EX-4.6



 Exhibit 4.6 
 SIXTEENTH SUPPLEMENTAL INDENTURE 
 SIXTEENTH SUPPLEMENTAL INDENTURE (this
“Supplemental Indenture”), dated as of April 3, 2013, among IONIAN TECHNOLOGIES INC., STANDING STONE, INC., AVEE LABORATORIES INC., ALERE INFORMATICS, INC., ALERE WELLOGIC, LLC, ESCREEN, INC., ATS LABORATORIES, INC., SCREEN
TOX, INC., GLOBAL ANALYTICAL DEVELOPMENT LLC, AND PEMBROOKE OCCUPATIONAL HEALTH, INC. (collectively, the “New Guarantors”), which are Subsidiaries of Alere Inc. (or its successor) (the “Issuer”), ALERE INC., a
Delaware corporation, on behalf of itself and the Guarantors (the “Existing Guarantors”) under the Indenture referred to below, and THE BANK OF NEW YORK MELLON TRUST COMPANY, N.A., as Trustee under the Indenture referred to below
(the “Trustee”). 
 WITNESSETH: 
 WHEREAS the Issuer has heretofore executed and delivered an Indenture dated as of August 11, 2009, as amended, supplemented and modified by a Fifteenth Supplemental Indenture dated as of
December 11, 2012 (as so amended, supplemented or modified, and as further amended, supplemented or modified to date, the “Indenture”), by and among the Issuer, the Existing Guarantors and the Trustee, providing for the
issuance of 7.250% Senior Notes due 2018 (the “Notes”); 
 WHEREAS Section 4.13 of the Indenture provides
that under certain circumstances the Issuer is required to cause each of the New Guarantors to execute and deliver to the Trustee a supplemental indenture pursuant to which each of the New Guarantors shall unconditionally and irrevocably guarantee
all of the Issuer’s obligations under the Notes pursuant to a guarantee on the terms and conditions set forth herein; and 

WHEREAS pursuant to Section 9.01 of the Indenture, the Trustee, the Issuer and the Existing Guarantors are authorized to execute and
deliver this Supplemental Indenture; 
 NOW THEREFORE, in consideration of the foregoing and for other good and valuable
consideration, the receipt of which is hereby acknowledged, the New Guarantors, the Trustee and, on behalf of itself and the Existing Guarantors, the Issuer mutually covenant and agree for the equal and ratable benefit of the Holders as follows:

 SECTION 1. Definitions. For all purposes of this Supplemental Indenture, except as otherwise herein expressly provided
or unless the context otherwise requires: (i) the terms and expressions used herein shall have the same meanings as corresponding terms and expressions used in the Indenture; and (ii) the words “herein,” “hereof” and
“hereby” and other words of similar import used in this Supplemental Indenture refer to this Supplemental Indenture as a whole and not to any particular section hereof. 

SECTION 2. Agreement to Guarantee. Each of the New Guarantors hereby unconditionally and irrevocably agrees, jointly and severally
with all other Guarantors, to guarantee the Issuer’s obligations under the Notes and the Indenture on the terms and subject to the conditions set forth in Article Ten of the Indenture and to be bound by all other applicable provisions of the
Indenture. 
 SECTION 3. Ratification of Indenture; Supplemental Indenture Part of Indenture. Except as expressly amended
hereby, the Indenture is in all respects ratified and confirmed and all the terms, conditions and provisions thereof shall remain in full force and effect. This Supplemental Indenture shall form a part of the Indenture for all purposes, and every
Holder of every Note heretofore or hereafter authenticated and delivered shall be bound hereby. 
 SECTION 4.
Governing Law. This Supplemental Indenture shall be governed by, and construed in accordance with, the laws of the State of New York, but without giving effect to applicable principles of conflicts of laws to the extent that the
application of the laws of another jurisdiction would be required thereby. 







 SECTION 5. Trustee Makes No Representation. The Trustee makes no representation as to
the validity or sufficiency of this Supplemental Indenture or as to the recitals contained herein. 
 SECTION 6.
Counterparts. The parties may sign any number of copies of this Supplemental Indenture. Each signed copy shall be an original, but all of them together represent the same agreement. 

SECTION 7. Effect of Headings. The Section headings herein are for convenience only and shall not affect the construction thereof.

 [Signature Page Follows] 

  
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 IN WITNESS WHEREOF, the parties hereto have caused this Supplemental Indenture to be duly executed as of the
date first above written. 
  

