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                MASTER LEASE COMBINATION AMENDMENT AND AGREEMENT

                                  BY AND AMONG

                            KINDRED HEALTHCARE, INC.
                              (f/k/a Vencor, Inc.),

                       KINDRED HEALTHCARE OPERATING, INC.
                         (f/k/a Vencor Operating, Inc.),

                                       AND

                       VENTAS REALTY, LIMITED PARTNERSHIP
--------------------------------------------------------------------------------

<PAGE>

                MASTER LEASE COMBINATION AMENDMENT AND AGREEMENT

<PAGE>

     THIS MASTER LEASE COMBINATION AMENDMENT AND AGREEMENT (hereinafter this
"Agreement" ) is dated as of the 10th day of May, 2006 (the "Effective Date"),
and is by and among VENTAS REALTY, LIMITED PARTNERSHIP, a Delaware limited
partnership (together with its successors and assigns, "Lessor"), having an
office at 10350 Ormsby Park Place, Suite 300, Louisville, Kentucky 40223, and
KINDRED HEALTHCARE, INC., a Delaware corporation (f/k/a Vencor, Inc.)
("Kindred"), and KINDRED HEALTHCARE OPERATING, INC., a Delaware corporation
(f/k/a Vencor Operating, Inc.) ("Operator"; Operator, jointly and severally with
Kindred and permitted successors and assignees of Operator and Kindred,
"Tenant"), both having an office at 680 South 4th Avenue, Louisville, Kentucky
40202.

                                    RECITALS

     A. Lessor and Tenant entered into a certain Amended and Restated Master
Lease Agreement No. 1 dated as of April 20, 2001 (as the same may have been or
may hereafter be amended, amended and restated, supplemented, modified, severed,
renewed, extended or replaced, the "Lease"), demising to Tenant certain
properties.

     B. Lessor and Tenant entered into a certain Master Lease Agreement dated as
of December 12, 2001 (as the same may have been or may hereafter be amended,
amended and restated, supplemented, modified, severed, renewed, extended or
replaced, the "CMBS Lease"), demising to Tenant certain properties. Lessor
assigned its interest in the CMBS Lease to Ventas Finance I, LLC, a Delaware
limited liability company, which entity in turn, prior to the date hereof, was
merged into Lessor, so that Lessor is the "Lessor" under the CMBS Lease.

     C. Lessor and Tenant entered into a certain Master Lease Agreement No. 1A
dated as of September 8, 2004 (as the same may have been or may hereafter be
amended, amended and restated, supplemented, modified, severed, renewed,
extended or replaced, "Lease 1A"), demising to Tenant certain properties (the
Lease, the CMBS Lease and Lease 1A are sometimes referred to herein collectively
as the "Master Leases").

     D. Each of the Lease, the CMBS Lease and Lease 1A includes provisions
providing for the combination of the Lease and the CMBS Lease and Lease 1A.

     E. Lessor and Tenant desire to combine and merge the CMBS Lease and Lease
1A into the Lease in accordance with the provisions of such leases providing for
the combination thereof, on the terms set forth in this Agreement.

     NOW, THEREFORE, in consideration of the premises and other good and
valuable consideration, the parties hereby amend each of the Master Leases and
agree as follows:

     1. Capitalized Terms. All capitalized terms used herein and not defined
herein shall have the meaning ascribed thereto in the Lease.

<PAGE>

     2. Combination of Leases. Effective as of the Effective Date, each of the
CMBS Lease and Lease 1A shall be combined, and otherwise merged, into the Lease
in accordance with the terms of Section 40.18 of the Master Leases, with the
Lease being treated as the "Section 40.18 Lease" for purposes of such
combination and merger (such combination and merger is referred to in this
Agreement as the "Combination").

     3. Base Rent and Current Rent Amendments. Relative to the definitions of
"Base Rent" and "Current Rent" contained in Section 2.1 of the Lease, Lessor and
Tenant agree that the Base Rent and Current Rent for the Leased Properties
demised under the Lease (after giving effect to the Combination) shall, for the
period from May 1, 2006 through April 30, 2007, be equal to Eighty Seven Million
Two Hundred Twenty-Eight Thousand One Hundred Sixteen and 55/100 Dollars
($87,228,116.55) per annum, and, for Rent Calculation Years thereafter, Base
Rent and Current Rent shall be determined as set forth in subsection (d) of the
definition of "Base Rent" or subsection (b) of the definition of "Current Rent",
as applicable, contained in such Section 2.1, in each case subject to the
provisions of Article XIX relative to the amount of the Base Rent and Current
Rent during Extended Terms. Notwithstanding the foregoing, (1) in the event
Lessor exercises the Reset Option referenced in Section 3.2 of the Lease, then,
for periods from and after the Reset Date, each of "Base Rent" and "Current
Rent" shall mean the Fair Market Rental applicable to such period, as determined
pursuant to Section 3.2 of the Lease and including any escalations that are part
of the Fair Market Rental as so determined, and (2) exercise of the Reset Option
shall not limit the applicability of Sections 19.2 and 19.3 of the Lease.

