Document:

<PAGE>

                                                                  Exhibit 10.2.2

                                 PROMISSORY NOTE

$55,000,000                                                   New York, New York
                                                                November 1, 2002

          FOR VALUE RECEIVED THOSE ENTITIES LISTED ON SCHEDULE I attached
hereto, each a Delaware limited liability company and each having its principal
place of business at 4660 Trindle Road, Suite 103, Camp Hill, Pennsylvania 17011
(each, a "Borrower" and collectively, the "Borrowers"), hereby jointly and
severally promise to pay to the order of VENTAS REALTY, LIMITED PARTNERSHIP, a
Delaware limited partnership, having an address at 4360 Brownsboro Road, Suite
115, Louisville, Kentucky 40207 (together with any subsequent holder of this
Note, and their respective successors and assigns, "Lender"), or at such other
place as the holder hereof may from time to time designate in writing, the
maximum principal sum of FIFTY FIVE MILLION AND NO/100 DOLLARS ($55,000,000), or
so much thereof as is advanced, in lawful money of the United States of America,
with interest thereon to be computed from the date of this Note at the Interest
Rate, and to be paid in accordance with the terms of this Note and that certain
Loan Agreement dated the date hereof between the Borrowers and Lender (as the
same may be amended, restated, supplemented or otherwise modified from time to
time, the "Loan Agreement"). All capitalized terms not defined herein shall have
the respective meanings set forth in the Loan Agreement.

                            ARTICLE 1 - PAYMENT TERMS

          Each Borrower agrees to pay the principal sum of this Note and
interest on the unpaid principal sum of this Note from time to time outstanding
at the rates and at the times specified in Article II of the Loan Agreement and
the outstanding balance of the principal sum of this Note and all accrued and
unpaid interest thereon shall be due and payable on the Maturity Date.

                      ARTICLE 2 - DEFAULT AND ACCELERATION

          The Debt shall without notice become immediately due and payable at
the option of Lender if any payment required under this Note is not paid on or
prior to the date when due or if not paid on the Maturity Date or on the
happening of any other Event of Default.

                           ARTICLE 3 - LOAN DOCUMENTS

          This Note is secured by the Mortgages and the other Loan Documents.
All of the terms, covenants and conditions contained in the Loan Agreement, the
Mortgages and the other Loan Documents are hereby made part of this Note to the
same extent and with the same force as if they were fully set forth herein. In
the event of a conflict or inconsistency between the terms of this Note and the
Loan Agreement, the terms and provisions of the Loan Agreement shall govern.

<PAGE>

                           ARTICLE 4 - SAVINGS CLAUSE

          Notwithstanding anything to the contrary, (a) all agreements and
communications between any Borrower and Lender are hereby and shall
automatically be limited so that, after taking into account all amounts deemed
interest, the interest contracted for, charged or received by Lender shall never
exceed the maximum lawful rate or amount, (b) in calculating whether any
interest exceeds the lawful maximum, all such interest shall be amortized,
prorated, allocated and spread over the full amount and term of all principal
indebtedness of the Borrowers to Lender, and (c) if through any contingency or
event, Lender receives or is deemed to receive interest in excess of the lawful
maximum, any such excess shall be deemed to have been applied toward payment of
the principal of any and all then outstanding indebtedness of the Borrowers to
Lender, or if there is no such indebtedness, shall immediately be returned to
the Borrowers.

                           ARTICLE 5 - NO ORAL CHANGE

          No modification, amendment, extension, discharge, termination or
waiver of any provision of this Note, nor consent to any departure by any
Borrower therefrom, shall in any event be effective unless the same shall be in
a writing signed by the party against whom enforcement is sought, and then such
waiver or consent shall be effective only in the specific instance, and for the
purpose, for which given. Except as otherwise expressly provided herein, no
notice to, or demand on any Borrower shall entitle such Borrower to any other or
future notice of demand in the same, similar or other circumstances.

                               ARTICLE 6 - WAIVERS

          Each Borrower and all others who may become liable for the payment of
all or any part of the Debt do hereby severally waive presentment and demand for
payment, notice of dishonor, notice of intention to accelerate, notice of
acceleration, protest and notice of protest and non-payment and all other
notices of any kind. No release of any security for the Debt or extension of
time for payment of this Note or any installment hereof, and no alteration,
amendment or waiver of any provision of this Note, the Loan Agreement or the
other Loan Documents made by agreement between Lender or any other Person shall
release, modify, amend, waive, extend, change, discharge, terminate or affect
the liability of any Borrower or any other Person who may become liable for the
payment of all or any part of the Debt under this Note, the Loan Agreement or
the other Loan Documents. No notice to or demand on any Borrower shall be deemed
to be a waiver of the obligation of such Borrower or of the right of Lender to
take further action without further notice or demand as provided for in this
Note, the Loan Agreement or the other Loan Documents. If any Borrower is a
partnership or limited liability company, the agreements herein contained shall
remain in force and be applicable, notwithstanding any changes in the
individuals comprising the partnership or limited liability company, and the
term "Borrower," as used herein, shall include any alternate or successor
partnership or limited liability company, but any predecessor partnership or
limited liability company and their partners or members shall not thereby be
released from any liability. If any Borrower is a corporation, the agreements
contained herein shall remain in full force and be applicable notwithstanding
any changes in the shareholders comprising, or the officers and directors
relating to, the corporation, and the term "Borrower," as used herein, shall
include any alternative or successor corporation, but any predecessor
corporation shall not be relieved of

                                      -2-

<PAGE>

liability hereunder. Nothing in the foregoing sentence shall be construed as a
consent to, or a waiver of, any prohibition or restriction on transfers of
interests in such partnership, limited liability company or corporation, which
may be set forth in the Loan Agreement, the Mortgages or any other Loan
Document.

                              ARTICLE 7 - TRANSFER

          Upon the transfer of this Note in accordance with the provisions of
the Loan Agreement, each Borrower hereby waiving notice of any such transfer,
Lender may deliver all the collateral mortgaged, granted, pledged or assigned
pursuant to the Loan Documents, or any part thereof, to the transferee who shall
thereupon become vested with all the rights herein or under applicable law given
to Lender with respect thereto, and Lender shall thereafter forever be relieved
and fully discharged from any liability or responsibility in the matter; but
Lender shall retain all rights hereby given to it with respect to any
liabilities and the collateral not so transferred.

                             ARTICLE 8 - EXCULPATION

          The provisions of Section 11.22 of the Loan Agreement are hereby
incorporated by reference into this Note to the same extent and with the same
force as if fully set forth herein.

                            ARTICLE 9 - GOVERNING LAW

          (A) THIS NOTE WAS NEGOTIATED IN THE STATE OF NEW YORK, AND MADE BY
EACH BORROWER AND ACCEPTED BY LENDER IN THE STATE OF NEW YORK, AND THE PROCEEDS
OF THIS NOTE WERE DISBURSED FROM THE STATE OF NEW YORK, WHICH STATE THE PARTIES
AGREE HAS A SUBSTANTIAL RELATIONSHIP TO THE PARTIES AND TO THE UNDERLYING
TRANSACTION EMBODIED HEREBY, AND IN ALL RESPECTS, INCLUDING, WITHOUT LIMITING
THE GENERALITY OF THE FOREGOING, MATTERS OF CONSTRUCTION, VALIDITY AND
PERFORMANCE, THIS NOTE AND THE OBLIGATIONS ARISING HEREUNDER SHALL BE GOVERNED
BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK
APPLICABLE TO CONTRACTS MADE AND PERFORMED IN SUCH STATE (WITHOUT REGARD TO
PRINCIPLES OF CONFLICT LAWS) AND ANY APPLICABLE LAW OF THE UNITED STATES OF
AMERICA. TO THE FULLEST EXTENT PERMITTED BY LAW, EACH BORROWER HEREBY
UNCONDITIONALLY AND IRREVOCABLY WAIVES ANY CLAIM TO ASSERT THAT THE LAW OF ANY
OTHER JURISDICTION GOVERNS THIS NOTE AND THIS NOTE SHALL BE GOVERNED BY AND
CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK PURSUANT TO
SECTION 5-1401 OF THE NEW YORK GENERAL OBLIGATIONS LAW.

