Document:

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                                                                   EXHIBIT 10.22

                     FIRST AMENDMENT TO SEVERANCE AGREEMENT

     This FIRST AMENDMENT TO SEVERANCE AGREEMENT ("First Amendment") by and
between, Manor Care, Inc. ("Manor Care"), Heartland Employment Services, Inc.
("Company"), Health Care and Retirement Corporation of America ("HCRA") and
_____________ ("Employee") is effective December 16, 2003.

                                    RECITALS

     WHEREAS, Employee is a participant in the Senior Executive Retirement
Program ("SERP"), a non-qualified benefit plan providing retirement benefits to
participants, in accordance with a formula based on the participant's highest
three-year average earnings and years of service (the "SERP Benefit") first
established by HCRA and then adopted by Manor Care and then the Company; and

     WHEREAS, HCRA, Manor Care and the Company each elected to fund their
obligations under the SERP through a collateral assignment split-dollar life
insurance arrangements; and

     WHEREAS, Employee entered into a Split Dollar Assignment Insurance
Agreement ("SDA") with HCRA, pursuant to which the Employee became the owner of
certain life insurance policy(ies) (the "Policy") which was designed to generate
cash value sufficient to fund the Employee's SERP Benefit, and HCRA and then
later Manor Care and the Company agreed to pay the premiums on such Policy and
retain an interest in the cash value of the Policy; and

     WHEREAS, Section 5.10 of the SDA provided that in the event of a change in
control, as defined in the SDA, Manor Care would be required to take actions to
fully fund the cash value of the Policy to equal the SERP Benefit Employee was
projected to receive at retirement including, if necessary, releasing a portion
of its corporate interest in the Policy and, to the extent applicable, providing
a gross-up payment to the Employee to cover any income taxes payable by the
Employee as the result of the release of the corporate interest; and

     WHEREAS, the transaction in September, 1998 between the former Health Care
and Retirement Corporation and the former Manor Care, Inc. constituted a change
in control under Section 5.10 of the SDA; and

     WHEREAS, on August 20, 1999 HCRA, Manor Care and Employee entered into a
Severance Agreement ("Severance Agreement") pursuant to which HCRA agreed to
provide Employee with certain severance benefits upon termination of his
employment following a change in control of Manor Care (as defined in the
Severance Agreement), including but not limited to, fully funding the SERP
Benefit and giving Employee additional service and earnings

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credits for determining the amount of the SERP Benefits, as well as making
certain assumptions regarding timing of payment of the SERP Benefit; and

     WHEREAS, the provisions of the Sarbanes-Oxley Act, effective in July, 2002,
negatively impacted the SDA by potentially prohibiting the continued payment of
premiums by Manor Care to the extent such payments may be considered loans to
the Employee; and

     WHEREAS, in September, 2003 the Internal Revenue Service adopted
regulations the effect of which will be to change the tax treatment of the SDA
by causing the full cash value in the Policy to become taxable to the Employee
at retirement; and

     WHEREAS, the provisions of Sarbanes-Oxley and the IRS regulations
referenced above, have impacted the original design of the SDA so as potentially
to reduce the advantages and benefits of the Policy for the Employee; and

     WHEREAS, the Compensation Committee of the Manor Care Board of Directors
has received and reviewed the recommendations of its consulting firm, Watson
Wyatt, regarding the implementation of Section 5.10 of the SDA, as well as
Watson Wyatt's recommendation regarding the provisions of Sarbanes-Oxley and the
IRS regulations referenced above; and

     WHEREAS, the Compensation Committee, having fully reviewed the impact of
Section 5.10 of the SDA, the provisions of Sarbanes-Oxley and the IRS
regulations referred to above, and in view of the recommendations of Watson
Wyatt has approved actions designed to implement the requirements of Section
5.10 and to mitigate the impact of the changes in tax treatment of the SDA; and

     WHEREAS, the Company, Manor Care, HCRA and Employee desire to enter into
this First Amendment for the purpose of documenting the actions of the
Compensation Committee with respect to Employee's SERP Benefit and Employee's
agreements with respect thereto.