     4. Post-Combination Exhibits. By virtue of the Combination, effective as of
the Effective Date, the Exhibits to the Lease, the CMBS Lease and Lease 1A shall
be combined as set forth in Section 40.18 of the Master Leases (e.g., after the
Combination, Exhibit A to the Lease, as the Section 40.18 Lease, shall consist
of the legal descriptions that, prior to the Combination, constituted Exhibit A
to the Lease, the CMBS Lease and Lease 1A), and Lessor and Tenant agree and
confirm that, by virtue of the Combination, effective as of the Effective Date:

     (a)  Exhibit B to the Lease shall read as set forth in Attachment 1 to this
          Agreement.

     (b)  Exhibit C to the Lease shall read as set forth in Attachment 2 to this
          Agreement.

     (c)  Exhibit D to the Lease shall read as set forth in Attachment 3 to this
          Agreement.

     (d)  Schedule 2.1A to the Lease shall read as set forth in Attachment 4 to
          this Agreement.

     (e)  Schedule 16.1(m)A to the Lease shall read as set forth in Attachment 5
          to this Agreement.

                                       2
<PAGE>

     (f)  Schedule 16.1(m)B to the Lease shall read as set forth in Attachment 6
          to this Agreement.

     5. No Other Amendments. Except as provided in this Agreement, the Master
Leases remain in full force and effect without modification.

     6. Successors and Assigns. This Agreement and the covenants and agreements
herein contained shall be binding upon and inure to the benefit of Lessor and
Tenant and their respective heirs, devisees, successors and assigns.

     7. Integrated Agreement; Modifications; Waivers. This Agreement constitutes
the entire agreement between the parties hereto with respect to the subject
matter hereof and supersedes any and all prior representations, understandings
and agreements, whether written or oral, with respect to such subject matter.
Each of the parties hereto acknowledges that it has not relied upon, in entering
into this Agreement, any representation, warranty, promise or condition not
specifically set forth in this Agreement. No supplement, modification or waiver
of any provision of this Agreement shall be binding unless executed in writing
by the party to be bound thereby. No waiver of any of the provisions of this
Agreement shall be deemed or shall constitute a waiver of any other provision
hereof (whether or not similar), nor shall such waiver constitute a continuing
waiver unless otherwise expressly provided.

     8. Headings and Captions. The headings and captions of the paragraphs of
this Agreement are for convenience of reference only and shall not affect the
meaning or interpretation of this Agreement or any provision hereof.

     9. Gender and Number. As used in this Agreement, the neuter shall include
the feminine and masculine, the singular shall include the plural, and the
plural shall include the singular, except where expressly provided to the
contrary.

     10. Severability. In the event that any paragraph, section, sentence,
clause or phrase contained in this Agreement becomes or is held by any court of
competent jurisdiction to be illegal, null or void or against public policy, the
remaining paragraphs, sections, sentences, clauses or phrases contained in this
Agreement shall not be affected thereby.

     11. Counterparts. This Agreement and any amendment to this Agreement may be
signed in any number of counterparts, each of which shall be an original, with
the same effect as if the signatures thereto were upon the same instrument.

                            [Signature Page Follows]

                                       3

<PAGE>

     IN WITNESS WHEREOF, the parties hereto have executed these presents the day
and year first above written.

                                   TENANT:

                                   KINDRED HEALTHCARE, INC., a Delaware
                                   corporation formerly known as Vencor, Inc.

                                   By: /s/ Douglas L. Curnutte
                                       -----------------------------------------
                                       Name:  Douglas L. Curnutte
                                       Title: Vice President of Facilities
                                              and Real Estate Development

                                   TENANT:

                                   KINDRED HEALTHCARE OPERATING, INC., a
                                   Delaware corporation formerly known as Vencor
                                   Operating, Inc.

