Document:

EX-4.6

 Exhibit 4.6 
 FOURTH SUPPLEMENTAL INDENTURE 
 This Fourth Supplemental Indenture (this
“Fourth Supplemental Indenture”) is dated as of July 13, 2011 and is entered into by and among inVentiv Health, Inc., a Delaware corporation (the “Issuer”), PDGI Holdco, Inc., a Delaware corporation, PharmaNet
Development Group, Inc., a Delaware corporation, Pharma Holdings, Inc., a Delaware corporation, PharmaNet, LLC, a Delaware limited liability company, PharmaNet USA, Inc., a New Jersey corporation, PharmaSoft, LLC, a Delaware limited liability
company, PharmaNet Resource Solutions, LLC, a Delaware limited liability company, South Florida Kinetics, Inc., a Florida corporation, Searento Trust, LLC, a Florida corporation, 11190 Biscayne, LLC, a Florida limited liability company, PharmaNet
FAR, LLC, a Delaware limited liability company (each, a “Guaranteeing Subsidiary” and, collectively, the “Guaranteeing Subsidiaries”), each a subsidiary of the Issuer, the existing Guarantors under the Indenture (as
defined below) and Wilmington Trust, National Association, as successor by merger to Wilmington Trust FSB, a federal savings bank, as Trustee (the “Trustee”). Capitalized terms not defined herein shall have the respective meanings
assigned to them in the Indenture. 
 W I T N E S S E T H 

WHEREAS, the Issuer, certain subsidiaries of the Issuer and the Trustee entered into an Indenture, dated as of August 4, 2010,
providing for the issuance of an unlimited aggregate principal amount of 10% Senior Notes due 2018, which Indenture was further supplemented by the Supplemental Indenture dated as of September 1, 2010, by and among Chamberlain Communications
Group LLC and the Trustee, the Supplemental Indenture dated as of February 11, 2011, by and among Campbell Alliance Group, Inc., Pharmaceutical Institute, Inc., Campbell Alliance Market Research and Analytics, LLC and the Trustee and the Third
Supplemental Indenture dated as of June 10, 2011, by and among the Issuer, Ingenix Pharmaceutical Services, Inc., Raven Holdco LLC, the existing Guarantors under the Indenture and the Trustee (as may be further amended supplemented or otherwise
modified from time to time, the “Indenture”); 
 WHEREAS, Section 2.01 and Section 9.01 of the
Indenture provide that the Issuer, the Guarantors, and the Trustee may enter into supplemental indentures to, among other things, provide for the issuance of Additional Notes in accordance with the provisions of the Indenture; and 

WHEREAS, the Issuer has duly authorized the issuance, delivery and authentication by the Trustee, of Additional Notes in an aggregate
principal amount of $390,000,000 having the same terms as the Initial Notes and accruing interest from February 15, 2011 (the “Additional Notes”), to be evidenced by a new Global Note evidencing the Additional Notes
substantially in the form of Exhibit A hereto, and each of the Issuer, the Guarantors, the Guaranteeing Subsidiaries and the Trustee has duly authorized the execution and delivery of this Fourth Supplemental Indenture. 

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”); 
 NOW, THEREFORE, for and in consideration of the promises and the mutual covenants hereinafter
contained, the parties hereto hereby agree as follows: 
 SECTION 1. Additional Notes. The terms of the Additional Notes shall be
governed under the Indenture and executed and delivered in the manner contemplated therein and each of the Guarantors shall guarantee such Additional Notes as set forth in Article 10 of the Indenture. 

 SECTION 2. Guaranteeing Subsidiaries. 

(1) Agreement to Guarantee. Each Guaranteeing Subsidiary hereby agrees as follows: 

(a) Along with all other Guarantors named in the Indenture (including pursuant to any supplemental indentures), to jointly
and severally unconditionally guarantee to each Holder of a Note authenticated and delivered by the Trustee and to the Trustee and its successors and assigns, irrespective of the validity and enforceability of the Indenture, the Notes or the
obligations of the Issuer hereunder or thereunder, that: 
 (i) the principal of and interest and premium, if
any, on the Notes shall be promptly paid in full when due, whether at maturity, by acceleration, redemption or otherwise, and interest on the overdue principal of and interest on the Notes, if any, if lawful, and all other obligations of the Issuer
to the Holders or the Trustee thereunder shall be promptly paid in full, all in accordance with the terms thereof; and 
 (ii) in case of any extension of time of payment or renewal of any Notes or any of such other obligations, that same shall be promptly paid in full when due in accordance with the terms of the extension
or renewal, whether at stated maturity, by acceleration or otherwise. Failing payment when due of any amount so guaranteed for whatever reason, the Guarantors and each Guaranteeing Subsidiary shall be jointly and severally obligated to pay the same
immediately. This is a guarantee of payment and not a guarantee of collection. 
 (b) The obligations hereunder
shall be unconditional, irrespective of the validity, regularity or enforceability of the Notes or the Indenture, the absence of any action to enforce the same, any waiver or consent by any Holder with respect to any provisions hereof or thereof,
the recovery of any judgment against the Issuer or any other Guarantor, any action to enforce the same or any other circumstance which might otherwise constitute a legal or equitable discharge or defense of a guarantor. 

