Document:

<PAGE>
                                                                EXHIBIT 10.5.3.2

                 RE-SIZING AND FIRST AMENDMENT TO LOAN DOCUMENTS

          THIS RE-SIZING AND FIRST AMENDMENT TO LOAN DOCUMENTS (as amended,
modified and in effect from time to time, this "Agreement") is entered into as
of this 27th day of December, 2002 and is effective as of December 15, 2002, by
and among VENTAS REALTY, LIMITED PARTNERSHIP, a Delaware limited partnership,
having an address at 4360 Brownsboro Road, Suite 115, Louisville, Kentucky 40207
(together with its successors and assigns "Mezzanine Lender"), THOSE ENTITIES
LISTED ON SCHEDULE III attached hereto, each a Delaware limited liability
company and each having an address at 4660 Trindle Road, Suite 103, Camp Hill,
Pennsylvania 17011 (each, a "Mezzanine Borrower" and collectively, the
"Mezzanine Borrowers") and TRANS HEALTHCARE, INC., a Delaware corporation,
having an address at 4660 Trindle Road, Suite 103, Camp Hill, Pennsylvania 17011
("THI") and THOSE ENTITIES LISTED ON SCHEDULE II attached hereto, each having an
address at 4660 Trindle Road, Suite 103, Camp Hill, Pennsylvania 17011 (each, a
"Subsidiary Guarantor" and collectively, the "Subsidiary Guarantors"; THI and
the Subsidiary Guarantors are referred to herein individually as, a "Guarantor"
and collectively as, the "Guarantors").

                                    RECITALS

          WHEREAS, those entities listed on Schedule I attached hereto, each a
Delaware limited liability company (each, a "Mortgage Borrower" and
collectively, the "Mortgage Borrowers") and Ventas Realty, Limited Partnership,
a Delaware limited partnership, as the original mortgage lender ("Original
Lender") entered into that certain Loan Agreement dated as of November 1, 2002
(the "Loan Agreement") pursuant to which Mortgage Borrowers obtained a loan (the
"Mortgage Loan") in the initial principal amount of $45,000,000 from Original
Lender.

          WHEREAS, Original Lender assigned the Mortgage Loan to Ventas TRS,
LLC, a Delaware limited liability company ("Mortgage Lender") pursuant to a
certain Note Allonge dated as of December 1, 2002 and a certain General
Assignment dated as of December 1, 2002.

          WHEREAS, Mezzanine Borrowers and Mezzanine Lender entered into that
certain Mezzanine Loan Agreement dated as of November 1, 2002 (as amended,
modified and in effect from time to time, the "Mezzanine Loan Agreement")
pursuant to which Mezzanine Borrowers obtained a loan (the "Mezzanine Loan") in
the initial principal amount of $22,000,000 from Mezzanine Lender. Unless
otherwise defined herein, capitalized terms used in this Agreement shall have
the meanings set forth in the Mezzanine Loan Agreement.

          WHEREAS, the Guarantors, by that certain Guaranty dated as of
November 1, 2002 (together with all extensions, renewals, modifications,
substitutions and amendments thereof, the "Master Guaranty") given to Mezzanine
Lender, in its capacity as the original holder of the Mortgage Loan and in its
capacity as holder of the Mezzanine Loan, have guaranteed, inter alia, the
obligations of the Mortgage Borrowers under the Mortgage Loan and the Mezzanine
Borrowers under the Mezzanine Loan.

<PAGE>

          WHEREAS, in connection with the Mortgage Loan and Mezzanine Loan,
Mortgage Borrowers, Mezzanine Borrowers, Guarantors, Mezzanine Lender and
Mortgage Lender also entered into that certain Cooperation Agreement dated as of
November 1, 2002 (as amended, modified and in effect from time to time, the
"Cooperation Agreement").

          WHEREAS, Section 2 of the Cooperation Agreement provides for an
adjustment of the initial principal amount of the Mortgage Loan, with a
corresponding adjustment of the Mezzanine Loan, upon completion of the
Securitization Accounting Procedures if certain conditions are satisfied.

          WHEREAS, the Securitization Accounting Procedures have been completed
and the Mortgage Lender is performing the Re-sizing (as defined in the
Cooperation Agreement) and entering into certain other amendments of the loan
documents executed in connection with the Mortgage Loan (as such documents may
be amended, modified and in effect from time to time, the "Mortgage Loan
Documents") pursuant to that certain Re-sizing and First Amendment dated as of
the date hereof among Mortgage Lender, Mortgage Borrowers and Guarantors (the
"Mortgage Resizing Agreement").

          WHEREAS, the Re-sizing and the Mortgage Resizing Agreement necessitate
certain amendments to the Mezzanine Loan Agreement and the other Loan Documents,
and Mezzanine Lender, Mezzanine Borrowers and Guarantors desire to effect such
amendments as more particularly set forth below.

                                    AGREEMENT

          NOW, THEREFORE, in consideration of the foregoing and for other
valuable consideration the receipt and sufficiency of which are hereby
acknowledged, the parties, intending to be legally bound, hereto agree as
follows:

     Section 1.     Re-Sizing: Notwithstanding anything to the contrary
contained in the Mezzanine Loan Agreement or in any other Loan Document,
Mezzanine Borrowers and Mezzanine Lender acknowledge and agree that (i) the
outstanding principal balance of the Mortgage Loan, after giving effect to the
Re-sizing contemplated by this Agreement, is $16,976,867.10 (the "Re-sized Loan
Amount") and (ii) the Mezzanine Loan Agreement shall be amended as follows:

               Section 1.1.   "SAP Completion Date" means November 1, 2002.

               Section 1.2.   "Re-sizing Date" means December 15, 2002.

               Section 1.3.   "Lockout Date" means April 15, 2004.

               Section 1.4.   Schedule VI attached to the Loan Agreement is
hereby deleted in its entirety and is replaced with the Schedule VI attached
hereto, which sets forth the revised amortization schedule for the Mortgage
Loan.

                                       -2-

<PAGE>

The pertinent provisions of the Loan Documents shall be deemed amended to the
extent described in this Section 1 and Section 2.

     Section 2.     Additional Amendments and Understandings.

               Section 2.1.   Loan Agreement.

                         (a)  The definition of "Deferred Maintenance Amount" is
hereby amended to read as follows:

"Deferred Maintenance Amount" means $55,556.25"

                         (b)  The definition of "Mezzanine Collection Account
Bank" is hereby amended to read as follows:

"Mezzanine Collection Account Bank" means The Bank of New York, a New York
banking institution, and any other Eligible Institution from time to time
selected in accordance with Section 6.l(c)."

                         (c)  In the first sentence of Section 3.1.40(a) of the
Mezzanine Loan Agreement, the phrase, "could have a Material Adverse Effect" is
hereby amended to read as follows, "would not have a Material Adverse Effect".