          (B) ANY LEGAL SUIT, ACTION OR PROCEEDING AGAINST LENDER OR ANY
BORROWER ARISING OUT OF OR RELATING TO THIS NOTE MAY AT LENDER'S OPTION BE
INSTITUTED IN ANY FEDERAL OR STATE COURT IN THE CITY OF NEW YORK, COUNTY OF NEW
YORK, PURSUANT TO SECTION 5-1402

                                      -3-

<PAGE>

OF THE NEW YORK GENERAL OBLIGATIONS LAW, AND EACH BORROWER WAIVES ANY OBJECTIONS
WHICH IT MAY NOW OR HEREAFTER HAVE BASED ON VENUE AND/OR FORUM NON CONVENIENCE
OF ANY SUCH SUIT, ACTION OR PROCEEDING, AND EACH BORROWER HEREBY IRREVOCABLY
SUBMITS TO THE JURISDICTION OF ANY SUCH COURT IN ANY SUIT, ACTION OR PROCEEDING.
EACH BORROWER DOES HEREBY DESIGNATE AND APPOINT:

          CT CORPORATION SYSTEM
          111 EIGHTH AVENUE
          NEW YORK, NEW YORK  10011

AS ITS AUTHORIZED AGENT TO ACCEPT AND ACKNOWLEDGE ON ITS BEHALF SERVICE OF ANY
AND ALL PROCESS WHICH MAY BE SERVED IN ANY SUCH SUIT, ACTION OR PROCEEDING IN
ANY FEDERAL OR STATE COURT IN NEW YORK, NEW YORK, AND AGREES THAT SERVICE OF
PROCESS UPON SAID AGENT AT SAID ADDRESS AND WRITTEN NOTICE OF SAID SERVICE
MAILED OR DELIVERED TO BORROWER IN THE MANNER PROVIDED HEREIN SHALL BE DEEMED IN
EVERY RESPECT EFFECTIVE SERVICE OF PROCESS UPON BORROWER IN ANY SUCH SUIT,
ACTION OR PROCEEDING IN THE STATE OF NEW YORK. EACH BORROWER (I) SHALL GIVE
PROMPT NOTICE TO LENDER OF ANY CHANGE IN ADDRESS OF ITS AUTHORIZED AGENT
HEREUNDER, (II) MAY AT ANY TIME AND FROM TIME TO TIME DESIGNATE A SUBSTITUTE
AUTHORIZED AGENT WITH AN OFFICE IN NEW YORK, NEW YORK (WHICH SUBSTITUTE AGENT
AND OFFICE SHALL BE DESIGNATED AS THE PERSON AND ADDRESS FOR SERVICE OF
PROCESS), AND (III) SHALL PROMPTLY DESIGNATE SUCH A SUBSTITUTE IF ITS AUTHORIZED
AGENT CEASES TO HAVE AN OFFICE IN NEW YORK, NEW YORK OR IS DISSOLVED WITHOUT
LEAVING A SUCCESSOR.

                              ARTICLE 10 - NOTICES

          All notices or other written communications hereunder shall be
delivered in accordance with Section 11.6 of the Loan Agreement.

                         [NO FURTHER TEXT ON THIS PAGE]

                                      -4-

<PAGE>

          IN WITNESS WHEREOF, each Borrower has duly executed this Note as of
the day and year first above written.

                                   BORROWER:

                                   THI OF OHIO REAL ESTATE HOLDING COMPANY, LLC,
                                   a Delaware limited liability company

                                   By:   /s/ JOHN E. BAUER
                                      ------------------------------------------
                                      Name:  John E. Bauer
                                      Title: Vice-President

                                   THI OF OHIO AT COLUMBUS, LLC,
                                   a Delaware limited liability company

                                   By:   /s/ JOHN E. BAUER
                                      ------------------------------------------
                                      Name:  John E. Bauer
                                      Title: Vice-President

                                   THI OF OHIO AT VALLEY VIEW, LLC,
                                   a Delaware limited liability company

                                   By:   /s/ JOHN E. BAUER
                                      ------------------------------------------
                                      Name:  John E. Bauer
                                      Title: Vice-President

                                   THI OF OHIO AT NORTHWESTERN, LLC,
                                   a Delaware limited liability company

                                   By:   /s/ JOHN E. BAUER
                                      ------------------------------------------
                                      Name:  John E. Bauer
                                      Title: Vice-President

                                   THI OF OHIO AT OAK GROVE, LLC,
                                   a Delaware limited liability company

                                   By:   /s/ JOHN E. BAUER
                                      ------------------------------------------
                                      Name:  John E. Bauer
                                      Title: Vice-President

<PAGE>

                                   THI OF OHIO AT PARADISE OAKS, LLC,
                                   a Delaware limited liability company

                                   By:   /s/ JOHN E. BAUER
                                      ------------------------------------------
                                      Name:  John E. Bauer
                                      Title: Vice-President

                                   THI OF OHIO AT SOMERSET, LLC,
                                   a Delaware limited liability company

                                   By:   /s/ JOHN E. BAUER
                                      ------------------------------------------
                                      Name:  John E. Bauer
                                      Title: Vice-President

                                   THI OF OHIO AT WILLARD, LLC,
                                   a Delaware limited liability company

                                   By:   /s/ JOHN E. BAUER
                                      ------------------------------------------
                                      Name:  John E. Bauer
                                      Title: Vice-President

                                   THI OF OHIO AT HILLCREST, LLC,
                                   a Delaware limited liability company

                                   By:   /s/ JOHN E. BAUER
                                      ------------------------------------------
                                      Name:  John E. Bauer
                                      Title: Vice-President

                                   THI OF OHIO AT MAPLE VIEW, LLC,
                                   a Delaware limited liability company

                                   By:   /s/ JOHN E. BAUER
                                      ------------------------------------------
                                      Name:  John E. Bauer
                                      Title: Vice-President

<PAGE>

                                   THI OF OHIO AT WINTERSONG VILLAGE, LLC,
                                   a Delaware limited liability company

                                   By:   /s/ JOHN E. BAUER
                                      ------------------------------------------
                                      Name:  John E. Bauer
                                      Title: Vice-President

                                   THI OF OHIO AT WOODLAND, LLC,
                                   a Delaware limited liability company

                                   By:   /s/ JOHN E. BAUER
                                      ------------------------------------------
                                      Name:  John E. Bauer
                                      Title: Vice-President

                                   THI OF OHIO AT GREENBRIAR SOUTH, LLC,
                                   a Delaware limited liability company

                                   By:   /s/ JOHN E. BAUER
                                      ------------------------------------------
                                      Name:  John E. Bauer
                                      Title: Vice-President

                                   THI OF OHIO AT GOLDEN YEARS, LLC,
                                   a Delaware limited liability company

                                   By:   /s/ JOHN E. BAUER
                                      ------------------------------------------
                                      Name:  John E. Bauer
                                      Title: Vice-President

                                   THI OF MARYLAND REAL ESTATE HOLDING CO., LLC,
                                   a Delaware limited liability company

                                   By:   /s/ JEFFREY A. BARNHILL
                                      ------------------------------------------
                                      Name:  Jeffrey A. Barnhill
                                      Title: Vice-President

<PAGE>

                                   THI OF MARYLAND AT BEL PRE, LLC,
                                   a Delaware limited liability company

                                   By:   /s/ JEFFREY A. BARNHILL
                                      ------------------------------------------
                                      Name:  Jeffrey A. Barnhill
                                      Title: Vice-President

                                   THI OF MARYLAND AT LIBERTY HEIGHTS, LLC,
                                   a Delaware limited liability company

                                   By:   /s/ JEFFREY A. BARNHILL
                                      ------------------------------------------
                                      Name:  Jeffrey A. Barnhill
                                      Title: Vice-President

                                   THI OF MARYLAND AT MARLEY NECK, LLC,
                                   a Delaware limited liability company

                                   By:   /s/ JEFFREY A. BARNHILL
                                      ------------------------------------------
                                      Name:  Jeffrey A. Barnhill
                                      Title: Vice-President

                                   THI OF MARYLAND AT NORTHWEST, LLC,
                                   a Delaware limited liability company

                                   By:   /s/ JEFFREY A. BARNHILL
                                      ------------------------------------------
                                      Name:  Jeffrey A. Barnhill
                                      Title: Vice-President

<PAGE>

                                   SCHEDULE I

                                   (BORROWERS)

1. THI of Ohio Real Estate Holding Company, LLC

2. THI of Ohio at Columbus, LLC

3. THI of Ohio at Valley View, LLC

4. THI of Ohio at Northwestern, LLC

5. THI of Ohio at Oak Grove, LLC

6. THI of Ohio at Paradise Oaks, LLC

7. THI of Ohio at Somerset, LLC

8. THI of Ohio at Willard, LLC

9. THI of Ohio at Hillcrest, LLC

10. THI of Ohio at Maple View, LLC

11. THI of Ohio at Wintersong Village, LLC

12. THI of Ohio at Woodland, LLC

13. THI of Ohio at Greenbriar South, LLC

14. THI of Ohio at Golden Years, LLC

15. THI of Maryland Real Estate Holding Co., LLC

16. THI of Maryland at Bel Pre, LLC

17. THI of Maryland at Liberty Heights, LLC

18. THI of Maryland at Marley Neck, LLC

19. THI of Maryland at Northwest, LLC<PAGE>

                                                                  EXHIBIT 10.2.3

                        GUARANTY OF RECOURSE OBLIGATIONS

          THIS GUARANTY (as amended, restated, replaced, supplemented or
otherwise modified from time to time, this "Guaranty") is executed as of
November 1, 2002 by THOSE ENTITIES LISTED ON SCHEDULE II attached hereto (each,
a "Guarantor" and collectively the, "Guarantors"), for the benefit of VENTAS
REALTY, LIMITED PARTNERSHIP, a Delaware limited partnership (together with its
successors and assigns, "Lender").

