Document:

EX-4.1

 Exhibit 4.1 

FIRST SUPPLEMENTAL INDENTURE 

THIS FIRST SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), entered into as of February 2, 2015, among Kindred
Healthcare, Inc., a Delaware corporation (the “Company”), each of the Subsidiary Guarantors listed on the signature pages hereto, (each a “Supplemental Guarantor” and, collectively, the “Supplemental
Guarantors”), and Wells Fargo Bank, National Association., as trustee (the “Trustee”). Capitalized terms used herein and not otherwise defined herein are used as defined in the Indenture referred to below. 

RECITALS 
 WHEREAS, Kindred
Escrow Corp. II, a Delaware corporation (the “Escrow Issuer”) and the Trustee have heretofore entered into that certain Indenture, dated as of December 18, 2014 (as amended or supplemented, the “Indenture”),
relating to the 8.00% Senior Notes due 2020 in original principal amount of $750,000,000 (the “Notes”). 
 WHEREAS, each
Supplemental Guarantor is to become a Subsidiary Guarantor under the Indenture; and 
 WHEREAS, on the date hereof, the Escrow Issuer is
merging with and into the Company, with the Company being the surviving Person of such merger (the “Merger”). 
 AGREEMENT

 NOW, THEREFORE, the parties to this Supplemental Indenture hereby agree as follows: 

Section 1. The Company, pursuant to Article 5 of the Indenture, hereby expressly assumes and agrees to pay, perform and discharge when
due each and every debt, obligation, covenant and agreement incurred, made or to be paid, performed or discharged by the Escrow Issuer under the Indenture and the Notes. 

Section 2. Each Supplemental Guarantor hereby agrees, jointly and severally with all other Supplemental Guarantors, and fully and
unconditionally, to be a Subsidiary Guarantor under the Indenture on the terms and subject to the conditions set forth in Article 10 of the Indenture and to be bound by (and shall be entitled to the benefits of) all other applicable provisions
of the Indenture as a Subsidiary Guarantor. 
 Section 3. This Supplemental Indenture is an amendment supplemental to the Indenture,
and the Indenture and this Supplemental Indenture will henceforth be read together. 
 Section 4. This Supplemental Indenture shall be
governed by and construed in accordance with the laws of the State of New York. 
 Section 5. This Supplemental Indenture may be signed
in various counterparts which together will constitute one and the same instrument. The exchange of copies of this Supplemental Indenture and of signature pages by facsimile or PDF transmission 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. 
 Section 6. 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 Company and each Subsidiary Guarantor. 

[Signature pages follow] 

 
					
	KINDRED HEALTHCARE, INC.
		
	By:	 	 /s/ Joseph L. Landenwich

		 	Name:	 	Joseph L. Landenwich
		 	Title:	 	Co-General Counsel and Corporate Secretary
	
	Aberdeen Holdings, Inc.
	Able Home Healthcare, Inc.
	Advanced Oncology Services, Inc.
	American VitalCare, LLC
	Avery Manor Nursing, L.L.C.
	Bayberry Care Center, L.L.C.
	Braintree Nursing, L.L.C.
	BWB Sunbelt Home Health Services, LLC
	California Nursing Centers, L.L.C.
	Care Center of Rossmoor, L.L.C.
	Central Arizona Home Health Care, Inc.
	Clear Lake Rehabilitation Hospital, L.L.C.
	Compass Hospice, Inc.
	Country Estates Nursing, L.L.C.
	Courtland Gardens Health Center, Inc.
	Focus Care Health Resources, Inc.
	Forestview Nursing, L.L.C.
	GBA Holding, Inc.
	GBA West, LLC
	Goddard Nursing, L.L.C.
	Greenbrae Care Center, L.L.C.
	Greens Nursing and Assisted Living, L.L.C.
	Harborlights Nursing, L.L.C.
	Haven Health, LLC
	Helian ASC of Northridge, Inc.
	Helian Health Group, Inc.
	HHS Healthcare Corp.
	Highgate Nursing, L.L.C.
	Highlander Nursing, L.L.C.
	Homecare Holdings, Inc.
	Home Health of Rural Texas, Inc.
	Home Health Services, Inc.
	Homestead Health and Rehabilitation Center, L.L.C.
	IntegraCare Holdings, Inc.
	IntegraCare Home Health Services, Inc.
	IntegraCare Hospice of Abilene, LLC
	IntegraCare Intermediate Holdings, Inc.
	IntegraCare of Abilene, LLC
	IntegraCare of Albany, LLC
	IntegraCare of Athens-Home Health, LLC
	IntegraCare of Athens-Hospice, LLC
	IntegraCare of Granbury, LLC
	IntegraCare of Littlefield, LLC
	IntegraCare of Olney Home Health, LLC
	IntegraCare of Texas, LLC
	IntegraCare of West Texas-Home Health, LLC
	IntegraCare of West Texas-Hospice, LLC
	IntegraCare of Wichita Falls, LLC

