Document:

<PAGE>

                                                                    EXHIBIT 10.4

                                 AMENDMENT NO. 1

         AMENDMENT No. 1 (this "Amendment") dated as of November 28, 2001, under
the $300,000,000 Credit Agreement dated as of April 20, 2001 (the "Credit
Agreement") among KINDRED HEALTHCARE OPERATING, INC. (formerly named Vencor
Operating, Inc.) (the "Borrower"), KINDRED HEALTHCARE, INC. (formerly named
Vencor, Inc.) ("Kindred"), the LENDERS party thereto and JPMORGAN CHASE BANK
(formerly named Morgan Guaranty Trust Company of New York), as Administrative
Agent and Collateral Agent.

                              W I T N E S S E T H:

         WHEREAS, Kindred and the Borrower have requested the Required Lenders
(such term and other capitalized terms used in this Amendment without definition
having the meanings set forth in the Credit Agreement) to extend the various
time periods set forth in the Encumbrance Letter to February 28, 2002 (the
"Encumbrance Letter Waiver"); and

         WHEREAS, the parties hereto desire to amend the Credit Agreement to
provide that compliance by Kindred and the Borrower with the provisions of the
Encumbrance Letter shall be sufficient to satisfy the requirements of Section
5.12(d) of the Credit Agreement;

         NOW, THEREFORE, the parties hereto agree as follows:

         SECTION 1. Encumbrance Letter. (a) (i) The undersigned Lenders hereby
(A) grant the Encumbrance Letter Waiver and (B) authorize the Collateral Agent,
in its sole discretion and from time to time, as contemplated by the Encumbrance
Letter, to waive compliance with the requirement that Kindred or the Borrower
remove or contest certain of the Liens or other defects listed in the schedule
attached to the Encumbrance Letter.

         (ii) The undersigned Lenders confirm and agree, without limiting the
generality of Section 9.05 of the Credit Agreement, that in the absence of gross
negligence or willful misconduct, the Collateral Agent shall not be liable to
any Lender on account of granting any such waiver and any consequences thereof.

         (b)  Clause (g) of the definition of "Permitted Encumbrances" is hereby
amended by deleting the word "removed" and replacing in substitution therefor
the words "removed, insured over by First American Title Insurance Company,
waived"

         (c) Section 5.12(d) of the Credit Agreement is hereby amended to read
as follows:

         "Vencor shall comply with the provisions of the Encumbrance Letter, as
such provisions may be amended or waived from time to time."

<PAGE>

         Section 2. Representations Correct; No Default. Kindred and the
Borrower each represents and warrants that (i) the representations and
warranties contained in the Financing Documents are true as though made on and
as of the date hereof and will be true on and as of the Amendment Effective Date
(as defined below) as though made on and as of such date and (ii) no Default has
occurred and is continuing on the date hereof and no Default will occur or be
continuing on the Amendment Effective Date.

         Section 3. Counterparts; Effectiveness. (a) This Amendment may be
signed in any number of counterparts, each of which shall be an original, with
the same effect as if the signatures thereto and hereto were upon the same
instrument.

         (b) This Amendment shall become effective as of the date hereof on the
date (the "Amendment Effective Date") when the Administrative Agent shall have
received duly executed counterparts hereof signed by Kindred, the Borrower and
the Required Lenders (or, in the case of any Lender as to which an executed
counterpart shall not have been received, the Administrative Agent shall have
received telegraphic, telex or other written confirmation from such party of
execution of a counterpart hereof by such Lender).

         (c) No later than the first Business Day after the Fee Determination
Date (as defined below), the Borrower shall pay the Administrative Agent, in
immediately available funds for the account of each Lender that has evidenced
its agreement hereto as provided in Section 3(b) by 5:00 P.M. (New York City
time) on the later of (i) November 29, 2001 and (ii) the date the Administrative
Agent issues a notice to the Lenders saying this Amendment has become effective
(such later date, the "Fee Determination Date"), an amendment fee in an amount
equal to 0.05% of the aggregate outstanding principal amount of such Lender's
Loans (as outstanding on the opening of business on the date of this Amendment).

         (d) Except as expressly set forth herein, the waivers and amendments
contained herein shall not constitute a waiver or amendment of any term or
condition of the Credit Agreement or any other Financing Document, and all such
terms and conditions shall remain in full force and effect and are hereby
ratified and confirmed in all respects.

         Section 4. Governing Law. THIS AMENDMENT SHALL BE GOVERNED BY AND
CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK.

