Document:

Second Supplemental Indenture

 Exhibit 4.2 
 SENIOR SUBORDINATED 
 SECOND SUPPLEMENTAL INDENTURE 
 THIS SECOND SUPPLEMENTAL INDENTURE (the “Supplemental Indenture”) dated as of the
9th day of February 2007, among DaVita Inc., a Delaware corporation (the “Company”), the Guarantors (as defined below), the persons named as Additional Guarantors signatory hereto (the “Additional Guarantors”) and The Bank of New
York Trust Company, N.A., as Trustee (the “Trustee”), amends and supplements the Indenture dated as of March 22, 2005 among the Company, the Guarantors named therein, as guarantors (the “Guarantors”), and the Trustee (the
“Original Indenture”) with respect to the Company’s 7 1/4% Senior Subordinated Notes due 2015, as
amended and supplemented by that certain First Supplemental Indenture dated as of October 5, 2005 among the Company, the Guarantors and the Trustee. 
 W I T N E S S E T H: 
 WHEREAS, the Additional Guarantors are, simultaneously herewith,
entering into a Guarantee with respect to certain Indebtedness of the Company and the Original Indenture provides that upon entering into any such Guarantee the Additional Guarantors shall enter into a supplemental indenture agreeing to guarantee
the obligations of the Company under the Original Indenture; 
 NOW, THEREFORE, THIS SUPPLEMENTAL INDENTURE WITNESSETH: 
 For and in consideration of the premises, it is mutually covenanted and agreed, for the equal and proportionate benefit of the Holders of Notes, as
follows: 
 Section 1. Defined Terms. All terms used in this Supplemental Indenture which are defined in the Original Indenture have
the meanings assigned to them in the Original Indenture. 

 Section 2. Additional Guarantors. Pursuant to Section 4.19 of the Original Indenture, each of
the Additional Guarantors hereby, jointly and severally, unconditionally and irrevocably Guarantees, on a senior basis, the full and prompt payment of the principal of, premium, if any, and interest on the Notes and all other obligations of the
Company (including, without limitation, to the Trustee and to the Holders of the Notes) under the Original Indenture on the terms and subject to the conditions set forth in the Original Indenture and agrees to be bound as a Guarantor under the
Original Indenture. In connection herewith, each Additional Guarantor will execute and deliver to the Trustee a notation of Note Guarantee. 
 Section 3. Miscellaneous. 
 (a) The Article and Section headings herein are for convenience only and shall not affect the
construction hereof. 
 (b) In case any one or more of the provisions in this Supplemental Indenture shall be invalid, illegal or
unenforceable, the validity, legality, and enforceability of any such provision in every other respect and of the remaining provisions shall not in any way be affected or impaired thereby, it being intended that all of the provisions hereof shall be
enforceable to the full extent permitted by law. 
 (c) This Supplemental Indenture will be governed by and construed in accordance with the
laws of the State of New York, as applied to contracts made and performed within the State of New York, without regard to principles of conflicts of laws. 
  

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 (d) Except as amended or supplemented by this Supplemental Indenture, the terms, conditions, covenants
and agreements set forth in the Original Indenture shall continue in full force and effect. 
 (e) This Supplemental Indenture may be
executed in any number of counterparts, each of which so executed shall be deemed to be an original, but all such counterparts shall together constitute but one and the same instrument. 
 (f) The Trustee makes no representations as to the validity or sufficiency of this Supplemental Indenture. The recitals and statements herein are deemed
to be those of the Company and the Additional Guarantors and not of the Trustee. 
  

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 SENIOR SUBORDINATED 
 IN WITNESS WHEREOF, the parties hereto have caused this Supplemental Indenture to be duly executed as of the day and year first above written.

  

					
	DAVITA INC.
		
