Document:

Exhibit
4.1

EXECUTION
VERSION

GENESIS HEALTHCARE CORPORATION,

THE SUBSIDIARY GUARANTORS SIGNATORY HERETO

AND

THE BANK OF NEW YORK
 as Trustee

 

FOURTH SUPPLEMENTAL INDENTURE

Dated as of
June 20, 2007

to

Indenture

Dated as of
October 28, 2003

8% Senior Subordinated
Notes due 2013

THIS FOURTH
SUPPLEMENTAL INDENTURE,
dated as of June 20, 2007 (this “Supplemental
Indenture”), is by and among Genesis HealthCare Corporation, a
Pennsylvania corporation (the “Issuer”),
the Subsidiary Guarantors signatory hereto, and The Bank of New York, as
trustee (the “Trustee”).

WHEREAS, the Issuer and the
Trustee have entered into that certain Indenture dated as of October 28,
2003, as supplemented by the first,
second and third supplemental indentures, dated as of January 20, 2004, March
16, 2005, and February 27, 2007, respectively (as supplemented and amended to
date, the “Indenture”),
providing for the issuance of 8% Senior Subordinated Notes due 2013 (the “Notes”);

WHEREAS, the Issuer
originally issued $225 million aggregate principal amount of the Notes;

WHEREAS, Section 9.02
of the Indenture provides that the Indenture may be amended with the consent of
the Holders of at least a majority in principal amount of the Notes then
outstanding (including consents obtained in connection with a tender offer or
exchange for Notes) subject to certain exceptions;

WHEREAS, the Issuer desires
and has requested the Trustee to join with it in entering into this
Supplemental Indenture for the purpose of amending the Indenture in certain respects
as permitted by Section 9.02 of the Indenture;

WHEREAS, the execution and
delivery of this Supplemental Indenture has been authorized by the Board of
Directors or similar governing body of the Issuer and of each Subsidiary
Guarantor; and

WHEREAS, (1) the Issuer
has received the consent of the Holders of at least a majority in principal
amount of the outstanding Notes and has satisfied all other conditions
precedent, if any, provided under the Indenture to enable the Issuer, the
Subsidiary Guarantors and the Trustee to enter into this Supplemental
Indenture, all as certified by an Officers’ Certificate, delivered to the
Trustee simultaneously with the execution and delivery of this Supplemental
Indenture as contemplated by Section 9.06 of the Indenture, and
(2) the Issuer has delivered to the Trustee simultaneously with the
execution and delivery of this Supplemental Indenture an Opinion of Counsel
relating to this Supplemental Indenture as contemplated by Section 9.06 of
the Indenture;

NOW, THEREFORE, in
consideration of the above premises, each party hereby agrees, for the benefit
of the others and for the equal and ratable benefit of the Holders of the
Notes, as follows:

ARTICLE I

DEFINITIONS

Section 1.1  Deletion of Definitions and Related References.
Section 1.01 of the Indenture is hereby amended to delete in its entirety
all terms and their respective definitions for which all references are
eliminated in the Indenture as a result of the amendments set forth in Article
II of this Supplemental Indenture.

ARTICLE II

AMENDMENTS TO INDENTURE

Section 2.1  Amendments to the Indenture. The Indenture is
hereby amended by:

(i) deleting the following
sections of the Indenture and all references thereto in the Indenture in their
entirety:

Section 3.09 (Offer to Purchase by Application of
Excess Proceeds)

Section 4.02 (Maintenance of Office or Agency)

Section 4.03 (Reports)

Section 4.05 (Taxes)

Section 4.06 (Stay, Extension and Usury Laws)

 1
 

Section 4.07 (Restricted Payments)

Section 4.08 (Dividend and Other Payment
Restrictions Affecting Restricted Subsidiaries)

Section 4.09 (Incurrence of Indebtedness and
Issuance of Preferred Stock)

Section 4.10 (Asset Sales)

Section 4.11 (Transactions with Affiliates)

Section 4.12 (Liens)

Section 4.13 (Business Activities)

Section 4.14 (Corporate Existence)

Section 4.15 (Offer to Repurchase Upon a Change of
Control)

Section 4.16 (Payments for Consent)

Section 4.17 (Additional Subsidiary Guarantees)

Section 4.18 (Designation of Restricted and
Unrestricted Subsidiaries)

Section 4.19 (No Senior Subordinated Debt)

Section 4.20 (Consummation of Spin-off)

Section 4.21 (Limitation on Activities of Genesis
Health Ventures, Inc.)

Section 4.22 (Spin-off)

Section 5.01 (Merger, Consolidation or Sale of
Assets)

Sections 6.01(3), 6.01(4),
6.01(5), 6.01(6), 6.01(7), 6.01(8), 6.01(9) and 6.01(10)

Section 10.04 (Guarantors
May Consolidate , etc., on Certain Terms)

Section 10.05 (Release of
Subsidiary Guarantors from Obligations); and

(ii) amending the definition
of “Unrestricted Subsidiary” in Section 1.01
of the Indenture to delete the second-to-last paragraph of such definition.

ARTICLE III

MISCELLANEOUS PROVISIONS

Section 3.1  Indenture. Except as amended hereby, the
Indenture is in all respects ratified and confirmed and all the terms,
conditions and provisions thereof shall remain in full force and effect. This
Supplemental Indenture shall form a part of the Indenture for all purposes, and
every Holder of Notes heretofore or hereafter authenticated and delivered under
the Indenture shall be bound by the Indenture as amended hereby. Subject to
Section 13.01 of the Indenture, in the case of conflict between the
Indenture and this Supplemental Indenture, the provisions of this Supplemental
Indenture shall control.

Section 3.2  Severability. In case any provision in this
Supplemental Indenture 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.

Section 3.3
Capitalized Terms.  Capitalized terms used herein but not defined
shall have the meanings assigned to them in the Indenture.

 2
 

Section 3.4  Effect of Headings. The Article and Section
headings used herein are for convenience only and shall not affect the
construction of this Supplemental Indenture.

Section 3.5  Trustee Makes No Representations. The Trustee
makes no representation as to the validity or sufficiency of this Supplemental
Indenture; the recitals and statements herein are deemed to be those of the
Issuer and the Subsidiary Guarantors and not of the Trustee.

Section 3.6  Certain Duties and Responsibilities of the Trustee.
In entering into this Supplemental Indenture, the Trustee shall be entitled to
the benefit of every provision of the Indenture relating to the conduct or
affecting the liability or affording protection to the Trustee, whether or not
elsewhere herein so provided.

Section 3.7  Governing Law. THIS SUPPLEMENTAL INDENTURE
AND THE NOTES SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS
OF THE STATE OF NEW YORK BUT WITHOUT GIVING EFFECT TO APPLICABLE PRINCIPLES OF
CONFLICTS OF LAW TO THE EXTENT THAT THE APPLICATION OF THE LAWS OF ANOTHER
JURISDICTION WOULD BE REQUIRED THEREBY.

Section 3.8  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 one and the same agreement.

Section 3.9  Successors. All agreements of the Issuer, the
Subsidiary Guarantors and the Trustee in this Supplemental Indenture and the
Notes shall bind their respective successors.

Section
3.10  Effectiveness. The
provisions of Articles I and II of this Supplemental Indenture shall be
effective at the time the Issuer accepts for purchase at least a majority in
principal amount of the outstanding Notes issued under the Indenture, excluding any Notes held by the Company or
any person directly or indirectly controlling or controlled by or under direct
or indirect common control with the Company.

Section
3.11  Endorsement and Change of Form of
Notes. Any Notes authenticated and delivered after the close of
business on the date that this Supplemental Indenture becomes effective may be
affixed to, stamped, imprinted or otherwise legended by the Trustee, with a
notation as follows:

“Effective as of
[                    
], 2007, the restrictive covenants of the Indenture and certain of the Events
of Default have been eliminated, as provided in the Fourth Supplemental
Indenture, dated as of June 20, 2007. Reference is hereby made to said Fourth
Supplemental Indenture, copies of which are on file with the Trustee, for a
description of the amendments made therein.”

[THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK]

 3

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

 

	
  

  	
  THE COMPANY

  
	
   

  	
   

  
	
   

  	
  GENESIS HEALTHCARE CORPORATION

  
	
   

  	
   

  
	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
  Name: George V. Hager, Jr.

  
	
   

  	
   

  	
  Title: Chief Executive Officer

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
  SUBSIDIARY GUARANTORS

  
	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  MARMET SNF OPERATIONS, LLC

  
	
   

  	
  1 SULPHIN DRIVE ASSOCIATES, LLC

  
	
   

  	
  OAK HILL SNF OPERATIONS, LLC

  
	
   

  	
  422 23RD STREET ASSOCIATES, LLC

  
	
   

  	
  OAK HILL ALF OPERATIONS, LLC

  
	
   

  	
  438 23RD STREET ASSOCIATES, LLC

  
	
   

  	
  CHARLESTON ALF OPERATIONS, LLC

  
	
   

  	
  699 SOUTH PARK ASSOCIATES, LLC

  
	
   

  	
  LEWISBERG ALF OPERATIONS, LLC

  
	
   

  	
  331 HOLT LANE ASSOCIATES, LLC

  
	
   

  	
  SCOTT DEPOT ALF OPERATIONS, LLC

  
	
   

  	
  5 ROLLING MEADOWS ASSOCIATES, LLC

  
	
   

  	
  WALDORF PROPERTY, LLC

  
	
   

  	
  WALDORF SNF OPERATIONS, LLC

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
  Chief Executive Officer of the foregoing entities

  
	
   

  	
   

  	
   

  
	
   

  	
  CANTERBURY OF SHEPHERDSTOWN LIMITED 

  
	
   

  	
  PARTNERSHIP

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  By: Glenmark Associates, Inc., a Managing General 

  
	
   

  	
   

  	
  Partner

  
	
   

  	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
  Chief Executive Officer

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  CANTERBURY OF SHEPHERDSTOWN LIMITED 

  
	
   

  	
   

  	
  PARTNERSHIP

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  By:  GMA
  Partnership Holding Company, Inc., a 

  
	
   

  	
   

  	
  Managing General Partner

  
	
   

  	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
  Chief Executive Officer

  

 

Signature Page to 8% Notes
Supplemental Indenture

 

	
  

  	
  BERKELEY HAVEN LIMITED PARTNERSHIP

  
	
   

  	
   

  	
  By:  Glenmark
  Associates, Inc., a general partner

  
	
   

  	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
  Chief Executive Officer

  
	
   

  	
   

  	
   

  
	
   

  	
  By:

  	
  GMA Partnership Holding Company, Inc., a general 

  
	
   

  	
   

  	
  partner

  
	
   

  	
   

  	
   

  
	
   

  	
  By:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
  Chief Executive Officer

  
	
   

  	
   

  	
   

  
	
   

  	
  MARKGLEN, INC.