     NOW THEREFORE, in consideration of the foregoing and the mutual promises
and commitments contained herein, and for other good and valuable consideration,
the parties agree as follows:

     1. SERP Benefit. In the event of (i) Employee's termination of employment
with the Company by reason of death; (ii) Employee's retirement on or after
Early Retirement (as defined in the SERP), or (iii) termination of Employee's
employment by the Company for reasons other than Cause (as defined in the
Severance Agreement), then upon commencement of the SERP Benefits in accordance
with the provisions of the SERP (as modified by Section 8 of the Severance
Agreement), HCRA, Manor Care and the Company agree that they will waive and
release that portion, or all, of their Corporate Interest (as defined in the
SDA) in the Policy to the extent that the remaining cash value of the Policy
shall equal the lump sum value of the SERP Benefit, but shall retain their
Corporate Interest in any cash value of the Policy that exceeds the lump sum
value of the SERP Benefit. In the event that after release of the Corporate
Interest, the cash value in the Policy is less than the lump sum value of the
SERP Benefit, the Company shall provide a cash payment to Employee in such
amount as is necessary

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to make up the difference between the lump sum value of the SERP Benefit and the
cash value of the Policy after the release of the Corporate Interest. Such
payment shall be made within sixty (60) days of commencement of the Employee's
benefit under the SERP. If Employee's employment is terminated for Cause at
anytime, then HCRA, Manor Care and the Company shall retain their full corporate
interest and Employee shall not be entitled to any of the benefits set forth in
Paragraphs 1, 2 or 3 of this First Amendment.

     2. Gross-Up Payment on Release of Corporate Interest and Shortfall Payment.
The Company agrees to make an additional payment to Employee ("Gross-Up Payment
A"), within 60 days of the commencement of Employee's benefits under the SDA, in
an amount such that after payment of all federal, state and local income taxes
imposed on Gross-Up Payment A, Employee retains an amount of Gross-Up Payment A
sufficient to pay all the income tax payments which Employee will be required to
pay on the release of the Corporate Interest and shortfall payments required by
Paragraph 1 of this First Amendment.

     3. Gross-Up Payment on Employee Interest. In addition to payments required
by Paragraphs 1 and 2 hereof, in the event of (i) Employee's termination of
employment with the Company by reason of death; (ii) Employee's retirement on or
after Early Retirement , or (iii) termination of Employee's employment by the
Company, for reasons other than Cause, the Company agrees to make an additional
payment to Employee ("Gross-Up Payment B"), within 60 days of Employee's
commencement of SERP Benefits under the SDA, in an amount such that after
payment of all federal, state and local income taxes imposed on Gross-Up Payment
B, Employee retains an amount of Gross-Up Payment B sufficient to pay all income
tax payments which Employee will be required to pay on the Employee's retained
interest in the cash value of the Policy in excess of the amount of the
Corporate Interest waived under Paragraph 1.

     4. Non-Competition/Non-Solicitation. In consideration of the benefits to be
provided by Paragraphs 1, 2 and 3 of this First Amendment, Employee agrees that
Paragraphs 13(a)-13(c) of the Severance Agreement are amended by adding one (1)
year to the periods specified therein so that the
non-competition/non-solicitation obligations contained therein shall be
effective for a period of two (2) years following the termination of his
employment.

     5. Acknowledgement. Employee acknowledges and agrees that Manor Care, the
Company and HCRA by complying with the terms of this amendment will have
fulfilled all obligations of HCRA under Section 5.10 of the SDA, and so long as
Manor Care and Company perform their obligations under this Amendment, Employee
shall take no action seeking additional benefits under Section 5.10 of the SDA.

     6. Other Provisions Effective. The parties agree that all other provisions
of the Severance Agreement, not amended herein, shall remain in full force and
effect.

     7. Further Actions. Each party agrees to take such further action, do such
other things, and execute such other writings as shall be necessary and proper
to carry out the terms and provisions of this First Amendment. Manor Care shall
cause the Company, HCRA or any successor employer of the Employee to honor and
fulfill its responsibilities and agreements under this First Amendment.

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     8. Interpretation. This First Amendment shall be subject to and shall be
construed under the laws of the State of Ohio.

     9. Headings. Any headings or captions in this First Amendment are for
reference purposes only, and shall not expand, limit, change or affect the
meaning of any provision of this First Amendment.

     10. Counterparts. This First Amendment may be executed in any number of
counterparts, each of which shall be deemed an original, and all of which
together shall constitute one and the same First Amendment.