	By:	 	/s/ Joseph Schohl
		 	Name: 	 	Joseph Schohl
		 	Title:	 	Vice President and General Counsel

			
	 GUARANTORS
 Astro,
Hobby, West Mt. Renal Care Limited Partnership
 Bay Area Dialysis Partnership
 Beverly Hills Dialysis Partnership
 Carroll County Dialysis Facility, Inc.
 Continental Dialysis Center of Springfield-Fairfax, Inc.
 Continental Dialysis Centers, Inc.
 DVA Healthcare of Pennsylvania, Inc.
 DVA Healthcare of Maryland, Inc.
 DVA Healthcare of Massachusetts, Inc.
 DVA Healthcare Nephrology Partners, Inc.
 DVA Healthcare Renal Care, Inc.
 DVA Healthcare Procurement Services, Inc.
 DVA Laboratory Services, Inc.
 DVA Nephrology Partners, Inc.
 DVA Nephrology Services, Inc.
 DVA of
New York, Inc.
 DVA Renal Healthcare, Inc.
 DVA Supply Corp.
 DaVita Nephrology Associates of Utah, L.L.C.
 DaVita – West, LLC
 Dialysis
Holdings, Inc.
 Dialysis Specialists of Dallas, Inc.
 Downriver Centers, Inc.
 East End Dialysis Center, Inc.
 Eastmont Dialysis Partnership
 Elberton Dialysis Facility, Inc.
 Flamingo Park Kidney Center, Inc.
 Freehold Artificial Kidney Center, LLC
 Houston Kidney Center/Total Renal Care
 Integrated Service Network Limited Partnership
 Kidney Care Rx, Inc. (fka Total Renal Support Services, Inc.)
 Kidney Care Services, LLC
 Lincoln Park Dialysis Services, Inc.
 Mason-Dixon Dialysis Facilities, Inc.
 Nephrology Medical Associates of Georgia, LLC
 Neptune Artificial Kidney Center, LLC
 Open Access Sonography, Inc.
 Orange
Dialysis, LLC

			
	 Pacific Coast Dialysis Center
 PDI Holdings, Inc. PDI Supply, Inc.
 PDI Supply, Inc.
 Peninsula Dialysis Center, Inc.
 Physicians Dialysis Acquisitions, Inc.
 Physicians Dialysis Ventures, Inc.
 Physicians Dialysis, Inc.
 Renal
Treatment Centers – California, Inc.
 Renal Treatment Centers – Hawaii, Inc.
 Renal Treatment Centers – Illinois, Inc.
 Renal Treatment Centers – Mid-Atlantic, Inc.
 Renal Treatment Centers – Northeast, Inc.
 Renal Treatment Centers – Southeast, LP
 Renal Treatment Centers – West, Inc.
 Renal Treatment Centers, Inc.
 RMS DM, LLC
 RTC – Texas
Acquisition, Inc.
 RTC Holdings, Inc.
 RTC TN, Inc.
 Sierra Rose Dialysis Center, LLC
 Southwest Atlanta Dialysis Centers, LLC
 Total Acute Kidney Care, Inc.
 Total Renal Care / Eaton Canyon Dialysis Center Partnership
 Total Renal Care of Colorado, Inc.
 Total Renal Care of Utah, L.L.C.
 Total Renal Care Texas Limited Partnership
 Total Renal Care, Inc.
 Total Renal
Care/Peralta Renal Center Partnership
 Total Renal Care/Piedmont Dialysis Partnership
 Total Renal Laboratories, Inc.
 Total
Renal Research, Inc.
 TRC – Indiana, LLC
 TRC of New York, Inc.
 TRC West, Inc.
 Tri-City Dialysis Center, Inc.

		
	By: 	 	/s/ H. W. Guy Seay
		 	H. W. Guy Seay, authorized signatory

					
	 ADDITIONAL GUARANTORS
  
 Dialysis Centers of Abilene, L.P.
 Mid-City New Orleans Dialysis Partnership,
LLC
 North Atlanta Dialysis Center, LLC
 Ontario Dialysis Center,
LLC
 Renal Life Link, Inc.
 South Shore Dialysis Center,
L.P.
 Southeast Florida Dialysis, LLC