(c) Each Guaranteeing Subsidiary hereby waives: diligence, presentment, demand of payment, filing of claims with a court
in the event of insolvency or bankruptcy of the Issuer, any right to require a proceeding first against the Issuer, protest, notice and all demands whatsoever. 
 (d) This Guarantee shall not be discharged except by full payment of the obligations contained in the Notes, the Indenture and this Fourth Supplemental Indenture. Each Guaranteeing Subsidiary accepts all
obligations applicable to a Guarantor under the Indenture, including Article 10 of the Indenture (which is deemed incorporated in this Fourth Supplemental Indenture and applicable to this Guarantee). Each Guaranteeing Subsidiary acknowledges that by
executing this Fourth Supplemental Indenture, it will become a Guarantor under the Indenture and subject to all the terms and conditions applicable to Guarantors contained therein. 

(e) If any Holder or the Trustee is required by any court or otherwise to return to the Issuer, the Guarantors (including
the Guaranteeing Subsidiaries), or any custodian, trustee, liquidator or other similar official acting in relation to either the Issuer or the Guarantors, any amount paid either to the Trustee or such Holder, this Guarantee, to the extent
theretofore discharged, shall be reinstated in full force and effect. 

  
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 (f) The Guaranteeing Subsidiaries shall not be entitled to any right of
subrogation in relation to the Holders in respect of any obligations guaranteed hereby until payment in full of all obligations guaranteed hereby. 
 (g) As between each Guaranteeing Subsidiary, on the one hand, and the Holders and the Trustee, on the other hand, (x) the maturity of the obligations guaranteed hereby may be accelerated as provided
in Article 6 of the Indenture for the purposes of this Guarantee, notwithstanding any stay, injunction or other prohibition preventing such acceleration in respect of the obligations guaranteed hereby, and (y) in the event of any declaration of
acceleration of such obligations as provided in Article 6 of the Indenture, such obligations (whether or not due and payable) shall forthwith become due and payable by the Guaranteeing Subsidiaries for the purpose of this Guarantee. 

(h) Each Guaranteeing Subsidiary shall have the right to seek contribution from any
non-paying Guarantor so long as the exercise of such right does not impair the rights of the Holders under this Guarantee. 

(i) Pursuant to Section 10.02 of the Indenture, after giving effect to all other contingent and fixed liabilities
that are relevant under any applicable Bankruptcy or fraudulent conveyance laws, and after giving effect to any collections from, rights to receive contribution from or payments made by or on behalf of any other Guarantor in respect of the
obligations of such other Guarantor under Article 10 of the Indenture, this new Guarantee shall be limited to the maximum amount permissible such that the obligations of such Guarantor under this Guarantee will not constitute a fraudulent transfer
or conveyance. 
 (j) This Guarantee shall remain in full force and effect and continue to be effective should
any petition be filed by or against the Issuer for liquidation, reorganization, should the Issuer become insolvent or make an assignment for the benefit of creditors or should a receiver or trustee be appointed for all or any significant part of the
Issuer’s assets, and shall, to the fullest extent permitted by law, continue to be effective or be reinstated, as the case may be, if at any time payment and performance of the Notes are, pursuant to applicable law, rescinded or reduced in
amount, or must otherwise be restored or returned by any obligee on the Notes and Guarantee, whether as a “voidable preference,” “fraudulent transfer” or otherwise, all as though such payment or performance had not been made. In
the event that any payment or any part thereof, is rescinded, reduced, restored or returned, the Note shall, to the fullest extent permitted by law, be reinstated and deemed reduced only by such amount paid and not so rescinded, reduced, restored or
returned. 
 (k) In case any provision of this Guarantee shall be invalid, illegal or unenforceable, the
validity, legality, and enforceability of the remaining provisions shall not in any way be affected or impaired thereby. 
 (l) This Guarantee shall be a general unsecured senior obligation of each Guaranteeing Subsidiary, ranking equally in right of payment with all existing and future Senior Indebtedness of the Guaranteeing
Subsidiaries, if any. 
 (m) Each payment to be made by each Guaranteeing Subsidiary in respect of this Guarantee
shall be made without set-off, counterclaim, reduction or diminution of any kind or nature. 