     11. Successors. This First Amendment shall inure to the benefit of and be
enforceable by the Employee's legal representatives. This First Amendment shall
inure to the benefit of and be binding upon Manor Care, the Company, HCRA and
their successors and assigns. Manor Care shall require any successor to all or
substantially all of the business and/or assets of Manor Care, the Company or
HCRA, whether direct or indirect, by purchase, merger, consolidation,
acquisition of stock, or otherwise, expressly to assume and agree to perform
this First Amendment in the same manner and to the same extent as Manor Care,
the Company or HCRA would be required to perform if no such succession had taken
place.

EMPLOYEE:                          HEALTH CARE AND RETIREMENT
                                   CORPORATION OF AMERICA

                                   By:
-----------------------------             -------------------------------------
                                   Name:  Wade B. O'Brian
                                   Its:   Vice President

                                   HEARTLAND EMPLOYMENT SERVICES, INC.

                                   By:
                                          -------------------------------------
                                   Name:  Wade B. O'Brian
                                   Its    Vice President

                                   MANOR CARE, INC.

                                   By:
                                          -------------------------------------
                                   Name:  Geoffrey G. Meyers
                                   Its    Executive Vice President

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                                                                   EXHIBIT 10.26

                     HEALTH CARE AND RETIREMENT CORPORATION

                           DEFERRED COMPENSATION PLAN

                              FOR OUTSIDE DIRECTORS

         HEALTH CARE AND RETIREMENT CORPORATION, a corporation organized under
the laws of the State of Delaware ("the Corporation") hereby adopts this
Deferred Compensation Plan for Outside Directors. The purpose of this Plan is to
permit the Outside Directors of the Corporation to defer receipt of all or part
of the compensation they are entitled to receive for service on the
Corporation's Board of Directors and to provide an opportunity for appreciation
in such deferred compensation based upon the appreciation in the price of the
Corporation's Common Stock.

                                    ARTICLE I

                                   DEFINITIONS

         Whenever the following terms are used in this Plan, they shall have the
meaning specified below unless the context clearly indicates to the contrary.
The masculine pronoun shall include the feminine and the singular shall include
the plural, where the context so indicates.

SECTION 1.1 - BOARD

         "Board" shall mean the Board of Directors of the Corporation.

SECTION 1.2 - CHIEF EXECUTIVE OFFICER

         "Chief Executive Officer" shall mean the Chief Executive Officer of the
Corporation.

SECTION 1.3 - CHIEF FINANCIAL OFFICER

         "Chief Financial Officer" shall mean the Chief Financial Officer of the
Corporation.

SECTION 1.4 - COMMITTEE

         "Committee" shall mean the Incentive Compensation Committee of the
Board.

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SECTION 1.5 - COMMON STOCK

         "Common Stock" shall mean the Corporation's Common Stock, $.01 par
value.

SECTION 1.6 - COMPENSATION

         "Compensation" shall mean any cash remuneration paid by the Corporation
to an Outside Director for services as a Director of the Corporation, including
the Director's annual fee and compensation for Board and Committee meetings.

SECTION 1.7 - CORPORATION

         "Corporation" shall mean Health Care and Retirement Corporation, a
Delaware corporation.

SECTION 1.8 - DEFERRAL ELECTION

         "Deferral Election" shall mean an election pursuant to Section 3.1.

SECTION 1.9 - DEFERRED COMPENSATION ACCOUNT

         "Deferred Compensation Account" shall mean a memorandum account
established and maintained on the books of the Corporation to reflect a
Participant's interest in the Plan.

SECTION 1.10 - DIRECTOR

         "Director" shall mean a member of the Board.

SECTION 1.11 - EMPLOYEE

         "Employee" shall mean any employee of the Corporation or of any
subsidiary or affiliated organization of the Corporation.