                               W I T N E S S E T H

          WHEREAS, pursuant to that certain Promissory Note, dated of even date
herewith, executed by the entities listed on Schedule I attached hereto, each a
Delaware limited liability company (each, a "Borrower" and collectively, the
"Borrowers") and payable to the order of Lender in the maximum principal amount
of Fifty Five Million and No/100 Dollars ($55,000,000) (together with all
renewals, modifications, increases and extensions thereof, the "Note"), the
Borrowers have become indebted, and may from time to time be further indebted,
to Lender with respect to a loan (the "Loan") which is made pursuant to that
certain Loan Agreement, dated of even date herewith, between the Borrowers and
Lender (as amended, restated, replaced, supplemented or otherwise modified from
time to time, the "Loan Agreement");

          WHEREAS, Lender is not willing to make the Loan, or otherwise extend
credit, to the Borrowers unless each Guarantor unconditionally guarantees
payment and performance to Lender of the Guaranteed Obligations (as herein
defined); and

          WHEREAS, the Guarantors are the owners of a direct or indirect
interest in the Borrowers, and will directly benefit from Lender's making the
Loan to the Borrowers.

          NOW, THEREFORE, as an inducement to Lender to make the Loan to the
Borrowers and to extend such additional credit as Lender may from time to time
agree to extend under the Loan Documents, and for other good and valuable
consideration, the receipt and legal sufficiency of which are hereby
acknowledged, the parties do hereby agree as follows:

                    ARTICLE I - NATURE AND SCOPE OF GUARANTY

          Section 1.1 Guaranty of Obligations. Each Guarantor hereby irrevocably
and unconditionally guarantees to Lender and its successors and assigns the
payment and performance of the Guaranteed Obligations as and when the same shall
be due and payable, whether by lapse of time, by acceleration of maturity or
otherwise. Each Guarantor hereby irrevocably and unconditionally covenants and
agrees that it is liable for the Guaranteed Obligations as a primary obligor.

          Section 1.2 Definition of Guaranteed Obligations. As used herein, the
term "Guaranteed Obligations" means the obligations or liabilities of any
Borrower to Lender for

<PAGE>

any loss, damage, cost, expense, liability, claim or other obligation incurred
by Lender (including attorneys' fees and costs reasonably incurred) arising out
of or in connection with the following:

               (a) fraud or intentional misrepresentation by any Borrower or any
     Guarantor in connection with the Loan;

               (b) the gross negligence or willful misconduct by any Borrower;

               (c) the breach of any representation, warranty, covenant or
     indemnification provision in the Environmental Indemnity concerning
     environmental laws, hazardous substances and asbestos and any
     indemnification of Lender with respect thereto contained in the
     Environmental Indemnity;

               (d) the removal or disposal of any portion of the Properties
     after an Event of Default;

               (e) the misapplication or conversion by any Borrower of (i) any
     insurance proceeds paid by reason of any loss, damage or destruction to the
     Properties, (ii) any Awards or other amounts received in connection with
     the Condemnation of all or a portion of the Properties or (iii) any Rents;

               (f) failure to pay charges for labor or materials or other
     charges that can create Liens on any portion of the Properties;

               (g) any security deposits, advance deposits or other deposits
     collected with respect to the Properties which are not delivered to Lender
     upon a foreclosure of the Properties or action in lieu thereof, except to
     the extent any such security deposits were applied in accordance with the
     terms and conditions of any of the Leases prior to the occurrence of the
     Event of Default that gave rise to such foreclosure or action in lieu
     thereof;

               (h) the breach by any Borrower of its indemnification obligations
     set forth in Section 9.2 of the Loan Agreement; and

               (i) the failure to deposit all Rents into the Cash Management
     Account as required by the Loan Agreement.

          Notwithstanding anything to the contrary in any of the Loan Documents,
(i) Lender shall not be deemed to have waived any right which Lender may have
under Section 506(a), 506(b), 1111(b) or any other provisions of the Bankruptcy
Code to file a claim for the full amount of the Debt or to require that all
collateral shall continue to secure all of the Debt owing to Lender in
accordance with the Loan Documents and (ii) each Guarantor shall be liable for
the full amount of the Debt (1) prior to a Securitization and (2) in the event
that: (A) any Borrower fails to permit on-site inspections of any Property,
fails to provide financial information, fails to maintain its status as a
Single-Purpose Entity or fails to appoint a new property manager or new Operator
upon the request of Lender after an Event of Default or other event that would
give rise to the right of Lender to request such Borrower to appoint a new
property manager or new Operator, each as required by, and in accordance with
the terms and

                                      -2-

<PAGE>

provisions of, the Loan Documents; (B) any Borrower fails to obtain Lender's
prior written consent to any subordinate financing, mezzanine financing or other
voluntary lien encumbering any Property; (C) any Borrower fails to obtain
Lender's prior written consent to any Transfer to the extent such consent is
required in the Loan Agreement or any Mortgage; (D) any Borrower files a
voluntary petition under the Bankruptcy Code or any other Federal or state
bankruptcy or insolvency law; (E) any Affiliate, officer, director, or
representative which controls, directly or indirectly, any Borrower files, or
joins in the filing of, an involuntary petition against such Borrower under the
Bankruptcy Code or any other Federal or state bankruptcy or insolvency law, or
solicits or causes to be solicited petitioning creditors for any involuntary
petition against such Borrower from any Person; (F) any Borrower files an answer
consenting to or otherwise acquiescing in or joining in any involuntary petition
filed against it, by any other Person under the Bankruptcy Code or any other
Federal or state bankruptcy or insolvency law, or solicits or causes to be
solicited petitioning creditors for any involuntary petition from any Person;
(G) any Affiliate, officer, director, or representative which controls any
Borrower consents to or acquiesces in or joins in an application for the
appointment of a custodian, receiver, trustee, or examiner for such Borrower or
any portion of the Properties; or (H) any Borrower makes an assignment for the
benefit of creditors, or admits, in writing or in any legal proceeding, its
insolvency or inability to pay its debts as they become due.

          Section 1.3 Nature of Guaranty. This Guaranty is an irrevocable,
absolute, continuing guaranty of payment and performance and not a guaranty of
collection. This Guaranty may not be revoked by any Guarantor and shall continue
to be effective with respect to any Guaranteed Obligations arising or created
after any attempted revocation by any Guarantor and after (if a Guarantor is a
natural person) such Guarantor's death (in which event this Guaranty shall be
binding upon such Guarantor's estate and such Guarantor's legal representatives
and heirs). The fact that at any time or from time to time the Guaranteed
Obligations may be increased or reduced shall not release or discharge the
obligation of any Guarantor to Lender with respect to the Guaranteed
Obligations. This Guaranty may be enforced by Lender and any subsequent holder
of the Note and shall not be discharged by the assignment or negotiation of all
or part of the Note.

          Section 1.4 Guaranteed Obligations Not Reduced by Offset. The
Guaranteed Obligations and the liabilities and obligations of each Guarantor to
Lender hereunder shall not be reduced, discharged or released because or by
reason of any existing or future offset, claim or defense of any Borrower or any
other party against Lender or against payment of the Guaranteed Obligations,
whether such offset, claim or defense arises in connection with the Guaranteed
Obligations (or the transactions creating the Guaranteed Obligations) or
otherwise.