  
	
   

  	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
  Chief Executive Officer

  
	
   

  	
   

  	
   

  
	
   

  	
  NORTHWEST TOTAL CARE CENTER ASSOCIATES, 

  
	
   

  	
  L.P.

  
	
   

  	
   

  	
  By:  Geriatric
  and Medical Services, Inc., its general 

  
	
   

  	
   

  	
  partner

  
	
   

  	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
  Chief Executive Officer

  
	
   

  	
   

  	
   

  
	
   

  	
  ACADEMY
  NURSING HOME, INC.

  
	
   

  	
   

  
	
   

  	
  ADS
  APPLE VALLEY, INC.

  
	
   

  	
   

  
	
   

  	
  ADS
  CONSULTING, INC.

  
	
   

  	
   

  
	
   

  	
  ADS
  DANVERS ALF, INC.

  
	
   

  	
   

  
	
   

  	
  ADS
  DARTMOUTH ALF, INC.

  
	
   

  	
   

  
	
   

  	
  ADS
  HINGHAM ALF, INC.

  

 

Signature
Page to 8% Notes Supplemental Indenture

 

	
   

  	
  ADS
  HINGHAM NURSING FACILITY, INC.

  
	
   

  	
   

  
	
   

  	
  ADS
  HOME HEALTH, INC.

  
	
   

  	
   

  
	
   

  	
  ADS
  MANAGEMENT, INC.

  
	
   

  	
   

  
	
   

  	
  ADS
  PALM CHELMSFORD, INC.

  
	
   

  	
   

  
	
   

  	
  ADS
  RECUPERATIVE CENTER, INC.

  
	
   

  	
   

  
	
   

  	
  ADS
  RESERVOIR WALTHAM, INC.

  
	
   

  	
   

  
	
   

  	
  ADS
  SENIOR HOUSING, INC.

  
	
   

  	
   

  
	
   

  	
  ADS/MULTICARE,
  INC.

  
	
   

  	
   

  
	
   

  	
  ANR,
  INC.

  
	
   

  	
   

  
	
   

  	
  APPLE
  VALLEY OPERATING CORP.

  
	
   

  	
   

  
	
   

  	
  APPLEWOOD
  HEALTH RESOURCES, INC.

  
	
   

  	
   

  
	
   

  	
  ASL,
  INC.

  
	
   

  	
   

  
	
   

  	
  ASSISTED
  LIVING ASSOCIATES OF BERKSHIRE, 

  
	
   

  	
  INC.

  
	
   

  	
   

  
	
   

  	
  ASSISTED
  LIVING ASSOCIATES OF LEHIGH, INC.

  
	
   

  	
   

  
	
   

  	
  ASSISTED
  LIVING ASSOCIATES OF SANATOGA, 

  
	
   

  	
  INC.

  
	
   

  	
   

  
	
   

  	
  BERKS
  NURSING HOMES, INC.

  
	
   

  	
   

  
	
   

  	
  BRIGHTWOOD
  PROPERTY, INC.

  
	
   

  	
   

  
	
   

  	
  BRINTON
  MANOR, INC.

  
	
   

  	
   

  
	
   

  	
  BURLINGTON
  WOODS CONVALESCENT CENTER, 

  
	
   

  	
  INC.

  
	
   

  	
   

  
	
   

  	
  CAREFLEET,
  INC.

  
	
   

  	
   

  
	
   

  	
  CENTURY
  CARE MANAGEMENT, INC.

  
	
   

  	
   

  
	
   

  	
  CHATEAU
  VILLAGE HEALTH RESOURCES, INC.

  

 

Signature Page to 8% Notes Supplemental Indenture

 

	
   

  	
  CHELTENHAM
  LTC MANAGEMENT, INC.

  
	
   

  	
   

  
	
   

  	
  CHG
  INVESTMENT CORP., INC.

  
	
   

  	
   

  
	
   

  	
  CHNR-I,
  INC.

  
	
   

  	
   

  
	
   

  	
  COLONIAL
  HALL HEALTH RESOURCES, INC.

  
	
   

  	
   

  
	
   

  	
  CONCORD
  HEALTH GROUP, INC.

  
	
   

  	
   

  
	
   

  	
  CONCORD
  SERVICE CORPORATION

  
	
   

  	
   

  
	
   

  	
  CRESTVIEW
  CONVALESCENT HOME, INC.

  
	
   

  	
   

  
	
   

  	
  CRESTVIEW
  NORTH, INC.

  
	
   

  	
   

  
	
   

  	
  CRYSTAL
  CITY NURSING CENTER, INC.

  
	
   

  	
   

  
	
   

  	
  CVNR,
  INC.

  
	
   

  	
   

  
	
   

  	
  DAWN
  VIEW MANOR, INC.

  
	
   

  	
   

  
	
   

  	
  DELM
  NURSING, INC.

  
	
   

  	
   

  
	
   

  	
  DIANE
  MORGAN AND ASSOCIATES, INC.

  
	
   

  	
   

  
	
   

  	
  DOVER
  HEALTHCARE ASSOCIATES, INC.

  
	
   

  	
   

  
	
   

  	
  EIDOS,
  INC.

  
	
   

  	
   

  
	
   

  	
  ELDERCARE
  RESOURCES CORP.

  
	
   

  	
   

  
	
   

  	
  ELMWOOD
  HEALTH RESOURCES, INC.

  
	
   

  	
   

  
	
   

  	
  ENCARE
  OF PENNYPACK, INC.

  
	
   

  	
   

  
	
   

  	
  ENCARE
  OF QUAKERTOWN, INC.

  
	
   

  	
   

  
	
   

  	
  ENCARE
  OF WYNCOTE, INC.

  
	
   

  	
   

  
	
   

  	
  ENR,
  INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE CENTERS — BELVEDERE, 

  
	
   

  	
  INC.

  

 

Signature Page to 8% Notes
Supplemental Indenture

 

	
   

  	
  GENESIS
  ELDERCARE CENTERS — CHAPEL 

  
	
   

  	
  MANOR,
  INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE CENTERS-HARSTON, INC. 

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE CENTERS — PENNSBURG,  

  
	
   

  	
  INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE CORP.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE DIAGNOSTIC SERVICES, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE HOME CARE SERVICES, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE HOSPITALITY SERVICES,  

  
	
   

  	
  INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE LIVING FACILITIES, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE NATIONAL CENTERS, INC. 

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE NETWORK SERVICES OF MASSACHUSETTS, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE NETWORK SERVICES, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE PARTNERSHIP CENTERS, 

  
	
   

  	
  INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE PHYSICIAN SERVICES, INC. 

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE PROPERTIES, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE REHABILITATION SERVICES, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE STAFFING SERVICES, INC. 

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE TRANSPORTATION 

  
	
   

  	
  SERVICES,
  INC.

  

 

Signature Page to 8% Notes
Supplemental Indenture

 

	
   

  	
  GENESIS
  HEALTH VENTURES OF ARLINGTON, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF BLOOMFIELD, 

  
	
   

  	
  INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF CLARKS SUMMIT, 

  
	
   

  	
  INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF INDIANA, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF LANHAM, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF .

  
	
   

  	
  MASSACHUSETTS,
  INC

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF NAUGATUCK, 

  
	
   

  	
  INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF NEW GARDEN, 

  
	
   

  	
  INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF POINT PLEASANT, 

  
	
   

  	
  INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF SALISBURY, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF WAYNE, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF WEST VIRGINIA, 

  
	
   

  	
  INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF WILKES-BARRE, 

  
	
   

  	
  INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF WINDSOR, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTHCARE CENTERS HOLDINGS, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTHCARE HOLDING COMPANY I, INC.

  

 

Signature Page to 8% Notes
Supplemental Indenture

	
  

  	
  GENESIS
  HEALTHCARE HOLDING COMPANY II, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  IMMEDIATE MED CENTER, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS OF
  PALISADO AVENUE, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  PROPERTIES OF DELAWARE CORPORATION

  
	
   

  	
   

  
	
   

  	
  GENESIS
  SELECTCARE CORP.

  
	
   

  	
   

  
	
   

  	
  GENESIS/VNA
  PARTNERSHIP HOLDING COMPANY, INC.

  
	
   

  	
   

  
	
   

  	
  GERIATRIC &
  MEDICAL COMPANIES, INC.

  
	
   

  	
   

  
	
   

  	
  GERIATRIC AND
  MEDICAL INVESTMENTS CORPORATION

  
	
   

  	
   

  
	
   

  	
  GERIATRIC AND
  MEDICAL SERVICES, INC.

  
	
   

  	
   

  
	
   

  	
  GERI-MED CORP.

  
	
   

  	
   

  
	
   

  	
  GLENMARK
  ASSOCIATES - DAWN VIEW MANOR, INC.

  
	
   

  	
   

  
	
   

  	
  GLENMARK
  ASSOCIATES, INC.

  
	
   

  	
   

  
	
   

  	
  GLENMARK
  PROPERTIES, INC.

  
	
   

  	
   

  
	
   

  	
  GMA-BRIGHTWOOD,
  INC.

  
	
   

  	
   

  
	
   

  	
  GMA
  CONSTRUCTION, INC.