  
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 (2) 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. 
 (3) Merger, Consolidation or Sale of All or Substantially All Assets. 
 (a)
Except as otherwise provided in Section 5.01(c) of the Indenture, no Guaranteeing Subsidiary may consolidate, amalgamate or merge with or into or wind up into (whether or not such Guaranteeing Subsidiary is the surviving Person), or sell,
assign, transfer, lease, convey or otherwise dispose of all or substantially all of its properties or assets, in one or more related transactions, to any Person unless: 

(i) (A) such Guaranteeing Subsidiary is the surviving Person or the Person formed by or surviving any such consolidation,
amalgamation or merger (if other than such Guaranteeing Subsidiary) or to which such sale, assignment, transfer, lease, conveyance or other disposition will have been made is a Person organized or existing under the laws of the jurisdiction of
organization of such Guaranteeing Subsidiary, as applicable, or the laws of the United States, any state thereof, the District of Columbia, or any territory thereof (such surviving Guaranteeing Subsidiary or such Person, as the case may be, being
herein called the “Successor Person”); 
 (B) the Successor Person, if other than such
Guaranteeing Subsidiary, expressly assumes all the obligations of such Guaranteeing Subsidiary under the Indenture and such Guaranteeing Subsidiary’s related Guarantee pursuant to supplemental indentures or other documents or instruments as
necessary; 
 (C) immediately after such transaction, no Default exists; and 

(D) the Issuer shall have delivered to the Trustee an Officer’s Certificate and an Opinion of Counsel, each stating
that such consolidation, merger, amalgamation or transfer and such supplemental indentures, if any, comply with this Indenture; 
 (ii) the transaction is made in compliance with Section 4.10 of the Indenture; or 
 (iii) such property or assets constitute Equity Interests of Restricted Subsidiaries that are not Guarantors, which Equity Interests are sold, assigned, transferred, leased, conveyed or otherwise disposed
to Restricted Subsidiaries that are not Guarantors. 
 (b) Subject to certain limitations described in the Indenture, the
Successor Person will succeed to, and be substituted for, such Guaranteeing Subsidiary under the Indenture and the Guaranteeing Subsidiary’s Guarantee. Notwithstanding the foregoing, such Guaranteeing Subsidiary may merge or consolidate with or
into, wind up into or transfer all or part of its properties and assets to another Guarantor or the Issuer. 
 (4)
Releases. The Guarantee of any Guaranteeing Subsidiary shall be automatically and unconditionally released and discharged, and no further action by such Guaranteeing Subsidiary, the Issuer or the Trustee is required for the release of such
Guaranteeing Subsidiary’s Guarantee, upon: 
 (a) (i) any sale, exchange, disposition or transfer (by
merger, amalgamation, consolidation or otherwise) of (x) the Capital Stock of such Guaranteeing Subsidiary, after which the applicable Guaranteeing Subsidiary is no longer a Restricted Subsidiary, (y) all the assets of such Guarantor or
(z) if such Guarantor is not at such time a guarantor of the Senior Secured Credit Facilities, all or substantially all the assets of such Guaranteeing Subsidiary, in each case if such 

  
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sale, exchange, disposition or transfer is made in compliance with the applicable provisions of this Indenture; 

(ii) the release or discharge of the guarantee by such Guaranteeing Subsidiary of Indebtedness under the Senior Secured
Credit Facilities, or such other guarantee that resulted in the creation of such Guarantee, except a discharge or release by or as a result of payment under such guarantee (it being understood that a release subject to a contingent reinstatement is
still a release, and that if any such Guarantee is so reinstated, such Guarantee shall also be reinstated to the extent that such Guaranteeing Subsidiary would then be required to provide a Guarantee pursuant to Section 4.15 in the Indenture);

 (iii) the designation of any Restricted Subsidiary that is a Guaranteeing Subsidiary as an Unrestricted
Subsidiary in compliance with the applicable provisions of the Indenture; or 
 (iv) the exercise by the Issuer
of its Legal Defeasance option or Covenant Defeasance option in accordance with Article 8 of the Indenture or the discharge of the Issuer’s obligations under this Indenture in accordance with the terms of the Indenture; and 

(b) such Guaranteeing Subsidiary delivering to the Trustee an Officer’s Certificate and an Opinion of Counsel, each
stating that all conditions precedent provided for in this Indenture relating to such transaction have been complied with. 