			
	 NEW GUARANTORS:
  

IONIAN TECHNOLOGIES INC.
 STANDING STONE,
INC.
 AVEE LABORATORIES INC.
 ALERE
INFORMATICS, INC.
 ALERE WELLOGIC, LLC

ESCREEN, INC.
 ATS LABORATORIES, INC.

SCREEN TOX, INC.
 PEMBROOKE OCCUPATIONAL HEALTH,
INC., as New Guarantors

		
	By:	 	/s/ Ellen V. Chiniara
		 	 Name: Ellen V. Chiniara

Title: Secretary



  

			
	 GLOBAL ANALYTICAL DEVELOPMENT LLC, as a New Guarantor

 
 By: ATS LABORATORIES, INC., ITS MANAGING MEMBER

		
	By:	 	/s/ Ellen V. Chiniara
		 	 Name: Ellen V. Chiniara

Title: Secretary



 Signature Page to Sixteenth Supplemental Indenture 







 
			
	 ISSUER:
  

ALERE INC.

		
	By:	 	/s/ David A. Teitel
		 	 Name: David A. Teitel

Title: Chief Financial Officer and Treasurer



 Signature Page to Sixteenth Supplemental Indenture 







 
			
	 EXISTING GUARANTORS:
  

ALERE HEALTH, LLC

ALERE HEALTHCARE OF ILLINOIS, INC.

ALERE HEALTH IMPROVEMENT COMPANY

ALERE HOME MONITORING, INC.

ALERE INTERNATIONAL HOLDING CORP.

ALERE NEWCO, INC.

ALERE NEWCO II, INC.

ALERE NORTH AMERICA, INC.

ALERE OF NEW YORK, INC.

ALERE SAN DIEGO, INC.

ALERE SCARBOROUGH, INC.

ALERE US HOLDINGS, LLC

ALERE WELLBEING
 ALERE WELLOLOGY, INC.
 ALERE WOMEN’S AND
CHILDREN’S HEALTH, LLC
 AMEDITECH INC.

BINAX, INC.
 BIOSITE INCORPORATED
 FIRST CHECK DIAGNOSTICS
CORP.
 FIRST CHECK ECOM, INC.

		
	By:	 	/s/ David A. Teitel
		 	 Name: David A. Teitel
 Title (respectively): Vice President and Treasurer; Vice President, Finance and Treasurer; Vice President and Treasurer; Vice President, Finance; President; President; President; Vice President, Finance;
Vice President, Finance; Vice President, Finance; Vice President, Finance; President; Vice President, Finance and Treasurer; Vice President and Treasurer; Vice President, Finance; Chief Financial Officer; Vice President, Finance; Vice President,
Finance; Vice President, Finance; Vice President, Finance



 Signature Page to Sixteenth Supplemental Indenture 







 
			
	 EXISTING GUARANTORS (continued):
  

INNOVACON, INC.
 INSTANT TECHNOLOGIES, INC.
 INVERNESS MEDICAL,
LLC
 IVC INDUSTRIES, INC.

QUALITY ASSURED SERVICES, INC.

REDWOOD TOXICOLOGY LABORATORY, INC.

RMD NETWORKS, INC.

RTL HOLDINGS, INC.

SELFCARE TECHNOLOGY, INC.

ZYCARE, INC.

		
	By:	 	/s/ David A. Teitel
		 	 Name: David A. Teitel
 Title (respectively): Vice President, Finance; Vice President, Finance; Vice President, Finance; President; Vice President, Finance; Vice President, Finance; Vice President, Finance and Treasurer; Vice
President, Finance; Vice President, Finance; Chief Financial Officer and Treasurer



 Signature Page to Sixteenth Supplemental Indenture 







 
			
	 EXISTING GUARANTORS (continued):
  

ALERE TOXICOLOY SERVICES, INC.

LABORATORY SPECIALISTS OF AMERICA, INC.

		
	By:	 	/s/ Jay McNamara
		 	 Name: Jay McNamara
 Title:
Assistant Secretary



 Signature Page to Sixteenth Supplemental Indenture 







 
			
	 THE BANK OF NEW YORK MELLON TRUST COMPANY, N.A.,
 as Trustee

		
	By:	 	/s/ Linda Garcia
		 	 Name: Linda Garcia
 Title:
Vice President



 Signature Page to Sixteenth Supplemental Indenture