  
	
   

  	
   

  
	
   

  	
  GMA-MADISON,
  INC.

  
	
   

  	
   

  
	
   

  	
  GMA - UNIONTOWN,
  INC.

  
	
   

  	
   

  
	
   

  	
  GMA PARTNERSHIP
  HOLDING COMPANY, INC.

  
	
   

  	
   

  
	
   

  	
  GMC LEASING
  CORPORATION

  
	
   

  	
   

  
	
   

  	
  GMC-LTC
  MANAGEMENT, INC.

  
	
   

  	
   

  
	
   

  	
  GMS INSURANCE SERVICES,
  INC.

  

 

Signature Page to 8% Notes
Supplemental Indenture

 

 

	
  

  	
  GOVERNOR’S HOUSE
  NURSING HOME, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF ACADEMY MANOR, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF BOARDMAN, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF BROOKLYN, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF CEDAR GROVE, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF CINNAMINSON, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF COLCHESTER, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF COLUMBUS, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF CUMBERLAND, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF ENGLEWOOD, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF EWING, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF FARMINGTON, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF GARDNER, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF GLASTONBURY, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF GROTON, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF LAKEVIEW, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF LEMONT, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF MARCELLA, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF MIDDLETOWN (RI), INC.

  

 

Signature Page to 8% Notes
Supplemental Indenture

 

 

	
  

  	
  HEALTH RESOURCES
  OF MORRISTOWN, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF NORTH ANDOVER, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF ROCKVILLE, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF TROY HILLS, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF WALLINGFORD, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF WARWICK, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH RESOURCES
  OF WESTWOOD, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTHCARE
  RESOURCES CORP.

  
	
   

  	
   

  
	
   

  	
  HELSTAT, INC.

  
	
   

  	
   

  
	
   

  	
  HILLTOP HEALTH
  CARE CENTER, INC.

  
	
   

  	
   

  
	
   

  	
  HMNH REALTY,
  INC.

  
	
   

  	
   

  
	
   

  	
  HNCA, INC.

  
	
   

  	
   

  
	
   

  	
  HORIZON
  ASSOCIATES, INC.

  
	
   

  	
   

  
	
   

  	
  HORIZON MOBILE,
  INC.

  
	
   

  	
   

  
	
   

  	
  HORIZON
  REHABILITATION, INC.

  
	
   

  	
   

  
	
   

  	
  HR OF
  CHARLESTON, INC.

  
	
   

  	
   

  
	
   

  	
  HRWV HUNTINGTON,
  INC.

  
	
   

  	
   

  
	
   

  	
  INNOVATIVE
  HEALTH CARE MARKETING, INC.

  
	
   

  	
   

  
	
   

  	
  KEYSTONE NURSING
  HOME, INC.

  
	
   

  	
   

  
	
   

  	
  KNOLLWOOD MANOR,
  INC.

  
	
   

  	
   

  
	
   

  	
  KNOLLWOOD
  NURSING HOME, INC.

  
	
   

  	
   

  
	
   

  	
  LAKE MANOR, INC.

  

 

Signature Page to 8% Notes
Supplemental Indenture

 

 

	
  

  	
  LAKEWOOD HEALTH
  RESOURCES, INC.

  
	
   

  	
   

  
	
   

  	
  LAUREL HEALTH
  RESOURCES, INC.

  
	
   

  	
   

  
	
   

  	
  LEHIGH NURSING
  HOMES, INC.

  
	
   

  	
   

  
	
   

  	
  LIFE SUPPORT
  MEDICAL EQUIPMENT, INC.

  
	
   

  	
   

  
	
   

  	
  LIFE SUPPORT
  MEDICAL, INC.

  
	
   

  	
   

  
	
   

  	
  LRC HOLDING
  COMPANY, INC.

  
	
   

  	
   

  
	
   

  	
  LWNR, INC.

  
	
   

  	
   

  
	
   

  	
  MABRI
  CONVALESCENT CENTER, INC.

  
	
   

  	
   

  
	
   

  	
  MANOR MANAGEMENT
  CORP. OF GEORGIAN MANOR, INC.

  
	
   

  	
   

  
	
   

  	
  MARLINTON
  ASSOCIATES, INC.

  
	
   

  	
   

  
	
   

  	
  MARLINTON
  PARTNERSHIP HOLDING COMPANY, INC.

  
	
   

  	
   

  
	
   

  	
  MCKERLEY HEALTH
  CARE CENTER-CONCORD, INC.

  
	
   

  	
   

  
	
   

  	
  MCKERLEY HEALTH
  CARE CENTERS, INC.

  
	
   

  	
   

  
	
   

  	
  MERIDIAN HEALTH,
  INC.

  
	
   

  	
   

  
	
   

  	
  MERIDIAN
  HEALTHCARE INVESTMENTS, INC.

  
	
   

  	
   

  
	
   

  	
  MERIDIAN
  HEALTHCARE, INC.

  
	
   

  	
   

  
	
   

  	
  MHNR, INC.

  
	
   

  	
   

  
	
   

  	
  MNR, INC.

  
	
   

  	
   

  
	
   

  	
  MONTGOMERY
  NURSING HOMES, INC.

  
	
   

  	
   

  
	
   

  	
  MULTICARE AMC,
  INC.

  
	
   

  	
   

  
	
   

  	
  NURSING AND
  RETIREMENT CENTER OF THE ANDOVERS, INC.

  
	
   

  	
   

  
	
   

  	
  OAK HILL HEALTH
  CARE CENTER, INC.

  

 

Signature Page to 8% Notes
Supplemental Indenture

 

 

	
  

  	
  PHC OPERATING
  CORP.

  
	
   

  	
   

  
	
   

  	
  PHILADELPHIA
  AVENUE CORPORATION

  
	
   

  	
   

  
	
   

  	
  POCAHONTAS
  CONTINUOUS CARE CENTER, INC.

  
	
   

  	
   

  
	
   

  	
  PRESCOTT NURSING
  HOME, INC.

  
	
   

  	
   

  
	
   

  	
  PROSPECT PARK
  LTC MANAGEMENT, INC.

  
	
   

  	
   

  
	
   

  	
  PROVIDENCE
  FUNDING CORPORATION

  
	
   

  	
   

  
	
   

  	
  PROVIDENCE
  HEALTH CARE, INC.

  
	
   

  	
   

  
	
   

  	
  REST HAVEN
  NURSING HOME, INC.

  
	
   

  	
   

  
	
   

  	
  RHS MEMBERSHIP
  INTEREST HOLDING COMPANY

  
	
   

  	
   

  
	
   

  	
  RIDGELAND HEALTH
  RESOURCES, INC.

  
	
   

  	
   

  
	
   

  	
  RIVERSHORES
  HEALTH RESOURCES, INC.

  
	
   

  	
   

  
	
   

  	
  RLNR, INC.

  
	
   

  	
   

  
	
   

  	
  ROSE HEALTHCARE,
  INC.

  
	
   

  	
   

  
	
   

  	
  ROSE VIEW MANOR,
  INC.

  
	
   

  	
   

  
	
   

  	
  RSNR, INC.

  
	
   

  	
   

  
	
   

  	
  RVNR, INC.

  
	
   

  	
   

  
	
   

  	
  S. T. B.
  INVESTORS, LTD.

  
	
   

  	
   

  
	
   

  	
  SCHUYLKILL
  NURSING HOMES, INC.

  
	
   

  	
   

  
	
   

  	
  SENIOR LIVING
  VENTURES, INC.

  
	
   

  	
   

  
	
   

  	
  SENIOR SOURCE,
  INC.

  
	
   

  	
   

  
	
   

  	
  SNOW VALLEY
  HEALTH RESOURCES, INC.

  
	
   

  	
   

  
	
   

  	
  SOLOMONT FAMILY
  MEDFORD VENTURE, INC.

  
	
   

  	
   

  
	
   

  	
  STAFFORD CONVALESCENT
  CENTER, INC.

  

 

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Supplemental Indenture

 

 

	
  

  	
  STATE STREET
  ASSOCIATES, INC.

  
	
   

  	
   

  
	
   

  	
  SVNR, INC.

  
	
   

  	
   

  
	
   

  	
  THE ADS GROUP,
  INC.

  
	
   

  	
   

  
	
   

  	
  THE APPLE VALLEY
  PARTNERSHIP HOLDING COMPANY, INC.

  
	
   

  	
   

  
	
   

  	
  THE HOUSE OF
  CAMPBELL, INC.

  
	
   

  	
   

  
	
   

  	
  THE MULTICARE
  COMPANIES, INC.

  
	
   

  	
   

  
	
   

  	
  THE SARAH
  BRAYTON PARTNERSHIP HOLDING COMPANY, INC.

  
	
   

  	
   

  
	
   

  	
  THE SOMERSET
  PARTNERSHIP HOLDING COMPANY, INC.

  
	
   

  	
   

  
	
   

  	
  TMC ACQUISITION
  CORP.

  
	
   

  	
   

  
	
   

  	
  TRI STATE MOBILE
  MEDICAL SERVICES, INC.

  
	
   

  	
   

  
	
   

  	
  VALLEY MEDICAL
  SERVICES, INC.

  
	
   

  	
   

  
	
   

  	
  VALLEY TRANSPORT
  AMBULANCE SERVICE, INC.

  
	
   

  	
   

  
	
   

  	
  VERSALINK, INC.

  
	
   

  	
   

  
	
   

  	
  VILLAS REALTY
  & INVESTMENTS, INC.

  
	
   

  	
   

  
	
   

  	
  WALNUT LTC
  MANAGEMENT, INC.

  
	
   

  	
   

  
	
   

  	
  WAYSIDE NURSING
  HOME, INC.

  
	
   

  	
   

  
	
   

  	
  WEISENFLUH
  AMBULANCE SERVICE, INC.

  
	
   

  	
   

  
	
   

  	
  WEST PHILA. LTC
  MANAGEMENT, INC.

  
	
   

  	
   

  
	
   

  	
  WESTFORD NURSING
  AND RETIREMENT CENTER, INC.

