Document:

<PAGE>

                                                                     Exhibit 4.2

                              [VENTAS LETTERHEAD]

T. Richard Riney
Executive Vice President
and General Counsel

Direct Dial: 502-357-9020

June 24, 2003

Mr. Joseph M. Harvey
Senior Vice President
Cohen & Steers Capital Management, Inc.
757 Third Avenue
New York, NY 10017

     RE:  Request by Cohen & Steers Capital Management, Inc. for a Waiver of the
          Provisions of Article XII of the Certificate of Incorporation of
          Ventas, Inc. (the "Company")

Dear Mr. Harvey:

          This letter is in response to the request by Cohen & Steers Capital
Management, Inc. ("C&S") for a waiver of the provisions of Article XII of the
Certificate of Incorporation of the Company with respect to C&S as described in
the letter from C&S to the Company dated June 25, 2003, which is attached hereto
(the "Request Letter"). Capitalized terms used but not defined herein shall have
the meaning set forth in the Request Letter.

          The Board hereby Waives, on the terms and subject to the conditions
set forth in this letter and the Request Letter, the application of Article XII
to C&S with respect to the provisions thereof limiting Beneficial Ownership of
Common Stock of the Company for the Waiver Period. The breach of any
representation, warranty, covenant or agreement contained in the Request Letter,
or the failure to comply with the covenants and agreements in the Request
Letter, shall cause the Waiver granted in this letter to become retroactively
null and void, and shall retroactively cause any Common Shares owned by C&S in
excess of the otherwise applicable 9.0% Ownership Limit to become designated
Excess Shares under Article XII, in addition to any other remedy available to
the Company.

          Notwithstanding the foregoing, the ownership of the Company's Common
Shares by C&S shall remain subject to the otherwise applicable 9.0% Ownership
Limit in the event that such ownership should result in (i) any "individual"
(within the meaning of Section 542(a)(2) of the Internal Revenue Code of 1986,
as amended (the "Code"), as modified by Section 856(h) of the Code) owning
(after taking into account the constructive ownership rules of Section 544 of
the Code, as modified by Section 856(h) of the Code) in excess of 9.0% of the
Common Shares

<PAGE>

Mr. Joseph M. Harvey
June 24,2003
Page 2

or (ii) any 10.0% Company Shareholder, alone or in combination with other 10.0%
Company Shareholders, owning (either directly or by operation of the attribution
rules of Section 318 of the Code, as modified by Section 856(d)(5) of the Code),
any interest in the stock of Kindred Healthcare, Inc. or in the stock, assets,
or net profits of any other present or future tenant of the Company. For
purposes of the preceding sentence, the term "10.0% Company Shareholder" means a
person who, but for the 9.0% Ownership Limit, would beneficially own 10.0% or
more of the total combined voting power, total number, or total value of all of
shares of stock of the Company, either directly or by operation of the
attribution rules of Section 318 of the Code, as modified by Section 856(d)(5)
of the Code.

          If this letter accurately sets forth our understanding, please sign
the letter where indicated below and return a signed copy to me. This letter
shall be of no force and effect, and may be revoked at any point in time prior
to the Company's receipt of a signed copy from C&S.

                                        Very truly yours,

                                        VENTAS, INC.

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

ACCEPTED AND AGREED
This 24th day of June, 2003

COHEN & STEERS CAPITAL MANAGEMENT, INC.

By: /s/ Joseph M. Harvey
    ---------------------------------
    Name: Joseph M. Harvey
    Senior Vice President

Attachment

                                       -2-

<PAGE>

                           [COHEN & STEERS LETTERHEAD]

                                                                  June 24, 2003

Board of Directors
Ventas, Inc.
4360 Brownsboro Road
Suite 115
Louisville, Kentucky 40207-1642

Re:  Request by Cohen & Steers Capital Management, Inc. for Waiver to Provisions
     of Article XII of the Certificate of Incorporation of Ventas, Inc. (the
     "Company")

To the Directors of Ventas, Inc.:

     Cohen & Steers Capital Management, Inc. ("C&S") is an investment advisor
registered under the Investment Advisers Act of 1940. As of date hereof, C&S has
purchased on behalf of its investment advisory clients (the "Advisory Clients"),
in the aggregate, 9,030,925 shares of the outstanding common stock, (the
"Common Shares") of the Company (the "Shares"). Pursuant to advisory contracts
with the Advisory Clients, C&S exercises sole investment discretion over such
shares and in certain cases sole voting discretion. No other person who would
constitute, along with C&S and with any one or more of the Advisory Clients, a
"group" as that term is used for purposes of Section 13(d)(3) ("Section 13(d)")
of the Securities Exchange Act of 1934, as amended (the "Exchange Act") owns any
shares of the Company. Because that portion of the Shares which exceed the
Ownership Limit (capitalized terms in this letter are used as defined in Article
XII of the Certificate of Incorporation of the Company) is subject to being
designated as Excess Shares under Article XII, C&S requests that the Board of
Directors of the Company (the "Board") grant a waiver to C&S and the Advisory
Clients from certain of the provisions of Article XII that relate to limitations
upon ownership of Common Shares, so that C&S, its Advisory Clients, and any
other Person who would constitute, along with C&S and any Advisory Client, a
"group" as that term is used for purposes of Section 13(d) of the Exchange Act,
may Beneficially Own, in the aggregate, up to 14%, in number of shares or value,
of the Common Shares during the period (the "Waiver Period") from the date
hereof, until the expiration of the Waiver Period (the "Waiver Expiration Date")
on the terms and subject to the conditions set forth herein.

     In consideration and as a condition to such waiver, C&S agrees, on behalf
of itself and with respect to assets C&S manages for the Advisory Clients, that
it shall not take any of the actions described below with respect to any
Additional Shares for so long as such shares shall constitute Additional Shares
or until any of the Events (as defined below) shall occur. "Additional Shares"
shall mean the number of Common Shares owned by all of C&S, the Advisory Clients
and any other persons who would constitute, along with C&S and any Advisory
Client, a "group" under Section 13(d), that exceeds 9.0% of the Common Shares of
the

<PAGE>

Company outstanding. The undersigned has the legal authority to bind C&S and
the Beneficial Owners of C&S to the terms of this letter and the related Waiver.
This letter does not request a waiver in respect of any Common Shares held,
owned, or Beneficially Owned by any Advisory Client that are not managed by C&S.
Nothing in this letter or the Waiver shall restrict the application of Article
XII to such other Common Shares, it being understood that all such other Common
Shares remain subject to Article XII of the Certificate of Incorporation of the
Company.

     C&S and the Company hereby acknowledge and agree that the waiver letter
dated May 12, 2003, a copy of which is attached hereto as Exhibit A, is hereby
terminated and shall be of no further force or effect.

     In support of its request for the Waiver, C&S makes the following
representations, warranties, covenants and agreements:

          1. Expiration of Waiver. The Waiver shall expire, and the Waiver
Period shall terminate, on the first to occur of (a) on the date that C&S
Beneficially Owns less than the Ownership Limitation, (b) a breach by C&S of any
of the representations, warranties, covenants or agreements contained in this
Request Letter or (c) ninety (90) days after C&S's receipt of notice from the
Company terminating the Waiver. Upon expiration of the Waiver and the Waiver
Period with respect to any Additional Shares, such Additional Shares shall
automatically be designated as "Excess Shares" under Article XII. Such
designation will be effective as of the close of business on the business day
prior to the date of the relevant event. C&S understands and acknowledges that
the "Excess Share" designation shall be in addition to any other remedy that the
Company may have upon a breach by C&S of any representation, warranty, covenant
or agreement contained herein.

          2. Representations and Warranties. C&S represents and warrants to the
Company as follows:

          a) As of the date hereof, and with respect to any Common Stock under
     C&S management, the Advisory Clients Beneficially Owned in the aggregate
     9,030,925 shares of the outstanding Common Stock of the Company. C&S is
     not in a partnership (as determined for federal income tax purposes)
     composed of C&S and one or more Advisory Clients, and C&S' Advisory Clients
     do not own more than 9.9% of C&S or any corporation controlled or managed
     by C&S.

          b) No other person who would constitute, along with C&S, a "group" as
     that term is used for purposes of Section 13(d)(3) ("Section 13(d)") of the
     Securities Exchange Act of 1934, as amended (the "Exchange Act"), owns any
     shares of Common Stock.

          c) None of C&S, C&S' Advisory Clients and any other person who would
     constitute, along with C&S, a "group" as that term is used for purposes of
     Section

                                        2

<PAGE>

     13(d)(3) Beneficially Own any of the stock, warrants, options, convertible
     debt or any other rights to acquire the stock of Kindred Healthcare, Inc.