(5) No Recourse Against Others. No past, present or future director, officer, employee, incorporator, member, partner or
stockholder of any Guaranteeing Subsidiary (other than the Issuer and the Guarantors) shall have any liability for any obligations of the Issuer or the Guarantors (including any Guaranteeing Subsidiary) under the Notes, any Guarantees, the Indenture
or this Fourth 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. 
 (6) Subrogation. Each Guaranteeing Subsidiary shall be subrogated to all
rights of Holders against the Issuer in respect of any amounts paid by each Guaranteeing Subsidiary pursuant to the provisions of Section 2(1) hereof and Section 10.01 of the Indenture; provided that, if an Event of Default has occurred
and is continuing, the Guaranteeing Subsidiaries shall not be entitled to enforce or receive any payments arising out of, or based upon, such right of subrogation until all amounts then due and payable by the Issuer under the Indenture or the Notes
shall have been paid in full. 
 (7) 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 Fourth Supplemental Indenture and
that the guarantee and waivers made by it pursuant to this Guarantee are knowingly made in contemplation of such benefits. 
 SECTION 3.
Miscellaneous. 
 (1) Governing Law. THIS FOURTH SUPPLEMENTAL INDENTURE WILL BE GOVERNED BY AND CONSTRUED IN
ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK. 
 (2) Counterparts. The parties may sign any number of copies of this
Fourth Supplemental Indenture. Each signed copy shall be an original, but all of them together represent the same agreement. 

  
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 (3) Effect of Headings. The Section headings herein are for convenience only and
shall not affect the construction hereof. 
 (4) The Trustee. The Trustee shall not be responsible in any manner
whatsoever for or in respect of the validity or sufficiency of this Fourth Supplemental Indenture or for or in respect of the recitals contained herein, all of which recitals are made solely by the Issuer, the existing Guarantors and each
Guaranteeing Subsidiary. 
 (5) Successors. All agreements of each Guaranteeing Subsidiary in this Fourth Supplemental
Indenture shall bind its Successors, except as otherwise provided in this Fourth Supplemental Indenture. All agreements of the Trustee in this Fourth Supplemental Indenture shall bind its successors. 

IN WITNESS WHEREOF, the Issuer, the existing Guarantors, the Guaranteeing Subsidiaries and the Trustee have caused this Fourth
Supplemental Indenture to be executed in their respective names as of the date first above written. 
  

					
	INVENTIV HEALTH, INC.
		
	By:	 	 /s/ Alessandro F. Nisita

		 	Name:	 	Alessandro F. Nisita
		 	Title:	 	Vice President, Assistant Secretary and Treasurer

  
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	RAVEN HOLDCO LLC, as a Guarantor
		
	By:	 	 /s/ Alessandro F. Nisita

		 	Name:	 	Alessandro F. Nisita
		 	Title:	 	Vice President, Assistant Secretary and Treasurer
	
	INGENIX PHARMACEUTICAL SERVICES, INC., as a Guarantor
		
	By:	 	 /s/ Alessandro F. Nisita

		 	Name:	 	Alessandro F. Nisita
		 	Title:	 	Vice President and Assistant Secretary

 [Supplemental Indenture] 

			
	 ADDISON WHITNEY LLC
 ADHERIS,
INC.
  
 ALLIDURA COMMUNICATIONS, LLC

 
 ANOVA CLINICAL RESOURCES LLC

 
 AWAC LLC

 
 AXCELO MSL SOLUTIONS, LLC

 
 BIOSECTOR 2 LLC

 
 BLUE DIESEL, LLC

 
 BRANDTECTONICS, L.L.C.

 
 CADENT MEDICAL COMMUNICATIONS, LLC

 
 CHAMBERLAIN COMMUNICATIONS GROUP LLC

 
 CHANDLER CHICCO AGENCY, L.L.C.

 
 CHANDLER CHICCO COMPANIES LLC

 
 CHANDLER CHICCO PRODUCTIONS LLC

 
 ESSENTIAL GROUP INTERNATIONAL LLC

 
 FRANKLIN PHARMA SERVICES, LLC

 
 GERBIG, SNELL/WEISHEIMER ADVERTISING, LLC

 
 HHI CLINICAL & STATISTICAL RESEARCHSERVICES, L.L.C.