                                    By: /s/ Douglas L. Curnutte
                                       -----------------------------------------
                                       Name:  Douglas L. Curnutte
                                       Title: Vice President of Facilities
                                              and Real Estate Development

                                       4
<PAGE>

                                   LESSOR:

                                   VENTAS REALTY, LIMITED PARTNERSHIP, a
                                   Delaware limited partnership

                                   By:  Ventas, Inc., a Delaware corporation,
                                        its general partner

                                        By: /s/ T. Richard Riney
                                            ------------------------------------
                                            T. Richard Riney, Executive Vice
                                            President, General Counsel and
                                            Secretary

                                       5

<PAGE>

                                     JOINDER

     The undersigned, VENTAS, INC., a Delaware corporation, hereby joins in the
foregoing instrument (capitalized terms used in this Joinder shall have the same
meaning herein as in such instrument) solely for the purposes of (i) confirming
to Tenant that, to the best of its knowledge, except as described in subsection
(ii) below, title to the Leased Properties is held in the name of Lessor, rather
than in the name of the respective entities that were the lessor under the
"Original Master Lease" referenced in the Lease, and that, if it is determined
that title has not properly been transferred to Lessor, Ventas, Inc. shall cause
the conveyance of such title to Lessor, effective as of April 20, 2001, (ii)
confirming to Tenant that, to the best of its knowledge, title to the Leased
Property commonly known as Vencor Hospital - Pittsburgh (Facility No. 4619) is
held in the name of Ventas, Inc., and (iii) subject to Section 40.2 of the
Lease, joining with Ventas Realty, Limited Partnership, on a joint and several
basis, as Lessor under the Lease with respect to, and only with respect to, the
aforesaid Vencor Hospital -Pittsburgh Leased Property, and for no other
purposes. Notwithstanding anything to the contrary contained in the Lease,
Tenant acknowledges and agrees, by the acceptance of this Joinder, that, except
as provided in subsection (i) above, Ventas, Inc. shall have no liability or
obligations under the Lease, as lessor or otherwise, with respect to any Leased
Property other than the aforesaid Vencor Hospital -Pittsburgh Leased Property.

                                        VENTAS, INC.

                                        By: /s/ T. Richard Riney
                                            ------------------------------------
                                            T. Richard Riney,
                                            Title:  Executive Vice PresidentEXHIBIT 4(a)

                            SUPPLEMENTAL INDENTURE

                           MERRILL LYNCH & CO., INC.

                                      AND

                          JPMORGAN CHASE BANK, N.A.,
                                  as Trustee

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

                            SUPPLEMENTAL INDENTURE

                           Dated as of May 16, 2006

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

                            Supplement to Indenture
                         Dated as of December 17, 1996

<PAGE>

      Supplemental Indenture, dated as of May 16, 2006 (the "Supplemental
Indenture"), by and between Merrill Lynch & Co., Inc., a corporation organized
and existing under the laws of the State of Delaware, having its principal
office at 4 World Financial Center, New York, New York 10080 (the "Company"),
and JPMorgan Chase Bank, N.A., successor to The Chase Manhattan Bank, a
national banking association duly organized and existing under the laws of the
United States of America and having its Corporate Trust Office at 4 New York
Plaza, 15th Floor, New York, New York 10004, as trustee (the "Trustee").

      WHEREAS, the Company has heretofore executed and delivered its
Indenture, dated as of December 17, 1996 (the "Principal Indenture"), to the
Trustee to provide for the issuance from time to time of its subordinated debt
securities (the "Securities"), unlimited as to principal amount; and

      WHEREAS, the Principal Indenture and this Supplemental Indenture are
hereinafter collectively referred to as the "Indenture"; and

      WHEREAS, Section 901 of the Principal Indenture provides that, without
the consent of any Holders, the Company, when authorized by a Board
Resolution, and the Trustee, at any time and from time to time, may enter into
one or more indentures supplemental to the Principal Indenture, in form
satisfactory to the Trustee, to make any provisions with respect to matters or
questions arising under the Principal Indenture which shall not be
inconsistent with the provisions of the Principal Indenture and which shall
not adversely affect the interests of the Holders of Securities of any series
or any related coupons in any material respect; and

      WHEREAS, the Company has duly authorized the execution and delivery of
this Supplemental Indenture, and all things necessary to make this
Supplemental Indenture a valid agreement of the Company, in accordance with
its terms, have been done;

      NOW, THEREFORE, the Company and the Trustee, in consideration of the
premises and for other good and valuable consideration, the receipt and
sufficiency of which are hereby acknowledged, hereby covenant and agree, for
the equal and proportionate benefit of all Holders of the Securities, as
follows:

<PAGE>

                                      I.