			
	J. B. Thomas Hospital, Inc.
	KAH Development 1, L.L.C.
	KAH Development 2, L.L.C.
	KAH Development 3, L.L.C.
	KAH Development 4, L.L.C.
	KAH Development 5, L.L.C.
	KAH Development 6, L.L.C.
	KAH Development 7, L.L.C.
	KAH Development 8, L.L.C.
	KAH Development 9, L.L.C.
	KAH Development 10, L.L.C.
	KAH Development 11, L.L.C.
	KAH Development 12, L.L.C.
	KAH Development 13, L.L.C.
	KAH Development 14, L.L.C.
	KAH Development 15, L.L.C.
	Kindred Braintree Hospital, L.L.C.
	Kindred Development 4, L.L.C.
	Kindred Development 7, L.L.C.
	Kindred Development 8, L.L.C.
	Kindred Development 9, L.L.C.
	Kindred Development 10, L.L.C.
	Kindred Development 11, L.L.C.
	Kindred Development 12, L.L.C.
	Kindred Development 13, L.L.C.
	Kindred Development 15, L.L.C.
	Kindred Development 17, L.L.C.
	Kindred Development 27, L.L.C.
	Kindred Development 29, L.L.C.
	Kindred Development Holdings 3, L.L.C.
	Kindred Development Holdings 5, L.L.C.
	Kindred Healthcare Operating, Inc.
	Kindred Healthcare Services, Inc.
	Kindred Hospice Services, L.L.C.
	Kindred Hospital-Pittsburgh-North Shore, L.L.C.
	Kindred Hospitals East, L.L.C.
	Kindred Hospital Palm Beach, L.L.C.
	Kindred Hospital-Springfield, L.L.C.
	Kindred Hospital-Toledo, L.L.C.
	Kindred Hospitals West, L.L.C.
	Kindred Nevada, L.L.C.
	Kindred Nursing Centers East, L.L.C.
	Kindred Nursing Centers North, L.L.C.
	Kindred Nursing Centers South, L.L.C.
	Kindred Nursing Centers West, L.L.C.
	Kindred Rehab Services, Inc.
	Kindred Systems, Inc.
	KND Development 50, L.L.C.
	KND Development 51, L.L.C.
	KND Development 52, L.L.C.
	KND Development 53, L.L.C.
	KND Development 54, L.L.C.
	KND Development 55, L.L.C.
	KND Development 56, L.L.C.
	KND Development 57, L.L.C.
	KND Development 58, L.L.C.

 
	
	KND Development 59, L.L.C.
	KND Development 60, L.L.C.
	KND Development 61, L.L.C.
	KND Development 62, L.L.C.
	KND Development 63, L.L.C.
	KND Hospital Real Estate Holdings, L.L.C.
	KND Real Estate 1, L.L.C.
	KND Real Estate 2, L.L.C.
	KND Real Estate 3, L.L.C.
	KND Real Estate 4, L.L.C.
	KND Real Estate 5, L.L.C.
	KND Real Estate 6, L.L.C.
	KND Real Estate 7, L.L.C.
	KND Real Estate 8, L.L.C.
	KND Real Estate 9, L.L.C.
	KND Real Estate 10, L.L.C.
	KND Real Estate 11, L.L.C.
	KND Real Estate 12, L.L.C.
	KND Real Estate 13, L.L.C.
	KND Real Estate 14, L.L.C.
	KND Real Estate 15, L.L.C.
	KND Real Estate 16, L.L.C.
	KND Real Estate 17, L.L.C.
	KND Real Estate 18, L.L.C.
	KND Real Estate 19, L.L.C.
	KND Real Estate 20, L.L.C.
	KND Real Estate 21, L.L.C.
	KND Real Estate 22, L.L.C.
	KND Real Estate 23, L.L.C.
	KND Real Estate 24, L.L.C.
	KND Real Estate 25, L.L.C.
	KND Real Estate 26, L.L.C.
	KND Real Estate 27, L.L.C.
	KND Real Estate 28, L.L.C.
	KND Real Estate 29, L.L.C.
	KND Real Estate 30, L.L.C.
	KND Real Estate 31, L.L.C.
	KND Real Estate 32, L.L.C.
	KND Real Estate 33, L.L.C.
	KND Real Estate 34, L.L.C.
	KND Real Estate 35, L.L.C.
	KND Real Estate 36, L.L.C.
	KND Real Estate 37, L.L.C.
	KND Real Estate 38, L.L.C.
	KND Real Estate 39, L.L.C.
	KND Real Estate 40, L.L.C.
	KND Real Estate 41, L.L.C.
	KND Real Estate 42, L.L.C.
	KND Real Estate 43, L.L.C.
	KND Real Estate 44, L.L.C.
	KND Real Estate 45, L.L.C.
	KND Real Estate 46, L.L.C.
	KND Real Estate 47, L.L.C.
	KND Real Estate 48, L.L.C.
	KND Real Estate 49, L.L.C.
	KND Real Estate 50, L.L.C.

 
	
	KND Real Estate 51, L.L.C.
	KND Real Estate Holdings, L.L.C.
	KND Rehab Real Estate Holdings, L.L.C.
	KND SNF Real Estate Holdings, L.L.C.
	Lafayette Health Care Center, Inc.
	Lafayette Specialty Hospital, L.L.C.
	Laurel Lake Health and Rehabilitation, L.L.C.
	Maine Assisted Living, L.L.C.
	Massachusetts Assisted Living, L.L.C.
	Meadows Nursing, L.L.C.
	MedEquities, Inc.
	Medical Hill Rehab Center, L.L.C.
	Med-Tech Private Care, Inc.
	Med-Tech Services of Dade, Inc.
	Med-Tech Services of Palm Beach, Inc.
	Med. Tech. Services of South Florida, Inc.
	Mills Medical Practices, LLC
	New Triumph HealthCare of Texas, LLC
	New Triumph HealthCare, Inc.
	North West Texas Home Health Services, LLC
	Northland LTACH, LLC
	NP Plus, LLC
	NRP Holdings Company
	Outreach Health Services of North Texas, LLC
	Outreach Health Services of the Panhandle, LLC
	Pacific Coast Care Center, L.L.C.
	Pacific West Home Care, LLC
	Peoplefirst HomeCare & Hospice of California, L.L.C.
	Peoplefirst HomeCare & Hospice of Colorado, L.L.C.
	Peoplefirst HomeCare & Hospice of Indiana, L.L.C.
	Peoplefirst HomeCare & Hospice of Massachusetts, L.L.C.
	Peoplefirst HomeCare & Hospice of Ohio, L.L.C.
	Peoplefirst HomeCare & Hospice of Utah, L.L.C.
	Peoplefirst HomeCare of Colorado, L.L.C.
	Peoplefirst Virginia, L.L.C.
	PersonaCare of Connecticut, Inc.
	PersonaCare of Huntsville, Inc.
	PersonaCare of Ohio, Inc.
	PersonaCare of Reading, Inc.
	PersonaCare of Wisconsin, Inc.
	PF Development 5, L.L.C.
	PF Development 6, L.L.C.
	PF Development 7, L.L.C.
	PF Development 8, L.L.C.
	PF Development 9, L.L.C.
	PF Development 10, L.L.C.
	PF Development 15, L.L.C.
	PF Development 16, L.L.C.
	PF Development 17, L.L.C.
	PF Development 18, L.L.C.
	PF Development 19, L.L.C.
	PF Development 20, L.L.C.
	PF Development 21, L.L.C.
	PF Development 22, L.L.C.
	PF Development 23, L.L.C.
	PF Development 26, L.L.C.

