EXHIBIT 10.18

                                  EXHIBIT 10.18

                    AMENDMENT NO. 4 TO MASTER OPERATING LEASE

      This AMENDMENT NO. 4 TO MASTER OPERATING LEASE (this "AMENDMENT") is made
as of November 1, 2005, by and between NHR/OP, L.P., a Delaware limited
partnership ("LANDLORD") and National HealthCare Corporation ("TENANT"), under
the following circumstances:

      WHEREAS, Landlord and Tenant are parties to that certain Master Operating
Lease dated as of December 29, 1997, as amended by that certain Amendment No. 1
to Master Operating Lease effective as of January 1, 2000, as amended by
Amendment No. 2 to Master Operating Lease effective as of October 1, 2000, and
as amended by Amendment No. 3 to Master Operating Lease effective as of August
1, 2005 (as amended, the "MASTER LEASE"), whereby Landlord has leased to Tenant
the "properties Leased" (as defined in the Master Lease), which Properties
Leased are described on Schedule A to the Master Lease (the "PREMISES"); and

      WHEREAS, Landlord and Tenant desire to enter into this Amendment in order
to modify certain terms of the Master Lease.

      NOW, THEREFORE, in consideration of the premises and the agreements and
covenants contained herein, Landlord and Tenant agree that the Master Lease is
amended and modified as follows:

      1.    Section 4.03(b) of the Lease is deleted in its entirety and replaced
with the following:

            (b)   The carriers of the policies shall have a Best's Resting of
            either "B++" or better and a Best's Financial Category of XII or
            larger and shall be authorized to do insurance business in the state
            in which the Leased Property is located, or exempt therefrom.

      2.    Except as amended by this Amendment, the Master Lease is not
otherwise amended, and the Master Lease remains in full force and effect, as
amended hereby. In the event of a conflict between the terms of this Amendment
and the terms of the Master Lease, the terms of this Amendment shall control.
Defined terms used in this Amendment not defined herein shall have the meaning
set forth in the Master Lease.

      IN WITNESS WHEREOF, Landlord and Tenant have executed this Amendment as of
the date first above written.

                                  LANDLORD:

                                  NHR/OP, L.P., A DELAWARE LIMITED
                                  PARTNERSHIP

                                  By:  NHR/Delaware, Inc., its General
                                       Partner

                                  By:  /s/ Xxxxxx X. Xxxxx
                                       Xxxxxx X. Xxxxx, President

                                  TENANT:

                                  NATIONAL HEALTHCARE CORPORATION, A
                                  DELAWARE CORPORATION

                                  By:  /s/ R. Xxxxxxx Xxxxxx
                                       R. Xxxxxxx Xxxxxx,
                                       Senior Vice-President