 
 IGNITE HEALTH LLC

 
 INCHORD HOLDING CORPORATION

 
 INTERPHAZ BIOCONSULTING, LLC

 
 INVENTIV ADVANCE INSIGHTS, INC.
	 	 INVENTIV CLINICAL SOLUTIONS LLC
  

INVENTIV COMMUNICATIONS, INC.
  
 INVENTIV MEDICAL EDUCATION GROUP, LLC
  
 LITMUS MEDICAL MARKETING SERVICES LLC
  
 MEDCONFERENCE LLC
  
 MEDFOCUS
LLC
  
 NAVICOR GROUP, LLC

 
 PALIO COMMUNICATIONS, LLC

 
 PARAGONRX INTERNATIONAL LLC

 
 PATIENT MARKETING GROUP LLC

 
 PROMOTECH LOGISTICS SOLUTIONS, LLC

 
 PROMOTECH RESEARCH ASSOCIATES, INC.

 
 SMITH HANLEY ASSOCIATES LLC

 
 SMITH HANLEY CONSULTING GROUP LLC

 
 SMITH HANLEY HOLDING CORPORATION

 
 SYNERGOS LLC

 
 THE CENTER FOR BIOMEDICAL CONTINUING EDUCATION, LLC

 
 THE SELVA GROUP, LLC

 
 VENTIV COMMERCIAL SERVICES, LLC

 
 VERSTONE DIGITAL, LLC

 
 each as a Guarantor

  

					
	By:	 	 /s/ Alessandro F. Nisita

		 	Name:	 	Alessandro F. Nisita
		 	Title:	 	Vice President and Treasurer

  
 [Supplemental
Indenture] 

					
	 CAMPBELL ALLIANCE GROUP, INC.
  

CAMPBELL ALLIANCE MARKET RESEARCH AND ANALYTICS, LLC
  

PHARMACEUTICAL INSTITUTE, INC.
  

each as a Guarantor

		
	By:	 	 /s/ John J. Campbell

		 	Name:	 	John J. Campbell
		 	Title:	 	Chief Executive Officer

  
 [Supplemental
Indenture] 

					
	 PDGI HOLDCO, INC.
  

PHARMANET DEVELOPMENT GROUP, INC.
  

PHARMA HOLDINGS, INC.
  
 PHARMANET, LLC
  
 PHARMANET USA,
INC.
  
 PHARMASOFT, LLC

 
 PHARMANET RESOURCE SOLUTIONS, LLC

 
 SOUTH FLORIDA KINETICS, INC.

 
 SEARENTO TRUST LLC

 
 11190 BISCAYNE, LLC

 
 PHARMANET FAR, LLC

 
 each as a Guarantor

		
	By:	 	 /s/ Christopher S. Brenna

		 	Name:	 	Christopher S. Brennan
		 	Title:	 	Secretary

  

  
 [Supplemental
Indenture] 

 
			
	 WILMINGTON TRUST, NATIONAL ASSOCIATION, as Trustee

		
	By:	 	 /s/ Joseph P. O’Donnell

		 	Authorized Officer

  
 [Supplemental
Indenture] 

 EXHIBIT A 
 [Face of Note] 
 [Insert the Global Note Legend] 

[Insert the Private Placement Legend, if applicable pursuant to the provisions of the Indenture] 

[Insert the Regulation S Temporary Global Note Legend, if applicable pursuant to the provisions of the Indenture] 

THIS SECURITY WAS ISSUED WITH ORIGINAL ISSUE DISCOUNT (“OID”), FOR PURPOSES OF SECTIONS 1272, 1273, AND 1275 OF THE CODE. THE ISSUER WILL,
BEGINNING NO LATER THAN TEN (10) DAYS AFTER THE ISSUE DATE, PROMPTLY PROVIDE TO HOLDERS OF SECURITIES, UPON WRITTEN REQUEST, THE ISSUE PRICE, THE AMOUNT OF OID, THE ISSUE DATE AND THE YIELD TO MATURITY WITH RESPECT TO THE SECURITIES. ANY SUCH
WRITTEN REQUEST SHOULD BE SENT TO THE ISSUER AT INVENTIV HEALTH, INC., 1 VAN DE GRAAFF DRIVE, BURLINGTON, MA 01803, ATTENTION: CHIEF FINANCIAL OFFICER. 