          3. Covenants Regarding Ownership Attributes of the Additional Shares.
During the Waiver Period, C&S agrees that it shall not take any of the following
actions with respect to any Additional Shares (it being understood that the
limitations of this Section 3 shall not apply to Shares that are not Additional
Shares):

          a) Solicit proxies from stockholders of the Company, the power to
          vote, become a "participant" in any "election contest" (as such terms
          are used in Rule 14a-11 of the Exchange Act), with respect to the
          Company, or make any communication (other than as required by law)
          referred to in Rule 14a-1(l)(2)(iv) of the Exchange Act in connection
          with any election contest or other vote by stockholders of the Company
          or otherwise that is contrary to or conflicts with actions taken or
          omitted or to be omitted by the Board;

          b) Seek or vote for the removal of any member of the Board, except
          removal "for cause" as such term is used under the Delaware General
          Corporation Law;

          c) Vote for any individual nominated for election to the Board thereof
          other than those individuals nominated by the Board or a Committee
          thereof;

          d) Call or seek to have called any meeting of the stockholders of the
          Company;

          e) Otherwise act, alone or in concert with others to (i) solicit,
          propose, seek to effect or negotiate with any other person with
          respect to (A) any business combination with the Company or (B) any
          restructuring, recapitalization or similar transaction of the Company,
          (ii) solicit, propose, seek to effect or negotiate with any other
          person with respect to, or announce an intent to make, any tender
          offer or exchange offer for any voting securities of the Company, or
          (iii) assist, participate in, facilitate or solicit any effort or
          attempt by any persons to do or seek to do any of the foregoing; or

          f) Form, join or participate in a "group" (within the meaning of
          Section 13(d) of the Exchange Act) with respect to any of the matters
          described above.

          4. Additional Covenants Regarding Ownership of Common Stock. During
the Waiver Period:

          a) C&S shall limit the aggregate Beneficial Ownership by it, any
     Advisory Client and any Person who would constitute, along with C&S or C&S
     with any such Person or Advisory Client, a "group", as that term is used
     for purposes of Section 13(d) of the Exchange Act, of the Company's Common
     Stock to no more than 14% of the shares of Common Stock outstanding.

                                        3

<PAGE>

          b) Neither 10% or greater Beneficial Owners of C&S, C&S nor any of its
     Advisory Clients, taken separately or taken together in any combination
     with C&S, have been during 2000, 2001, 2002 or 2003 are, and shall not in
     the future be, partners in any partnership between or among C&S and any one
     or more of them as determined for federal income tax purposes which
     partnership Beneficially Owns any of the Company's Common Stock. With
     respect to assets under C&S' management, no single Advisory Client or
     combination of Advisory Clients with a mutual 10.0% or greater owner or any
     Person in control of them, Beneficially Owns or will at any time in the
     future Beneficially Own more than 9.0% of the Company's Common Stock
     outstanding. Neither C&S nor any Advisory Client, with respect to assets
     under C&S' management, currently Beneficially Owns, and will not
     Beneficially Own, more than 9.0% of the Company's Common Stock outstanding
     (excluding for this purpose Beneficial Ownership of Common Stock in excess
     of such amounts to the extent such Beneficial Ownership results solely from
     it being treated, along with the Advisory Clients, as a "group" under
     Section 13(d) of the Exchange Act).

          c) C&S, its Advisory Clients and any Person who would constitute,
     along with C&S or any Advisory Client, a "group" under Section 13(d) of the
     Exchange Act, shall comply with the terms of Article XII, except as
     expressly waived by the Board.

          d) During the term of the Waiver, none of C&S, C&S' Advisory Clients
     and any other person who would constitute, along with C&S, a "group" as
     that term is used for purposes of Section 13(d)(3), shall Beneficially Own
     any of the stock, warrants, options, convertible debt or any other rights
     to acquire the stock of Kindred Healthcare, Inc. or, after written notice
     from the Company to C&S of a proposed new tenant after the date hereof, any
     other such tenant of the Company.

          e) Notwithstanding any other provision of this letter or the related
     waiver, if any 10.0% or greater Beneficial Owners of C&S, C&S, its Advisory
     Clients, or any other person who would, along with C&S or the Beneficial
     Owners of C&S or any of them, either constitute a "group" under Section
     13(d)(3) or a partnership for federal income tax purposes, Beneficially
     Owns (excluding for this purpose Beneficial Ownership of Common Stock that
     results solely from being treated as part of a "group" under Section 13(d))
     more than 9.9% of the stock of the Company while Beneficially Owning,
     singly or taken together in any combination, any of the stock, warrants,
     options, convertible debt or any other rights to acquire the stock of
     Kindred Healthcare, Inc. or, after written notice from the Company to C&S
     of a proposed new tenant after the date hereof, any other such tenant of
     the Company, the Additional Shares owned will be automatically designated
     as "Excess Shares" under Article XII. Such designation will be effective as
     of the close of business on the business day prior to the date of the
     relevant event.