          Section 1.5 Payment by Guarantor. If all or any part of the Guaranteed
Obligations shall not be punctually paid when due, whether at demand, maturity,
acceleration or otherwise, each Guarantor shall, immediately upon demand by
Lender and without presentment, protest, notice of protest, notice of
non-payment, notice of intention to accelerate the maturity, notice of
acceleration of the maturity or any other notice whatsoever, pay in lawful money
of the United States of America, the amount due on the Guaranteed Obligations to
Lender at Lender's address as set forth herein. Such demand(s) may be made at
any time coincident with or after the time for payment of all or part of the
Guaranteed Obligations and may be made from time to time

                                      -3-

<PAGE>

with respect to the same or different items of Guaranteed Obligations. Such
demand shall be deemed made, given and received in accordance with the notice
provisions hereof.

          Section 1.6 No Duty to Pursue Others. It shall not be necessary for
Lender (and each Guarantor hereby waives any rights which it may have to require
Lender), in order to enforce the obligations of each Guarantor hereunder, first
to (i) institute suit or exhaust its remedies against any Borrower or others
liable on the Loan or the Guaranteed Obligations or any other person, (ii)
enforce Lender's rights against any collateral which shall ever have been given
to secure the Loan, (iii) enforce Lender's rights against any other guarantors
of the Guaranteed Obligations, (iv) join any Borrower or any others liable on
the Guaranteed Obligations in any action seeking to enforce this Guaranty, (v)
exhaust any remedies available to Lender against any collateral which shall ever
have been given to secure the Loan, or (vi) resort to any other means of
obtaining payment of the Guaranteed Obligations. Lender shall not be required to
mitigate damages or take any other action to reduce, collect or enforce the
Guaranteed Obligations.

          Section 1.7 Waivers. Each Guarantor agrees to the provisions of the
Loan Documents and hereby waives notice of (i) any loans or advances made by
Lender to any Borrower, (ii) acceptance of this Guaranty, (iii) any amendment,
modification, replacement or extension of the Note, the Mortgages, the Loan
Agreement or of any other Loan Documents, (iv) the execution and delivery by any
Borrower and Lender of any other loan or credit agreement or of any Borrower's
execution and delivery of any promissory notes or other documents arising under
the Loan Documents or in connection with any of the Properties, (v) the
occurrence of any breach by any Borrower or an Event of Default, (vi) Lender's
transfer or disposition of the Guaranteed Obligations, or any part thereof,
(vii) sale or foreclosure (or posting or advertising for sale or foreclosure) of
any collateral for the Guaranteed Obligations, (viii) protest, proof of
non-payment or default by any Borrower, or (ix) any other action at any time
taken or omitted by Lender and, generally, all demands and notices of every kind
in connection with this Guaranty, the Loan Documents, any documents or
agreements evidencing, securing or relating to any of the Guaranteed Obligations
and the obligations hereby guaranteed.

          Section 1.8 Payment of Expenses. In the event that any Guarantor
should breach or fail to timely perform any provisions of this Guaranty, each
Guarantor shall, immediately upon demand by Lender, pay Lender all costs and
expenses (including court costs and attorneys' fees) incurred by Lender in the
enforcement hereof or the preservation of Lender's rights hereunder. The
covenant contained in this Section shall survive the payment and performance of
the Guaranteed Obligations.

          Section 1.9 Effect of Bankruptcy. In the event that pursuant to any
insolvency, bankruptcy, reorganization, receivership or other debtor relief law
or any judgment, order or decision thereunder, Lender must rescind or restore
any payment or any part thereof received by Lender in satisfaction of the
Guaranteed Obligations, as set forth herein, any prior release or discharge from
the terms of this Guaranty given to any Guarantor by Lender shall be without
effect and this Guaranty shall remain in full force and effect. It is the
intention of each Borrower and each Guarantor that each Guarantor's obligations
hereunder shall not be discharged except by performance of such obligations and
then only to the extent of such performance.

                                      -4-

<PAGE>

          Section 1.10 Waiver of Subrogation, Reimbursement and Contribution.
Notwithstanding anything to the contrary contained in this Guaranty, unless and
until the indefeasible payment and satisfaction in full of all of the Guaranteed
Obligations, each Guarantor hereby unconditionally and irrevocably waives,
releases and abrogates any and all rights it may now or hereafter have under any
agreement, at law or in equity (including, without limitation, any law
subrogating such Guarantor to the rights of Lender), to assert any claim against
or seek contribution, indemnification or any other form of reimbursement from
any Borrower or any other party liable for payment of any or all of the
Guaranteed Obligations for any payment made by such Guarantor under or in
connection with this Guaranty or otherwise.

          Section 1.11 Borrower. The term "Borrower" as used herein shall
include any new or successor corporation, association, partnership (general or
limited), limited liability company joint venture, trust or other individual or
organization formed as a result of any merger, reorganization, sale, transfer,
devise, gift or bequest of any Borrower or any interest in any Borrower.

                    ARTICLE II - EVENTS AND CIRCUMSTANCES NOT
                 REDUCING OR DISCHARGING GUARANTOR'S OBLIGATIONS

          Section 2.1 Events and Circumstances Not Reducing or Discharging
Guarantor's Obligations. Each Guarantor hereby consents and agrees to each of
the following and agrees that its obligations under this Guaranty shall not be
released, diminished, impaired, reduced or adversely affected by any of the
following and waives any common law, equitable, statutory or other rights
(including without limitation rights to notice) which it might otherwise have as
a result of or in connection with any of the following:

               (a) Modifications. Any renewal, extension, increase,
     modification, alteration or rearrangement of all or any part of the
     Guaranteed Obligations, the Note, the Mortgages, the Loan Agreement, the
     other Loan Documents or any other document, instrument, contract or
     understanding between any Borrower and Lender or any other parties
     pertaining to the Guaranteed Obligations or any failure of Lender to notify
     any Guarantor of any such action.

               (b) Adjustment. Any adjustment, indulgence, forbearance or
     compromise that might be granted or given by Lender to any Borrower or any
     Guarantor.

               (c) Condition of Borrower or Guarantor. The insolvency,
     bankruptcy, arrangement, adjustment, composition, liquidation, disability,
     dissolution or lack of power of any Borrower, any Guarantor or any other
     party at any time liable for the payment of all or part of the Guaranteed
     Obligations; or any dissolution of any Borrower or any Guarantor or any
     sale, lease or transfer of any or all of the assets of any Borrower or any
     Guarantor or any changes in the shareholders, partners or members of any
     Borrower or any Guarantor; or any reorganization of any Borrower or any
     Guarantor.

               (d) Invalidity of Guaranteed Obligations. The invalidity,
     illegality or unenforceability of all or any part of the Guaranteed
     Obligations or any document or agreement executed in connection with the
     Guaranteed Obligations for any reason

                                      -5-

<PAGE>

     whatsoever, including without limitation the fact that (i) the Guaranteed
     Obligations or any part thereof exceeds the amount permitted by law, (ii)
     the act of creating the Guaranteed Obligations or any part thereof is ultra
     vires, (iii) the officers or representatives executing the Note, the
     Mortgages, the Loan Agreement or the other Loan Documents or otherwise
     creating the Guaranteed Obligations acted in excess of their authority,
     (iv) the Guaranteed Obligations violate applicable usury laws, (v) any
     Borrower has valid defenses, claims or offsets (whether at law, in equity
     or by agreement) which render the Guaranteed Obligations wholly or
     partially uncollectible from such Borrower, (vi) the creation, performance
     or repayment of the Guaranteed Obligations (or the execution, delivery and
     performance of any document or instrument representing part of the
     Guaranteed Obligations or executed in connection with the Guaranteed
     Obligations or given to secure the repayment of the Guaranteed Obligations)
     is illegal, uncollectible or unenforceable, or (vii) the Note, the
     Mortgages, the Loan Agreement or any of the other Loan Documents have been
     forged or otherwise are irregular or not genuine or authentic, it being
     agreed that each Guarantor shall remain liable hereon regardless of whether
     any Borrower or any other person be found not liable on the Guaranteed
     Obligations or any part thereof for any reason.

