EX-4.11



 Exhibit 4.11 

TWENTIETH SUPPLEMENTAL INDENTURE 

TWENTIETH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of October 30, 2014, among NEWCO SS, LLC,
NEWCO AA, INC., NEWCO RD, LLC, NEWCO RD2, LLC, AND ALERE HOLDCO, INC., (collectively, the “New Guarantors”), which are Subsidiaries of Alere Inc. (or its successor) (the “Issuer”), ALERE INC., a Delaware
corporation, each of the existing Guarantors (the “Existing Guarantors”) under the Indenture referred to below, and U.S. BANK NATIONAL ASSOCIATION, as Trustee under the Indenture referred to below (the “Trustee”).

 WITNESSETH: 
 WHEREAS the
Issuer has heretofore executed and delivered to the Trustee an Indenture dated as of May 12, 2009, as amended, supplemented and modified by a Sixteenth Supplemental Indenture dated as of May 24, 2013, and an Eighteenth Supplemental
Indenture dated as of June 5, 2014 (as so amended, supplemented and 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 6.50% Senior Subordinated Notes due 2020 (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, each of the New Guarantors, the Trustee, the Issuer and the Existing Guarantors 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 Eleven 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
Notes 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. 
 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 effect 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. 
  

			
	ISSUER:
	
	ALERE INC.
		
	By:		 /s/ David A. Teitel

	Name:		David A. Teitel
	Title:		Chief Financial Officer and Treasurer


 Signature Page to Twentieth Supplemental Indenture 







 
			
	NEW GUARANTORS:
	
	NEWCO SS, LLC
	NEWCO AA, INC.
	NEWCO RD, LLC
	NEWCO RD2, LLC
	ALERE HOLDCO, INC., as New Guarantors
		
	By:		 /s/ Jay McNamara

			Name: Jay McNamara
			Title: Assistant Secretary


 Signature Page to Twentieth 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
NORTH AMERICA, INC.
 ALERE OF NEW YORK, INC.
 ALERE SAN DIEGO,
INC.
 ALERE SCARBOROUGH, INC.
 ALERE US HOLDINGS, LLC

ALERE WELLBEING, INC.
 ALERE WELLOLOGY, INC.

ALERE WOMEN’S AND CHILDREN’S HEALTH, LLC

AMEDITECH INC.
 BIOSITE INCORPORATED

FIRST CHECK DIAGNOSTICS CORP.

		
	By:		 /s/ David A. Teitel

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



 Signature Page to Twentieth Supplemental Indenture 







 
			
	EXISTING GUARANTORS (continued):
	
	INNOVACON, INC.
	INVERNESS MEDICAL, LLC
	QUALITY ASSURED SERVICES, INC.
	REDWOOD TOXICOLOGY LABORATORY, INC.
	RTL HOLDINGS, INC.
	SELFCARE TECHNOLOGY, INC.
	ZYCARE, INC.
		
	By:		 /s/ David A. Teitel

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



 Signature Page to Twentieth Supplemental Indenture 







 
					
	EXISTING GUARANTORS (continued):
	
	ALERE INFORMATICS, INC.
	ALERE TOXICOLOY SERVICES, INC.
	ATS LABORATORIES, INC.
	AVEE LABORATORIES INC.
	ESCREEN, INC.
	INSTANT TECHNOLOGIES, INC.
	LABORATORY SPECIALISTS OF AMERICA, INC.
	PEMBROOKE OCCUPATIONAL HEALTH, INC.
	SCREEN TOX, INC.
		
	By:		 /s/ Jay McNamara

			Name: Jay McNamara
			Title: Assistant Secretary
	
	GLOBAL ANALYTICAL DEVELOPMENT LLC,
		
			By: ATS LABORATORIES, INC., ITS
			MANAGING MEMBER
			
			By:		 /s/ Ellen V. Chiniara

					Name: Ellen V. Chiniara
					Title: Secretary


 Signature Page to Twentieth Supplemental Indenture 







 
			
	TRUSTEE:
	
	 U.S. BANK NATIONAL ASSOCIATION,

as Trustee

		
	By:		 /s/ Thomas E. Tabor

			Name: Thomas E. Tabor
			Title: Vice President


 Signature Page to Twentieth Supplemental Indenture