Document:

First Supplemental Indenture

 Exhibit 4.1.1 
 FIRST SUPPLEMENTAL INDENTURE (this “First Supplemental Indenture”), dated as of November 4, 2010, among Sabra Health Care Limited Partnership, a Delaware limited partnership, and
Sabra Capital Corporation, a Delaware corporation (each, an “Issuer”, and together, the “Issuers”), Sabra Health Care REIT, Inc., a Maryland corporation (the “Parent”), Orchard Ridge Nursing Center
LLC, a Massachusetts limited liability company, New Hampshire Holdings LLC, a Delaware limited liability company, Oakhurst Manor Nursing Center LLC, a Massachusetts limited liability company, Sunset Point Nursing Center LLC, a Massachusetts limited
liability company, Connecticut Holdings I LLC, a Delaware limited liability company, West Bay Nursing Center LLC, a Massachusetts limited liability company, HHC 1998-I Trust, a Massachusetts trust, Northwest Holdings I LLC, a Delaware limited
liability company, 395 Harding Street, LLC, a Delaware limited liability company, 1104 Wesley Avenue, LLC, a Delaware limited liability company, Kentucky Holdings I, LLC, a Delaware limited liability company, Sabra Lake Drive, LLC (fka Peak Medical
Oklahoma Holdings-Lake Drive, Inc.), a Delaware limited liability company, Bay Tree Nursing Center LLC, a Massachusetts limited liability company, Sabra Health Care Holdings III, LLC, a Delaware limited liability company, Sabra Health Care Holdings
IV, LLC, a Delaware limited liability company, Sabra Idaho, LLC, a Delaware limited liability company, Sabra California II, LLC, a Delaware limited liability company, Sabra New Mexico, LLC, a Delaware limited liability company, Sabra Connecticut II,
LLC, a Delaware limited liability company, Sabra Ohio, LLC, a Delaware limited liability company, Sabra Kentucky, LLC, a Delaware limited liability company, Sabra NC, LLC, a Delaware limited liability company, (each, a “Guaranteeing
Subsidiary” and, together the “Guaranteeing Subsidiaries”), the other Guarantors (as defined in the Indenture referred to herein) and Wells Fargo Bank, National Association, a national banking association organized and
existing under the laws of the United States of America, as Trustee (the “Trustee”). 
 WITNESSETH 

WHEREAS, the Issuers, the Parent and the Guarantors have heretofore executed and delivered to the Trustee an indenture (the
“Indenture”), dated as of October 27, 2010 providing for the issuance of 8.125% Senior Notes due 2018 (the “Notes”); 
 WHEREAS, Section 4.18 of the Indenture provides that under certain circumstances each Guaranteeing Subsidiary shall execute and deliver to the Trustee a supplemental indenture pursuant to which each
Guaranteeing Subsidiary shall unconditionally guarantee all of the obligations of the Issuers and the Parent under the Notes and the Indenture on the terms and conditions set forth herein (the “Note Guaranty”); 

WHEREAS, pursuant to Section 10.03 of the Indenture, each Guaranteeing Subsidiary is required to endorse a notation of its Note
Guaranty substantially in the form included in Exhibit D to the Indenture; 
 WHEREAS, pursuant to Section 9.01 of the
Indenture, the Trustee is authorized to execute and deliver this First Supplemental Indenture; and 

 WHEREAS, all the conditions and requirements necessary to make this First Supplemental
Indenture a valid, binding and legal instrument in accordance with its terms have been performed and fulfilled by the parties hereto and the execution and delivery thereof have been in all respects duly authorized by the parties hereto. 