SECTION 1.12 - FAIR MARKET VALUE

         "Fair Market Value" of a share of the Corporation's Common Stock as of
a given date shall mean: (i) the closing price of a share of the Corporation's
stock on the principal exchange on which shares of the Corporation's stock are
then trading, if any, on the day previous to such date, or, if shares were not
traded on the day previous to such date, then on the next preceding trading day
during which a sale occurred; or (ii) if such stock is not traded on an exchange
but is quoted on NASDAQ or a successor quotation system, (1) the last sales
price (if the stock is then listed as a National Market Issue under the NASD
National Market System) or (2) the mean between the closing representative bid
and asked prices

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(in all other cases) for the stock on the day previous to such date as reported
by NASDAQ or such successor quotation system; or (iii) if such stock is not
publicly traded on an exchange and not quoted on NASDAQ or a successor quotation
system, the mean between the closing bid and asked prices for the stock, on the
day previous to such date, as determined in good faith by the Chief Financial
Officer; or (iv) if the Corporation's stock is not publicly traded, the fair
market value established by the Chief Financial Officer acting in good faith.

SECTION 1.13 - OFFICER

         "Officer" shall mean an officer of the Corporation, as defined in Rule
16a - 1(f), or any successor provision thereof, under the Securities Exchange
Act of 1934, as such Rule may be amended in the future.

SECTION 1.14 - OUTSIDE DIRECTOR

         "Outside Director" shall mean a Director who is not an Officer or
Employee of the Corporation.

SECTION 1.15 - PLAN

         "Plan" shall mean this Health Care and Retirement Corporation Deferred
Compensation Plan for Outside Directors.

SECTION 1.16 - SECRETARY

         "Secretary" shall mean the Secretary of the Corporation.

                                   ARTICLE II

                                  PARTICIPATION

SECTION 2.1 - ELIGIBILITY

         Any Outside Director of the Corporation receiving compensation as a
Director may elect to have any or all compensation otherwise payable to him as a
Director deferred and paid to him upon his Deferral Termination Date as defined
below. Each Outside Director who elects to participate in this Plan shall be
referred to herein as a "Participant". A Director who is not an Outside Director
is not eligible to participate in this Plan. Officers and Employees of the
Corporation are not eligible to participate in this Plan.

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                                   ARTICLE III

                               DEFERRAL ELECTIONS

SECTION 3.1 - DEFERRAL ELECTIONS

         An Outside Director who desires to participate in this Plan shall make
such election in writing specifying the portion of his compensation which he
desires to defer. Such election shall be submitted to the Secretary of the
Corporation no later than 10 days prior to the commencement of the quarter in
which such compensation is to be earned.

SECTION 3.2 - IRREVOCABLE ELECTION

         Each Deferral Election shall apply only to that portion of compensation
to which it is made and shall be irrevocable. A Participant may elect one time
per quarter to change the rate of, or revoke, his Deferral Election with respect
to his future compensation. Until so changed or revoked, such Deferral Election
shall remain in effect with respect to all future compensation earned by the
Participant.

                                   ARTICLE IV

                         DEFERRED COMPENSATION ACCOUNTS

SECTION 4.1 - DEFERRED COMPENSATION ACCOUNT

         There shall be established for each Participant an account to be
designated as such Participant's Deferred Compensation Account. All amounts
deferred under the Plan shall be credited by the Corporation to the
Participant's Deferred Compensation Account. The Corporation shall provide each
Participant, at least quarterly, a statement of the balance in his Deferred
Compensation Account.

SECTION 4.2 - INVESTMENT UNITS

         The dollar amounts credited to each Deferred Compensation Account shall
be converted to, and thereafter expressed in terms of a number of Investment
Units, and the value of each Account shall at all times be equal to the value of
the Investment Units so allocated to it. The Investment Units available for
allocation under the Plan shall be equivalent in value and rate of return to:

         (a)      Shares of the Common Stock of the Corporation ("HCR Stock
Units"); or

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         (b)      The dollar amount so allocated plus the average annual yield
on Domestic Corporate Bonds of Moody's A-rated Companies, compounded monthly
("Corporate Bond Units").

         Whenever interest, dividends, or any other form of realized investment
return are paid on the Investment Unit equivalencies, a like amount shall be
credited to each Account to which such Investment Units have been allocated.

SECTION 4.3 - SELECTION OF INVESTMENT UNITS

         At the time of making his Deferral Election, the Participant shall also
specify in writing the percentage of each amount credited to his Deferred
Compensation Account that is to be allocated to HCR Stock Units and/or to
Corporate Bond Units. A Participant may elect to change one time per quarter the
allocation of amounts to be credited to his Deferred Compensation Account.