                         (d)  In the first sentence of Section 3.1.40(b) of the
Mezzanine Loan Agreement, the phrase, "could have a Material Adverse Effect" is
hereby amended to read as follows, "would not have a Material Adverse Effect".

                         (e)  In Section 4.1.1 of the Mezzanine Loan Agreement,
the phrase, "except to the extent such preservation, renewal and effectiveness
could not have a Material Adverse Effect" is hereby amended to read as follows,
"except to the extent the absence of such preservation, renewal and
effectiveness would not have a Material Adverse Effect".

                         (f)  In clause (vi) of Section 4.1.2 of the Mezzanine
Loan Agreement, the term, "contested" is hereby amended to read, "unpaid".

                         (g)  In the first sentence of Section 5.2.1 of the
Mezzanine Loan Agreement, the phrase, ", provided Lender permits the applicable
Borrower to utilize the Net Proceeds, if any, for any such Restoration," is
hereby amended to read, "provided Lender is not in default under Section
5.3.2(a),".

                         (h)  Each reference to the term, "transfer" contained
in Sections 8.1 and 8.2 of the Mezzanine Loan Agreement is hereby replaced with
the term, "Transfer". In addition, in Section 8.1 of the Mezzanine Loan
Agreement, the phrase, "all of the Properties" is hereby amended to read "all or
any part of any Property".

                                       -3-

<PAGE>

                         (i)  The following phrase is hereby added at the end of
Section 10.l(b) of the Mezzanine Loan Agreement, "and Lender may enforce or
avail itself of any or all rights or remedies provided in the Loan Documents
against any Borrower and any or all of the Properties, including, without
limitation, all rights or remedies available at law or in equity".

               Section 2.2.   Intentionally Omitted.

               Section 2.3.   Post-Closing Agreement.

                         (a)  The last sentence in paragraph (a) of that certain
Post-Closing Obligations Agreement dated as of November 1, 2002 among Mezzanine
Borrowers, THI and Mezzanine Lender (the "Post-Closing Agreement") the phrase,
"by November 15, 2002" is hereby amended to read, "by no later than January 20,
2003".

                         (b)  The last sentence of paragraph (b) of the
Post-Closing Agreement is hereby amended to read: "The Mezzanine Borrowers shall
comply with their obligations under this paragraph by December 30, 2002."

                         (c)  The following sentence is hereby added to
paragraph (e) of the Post-Closing Agreement:

"Mezzanine Borrowers shall deliver to Lender a separate certificate of insurance
for each Mezzanine Property by no later than January 15, 2003"

                         (d)  Paragraph (f) of the Post-Closing Agreement is
hereby deleted in its entirety and the following paragraph (f) shall be
substituted in its place:

"(f)   Mezzanine Borrowers shall diligently take all commercially reasonable
actions necessary to (i) obtain all regulatory licenses necessary for the
continued operation of the Properties as nursing homes or adult care facilities,
as applicable, and (ii) ensure that each Property remains certified for
participation in the Medicare and Medicaid programs."

                         (e)  Mezzanine Borrowers hereby confirm that attached
hereto as Exhibit B is a chart describing all of the obligations set forth in
the Post-Closing Agreement which have not been satisfied as of the date hereof
(the "Outstanding Obligations"). Mezzanine Borrowers represent that all of the
obligations set forth in the Post-Closing Agreement have been satisfied as of
the date hereof, other than the Outstanding Obligations.

               Section 2.4.   Settlement Statement. The line item labeled,
"CAPITAL EXPENDITURES (hold back)" on that certain Settlement Statement executed
by Mezzanine Borrowers on November 1, 2002 is hereby amended to read, "DEFERRED
MAINTENANCE AMOUNT".

               Section 2.5.   Deferred Maintenance Amount. Mezzanine Borrowers
and Mezzanine Lender acknowledge and agree that the Deferred Maintenance Amount
(as such term

                                       -4-

<PAGE>

is used herein) shall be funded by Mezzanine Lender into the Deferred
Maintenance and Environmental Escrow Account and shall be disbursed to Mezzanine
Borrowers in accordance with, and subject to the conditions stated in, Section
6.7 of the Mezzanine Loan Agreement.

               Section 2.6.   Disbursement Instruction. Mezzanine Lender shall
send to Mezzanine Cash Management Bank a Disbursement Instruction in the form
attached hereto as Exhibit C. Such instruction (i) shall direct the Mezzanine
Cash Management Bank to deposit the Deferred Maintenance Amount into the
Deferred Maintenance and Environmental Escrow Account and (ii) shall revise the
Disbursement Instruction delivered to Mezzanine Cash Management Bank on December
13, 2002 so as to take into account the Re-sized Loan Amount.

               Section 2.7.   Contribution Agreement. Exhibit A attached to that
certain Contribution Agreement dated as of November 1, 2002 between Mezzanine
Borrowers and Mezzanine Lender is hereby deleted in its entirety and is replaced
with the Exhibit A attached hereto, which sets forth the revised Allocated Loan
Amount for each of the Collateral.

     Section 3.     Intentionally Omitted.

     Section 4.     Representations and Warranties of Mezzanine Borrowers.
Without limiting in any way any representation or warranty in any Loan Document,
each Mezzanine Borrower represents and warrants that as of the date hereof:

               Section 4.1.   Organization.  Mezzanine Borrower (i) is a duly
organized and validly existing limited liability company in good standing under
the laws of the State of Delaware, (ii) has the requisite power and authority to
carry on its business as now being conducted and (iii) has the requisite power
to execute and deliver, and perform its obligations under, this Agreement.

               Section 4.2.   Authorization.  The execution and delivery by
Mezzanine Borrower of this Agreement and Mezzanine Borrower's performance of its
obligations hereunder (i) have been duly authorized by all requisite action on
the part of Mezzanine Borrower, (ii) will not violate any provision of any
applicable legal requirements, any order, writ, decree, injunction or demand of
any court or other governmental authority, any organizational document of
Mezzanine Borrower or any indenture or agreement or other instrument to which
Mezzanine Borrower is a party or by which Mezzanine Borrower is bound and (iii)
will not be in conflict with, result in a breach of, or constitute (with due
notice or lapse of time or both) a default under, or result in the creation or
imposition of any lien of any nature whatsoever upon any of the property or
assets of Mezzanine Borrower pursuant to, any indenture or agreement or
instrument. Except for those obtained or filed on or prior to the date hereof,
Mezzanine Borrower is not required to obtain any consent, approval or
authorization from, or to file any declaration or statement with, any
governmental authority or other agency in connection with or as a condition to
the execution, delivery or performance of this Agreement. This Agreement has
been duly authorized, executed and delivered by Mezzanine Borrower.

