EX-4.2



 Exhibit 4.2 

FIRST SUPPLEMENTAL INDENTURE 

First Supplemental Indenture (this “Supplemental Indenture”), dated as of August 12, 2015, among Altegra Health,
Inc., a Delaware corporation, Altegra Health Operating Company, a Delaware corporation, Altegra Health Operating Company – Puerto Rico, LLC, a Delaware limited liability company, and Altegra Health Connections, LLC, a Delaware limited liability
company (collectively, the “Guaranteeing Subsidiaries”), each a subsidiary of Emdeon Inc., a Delaware corporation (the “Issuer”), and Wilmington Trust, National Association, a national banking association, as
trustee (the “Trustee”), Transfer Agent, Registrar and Paying Agent. 
 W I T N E S S E T H 

WHEREAS, the Issuer and the Guarantors have heretofore executed and delivered to the Trustee an Indenture (the
“Indenture”), dated as of August 12, 2015, providing for the issuance of $250,000,000 aggregate principal amount of 6.00% Senior Notes due 2021 (the “Initial Notes”); 

WHEREAS, the Indenture provides that under certain circumstances the Guaranteeing Subsidiaries shall execute and deliver to the Trustee
a supplemental indenture pursuant to which the Guaranteeing Subsidiaries shall unconditionally guarantee all of the Issuer’s Obligations under the Notes and the Indenture on the terms and conditions set forth herein and under the Indenture (the
“Guarantee”); and 
 WHEREAS, pursuant to Section 9.01 of the Indenture, the Trustee is 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 parties mutually covenant and agree for the equal and ratable benefit of the Holders as follows: 

(1) Capitalized Terms. Capitalized terms used herein without definition shall have the meanings assigned to them in the Indenture. 

(2) Agreement to Guarantee. Each Guaranteeing Subsidiary acknowledges that it has received and reviewed a copy of the Indenture and all
other documents it deems necessary to review in order to enter into this Supplemental Indenture, and acknowledges and agrees to (i) join and become a party to the Indenture as indicated by its signature below; (ii) be bound by the
Indenture, as of the date hereof, as if made by, and with respect to, each signatory hereto; and (iii) perform all obligations and duties required of a Guarantor pursuant to the Indenture. Each Guaranteeing Subsidiary hereby agrees to provide
an unconditional Guarantee on the terms and subject to the conditions set forth in the Indenture, including, but not limited to, Article 10 thereof. 

(3) Execution and Delivery. Each Guaranteeing Subsidiary agrees that the Guarantee shall remain in full force and effect
notwithstanding the absence of the endorsement of any notation of such Guarantee on the Notes. 
 (4) No Recourse Against Others. No
past, present or future director, officer, employee, incorporator, member, partner or stockholder of the Issuer or any Guaranteeing Subsidiary shall have any liability for any obligations of the Issuer or the Guarantors (including the Guaranteeing
Subsidiaries) under the Notes, any Guarantees, the Indenture or this Supplemental Indenture or for any claim based on, in respect of, or by reason of, such obligations or their creation. Each Holder by accepting Notes waives and releases all such
liability. The waiver and release are part of the consideration for issuance of the Notes. 







 (5) Governing Law. THIS SUPPLEMENTAL INDENTURE, AND ANY CLAIM, CONTROVERSY OR DISPUTE
ARISING UNDER OR RELATED TO THIS SUPPLEMENTAL INDENTURE, WILL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK. 

(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. This Supplemental Indenture may be executed in multiple counterparts which, when taken together, shall constitute one instrument. The exchange of copies of this Supplemental Indenture and of
signature pages by facsimile or PDF transmissions shall constitute effective execution and delivery of this Supplemental Indenture as to the parties hereto and may be used in lieu of the original Supplemental Indenture for all purposes. Signatures
of the parties hereto transmitted by facsimile or PDF shall be deemed to be their original signatures for all purposes. 
 (7) Effect of
Headings. The Section headings herein are for convenience only and shall not affect the construction hereof. 
 (8) The Trustee.
The Trustee shall not be responsible in any manner whatsoever for or in respect of the validity or sufficiency of this Supplemental Indenture or for or in respect of the recitals contained herein, all of which recitals are made solely by the
Guaranteeing Subsidiaries. 
 (9) Benefits Acknowledged. Each Guaranteeing Subsidiary’s Guarantee is subject to the terms and
conditions set forth in the Indenture. Each Guaranteeing Subsidiary acknowledges that it will receive direct and indirect benefits from the financing arrangements contemplated by the Indenture and this Supplemental Indenture and that the guarantee
and waivers made by it pursuant to this Guarantee are knowingly made in contemplation of such benefits. 
 (10) Successors. All
agreements of each Guaranteeing Subsidiary in this Supplemental Indenture shall bind the Successors of such Guaranteeing Subsidiary, except as otherwise provided in this Supplemental Indenture. All agreements of the Trustee in this Supplemental
Indenture shall bind its successors. 

  
 -2- 








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

					
	ALTEGRA HEALTH, INC.
		
	By:	 	 /s/ Gregory T. Stevens

		 	Name:	 	Gregory T. Stevens
		 	Title:	 	Secretary
	
	ALTEGRA HEALTH OPERATING COMPANY
		
	By:	 	 /s/ Gregory T. Stevens

		 	Name:	 	Gregory T. Stevens
		 	Title:	 	Secretary
	
	ALTEGRA HEALTH OPERATING COMPANY – PUERTO RICO, LLC
		
	By:	 	 /s/ Gregory T. Stevens

		 	Name:	 	Gregory T. Stevens
		 	Title:	 	Secretary
	
	ALTEGRA HEALTH CONNECTIONS, LLC
		
	By:	 	 /s/ Gregory T. Stevens

		 	Name:	 	Gregory T. Stevens
		 	Title:	 	Secretary
	
	WILMINGTON TRUST, NATIONAL ASSOCIATION, as Trustee
		
	By:	 	 /s/ Joseph P. O’Donnell

		 	Name:	 	Joseph P. O’Donnell
		 	Title:	 	Vice President