 
	
	PF Development 27, L.L.C.
	PHH Acquisition Corp.
	Professional Healthcare at Home, LLC
	Professional Healthcare, LLC
	Rehab Insurance Corporation
	Rehab Staffing, L.L.C.
	RehabCare Development 2, L.L.C.
	RehabCare Development 3, L.L.C.
	RehabCare Development 4, L.L.C.
	RehabCare Development 5, L.L.C.
	RehabCare Group, Inc.
	RehabCare Group East, Inc.
	RehabCare Group Management Services, Inc.
	RehabCare Group of California, LLC
	RehabCare Group of Texas, LLC
	RehabCare Hospital Holdings, L.L.C.
	Salt Lake Physical Therapy Associates, Inc.
	SCCI Health Services Corporation
	SCCI Hospital – Easton, Inc.
	SCCI Hospital – El Paso, Inc.
	SCCI Hospital – Mansfield, Inc.
	SCCI Hospital Ventures, Inc.
	SCCI Hospitals of America, Inc.
	Senior Home Care, Inc.
	SHC Holding, Inc.
	SHC Rehab, Inc.
	Siena Care Center, L.L.C.
	Smith Ranch Care Center, L.L.C.
	Southern California Specialty Care, Inc.
	Southern Nevada Home Health Care, Inc.
	Southern Utah Home Health, Inc.
	Southern Utah Home Oxygen & Medical Equipment, Inc.
	Specialty Healthcare Services, Inc.
	Specialty Hospital of Cleveland, Inc.
	Specialty Hospital of Philadelphia, Inc.
	Specialty Hospital of South Carolina, Inc.
	Springfield Park View Hospital, L.L.C.
	Symphony Health Services, LLC
	Synergy, Inc.
	Synergy Healthcare Group, Inc.
	Synergy Home Care-Acadiana Region, Inc.
	Synergy Home Care-Capitol Region, Inc.
	Synergy Home Care-Central Region, Inc.
	Synergy Home Care-Northeastern Region, Inc.
	Synergy Home Care-Northshore Region, Inc.
	Synergy Home Care-Northwestern Region, Inc.
	Synergy Home Care-Southeastern Region, Inc.
	Texas Health Management Group, LLC
	THC – Chicago, Inc.
	THC – Houston, Inc.
	THC – North Shore, Inc.
	THC – Orange County, Inc.
	THC–Seattle, Inc.
	TherEX, Inc.
	The Therapy Group, Inc.
	Tower Hill Nursing, L.L.C.

 
	
	Transitional Hospitals Corporation of Indiana, Inc.
	Transitional Hospitals Corporation of Louisiana, Inc.
	Transitional Hospitals Corporation of Nevada, Inc.
	Transitional Hospitals Corporation of New Mexico, Inc.
	Transitional Hospitals Corporation of Tampa, Inc.
	Transitional Hospitals Corporation of Texas, Inc.
	Transitional Hospitals Corporation of Wisconsin, Inc.
	Trinity Hospice of Texas, LLC
	Triumph HealthCare Holdings, Inc.
	Triumph HealthCare Second Holdings, LLC
	Triumph HealthCare Third Holdings, LLC
	Triumph Hospital Northwest Indiana, Inc.
	Triumph Rehabilitation Hospital Northern Indiana, LLC
	Triumph Rehabilitation Hospital of Northeast Houston, LLC
	Tucker Nursing Center, Inc.
	Tulsa Specialty Hospital L.L.C.
	Vernon Home Health Care Agency, LLC
	VTA Management Services, LLC
	VTA Staffing Services, LLC
	Wellstream Health Services, LLC
	West Texas, LLC
	Ygnacio Valley Care Center, L.L.C.
	Foothill Nursing Company Partnership
	Hillhaven–MSC Partnership
	Kindred Hospitals Limited Partnership
	Kindred Nursing Centers Central Limited Partnership
	Kindred Nursing Centers Limited Partnership
	New Triumph HealthCare, LLP
	RehabCare Group of Amarillo, LP
	RehabCare Group of Arlington, LP
	ABC Hospice, LLC
	Access Home Health of Florida, LLC
	Alpine Home Health Care, LLC
	Alpine Home Health II, Inc.
	Alpine Home Health, Inc.
	Alpine Resource Group, Inc.
	American Homecare Management Corp.
	American Hospice, Inc.
	Asian American Home Care, Inc.
	Bethany Hospice, LLC
	California Hospice, LLC
	Capital Care Resources of South Carolina, LLC
	Capital Care Resources, LLC
	Capital Health Management Group, LLC
	Chaparral Hospice, Inc.
	Chattahoochee Valley Home Care Services, LLC
	Chattahoochee Valley Home Health, LLC
	CHMG Acquisition LLC
	CHMG of Atlanta, LLC
	CHMG of Griffin, LLC
	Colorado Hospice, L.L.C.
	Eastern Carolina Home Health Agency, LLC
	Faith Home Health and Hospice, LLC
	Faith in Home Services, L.L.C.
	FHI GP, Inc.
	FHI Health Systems, Inc.