                                       -5-

<PAGE>

               Section 4.3.   Full and Accurate Disclosure. No statement of fact
made by or on behalf of Mezzanine Borrower in this Agreement or in any other
document or certificate delivered to Lender by Mezzanine Borrower contains any
untrue statement of a material fact or omits to state any material fact
necessary to makes statements contained herein or therein not misleading. There
is no fact presently known to Mezzanine Borrower which has not been disclosed to
Lender which materially adversely affects, nor as far as Mezzanine Borrower can
foresee, might materially adversely affect the business, operations or condition
(financial or otherwise) of Mezzanine Borrower.

               Section 4.4.   Enforceability. This Agreement is a legal, valid
and binding obligation of Mezzanine Borrower, enforceable against Mezzanine
Borrower in accordance with its terms, subject to bankruptcy, insolvency and
other limitations on creditors' rights generally and to equitable principles.

               Section 4.5.   No Defaults. To Mezzanine Borrower's actual
knowledge, no Event of Default or monetary default under the Note, the Loan
Agreement or under any of the other Loan Documents has occurred or with the
passage of time, giving of notice or both will exist.

               Section 4.6.   No Offsets or Defenses. Through the date of this
Agreement, Mezzanine Borrower neither has nor claims any offset, defense, claim,
right of set-off or counterclaim against Lender under, arising out of or in
connection with this Agreement, the Note, or any of the other Loan Documents. In
addition, Mezzanine Borrower covenants and agrees with Lender that if any
offset, defense, claim, right of set-off or counterclaim exists as of the date
of this Agreement, Mezzanine Borrower hereby irrevocably and expressly waives
the right to assert such matter.

               Section 4.7.   Damage or Injury. Since the Closing Date, the
existing Improvements relating to each Property have not been materially injured
or damaged by fire or other casualty.

               Section 4.8.   Change. Since the Closing Date, no material
adverse change with respect to any Property or Mezzanine Borrower has occurred.

               Section 4.9.   Representation and Warranties in Loan Agreement.
All of the representations and warranties made by the Mezzanine Borrowers in the
Mezzanine Loan Agreement remain true and correct as if made on the date hereof,
except those representations and warranties as to which the facts or
circumstances causing such representations and warranties to not be true and
correct would not have a Material Adverse Effect.

               Section 4.10.  Survival of Representations and Warranties.
Without in any way limiting any provision of any Loan Document which provides
for a longer period of survival, Mezzanine Borrower hereby agrees that (i) all
representations and warranties made by Mezzanine Borrower in this Agreement
shall continue for so long as any amount remains owing under the Note or any of
the other Loan Documents, and (ii) all representations, warranties,

                                       -6-

<PAGE>

covenants and agreements made in this Agreement shall be deemed to have been
relied upon by Lender notwithstanding any investigation heretofore or hereafter
made by Lender.

     Section 5.     Representations and Warranties of Guarantors. Without
limiting in any way any representation or warranty in the Master Guaranty, each
Guarantor represents and warrants that as of the date hereof:

               Section 5.1.   Organization. Guarantor (i) is a duly organized
and validly existing entity as set forth on the attached Schedule II in good
standing in the State of its organization as set forth on the attached Schedule
II, (ii) has the requisite power and authority to carry on its business as now
being conducted and (iii) has the requisite power to execute and deliver, and
perform its obligations under, this Agreement.

               Section 5.2.   Authorization. The execution and delivery by
Guarantor of this Agreement and Guarantor's performance of its obligations
hereunder (i) have been duly authorized by all requisite action on the part of
Guarantor, (ii) will not violate any provision of any applicable legal
requirements, any order, writ, decree, injunction or demand of any court or
other governmental authority, any organizational document of Guarantor or any
indenture or agreement or other instrument to which Guarantor is a party or by
which Guarantor is bound and (iii) will not be in conflict with, result in a
breach of, or constitute (with due notice or lapse of time or both) a default
under, or result in the creation or imposition of any lien of any nature
whatsoever upon any of the property or assets of Guarantor pursuant to, any
indenture or agreement or instrument. Except for those obtained or filed on or
prior to the date hereof, Guarantor is not required to obtain any consent,
approval or authorization from, or to file any declaration or statement with,
any governmental authority or other agency in connection with or as a condition
to the execution, delivery or performance of this Agreement. This Agreement has
been duly authorized, executed and delivered by Guarantor.

               Section 5.3.   Full and Accurate Disclosure. No statement of fact
made by or on behalf of Guarantor in this Agreement or in any other document or
certificate delivered to Lender by Guarantor contains any untrue statement of a
material fact or omits to state any material fact necessary to makes statements
contained herein or therein not misleading. There is no fact presently known to
Guarantor which has not been disclosed to Lender which materially adversely
affects, nor as far as Guarantor can foresee, might materially adversely affect
the business, operations or condition (financial or otherwise) of Guarantor.

               Section 5.4.   Enforceability. This Agreement is a legal, valid
and binding obligation of Guarantor, enforceable against Guarantor in accordance
with its terms, subject to bankruptcy, insolvency and other limitations on
creditors' rights generally and to equitable principles.

               Section 5.5.   No Defaults. To Guarantor's actual knowledge, no
Event of Default (as defined in the Loan Agreement and the Mezzanine Loan
Agreement) or monetary default under the Note, the Loan Agreement, the Mezzanine
Loan Agreement or under any of the

                                       -7-

<PAGE>

other Loan Documents (as defined in the Loan Agreement and the Mezzanine Loan
Agreement) has occurred or with the passage of time, giving of notice or both
will exist.

               Section 5.6.   No Offsets or Defenses. Through the date of this
Agreement, Guarantor neither has nor claims any offset, defense, claim, right of
set-off or counterclaim against Lender under, arising out of or in connection
with this Agreement, the Note (as defined in the Loan Agreement and the
Mezzanine Loan Agreement), or any of the other Loan Documents (as defined in the
Loan Agreement and the Mezzanine Loan Agreement). In addition, Guarantor
covenants and agrees with Lender that if any offset, defense, claim, right of
set-off or counterclaim exists as of the date of this Agreement, Guarantor
hereby irrevocably and expressly waives the right to assert such matter.

               Section 5.7.   Reliance on Representations and Warranties. Each
Guarantor hereby agrees all representations, warranties, covenants and
agreements made in this Agreement shall be deemed to have been relied upon by
Lender notwithstanding any investigation heretofore or hereafter made by Lender.

     Section 6.     Transactions Costs. Each Mezzanine Borrower and each
Guarantor agrees to pay on the date hereof all costs and expenses incurred by
Lender in connection with the Re-sizing and the sale of the Mortgage Loan to
General Electric Capital Corporation (the "Loan Sale"), including, without
limitation, all legal fees of Lender's counsel which shall not to exceed
$150,000. Each Mezzanine Borrower and each Guarantor shall pay its respective
costs and expenses incurred in connection with the Re-sizing and the Loan Sale.