  
 A-1EX-4.7

 Exhibit 4.7 

Execution Version 
 FIFTH
SUPPLEMENTAL INDENTURE 
 Fifth Supplemental Indenture (this “Supplemental Indenture”), dated as of April 30,
2012, among Kforce Clinical Research, LLC, a Florida limited liability company, Kforce Clinical Research Flex, LLC, a Florida limited liability company, KCR Canada, Inc., a Florida corporation, and KCR Puerto Rico, LLC, a Florida limited liability
company (each, a “Guaranteeing Subsidiary” and collectively, the “Guaranteeing Subsidiaries”), each, a subsidiary of inVentiv Health, Inc., a Delaware corporation (the “Issuer”), and Wilmington
Trust, National Association, as successor by merger to Wilmington Trust FSB, as trustee (the “Trustee”). 
 W I T N E S S E
T H 
 WHEREAS, inVentiv Health, Inc. and the Guarantors (as defined in the Indenture referred to below) have heretofore executed and
delivered to the Trustee an Indenture (the “Indenture”), dated as of August 4, 2010, providing for the issuance of an unlimited aggregate principal amount of 10% Senior Notes due 2018; 

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 hereby agrees as follows: 

(a) Along with all other Guarantors named in the Indenture (including pursuant to any supplemental indentures), to jointly and
severally unconditionally guarantee to each Holder of a Note authenticated and delivered by the Trustee and to the Trustee and its successors and assigns, irrespective of the validity and enforceability of the Indenture, the Notes or the obligations
of the Issuer hereunder or thereunder, that: 
 (i) the principal of and interest and premium, if any, on the Notes shall be
promptly paid in full when due, whether at maturity, by acceleration, redemption or otherwise, and interest on the overdue principal of and interest on the Notes, if any, if lawful, and all other obligations of the Issuer to the Holders or the
Trustee thereunder shall be promptly paid in full, all in accordance with the terms thereof; and 
 (ii) in case of any
extension of time of payment or renewal of any Notes or any of such other obligations, that same shall be promptly paid in full when due in accordance with the terms of the extension or renewal, whether at stated maturity, by acceleration or
otherwise. Failing payment when due of any amount so guaranteed for whatever reason, the Guarantors and each Guaranteeing Subsidiary shall be jointly and severally obligated to pay the same immediately. This is a guarantee of payment and not a
guarantee of collection. 
 (b) The obligations hereunder shall be unconditional, irrespective of the validity, regularity or
enforceability of the Notes or the Indenture, the absence of any action to enforce the same, any waiver or consent by any Holder with respect to any provisions hereof or thereof, the recovery of any judgment against the Issuer or any other
Guarantor, any action to enforce the same or any other circumstance which might otherwise constitute a legal or equitable discharge or defense of a guarantor. 

 (c) Each Guaranteeing Subsidiary hereby waives: diligence, presentment, demand of
payment, filing of claims with a court in the event of insolvency or bankruptcy of the Issuer, any right to require a proceeding first against the Issuer, protest, notice and all demands whatsoever. 

(d) This Guarantee shall not be discharged except by full payment of the obligations contained in the Notes, the Indenture and
this Supplemental Indenture. Each Guaranteeing Subsidiary accepts all obligations applicable to a Guarantor under the Indenture, including Article 10 of the Indenture (which is deemed incorporated in this Supplemental Indenture and applicable to
this Guarantee). Each Guaranteeing Subsidiary acknowledges that by executing this Supplemental Indenture, it will become a Guarantor under the Indenture and subject to all the terms and conditions applicable to Guarantors contained therein. 

(e) If any Holder or the Trustee is required by any court or otherwise to return to the Issuer, the Guarantors (including the
Guaranteeing Subsidiaries), or any custodian, trustee, liquidator or other similar official acting in relation to either the Issuer or the Guarantors, any amount paid either to the Trustee or such Holder, this Guarantee, to the extent theretofore
discharged, shall be reinstated in full force and effect. 
 (f) The Guaranteeing Subsidiaries shall not be entitled to any
right of subrogation in relation to the Holders in respect of any obligations guaranteed hereby until payment in full of all obligations guaranteed hereby. 

(g) As between each Guaranteeing Subsidiary, on the one hand, and the Holders and the Trustee, on the other hand, (x) the
maturity of the obligations guaranteed hereby may be accelerated as provided in Article 6 of the Indenture for the purposes of this Guarantee, notwithstanding any stay, injunction or other prohibition preventing such acceleration in respect of the
obligations guaranteed hereby, and (y) in the event of any declaration of acceleration of such obligations as provided in Article 6 of the Indenture, such obligations (whether or not due and payable) shall forthwith become due and payable by
the Guaranteeing Subsidiaries for the purpose of this Guarantee. 
 (h) Each Guaranteeing Subsidiary shall have the right to
seek contribution from any non-paying Guarantor so long as the exercise of such right does not impair the rights of the Holders under this Guarantee. 

