effect notwithstanding any failure to endorse
on each Security a notation of such Guarantee.

            If an Officer whose signature is on this Supplemental Indenture or
on the Guarantee no longer holds that office at the time the Trustee
authenticates the Security on which a Guarantee is endorsed, the Guarantee shall
be valid nevertheless.

                                       B-2

<PAGE>

            The delivery of any Security by the Trustee, after the
authentication thereof hereunder, shall constitute due delivery of the Guarantee
set forth in this Indenture on behalf of the Guarantors.

      4.    GUARANTORS MAY CONSOLIDATE, ETC. ON CERTAIN TERMS.

            (a)   Except as set forth in Articles 4 and 5 of the Indenture,
nothing contained in this Supplemental Indenture or in the Securities shall
prevent any consolidation or merger of the Guarantor with or into the Company or
any Subsidiary of the Company that has executed and delivered a supplemental
indenture substantially in the form hereof or shall prevent any sale or
conveyance of the property of the Guarantor as an entirety or substantially as
an entirety, to the Company or any such Subsidiary of the Company.

            (b)   Except as provided in Section 4(a) hereof or in a transaction
referred to in Section 5 hereof, the Guarantor shall not consolidate with or
merge with or into, or sell, assign, transfer, lease, convey or otherwise
dispose of all or substantially all of its assets to, another Person unless (1)
either (x) the Guarantor shall be the surviving Person of such merger or
consolidation or (y) the surviving Person or transferee is a corporation,
partnership or trust organized and existing under the laws of the United States,
any state thereof or the District of Columbia and such surviving Person or
transferee shall expressly assume all the obligations of the Guarantor under
this Guarantee and the Indenture pursuant to a supplemental indenture
substantially in the form  hereof; (2) immediately after giving effect to such
transaction (including the incurrence of any Indebtedness incurred or
anticipated to be incurred in connection with such transaction) no Default or
Event of Default shall have occurred and be continuing; and (3) the Company has
delivered to the Trustee an Officers' Certificate and Opinion of Counsel, each
stating that such consolidation, merger or transfer complies with the Indenture,
that the surviving Person agrees to be bound thereby, and that all conditions
precedent in the Indenture relating to such transaction have been satisfied.
For purposes of the foregoing, the transfer (by lease, assignment, sale or
otherwise, in a single transaction or series of related transactions) of all or
substantially all of the properties and assets of one or more Subsidiaries of
the Guarantor, the Capital Stock of which constitutes all or substantially all
of the properties and assets of the Guarantor, shall be deemed to be the
transfer of all or substantially all of the properties and assets of the
Guarantor.

            Upon any consolidation or merger, or any sale, assignment, transfer,
lease, conveyance or other disposition of all or substantially all of the assets
of the Guarantor in accordance with this Section 4(b) hereof, the successor
corporation shall succeed to and be substituted for the Guarantor with the same
effect as if it had been named herein as a Guarantor.  Such successor
corporation thereupon may cause to be signed any or all of the Guarantees to be
endorsed upon all of the Securities issuable hereunder which theretofore shall
not have been signed by the Company and delivered to the Trustee.  All
Guarantees so issued shall in all respects have the same legal rank and benefit
under the Indenture as the Guarantees theretofore and thereafter issued in
accordance with the terms of the Indenture as though all of such Guarantees had
been issued at the date of the execution hereof.

                                       B-3

<PAGE>

      5.    RELEASES FOLLOWING SALE OF ASSETS.  Concurrently with any sale,
lease, conveyance or other disposition (by merger, consolidation or otherwise)
of assets of the Guarantor (including, if applicable, disposition of all of the
Capital Stock of the Guarantor), any Liens in favor of the Trustee in the assets
sold, leased, conveyed or otherwise disposed of shall be released; PROVIDED
that in the event of an Asset Sale, such Asset Sale is effected, and the Net
Proceeds therefrom are applied, in accordance with Section 4.10 of the
Indenture.  If the assets sold, leased, conveyed or otherwise disposed of (by
merger, consolidation or otherwise) include all or substantially all of the
assets of the Guarantor or all of the Capital Stock of the Guarantor in each
case, in compliance with the terms of the Indenture, then the Guarantor shall be
automatically and unconditionally released from and relieved of its Obligations
under its Guarantee; PROVIDED that in the event of an Asset Sale, such Asset
Sale is effected, and the Net Proceeds therefrom are applied, in accordance with
Section 4.10 of the Indenture.  Upon delivery by the Company to the Trustee of
an Officers' Certificate to the effect that such sale, lease, conveyance or
other disposition was made by the Company in accordance with the provisions of
the Indenture, including without limitation of Section 4.10 thereof, if
applicable, the Trustee shall execute any documents reasonably required in order
to evidence the release of the Guarantor from its Obligations under its
Guarantee.

