EXHIBIT 10.1

SECOND AMENDMENT TO CREDIT AGREEMENT

THIS SECOND AMENDMENT TO CREDIT AGREEMENT (this "Amendment"), dated October 27, 2009, is made and entered into on the terms and conditions hereinafter set forth, by and between NATIONAL HEALTHCARE CORPORATION, a Delaware corporation (the "Borrower"), and BANK OF AMERICA, N.A., a national banking association ("Lender").

RECITALS:

1.

Pursuant to a Credit Agreement dated as of October 30, 2007, by and between the Borrower and the Lender, as amended by First Amendment to Credit Agreement dated as of October 28, 2008, by and between the Borrower and the Lender (as the same heretofore has been or hereafter may be further amended, restated, supplemented, extended, renewed, replaced or otherwise modified from time to time, the "Credit Agreement"), the Lender agreed to make Loans to the Borrower and to issue Letters of Credit for the account of the Borrower, all as more specifically described in the Credit Agreement.

2.

The parties hereto desire to amend the Credit Agreement in certain respects as more particularly hereinafter set forth.

AGREEMENTS:

NOW, THEREFORE, in consideration of the mutual covenants and agreements hereinafter set forth, and for other good and valuable consideration, the receipt and sufficiency of all of which are hereby acknowledged, the parties hereto agree as follows:

1.

Amendment of Section 1.1.  Section 1.1 of the Credit Agreement is hereby amended by (a) deleting the definition of "Royal Health Acquisition" and (b) inserting the following new definitions in the appropriate locations according to alphabetical order, or by amending and restating existing definitions to read as indicated, as applicable:

"Applicable Rate" means, (a) in connection with computations of interest for Loans and Letters of Credit, a rate per annum equal to (i) 0.00% with respect to Base Rate Loans, (ii) 1.00% with respect to Eurodollar Rate Loans, and (iii) 1.00% with respect to Letters of Credit, and (b) in connection with computations of commitment fees, a rate per annum equal to one-fifth of one percentage point (0.20%).

"Maturity Date" means the later of (a) October 26, 2010 and (b) if maturity is extended pursuant to Section 2.12, such extended maturity date as determined pursuant to such Section.

Schedule 7.03, p. 1

"Required Guarantor" means (i) each Guarantor identified by name in the definition of "Guarantor" hereinabove set forth, (ii) upon consummation of the NHR Acquisition, Post-Acquisition NHR, and (iii) each existing and future direct Subsidiary of the Borrower other than (a) FMSC, Inc., a Florida corporation, (b) National Healthcare Center of Fort Oglethorpe, L.P., a Tennessee limited partnership, and (c) Premier Plus.

"Second Amendment" means the Second Amendment to Credit Agreement dated October 27, 2009, by and between the Borrower and the Lender.

"Second Amendment Effective Date" means October 27, 2009.

2.

Amendment of Section 5.13.  Section 5.13 is hereby amended to read as follows:

5.13

Subsidiaries.  As of the Second Amendment Effective Date, the Borrower has no Subsidiaries other than those specifically disclosed in Part (a) of Schedule 5.13 and has no equity investments in any other Person other than those specifically disclosed in Part (b) of Schedule 5.13.  The organizational structure of the Borrower and its Subsidiaries is in all material respects as described in Schedule 5.13.

3.

Amendments of Section 7.02.

(a)

Subsection 7.02(b) is hereby amended by deleting the word "First" in the two places in which it appears and substituting in lieu thereof the word "Second".

(b)

Subsection 7.02(h) is hereby deleted, and the following is hereby substituted in lieu thereof:

(h)

[Reserved];

4.

Amendments of Section 7.03.

(a)

Subsection 7.03(b) is hereby amended by deleting the word "First" in the two places in which it appears and substituting in lieu thereof the word "Second".

(b)

Subsection 7.03(g) is hereby deleted, and the following is hereby substituted in lieu thereof:

(g)

[Reserved];

5.

Amendment of Section 7.06.  Subsection 7.06(e) is hereby amended by deleting the date "December 31, 2007" in the fourth line and substituting in lieu thereof the date "December 31, 2008".

6.

Amendment of Schedule 5.13.  Schedule 5.13 to the Credit Agreement is hereby replaced with Schedule 5.13 to this Amendment.

Schedule 7.03, p. 2

7.

Conditions to Effectiveness.  This Amendment shall be effective only upon the satisfaction of the following conditions:

(a)

the Borrower and the Lender shall have executed and delivered a counterpart of this Amendment;

(b)

each of the representations and warranties of the Borrower contained in Section 8 shall be true and correct in all material respects as of the date as of which all of the other conditions contained in this Section 7 shall have been satisfied; and

(c)

the Lender shall have received such documents, instruments, certificates, opinions and approvals as it reasonably may have requested.

8.

Representations and Warranties of the Borrower.  As an inducement to the Lender to enter into this Amendment, the Borrower hereby represents and warrants that, on and as of the date hereof, and taking into account the provisions hereof, the representations and warranties contained in the Credit Agreement and the other Loan Documents are true and correct in all material respects, except for (a) representations and warranties that expressly relate to an earlier date, which remain true and correct as of said earlier date, and (b) representations and warranties that have become untrue or incorrect solely because of changes permitted by the terms of the Credit Agreement and the other Loan Documents.

9.

Effect of Amendment; Continuing Effectiveness of Credit Agreement and Loan Documents.