                                       2

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

                                            KINDRED HEALTHCARE OPERATING, INC.

                                            By:/s/ Richard A. Schweinhart
                                               --------------------------------
                                            Name:  Richard A. Schweinhart
                                            Title: Senior Vice President and
                                                   Chief Financial Officer

                                            KINDRED HEALTHCARE, INC.

                                            By:/s/ Richard A. Schweinhart
                                               --------------------------------
                                            Name:  Richard A. Schweinhart
                                            Title: Senior Vice President and
                                                   Chief Financial Officer

                                        3

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                                        CREDIT LYONNAIS NEW YORK
                                        BRANCH

                                        By:  /s/  John-Charles Van Essche
                                             ----------------------------------
                                        Name:  John-Charles Van Essche
                                        Title:  Vice President

                                        4

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                                           BANKERS TRUST COMPANY

                                           By:  /s/ Alice L. Wagner
                                                -------------------------------
                                           Name:  Alice L. Wagner
                                           Title:  Vice President

                                        5

<PAGE>

                                    VAN KAMPEN
                                    PRIME RATE INCOME TRUST
                                    By: Van Kampen Investment Advisory Corp.

                                    By: /s/ Darvin D. Pierce
                                        -------------------------------------
                                    Name:   Darvin D. Pierce
                                    Title:  Executive Director

                                        6

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                                          BEAR STEARNS & CO., INC.

                                          By: /s/ Gregory A. Hanley
                                              --------------------------------
                                          Name:   Gregory A. Hanley
                                          Title:  Senior Managing Director

                                       7

<PAGE>

                                           GOLDMAN, SACHS CREDIT
                                           PARTNERS L.P.

                                           By: /s/ Robert S. Fanelli
                                               -------------------------------
                                           Name:   Robert S. Fanelli
                                           Title:  Authorized Signatory

                                       8

<PAGE>

                                              JPMORGAN CHASE BANK

                                              By: /s/ Houston A. Stebbins
                                                  ----------------------------
                                              Name:   Houston A. Stebbins
                                              Title:  Managing Director

                                       9

<PAGE>

                                      VAN KAMPEN
                                      SENIOR INCOME TRUST
                                      By: Van Kampen Investment Advisory Corp.

                                      By: /s/ Darvin D. Pierce
                                          ------------------------------------
                                      Name:   Darvin D. Pierce
                                      Title:  Executive Director

                                       10

<PAGE>

                                        VAN KAMPEN
                                        SENIOR FLOATING RATE FUND
                                        By: Van Kampen Investment Advisory Corp.

                                        By:  /s/ Darvin D. Pierce
                                             -------------------------------
                                        Name:  Darvin D. Pierce
                                        Title:  Executive Director

                                       11

<PAGE>

                                                 SILVER OAK CAPITAL LLC

                                                 By: /s/ Jeffrey H. Aronson
                                                     -------------------------
                                                 Name:  Jeffrey H. Aronson
                                                 Title:  Authorized Signatory

                                       12

<PAGE>

                                            T. ROWE PRICE RECOVERY FUND II, L.P.

                                            By: /s/ Kim Z. Golden
                                                -------------------------------
                                            Name:  Kim Z. Golden
                                            Title:  Managing Director

                                       13

<PAGE>

                                                     PENSLER CAPITAL CORPORATION

                                                     By: /s/ Sanford Pensler
                                                         ----------------------
                                                     Name: Sanford Pensler
                                                     Title: President

                                       14

<PAGE>

                                                     GOLDEN TREE HIGH YIELD
                                                     OPPORTUNITIES I, LP

                                                     By: /s/ Treacy Goffrey
                                                         ----------------------
                                                     Name: Treacy Goffrey
                                                     Title: Partner

                                       15

<PAGE>

                                                GOLDEN TREE HIGH YIELD MASTER
                                                FUND, LTD

                                                By: /s/ Treacy Goffrey
                                                    ------------------------
                                                Name: Treacy Goffrey
                                                Title: Partner

                                       16

<PAGE>

                                                  CONTINENTAL CASUALTY COMPANY

                                                  By: /s/ Richard W. Dubbarke
                                                      -------------------------
                                                  Name: Richard W. Dubbarke
                                                  Title: Vice President

                                       17

<PAGE>

                                                PRESIDENT & FELLOWS HARVARD
                                                COLLEGE

                                                By: /s/ Timothy S. Peterson
                                                    ----------------------------
                                                Name: Timothy S. Peterson
                                                Title:

                                       18

<PAGE>

                                                 REGIMENT CAPITAL, LTD.