 
	
	FHI LP, Inc.
	First Home Health, Inc.
	Gentiva Certified Healthcare Corp.
	Gentiva Health Services (Certified), Inc.
	Gentiva Health Services (USA) LLC
	Gentiva Health Services Holding Corp.
	Gentiva Health Services, Inc.
	Gentiva Rehab Without Walls, LLC
	Gentiva Services of New York, Inc.
	Georgia Hospice, LLC
	Gilbert’s Home Health Agency, Inc.
	Gilbert’s Hospice Care, LLC
	Gilbert’s Hospice Care of Mississippi, LLC
	Girling Health Care Services of Knoxville, Inc.
	Girling Health Care, Inc.
	Harden Clinical Services, LLC
	Harden HC Texas Holdco, LLC
	Harden Healthcare Holdings, LLC
	Harden Healthcare Services, LLC
	Harden Healthcare, LLC
	Harden Home Health, LLC
	Harden Home Option, LLC
	Harden Hospice, LLC
	Hawkeye Health Services, Inc.
	Healthfield Home Health, LLC
	Healthfield Hospice Services, LLC
	Healthfield of Southwest Georgia, LLC
	Healthfield of Statesboro, LLC
	Healthfield of Tennessee, LLC
	Healthfield Operating Group, LLC
	Healthfield, LLC
	Home Health Care Affiliates of Central Mississippi, L.L.C.
	Home Health Care Affiliates of Mississippi, Inc.
	Home Health Care Affiliates, Inc.
	Home Health Care of Carteret County, LLC
	HomeCare Plus, Inc.
	Horizon Health Care Services, Inc.
	Horizon Health Network LLC
	Hospice Care of Kansas and Missouri, L.L.C.
	Hospice Care of Kansas, L.L.C.
	Hospice Care of the Midwest, L.L.C.
	Iowa Hospice, L.L.C.
	Isidora’s Health Care Inc.
	Lakes Hospice, L.L.C.
	Lighthouse Hospice Management, LLC
	Lighthouse Hospice Partners, LLC
	Lighthouse Hospice - Coastal Bend, LLC
	Lighthouse Hospice - Metroplex, LLC
	Lighthouse Hospice-San Antonio, LLC
	Mid-South Home Care Services, LLC
	Mid-South Home Health Agency, LLC
	Mid-South Home Health of Gadsden, LLC
	Mid-South Home Health, LLC
	Missouri Home Care of Rolla, Inc.
	New York Healthcare Services, Inc.
	Nursing Care - Home Health Agency, Inc.

 
	
	Odyssey HealthCare Austin, LLC
	Odyssey HealthCare Detroit, LLC
	Odyssey HealthCare Fort Worth, LLC
	Odyssey HealthCare GP, LLC
	Odyssey HealthCare Holding Company
	Odyssey HealthCare LP, LLC
	Odyssey HealthCare of Augusta, LLC
	Odyssey HealthCare of Flint, LLC
	Odyssey HealthCare of Marion County, LLC
	Odyssey HealthCare of Savannah, LLC
	Odyssey HealthCare of St. Louis, LLC
	Odyssey HealthCare, Inc.
	OHS Service Corp.
	Omega Hospice, LLC
	PHHC Acquisition Corp.
	QC-Medi New York, Inc.
	Quality Care - USA, Inc.
	Saturday Partners, LLC
	Tar Heel Health Care Services, LLC
	The American Heartland Hospice Corp.
	The Home Option, LLC
	The Home Team of Kansas, LLC
	Total Care Home Health of Louisburg, LLC
	Total Care Home Health of North Carolina, LLC
	Total Care Home Health of South Carolina, LLC
	Van Winkle Home Health Care, Inc.
	Vista Hospice Care, LLC
	VistaCare of Boston, LLC
	VistaCare USA, LLC
	VistaCare, LLC
	Voyager Home Health, Inc.
	Voyager HospiceCare, Inc.
	We Care Home Health Services, Inc.
	Wiregrass Hospice Care, LLC
	Wiregrass Hospice of South Carolina, LLC
	Wiregrass Hospice LLC
	Family Hospice, Ltd.
	FHI Management, Ltd.
	Odyssey HealthCare Management, LP
	Odyssey HealthCare Operating A, LP
	Odyssey HealthCare Operating B, LP
	Voyager Acquisition, L.P.
	Centerre Healthcare Corporation
	CHC Management Services, LLC
	CRH of Arlington, LLC
	CRH of Avon, LLC
	CRH of Cleveland, LLC
	CRH of Dallas, LLC
	CRH of Fort Worth, LLC
	CRH of Indianapolis, LLC
	CRH of Lancaster, LLC
	CRH of Langhorne, LLC
	CRH of Madison, LLC
	CRH of Memphis, LLC
	CRH of Oklahoma City, LLC
	CRH of Springfield, LLC

 
					
	 CRH of St. Louis, LLC
 CRH of
Waukesha, LLC,

		
		 	as a Supplemental Guarantors
		
	By:	 	 /s/ Joseph L. Landenwich

		 	Name:	 	Joseph L. Landenwich
		 	Title:	 	Co-General Counsel and Corporate Secretary

  

			
	WELLS FARGO BANK, NATIONAL ASSOCIATION, as Trustee
		
	By:	 	 /s/ Julius R. Zamora

	Name:	 	Julius R. Zamora
	Title:	 	Vice PresidentEX-4.2

 Exhibit 4.2 

FIRST SUPPLEMENTAL INDENTURE 

THIS FIRST SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), entered into as of February 2, 2015, among Kindred
Healthcare, Inc., a Delaware corporation (the “Company”), each of the Subsidiary Guarantors listed on the signature pages hereto, (each a “Supplemental Guarantor” and, collectively, the “Supplemental
Guarantors”), and Wells Fargo Bank, National Association., as trustee (the “Trustee”). Capitalized terms used herein and not otherwise defined herein are used as defined in the Indenture referred to below. 