     Section 7.     Modifications. This Agreement may not be amended, modified
or otherwise changed in any manner except by a writing executed by all of the
parties hereto.

     Section 8.     Severability. In case any provision of this Agreement shall
be invalid, illegal, or unenforceable, such provision shall be deemed to have
been modified to the extent necessary to make it valid, legal, and enforceable.
The validity, legality, and enforceability of the remaining provisions shall not
in any way be affected or impaired thereby.

     Section 9.     Further Assurances. Each Mezzanine Borrower and each
Guarantor shall execute and deliver such further instruments and perform such
further acts as may be requested by Lender from time to time to confirm the
provisions of this Agreement and the Loan Documents (as defined in the Loan
Agreement and the Mezzanine Loan Agreement), to carry out more effectively the
purposes of this Agreement and the Loan Documents (as defined in the Loan
Agreement and the Mezzanine Loan Agreement), or to confirm the priority of any
lien created by any of the Loan Documents.

     Section 10.    Successors and Assigns. This Agreement applies to, inures to
the benefit of, and binds all parties hereof, their heirs, legatees, devisees,
administrators, executors, and permitted successors and assigns.

     Section 11.    Governing Law. This Agreement shall be governed by, and
construed

                                       -8-

<PAGE>

in accordance with, the laws of the State of New York, without giving effect to
the conflict of laws provisions of said State.

     Section 12.    Entire Agreement. This Agreement constitutes all of the
agreements among the parties relating to the matters set forth herein and
supersedes all other prior or concurrent oral or written letters, agreements and
understandings with respect to the matters set forth herein.

     Section 13.    Full Force and Effect. The Loan Documents remain in full
force and effect. None of the representations, warranties or covenants contained
herein shall in no way limit in any way any representation, warranty or covenant
contained in any Loan Document. This Agreement shall constitute a "Loan
Document" as defined in the Loan Agreement.

     Section 14.    Counterparts. This Agreement may be signed in any number of
counterparts by the parties hereto, all of which taken together shall constitute
one and the same instrument.

                      [Signatures begin on following page]

                                       -9-

<PAGE>

     IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be
duly executed by their duly authorized representatives, all as of the day and
year first above written.

                                 LENDER:

                                 VENTAS REALTY, LIMITED PARTNERSHIP,
                                 a Delaware limited partnership

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

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

                     [Signatures continue on following page]

<PAGE>

                                 MEZZANINE BORROWER:

                                 THI OF OHIO SNFS, LLC,
                                 a Delaware limited liability company

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

                                 THI OF OHIO ALFS I, LLC,
                                 a Delaware limited liability company

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

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

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

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

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

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

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

<PAGE>

                                 THI OF MARYLAND SNFS I, LLC,
                                 a Delaware limited liability company

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

                                 THI OF MARYLAND SNFS II, LLC,
                                 a Delaware limited liability company

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

                                 THI OF MARYLAND AT FRANKLIN SQUARE, LLC,
                                 a Delaware limited liability company

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

                                 THI OF MARYLAND AT FORT WASHINGTON, LLC,
                                 a Delaware limited liability company

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

<PAGE>

                                 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

                                 THI SERVICES CORP.,
                                 a Delaware corporation

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

<PAGE>

                                 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

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

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

<PAGE>

                                 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

                                 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

<PAGE>

                                 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>
                                                                EXHIBIT 10.5.4.1

                           PURCHASE AND SALE AGREEMENT

     THIS PURCHASE AND SALE AGREEMENT (this "Agreement") is entered into by and
between VENTAS TRS, LLC, a Delaware limited liability company ("Seller") and
GENERAL ELECTRIC CAPITAL CORPORATION, a Delaware corporation ("Purchaser") this
27th day of December, 2002 (the "Closing Date").

                                    RECITALS:

     WHEREAS, Ventas Realty, Limited Partnership, a Delaware limited partnership
("Ventas"), has made a certain loan (the "Loan") to those entities listed on
Schedule I attached hereto, each a Delaware limited liability company (each, a
"Borrower" and collectively, the "Borrowers"), pursuant to that certain Loan
Agreement dated as of November 1, 2002 between Ventas and the Borrowers (as
amended, restated, replaced, supplemented or otherwise modified from time to
time, the "Loan Agreement").

     WHEREAS, the Loan is evidenced by a certain Promissory Note dated as of
November 1, 2002 made by the Borrowers to Ventas (as amended, restated,
replaced, supplemented or otherwise modified from time to time, the "Note").

     WHEREAS, the Note is secured by those certain liens and security interests
evidenced by (i) the Mortgages as defined in the Loan Agreement (as amended,
restated, replaced, supplemented or otherwise modified from time to time,
collectively, the "Security Instruments"), which encumber the real properties
described therein (collectively, the "Properties") and (ii) the Assignments of
Leases and Rents as defined in the Loan Agreement (as amended, restated,
replaced, supplemented or otherwise modified from time to time, collectively,
the "Assignments of Leases and Rents").

     WHEREAS, the Loan Agreement, the Note, the Security Instruments and the
Assignments of Leases and Rents, together with all other documents and
instruments securing or otherwise evidencing the Loan are collectively referred
to as the "Loan Documents."

     WHEREAS, the Loan Documents and the Loan were assigned by Ventas to Seller
pursuant to (i) that certain Note Allonge dated as of December 1, 2002 and (ii)
that certain General Assignment, dated as of December 1, 2002.

     NOW, THEREFORE, in consideration of the payment of the Purchase Price (as
defined below), the terms and conditions contained herein, and other good and
valuable consideration, the receipt and sufficiency of which are hereby
acknowledged, the parties hereby covenant and agree as follows:

          1.   Purchase of Loan. In consideration of the payment by Purchaser to
Seller by wire transfer to Seller's account on the Closing Date in immediately
available funds the sum set forth on the closing statement set forth on Schedule
II hereof (the "Purchase Price") and satisfaction of all of the terms and
conditions set forth herein, Seller shall sell, assign and transfer on an as-is,
where-is basis, without recourse, representation or warranty, expressed or
implied, except the representations and warranties expressly made by Seller in
favor of Purchaser herein and in the documents executed and delivered to
Purchaser in connection herewith (collectively,

<PAGE>

the "Express Warranties"), all of Seller's right, title and interest in and to
the Loan and the Loan Documents. On and prior to the Closing Date, all payments,
penalties or credits received by or for the account of Seller in connection with
the Loan which are due and payable on or prior to the Closing Date shall be the
property of Seller without adjustment to the Purchase Price. All payments,
penalties or credits received by Seller in connection with the Loan after the
Closing Date, except for the receipt by Seller of the Purchase Price from
Purchaser, shall be held by Seller in trust for Purchaser and promptly remitted
to Purchaser in the form received by Seller, except that, with respect to all
checks, drafts or other instruments, Seller shall provide all necessary
endorsements, without representation, warranty or recourse, to enable Purchaser
to negotiate the same.