  
	
   

  	
   

  
	
   

  	
  WILLOW MANOR
  NURSING HOME, INC.

  
	
   

  	
   

  
	
   

  	
  WYNCOTE
  HEALTHCARE CORP.

  

 

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Supplemental Indenture

 

 

	
  

  	
  YE OLDE
  AMBULANCE COMPANY, INC.

  
	
   

  	
   

  
	
   

  	
  YORK LTC
  MANAGEMENT, INC.

  
	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ George V.
  Hager, Jr.

  
	
   

  	
   

  	
  Name:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
  Title:

  	
  Chief Executive Officer of each of the foregoing
  entities

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  ADS APPLE VALLEY LIMITED
  PARTNERSHIP

  By: ADS Apple Valley, Inc., its general partner

  
	
   

  	
   

  
	
   

  	
  ADS HINGHAM LIMITED PARTNERSHIP

  By:  ADS Hingham Nursing Facility,
  Inc., its general partner

  
	
   

  	
   

  
	
   

  	
  ADS RECUPERATIVE CENTER LIMITED
  PARTNERSHIP

  By:  ADS Recuperative Center, Inc., its
  general partner

  
	
   

  	
   

  
	
   

  	
  BREVARD MERIDIAN LIMITED
  PARTNERSHIP

  By:  Meridian Healthcare, Inc., its general
  partner

  
	
   

  	
   

  
	
   

  	
  CARE HAVEN ASSOCIATES LIMITED
  PARTNERSHIP

  By: 
  Glenmark Associates, Inc., its general partner

  
	
   

  	
   

  
	
   

  	
  CATONSVILLE MERIDIAN LIMITED
  PARTNERSHIP

  By:  Meridian Healthcare, Inc. and
  Meridian Health, Inc., its general partners

  
	
   

  	
   

  
	
   

  	
  CUMBERLAND
  ASSOCIATES OF RHODE ISLAND, L.P.

  By:  Health Resources of Cumberland,
  Inc., its general partner

  
	
   

  	
   

  
	
   

  	
  EASTON MERIDIAN LIMITED
  PARTNERSHIP

  By:  Meridian Healthcare, Inc. and
  Meridian Health, Inc., its general partners

  
	
   

  	
   

  
	
   

  	
  EDELLA STREET ASSOCIATES

  By:  Genesis Health Ventures of Clarks
  Summit, Inc., its general partner

  

 

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Supplemental Indenture

 

 

	
  

  	
  GENESIS ELDERCARE CENTERS I, L.P.

  By:  Genesis Eldercare Partnership
  Centers, Inc., its general partner

  
	
   

  	
   

  
	
   

  	
  GENESIS ELDERCARE CENTERS II,
  L.P.

  By:  Genesis Eldercare Partnership
  Centers, Inc., its general partner

  
	
   

  	
   

  
	
   

  	
  GENESIS ELDERCARE CENTERS III,
  L.P.

  By:  Genesis Eldercare Partnership
  Centers, Inc., its general partner

  
	
   

  	
   

  
	
   

  	
  GENESIS HEALTH VENTURES OF WEST
  VIRGINIA, LIMITED PARTNERSHIP

  By:  Genesis ElderCare Network
  Services, Inc. and Genesis ElderCare Rehabilitation Services, Inc., its
  general partners

  
	
   

  	
   

  
	
   

  	
  GENESIS PROPERTIES LIMITED
  PARTNERSHIP

  By:  Genesis Health Ventures of
  Arlington, Inc., its general partner

  
	
   

  	
   

  
	
   

  	
  GENESIS PROPERTIES OF DELAWARE
  LTD. PARTNERSHIP, L.P.

  By:  Genesis Properties of Delaware
  Corporation, its general partner

  
	
   

  	
   

  
	
   

  	
  GLENMARK PROPERTIES I, LIMITED
  PARTNERSHIP

  By:  Glenmark Associates, Inc., its
  general partner

  
	
   

  	
   

  
	
   

  	
  GREENSPRING MERIDIAN LIMITED
  PARTNERSHIP

  By:  Meridian Healthcare, Inc., its
  general partner

  
	
   

  	
   

  
	
   

  	
  GROTON ASSOCIATES OF CONNECTICUT,
  L.P.

  By:  Health Resources of Groton, Inc.,
  its general partner

  
	
   

  	
   

  
	
   

  	
  HAMMONDS LANE MERIDIAN LIMITED
  PARTNERSHIP

  By:  Meridian Healthcare, Inc. and Meridian
  Health, Inc., its general partners

  
	
   

  	
   

  
	
   

  	
  LAKE WASHINGTON, LTD.

  By:  Lake Manor, Inc., its general
  partner

  

 

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  MCKERLEY HEALTH CARE CENTER-CONCORD

  
	
   

  	
  LIMITED
  PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  McKerley Health Care Center-Concord, Inc., its
  general partner

  
	
   

  	
   

  	
   

  
	
   

  	
  MERIDIAN/CONSTELLATION LIMITED 

  
	
   

  	
  PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  Meridian Healthcare, Inc., its general partner

  
	
   

  	
   

  	
   

  
	
   

  	
  MERIDIAN EDGEWOOD LIMITED PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  Meridian Healthcare, Inc., its general partner

  
	
   

  	
   

  	
   

  
	
   

  	
  MERIDIAN PERRING LIMITED PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  Meridian Healthcare, Inc., its general partner

  
	
   

  	
   

  	
   

  
	
   

  	
  MERIDIAN VALLEY LIMITED PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  Meridian Healthcare, Inc., its general partner

  
	
   

  	
   

  	
   

  
	
   

  	
  MERIDIAN VALLEY VIEW LIMITED PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  Meridian Healthcare, Inc., its general partner

  
	
   

  	
   

  	
   

  
	
   

  	
  MIDDLETOWN (RI) ASSOCIATES OF RHODE 

  
	
   

  	
  ISLAND, L.P.

  
	
   

  	
   

  	
  By:

  	
  Health Resources of Middletown (RI), Inc., its 

  general partner

  
	
   

  	
   

  	
   

  
	
   

  	
  MILLVILLE MERIDIAN LIMITED PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  Meridian Healthcare, Inc., its general partner

  
	
   

  	
   

  	
   

  
	
   

  	
  NORTH CAPE CONVALESCENT CENTER 

  
	
   

  	
  ASSOCIATES, L.P.

  
	
   

  	
   

  	
  By:

  	
  Geriatric and Medical Services, Inc., its general
  partner

  
	
   

  	
   

  	
   

  
	
   

  	
  PHILADELPHIA AVENUE ASSOCIATES

  
	
   

  	
   

  	
  By:

  	
  Philadelphia Avenue Corporation, its general partner

  
	
   

  	
   

  	
   

  
	
   

  	
  POINT PLEASANT HAVEN LIMITED PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  Glenmark Associates, Inc. and GMA Partnership
  Holding Company, Inc., its general partners

  
	
   

  	
   

  	
   

  
	
   

  	
  RALEIGH MANOR LIMITED PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  Glenmark Associates, Inc., its general partner

  
							

 

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  RIVER STREET ASSOCIATES

  
	
   

  	
   

  	
  By:

  	
  Genesis Health Ventures of Wilkes-Barre, Inc., its
  general partner

  
	
   

  	
   

  	
   

  
	
   

  	
  ROMNEY HEALTH CARE CENTER, LTD., LIMITED 

  
	
   

  	
  PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  Glenmark Associates, Inc., its general partner

  
	
   

  	
   

  	
   

  
	
   

  	
  SEMINOLE MERIDIAN LIMITED PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  Meridian Health, Inc., its general partner

  
	
   

  	
   

  	
   

  
	
   

  	
  SISTERVILLE HAVEN LIMITED PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  Glenmark Associates, Inc., its general partner

  
	
   

  	
   

  	
   

  
	
   

  	
  STAFFORD ASSOCIATES OF N.J., L.P.

  
	
   

  	
   

  	
  By:

  	
  Southern Ocean GP, LLC, its general partner

  
	
   

  	
   

  	
   

  
	
   

  	
  STATE STREET ASSOCIATES, L.P.

  
	
   

  	
   

  	
  By:

  	
  State Street Associates, Inc., its general partner

  
	
   

  	
   

  	
   

  
	
   

  	
  TEAYS VALLEY HAVEN LIMITED PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  Glenmark Associates, Inc., its general partner

  
	
   

  	
   

  	
   

  
	
   

  	
  THE APPLE VALLEY LIMITED PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  The Apple Valley Partnership Holding Company,

  
	
   

  	
   

  	
   

  	
  Inc. and Apple Valley Operating Corp., its general partners

  
	
   

  	
   

  	
   

  
	
   

  	
  THE STRAUS GROUP-HOPKINS HOUSE, L.P.

  
	
   

  	
   

  	
  By: 

  	
  Encare of Wyncote, Inc., its general partner

  
	
   

  	
   

  	
   

  
	
   

  	
  THE STRAUS GROUP-QUAKERTOWN MANOR, L.P.

  
	
   

  	
   

  	
  By:

  	
  Encare of Quakertown, Inc., its general partner

  
	
   

  	
   

  	
   

  
	
   

  	
  THERAPY CARE SYSTEMS, L.P.

  
	
   

  	
   

  	
  By:

  	
  Genesis ElderCare Rehabilitation Services, Inc., its
  general partner

  
	
   

  	
   

  	
   

  
	
   

  	
  VOLUSIA MERIDIAN LIMITED PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  Meridian Health, Inc., its general partner

  
	
   

  	
   

  	
   

  
	
   

  	
  WALLINGFORD ASSOCIATES OF CONNECTICUT, L.P.

  
	
   

  	
   

  	
  By:

  	
  Health Resources of Wallingford, Inc., its general
  partner

  
						

 

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  WARWICK ASSOCIATES OF RHODE ISLAND, L.P.