(a)

Neither this Amendment nor any other indulgences that may have been granted to the Borrower by the Lender shall constitute a course of dealing or otherwise obligate the Lender to modify, expand or extend the agreements contained herein, to agree to any other amendments to the Credit Agreement or to grant any consent to, waiver of or indulgence with respect to any other noncompliance with any provision of the Loan Documents.

(b)

Upon and after the effectiveness of this Amendment, each reference in the Credit Agreement to "this Agreement", "hereunder", "hereof" or words of like import referring to the Credit Agreement, and each reference in the other Loan Documents to "the Credit Agreement", "thereunder", "thereof" or words of like import referring to the Credit Agreement, shall mean and be a reference to the Credit Agreement as modified hereby.  This Amendment shall constitute a Loan Document for all purposes of the Credit Agreement and the other Loan Documents.

(c)

Any noncompliance by the Borrower with any of the covenants, terms, conditions or provisions of this Amendment shall constitute an Event of Default.

Schedule 7.03, p. 3

(d)

Except to the extent amended or modified hereby, the Credit Agreement, the other Loan Documents and all terms, conditions and provisions thereof shall continue in full force and effect in all respects and shall be construed in accordance with the modifications of the Credit Agreement effected hereby.  Without limiting the generality of the foregoing, the Loan Documents and all of the Collateral described therein secure and shall continue to secure the payment of all Obligations, in each case taking into account the modifications of the Credit Agreement effected hereby.

10.

Further Actions.  Each of the parties to this Amendment agrees that at any time and from time to time upon written request of any other party, it will execute and deliver such further documents and do such further acts and things as such other party reasonably may request in order to effect the intents and purposes of this Amendment.

11.

Counterparts.  This Amendment may be executed in multiple counterparts or copies, each of which shall be deemed an original hereof for all purposes.  One or more counterparts or copies of this Amendment may be executed by one or more of the parties hereto, and some different counterparts or copies executed by one or more of the other parties.  Each counterpart or copy hereof executed by any party hereto shall be binding upon the party executing same even though other parties may execute one or more different counterparts or copies, and all counterparts or copies hereof so executed shall constitute but one and the same agreement.  Each party hereto, by execution of one or more counterparts or copies hereof, expressly authorizes and directs any other party hereto to detach the signature pages and any corresponding acknowledgment, attestation, witness or similar pages relating thereto from any such counterpart or copy hereof executed by the authorizing party and affix same to one or more other identical counterparts or copies hereof so that upon execution of multiple counterparts or copies hereof by all parties hereto, there shall be one or more counterparts or copies hereof to which is(are) attached signature pages containing signatures of all parties hereto and any corresponding acknowledgment, attestation, witness or similar pages relating thereto.

12.

Miscellaneous.

(a)

This Amendment shall be governed by, construed and enforced in accordance with the laws of the State of Tennessee, without reference to the conflicts or choice of law principles thereof.

(b)

The headings in this Amendment and the usage herein of defined terms are for convenience of reference only, and shall not be construed as amplifying, limiting or otherwise affecting the substantive provisions hereof.

(c)

All references herein to the preamble, the recitals or sections, paragraphs, subparagraphs, annexes or exhibits are to the preamble, recitals, sections, paragraphs, subparagraphs, annexes and exhibits of or to this Amendment unless otherwise specified.  The words "hereof", "herein" and "hereunder" and words of similar import, when used in this Amendment, refer to this Amendment as a whole and not to any particular provision of this Amendment.

Schedule 7.03, p. 4

(d)

Any reference herein to any instrument, document or agreement, by whatever terminology used, shall be deemed to include any and all amendments, modifications, supplements, extensions, renewals, substitutions and/or replacements thereof as the context may require.

(e)

When used herein, (1) the singular shall include the plural, and vice versa, and the use of the masculine, feminine or neuter gender shall include all other genders, as appropriate, (2) "include", "includes" and "including" shall be deemed to be followed by "without limitation" regardless of whether such words or words of like import in fact follow same, and (3) unless the context clearly indicates otherwise, the disjunctive "or" shall include the conjunctive "and".

 IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be duly executed and delivered as of the date first written above.

[Remainder of Page Intentionally Left Blank;

Signature Page Follows]

Schedule 7.03, p. 5

[Signature Page to Second Amendment to Credit Agreement

(National HealthCare Corporation) dated October 27, 2009]

BORROWER:

NATIONAL HEALTHCARE CORPORATION

By:  /s/ John. K. Lines

Name:  John K. Lines

Title:    Senior V.P., Secretary & General Counsel

LENDER:

BANK OF AMERICA, N.A.

By:   /s/ H. Hope Walker

Name:  H. Hope Walker

Title:    V.P.

Schedule 7.03, p. 6

SCHEDULE 5.13

SUBSIDIARIES

AND OTHER EQUITY INVESTMENTS

Part (a).

Subsidiaries.

Subsidiaries of National HealthCare Corporation:

Subsidiary of City Corporation:

Subsidiaries of NHC/Delaware, Inc.:

Schedule 7.03, p. 7

Subsidiaries of NHC/OP, L.P.:

Schedule 7.03, p. 8

Schedule 7.03, p. 9

Part (b).

Other Equity Investments.

Schedule 7.03, p. 10

Schedule 7.03, p. 11

SCHEDULE 7.02

EXISTING INVESTMENTS

Schedule 7.03, p. 12

Schedule 7.03, p. 13

Schedule 7.03, p. 14

SCHEDULE 7.03

EXISTING INDEBTEDNESS

Schedule 7.03, p. 15