RECITALS 
 WHEREAS, Kindred
Escrow Corp. II, a Delaware corporation (the “Escrow Issuer”) and the Trustee have heretofore entered into that certain Indenture, dated as of December 18, 2014 (as amended or supplemented, the “Indenture”),
relating to the 8.75% Senior Notes due 2023 in original principal amount of $600,000,000 (the “Notes”). 
 WHEREAS, each
Supplemental Guarantor is to become a Subsidiary Guarantor under the Indenture; and 
 WHEREAS, on the date hereof, the Escrow Issuer is
merging with and into the Company, with the Company being the surviving Person of such merger (the “Merger”). 
 AGREEMENT

 NOW, THEREFORE, the parties to this Supplemental Indenture hereby agree as follows: 

Section 1. The Company, pursuant to Article 5 of the Indenture, hereby expressly assumes and agrees to pay, perform and discharge when
due each and every debt, obligation, covenant and agreement incurred, made or to be paid, performed or discharged by the Escrow Issuer under the Indenture and the Notes. 

Section 2. Each Supplemental Guarantor hereby agrees, jointly and severally with all other Supplemental Guarantors, and fully and
unconditionally, to be a Subsidiary Guarantor under the Indenture on the terms and subject to the conditions set forth in Article 10 of the Indenture and to be bound by (and shall be entitled to the benefits of) all other applicable provisions
of the Indenture as a Subsidiary Guarantor. 
 Section 3. This Supplemental Indenture is an amendment supplemental to the Indenture,
and the Indenture and this Supplemental Indenture will henceforth be read together. 
 Section 4. This Supplemental Indenture shall be
governed by and construed in accordance with the laws of the State of New York. 
 Section 5. This Supplemental Indenture may be signed
in various counterparts which together will constitute one and the same instrument. The exchange of copies of this Supplemental Indenture and of signature pages by facsimile or PDF transmission 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. 
 Section 6. 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 Company and each Subsidiary Guarantor. 

[Signature pages follow] 

 
					
	KINDRED HEALTHCARE, INC.
		
	By:	 	 /s/ Joseph L. Landenwich

		 	Name:	 	Joseph L. Landenwich
		 	Title:	 	Co-General Counsel and Corporate Secretary
	
	Aberdeen Holdings, Inc.
	Able Home Healthcare, Inc.
	Advanced Oncology Services, Inc.
	American VitalCare, LLC
	Avery Manor Nursing, L.L.C.
	Bayberry Care Center, L.L.C.
	Braintree Nursing, L.L.C.
	BWB Sunbelt Home Health Services, LLC
	California Nursing Centers, L.L.C.
	Care Center of Rossmoor, L.L.C.
	Central Arizona Home Health Care, Inc.
	Clear Lake Rehabilitation Hospital, L.L.C.
	Compass Hospice, Inc.
	Country Estates Nursing, L.L.C.
	Courtland Gardens Health Center, Inc.
	Focus Care Health Resources, Inc.
	Forestview Nursing, L.L.C.
	GBA Holding, Inc.
	GBA West, LLC
	Goddard Nursing, L.L.C.
	Greenbrae Care Center, L.L.C.
	Greens Nursing and Assisted Living, L.L.C.
	Harborlights Nursing, L.L.C.
	Haven Health, LLC
	Helian ASC of Northridge, Inc.
	Helian Health Group, Inc.
	HHS Healthcare Corp.
	Highgate Nursing, L.L.C.
	Highlander Nursing, L.L.C.
	Homecare Holdings, Inc.
	Home Health of Rural Texas, Inc.
	Home Health Services, Inc.
	Homestead Health and Rehabilitation Center, L.L.C.
	IntegraCare Holdings, Inc.
	IntegraCare Home Health Services, Inc.
	IntegraCare Hospice of Abilene, LLC
	IntegraCare Intermediate Holdings, Inc.
	IntegraCare of Abilene, LLC
	IntegraCare of Albany, LLC
	IntegraCare of Athens-Home Health, LLC
	IntegraCare of Athens-Hospice, LLC
	IntegraCare of Granbury, LLC
	IntegraCare of Littlefield, LLC
	IntegraCare of Olney Home Health, LLC
	IntegraCare of Texas, LLC
	IntegraCare of West Texas-Home Health, LLC
	IntegraCare of West Texas-Hospice, LLC
	IntegraCare of Wichita Falls, LLC

 
	