  
	
   

  	
   

  	
  By:

  	
  Health Resources of Warwick, Inc., its general
  partner

  
	
   

  	
   

  	
   

  
	
   

  	
  WESTFORD NURSING AND RETIREMENT CENTER, 

  
	
   

  	
  LIMITED
  PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  Westford Nursing and Retirement Center, Inc., its general
  partner

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
  Name:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
  Title:

  	
  Chief Executive Officer of the respective general 

  
	
   

  	
   

  	
   

  	
  partners of each of the foregoing entities

  
							

 

	
  

  	
   

  	
   

  
	
   

  	
  HOLLY MANOR ASSOCIATES OF NEW JERSEY, L.P.

  
	
   

  	
   

  	
  By:

  	
  Encare of Mendham, L.L.C., its general partner

  
	
   

  	
   

  
	
   

  	
  MMERCERVILLE ASSOCIATES
  OF NEW JERSEY, L.P.

  
	
   

  	
   

  	
  By:

  	
  Breyut Convalescent Center, L.L.C., its general
  partner

  
	
   

  	
   

  	
   

  
	
   

  	
  POMPTON ASSOCIATES, L.P.

  
	
   

  	
   

  	
  By:

  	
  Pompton Care, L.L.C., its general partner

  
	
   

  	
   

  
	
   

  	
  THE STRAUS GROUP-OLD BRIDGE, L.P.

  
	
   

  	
   

  	
  By:

  	
  Health Resources of Emery, L.L.C., its general
  partner

  
	
   

  	
   

  	
   

  
	
   

  	
  THE STRAUS GROUP-RIDGEWOOD, L.P.

  
	
   

  	
   

  	
  By:

  	
  Health Resources of Ridgewood, L.L.C., its general
  partner

  
	
   

  	
   

  	
   

  
	
   

  	
  By:

  	
  Century Care Management, Inc., the manager of the
  respective general partners of each of the foregoing entities

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
  Name:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
  Title:

  	
  Chief Executive Officer of
  each of the foregoing entities

  
	
   

  	
   

  	
   

  	
   

  
							

 

Signature Page to 8% Notes
Supplemental Indenture

 

 

	
  

  	
   

  	
   

  	
   

  
	
   

  	
  SOMERSET RIDGE LIMITED PARTNERSHIP

  
	
   

  	
  By:

  	
  Somerset Ridge LLC, its general partner

  
	
   

  	
   

  	
  By:

  	
  Somerset Ridge General Partnership, its Manager

  
	
   

  	
   

  	
  By:

  	
  Solomont Family Fall River Venture, Inc., its

  
	
   

  	
   

  	
   

  	
  general partner

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
  Name:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
  Title:

  	
  Chief Executive Officer

  
							

 

	
  

  	
  ARCADIA ASSOCIATES 

  
	
   

  	
   

  	
  By:

  	
  ADS/Multicare, Inc., its managing partner

  
	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
  Name:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
  Title:

  	
  Chief Executive Officer

  
							

 

	
  

  	
  MCKERLEY HEALTH FACILITIES

  
	
   

  	
   

  	
  By:

  	
  Meridian Healthcare, Inc. and Meridian Health, Inc.,
  its partners

  
	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
  Name:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
  Title:

  	
  Chief Executive Officer

  
							

 

	
  

  	
  SARAH BRAYTON GENERAL PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  ADS Multicare Inc. and The Sarah Brayton Partnership
  Holding Company, Inc., its general partners

  
	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
  Name:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
  Title:

  	
  Chief Executive Officer

  
							

 

Signature Page to 8% Notes
Supplemental Indenture

 

 

	
  

  	
   

  	
  SOMERSET RIDGE GENERAL PARTNERSHIP

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  By:

  	
  Solomont Family Fall River Venture, Inc. and The
  Somerset Partnership Holding Company, Inc., its general partners

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
  Name:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
  Title:

  	
  Chief Executive Officer

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  BREYUT CONVALESCENT CENTER, L.L.C.

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  ENCARE OF MENDHAM, L.L.C.

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF BRIDGETON, L.L.C.

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF CINNAMINSON, L.L.C.

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF CRANBURY, L.L.C.

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF EATONTOWN, L.L.C.

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF EMERY, L.L.C.

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF ENGLEWOOD, L.L.C.

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF EWING, L.L.C.

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF FAIR LAWN, L.L.C.

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF JACKSON, L.L.C.

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF RIDGEWOOD, L.L.C.

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF SOUTH BRUNSWICK, L.L.C.

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF WEST ORANGE, L.L.C.

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  POMPTON CARE, L.L.C.

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  ROEPHEL CONVALESCENT CENTER, L.L.C.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  By:

  	
  Century Care Management, Inc., the manager of each
  of the foregoing entities

  
							

 

Signature Page to 8% Notes
Supplemental Indenture

 

 

	
  

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
  Name:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
  Title:

  	
  Chief Executive Officer

  
	
   

  	
   

  
	
   

  	
  GENESIS-GEORGETOWN SNF/JV, LLC

  
	
   

  	
   

  
	
   

  	
  GLENMARK LIMITED LIABILITY COMPANY I

  
	
   

  	
   

  
	
   

  	
  MILFORD ALF, LLC

  
	
   

  	
   

  
	
   

  	
  RESPIRATORY HEALTH SERVICES LLC

  
	
   

  	
   

  
	
   

  	
  RIVERVIEW RIDGE LIMITED LIABILITY COMPANY

  
	
   

  	
   

  
	
   

  	
  SOUTHERN OCEAN GP, L.L.C.

  
	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
  Name:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
  Title:

  	
  Chief Executive Officer

  
	
   

  	
   

  
						

 

	
  

  	
   

  	
   

  	
  SOMERSET RIDGE L.L.C.

  
	
   

  	
   

  	
   

  	
  By:

  	
  Somerset Ridge General Partnership, its Manager

  
	
   

  	
   

  	
   

  	
   

  	
  By:

  	
  Solomont Family Fall River Venture, Inc., its
  general partner

  
	
   

  	
   

  	
   

  	
   

  	
  By:

  	
  The Somerset Partnership Holding Company, Inc.,

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Name:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Title:

  	
  Chief Executive Officer

  
								

 

 

Signature Page to 8% Notes
Supplemental Indenture

 

 

	
  

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  THE BANK OF NEW YORK, as Trustee

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  By:

  	
  /s/ Mary LaGumina

  
	
   

  	
   

  	
   

  	
  Name:

  	
  Mary LaGumina

  
	
   

  	
   

  	
   

  	
  Title:

  	
  Vice President

  
							

 

Signature Page to 8% Notes
Supplemental IndentureExhibit
4.2

EXECUTION
VERSION

GENESIS HEALTHCARE CORPORATION,

THE SUBSIDIARY GUARANTORS SIGNATORY HERETO

AND

THE BANK OF NEW YORK

as Trustee

 

SECOND SUPPLEMENTAL INDENTURE

Dated as of
June 20, 2007

to

Indenture

Dated as of
March 2, 2005

2.5%
Convertible Senior Subordinated Debentures due 2025

THIS SECOND
SUPPLEMENTAL INDENTURE,
dated as of June 20, 2007 (this “Supplemental
Indenture”), is by and among Genesis HealthCare Corporation, a
Pennsylvania corporation (the “Issuer”),
the Subsidiary Guarantors signatory hereto, and The Bank of New York, as
trustee (the “Trustee”).

WHEREAS, the Issuer and the
Trustee have entered into that certain Indenture dated as of March 2, 2005, as supplemented by the supplemental
indenture, dated as of February 27, 2007 (as supplemented and amended to date,
the “Indenture”),
providing for the issuance of 2.5% Convertible Senior Subordinated Debentures
due 2025 (the “Notes”);

WHEREAS, the Issuer
originally issued $180 million aggregate principal amount of the Notes;

WHEREAS, Section 12.02
of the Indenture provides that the Indenture may be amended with the consent of
the Holders of at least a majority in principal amount of the Notes then
outstanding (including consents obtained in connection with a tender offer or
exchange for Notes) subject to certain exceptions, including the requirement
that certain amendments to Article 4 require such consents from the Holders of
at least 75% in principal amount of the Notes then outstanding;

WHEREAS, the Issuer desires
and has requested the Trustee to join with it in entering into this
Supplemental Indenture for the purpose of amending the Indenture in certain
respects as permitted by Section 12.02 of the Indenture;

WHEREAS, the execution and
delivery of this Supplemental Indenture has been authorized by the Board of
Directors or similar governing body of the Issuer and of each Subsidiary
Guarantor; and

WHEREAS, (1) the Issuer
has received the consent of the Holders of at least the requisite percentage in
principal amount of the outstanding Notes and has satisfied all other
conditions precedent, if any, provided under the Indenture to enable the
Issuer, the Subsidiary Guarantors and the Trustee to enter into this
Supplemental Indenture, all as certified by an Officers’ Certificate, delivered
to the Trustee simultaneously with the execution and delivery of this
Supplemental Indenture as contemplated by Section 12.05 of the Indenture,
and (2) the Issuer has delivered to the Trustee simultaneously with the
execution and delivery of this Supplemental Indenture an Opinion of Counsel
relating to this Supplemental Indenture as contemplated by Section 12.05
of the Indenture;

NOW, THEREFORE, in
consideration of the above premises, each party hereby agrees, for the benefit
of the others and for the equal and ratable benefit of the Holders of the
Notes, as follows:

ARTICLE I

DEFINITIONS

Section 1.1  Deletion of Definitions and Related References.
Section 1.01 of the Indenture is hereby amended to delete in its entirety
all terms and their respective definitions for which all references are
eliminated in the Indenture as a result of the amendments set forth in Article
II of this Supplemental Indenture.