                                    ARTICLE V

                           PAYMENT OF ACCOUNT BALANCES

SECTION 5.1 - PAYMENT AT DEFERRAL TERMINATION DATE

         The entire amount credited to the Participant's account shall become
payable upon the participant's Deferral Termination date which shall be the date
upon which the Participant shall cease to be a Director of the Corporation. The
amount credited to the Participant's Deferred Compensation Account shall be
converted to cash and paid to the Participant in a lump sum within 10 days of
the Deferral Termination Date.

SECTION 5.2 - DEATH BEFORE PAYMENT

         In the event of a Participant's death before his Deferred Compensation
Account has been paid to him in full, the entire amount then credited to his
Account shall be paid in cash in a lump sum to the beneficiary or beneficiaries
named by him in a written designation filed with the Secretary (or, in the
absence of such a designation, to his estate).

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                                   ARTICLE VI

                                 ADMINISTRATION

SECTION 6.1 - DUTIES AND POWERS OF CHIEF EXECUTIVE OFFICER

         It shall be the duty of the Chief Executive Officer to conduct the
general administration of the Plan in accordance with its provisions. The Chief
Executive Officer shall have the power to interpret the Plan and to adopt such
rules for the administration, interpretation and application of the Plan as are
consistent therewith and to interpret, amend or revoke any such rules; provided
however, that Deferral Elections under the Plan are intended to defer a
Participant's receipt of income, for purpose of the Internal Revenue Code of
1986, and all such rules shall be made and interpreted consistent with such
intention.

SECTION 6.2 - AMENDMENT AND TERMINATION OF THE PLAN

         The Board may at any time, and from time to time, amend, suspend, or
terminate the Plan in whole or in part; provided, however, that no such
amendment, suspension or termination may, without the consent of each
Participant affected thereby, have any adverse retroactive effect on the rights
of any Participant (or any person claiming through or under him) under the Plan
unless required by applicable law.

SECTION 6.3 - NO RIGHT TO CONTINUED MEMBERSHIP ON THE BOARD

         Nothing in this Plan shall confer upon any Outside Director any right
to continue as a director of the Corporation or shall interfere with the rights
of the Corporation and its stockholders, which are hereby expressly reserved, to
remove any Outside Director at any time for any reason whatsoever, with or
without cause.

SECTION 6.4 - NONASSIGNABILITY

         Rights under the Plan shall not be assignable or transferable or
subject to encumbrance or change of any nature, other than by designation of
beneficiary to take effect at death or, in the absence of such designation, by
will or the laws of descent and distribution. The Plan shall be binding on and
inure to the benefit of the Company, each Participant and every person claiming
through or under a Participant, and their respective heirs, successors, and
assigns.

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SECTION 6.5 - NO FUNDING REQUIRED

         The Corporation shall be under no duty to segregate or set aside any
amount credited to any Account from the general assets of the Corporation, but
the Board may, in its discretion, direct the establishment of any trusteed,
insured, or other payment arrangement from which the Corporation's obligations
as to a Participant under the Plan may be paid. No Participant beneficiary,
estate, or other person claiming through or under a Participant shall have any
legal or beneficial property interest whatsoever in any assets of the
Corporation or in any such payment arrangement which may be established at the
direction of the Board except as may be expressly provided by such payment
arrangement. Neither the establishment of an Account nor the crediting of any
amounts thereto nor the establishment of any payment arrangement (except as may
be expressly provided by such payment arrangement) shall be deemed to create a
trust of any kind, any fiduciary relationship between the Corporation and any
person, or any collateral security for the Corporation's obligations under the
Plan. To the extent that a Participant or any other person acquires a right to
receive any payment from the Corporation under this Plan, such right shall be no
greater than that of any other unsecured general creditor of the Corporation.

SECTION 6.6 - RECAPITALIZATION

         If, as a result of a recapitalization of the Corporation, the
Corporation's outstanding shares of Common Stock shall be changed into a greater
or smaller number of shares, the number of units credited to a Participant's
Common Stock Fund account shall be appropriately adjusted on the same basis.

                                    * * * * *

         I hereby certify that the foregoing Deferred Compensation Plan for
Outside Directors was duly adopted by the Board of Directors of Health Care and
Retirement Corporation on December 8, 1992.

         Executed on this 9th day of December, 1992.

                                            /s/ R. Jeffery Bixler
                                            ----------------------------
                                                   Secretary

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