          2.   Closing. The closing shall take place at the offices of Seller's
counsel on the Closing Date.

          3.   Representations and Warranties.

               3.1. Each of Seller and Ventas hereby represents and warrants to
Purchaser as follows:

                    (a)   Attached hereto as Exhibit A is a true, correct and
     complete listing of all of the Loan Documents as of the Closing Date. The
     Loan Documents have not been materially amended except pursuant to that
     certain Re-Sizing and First Amendment to Loan Documents dated as of the
     date hereof among Seller, Borrowers, Trans Healthcare, Inc. ("THI") and the
     Subsidiary Guarantors named therein (the "Re-Sizing Agreement"). To
     Seller's knowledge, there currently exists no default or event which, with
     the giving of notice or the lapse of time, or both, or at the option of
     Seller, would constitute a material default under any of the Loan
     Documents, except for (i) the potential failure of the Borrowers to
     complete all of the items in that certain Post Closing Obligations
     Agreement dated as of November 1, 2002 between the Borrowers, Ventas and
     THI (the "Post-Closing Obligations Agreement") by the dates required
     thereby (as such dates have been extended pursuant to the Re-Sizing
     Agreement) and (ii) the failure of the Borrowers to comply with the
     insurance requirements set forth in the Loan Agreement. Seller has not
     received any written notice as to any casualty or condemnation occurring
     with respect to any of the Properties.

                    (b)   Seller is, and as of the Closing Date will be, the
     holder of the Loan and the Loan Documents, free and clear of any lien,
     security interest, option or other charge or encumbrance.

                    (c)   As of the Closing Date, the Loan and the related Loan
     Documents will not be pledged or hypothecated or subject to a security
     interest in favor of any other person.

                    (d)   As of the Closing Date, the outstanding principal
     balance of the Note is $49,952,682.70.

               3.2. Seller hereby represents and warrants to Purchaser as
follows:

                                       -2-

<PAGE>

                    (a)   Seller (i) is a limited liability company duly
     organized, validly existing and in good standing under the laws of the
     jurisdiction of its organization, (ii) has all requisite authority to own,
     lease and operate its properties and to carry on its business as now being
     conducted and (iii) is duly qualified or licensed and otherwise authorized
     to transact business in each jurisdiction in which the properties owned,
     leased or operated by it or the nature of the business conducted by it
     makes such qualification or license necessary.

                    (b)   Seller has the requisite power and authority to
     execute and deliver this Agreement, to perform its obligations hereunder
     and to consummate the transactions contemplated hereunder. The execution
     and delivery of this Agreement by Seller, the performance by it of its
     obligations hereunder and the consummation by it of the transactions
     contemplated hereunder have been duly and validly authorized. This
     Agreement has been duly and validly executed and delivered by it and
     constitutes the valid and binding agreement of it, enforceable against it
     in accordance with its terms except (i) as limited by applicable
     bankruptcy, insolvency, reorganization, moratorium, and other laws of
     general application affecting enforcement of creditors' rights generally
     and (ii) as limited by laws relating to the availability of specific
     performance, injunctive relief or other equitable remedies.

                    (c)   Neither the negotiation, execution or delivery of this
     Agreement by Seller nor the performance by Seller of its obligations
     hereunder nor the consummation by such entity of the transactions
     contemplated hereunder has or will (i) constitute a breach or violation
     under Seller's constituent documents, (ii) constitute a breach, violation
     or default (or be an event which, with notice or lapse of time or both,
     would constitute a default) under, or result in the termination of, or
     result in the creation of any lien upon any of Seller's properties or
     assets under, any material note, bond, mortgage, indenture, deed of trust,
     license, lease, agreement or other instrument to which Seller is a party or
     by which any of its properties or assets are bound or (iii) constitute a
     violation of any order, writ, injunction, decree, statute, rule or
     regulation of any court or governmental authority applicable to it or any
     of its properties or assets, in each case except for such breaches,
     violations, defaults, terminations or liens that could not reasonably be
     expected to have a material adverse effect on the ability of Seller to
     perform its obligations hereunder.

                    (d)   No authorization, consent or approval of, or filing
     with, any court or any public body or authority and no consent or approval
     of any third party or parties is necessary for the consummation by Seller
     of the transactions contemplated by this Agreement.

                    (e)   There are no actions or proceedings against, or
     investigations of, the Seller pending, or, to the knowledge of the Seller,
     threatened, before any court, arbitrator, administrative agency or other
     tribunal (i) asserting the invalidity of this Agreement or (ii) seeking to
     prevent the sale of the Loan or the consummation of the transaction
     contemplated by this Agreement by the Seller.

                    (f)   Seller is duly authorized to enter into this Agreement
     and to sell the Loan and the Loan Documents to Purchaser as contemplated
     herein.

                                       -3-

<PAGE>

               3.3. The Loan is being sold in an "AS IS" condition, on a "WHERE
IS" basis and "WITH ALL FAULTS" as of the Closing Date. Except for the Express
Warranties, Seller makes no warranties or representations of any type, kind,
character or nature, whether expressed or implied, statutory or otherwise (the
warranties provided for in the applicable Uniform Commercial Code being
specifically negated), in fact or in law, or any warranties of merchantability
or fitness for a particular purpose with respect to any term or condition of the
Note, any Security Instrument or any of the other Loan Documents, the Loan, or
with respect to any of the Properties. Without in any way limiting the
generality of the foregoing, except for the Express Warranties, Seller has not
made, does not make or undertake, and expressly disclaims any representation,
warranty or obligation, expressed or implied, as to any characteristic or other
matter affecting or related to any of the Properties. Purchaser hereby waives
any such representation, warranty or obligation, expressed or implied, related
to any such characteristic or matter. Without in any way limiting the generality
of the foregoing, except for the Express Warranties, Seller makes no
representation or warranty, whether expressed or implied, and assumes no
responsibility with respect to (i) the collectability of the Note or the value
of the Loan, (ii) the creditworthiness or financial condition of any Borrower or
the ability of any Borrower to perform its obligations under the Loan Documents,
(iii) the due execution, validity, sufficiency, or the perfection or priority of
any liens or security interests securing or appearing to secure or relating to
the Loan or with respect to any property or collateral covered by such liens,
(iv) the condition of the Loan or the value or income potential of the Loan or
any collateral included in the Loan Documents, (v) rights of offset, deductions,
negotiability, or holder in due course status, the accuracy or completeness of
the matters disclosed, represented or warranted by any party in any of the Loan
Documents, (vi) the performance of the obligations of any party under any of the
Loan Documents, (vii) the adequacy of the collateral described in the Loan
Documents, or (viii) the existence or nonexistence of any default or event of
default under any of the Loan Documents. Seller shall have no responsibility for
the financial condition of any Borrower or the ability of any Borrower to
perform its obligations under the Loan Documents. After the Closing Date,
Purchaser shall have no recourse against Seller arising out of this Agreement,
the Loan, the Loan Documents, any of the Properties or the transactions
contemplated hereby or thereby, except for breaches of the Express Warranties
and obligations under this Agreement to be performed after the Closing Date.
Seller shall not under any circumstances have any duty to repurchase any Loan or
rescind any transaction contemplated by this Agreement.