ARTICLE II

AMENDMENTS TO INDENTURE

Section 2.1  Amendments to the Indenture. The Indenture is
hereby amended by:

(i) deleting the following
sections of the Indenture and all references thereto in the Indenture in their
entirety:

Section 4.15 (No Senior
Subordinated Indebtedness)

Section 6.02 (Maintenance of
Office or Agency)

Section 6.03 (Appointments
to Fill Vacancies in Trustee’s Office)

Section 6.04 (Provisions as
to Paying Agent)

 

Section 6.05 (Existence)

Section 6.06 (Rule 144A
Information Requirement)

Section 6.07 (Stay,
Extension and Usury Laws)

Section 6.10 (Additional
Subsidiary Guarantees)

Section 6.11 (Designation of
Restricted and Unrestricted Subsidiaries)

Section 6.12 (Assumptions of
Obligations under Registration Rights Agreement)

Sections 8.01(e), 8.01(f),
8.01(g), 8.01(h), 8.01(i), 8.01(j), 8.01(k) and 8.01(l)

Section 14.01 (Consolidation, Merger, Sale,
Conveyance and Lease); and

(ii) amending the definition
of “Unrestricted Subsidiary” in
Section 1.01 of the Indenture to delete the second-to-last paragraph of
such definition.

ARTICLE III

MISCELLANEOUS PROVISIONS

Section 3.1  Indenture. Except as amended hereby, the
Indenture is in all respects ratified and confirmed and all the terms,
conditions and provisions thereof shall remain in full force and effect. This
Supplemental Indenture shall form a part of the Indenture for all purposes, and
every Holder of Notes heretofore or hereafter authenticated and delivered under
the Indenture shall be bound by the Indenture as amended hereby. Subject to
Section 18.07 of the Indenture, in the case of conflict between the
Indenture and this Supplemental Indenture, the provisions of this Supplemental
Indenture shall control.

Section 3.2  Severability. In case any provision in this
Supplemental Indenture 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.

Section 3.3
Capitalized Terms.  Capitalized terms used herein but not defined
shall have the meanings assigned to them in the Indenture.

Section 3.4  Effect of Headings. The Article and Section
headings used herein are for convenience only and shall not affect the
construction of this Supplemental Indenture.

Section 3.5  Trustee Makes No Representations. The Trustee
makes no representation as to the validity or sufficiency of this Supplemental
Indenture; the recitals and statements herein are deemed to be those of the
Issuer and the Subsidiary Guarantors and not of the Trustee.

Section 3.6  Certain Duties and Responsibilities of the Trustee.
In entering into this Supplemental Indenture, the Trustee shall be entitled to
the benefit of every provision of the Indenture relating to the conduct or
affecting the liability or affording protection to the Trustee, whether or not
elsewhere herein so provided.

Section 3.7  Governing Law. THIS SUPPLEMENTAL INDENTURE
AND THE NOTES SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS
OF THE STATE OF NEW YORK BUT WITHOUT GIVING EFFECT TO APPLICABLE PRINCIPLES OF
CONFLICTS OF LAW TO THE EXTENT THAT THE APPLICATION OF THE LAWS OF ANOTHER
JURISDICTION WOULD BE REQUIRED THEREBY.

Section 3.8  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 one and the same agreement.

Section 3.9  Successors. All agreements of the Issuer, the
Subsidiary Guarantors and the Trustee in this Supplemental Indenture and the
Notes shall bind their respective successors.

 

Section
3.10  Effectiveness. The
provisions of Articles I and II of this Supplemental Indenture shall be
effective at the time the Issuer accepts for purchase at least a majority in
principal amount of the outstanding Notes issued under the Indenture (provided, however, that the provisions of Article II
affecting Article 4 of the Indenture shall only be effective at the time the
Issuer accepts for purchase at least 75% in principal amount of the outstanding
Notes issued under the Indenture),
excluding, in each case, any Notes held by the Company or any person directly
or indirectly controlling or controlled by or under direct or indirect common
control with the Company.

Section
3.11  Endorsement and Change of Form of
Notes. Any Notes authenticated and delivered after the close of
business on the date that this Supplemental Indenture becomes effective may be
affixed to, stamped, imprinted or otherwise legended by the Trustee, with a
notation as follows:

“Effective as of [                    
], 2007, the restrictive
covenants of the Indenture and certain of the Events of Default have been
eliminated, as provided in the Second Supplemental Indenture, dated as of June
20, 2007. Reference is hereby made to said Second Supplemental Indenture,
copies of which are on file with the Trustee, for a description of the
amendments made therein.”

[THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK]

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

	
  

  	
  THE COMPANY

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  

  	
  GENESIS HEALTHCARE CORPORATION

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
  Name:  George V. Hager, Jr.

  
	
   

  	
   

  	
  Title:    Chief Executive
  Officer

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
  SUBSIDIARY GUARANTORS

  
	
   

  	
   

  	
   

  
	
   

  	
  MARMET SNF OPERATIONS, LLC

  
	
   

  	
  1 SULPHIN DRIVE ASSOCIATES, LLC

  
	
   

  	
  OAK HILL SNF OPERATIONS, LLC

  
	
   

  	
  422 23RD STREET ASSOCIATES, LLC

  
	
   

  	
  OAK HILL ALF OPERATIONS, LLC

  
	
   

  	
  438 23RD STREET ASSOCIATES, LLC

  
	
   

  	
  CHARLESTON ALF OPERATIONS, LLC

  
	
   

  	
  699 SOUTH PARK ASSOCIATES, LLC

  
	
   

  	
  LEWISBERG ALF OPERATIONS, LLC

  
	
   

  	
  331 HOLT LANE ASSOCIATES, LLC

  
	
   

  	
  SCOTT DEPOT ALF OPERATIONS, LLC

  
	
   

  	
  5 ROLLING MEADOWS ASSOCIATES, LLC

  
	
   

  	
  WALDORF PROPERTY, LLC

  
	
   

  	
  WALDORF SNF OPERATIONS, LLC

  
	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
  Chief Executive Officer of the foregoing entities

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
  CANTERBURY OF SHEPHERDSTOWN LIMITED PARTNERSHIP

  
	
   

  	
  By:

  	
  Glenmark Associates, Inc., a Managing General
  Partner

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
  Chief Executive Officer

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
  CANTERBURY OF SHEPHERDSTOWN LIMITED PARTNERSHIP

  
	
   

  	
  By:  GMA Partnership Holding Company, Inc., a
  Managing General Partner

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
  By: 

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
  Chief Executive Officer

  
				

 

Signature Page to 2.5%
Notes Supplemental Indenture

 

	
  

  	
  BERKELEY HAVEN
  LIMITED PARTNERSHIP 

  
	
   

  	
  By:  Glenmark
  Associates, Inc., a general partner 

  
	
   

  	
   

  
	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ George V.
  Hager, Jr.

  
	
   

  	
   

  	
  George V. Hager,
  Jr. 

  
	
   

  	
   

  	
  Chief Executive
  Officer 

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
  By: GMA
  Partnership Holding Company, Inc., a general partner 

  
	
   

  	
   

  
	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ George V.
  Hager, Jr.

  
	
   

  	
   

  	
  George V. Hager,
  Jr.

  
	
   

  	
   

  	
  Chief Executive
  Officer

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
  MARKGLEN, INC. 

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ George V.
  Hager, Jr.

  
	
   

  	
   

  	
  George V. Hager,
  Jr. 

  
	
   

  	
   

  	
  Chief Executive
  Officer

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
  NORTHWEST TOTAL
  CARE CENTER ASSOCIATES, L.P.

  
	
   

  	
  By: Geriatric
  and Medical Services, Inc., its general partner

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ George V.
  Hager, Jr.

  
	
   

  	
   

  	
  George V. Hager,
  Jr.

  
	
   

  	
   

  	
  Chief Executive
  Officer

  
	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  ACADEMY NURSING
  HOME, INC.

  
	
   

  	
   

  
	
   

  	
  ADS
  APPLE VALLEY, INC.

  
	
   

  	
   

  
	
   

  	
  ADS
  CONSULTING, INC.

  
	
   

  	
   

  
	
   

  	
  ADS
  DANVERS ALF, INC.

  
	
   

  	
   

  
	
   

  	
  ADS
  DARTMOUTH ALF, INC.

  
	
   

  	
   

  
	
   

  	
  ADS
  HINGHAM ALF, INC.

  
	
   

  	
   

  
	
   

  	
  ADS
  HINGHAM NURSING FACILITY, INC.

  
	
   

  	
   

  
	
   

  	
  ADS
  HOME HEALTH, INC.

  

 

Signature Page to 2.5%
Notes Supplemental Indenture

 

 

	
   

  	
  ADS
  MANAGEMENT, INC.

  
	
   

  	
   

  
	
   

  	
  ADS
  PALM CHELMSFORD, INC.

  
	
   

  	
   

  
	
   

  	
  ADS
  RECUPERATIVE CENTER, INC.

  
	
   

  	
   

  
	
   

  	
  ADS
  RESERVOIR WALTHAM, INC.

  
	
   

  	
   

  
	
   

  	
  ADS
  SENIOR HOUSING, INC.

  
	
   

  	
   

  
	
   

  	
  ADS/MULTICARE,
  INC.

  
	
   

  	
   

  
	
   

  	
  ANR,
  INC.

  
	
   

  	
   

  
	
   

  	
  APPLE
  VALLEY OPERATING CORP.

  
	
   

  	
   

  
	
   

  	
  APPLEWOOD
  HEALTH RESOURCES, INC.

  
	
   

  	
   

  
	
   

  	
  ASL,
  INC.

  
	
   

  	
   

  
	
   

  	
  ASSISTED
  LIVING ASSOCIATES OF BERKSHIRE, INC.

  
	
   

  	
   

  
	
   

  	
  ASSISTED
  LIVING ASSOCIATES OF LEHIGH, INC.

  
	
   

  	
   

  
	
   

  	
  ASSISTED
  LIVING ASSOCIATES OF SANATOGA, INC.

  
	
   

  	
   

  
	
   

  	
  BERKS
  NURSING HOMES, INC.

  
	
   

  	
   

  
	
   

  	
  BRIGHTWOOD
  PROPERTY, INC.

  
	
   

  	
   

  
	
   

  	
  BRINTON
  MANOR, INC.

  
	
   

  	
   

  
	
   

  	
  BURLINGTON
  WOODS CONVALESCENT CENTER, 

  INC.