               (e) Release of Obligors. Any full or partial release of the
     liability of any Borrower on the Guaranteed Obligations or any part
     thereof, or of any co-guarantors, or any other Person now or hereafter
     liable, whether directly or indirectly, jointly, severally, or jointly and
     severally, to pay, perform, guarantee or assure the payment of the
     Guaranteed Obligations, or any part thereof, it being recognized,
     acknowledged and agreed by each Guarantor that it may be required to pay
     the Guaranteed Obligations in full without assistance or support of any
     other party, and each Guarantor has not been induced to enter into this
     Guaranty on the basis of a contemplation, belief, understanding or
     agreement that other parties will be liable to pay or perform the
     Guaranteed Obligations, or that Lender will look to other parties to pay or
     perform the Guaranteed Obligations.

               (f) Other Collateral. The taking or accepting of any other
     security, collateral or guaranty, or other assurance of payment, for all or
     any part of the Guaranteed Obligations.

               (g) Release of Collateral. Any release, surrender, exchange,
     subordination, deterioration, waste, loss or impairment (including without
     limitation negligent, willful, unreasonable or unjustifiable impairment) of
     any collateral, property or security at any time existing in connection
     with, or assuring or securing payment of, all or any part of the Guaranteed
     Obligations.

               (h) Care and Diligence. The failure of Lender or any other party
     to exercise diligence or reasonable care in the preservation, protection,
     enforcement, sale or other handling or treatment of all or any part of any
     collateral, property or security, including but not limited to any neglect,
     delay, omission, failure or refusal of Lender (i) to take or prosecute any
     action for the collection of any of the Guaranteed Obligations or (ii) to
     foreclose, or initiate any action to foreclose, or, once commenced,
     prosecute to completion any action to foreclose upon any security therefor,
     or (iii) to take or prosecute

                                      -6-

<PAGE>

     any action in connection with any instrument or agreement evidencing or
     securing all or any part of the Guaranteed Obligations.

               (i) Unenforceability. The fact that any collateral, security,
     security interest or lien contemplated or intended to be given, created or
     granted as security for the repayment of the Guaranteed Obligations, or any
     part thereof, shall not be properly perfected or created, or shall prove to
     be unenforceable or subordinate to any other security interest or lien, it
     being recognized and agreed by each Guarantor that it is not entering into
     this Guaranty in reliance on, or in contemplation of the benefits of, the
     validity, enforceability, collectibility or value of any of the collateral
     for the Guaranteed Obligations.

               (j) Offset. The Note, the Guaranteed Obligations and the
     liabilities and obligations of each Guarantor to Lender hereunder shall not
     be reduced, discharged or released because of or by reason of any existing
     or future right of offset, claim or defense of any Borrower against Lender,
     or any other party, or against payment of the Guaranteed Obligations,
     whether such right of offset, claim or defense arises in connection with
     the Guaranteed Obligations (or the transactions creating the Guaranteed
     Obligations) or otherwise.

               (k) Merger. The reorganization, merger or consolidation of any
     Borrower into or with any other Person.

               (l) Preference. Any payment by any Borrower to Lender is held to
     constitute a preference under bankruptcy laws or for any reason Lender is
     required to refund such payment or pay such amount to any Borrower or
     someone else.

               (m) Other Actions Taken or Omitted. Any other action taken or
     omitted to be taken with respect to the Loan Documents, the Guaranteed
     Obligations, or the security and collateral therefor, whether or not such
     action or omission prejudices any Guarantor or increases the likelihood
     that any Guarantor will be required to pay the Guaranteed Obligations
     pursuant to the terms hereof, it is the unambiguous and unequivocal
     intention of each Guarantor that it shall be obligated to pay the
     Guaranteed Obligations when due, notwithstanding any occurrence,
     circumstance, event, action, or omission whatsoever, whether contemplated
     or uncontemplated, and whether or not otherwise or particularly described
     herein, which obligation shall be deemed satisfied only upon the full and
     final payment and satisfaction of the Guaranteed Obligations.

                  ARTICLE III - REPRESENTATIONS AND WARRANTIES

          Section 3.1 Representations and Warranties. To induce Lender to enter
into the Loan Documents and extend credit to the Borrowers, each Guarantor
represents and warrants to Lender as follows:

               (a) Benefit. Guarantor is an Affiliate of the Borrowers, is the
     owner of a direct or indirect interest in the Borrowers, and has received,
     or will receive, direct or

                                      -7-

<PAGE>

     indirect benefit from the making of this Guaranty with respect to the
     Guaranteed Obligations.

               (b) Familiarity and Reliance. Guarantor is familiar with, and has
     independently reviewed books and records regarding, the financial condition
     of each Borrower and is familiar with the value of any and all collateral
     intended to be created as security for the payment of the Note or
     Guaranteed Obligations; however, Guarantor is not relying on such financial
     condition or the collateral as an inducement to enter into this Guaranty.

               (c) No Representation by Lender. Neither Lender nor any other
     party has made any representation, warranty or statement to Guarantor in
     order to induce Guarantor to execute this Guaranty.

               (d) Guarantor's Financial Condition. As of the date hereof, and
     after giving effect to this Guaranty and the contingent obligation
     evidenced hereby, Guarantor is and will be solvent and has and will have
     assets which, fairly valued, exceed its obligations, liabilities (including
     contingent liabilities) and debts, and has and will have property and
     assets sufficient to satisfy and repay its obligations and liabilities.

               (e) Legality. The execution, delivery and performance by
     Guarantor of this Guaranty and the consummation of the transactions
     contemplated hereunder do not and will not contravene or conflict with any
     law, statute or regulation whatsoever to which Guarantor is subject or
     constitute a default (or an event which with notice or lapse of time or
     both would constitute a default) under, or result in the breach of, any
     indenture, mortgage, charge, lien, or any contract, agreement or other
     instrument to which Guarantor is a party or which may be applicable to
     Guarantor. This Guaranty is a legal and binding obligation of Guarantor and
     is enforceable in accordance with its terms, except as limited by
     bankruptcy, insolvency or other laws of general application relating to the
     enforcement of creditors' rights.

               (f) Survival. All representations and warranties made by
     Guarantor herein shall survive the execution hereof.

               ARTICLE IV - SUBORDINATION OF CERTAIN INDEBTEDNESS

          Section 4.1 Subordination of All Guarantor Claims. As used herein, the
term "Guarantor Claims" shall mean all debts and liabilities of any Borrower to
any Guarantor, whether such debts and liabilities now exist or are hereafter
incurred or arise, or whether the obligations of any Borrower thereon be direct,
contingent, primary, secondary, several, joint and several, or otherwise, and
irrespective of whether such debts or liabilities be evidenced by note,
contract, open account, or otherwise, and irrespective of the person or persons
in whose favor such debts or liabilities may, at their inception, have been, or
may hereafter be created, or the manner in which they have been or may hereafter
be acquired by any Guarantor. The Guarantor Claims shall include without
limitation all rights and claims of any Guarantor against any Borrower (arising
as a result of subrogation or otherwise) as a result of such Guarantor's payment
of all or a portion of the Guaranteed Obligations. After the occurrence of an
Event of

                                      -8-

<PAGE>

Default or the occurrence of an event which would, with the giving of notice or
the passage of time, or both, constitute an Event of Default, no Guarantor shall
receive or collect, directly nor indirectly, from any Borrower or any other
party any amount upon the Guarantor Claims.

          Section 4.2 Claims in Bankruptcy. In the event of receivership,
bankruptcy, reorganization, arrangement, debtor's relief, or other insolvency
proceedings involving any Guarantor as debtor, Lender shall have the right to
prove its claim in any such proceeding so as to establish its rights hereunder
and receive directly from the receiver, trustee or other court custodian
dividends and payments which would otherwise be payable upon Guarantor Claims.
Each Guarantor hereby assigns such dividends and payments to Lender. Should
Lender receive, for application against the Guaranteed Obligations, any dividend
or payment which is otherwise payable to any Guarantor and which, as between any
Borrower and such Guarantor, shall constitute a credit against the Guarantor
Claims, then, upon payment to Lender in full of the Guaranteed Obligations, such
Guarantor shall become subrogated to the rights of Lender to the extent that
such payments to Lender on the Guarantor Claims have contributed toward the
liquidation of the Guaranteed Obligations, and such subrogation shall be with
respect to that proportion of the Guaranteed Obligations which would have been
unpaid if Lender had not received dividends or payments upon the Guarantor
Claims.

          Section 4.3 Payments Held in Trust. In the event that, notwithstanding
anything to the contrary in this Guaranty, any Guarantor should receive any
funds, payment, claim or distribution which is prohibited by this Guaranty, it
agrees to hold in trust for Lender an amount equal to the amount of all funds,
payments, claims or distributions so received, and agrees that it shall have
absolutely no dominion over the amount of such funds, payments, claims or
distributions so received except to pay them promptly to Lender, and it
covenants promptly to pay the same to Lender.