            Nothing herein shall relieve the Company from its obligation to
apply the proceeds of any Asset Sale as provided in Section 4.10 of the
Indenture.

      6.    LIMITATION ON GUARANTOR LIABILITY.  For purposes hereof, the
Guarantor's liability will be that amount from time to time equal to the
aggregate liability of the Guarantor hereunder, but shall be limited to the
lesser of (i) the aggregate amount of the Obligations of the Company under the
Securities and the Indenture and (ii) the amount, if any, which would not have
(a) rendered the Guarantor "insolvent" (as such term is defined in the federal
Bankruptcy Law and in the Debtor and Creditor Law of the State of New York) or
(b) left it with unreasonably small capital at the time its Guarantee of the
Securities was entered into, after giving effect to the incurrence of existing
Indebtedness immediately prior to such time; PROVIDED that it shall be a
presumption in any lawsuit or other proceeding in which the Guarantor is a party
that the amount guaranteed pursuant to its Guarantee is the amount set forth in
clause (i) above unless any creditor, or representative of creditors of the
Guarantor, or debtor in possession or trustee in bankruptcy of the Guarantor,
otherwise proves in such a lawsuit that the aggregate liability of the Guarantor
is limited to the amount set forth in clause (ii).  In making any determination
as to the solvency or sufficiency of capital of the Guarantor in accordance with
the previous sentence, the right of the Guarantor to contribution from other
Subsidiaries of the Company that have executed and delivered a supplemental
indenture substantially in the form hereof and any other rights the Guarantor
may have, contractual or otherwise, shall be taken into account.

      7.    "TRUSTEE" TO INCLUDE PAYING AGENT.  In case at any time any Paying
Agent other than the Trustee shall have been appointed by the Company and be
then acting under the Indenture, the term "Trustee" as used in this Supplemental
Indenture shall in each case (unless the context shall otherwise require) be
construed as extending to and including such Paying Agent within its meaning as
fully and for all intents and purposes as if such Paying Agent were named in
this Supplemental Indenture in place of the Trustee.

                                       B-4

<PAGE>

      8.    SUBORDINATION.  The Obligations of the Guarantor to the Holders of
the Securities and to the Trustee pursuant to this Guarantee are subordinated to
the Guarantor's Guarantee of or pledge to secure [the Indebtedness giving rise
to the requirement to execute this Guarantee pursuant to Section 4.16 of the
Indenture] to the same extent as the Securities are subordinated to such other
Indebtedness under the Indenture.

      9.    NO RECOURSE AGAINST OTHERS.  No director, officer, employee,
incorporator or stockholder of the Guarantor, as such, shall have any liability
for any obligations of the Company or the Guarantor under the Securities, any
Guarantees, the Indenture or this Supplemental Indenture or for any claim based
on, in respect of, or by reason of, such obligations or their creation.  Each
Holder of the Securities by accepting a Security waives and releases all such
liability.  The waiver and release are part of the consideration for issuance of
the Securities.  Such waiver may not be effective to waive liabilities under the
federal securities laws and it is the view of the Commission that such a waiver
is against public policy.

      10.   NEW YORK LAW TO GOVERN.  The internal law of the State of New York
shall govern and be used to construe this Supplemental Indenture.

      11.   COUNTERPARTS  The parties may sign any number of copies of this
Supplemental Indenture.  Each signed copy shall be an original, but all of them
together represent the same agreement.

      12.   EFFECT OF HEADINGS.  The Section headings herein are for convenience
only and shall not affect the construction hereof.

IN WITNESS WHEREOF, the parties hereto have caused this Supplemental Indenture
to be duly executed and attested, all as of the date first above written.