NOW, THEREFORE, in consideration of the foregoing and for other good and valuable consideration, the receipt of which is hereby
acknowledged, each Guaranteeing Subsidiary and the Trustee mutually covenant and agree for the equal and ratable benefit of the Holders of the Notes as follows: 
 1. CAPITALIZED TERMS. Capitalized terms used herein without definition shall have the meanings assigned to them in the Indenture. 
 2. EFFECTIVENESS. Notwithstanding anything to the contrary contained herein, this First Supplemental Indenture shall become effective upon the declaration of the distribution to holders of Sun’s
common stock to effect the Separation. 
 3. AGREEMENT TO GUARANTY. Each Guaranteeing Subsidiary hereby agrees, jointly and
severally with all Guarantors, to provide an unconditional Guaranty, on and subject to the terms, conditions and limitations set forth in the Guaranty and in the Indenture, including, but not limited, to Article Ten thereof and to perform all of the
obligations and agreements of a Guarantor under the Indenture as if named as a Guarantor there under. 
 4. NOTATION OF
GUARANTY. Each Guaranteeing Subsidiary hereby agrees that a notation of such Note Guaranty substantially in the form included in Exhibit D to the Indenture shall be endorsed by an Officer of such Guaranteeing Subsidiary in accordance with the
requirements of Section 10.03 of the Indenture, which Note Guaranty shall become effective upon the declaration of the distribution to holders of Sun’s common stock to effect the Separation. 

5. NEW YORK LAW TO GOVERN. THIS FIRST SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE
OF NEW YORK, WITHOUT GIVING EFFECT TO CONFLICTS OF LAW PRINCIPLES TO THE EXTENT THAT THE APPLICATION OF THE LAWS OF ANOTHER JURISDICTION WOULD BE REQUIRED THEREBY. 
 6. COUNTERPARTS. The parties may sign any number of copies of this First Supplemental Indenture. Each signed copy shall be an original, but all of them together represent the same agreement. 

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
First Supplemental Indenture or for or in respect of the recitals contained herein, all of 

 
which recitals are made solely by each Guaranteeing Subsidiary, the Issuers and the Parent. 

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

					
	 SABRA HEALTH CARE LIMITED PARTNERSHIP,
 as Issuer,

			
		 	by	 	 /s/ Richard K. Matros

		 		 	Name: Richard K. Matros
		 		 	Title:   President
	
	 SABRA CAPITAL CORPORATION,
 as Issuer,

			
		 	by	 	 /s/ Richard K. Matros

		 		 	Name: Richard K. Matros
		 		 	Title:   Chief Executive Officer and President
	
	 SABRA HEALTH CARE REIT, INC.,
 as Parent and a Guarantor,

			
		 	by	 	 /s/ Richard K. Matros

		 		 	Name: Richard K. Matros
		 		 	Title:   Chief Executive Officer

 [Signature Page to Supplemental Indenture] 

  

					
	 SUN HEALTHCARE GROUP, INC.,
 as Guarantor

			
		 	by	 	 /s/ Richard K. Matros

		 		 	Name: Richard K. Matros
		 		 	Title:   Chairman of the Board and Chief
		 		 	   Executive Officer

	
	 SABRA HEALTH CARE LLC,
 as Subsidiary Guarantor

			
		 	by	 	 /s/ Richard K. Matros

		 		 	Name: Richard K. Matros
		 		 	Title:   President
	
	 SABRA HEALTH CARE HOLDINGS I, LLC,
 as Subsidiary Guarantor

			
		 	by	 	 /s/ Richard K. Matros

		 		 	Name: Richard K. Matros
		 		 	Title: President
	
	 SABRA HEALTH CARE HOLDINGS II, LLC,
 as Subsidiary Guarantor

			
		 	by	 	 /s/ Richard K. Matros

		 		 	Name: Richard K. Matros
		 		 	Title:   President

[Signature Page to Supplemental Indenture] 

  

			
	 ORCHARD RIDGE NURSING CENTER LLC,
 as a Guaranteeing Subsidiary

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 NEW HAMPSHIRE HOLDINGS LLC,
 as a Guaranteeing Subsidiary

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 OAKHURST MANOR NURSING CENTER LLC,
 as a Guaranteeing Subsidiary

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 SUNSET POINT NURSING CENTER LLC,
 as a Guaranteeing Subsidiary

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 CONNECTICUT HOLDINGS I LLC,
 as a Guaranteeing Subsidiary

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 WEST BAY NURSING CENTER LLC,
 as a Guaranteeing Subsidiary