  
	
   

  	
   

  
	
   

  	
  CAREFLEET,
  INC.

  
	
   

  	
   

  
	
   

  	
  CENTURY
  CARE MANAGEMENT, INC.

  
	
   

  	
   

  
	
   

  	
  CHATEAU
  VILLAGE HEALTH RESOURCES, INC.

  
	
   

  	
   

  
	
   

  	
  CHELTENHAM
  LTC MANAGEMENT, INC.

  
	
   

  	
   

  
	
   

  	
  CHG
  INVESTMENT CORP., INC.

  
	
   

  	
   

  
	
   

  	
  CHNR-I,
  INC.

  
	
   

  	
   

  
	
   

  	
  COLONIAL
  HALL HEALTH RESOURCES, INC.

  
	
   

  	
   

  
	
   

  	
  CONCORD
  HEALTH GROUP, INC.

  
	
   

  	
   

  
	
   

  	
  CONCORD
  SERVICE CORPORATION

  

 

 

Signature Page to 2.5%
Notes Supplemental Indenture

 

	
  

  	
  CRESTVIEW
  CONVALESCENT HOME, INC.

  
	
   

  	
   

  
	
   

  	
  CRESTVIEW
  NORTH, INC.

  
	
   

  	
   

  
	
   

  	
  CRYSTAL
  CITY NURSING CENTER, INC.

  
	
   

  	
   

  
	
   

  	
  CVNR,
  INC.

  
	
   

  	
   

  
	
   

  	
  DAWN
  VIEW MANOR, INC.

  
	
   

  	
   

  
	
   

  	
  DELM
  NURSING, INC.

  
	
   

  	
   

  
	
   

  	
  DIANE
  MORGAN AND ASSOCIATES, INC.

  
	
   

  	
   

  
	
   

  	
  DOVER
  HEALTHCARE ASSOCIATES, INC.

  
	
   

  	
   

  
	
   

  	
  EIDOS,
  INC.

  
	
   

  	
   

  
	
   

  	
  ELDERCARE
  RESOURCES CORP.

  
	
   

  	
   

  
	
   

  	
  ELMWOOD
  HEALTH RESOURCES, INC.

  
	
   

  	
   

  
	
   

  	
  ENCARE
  OF PENNYPACK, INC.

  
	
   

  	
   

  
	
   

  	
  ENCARE
  OF QUAKERTOWN, INC.

  
	
   

  	
   

  
	
   

  	
  ENCARE
  OF WYNCOTE, INC.

  
	
   

  	
   

  
	
   

  	
  ENR,
  INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE CENTERS — BELVEDERE, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE CENTERS — CHAPEL MANOR, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE CENTERS-HARSTON, INC. 

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE CENTERS — PENNSBURG, INC. 

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE CORP.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE DIAGNOSTIC SERVICES, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE HOME CARE SERVICES, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE HOSPITALITY SERVICES, INC. 

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE LIVING FACILITIES, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE NATIONAL CENTERS, INC. 

  

 

Signature Page to 2.5% Notes
Supplemental Indenture

 

 

	
  

  	
  GENESIS
  ELDERCARE NETWORK SERVICES OF MASSACHUSETTS, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE NETWORK SERVICES, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE PARTNERSHIP CENTERS, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE PHYSICIAN SERVICES, INC. 

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE PROPERTIES, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE REHABILITATION SERVICES, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE STAFFING SERVICES, INC. 

  
	
   

  	
   

  
	
   

  	
  GENESIS
  ELDERCARE TRANSPORTATION SERVICES, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF ARLINGTON, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF BLOOMFIELD, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF CLARKS SUMMIT, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF INDIANA, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF LANHAM, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF MASSACHUSETTS, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF NAUGATUCK, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF NEW GARDEN, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF POINT PLEASANT, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF SALISBURY, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF WAYNE, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF WEST VIRGINIA, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTH VENTURES OF WILKES-BARRE, INC.

  

 

 

Signature Page to 2.5% Notes
Supplemental Indenture

 

	
  

  	
  GENESIS
  HEALTH VENTURES OF WINDSOR, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTHCARE CENTERS HOLDINGS, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTHCARE HOLDING COMPANY I, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  HEALTHCARE HOLDING COMPANY II, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  IMMEDIATE MED CENTER, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  OF PALISADO AVENUE, INC.

  
	
   

  	
   

  
	
   

  	
  GENESIS
  PROPERTIES OF DELAWARE CORPORATION

  
	
   

  	
   

  
	
   

  	
  GENESIS
  SELECTCARE CORP.

  
	
   

  	
   

  
	
   

  	
  GENESIS/VNA
  PARTNERSHIP HOLDING COMPANY, INC.

  
	
   

  	
   

  
	
   

  	
  GERIATRIC
  & MEDICAL COMPANIES, INC.

  
	
   

  	
   

  
	
   

  	
  GERIATRIC
  AND MEDICAL INVESTMENTS CORPORATION

  
	
   

  	
   

  
	
   

  	
  GERIATRIC
  AND MEDICAL SERVICES, INC.

  
	
   

  	
   

  
	
   

  	
  GERI-MED
  CORP.

  
	
   

  	
   

  
	
   

  	
  GLENMARK
  ASSOCIATES - DAWN VIEW MANOR, INC.

  
	
   

  	
   

  
	
   

  	
  GLENMARK
  ASSOCIATES, INC.

  
	
   

  	
   

  
	
   

  	
  GLENMARK
  PROPERTIES, INC.

  
	
   

  	
   

  
	
   

  	
  GMA-BRIGHTWOOD,
  INC.

  
	
   

  	
   

  
	
   

  	
  GMA
  CONSTRUCTION, INC.

  
	
   

  	
   

  
	
   

  	
  GMA-MADISON,
  INC.

  
	
   

  	
   

  
	
   

  	
  GMA
  - UNIONTOWN, INC.

  
	
   

  	
   

  
	
   

  	
  GMA
  PARTNERSHIP HOLDING COMPANY, INC.

  
	
   

  	
   

  
	
   

  	
  GMC
  LEASING CORPORATION

  
	
   

  	
   

  
	
   

  	
  GMC-LTC
  MANAGEMENT, INC.

  
	
   

  	
   

  
	
   

  	
  GMS
  INSURANCE SERVICES, INC.

  

 

 

Signature Page to 2.5% Notes
Supplemental Indenture

 

	
  

  	
  GOVERNOR’S
  HOUSE NURSING HOME, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF ACADEMY MANOR, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF BOARDMAN, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF BROOKLYN, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF CEDAR GROVE, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF CINNAMINSON, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF COLCHESTER, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF COLUMBUS, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF CUMBERLAND, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF ENGLEWOOD, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF EWING, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF FARMINGTON, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF GARDNER, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF GLASTONBURY, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF GROTON, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF LAKEVIEW, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF LEMONT, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF MARCELLA, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF MIDDLETOWN (RI), INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF MORRISTOWN, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF NORTH ANDOVER, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF ROCKVILLE, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF TROY HILLS, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF WALLINGFORD, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF WARWICK, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTH
  RESOURCES OF WESTWOOD, INC.

  
	
   

  	
   

  
	
   

  	
  HEALTHCARE
  RESOURCES CORP.

  

 

 

Signature Page to 2.5% Notes
Supplemental Indenture

 

	
  

  	
  HELSTAT,
  INC.

  
	
   

  	
   

  
	
   

  	
  HILLTOP
  HEALTH CARE CENTER, INC.

  
	
   

  	
   

  
	
   

  	
  HMNH
  REALTY, INC.

  
	
   

  	
   

  
	
   

  	
  HNCA,
  INC.

  
	
   

  	
   

  
	
   

  	
  HORIZON
  ASSOCIATES, INC.

  
	
   

  	
   

  
	
   

  	
  HORIZON
  MOBILE, INC.

  
	
   

  	
   

  
	
   

  	
  HORIZON
  REHABILITATION, INC.

  
	
   

  	
   

  
	
   

  	
  HR
  OF CHARLESTON, INC.

  
	
   

  	
   

  
	
   

  	
  HRWV
  HUNTINGTON, INC.

  
	
   

  	
   

  
	
   

  	
  INNOVATIVE
  HEALTH CARE MARKETING, INC.

  
	
   

  	
   

  
	
   

  	
  KEYSTONE
  NURSING HOME, INC.

  
	
   

  	
   

  
	
   

  	
  KNOLLWOOD
  MANOR, INC.

  
	
   

  	
   

  
	
   

  	
  KNOLLWOOD
  NURSING HOME, INC.

  
	
   

  	
   

  
	
   

  	
  LAKE
  MANOR, INC.

  
	
   

  	
   

  
	
   

  	
  LAKEWOOD
  HEALTH RESOURCES, INC.

  
	
   

  	
   

  
	
   

  	
  LAUREL
  HEALTH RESOURCES, INC.

  
	
   

  	
   

  
	
   

  	
  LEHIGH
  NURSING HOMES, INC.

  
	
   

  	
   

  
	
   

  	
  LIFE
  SUPPORT MEDICAL EQUIPMENT, INC.

  
	
   

  	
   

  
	
   

  	
  LIFE
  SUPPORT MEDICAL, INC.

  
	
   

  	
   

  
	
   

  	
  LRC
  HOLDING COMPANY, INC.

  
	
   

  	
   

  
	
   

  	
  LWNR,
  INC.

  
	
   

  	
   

  
	
   

  	
  MABRI
  CONVALESCENT CENTER, INC.

  
	
   

  	
   

  
	
   

  	
  MANOR
  MANAGEMENT CORP. OF GEORGIAN MANOR, INC.

  
	
   

  	
   

  
	
   

  	
  MARLINTON
  ASSOCIATES, INC.

  
	
   

  	
   

  
	
   

  	
  MARLINTON
  PARTNERSHIP HOLDING COMPANY, INC.

  
	
   

  	
   

  
	
   

  	
  MCKERLEY
  HEALTH CARE CENTER-CONCORD, INC.