(i) Pursuant to Section 10.02 of the Indenture, after giving effect to all other contingent and fixed liabilities that are
relevant under any applicable Bankruptcy or fraudulent conveyance laws, and after giving effect to any collections from, rights to receive contribution from or payments made by or on behalf of any other Guarantor in respect of the obligations of
such other Guarantor under Article 10 of the Indenture, this new Guarantee shall be limited to the maximum amount permissible such that the obligations of such Guarantor under this Guarantee will not constitute a fraudulent transfer or conveyance.

 (j) This Guarantee shall remain in full force and effect and continue to be effective should any petition be filed by or
against the Issuer for liquidation, reorganization, should the Issuer become insolvent or make an assignment for the benefit of creditors or should a receiver or trustee be appointed for all or any significant part of the Issuer’s assets, and
shall, to the fullest extent permitted by law, continue to be effective or be reinstated, as the case may be, if at any time payment and performance of the Notes are, pursuant to applicable law, rescinded or reduced in amount, or must otherwise be
restored or returned by any obligee on the Notes and Guarantee, whether as a “voidable preference,” “fraudulent transfer” or otherwise, all as though such payment or performance had not been made. In the event that any payment or
any part thereof, is rescinded, reduced, restored or returned, the Note shall, to the fullest extent permitted by law, be reinstated and deemed reduced only by such amount paid and not so rescinded, reduced, restored or returned. 

  
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 (k) In case any provision of this Guarantee shall be invalid, illegal or
unenforceable, the validity, legality, and enforceability of the remaining provisions shall not in any way be affected or impaired thereby. 

(l) This Guarantee shall be a general unsecured senior obligation of each Guaranteeing Subsidiary, ranking equally in right of
payment with all existing and future Senior Indebtedness of the Guaranteeing Subsidiaries, if any. 
 (m) Each payment to be
made by each Guaranteeing Subsidiary in respect of this Guarantee shall be made without set-off, counterclaim, reduction or diminution of any kind or nature. 

(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) Merger, Consolidation or Sale of
All or Substantially All Assets. 
 (a) Except as otherwise provided in Section 5.01(c) of the Indenture, no Guaranteeing
Subsidiary may consolidate, amalgamate or merge with or into or wind up into (whether or not such Guaranteeing Subsidiary is the surviving Person), or sell, assign, transfer, lease, convey or otherwise dispose of all or substantially all of its
properties or assets, in one or more related transactions, to any Person unless: 
 (i) (A) such Guaranteeing Subsidiary
is the surviving Person or the Person formed by or surviving any such consolidation, amalgamation or merger (if other than such Guaranteeing Subsidiary) or to which such sale, assignment, transfer, lease, conveyance or other disposition will have
been made is a Person organized or existing under the laws of the jurisdiction of organization of such Guaranteeing Subsidiary, as applicable, or the laws of the United States, any state thereof, the District of Columbia, or any territory thereof
(such surviving Guaranteeing Subsidiary or such Person, as the case may be, being herein called the “Successor Person”); 

(B) the Successor Person, if other than such Guaranteeing Subsidiary, expressly assumes all the obligations of such
Guaranteeing Subsidiary under the Indenture and such Guaranteeing Subsidiary’s related Guarantee pursuant to supplemental indentures or other documents or instruments as necessary; 

(C) immediately after such transaction, no Default exists; and 

(D) the Issuer shall have delivered to the Trustee an Officer’s Certificate and an Opinion of Counsel, each stating that
such consolidation, merger, amalgamation or transfer and such supplemental indentures, if any, comply with this Indenture; or 

(ii) the transaction is made in compliance with Section 4.10 of the Indenture; or 

(iii) such property or assets constitute Equity Interests of Restricted Subsidiaries that are not Guarantors, which Equity
Interests are sold, assigned, transferred, leased, conveyed or otherwise disposed to Restricted Subsidiaries that are not Guarantors. 
 (b)
Subject to certain limitations described in the Indenture, the Successor Person will succeed to, and be substituted for, such Guaranteeing Subsidiary under the Indenture and the Guaranteeing Subsidiary’s Guarantee. Notwithstanding the
foregoing, such Guaranteeing Subsidiary may merge or consolidate with or into, wind up into or transfer all or part of its properties and assets to another Guarantor or the Issuer. 