	J. B. Thomas Hospital, Inc.
	KAH Development 1, L.L.C.
	KAH Development 2, L.L.C.
	KAH Development 3, L.L.C.
	KAH Development 4, L.L.C.
	KAH Development 5, L.L.C.
	KAH Development 6, L.L.C.
	KAH Development 7, L.L.C.
	KAH Development 8, L.L.C.
	KAH Development 9, L.L.C.
	KAH Development 10, L.L.C.
	KAH Development 11, L.L.C.
	KAH Development 12, L.L.C.
	KAH Development 13, L.L.C.
	KAH Development 14, L.L.C.
	KAH Development 15, L.L.C.
	Kindred Braintree Hospital, L.L.C.
	Kindred Development 4, L.L.C.
	Kindred Development 7, L.L.C.
	Kindred Development 8, L.L.C.
	Kindred Development 9, L.L.C.
	Kindred Development 10, L.L.C.
	Kindred Development 11, L.L.C.
	Kindred Development 12, L.L.C.
	Kindred Development 13, L.L.C.
	Kindred Development 15, L.L.C.
	Kindred Development 17, L.L.C.
	Kindred Development 27, L.L.C.
	Kindred Development 29, L.L.C.
	Kindred Development Holdings 3, L.L.C.
	Kindred Development Holdings 5, L.L.C.
	Kindred Healthcare Operating, Inc.
	Kindred Healthcare Services, Inc.
	Kindred Hospice Services, L.L.C.
	Kindred Hospital-Pittsburgh-North Shore, L.L.C.
	Kindred Hospitals East, L.L.C.
	Kindred Hospital Palm Beach, L.L.C.
	Kindred Hospital-Springfield, L.L.C.
	Kindred Hospital-Toledo, L.L.C.
	Kindred Hospitals West, L.L.C.
	Kindred Nevada, L.L.C.
	Kindred Nursing Centers East, L.L.C.
	Kindred Nursing Centers North, L.L.C.
	Kindred Nursing Centers South, L.L.C.
	Kindred Nursing Centers West, L.L.C.
	Kindred Rehab Services, Inc.
	Kindred Systems, Inc.
	KND Development 50, L.L.C.
	KND Development 51, L.L.C.
	KND Development 52, L.L.C.
	KND Development 53, L.L.C.
	KND Development 54, L.L.C.
	KND Development 55, L.L.C.
	KND Development 56, L.L.C.
	KND Development 57, L.L.C.
	KND Development 58, L.L.C.

 
	
	KND Development 59, L.L.C.
	KND Development 60, L.L.C.
	KND Development 61, L.L.C.
	KND Development 62, L.L.C.
	KND Development 63, L.L.C.
	KND Hospital Real Estate Holdings, L.L.C.
	KND Real Estate 1, L.L.C.
	KND Real Estate 2, L.L.C.
	KND Real Estate 3, L.L.C.
	KND Real Estate 4, L.L.C.
	KND Real Estate 5, L.L.C.
	KND Real Estate 6, L.L.C.
	KND Real Estate 7, L.L.C.
	KND Real Estate 8, L.L.C.
	KND Real Estate 9, L.L.C.
	KND Real Estate 10, L.L.C.
	KND Real Estate 11, L.L.C.
	KND Real Estate 12, L.L.C.
	KND Real Estate 13, L.L.C.
	KND Real Estate 14, L.L.C.
	KND Real Estate 15, L.L.C.
	KND Real Estate 16, L.L.C.
	KND Real Estate 17, L.L.C.
	KND Real Estate 18, L.L.C.
	KND Real Estate 19, L.L.C.
	KND Real Estate 20, L.L.C.
	KND Real Estate 21, L.L.C.
	KND Real Estate 22, L.L.C.
	KND Real Estate 23, L.L.C.
	KND Real Estate 24, L.L.C.
	KND Real Estate 25, L.L.C.
	KND Real Estate 26, L.L.C.
	KND Real Estate 27, L.L.C.
	KND Real Estate 28, L.L.C.
	KND Real Estate 29, L.L.C.
	KND Real Estate 30, L.L.C.
	KND Real Estate 31, L.L.C.
	KND Real Estate 32, L.L.C.
	KND Real Estate 33, L.L.C.
	KND Real Estate 34, L.L.C.
	KND Real Estate 35, L.L.C.
	KND Real Estate 36, L.L.C.
	KND Real Estate 37, L.L.C.
	KND Real Estate 38, L.L.C.
	KND Real Estate 39, L.L.C.
	KND Real Estate 40, L.L.C.
	KND Real Estate 41, L.L.C.
	KND Real Estate 42, L.L.C.
	KND Real Estate 43, L.L.C.
	KND Real Estate 44, L.L.C.
	KND Real Estate 45, L.L.C.
	KND Real Estate 46, L.L.C.
	KND Real Estate 47, L.L.C.
	KND Real Estate 48, L.L.C.
	KND Real Estate 49, L.L.C.
	KND Real Estate 50, L.L.C.

 
	
	KND Real Estate 51, L.L.C.
	KND Real Estate Holdings, L.L.C.
	KND Rehab Real Estate Holdings, L.L.C.
	KND SNF Real Estate Holdings, L.L.C.
	Lafayette Health Care Center, Inc.
	Lafayette Specialty Hospital, L.L.C.
	Laurel Lake Health and Rehabilitation, L.L.C.
	Maine Assisted Living, L.L.C.
	Massachusetts Assisted Living, L.L.C.
	Meadows Nursing, L.L.C.
	MedEquities, Inc.
	Medical Hill Rehab Center, L.L.C.
	Med-Tech Private Care, Inc.
	Med-Tech Services of Dade, Inc.
	Med-Tech Services of Palm Beach, Inc.
	Med. Tech. Services of South Florida, Inc.
	Mills Medical Practices, LLC
	New Triumph HealthCare of Texas, LLC
	New Triumph HealthCare, Inc.
	North West Texas Home Health Services, LLC
	Northland LTACH, LLC
	NP Plus, LLC
	NRP Holdings Company
	Outreach Health Services of North Texas, LLC
	Outreach Health Services of the Panhandle, LLC
	Pacific Coast Care Center, L.L.C.
	Pacific West Home Care, LLC
	Peoplefirst HomeCare & Hospice of California, L.L.C.
	Peoplefirst HomeCare & Hospice of Colorado, L.L.C.
	Peoplefirst HomeCare & Hospice of Indiana, L.L.C.
	Peoplefirst HomeCare & Hospice of Massachusetts, L.L.C.
	Peoplefirst HomeCare & Hospice of Ohio, L.L.C.
	Peoplefirst HomeCare & Hospice of Utah, L.L.C.
	Peoplefirst HomeCare of Colorado, L.L.C.
	Peoplefirst Virginia, L.L.C.
	PersonaCare of Connecticut, Inc.
	PersonaCare of Huntsville, Inc.
	PersonaCare of Ohio, Inc.
	PersonaCare of Reading, Inc.
	PersonaCare of Wisconsin, Inc.
	PF Development 5, L.L.C.
	PF Development 6, L.L.C.
	PF Development 7, L.L.C.
	PF Development 8, L.L.C.
	PF Development 9, L.L.C.
	PF Development 10, L.L.C.
	PF Development 15, L.L.C.
	PF Development 16, L.L.C.
	PF Development 17, L.L.C.
	PF Development 18, L.L.C.
	PF Development 19, L.L.C.
	PF Development 20, L.L.C.
	PF Development 21, L.L.C.
	PF Development 22, L.L.C.
	PF Development 23, L.L.C.
	PF Development 26, L.L.C.