          Section 4.4 Liens Subordinate. Each Guarantor agrees that any liens,
security interests, judgment liens, charges or other encumbrances upon any
Borrower's assets securing payment of the Guarantor Claims shall be and remain
inferior and subordinate to any liens, security interests, judgment liens,
charges or other encumbrances upon any Borrower's assets securing payment of the
Guaranteed Obligations, regardless of whether such encumbrances in favor of any
Guarantor or Lender presently exist or are hereafter created or attach. Without
the prior written consent of Lender, no Guarantor shall (i) exercise or enforce
any creditor's right it may have against any Borrower, or (ii) foreclose,
repossess, sequester or otherwise take steps or institute any action or
proceedings (judicial or otherwise, including without limitation the
commencement of, or joinder in, any liquidation, bankruptcy, rearrangement,
debtor's relief or insolvency proceeding) to enforce any liens, mortgage, deeds
of trust, security interests, collateral rights, judgments or other encumbrances
on assets of any Borrower held by it.

                            ARTICLE V - MISCELLANEOUS

          Section 5.1 Waiver. No failure to exercise, and no delay in
exercising, on the part of Lender, any right hereunder shall operate as a waiver
thereof, nor shall any single or partial exercise thereof preclude any other or
further exercise thereof or the exercise of any other right. The rights of
Lender hereunder shall be in addition to all other rights provided by law. No

                                      -9-

<PAGE>

modification or waiver of any provision of this Guaranty, nor consent to
departure therefrom, shall be effective unless in writing and no such consent or
waiver shall extend beyond the particular case and purpose involved. No notice
or demand given in any case shall constitute a waiver of the right to take other
action in the same, similar or other instances without such notice or demand.

          Section 5.2 Notices. All notices, demands, requests, consents,
approvals or other communications (any of the foregoing, a "Notice") required,
permitted, or desired to be given hereunder shall be in writing sent by telefax
(with answer back acknowledged) or by registered or certified mail, postage
prepaid, return receipt requested, or delivered by hand or reputable overnight
courier addressed to the party to be so notified at its address hereinafter set
forth, or to such other address as such party may hereafter specify in
accordance with the provisions of this Section 5.2. Any Notice to any Guarantor
shall be deemed effective as to all Guarantors to the extent delivered to one
Guarantor; it being understood that Notice to all Guarantors shall not be
required if Notice is given to one Guarantor. Any Notice shall be deemed to have
been received: (a) three (3) days after the date such Notice is mailed, (b) on
the date of sending by telefax if sent during business hours on a Business Day
(otherwise on the next Business Day), (c) on the date of delivery by hand if
delivered during business hours on a Business Day (otherwise on the next
Business Day), and (d) on the next Business Day if sent by an overnight
commercial courier, in each case addressed to the parties as follows:

          If to Lender:      Ventas Realty, Limited Partnership
                             c/o Ventas, Inc.
                             4360 Brownsboro Road, Suite 115
                             Louisville, Kentucky 40207
                             Attention: Chief Financial Officer
                             Facsimile No. (502) 357-9001

          with a copy to:    Ventas Realty, Limited Partnership
                             c/o Ventas, Inc.
                             4360 Brownsboro Road, Suite 115
                             Louisville, Kentucky 40207
                             Attention: General Counsel
                             Facsimile No. (502) 357-9001

          with a copy to:    Dechert
                             4000 Bell Atlantic Tower
                             1717 Arch Street
                             Philadelphia, Pennsylvania 19103
                             Attention:  David W. Forti, Esquire
                             Facsimile No: (215) 994-2222

          If to Guarantor:   c/o Trans Healthcare, Inc.
                             4660 Trindle Road, Suite 103
                             Camp Hill, Pennsylvania 17011
                             Attention: Anthony Misitano
                             Facsimile No. (717) 730-8722

                                      -10-

<PAGE>

          with a copy to:    Latsha Davis & Yohe, P.C.
                             4720 Old Gettysburg Road, Suite 101
                             Harrisburg, Pennsylvania 17108
                             Attention:  Douglas C. Yohe, Esquire
                             Facsimile No. (717)761-2286

          Section 5.3 Governing Law; Submission to Jurisdiction.

               (a) THIS AGREEMENT WAS NEGOTIATED IN THE STATE OF NEW YORK AND
     MADE BY EACH GUARANTOR AND ACCEPTED BY LENDER IN THE STATE OF NEW YORK, AND
     THE PROCEEDS OF THE LOAN WERE DISBURSED FROM THE STATE OF NEW YORK, WHICH
     STATE THE PARTIES AGREE HAS A SUBSTANTIAL RELATIONSHIP TO THE PARTIES AND
     TO THE UNDERLYING TRANSACTION EMBODIED HEREBY, AND IN ALL RESPECTS,
     INCLUDING, WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, MATTERS OF
     CONSTRUCTION, VALIDITY AND PERFORMANCE, THIS GUARANTY AND THE OBLIGATIONS
     ARISING HEREUNDER SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH,
     THE LAWS OF THE STATE OF NEW YORK APPLICABLE TO CONTRACTS MADE AND
     PERFORMED IN SUCH STATE (WITHOUT REGARD TO PRINCIPLES OF CONFLICT LAWS) AND
     ANY APPLICABLE LAW OF THE UNITED STATES OF AMERICA. TO THE FULLEST EXTENT
     PERMITTED BY LAW, EACH GUARANTOR HEREBY UNCONDITIONALLY AND IRREVOCABLY
     WAIVES ANY CLAIM TO ASSERT THAT THE LAW OF ANY OTHER JURISDICTION GOVERNS
     THIS GUARANTY AND THE NOTE, AND THIS GUARANTY AND THE NOTE SHALL BE
     GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF NEW
     YORK PURSUANT TO SECTION 5-1401 OF THE NEW YORK GENERAL OBLIGATIONS LAW.

               (b) ANY LEGAL SUIT, ACTION OR PROCEEDING AGAINST LENDER OR ANY
     GUARANTOR ARISING OUT OF OR RELATING TO THIS GUARANTY MAY AT LENDER'S
     OPTION BE INSTITUTED IN ANY FEDERAL OR STATE COURT IN THE CITY OF NEW YORK,
     COUNTY OF NEW YORK, PURSUANT TO SECTION 5-1402 OF THE NEW YORK GENERAL
     OBLIGATIONS LAW, AND EACH GUARANTOR WAIVES ANY OBJECTIONS WHICH IT MAY NOW
     OR HEREAFTER HAVE BASED ON VENUE AND/OR FORUM NON CONVENIENS OF ANY SUCH
     SUIT, ACTION OR PROCEEDING, AND EACH GUARANTOR HEREBY IRREVOCABLY SUBMITS
     TO THE JURISDICTION OF ANY SUCH COURT IN ANY SUIT, ACTION OR PROCEEDING.
     EACH GUARANTOR DOES HEREBY DESIGNATE AND APPOINT:

               CT CORPORATION SYSTEM
               111 EIGHTH AVENUE
               NEW YORK, NEW YORK  10011

                                      -11-

<PAGE>

     AS ITS AUTHORIZED AGENT TO ACCEPT AND ACKNOWLEDGE ON ITS BEHALF SERVICE OF
ANY AND ALL PROCESS WHICH MAY BE SERVED IN ANY SUCH SUIT, ACTION OR PROCEEDING
IN ANY FEDERAL OR STATE COURT IN NEW YORK, NEW YORK, AND AGREES THAT SERVICE OF
PROCESS UPON SAID AGENT AT SAID ADDRESS AND WRITTEN NOTICE OF SAID SERVICE
MAILED OR DELIVERED TO GUARANTOR IN THE MANNER PROVIDED HEREIN SHALL BE DEEMED
IN EVERY RESPECT EFFECTIVE SERVICE OF PROCESS UPON GUARANTOR IN ANY SUCH SUIT,
ACTION OR PROCEEDING IN THE STATE OF NEW YORK. EACH GUARANTOR (I) SHALL GIVE
PROMPT NOTICE TO LENDER OF ANY CHANGED ADDRESS OF ITS AUTHORIZED AGENT
HEREUNDER, (II) MAY AT ANY TIME AND FROM TIME TO TIME DESIGNATE A SUBSTITUTE
AUTHORIZED AGENT WITH AN OFFICE IN NEW YORK, NEW YORK (WHICH SUBSTITUTE AGENT
AND OFFICE SHALL BE DESIGNATED AS THE PERSON AND ADDRESS FOR SERVICE OF PROCESS)
AND (III) SHALL PROMPTLY DESIGNATE SUCH A SUBSTITUTE IF ITS AUTHORIZED AGENT
CEASES TO HAVE AN OFFICE IN NEW YORK, NEW YORK OR IS DISSOLVED WITHOUT LEAVING A
SUCCESSOR.