               3.4. Purchaser represents and warrants to Seller as follows:

                    (a)   Purchaser (i) is a corporation duly organized, validly
     existing and in good standing under the laws of the jurisdiction of its
     organization, (ii) has all requisite authority to own, lease and operate
     its properties and to carry on its business as now being conducted and
     (iii) is duly qualified or licensed and otherwise authorized to transact
     business in each jurisdiction in which the properties owned, leased or
     operated by it or the nature of the business conducted by it makes such
     qualification or license necessary.

                    (b)   Purchaser has the requisite power and authority to
     execute and deliver this Agreement, to perform its obligations hereunder
     and to consummate the transactions contemplated hereunder. The execution
     and delivery of this Agreement by

                                       -4-

<PAGE>

     Purchaser, the performance by it of its obligations hereunder and the
     consummation by it of the transactions contemplated hereunder have been
     duly and validly authorized. This Agreement has been duly and validly
     executed and delivered by it and constitutes the valid and binding
     agreement of it, enforceable against it in accordance with its terms except
     (i) as limited by applicable bankruptcy, insolvency, reorganization,
     moratorium, and other laws of general application affecting enforcement of
     creditors' rights generally and (ii) as limited by laws relating to the
     availability of specific performance, injunctive relief or other equitable
     remedies.

                    (c)   Neither the negotiation, execution or delivery of this
     Agreement by Purchaser nor the performance by Purchaser of its obligations
     hereunder nor the consummation by such entity of the transactions
     contemplated hereunder has or will (i) constitute a breach or violation
     under Purchaser's constituent documents, (ii) constitute a breach,
     violation or default (or be an event which, with notice or lapse of time or
     both, would constitute a default) under, or result in the termination of,
     or result in the creation of any lien upon any of Purchaser's properties or
     assets under, any material note, bond, mortgage, indenture, deed of trust,
     license, lease, agreement or other instrument to which Purchaser is a party
     or by which any of its properties or assets are bound or (iii) constitute a
     violation of any order, writ, injunction, decree, statute, rule or
     regulation of any court or governmental authority applicable to it or any
     of its properties or assets, in each case except for such breaches,
     violations, defaults, terminations or liens that could not reasonably be
     expected to have a material adverse effect on the ability of Purchaser to
     perform its obligations hereunder.

                    (d)   No authorization, consent or approval of, or filing
     with, any court or any public body or authority and no consent or approval
     of any third party or parties is necessary for the consummation by
     Purchaser of the transactions contemplated by this Agreement.

                    (e)   There are no actions or proceedings against, or
     investigations of, the Purchaser pending, or, to the knowledge of the
     Purchaser, threatened, before any court, arbitrator, administrative agency
     or other tribunal (i) asserting the invalidity of this Agreement or (ii)
     seeking to prevent the purchase of the Loan or the consummation of the
     transaction contemplated by this Agreement by the Purchaser.

                    (f)   Purchaser has such knowledge and experience in
     financial and relevant business matters so as to be capable of evaluating
     the merits and risks of purchasing the Loan. Purchaser is financially able
     to hold the Loan for long-term investment, believes that the nature of the
     Loan is consistent with its overall investment program and financial
     position, and recognizes that there are substantial risks involved in the
     purchase of the Loan. Purchaser is able to bear the economic risk of an
     investment in the Loan and is able to afford a complete loss of such
     investment. Purchaser, together with its own professional advisors, has
     performed its own due diligence with respect to the Loan, has reviewed the
     Loan Documents and the additional information supplied by Seller with
     respect to such Loan, and requested such additional information and
     undertook such additional investigations and evaluations with respect to
     the Loan, tax,

                                       -5-

<PAGE>

     legal and other issues and any other matters, as it has deemed necessary or
     appropriate to make an informed investment decision to enter into this
     Agreement.

                    (g)   Purchaser has available to it financial resources
     sufficient to pay the Purchase Price in cash on the Closing Date.

     All representations and warranties made by the parties in this Section
shall survive the closing of this transaction and/or any termination of this
Agreement.

               4.   Title Insurance Policies. The priority of the lien of the
Security Instruments, as of the date of issuance of the policies, is as insured
by the title proforma policies (the "Title Policies") described on Exhibit B
attached hereto. Purchaser shall bear full responsibility for and shall pay all
costs associated with transferring and obtaining any endorsements to the Title
Policies in connection with this transaction, if available.

               5.   Payment of the Purchase Price. On or prior to the Closing
Date, Purchaser shall pay the Purchase Price to Seller by wire transfer of
immediately available funds to an account specified by Seller.

               6.   Closing; Execution of Documents of Transfer. On the Closing
Date, simultaneously with the Purchase Price in accordance with Section 5
hereof:

                    (a)   Seller shall attach to the Note an allonge (the
     "Allonge") executed by Seller as follows:

                    "Pay to the order of General Electric Capital Corporation
                    without recourse, representation or warranty, except as
                    specifically provided in that certain Purchase and Sale
                    Agreement, dated as of December 27th, 2002 by and between
                    Ventas TRS, LLC and General Electric Capital Corporation."

                    (b)   Seller shall deliver to Purchaser the executed
     original Note (or, if not available, lost note affidavit), attached to
     which shall be the Allonge.

                    (c)   Seller shall execute and deliver to Purchaser a
     general assignment of the Loan Documents in the form attached hereto as
     Exhibit D.

                    (d)   Seller shall deliver to Purchaser the original
     executed Loan Documents, other than the Loan Documents which were sent for
     recording and/or filing which have not been returned by the applicable
     recording and/or filing office (collectively, the "Recorded Documents").
     Seller shall deliver to Purchaser true and correct copies of the Recorded
     Documents. After the Closing Date, Seller agrees to deliver, or cause to be
     delivered to Purchaser, the Recorded Documents upon receipt of same from
     the applicable recording and/or filing office. Seller reserves the right to
     retain copies of the Loan Documents and the Due Diligence Items (as
     hereinafter defined).