 
	
	PF Development 27, L.L.C.
	PHH Acquisition Corp.
	Professional Healthcare at Home, LLC
	Professional Healthcare, LLC
	Rehab Insurance Corporation
	Rehab Staffing, L.L.C.
	RehabCare Development 2, L.L.C.
	RehabCare Development 3, L.L.C.
	RehabCare Development 4, L.L.C.
	RehabCare Development 5, L.L.C.
	RehabCare Group, Inc.
	RehabCare Group East, Inc.
	RehabCare Group Management Services, Inc.
	RehabCare Group of California, LLC
	RehabCare Group of Texas, LLC
	RehabCare Hospital Holdings, L.L.C.
	Salt Lake Physical Therapy Associates, Inc.
	SCCI Health Services Corporation
	SCCI Hospital – Easton, Inc.
	SCCI Hospital – El Paso, Inc.
	SCCI Hospital – Mansfield, Inc.
	SCCI Hospital Ventures, Inc.
	SCCI Hospitals of America, Inc.
	Senior Home Care, Inc.
	SHC Holding, Inc.
	SHC Rehab, Inc.
	Siena Care Center, L.L.C.
	Smith Ranch Care Center, L.L.C.
	Southern California Specialty Care, Inc.
	Southern Nevada Home Health Care, Inc.
	Southern Utah Home Health, Inc.
	Southern Utah Home Oxygen & Medical Equipment, Inc.
	Specialty Healthcare Services, Inc.
	Specialty Hospital of Cleveland, Inc.
	Specialty Hospital of Philadelphia, Inc.
	Specialty Hospital of South Carolina, Inc.
	Springfield Park View Hospital, L.L.C.
	Symphony Health Services, LLC
	Synergy, Inc.
	Synergy Healthcare Group, Inc.
	Synergy Home Care-Acadiana Region, Inc.
	Synergy Home Care-Capitol Region, Inc.
	Synergy Home Care-Central Region, Inc.
	Synergy Home Care-Northeastern Region, Inc.
	Synergy Home Care-Northshore Region, Inc.
	Synergy Home Care-Northwestern Region, Inc.
	Synergy Home Care-Southeastern Region, Inc.
	Texas Health Management Group, LLC
	THC – Chicago, Inc.
	THC – Houston, Inc.
	THC – North Shore, Inc.
	THC – Orange County, Inc.
	THC–Seattle, Inc.
	TherEX, Inc.
	The Therapy Group, Inc.
	Tower Hill Nursing, L.L.C.

 
	
	Transitional Hospitals Corporation of Indiana, Inc.
	Transitional Hospitals Corporation of Louisiana, Inc.
	Transitional Hospitals Corporation of Nevada, Inc.
	Transitional Hospitals Corporation of New Mexico, Inc.
	Transitional Hospitals Corporation of Tampa, Inc.
	Transitional Hospitals Corporation of Texas, Inc.
	Transitional Hospitals Corporation of Wisconsin, Inc.
	Trinity Hospice of Texas, LLC
	Triumph HealthCare Holdings, Inc.
	Triumph HealthCare Second Holdings, LLC
	Triumph HealthCare Third Holdings, LLC
	Triumph Hospital Northwest Indiana, Inc.
	Triumph Rehabilitation Hospital Northern Indiana, LLC
	Triumph Rehabilitation Hospital of Northeast Houston, LLC
	Tucker Nursing Center, Inc.
	Tulsa Specialty Hospital L.L.C.
	Vernon Home Health Care Agency, LLC
	VTA Management Services, LLC
	VTA Staffing Services, LLC
	Wellstream Health Services, LLC
	West Texas, LLC
	Ygnacio Valley Care Center, L.L.C.
	Foothill Nursing Company Partnership
	Hillhaven–MSC Partnership
	Kindred Hospitals Limited Partnership
	Kindred Nursing Centers Central Limited Partnership
	Kindred Nursing Centers Limited Partnership
	New Triumph HealthCare, LLP
	RehabCare Group of Amarillo, LP
	RehabCare Group of Arlington, LP
	ABC Hospice, LLC
	Access Home Health of Florida, LLC
	Alpine Home Health Care, LLC
	Alpine Home Health II, Inc.
	Alpine Home Health, Inc.
	Alpine Resource Group, Inc.
	American Homecare Management Corp.
	American Hospice, Inc.
	Asian American Home Care, Inc.
	Bethany Hospice, LLC
	California Hospice, LLC
	Capital Care Resources of South Carolina, LLC
	Capital Care Resources, LLC
	Capital Health Management Group, LLC
	Chaparral Hospice, Inc.
	Chattahoochee Valley Home Care Services, LLC
	Chattahoochee Valley Home Health, LLC
	CHMG Acquisition LLC
	CHMG of Atlanta, LLC
	CHMG of Griffin, LLC
	Colorado Hospice, L.L.C.
	Eastern Carolina Home Health Agency, LLC
	Faith Home Health and Hospice, LLC
	Faith in Home Services, L.L.C.
	FHI GP, Inc.
	FHI Health Systems, Inc.