          Section 5.4 Invalid Provisions. If any provision of this Guaranty is
held to be illegal, invalid, or unenforceable under present or future laws
effective during the term of this Guaranty, such provision shall be fully
severable and this Guaranty shall be construed and enforced as if such illegal,
invalid or unenforceable provision had never comprised a part of this Guaranty,
and the remaining provisions of this Guaranty shall remain in full force and
effect and shall not be affected by the illegal, invalid or unenforceable
provision or by its severance from this Guaranty, unless such continued
effectiveness of this Guaranty, as modified, would be contrary to the basic
understandings and intentions of the parties as expressed herein.

          Section 5.5 Amendments. This Guaranty may be amended only by an
instrument in writing executed by the party or an authorized representative of
the party against whom such amendment is sought to be enforced.

          Section 5.6 Number and Gender/Successors and Assigns. All pronouns and
any variations thereof shall be deemed to refer to the masculine, feminine,
neuter, singular or plural as the identity of the person or persons referred to
may require. Without limiting the effect of specific references in any provision
of this Guaranty, the term "Guarantor" shall be deemed to refer to each and
every person comprising a Guarantor from time to time, as the sense of a
particular provision may require, and to include the heirs, executors,
administrators, legal representatives, successors and assigns of such Guarantor,
all of whom shall be bound by the provisions of this Guaranty, provided that no
obligation of any Guarantor may be assigned except with the written consent of
Lender. Without limiting the effect of specific references in any provision of
this Guaranty, the term "Borrower" shall be deemed to refer to each and every
person comprising a Borrower from time to time, as the sense of a particular
provision may require, and to include the heirs, executors, administrators,
legal representatives, successors and assigns of such Borrower. Each reference
herein to Lender shall be deemed to include its successors and assigns. This
Guaranty shall inure to the benefit of Lender and its respective successors and
assigns forever.

                                      -12-

<PAGE>

          Section 5.7 Headings, Etc. The headings and captions of various
paragraphs of this Guaranty are for the convenience of reference only and are
not to be construed as defining or limiting, in any way, the scope or intent of
the provisions hereof.

          Section 5.8 Recitals. The recital and introductory paragraphs hereof
are a part hereof, form a basis for this Guaranty and shall be considered prima
facie evidence of the facts and documents referred to therein.

          Section 5.9 Counterparts. To facilitate execution, this Guaranty may
be executed in as many counterparts as may be convenient or required. It shall
not be necessary that the signature of, or on behalf of, each party, or that the
signature of all persons required to bind any party, appear on each counterpart.
All counterparts shall collectively constitute a single instrument. It shall not
be necessary in making proof of this Guaranty to produce or account for more
than a single counterpart containing the respective signatures of, or on behalf
of, each of the parties hereto. Any signature page to any counterpart may be
detached from such counterpart without impairing the legal effect of the
signatures thereon and thereafter attached to another counterpart identical
thereto except having attached to it additional signature pages.

          Section 5.10 Rights and Remedies. If any Guarantor becomes liable for
any indebtedness owing by any Borrower to Lender, by endorsement or otherwise,
other than under this Guaranty, such liability shall not be in any manner
impaired or affected hereby and the rights of Lender hereunder shall be
cumulative of any and all other rights that Lender may ever have against such
Guarantor. The exercise by Lender of any right or remedy hereunder or under any
other instrument, or at law or in equity, shall not preclude the concurrent or
subsequent exercise of any other right or remedy.

          Section 5.11 Other Defined Terms. Any capitalized term utilized herein
shall have the meaning as specified in the Loan Agreement, unless such term is
otherwise specifically defined herein.

          Section 5.12 Entirety. THIS GUARANTY EMBODIES THE FINAL, ENTIRE
AGREEMENT OF EACH GUARANTOR AND LENDER WITH RESPECT TO EACH GUARANTOR'S GUARANTY
OF THE GUARANTEED OBLIGATIONS AND SUPERSEDES ANY AND ALL PRIOR COMMITMENTS,
AGREEMENTS, REPRESENTATIONS, AND UNDERSTANDINGS, WHETHER WRITTEN OR ORAL,
RELATING TO THE SUBJECT MATTER HEREOF. THIS GUARANTY IS INTENDED BY EACH
GUARANTOR AND LENDER AS A FINAL AND COMPLETE EXPRESSION OF THE TERMS OF THE
GUARANTY, AND NO COURSE OF DEALING BETWEEN ANY GUARANTOR AND LENDER, NO COURSE
OF PERFORMANCE, NO TRADE PRACTICES, AND NO EVIDENCE OF PRIOR, CONTEMPORANEOUS OR
SUBSEQUENT ORAL AGREEMENTS OR DISCUSSIONS OR OTHER EXTRINSIC EVIDENCE OF ANY
NATURE SHALL BE USED TO CONTRADICT, VARY, SUPPLEMENT OR MODIFY ANY TERM OF THIS
GUARANTY AGREEMENT. THERE ARE NO ORAL AGREEMENTS BETWEEN ANY GUARANTOR AND
LENDER.

          Section 5.13 Waiver of Right to Trial by Jury. EACH GUARANTOR HEREBY
AGREES NOT TO ELECT A TRIAL BY JURY OF ANY ISSUE TRIABLE OF

                                      -13-

<PAGE>

RIGHT BY JURY, AND WAIVES ANY RIGHT TO TRIAL BY JURY FULLY TO THE EXTENT THAT
ANY SUCH RIGHT SHALL NOW OR HEREAFTER EXIST WITH REGARD TO THIS GUARANTY, THE
NOTE, THE MORTGAGES, THE LOAN AGREEMENT, OR THE OTHER LOAN DOCUMENTS, OR ANY
CLAIM, COUNTERCLAIM OR OTHER ACTION ARISING IN CONNECTION THEREWITH. THIS WAIVER
OF RIGHT TO TRIAL BY JURY IS GIVEN KNOWINGLY AND VOLUNTARILY BY EACH GUARANTOR,
AND IS INTENDED TO ENCOMPASS INDIVIDUALLY EACH INSTANCE AND EACH ISSUE AS TO
WHICH THE RIGHT TO A TRIAL BY JURY WOULD OTHERWISE ACCRUE. LENDER IS HEREBY
AUTHORIZED TO FILE A COPY OF THIS PARAGRAPH IN ANY PROCEEDING AS CONCLUSIVE
EVIDENCE OF THIS WAIVER BY EACH GUARANTOR.

          Section 5.14 Cooperation. Each Guarantor acknowledges that Lender and
its successors and assigns may (i) sell this Guaranty, the Note and other Loan
Documents to one or more investors as a whole loan, (ii) participate the Loan
secured by this Guaranty to one or more investors, (iii) deposit this Guaranty,
the Note and other Loan Documents with a trust, which trust may sell
certificates to investors evidencing an ownership interest in the trust assets,
or (iv) otherwise sell the Loan or interest therein to investors (the
transactions referred to in clauses (i) through (iv) are hereinafter each
referred to as "Secondary Market Transaction"). Each Guarantor shall cooperate
with Lender in effecting any such Secondary Market Transaction and shall
cooperate to implement all requirements imposed by any Rating involved in any
Secondary Market Transaction. Each Guarantor shall provide such information and
documents relating to any Guarantor, any Borrower, the Properties and any
tenants of the Improvements as Lender may reasonably request in connection with
such Secondary Market Transaction. In addition, each Guarantor shall make
available to Lender all information concerning its business and operations that
Lender may reasonably request. Lender shall be permitted to share all such
information with the investment banking firms, Rating Agencies, accounting
firms, law firms and other third-party advisory firms involved with the Loan and
the Loan Documents or the applicable Secondary Market Transaction. It is
understood that the information provided by any Guarantor to Lender may
ultimately be incorporated into the offering documents for the Secondary Market
Transaction and thus various investors may also see some or all of the
information. Lender and all of the aforesaid third-party advisors and
professional firms shall be entitled to rely on the information supplied by, or
on behalf of, any Guarantor in the form as provided by such Guarantor. Lender
may publicize the existence of the Loan in connection with its marketing for a
Secondary Market Transaction or otherwise as part of its business development.