		
	By:	 	/s/ H.W. Guy Seay
		 	H. W. Guy Seay, authorized signatory
	
	THE BANK OF NEW YORK TRUST COMPANY, N.A., as Trustee
		
	By: 	 	 /s/ Raymond Torres
  

		 	Name: 	 	Raymond Torres
		 	Title:	 	Assistant Vice PresidentOffer of Employment Letter to Mary Kowenhoven

 Exhibit 10.2 
 

 
 February 15, 2007 
 By
E-Mail 
 Mary Kowenhoven 
 Dear Mary: 
 On behalf of DaVita Inc., I am pleased to confirm your offer of employment at our Casa DaVita location. We look forward to your first day of work on March 26, 2007.
You will be working as the Vice President, Strategy, reporting to me. The following represents the terms and conditions in this regard: 
 As we discussed,
your base salary for this position has been set at $200,000 per annum, less standard deductions and authorized withholdings. Your position is exempt under the wage and hour laws. You will be paid bi-weekly pursuant to our normal payroll practices.
Your status will be that of a regular full-time benefit eligible teammate. In addition, you will be eligible to receive an annual performance bonus between zero and $125,000 (you are guaranteed a minimum bonus of 40% of your bonus potential for the
first year), which is a discretionary bonus and which is payable in a manner consistent with our practices and procedures. Any further salary increases will be based upon DaVita’s compensation program and your performance. 
 You will be eligible to receive health and disability insurance benefits, as well as other related benefits, under the same terms and conditions generally applicable to
DaVita teammates at the similar level of compensation and responsibility. You will be eligible to participate in DaVita’s health and disability insurance plans on the first of the month after you have completed two (2) months of continuous
employment. You will be receiving an enrollment kit outlining your choices. 
 On your hire date, the
Company will issue you a grant of Stock-settled Stock Appreciation Rights (“SSARs”) on a base number of 22,000 shares of DaVita common stock. This SSAR grant will have a five-year term and will vest 25% on the first anniversary date of the
grant, 8.33% on the 20th month after the grant date, and 8.33% every four months thereafter. The exercise price will
be the closing price of DaVita common stock as reported on the New York Stock Exchange on the start date of your employment. The terms of the SSAR grant will be set forth in a separate SSAR agreement to be signed by both you and the Company. I am
enclosing a copy of our form SSAR agreement for your review, as well as our Management Share Ownership Policy for your review. 
 It is understood and agreed
that your employment will be at-will, and either you or DaVita may terminate the relationship at any time, for any or no reason, with or without notice. The terms of this letter, therefore, do not, and are not intended to, create an express or
implied contract of employment. 

 Your at-will employment relationship may only be modified by a written agreement, signed by an officer or director of
DaVita. 
 It is also understood and agreed that, by virtue of your employment with DaVita, you will gain special knowledge and familiarity with the needs
and requirement of the Company, its customers, and business partners, and that but for your employment with DaVita, you would not have contact with such customers and business partners. You also acknowledge that, as a result of your employment, you
will acquire trade secrets and confidential information of DaVita. In consideration for receiving such special knowledge and information, you agree to comply with the terms of the Noncompetition, Nonsolicitation, and Confidentiality Agreement, which
is attached and which is incorporated herein by reference. 
 Please note that this offer is contingent upon successful completion & receipt of our
pre-employment drug test and background check and a pre-employment physical (use where applicable) results before your first day of employment. Please contact Lisa Joins at 310-536-2566 to arrange for a pre-employment drug test or enclosed are
instructions on where to go for the drug test, as well as the form that you will need to take with you to the collection site. 
 If you accept the terms of
this offer, please sign the letter below and return it to me as soon as possible. We look forward to your first day of work, and being a part of DaVita’s efforts and mission to be the Provider, Partner and Employer of Choice. If you have any
questions, or if I may provide further information, please do not hesitate to contact me directly. 
 Sincerely, 
  

					
		  		  	
	Kent J. Thiry	  		  	
	Chairman and Chief Executive Officer	  		  	

 I accept the position of Vice President, Strategy under the terms and conditions outlined above. 
  

					
	/s/ Mary Kowenhoven	  		  	2/15/07
	Mary Kowenhoven	  		  	Date

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