 
	
	FHI LP, Inc.
	First Home Health, Inc.
	Gentiva Certified Healthcare Corp.
	Gentiva Health Services (Certified), Inc.
	Gentiva Health Services (USA) LLC
	Gentiva Health Services Holding Corp.
	Gentiva Health Services, Inc.
	Gentiva Rehab Without Walls, LLC
	Gentiva Services of New York, Inc.
	Georgia Hospice, LLC
	Gilbert’s Home Health Agency, Inc.
	Gilbert’s Hospice Care, LLC
	Gilbert’s Hospice Care of Mississippi, LLC
	Girling Health Care Services of Knoxville, Inc.
	Girling Health Care, Inc.
	Harden Clinical Services, LLC
	Harden HC Texas Holdco, LLC
	Harden Healthcare Holdings, LLC
	Harden Healthcare Services, LLC
	Harden Healthcare, LLC
	Harden Home Health, LLC
	Harden Home Option, LLC
	Harden Hospice, LLC
	Hawkeye Health Services, Inc.
	Healthfield Home Health, LLC
	Healthfield Hospice Services, LLC
	Healthfield of Southwest Georgia, LLC
	Healthfield of Statesboro, LLC
	Healthfield of Tennessee, LLC
	Healthfield Operating Group, LLC
	Healthfield, LLC
	Home Health Care Affiliates of Central Mississippi, L.L.C.
	Home Health Care Affiliates of Mississippi, Inc.
	Home Health Care Affiliates, Inc.
	Home Health Care of Carteret County, LLC
	HomeCare Plus, Inc.
	Horizon Health Care Services, Inc.
	Horizon Health Network LLC
	Hospice Care of Kansas and Missouri, L.L.C.
	Hospice Care of Kansas, L.L.C.
	Hospice Care of the Midwest, L.L.C.
	Iowa Hospice, L.L.C.
	Isidora’s Health Care Inc.
	Lakes Hospice, L.L.C.
	Lighthouse Hospice Management, LLC
	Lighthouse Hospice Partners, LLC
	Lighthouse Hospice - Coastal Bend, LLC
	Lighthouse Hospice - Metroplex, LLC
	Lighthouse Hospice-San Antonio, LLC
	Mid-South Home Care Services, LLC
	Mid-South Home Health Agency, LLC
	Mid-South Home Health of Gadsden, LLC
	Mid-South Home Health, LLC
	Missouri Home Care of Rolla, Inc.
	New York Healthcare Services, Inc.
	Nursing Care - Home Health Agency, Inc.

 
	
	Odyssey HealthCare Austin, LLC
	Odyssey HealthCare Detroit, LLC
	Odyssey HealthCare Fort Worth, LLC
	Odyssey HealthCare GP, LLC
	Odyssey HealthCare Holding Company
	Odyssey HealthCare LP, LLC
	Odyssey HealthCare of Augusta, LLC
	Odyssey HealthCare of Flint, LLC
	Odyssey HealthCare of Marion County, LLC
	Odyssey HealthCare of Savannah, LLC
	Odyssey HealthCare of St. Louis, LLC
	Odyssey HealthCare, Inc.
	OHS Service Corp.
	Omega Hospice, LLC
	PHHC Acquisition Corp.
	QC-Medi New York, Inc.
	Quality Care - USA, Inc.
	Saturday Partners, LLC
	Tar Heel Health Care Services, LLC
	The American Heartland Hospice Corp.
	The Home Option, LLC
	The Home Team of Kansas, LLC
	Total Care Home Health of Louisburg, LLC
	Total Care Home Health of North Carolina, LLC
	Total Care Home Health of South Carolina, LLC
	Van Winkle Home Health Care, Inc.
	Vista Hospice Care, LLC
	VistaCare of Boston, LLC
	VistaCare USA, LLC
	VistaCare, LLC
	Voyager Home Health, Inc.
	Voyager HospiceCare, Inc.
	We Care Home Health Services, Inc.
	Wiregrass Hospice Care, LLC
	Wiregrass Hospice of South Carolina, LLC
	Wiregrass Hospice LLC
	Family Hospice, Ltd.
	FHI Management, Ltd.
	Odyssey HealthCare Management, LP
	Odyssey HealthCare Operating A, LP
	Odyssey HealthCare Operating B, LP
	Voyager Acquisition, L.P.
	Centerre Healthcare Corporation
	CHC Management Services, LLC
	CRH of Arlington, LLC
	CRH of Avon, LLC
	CRH of Cleveland, LLC
	CRH of Dallas, LLC
	CRH of Fort Worth, LLC
	CRH of Indianapolis, LLC
	CRH of Lancaster, LLC
	CRH of Langhorne, LLC
	CRH of Madison, LLC
	CRH of Memphis, LLC
	CRH of Oklahoma City, LLC
	CRH of Springfield, LLC

 
					
	 CRH of St. Louis, LLC
 CRH of
Waukesha, LLC,

		
		 	as a Supplemental Guarantors
		
	By:	 	 /s/ Joseph L. Landenwich

		 	Name:	 	Joseph L. Landenwich
		 	Title:	 	Co-General Counsel and Corporate Secretary

  

			
	WELLS FARGO BANK, NATIONAL ASSOCIATION, as Trustee
		
	By:	 	 /s/ Julius R. Zamora

	Name:	 	Julius R. Zamora
	Title:	 	Vice President

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