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary

 [Signature Page to
Supplemental Indenture] 

  

			
	HHC 1998-I TRUST,
	as a Guaranteeing Subsidiary
		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 NORTHWEST HOLDINGS I LLC,
 as a Guaranteeing Subsidiary

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 395 HARDING STREET, LLC,
 as a Guaranteeing Subsidiary

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 1104 WESLEY AVENUE, LLC,
 as a Guaranteeing Subsidiary

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 KENTUCKY HOLDINGS I, LLC,
 as a Guaranteeing Subsidiary

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 SABRA LAKE DRIVE, LLC (FKA PEAK MEDICAL OKLAHOMA HOLDINGS-LAKE DRIVE, INC.),

as a Guaranteeing Subsidiary

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary

 [Signature Page to
Supplemental Indenture) 

  

			
	BAY TREE NURSING CENTER LLC,
	as a Guaranteeing Subsidiary
		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 SABRA HEALTH CARE HOLDINGS III, LLC,
 as a Guaranteeing Subsidiary

		
	By:	 	  

		 	Name: Harold W. Andrews, Jr.
		 	Title: Secretary
	
	 SABRA HEALTH CARE HOLDINGS IV, LLC,
 as a Guaranteeing Subsidiary

		
	By:	 	  

		 	Name: Harold W. Andrews, Jr.
		 	Title: Secretary
	
	 SABRA IDAHO, LLC,

as a Guaranteeing Subsidiary

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 SABRA CALIFORNIA II, LLC,
 as a Guaranteeing Subsidiary

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 SABRA NEW MEXICO, LLC,
 as a Guaranteeing Subsidiary

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary

 [Signature Page to
Supplemental Indenture] 

  

			
	SABRA CONNECTICUT II, LLC,
	as a Guaranteeing Subsidiary
		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 SABRA OHIO, LLC,

as a Guaranteeing Subsidiary

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 SABRA KENTUCKY, LLC,

as a Guaranteeing Subsidiary

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 SABRA NC, LLC,
 as
a Guaranteeing Subsidiary

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary

 [Signature Page to
Supplemental Indenture] 

  

					
	WELLS FARGO BANK, NATIONAL ASSOCIATION,
	as Trustee,
		
	by	 	 /s/ Maddy Hall

		 	Name:	 	Maddy Hall
		 	Title:	 	Vice President

 [Signature Page to
Supplemental Indenture]Joinder

 Exhibit 4.2.1 

JOINDER dated as of November 4, 2010 (this “Joinder”), to the Registration Rights Agreement dated as of
October 27, 2010 (the “Registration Rights Agreement”) among Sabra Health Care REIT, Inc., Sabra Health Care Limited Partnership, Sabra Capital Corporation, Sun Healthcare Group, Inc., the Closing Date Subsidiary
Guarantors identified therein and Banc of America Securities LLC, in its individual capacity and as Representative for the other Initial Purchasers. 
 A. Reference is made to the Registration Rights Agreement. 
 B. Capitalized terms used herein and
not otherwise defined herein shall have the meanings assigned to such terms in the Registration Rights Agreement. 
 C. Each of Sabra, Old Sun,
the Issuers and the Closing Date Subsidiary Guarantors have entered into the Registration Rights Agreement in order to induce the Initial Purchasers to purchase the Initial Securities, all as set forth in more detail in the Registration Rights
Agreement. As a condition to the Representative entering into the Registration Rights Agreement on behalf of itself and as the Representative of the several Initial Purchasers, and thereby agreeing to purchase the Initial Securities on the terms set
forth in the Purchase Agreement, it required the other parties to the Registration Rights Agreement to provide certain representations and warranties and to make certain other covenants and agreements. At the time of the entering into of the
Registration Rights Agreement, it was also contemplated that any Subsequent Subsidiary Guarantor would become party to the Registration Rights Agreement on or prior to the Escrow Release Date and execute a Supplemental Indenture to the Indenture as
a condition to the proceeds of the Initial Securities being released by the Escrow Agent. Section 12(e) of the Registration Rights Agreement provides that any Subsequent Subsidiary Guarantor will become a "Guarantor" for purposes of the
Registration Rights Agreement by execution and delivery of an instrument in the form of this Joinder. The undersigned Subsequent Subsidiary Guarantor (the “New Guarantor”) is executing this Joinder to become a Guarantor under the
Registration Rights Agreement as consideration for the prior issuance of the Initial Securities under the Purchase Agreement and is concurrently executing a Supplemental Indenture to the Indenture in satisfaction of a condition to the release of the
Escrowed Funds (as defined in the Purchase Agreement). 
 Accordingly, the Representative and the New Guarantor agree as follows: 