                    (e)   Seller shall deliver to Purchaser UCC-3 Financing
     Statements (or similar instruments) assigning the UCC-1 Financing
     Statements related to the Loan to Purchaser as secured party.

                                       -6-

<PAGE>

                    (f)   Seller shall deliver to Purchaser (i) notice letters
     to be sent by Purchaser to the Cash Management Bank (as defined in the Loan
     Agreement) and the Collection Account Bank (as defined in the Loan
     Agreement), notifying the Cash Management Bank and the Collection Account
     Bank of the assignment of the Loan from Seller to Purchaser (ii) notice
     letters to be sent by Purchaser to Borrowers and the property manager,
     notifying the Borrowers and the property manager of the transfer of the
     Loan and (iii) notice letters to be sent by Purchaser to the Counterparty
     (as defined in that certain Collateral Assignment of Interest Rate Cap
     dated as on November 1, 2002) and SMBC Capital Markets, Inc. notifying such
     parties of the transfer of the Loan.

                    (g)   Seller shall deliver to Purchaser originals (or
     copies, if originals are not available) of the Title Policies; surveys;
     zoning reports; environmental reports; engineering reports; legal opinions;
     insurance policies and/or certificates; UCC searches; organizational
     documents, good standing certificates and other customary due diligence
     items delivered by the Borrowers in connection with the Loan including all
     material documents delivered at the Closing of the Loan by the Borrowers to
     Ventas (collectively, the "Due Diligence Items") and copies of all notices
     given by Borrowers, Ventas, or Seller since the closing date of the Loan.

                    (h)   Seller shall deliver to Purchaser true and correct
     copies of the assignments of the Recorded Documents from Ventas to Seller
     and shall execute and deliver to Purchaser assignments of the Recorded
     Documents from Seller to Purchaser, which shall be in recordable form in
     the applicable jurisdictions.

                    (i)   Seller shall use commercially reasonable efforts to
     obtain and deliver an estoppel certificate from Borrowers and an estoppel
     certificate from Guarantors in the form agreed to by the parties.

                    (j)   Purchaser is responsible for having itself substituted
     as loss payee on, or obtaining any additional or substitute coverage for,
     any risk insurance policy related to the Loan in which Seller currently is
     listed as a loss payee. Notwithstanding the foregoing, Purchaser shall not
     obtain any additional or substitute coverage which is in violation of the
     terms and provisions of the Intercreditor Agreement dated as of the date
     hereof between Ventas and Purchaser (the "Intercreditor Agreement"). Seller
     agrees to reasonably cooperate with Purchaser to effect such substitution.

                    (k)   Purchaser shall deliver to Seller a receipt for all of
     the items delivered pursuant to this Section.

                    (1)   Each of Seller and Purchaser shall execute and deliver
     to the other a release of claims in the form negotiated by the parties.

                    (m)   Each of Seller and Purchaser shall execute and deliver
     to the other a closing statement in the form negotiated by the parties.

               7.   Escrows; Loan Assumption; Indemnification. Seller holds
escrows at the Cash Management Bank for the payment of real estate taxes,
insurance premiums, capital expenditures, operating expenses and other expenses
in the amounts set forth on Exhibit C.

                                       -7-

<PAGE>

These escrow amounts do not include funds held in any account or reserve to be
applied to pay amounts due on the Loan. On the Closing Date, Seller shall
deliver to Purchaser a letter to be delivered to the Cash Management Bank
notifying the Cash Management Bank of the transfer of the Loan and directing the
Cash Management Bank to register all of Seller's right, title and interest in
and to such escrows in the name of the Purchaser. Seller hereby assigns all
rights, responsibilities and obligations with respect to the Loan and the Loan
Documents to Purchaser, and Purchaser hereby expressly assumes all
responsibilities and obligations with respect to the Loan arising on and after
the Closing Date. Purchaser shall indemnify Seller, and its attorneys,
successors and assigns, servicers and sub-servicers, parent, subsidiary and/or
affiliated companies and the shareholders, trustees, officers, directors,
partners, members, employees, agents, representatives and attorneys of all of
the foregoing and their respective heirs, executors, administrators, attorneys,
successors, legal representatives and assigns against, and hold them harmless
from, any loss, liability, claim, damage or expense (including reasonable legal
fees and expenses) suffered or incurred by any such indemnified party to the
extent attributable to or arising out of the duties, responsibilities, or
obligations of the "Lender" under the Loan Documents existing on or arising
after the Closing Date. Each of Purchaser's obligations under this Section shall
survive the closing of this transaction and/or any termination of this
Agreement. Seller shall indemnify Purchaser, and its attorneys, successors and
assigns, servicers and sub-servicers, parent, subsidiary and/or affiliated
companies and the shareholders, trustees, officers, directors, partners,
members, employees, agents, representatives and attorneys of all of the
foregoing and their respective heirs, executors, administrators, attorneys,
successors, legal representatives and assigns against, and hold them harmless
from, any loss, liability, claim, damage or expense (including reasonable legal
fees and expenses) suffered or incurred by any such indemnified party to the
extent attributable to or arising out of the duties, responsibilities, or
obligations of the "Lender" under the Loan Documents existing or arising prior
to the Closing Date. Seller's obligations under this Section shall survive the
closing of this transaction and/or any termination of this Agreement. By its
signature below Ventas hereby agrees to guaranty the indemnification obligations
of Seller under this Section.

               8.   Status of Loan. Purchaser acknowledges that except for the
Express Warranties (i) there may be certain issues and/or risks with respect to
the Loan or the transactions related thereto that may not be disclosed by, or
apparent in, the Loan Documents, (ii) Purchaser assumes the risk that adverse
matters may not have been revealed by Seller or by Purchaser's inspections and
investigations, (iii) Seller is not obligated to provide any documents or
information to Purchaser except as set forth in Section 6, (iv) certain
documents and information may exist and may not have been provided to Purchaser,
including without limitation, certain documents which pertain to the certain
internal correspondence, electronic mail, internal analysis, internal memoranda,
general regulatory reports required to be filed by Seller and internal
assessments of valuation, and that Seller makes no representations or warranties
that these documents and information do not include significant and material
information which, if made known to Purchaser, could have a material,
significant, direct or indirect impact upon perceived, apparent or actual value
of the Loan, (v) Purchaser has been given the opportunity to inspect the Loan
and Loan Documents to Purchaser's complete satisfaction, and Purchaser is
relying solely on Purchaser's own investigation and not on any information of
any kind provided by Seller or any officer, agent or representative of Seller,
(vi) Purchaser has reviewed all of the financial or other information that
Purchaser believes to be necessary to enable Purchaser to make an independent,
informed judgment with respect to the

                                       -8-

<PAGE>

creditworthiness of the Borrowers, the value and extent of the collateral for
the Loan and the desirability of purchasing the Loan and (vii) Seller has no
responsibility or liability for the authenticity, validity, accuracy or
completeness of any financial or other information received by Purchaser
concerning any Borrower or the collateral for the Loan.