               AMENDMENT OF CERTAIN PROVISIONS OF THE INDENTURE

      Section 101. Amendment of Section 101 of Principal Indenture. Section
101 of the Principal Indenture is hereby amended, with respect to all series
of Securities issued on or after the date hereof, as follows:

      (a) By deleting in its entirety the definition of "Company" contained
therein and inserting in its stead the following:

      "`Company' means the Person named as the `Company' in the first
paragraph of this instrument until a successor Person shall have become such
pursuant to the applicable provisions of this Indenture, and thereafter
`Company' shall mean such successor Person."

      (b) By deleting in its entirety the definition of "Company Request" and
"Company Order" contained therein and inserting in its stead the following:

      "`Company Request' and `Company Order' mean, respectively, a written
request or order signed in the name of the Company by the Chairman of the
Board, the President, a Vice President, the Treasurer or an Assistant
Treasurer, and by the Secretary or an Assistant Secretary of the Company, and
delivered to the Trustee."

      (c) By deleting in its entirety the definition of "Controlled
Subsidiary" contained therein.

      (d) By deleting in its entirety the definition of "Officers'
Certificate" contained therein and inserting in its stead the following:

      "`Officers' Certificate' means a certificate signed by the Chairman of
the Board, the President, a Vice President, the Treasurer or an Assistant
Treasurer, and by the Secretary or an Assistant Secretary of the Company, and
delivered to the Trustee."

      (e) By deleting in its entirety the definition of "Person" contained
therein and inserting in its stead the following:

      "`Person' means any individual, corporation, partnership, joint venture,
association, limited liability company, joint-stock company, trust,
unincorporated organization or government or any agency or political
subdivision thereof."

      (f) By deleting in its entirety the definition of "Subsidiary" contained
therein.

      (g) By deleting in its entirety the definition of "Voting Stock"
contained therein.

      Section 102. Amendment of Section 303 of Principal Indenture. Section
303 of the Principal Indenture is hereby amended, with respect to all series
of Securities issued on or after

                                      2
<PAGE>

the date hereof, by deleting in its entirety the first sentence of such
Section and inserting in its stead the following:

      "The Securities shall be executed on behalf of the Company by its
Chairman of the Board, President, Vice President serving as Chief Financial
Officer or its Treasurer or Assistant Treasurer under its corporate seal
reproduced thereon and attested by its Secretary or one of its Assistant
Secretaries."

      Section 103. Amendment of Section 501 of Principal Indenture. Section
501 of the Principal Indenture is hereby amended, with respect to all series
of Securities issued on or after the date hereof, by deleting in its entirety
the portion of the definition of "Event of Default" prior to the numbered
items and inserting in its stead the following:

      "`Event of Default', wherever used herein with respect to Securities of
any series, means, unless provided for otherwise with respect to Securities of
such Series (in or pursuant to a Board Resolution, and set forth in an
Officer's Certificate, or in one or more indentures supplemental hereto), any
one of the following events (whatever the reason for such Event of Default and
whether it shall be voluntary or involuntary or be effected by operation of
law pursuant to any judgment, decree or order of any court or any order, rule
or regulation of any administrative or governmental body):"

      Section 104. Amendment of Section 801 of Principal Indenture. Section
801 of the Principal Indenture is hereby amended, with respect to all series
of Securities issued on or after the date hereof, by deleting it in its
entirety and inserting in its stead the following:

      "SECTION 801. Consolidations and Mergers of Company and Sales, Leases
and Conveyances Permitted Subject to Certain Conditions.

      The Company may consolidate with, or sell, lease or convey all or
substantially all of its assets to, or merge with or into any other Person,
provided that in any such case, (i) either the Company shall be the continuing
Person, or the successor Person shall be a Person organized and existing under
the laws of the United States of America or a State thereof and such successor
Person shall expressly assume the due and punctual payment of the principal of
(and premium, if any), any interest on, and any Additional Amounts payable
pursuant to Section 1004 with respect to, all the Securities, according to
their tenor, and the due and punctual performance and observance of all the
covenants and conditions of this Indenture to be performed by the Company by
supplemental indenture satisfactory to the Trustee, executed and delivered to
the Trustee by such Person, and (ii) the Company or such successor Person, as
the case may be, shall not, immediately after such merger or consolidation, or
such sale, lease or conveyance, be in default in the performance of any such
covenant or condition."