                                                 By: /s/ Timothy S. Peterson
                                                     --------------------------
                                                 Name: Timothy S. Peterson
                                                 Title:

                                       19

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                                                 WELLS FARGO BANK

                                                 By: /s/  Cory Branden
                                                     ---------------------------
                                                 Name: Cory Branden
                                                 Title: Corporate Trust Officer

                                       20

<PAGE>

                               CERBERUS PARTNER, L.P.
                               By:  Cerberus Associates, LLC, General Partner

                               By:  /s/ Mark A. Neporent
                                    -------------------------
                               Name:    Mark A. Neporent
                               Title: Managing Director

                                       21

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                                     LCMI I LIMITED PARTNERSHIP

                                     By:  /s/ Mark A. Campellone
                                          ----------------------
                                          Name:    Lyon Capital Management LLC
                                                   Mark A. Campellone
                                          Title:   Senior Portfolio Manager

                                       22

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                                       NORTHWOODS CAPITAL III, LIMITED
                                       By:  Angelo, Gordon & Co., L.P.,
                                            as Collateral Manager

                                       By:  /s/ John W. Fraser
                                            -------------------------
                                       Name:    John W. Fraser
                                       Title: Managing Director

                                       23

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                                       OPPENHEIMER SENIOR FLOATING
                                       RATE FUND

                                       By:  /s/ Lisa Chaffee
                                            --------------------
                                       Name:    Lisa Chaffee
                                       Title:  Manager

                                       24

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                                       NORTHWOODS CAPITAL II, LIMITED
                                       By:  Angelo, Gordon & Co., L.P.
                                            As Collateral Manager

                                       By:  /s/ John W. Fraser
                                            -------------------------
                                       Name:    John W. Fraser
                                       Title:  Managing Director

                                       25

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                                       NORTHWOODS CAPITAL, LIMITED
                                       By:  Angelo, Gordon & Co., L.P.,
                                            as Collateral Manager

                                       By:  /s/ John W. Fraser
                                            -------------------------
                                       Name:    John W. Fraser
                                       Title:  Managing Director

                                       26

<PAGE>

                                       AG CAPITAL FUNDING PARTNERS,
                                       L.P.

                                       By:  _______________________________
                                       Name:
                                       Title:

                                       27

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                                       LONGACRE MASTER FUND LTD.

                                       By:  _____________________________
                                       Name:
                                       Title:

                                       28

<PAGE>

                                       SUNAMERICA CORPORATION

                                       By:  __________________________
                                       Name:
                                       Title:

                                       29

<PAGE>

                                       THOROUGHBRED LTD PARTNERSHIP I

                                       By:  ________________________________
                                       Name:
                                       Title:

                                       30

<PAGE>

                                                     LIPIZZANER LDC

                                                     By: _______________________
                                                     Name:
                                                     Title:

                                       31

<PAGE>

                                                     PALOMINO FUND LTD.

                                                     By:  ______________________
                                                     Name:
                                                     Title:

                                       32

<PAGE>

                                                    APPALOOSA INVESTMENT LIMITED
                                                    PARTNERSHIP I

                                                    By: ________________________
                                                    Name:
                                                    Title:

                                       33

<PAGE>

                                                     SPS HIGH YIELD LOAN TRADING

                                                     By: _______________________
                                                     Name:
                                                     Title:

                                       34<PAGE>

                                                                   EXHIBIT 10.11

                                 AMENDMENT NO. 2
                                     TO THE
                         VENCOR RETIREMENT SAVINGS PLAN

         This is Amendment No. 2 to the Vencor Retirement Savings Plan (the
"Plan") as last amended and restated as of March 1, 2000, which Amendment shall
be effective as of the date of its adoption.

                                    RECITALS
                                    --------

A.       Vencor, Inc. (the "Company") maintains the Plan and has reserved the
         right in Section 9.1 of the Plan to amend the Plan from time to time in
         its discretion.

B.       The Company has changed its name to Kindred Healthcare, Inc.

C.       Ventas stock was a frozen investment option in the Plan which was
         determined by the Retirement Committee in accordance with its duties
         pursuant to Sections 4.2(a) and 8.4(c) to no longer fit within the
         Plan's investment philosophy; Ventas stock in the trust has all been
         sold.