          Section 5.15 Reinstatement in Certain Circumstances. If at any time
any payment of the principal of or interest under the Note or any other amount
payable by any Borrower under the Loan Documents is rescinded or must be
otherwise restored or returned upon the insolvency, bankruptcy or reorganization
of any Borrower or otherwise, each Guarantor's obligations hereunder with
respect to such payment shall be reinstated as though such payment has been due
but not made at such time.

          Section 5.16 Joint and Several Liability. If more than one Person has
executed this Agreement as "Guarantor," the representations, covenants,
warranties and obligations of all such Persons hereunder shall be joint and
several.

                                      -14-

<PAGE>

          IN WITNESS WHEREOF, the undersigned has executed this Guaranty all as
of the day and year first above written.

                                        GUARANTOR:

                                        TRANS HEALTHCARE, INC.,
                                        a Delaware corporation

                                        By:   /s/ ANTHONY F. MISITANO
                                           -------------------------------------
                                           Name:  Anthony F. Misitano
                                           Title: President

                                        TRANS HEALTHCARE OF OHIO, INC.,
                                        a Delaware corporation

                                        By:   /s/ ANTHONY F. MISITANO
                                           -------------------------------------
                                           Name:  Anthony F. Misitano
                                           Title: President

                                        THI OF OHIO ALFS, INC.,
                                        a Delaware corporation

                                        By:   /s/ ANTHONY F. MISITANO
                                           -------------------------------------
                                           Name:  Anthony F. Misitano
                                           Title: President

                                        THI PROPERTIES, INC.,
                                        a Delaware corporation

                                        By:   /s/ ANTHONY F. MISITANO
                                           -------------------------------------
                                           Name:  Anthony F. Misitano
                                           Title: President

<PAGE>

                                        THI SERVICES CORP.,
                                        a Delaware corporation

                                        By:   /s/ ANTHONY F. MISITANO
                                           -------------------------------------
                                           Name:  Anthony F. Misitano
                                           Title: President

                                        THI SPECIALTY HOSPITALS OF OHIO, INC.,
                                        a Delaware corporation

                                        By:   /s/ ANTHONY F. MISITANO
                                           -------------------------------------
                                           Name:  Anthony F. Misitano
                                           Title: President

                                        TRANS HEALTH MANAGEMENT, INC.,
                                        a Delaware corporation

                                        By:   /s/ ANTHONY F. MISITANO
                                           -------------------------------------
                                           Name:  Anthony F. Misitano
                                           Title: President

                                        THI OF MARYLAND, INC.,
                                        a Delaware corporation

                                        By:   /s/ ANTHONY F. MISITANO
                                           -------------------------------------
                                           Name:  Anthony F. Misitano
                                           Title: President

                                        PHYSICAL THERAPY PLUS, INC.,
                                        a Pennsylvania corporation

                                        By:   /s/ ANTHONY F. MISITANO
                                           -------------------------------------
                                           Name:  Anthony F. Misitano
                                           Title: President

<PAGE>

                                        DALE J. CORDIAL, PT, INC.,
                                        a Pennsylvania corporation

                                        By:   /s/ ANTHONY F. MISITANO
                                           -------------------------------------
                                           Name:  Anthony F. Misitano
                                           Title: President

                                        DALE J. CORDIAL, PT, INC., NUMBER 4,
                                        a Pennsylvania corporation

                                        By:   /s/ ANTHONY F. MISITANO
                                           -------------------------------------
                                           Name:  Anthony F. Misitano
                                           Title: President

                                        THE PT GROUP OF PENN HILLS,
                                        a Pennsylvania general partnership

                                        By: Trans Healthcare, Inc.,
                                            a Delaware corporation,
                                            its Partner

                                            By:   /s/ ANTHONY F. MISITANO
                                               ---------------------------------
                                               Name:  Anthony F. Misitano
                                               Title: President

                                        THE PT GROUP PHYSICAL THERAPY FOR WOMEN,
                                        a Pennsylvania general partnership

                                        By: Dale J. Cordial, PT, Inc.,
                                            a Pennsylvania corporation,
                                            its Partner

                                            By:   /s/ ANTHONY F. MISITANO
                                               ---------------------------------
                                               Name:  Anthony F. Misitano
                                               Title: President

<PAGE>

                                        THE PT GROUP OF MOON TOWNSHIP,
                                        a Pennsylvania general partnership

                                        By: Dale J. Cordial, PT, Inc., Number 4,
                                            a Pennsylvania corporation,
                                            its Partner

                                            By:   /s/ ANTHONY F. MISITANO
                                               ---------------------------------
                                               Name:  Anthony F. Misitano
                                               Title: President

                                        THI Therapy Concepts, LLC,
                                        a Delaware limited liability company

                                        By:   /s/ JEFFREY A. BARNHILL
                                           -------------------------------------
                                           Name:  Jeffrey A. Barnhill
                                           Title: Vice-President

                                        THI SERVICES OF MARYLAND, LLC,
                                        a Delaware limited liability company

                                        By:   /s/ JEFFREY A. BARNHILL
                                           -------------------------------------
                                           Name:  Jeffrey A. Barnhill
                                           Title: Vice-President

<PAGE>

                                   SCHEDULE I

                                   (BORROWERS)

1.   THI of Ohio Real Estate Holding Company, LLC

2.   THI of Ohio at Columbus, LLC

3.   THI of Ohio at Valley View, LLC

4.   THI of Ohio at Northwestern, LLC

5.   THI of Ohio at Oak Grove, LLC

6.   THI of Ohio at Paradise Oaks, LLC

7.   THI of Ohio at Somerset, LLC

8.   THI of Ohio at Willard, LLC

9.   THI of Ohio at Hillcrest, LLC

10.  THI of Ohio at Maple View, LLC

11.  THI of Ohio at Wintersong Village, LLC

12.  THI of Ohio at Woodland, LLC

13.  THI of Ohio at Greenbriar South, LLC

14.  THI of Ohio at Golden Years, LLC

15.  THI of Maryland Real Estate Holding Co., LLC

16.  THI of Maryland at Bel Pre, LLC

17.  THI of Maryland at Liberty Heights, LLC

18.  THI of Maryland at Marley Neck, LLC

19.  THI of Maryland at Northwest, LLC

<PAGE>

                                   SCHEDULE II

                                  (GUARANTORS)

<TABLE>
<CAPTION>
----------------------------------------------------------------------------------
GUARANTOR                                     TYPE OF ENTITY

----------------------------------------------------------------------------------
<S>                                           <C>
1.  Trans Healthcare, Inc.                    a Delaware corporation

----------------------------------------------------------------------------------
2.  Trans Healthcare of Ohio, Inc.            a Delaware corporation

----------------------------------------------------------------------------------
3.  THI of Ohio ALFs, Inc.                    a Delaware corporation

----------------------------------------------------------------------------------
4.  THI Properties, Inc.                      a Delaware corporation

----------------------------------------------------------------------------------
5.  THI Services Corp.                        a Delaware corporation

----------------------------------------------------------------------------------
6.  THI Specialty Hospitals of Ohio, Inc.     a Delaware corporation

----------------------------------------------------------------------------------
7.  Trans Health Management, Inc.             a Delaware corporation

----------------------------------------------------------------------------------
8.  THI of Maryland, Inc.                     a Delaware corporation

----------------------------------------------------------------------------------
9.  THI Therapy Concepts, LLC                 a Maryland limited liability company

----------------------------------------------------------------------------------
10. THI Services of Maryland, LLC             a Maryland limited liability company

----------------------------------------------------------------------------------
11. Physical Therapy Plus, Inc.               a Pennsylvania corporation

----------------------------------------------------------------------------------
12. Dale J. Cordial, PT, Inc.                 a Pennsylvania corporation

----------------------------------------------------------------------------------
13. Dale J. Cordial, PT, Inc., Number Four    a Pennsylvania corporation

----------------------------------------------------------------------------------
14. The pt Group of Penn Hills                a Pennsylvania general partnership

----------------------------------------------------------------------------------
15. The pt Group Physical Therapy for Women   a Pennsylvania general partnership

----------------------------------------------------------------------------------
16. The pt Group of Moon Township             a Pennsylvania general partnership

----------------------------------------------------------------------------------
</TABLE>

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