SECTION 1. In accordance with Section 12(e) of the Registration Rights Agreement, the New Guarantor by its signature below becomes a Guarantor for
all purposes of the Registration Rights with the same force and effect as if originally named therein (with due acknowledgment of the fact that the joinder of such New Guarantor to the Registration Rights Agreement shall only become effective as of
the date hereof) and the New Guarantor hereby agrees to all the terms and provisions of the Registration Rights Agreement applicable to it as a Guarantor thereunder, including, for the avoidance of doubt, the provisions of Section 8 of the
Registration Rights Agreement. The Registration Rights Agreement is hereby incorporated herein by reference. 

 SECTION 2. The New Guarantor represents and warrants to, and agrees with, the Representative, on behalf of
itself and as the Representative of the several Initial Purchasers, on and as of the date hereof that: 
 (a) this Joinder has been duly
authorized, executed and delivered by such New Guarantor; 
 (e) The execution, delivery and performance of this Joinder by the New Guarantor
and the consummation of the transactions contemplated hereby and by the Registration Rights Agreement will not conflict with, result in any breach or violation of or constitute a default under (nor constitute any event which, with notice, lapse of
time or both, would result in any breach or violation of, constitute a default under or give the holder of any indebtedness (or a person acting on such holder's behalf) the right to require the repurchase, redemption or repayment of all or a part of
such indebtedness under) (or result in the creation or imposition of a lien, charge or encumbrance on any property or assets of the New Guarantor) (A) the charter, partnership agreement or bylaws, as the case may be, of the New Guarantor,
(B) any indenture, mortgage, deed of trust, bank loan or credit agreement or other evidence of indebtedness, or any license, lease, contract or other agreement or instrument to which the New Guarantor is a party or by which any of its
properties may be bound or affected, (C) any Federal, state, local or foreign law, regulation or rule, including any such law, rule or regulation applicable to the health care industry as they apply to the businesses of the New Guarantor
(collectively “Applicable Laws”), (D) any rule or regulation of any self-regulatory organization or other non-governmental regulatory authority (including the rules and regulations of FINRA) or (E) any decree,
judgment or order applicable to the New Guarantor or any of its properties, other than in the case of clause (B) for such breaches, violations and defaults that would not, individually or in the aggregate, reasonably be expected to have a
Material Adverse Effect. 
 SECTION 3. This Joinder may be executed in two or more counterparts, each one of which shall be an original, with
the same effect as if the signatures thereto and hereto were upon the same instrument. Delivery of an executed counterparty of a signature page to this Joinder by telecopier, facsimile or other electronic transmission (i.e., a “pdf” or
“tif”) shall be effective as delivery of a manually executed counterpart thereof. 
 SECTION 4. Except as expressly supplemented
hereby, the Purchase Agreement shall remain in full force and effect. 
 SECTION 5. THIS JOINDER SHALL BE GOVERNED BY AND CONSTRUED IN
ACCORDANCE WITH THE INTERNAL LAWS OF THE STATE OF NEW YORK APPLICABLE TO AGREEMENTS MADE AND TO BE PERFORMED IN SUCH STATE WITHOUT REGARD TO CONFLICTS OF LAW PRINCIPLES THEREOF. 
 SECTION 6. The invalidity or unenforceability of any section, paragraph or provision of this Joinder shall not affect the validity or enforceability of any other section, paragraph or provision hereof. If
any section, paragraph or provision of this Joinder is for any reason determined to be invalid or unenforceable, there shall be deemed to be made such minor changes (and only such minor changes) as are necessary to make it valid and enforceable.