(5) Releases. The Guarantee of any Guaranteeing Subsidiary shall be automatically and unconditionally released and discharged, and no
further action by such Guaranteeing Subsidiary, the Issuer or the Trustee is required for the release of such Guaranteeing Subsidiary’s Guarantee, upon: 

(a) (i) any sale, exchange, disposition or transfer (by merger, amalgamation, consolidation or otherwise) of (x) the
Capital Stock of such Guaranteeing Subsidiary, after which the applicable Guaranteeing Subsidiary is no longer a Restricted Subsidiary, (y) all the assets of such Guarantor or (z) if such Guarantor is not at such time a guarantor of the
Senior Secured Credit Facilities, all or substantially all the assets of such Guaranteeing Subsidiary, in each case if such sale, exchange, disposition or transfer is made in compliance with the applicable provisions of this Indenture; 

  
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 (ii) the release or discharge of the guarantee by such Guaranteeing Subsidiary of
Indebtedness under the Senior Secured Credit Facilities, or such other guarantee that resulted in the creation of such Guarantee, except a discharge or release by or as a result of payment under such guarantee (it being understood that a release
subject to a contingent reinstatement is still a release, and that if any such Guarantee is so reinstated, such Guarantee shall also be reinstated to the extent that such Guaranteeing Subsidiary would then be required to provide a Guarantee pursuant
to Section 4.15 in the Indenture); 
 (iii) the designation of any Restricted Subsidiary that is a Guaranteeing
Subsidiary as an Unrestricted Subsidiary in compliance with the applicable provisions of the Indenture; or 
 (iv) the
exercise by the Issuer of its Legal Defeasance option or Covenant Defeasance option in accordance with Article 8 of the Indenture or the discharge of the Issuer’s obligations under this Indenture in accordance with the terms of the Indenture;
and 
 (b) such Guaranteeing Subsidiary delivering to the Trustee an Officer’s Certificate and an Opinion of Counsel,
each stating that all conditions precedent provided for in this Indenture relating to such transaction have been complied with. 
 (6) No
Recourse Against Others. No past, present or future director, officer, employee, incorporator, member, partner or stockholder of any Guaranteeing Subsidiary (other than the Issuer and the Guarantors) shall have any liability for any obligations
of the Issuer or the Guarantors (including any Guaranteeing Subsidiary) 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. 

(7) Governing Law. THIS SUPPLEMENTAL INDENTURE WILL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK.

 (8) 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. 
 (9) Effect of Headings. The Section headings herein are for convenience
only and shall not affect the construction hereof. 
 (10) 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 each Guaranteeing Subsidiary. 

(11) Subrogation. Each Guaranteeing Subsidiary shall be subrogated to all rights of Holders against the Issuer in respect of any
amounts paid by each Guaranteeing Subsidiary pursuant to the provisions of Section 2 hereof and Section 10.01 of the Indenture; provided that, if an Event of Default has occurred and is continuing, the Guaranteeing Subsidiaries
shall not be entitled to enforce or receive any payments arising out of, or based upon, such right of subrogation until all amounts then due and payable by the Issuer under the Indenture or the Notes shall have been paid in full. 

(12) 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. 

  
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 (13) Successors. All agreements of each Guaranteeing Subsidiary in this Supplemental
Indenture shall bind its Successors, except as otherwise provided in this Supplemental Indenture. All agreements of the Trustee in this Supplemental Indenture shall bind its successors. 

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

					
	KFORCE CLINICAL RESEARCH, LLC
		
	By:	 	 /s/ Alex Nisita

		 	Name:	 	Alex Nisita
		 	Title:	 	Treasurer

  
 Signature Page to
Supplemental Indenture 

 
					
	KFORCE CLINICAL RESEARCH FLEX, LLC
		
	By:	 	 /s/ Alessandro F. Nisita

		 	Name:	 	Alessandro F. Nisita
		 	Title:	 	Vice President and Treasurer

  
 Signature Page to
Supplemental Indenture 

 
					
	KCR CANADA, INC.
		
	By:	 	 /s/ Alessandro F. Nisita

		 	Name:	 	Alessandro F. Nisita
		 	Title:	 	Vice President and Treasurer

  
 Signature Page to
Supplemental Indenture 

 
					
	KCR PUERTO RICO, LLC
		
	By:	 	 /s/ Alessandro F. Nisita

		 	Name:	 	Alessandro F. Nisita
		 	Title:	 	Vice President and Treasurer

  
 Signature Page to
Supplemental Indenture 

 
					
	 WILMINGTON TRUST, NATIONAL ASSOCIATION,

as Trustee

		
	By:	 	 /s/ Joseph P O’Donnell

		 	Name:	 	Joseph P O’Donnell
		 	Title:	 	Vice President

  
 Signature Page to
Supplemental Indenture

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