      Section 105. Amendment of Section 802 of Principal Indenture. Section
802 of the Principal Indenture is hereby amended, with respect to all series
of Securities issued on or after the date hereof, by deleting it in its
entirety and inserting in its stead the following:

                                      3
<PAGE>

      "SECTION 802. Rights and Duties of Successor Person.

      In case of any such consolidation, merger, sale, lease or conveyance and
upon any such assumption by the successor Person, such successor Person shall
succeed to and be substituted for the Company, with the same effect as if it
had been named herein as the party of the first part, and the predecessor
Person, except in the event of a lease, shall be relieved of any further
obligation under this Indenture and the Securities and coupons. Such successor
Person thereupon may cause to be signed, and may issue either in its own name
or in the name of the Company, any or all of the Securities and coupons
issuable hereunder which theretofore shall not have been signed by the Company
and delivered to the Trustee; and, upon the order of such successor Person,
instead of the Company, and subject to all the terms, conditions and
limitations in this Indenture prescribed, the Trustee shall authenticate and
shall deliver any Securities and coupons which previously shall have been
signed and delivered by the officers of the Company to the Trustee for
authentication, and any Securities or coupons which such successor Person
thereafter shall cause to be signed and delivered to the Trustee for that
purpose. All the Securities and coupons so issued shall in all respects have
the same legal rank and benefit under this Indenture as the Securities and
coupons theretofore or thereafter issued in accordance with the terms of this
Indenture as though all of such Securities and coupons had been issued at the
date of the execution hereof.

      In case any of such consolidation, merger, sale, lease or conveyance,
such changes in phraseology and form (but not in substance) may be made in the
Securities and coupons thereafter to be issued as may be appropriate."

                                     II.

                                 MISCELLANEOUS

      Section 201. Effect of Supplemental Indenture. The Principal Indenture,
as supplemented and amended by this Supplemental Indenture and all other
indentures supplemental thereto, is in all respects ratified and confirmed,
and the Principal Indenture, this Supplemental Indenture and all indentures
supplemental thereto shall be read, taken and construed as one and the same
instrument.

      Section 202. Conflict with Trust Indenture Act. If any provision hereof
limits, qualifies or conflicts with another provision hereof which is required
or deemed to be included in this Supplemental Indenture by any of the
provisions of the Trust Indenture Act, such required or deemed included
provision shall control.

      Section 203. Definitions. Capitalized terms used in the Principal
Indenture and in this Supplemental Indenture, but not defined herein, are used
as they are defined in the Principal Indenture.

      Section 204. Successors and Assigns. All covenants and agreements in
this Supplemental Indenture by the Company shall bind its successors and
assigns, whether so expressed or not.

      Section 205. Separability Clause. In case any provision in this
Supplemental Indenture shall be invalid, illegal or unenforceable, the
validity, legality and enforceability of the remaining

                                      4
<PAGE>

provisions (or of the other series of Securities) shall not in any way be
affected or impaired thereby.

      Section 206. Benefits of Supplemental Indenture. Nothing in this
Supplemental Indenture, express or implied, shall give to any Person, other
than the parties hereto and their successors hereunder and any Holders of
Securities or coupons, any benefit or any legal or equitable right, remedy or
claim under this Supplemental Indenture.

      Section 207. Governing Law. THIS SUPPLEMENTAL INDENTURE SHALL BE DEEMED
TO BE A CONTRACT MADE UNDER THE LAWS OF THE STATE OF NEW YORK AND THIS
SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH
THE LAWS OF THE STATE OF NEW YORK.

      Section 208. Execution in Counterparts. This Supplemental Indenture may
be executed in any number of counterparts, each of which shall be an original;
but such counterparts shall together constitute but one and the same
instrument.

      Section 209. Responsibility for Recitals. The recitals contained herein
shall be taken as statements of the Company, and the Trustee assumes no
responsibility for their correctness. The Trustee makes no representations as
to the validity or sufficiency of the Principal Indenture or this Supplemental
Indenture.

      Section 210. Effectiveness of Supplemental Indenture. The Company and
the Trustee hereby agree that this Supplemental Indenture shall take effect on
May 16, 2006.

                                      5
<PAGE>

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

                                              MERRILL LYNCH & CO., INC.

                                              By:  ____________________________
                                                    Name:
                                                    Title:

                                              [SEAL]

                                              Attest:  ________________________
                                                    Name:
                                                    Title:

                                              JPMORGAN CHASE BANK, N.A.,
                                              as Trustee

                                              By:
                                                    Name:
                                                    Title:

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