Dated:  _________________ ___, ____

[Guarantor]

By:  ______________________________
Name:
Title:

The Bank of New York,
      as Trustee

By:  ______________________________
Name:
Title:

                                       B-5

<PAGE>

                      EXHIBIT A TO SUPPLEMENTAL INDENTURE

                                   GUARANTEE

            The Guarantor hereby unconditionally guarantees to each Holder of a
Security authenticated and delivered by the Trustee and to the Trustee and its
successors and assigns, irrespective of the validity and enforceability of the
Indenture, the Securities or the Obligations of the Company to the Holders or
the Trustee under the Securities or under the Indenture, that: (a) the principal
of, and premium, if any, and interest on the Securities will be promptly paid in
full when due, whether at maturity, by acceleration, redemption or otherwise,
and interest on overdue principal, premium, if any, and (to the extent permitted
by law) interest on any interest on the Securities and all other payment
Obligations of the Company to the Holders or the Trustee under the Indenture or
under the Securities will be promptly paid in full, all in accordance with the
terms thereof; and (b) in case of any extension of time of payment or renewal of
any Securities or any of such other payment Obligations, the same will be
promptly paid in full when due in accordance with the terms of the extension or
renewal, whether at stated maturity, by acceleration, redemption  or otherwise.
Failing payment when due of any amount so guaranteed, for whatever reason, the
Guarantor shall be obligated to pay the same immediately.

            The obligations of the Guarantor to the Holders of Securities and to
the Trustee pursuant to this Guarantee and the Indenture are expressly set forth
in a Supplemental Indenture, dated as of _________ __, ____ to the Indenture,
and reference is hereby made to the Indenture, as supplemented, for the precise
terms of this Guarantee.

            This is a continuing Guarantee and shall remain in full force and
effect and shall be binding upon the Guarantor and its respective successors and
assigns to the extent set forth in the Indenture until full and final payment of
all of the Company's Obligations under the Securities and the Indenture and
shall inure to the benefit of the successors and assigns of the Trustee and the
Holders of Securities and, in the event of any transfer or assignment of rights
by any Holder of Securities or the Trustee, the rights and privileges herein
conferred upon that party shall automatically extend to and be vested in such
transferee or assignee, all subject to the terms and conditions hereof.  This a
Guarantee of payment and not a guarantee of collection.

            This Guarantee shall not be valid or obligatory for any purpose
until the certificate of authentication on the Security upon which this
Guarantee is noted shall have been executed by the Trustee under the Indenture
by the manual signature of one of its authorized signatories.

            For purposes hereof, the Guarantor's liability will be that amount
from time to time equal to the aggregate liability of the Guarantor hereunder,
but shall be limited to the lesser of (i) the aggregate amount of the
Obligations of the Company under the Securities and the Indenture and (ii) the
amount, if any, which would not have (a) rendered the Guarantor "insolvent" (as
such term is defined in the federal Bankruptcy Law and in the Debtor and
Creditor Law of the State of New York) or (b) left it with unreasonably small
capital at the time its Guarantee of the Securities was entered into, after
giving effect to the incurrence of existing

                                       B-6

<PAGE>

Indebtedness immediately prior to such time; PROVIDED that it shall be a
presumption in any lawsuit or other proceeding in which the Guarantor is a party
that the amount guaranteed pursuant to its Guarantee is the amount set forth in
clause (i) above unless any creditor, or representative of creditors of the
Guarantor, or debtor in possession or trustee in bankruptcy of the Guarantor,
otherwise proves in such a lawsuit that the aggregate liability of the Guarantor
is limited to the amount set forth in clause (ii).  The Indenture provides that,
in making any determination as to the solvency or sufficiency of capital of a
Guarantor in accordance with the previous sentence, the right of the Guarantor
to contribution from other Subsidiaries of the Company that have become
Guarantors and any other rights the Guarantor may have, contractual or
otherwise, shall be taken into account.

            The Obligations of the Guarantor to the Holders of the Securities
and to the Trustee pursuant to this Guarantee are subordinated to the
Guarantor's Guarantee of or pledge to secure [the Indebtedness giving rise to
the requirement to execute this Guarantee pursuant to Section 4.16 of the
Indenture] to the same extent as the Securities are subordinated to such other
Indebtedness under the Indenture.

            Capitalized terms used herein have the same meanings given in the
Indenture unless otherwise indicated.

                                    [GUARANTOR]

                                    By:_________________________
                                        Name:
                                        Title:

                                       B-7

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00013-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00013-of-00352.parquet"}]]