D.       All Company Stock held in the Plan was cancelled by court order upon
         Vencor, Inc.'s emergence from bankruptcy proceedings.

E.       As of June 1, 2001, the Company has acquired the management of
         facilities at

                         Ozark Mountain Regional Health
                               127 Northwest Blvd
                              Crane, Missouri 65633

                             Table Rock Care Center
                                276 Fountain Lane
                         Kimberling City, Missouri 65686

         (the "Lenox Facilities") and employed the persons who operate them,
         which employees previously participated in the Lenox Healthcare, Inc.
         401(k) plan (the "Lenox Plan").

F.       The Company, now wishes to amend the Plan to reflect the change of
         Company name, to clarify the eligibility computation period, and to
         clarify the Investment Funds available thereunder after sale of all
         Ventas stock and cancellation of Company Stock by elimination of all
         references to Ventas stock and the Company Stock Fund, and to grant
         past service credit to certain recently-hired employees.

<PAGE>

                                    AMENDMENT
                                    ---------

The Plan is hereby amended as follows:

         1.    Section 1.8 of the Plan and all other references therein to
Vencor, Inc. shall be a refer to "Kindred Healthcare, Inc."

         2.    Section 1.34 of the Plan is hereby amended to change the Plan
from the Vencor Retirement Savings Plan to "Kindred 401(k) Plan."

         3.    Section 2.1(a) of the Plan is hereby clarified to provide that
the phrase "remained an Employee" in the first sentence thereof does not require
continuous employment for the 12 month period required for participation, but
simply requires employment on the 12 month anniversary of the date on which the
Employee first logged an hour of Service.

         4.    Section 2.1(d) of the Plan is hereby amended so that as amended,
it shall correctly refer to the changed name of another plan maintained by the
Company, and to all of the various circumstances under which an employee of the
Company who is or was excluded from participation might have a change in his
rights to participate in the Plan:

         (d)   For purposes of this Section, in the event that an employee of
               the Company that is (i) not a Participating or Sponsoring
               Employer in this Plan, or (ii) is an employee of any company
               which participates in the Kindred & Affiliates 401(k) Plan also
               maintained by the Company, or (iii) is excluded due to
               classification as a per diem or "on call" employee, becomes an
               Employee as defined in Section 1.15 (either because of a change
               in employment status or adoption of this Plan by the entity by
               which he is employed), all periods of service while an employee
               of the Company or of a company which participates in the Kindred
               & Affiliates 401(k) Plan, shall be counted for purposes of
               determining eligibility to participate in the Plan. In all
               events, this Plan and the Kindred & Affiliates 401(k) Plan shall
               be construed so that, at no point in time, does any one
               Participant have a right to participate in both this Plan and the
               Kindred & Affiliates 401(k) Plan.

         5.    References in Section 2.1(d) and 3.2 of the Plan to persons who
participate in the Retirement Savings Plan for Certain Vencor Employees and
Affiliates shall hereafter refer to that plan as the "Kindred & Affiliates
401(k) Plan," to acknowledge the name change of the other plan.

         6.    Section 4.2(d) of the Plan is hereby amended by adding the
following sentence to the end of (d) of that Section as follows:

               Effective April 25, 2001, all shares of Ventas, Inc. common stock
               in the Company Stock Fund will begin to be liquidated and no
               longer be an investment option in the Plan. All proceeds from the
               liquidation of shares

                                        2

<PAGE>

               of Ventas, Inc. will be reinvested based on each Participant's
               interest in the fund in accordance with each Participant's
               then-current investment election for new money in the Plan.

         7.    Section 4.3(e) of the Plan is hereby deleted and reserved, and
all references elsewhere in the Plan to Ventas stock, Company Stock, or the
Company Stock Fund shall be deleted.

         8.    Appendix A to the Plan is hereby amended to add to the end
thereof the following so that credit for service for eligibility and vesting
will be granted for the Lenox Facilities' employees:

         All past service of Employees hired prior to August 1, 2001 by the
         Employer at the Lenox Facilities that would have been credited in the
         Lenox Plan shall be credited for purposes of eligibility and vesting
         under the Plan, effective August 1, 2001.

         IN WITNESS WHEREOF, this Amendment No. 2 is hereby adopted this 26/th/
day of  September, 2000.

                                KINDRED HEALTHCARE, INC.

                                By:  /s/ Owen Dorsey
                                    -----------------------------------------

                                Title: Chief Administrative Officer
                                       --------------------------------------

                                       3

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