          f) This letter does not request a waiver in respect of any Common
     Shares held, owned, or Beneficially Owned by any Advisory Client that are
     not managed by C&S. Nothing in this letter or the Waiver shall restrict the
     application of Article XII to

                                        4

<PAGE>

     such other Common Shares, it being understood that all such other Common
     Shares remain subject to Article XII of the Certificate of Incorporation of
     the Company.

          5. Breach of Representations and Warranties. C&S understands that the
breach of any representation, warranty or covenant contained herein or the
failure to comply with its covenants and undertakings in this letter, in
addition to any other remedy available to the Company, subjects the Additional
Shares to being designated as "Excess Shares" under Article XII. In such event,
any waiver granted by the Board shall terminate and the Company may proceed in
any manner permitted under Article XII.

          6. Reduction and Termination of the Waiver. If at any time after C&S
Beneficially Owns more than the Ownership Limitation the ownership of Common
Shares by any Person covered by this waiver falls below the 9% limitation, this
waiver shall, as to each such Person, lapse and be of no further effect, with
the consequence that thereafter any subsequent purported acquisition of Common
Shares in violation of such limitation shall result in any shares above the 9%
limitation being Excess Shares.

                                       Very truly yours,

                                       COHEN & STEERS CAPITAL MANAGEMENT, INC.

                                       By: /s/ Joseph M. Harvey
                                           -------------------------------------
                                       Name:  Joseph M. Harvey
                                       Title: Senior Vice President

                                        5<PAGE>

                                                                    Exhibit 10.1

                                 AMENDMENT NO. 1

     THIS AMENDMENT NO. 1 dated as of June 10, 2003 (this "Amendment") to the
Credit Agreement referenced below is by and among VENTAS REALTY, LIMITED
PARTNERSHIP, a Delaware limited partnership (the "Borrower"), VENTAS, INC., a
Delaware corporation ("Ventas") and certain subsidiaries of Ventas identified
herein (together with Ventas, the "Guarantors") and BANK OF AMERICA, N.A., as
Administrative Agent for the Lenders. Capitalized terms used but not otherwise
defined herein shall have the meanings provided in the Credit Agreement.

                               W I T N E S S E T H

     WHEREAS, a $350 million revolving credit and term loan facility has been
established in favor of the Borrower pursuant to the terms of that Second
Amended and Restated Credit, Security and Guaranty Agreement dated as of April
17, 2002 (as amended and modified, the "Credit Agreement") among the Borrower,
the Guarantors, the Lenders and the Administrative Agent;

     WHEREAS, the Borrower has requested certain modifications to the terms of
the Credit Agreement; and

     WHEREAS, the requisite Lenders have agreed to the requested modifications
on the terms and conditions set forth herein;

     NOW, THEREFORE, in consideration of these premises and other good and
valuable consideration, the receipt and sufficiency of which is hereby
acknowledged, the parties agree as follows:

     SECTION 1 Amendments to the Credit Agreement. The Credit Agreement is
hereby amended in the following respects:

     1.1  Section 1.1 - Definitions. The definition of "Consolidated Adjusted
Net Worth" in Section 1.1 is amended to read as follows:

          "Consolidated Adjusted Net Worth" shall mean, as of any date, for
     Ventas and its Consolidated Subsidiaries on a consolidated basis, the sum
     of (i) consolidated shareholders' equity or net worth as of such day as
     determined in accordance with GAAP plus (ii) accumulated depreciation
     determined in accordance with GAAP, but excluding, for purposes hereof, the
     unrealized gain or loss on interest rate hedges or other interest rate
     derivatives reported on the Ventas Consolidated Balance Sheet as
     accumulated other comprehensive income (loss).

     1.2  Section 3.30 - Reportable Transactions. A new Section 3.30 is added to
read as follows:

     Section 3.30 Reportable Transactions.