 SECTION 7. All communications and notices hereunder shall be in writing and given as provided in
Section 12(e) of the Registration Rights Agreement. 
 [remainder of page intentionally blank] 

 IN WITNESS WHEREOF, the New Guarantor and the Representative have duly executed this Joinder to the
Registration Rights Agreement as of the day and year first above written. 
  

			
	 Orchard Ridge Nursing Center LLC,
 as a New Guarantor

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 New Hampshire Holdings LLC,

as a New Guarantor

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 Oakhurst Manor Nursing Center LLC,
 as a New Guarantor

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 Sunset Point Nursing Center LLC,
 as a New Guarantor

		
	 By:
	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary

[Signature Page to Joinder to Registration Rights Agreement] 

  

			
	 Connecticut Holdings I LLC,
 as a New Guarantor

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 West Bay Nursing Center LLC,
 as a New Guarantor

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 HHC 1998-I Trust,
 as a New Guarantor

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 Northwest Holdings I LLC,
 as a New Guarantor

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary

[Signature Page to Joinder to Registration Rights Agreement] 

  

			
	 395 Harding Street, LLC,
 as a New Guarantor

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 1104 Wesley Avenue, LLC,
 as a New Guarantor

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 Kentucky Holdings I, LLC,
 as a New Guarantor

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 Sabra Lake Drive, LLC (fka Peak Medical
 Oklahoma Holdings-Lake Drive, Inc.),
 as a New Guarantor

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary

[Signature Page to Joinder to Registration Rights Agreement] 

  

			
	 Bay Tree Nursing Center LLC,
 as a New Guarantor

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 Sabra Health Care Holdings III, LLC,
 as a New Guarantor

		
	By:	 	  

		 	Name: Harold W. Andrews, Jr.
		 	Title: Secretary
	
	 Sabra Health Care Holdings IV, LLC,
 as a New Guarantor

		
	By:	 	  

		 	Name: Harold W. Andrews, Jr.
		 	Title: Secretary
	
	 Sabra Idaho, LLC,

as a New Guarantor

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary

[Signature Page to Joinder to Registration Rights Agreement] 

  

			
	 Bay Tree Nursing Center LLC,
 as a New Guarantor

		
	By:	 	  

		 	Name: Mike Berg
		 	Title: Secretary
	
	 Sabra Health Care Holdings III, LLC,
 as a New Guarantor

		
	By:	 	 /s/ Harold W. Andrews, Jr.

		 	Name: Harold W. Andrews, Jr.
		 	Title: Secretary
	
	 Sabra Health Care Holdings IV, LLC,
 as a New Guarantor

		
	By:	 	 /s/ Harold W. Andrews, Jr.

		 	Name: Harold W. Andrews, Jr.
		 	Title: Secretary
	
	 Sabra Idaho, LLC,

as a New Guarantor

		
	By:	 	  

		 	Name: Mike Berg
		 	Title: Secretary

[Signature Page to Joinder to Registration Rights Agreement] 

  

			
	 Sabra California II, LLC,
 as a New Guarantor

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 Sabra New Mexico, LLC,
 as a New Guarantor

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 Sabra Connecticut II, LLC,
 as a New Guarantor

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 Sabra Ohio, LLC,

as a New Guarantor

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary

[Signature Page to Joinder to Registration Rights Agreement] 

  

			
	 Sabra Kentucky, LLC,

as a New Guarantor

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary
	
	 Sabra NC, LLC,
 as
a New Guarantor

		
	By:	 	 /s/ Mike Berg

		 	Name: Mike Berg
		 	Title: Secretary

[Signature Page to Joinder to Registration Rights Agreement] 

  

					
	 BANC OF AMERICA SECURITIES LLC
as the
Representative

			
	By:	 		 	Banc of America Securities LLC
			
		 	By:	 	 /s/ Sarang Gadkari

		 		 	Name: Sarang Gadkari
		 		 	Title: Managing Director

[Signature Page to Joinder to Registration Rights Agreement]

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