               9.   Payment of Expenses. Each party shall pay its respective
fees, costs, expenses and disbursements relating to the transactions
contemplated hereby. Purchaser shall bear the cost of all recordation fees
and/or taxes associated with purchasing the Loan, including, without limitation,
recording assignments of the Security Instruments, assignment of any financing
statements, and any fees and/or taxes associated with other transfer documents
which the parties determine are to be recorded in connection with the
transactions contemplated hereby.

               10.  Further Assurances. Purchaser, Seller and Ventas hereby
agree to execute and deliver, both at and after the Closing Date, such
instruments and take such further actions as another party may, from time to
time, reasonably request in order to effectuate the purposes and to carry out
the terms of this Agreement. Without limiting the generality of the foregoing,
Seller agrees that following the Closing Date, Seller shall execute any notice
or instrument of transfer, assignment or conveyance reasonably requested by the
Purchaser (which request is accompanied by the form of instrument sufficient to
satisfy Purchaser's request) to more fully confirm or effect the transfer of the
Loan. Purchaser shall pay any costs or expenses incurred by Seller in connection
with this Section, other than Seller's attorneys' fees.

               11.  Notices. Any notice required or permitted by or in
connection with the Agreement, without implying the obligation to provide any
such notice, shall be in writing at the appropriate addresses set forth below or
to such other addresses as may be hereafter specified by written notice by
Seller or Purchaser. Any such notice shall be deemed to be effective one (1) day
after dispatch if sent by overnight delivery, express mail or Federal Express or
three (3) days after mailing if sent by first class mail with postage prepaid.
All notices shall be considered to be effective upon receipt if accomplished by
hand delivery or by facsimile (with answer back confirmation).

               If to Seller:

               Ventas TRS, LLC
               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
               Facsimile No. (215) 994-2222

                                       -9-

<PAGE>

               If to the Purchaser:

               General Electric Capital Corporation
               Loan No. 70004027
               2 Wisconsin Circle, Suite 400
               Chevy Chase, Maryland 20815
               Attention: Manager, Portfolio Management Group
               Facsimile No. (301) 664-9843

               With a copy to:

               General Electric Capital Corporation
               Loan No. 70004027
               100 Congress, Suite 700
               Austin, Texas 78701
               Attention: Diana Pennington, Vice President
                  and Chief Counsel, Senior Living Group
               Facsimile No. (512) 476-7832

               With a copy to:

               General Electric Capital Corporation
               Loan No. 70004027
               500 West Monroe Street
               Chicago, Illinois 60661
               Attention: Kevin McMeen, Senior Vice President
               Facsimile No. (312) 441-6755

               With a copy to:

               Goldberg, Kohn, Bell, Black, Rosenbloom & Moritz, Ltd.
               55 East Monroe Street, Suite 3700
               Chicago, Illinois 60603-5802
               Attention: Stephen B. Bell, Esq.
               Facsimile No. (312) 863-7431

               12.  Choice of Law. The laws of the State of New York shall
govern the rights and obligations of the parties to this Agreement, and the
interpretation and construction and enforceability thereof, and any and all
issues relating to the transactions contemplated herein.

               13.  Broker Fees. Purchaser and Seller each represent and warrant
to the other that it has dealt with no broker, investment broker or agent in
connection with the purchase of the Loan and that no commission, finders fees or
other such payments are due any broker. Purchaser and Seller each hereby
indemnifies and agrees to hold the other harmless from and against any and all
loss, liability, cost or expense (including without limitation, court costs and
reasonable attorneys' fees and expenses) that the one may suffer or sustain
should the foregoing representations and warranties of the other prove
inaccurate. The foregoing indemnity shall survive the closing of this
transaction and/or any termination of this Agreement.

                                      -10-

<PAGE>

               14.  Assignment. This Agreement may not be assigned by Purchaser
without the prior written consent of Seller, which consent may be granted or
withheld in Seller's sole and absolute discretion and any such assignment by
Purchaser without Seller's consent shall be null and void and of no effect. This
Agreement may be freely assigned by Seller without Purchaser's consent in
connection with a transfer of the Loan prior to the Closing Date.

               15.  Final Agreement. This Agreement (including the exhibits
hereto) constitutes the final and entire agreement and understanding of the
parties with respect to the purchase and sale of the Loan, and any terms and
conditions not set forth in this Agreement are not a part of this Agreement and
the understanding of the parties hereto may not be contradicted by evidence of
prior, contemporaneous or subsequent oral agreements of the parties. No
variation, modification, or changes hereof shall be binding on either party
hereto unless set forth in a document executed by both parties.

               16.  Severability. If any paragraph, section, sentence, clause or
phrase contained in this Agreement shall become illegal, null or void or against
public policy, for any reason, or shall be held by any court of competent
jurisdiction to be illegal, null or void or against public policy, the remaining
paragraphs, sections, sentences, clauses or phrases contained in this Agreement
shall not be affected thereby to the extent that the intent of the parties
hereto can be carried out absent such provision.

               17.  Counterparts. This Agreement may be executed in separate
counterparts, each of which shall be an enforceable document, but all of which
together shall constitute one and the same document.

               18.  Time of the Essence. Time is of the essence in the execution
and performance of this Agreement.

               19.  Rule of Construction. The parties acknowledge that each
party and its counsel have reviewed this Agreement and the parties hereby agree
that the normal rule of construction to the effect that any ambiguities are to
be resolved against the drafting party shall not be employed in the
interpretation of this Agreement or any amendments or exhibits hereto.

                      [Signatures begin on following page]

                                      -11-

<PAGE>

               IN WITNESS WHEREOF, the parties have executed this Purchase and
Sale Agreement as of the date first written above.

                                  SELLER:

                                  VENTAS TRS, LLC,
                                  a Delaware limited liability company

                                  By: /s/ T. Richard Riney
                                     ----------------------------
                                     Name:  T. Richard Riney
                                     Title: Executive Vice President and General
                                            Counsel

                                  Solely with respect to the representations
                                  and warranties contained in Section 3.1, the
                                  guaranty of the indemnification of Seller
                                  contained in Section 7 and the further
                                  assurances provisions contained in Section 10

                                  VENTAS REALTY, LIMITED PARTNERSHIP,
                                  a Delaware limited partnership

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

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

                                  PURCHASER:

                                  GENERAL ELECTRIC CAPITAL CORPORATION,
                                  a Delaware corporation

                                  By: /s/ Jeffrey M. Muchmore
                                     ----------------------------
                                     Name:  Jeffrey M. Muchmore
                                     Title: VP

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