          The Credit Parties do not intend to treat any of the Loans, the
     Letters of Credit or any related transaction as a "reportable transaction"
     (within the meaning of Treasury Regulation Section 1.6011-4). In the event
     a Credit Party determines that it will take any action inconsistent with
     such intention, it will promptly notify the Administrative Agent thereof.
     If a Credit Party so notifies the Administrative Agent, any Lender may
     treat its Loans (and its Participation Interests in Letters of Credit and
     Swingline Loans) as subject to Treasury Regulation Section 301.6112-1, and
     such Lender will maintain any lists and other records required thereby.

     1.3  Section 5.1 - Reports. Subsection (o) of Section 5.1 is relettered as
subsection (p), and a new subsection (o) is added to read as follows:

<PAGE>

          (o) Promptly after any Credit Party has notified the Administrative
     Agent of its intention to treat any of the Loans, the Letters of Credit or
     any related transaction as a "reportable transaction" (within the meaning
     of Treasury Regulation Section 1.6011-4), a duly completed copy of IRS Form
     8886 or any successor form thereto; and

     1.4  Section 12.17 - Confidentiality. A new sentence is added at the end of
Section 12.17 to read as follows:

     Notwithstanding anything herein to the contrary, the Administrative Agent
     and each Lender may disclose to any and all Persons, without limitation of
     any kind (other than limitations provided by Applicable Law), any
     information with respect to the "tax treatment" and "tax structure" (in
     each case, within the meaning of Treasury Regulation Section 1.6011-4) of
     the transactions contemplated hereby and all materials of any kind
     (including opinions or other tax analyses) that are provided to the
     Administrative Agent or any Lender relating to such tax treatment and tax
     structure; provided that with respect to any document or similar item that
     contains information concerning the tax treatment or tax structure of the
     transaction as well as other confidential information, this sentence shall
     only apply to such portions of the document or similar item that relate to
     the tax treatment or tax structure of the Loans, the Letters of Credit and
     the transactions contemplated hereby.

     SECTION 2 Conditions Precedent.

     2.1  This Amendment shall be effective immediately upon receipt by the
Administrative Agent, in form and substance satisfactory to the Administrative
Agent, of each of the following:

          (a) Counterparts of this Amendment duly executed by each of the Credit
     Parties and, at the direction of the Required Lenders, the Administrative
     Agent; and

          (b) Consents to this Amendment duly executed by the Required Lenders
     directing the Administrative Agent to enter this Amendment on their behalf.

     SECTION 3 Miscellaneous.

     3.1  The Credit Parties hereby affirm that, after giving effect to this
Amendment, the representations and warranties set forth in the Credit Agreement
and the other Credit Documents are true and correct in all material respects as
of the date hereof (except those which expressly relate to an earlier period).

     3.2  Except as modified hereby, all of the terms and provisions of the
Credit Agreement and the other Credit Documents (including schedules and
exhibits thereto) shall remain in full force and effect.

     3.3  The Borrower agrees to pay all reasonable costs and expenses of the
Administrative Agent in connection with the preparation, execution and delivery
of this Amendment, including the reasonable fees and expenses of Moore & Van
Allen, PLLC.

     3.4  This Amendment may be executed in any number of counterparts, each of
which when so executed and delivered shall be deemed an original, and it shall
not be necessary in making proof of this Amendment to produce or account for
more than one such counterpart. Delivery by any party hereto of an executed
counterpart of this Amendment by facsimile shall be effective as such party's
original

                                        2

<PAGE>

executed counterpart and shall constitute a representation that such party's
original executed counterpart will be delivered promptly.

     3.5  This Amendment shall be deemed to be a contract made under, and for
all purposes shall be construed in accordance with, the laws of the State of New
York.

                  [remainder of page intentionally left blank]

                                        3

<PAGE>

     IN WITNESS WHEREOF, each of the parties hereto has caused a counterpart of
this Amendment to be duly executed and delivered as of the date first above
written.

BORROWER:                        VENTAS REALTY, LIMITED PARTNERSHIP,
                                 a Delaware limited partnership

                                 By: Ventas, Inc., its General Partner

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

GUARANTORS:                      VENTAS, INC., a Delaware corporation

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

ADMINISTRATIVE AGENT:            BANK OF AMERICA, N.A., as Administrative Agent,
                                 at the direction and on behalf of the Lenders

                                 By: /s/ Kevin R. Wagley
                                    ----------------------------------
                                 Name:   Kevin R. Wagley
                                 Title:  Principal

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00054-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00054-of-00352.parquet"}]]