  

 

 

Signature Page to 2.5% Notes
Supplemental Indenture

 

	
  

  	
  MCKERLEY
  HEALTH CARE CENTERS, INC.

  
	
   

  	
   

  
	
   

  	
  MERIDIAN
  HEALTH, INC.

  
	
   

  	
   

  
	
   

  	
  MERIDIAN
  HEALTHCARE INVESTMENTS, INC.

  
	
   

  	
   

  
	
   

  	
  MERIDIAN
  HEALTHCARE, INC.

  
	
   

  	
   

  
	
   

  	
  MHNR,
  INC.

  
	
   

  	
   

  
	
   

  	
  MNR,
  INC.

  
	
   

  	
   

  
	
   

  	
  MONTGOMERY
  NURSING HOMES, INC.

  
	
   

  	
   

  
	
   

  	
  MULTICARE
  AMC, INC.

  
	
   

  	
   

  
	
   

  	
  NURSING
  AND RETIREMENT CENTER OF THE 

  ANDOVERS, INC.

  
	
   

  	
   

  
	
   

  	
  OAK
  HILL HEALTH CARE CENTER, INC.

  
	
   

  	
   

  
	
   

  	
  PHC
  OPERATING CORP.

  
	
   

  	
   

  
	
   

  	
  PHILADELPHIA
  AVENUE CORPORATION

  
	
   

  	
   

  
	
   

  	
  POCAHONTAS
  CONTINUOUS CARE CENTER, INC.

  
	
   

  	
   

  
	
   

  	
  PRESCOTT
  NURSING HOME, INC.

  
	
   

  	
   

  
	
   

  	
  PROSPECT
  PARK LTC MANAGEMENT, INC.

  
	
   

  	
   

  
	
   

  	
  PROVIDENCE
  FUNDING CORPORATION

  
	
   

  	
   

  
	
   

  	
  PROVIDENCE
  HEALTH CARE, INC.

  
	
   

  	
   

  
	
   

  	
  REST
  HAVEN NURSING HOME, INC.

  
	
   

  	
   

  
	
   

  	
  RHS
  MEMBERSHIP INTEREST HOLDING COMPANY

  
	
   

  	
   

  
	
   

  	
  RIDGELAND
  HEALTH RESOURCES, INC.

  
	
   

  	
   

  
	
   

  	
  RIVERSHORES
  HEALTH RESOURCES, INC.

  
	
   

  	
   

  
	
   

  	
  RLNR,
  INC.

  
	
   

  	
   

  
	
   

  	
  ROSE
  HEALTHCARE, INC.

  
	
   

  	
   

  
	
   

  	
  ROSE
  VIEW MANOR, INC.

  
	
   

  	
   

  
	
   

  	
  RSNR,
  INC.

  
	
   

  	
   

  
	
   

  	
  RVNR,
  INC.

  
	
   

  	
   

  
	
   

  	
  S.
  T. B. INVESTORS, LTD.

  

 

 

Signature Page to 2.5% Notes
Supplemental Indenture

 

	
  

  	
  SCHUYLKILL
  NURSING HOMES, INC.

  
	
   

  	
   

  
	
   

  	
  SENIOR
  LIVING VENTURES, INC.

  
	
   

  	
   

  
	
   

  	
  SENIOR
  SOURCE, INC.

  
	
   

  	
   

  
	
   

  	
  SNOW
  VALLEY HEALTH RESOURCES, INC.

  
	
   

  	
   

  
	
   

  	
  SOLOMONT
  FAMILY MEDFORD VENTURE, INC.

  
	
   

  	
   

  
	
   

  	
  STAFFORD
  CONVALESCENT CENTER, INC.

  
	
   

  	
   

  
	
   

  	
  STATE
  STREET ASSOCIATES, INC.

  
	
   

  	
   

  
	
   

  	
  SVNR,
  INC.

  
	
   

  	
   

  
	
   

  	
  THE
  ADS GROUP, INC.

  
	
   

  	
   

  
	
   

  	
  THE
  APPLE VALLEY PARTNERSHIP HOLDING

  COMPANY, INC.

  
	
   

  	
   

  
	
   

  	
  THE
  HOUSE OF CAMPBELL, INC.

  
	
   

  	
   

  
	
   

  	
  THE
  MULTICARE COMPANIES, INC.

  
	
   

  	
   

  
	
   

  	
  THE
  SARAH BRAYTON PARTNERSHIP HOLDING

  COMPANY, INC.

  
	
   

  	
   

  
	
   

  	
  THE
  SOMERSET PARTNERSHIP HOLDING COMPANY, INC.

  
	
   

  	
   

  
	
   

  	
  TMC
  ACQUISITION CORP.

  
	
   

  	
   

  
	
   

  	
  TRI
  STATE MOBILE MEDICAL SERVICES, INC.

  
	
   

  	
   

  
	
   

  	
  VALLEY
  MEDICAL SERVICES, INC.

  
	
   

  	
   

  
	
   

  	
  VALLEY
  TRANSPORT AMBULANCE SERVICE, INC.

  
	
   

  	
   

  
	
   

  	
  VERSALINK,
  INC.

  
	
   

  	
   

  
	
   

  	
  VILLAS
  REALTY & INVESTMENTS, INC.

  
	
   

  	
   

  
	
   

  	
  WALNUT
  LTC MANAGEMENT, INC.

  
	
   

  	
   

  
	
   

  	
  WAYSIDE
  NURSING HOME, INC.

  
	
   

  	
   

  
	
   

  	
  WEISENFLUH
  AMBULANCE SERVICE, INC.

  
	
   

  	
   

  
	
   

  	
  WEST
  PHILA. LTC MANAGEMENT, INC.

  
	
   

  	
   

  
	
   

  	
  WESTFORD
  NURSING AND RETIREMENT CENTER, INC.

  

 

 

Signature Page to 2.5% Notes
Supplemental Indenture

 

	
  

  	
  WILLOW
  MANOR NURSING HOME, INC.

  
	
   

  	
   

  
	
   

  	
  WYNCOTE
  HEALTHCARE CORP.

  
	
   

  	
   

  
	
   

  	
  YE OLDE AMBULANCE COMPANY, INC.

  
	
   

  	
   

  
	
   

  	
  YORK LTC MANAGEMENT, INC.

  
	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
  Name:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
  Title:

  	
  Chief Executive Officer of each
  of the foregoing entities

  
	
   

  	
   

  
	
   

  	
  ADS APPLE VALLEY LIMITED
  PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  ADS Apple Valley, Inc., its
  general partner

  
	
   

  	
   

  
	
   

  	
  ADS HINGHAM LIMITED PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  ADS Hingham Nursing Facility,
  Inc., its general partner

  
	
   

  	
   

  
	
   

  	
  ADS RECUPERATIVE CENTER LIMITED
  PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  ADS Recuperative Center, Inc.,
  its general partner

  
	
   

  	
   

  
	
   

  	
  BREVARD MERIDIAN LIMITED
  PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  Meridian Healthcare, Inc., its
  general partner

  
	
   

  	
   

  
	
   

  	
  CARE HAVEN ASSOCIATES LIMITED
  PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  Glenmark Associates, Inc., its
  general partner

  
	
   

  	
   

  
	
   

  	
  CATONSVILLE MERIDIAN LIMITED
  PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  Meridian Healthcare, Inc. and
  Meridian Health, Inc., its 

  general partners

  
	
   

  	
   

  
	
   

  	
  CUMBERLAND ASSOCIATES OF RHODE
  ISLAND, L.P.

  
	
   

  	
   

  	
  By:

  	
  Health Resources of Cumberland,
  Inc., its general partner

  
	
   

  	
   

  
	
   

  	
  EASTON MERIDIAN LIMITED
  PARTNERSHIP

  
	
   

  	
   

  	
  By:

  	
  Meridian Healthcare, Inc. and
  Meridian Health, Inc., its 

  general partners

  
	
   

  	
   

  
	
   

  	
  EDELLA STREET ASSOCIATES

  
	
   

  	
   

  	
  By:

  	
  Genesis Health Ventures of Clarks
  Summit, Inc., its general partner

  
	
   

  	
   

  
	
   

  	
  GENESIS ELDERCARE CENTERS I, L.P.

  
	
   

  	
   

  	
  By:

  	
  Genesis Eldercare Partnership
  Centers, Inc., its general partner

  
	
   

  	
   

  
					

 

 

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Supplemental Indenture

	
  

  	
   

  	
  GENESIS ELDERCARE CENTERS II, L.P.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  By:

  	
  Genesis Eldercare Partnership Centers, Inc.,

  its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  GENESIS ELDERCARE CENTERS III, L.P.

  
	
   

  	
   

  	
   

  	
  By:

  	
  Genesis Eldercare Partnership Centers, Inc., its

  general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  GENESIS HEALTH VENTURES OF WEST VIRGINIA, LIMITED
  PARTNERSHIP

  
	
   

  	
   

  	
   

  	
  By:

  	
  Genesis ElderCare Network Services, Inc. and

  Genesis ElderCare Rehabilitation Services, Inc., its

  general partners

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  GENESIS PROPERTIES LIMITED PARTNERSHIP  

  
	
   

  	
   

  	
   

  	
  By:

  	
  Genesis Health Ventures of Arlington, Inc., its

  general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  GENESIS PROPERTIES OF DELAWARE LTD. PARTNERSHIP,
  L.P.

  
	
   

  	
   

  	
   

  	
  By:

  	
  Genesis Properties of Delaware Corporation, its
  general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  GLENMARK PROPERTIES I, LIMITED PARTNERSHIP

  
	
   

  	
   

  	
   

  	
  By:

  	
  Glenmark Associates, Inc., its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  GREENSPRING MERIDIAN LIMITED PARTNERSHIP 

  
	
   

  	
   

  	
   

  	
  By:

  	
  Meridian Healthcare, Inc., its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  GROTON ASSOCIATES OF CONNECTICUT, L.P.  

  
	
   

  	
   

  	
   

  	
  By:

  	
  Health Resources of Groton, Inc., its general
  partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HAMMONDS LANE MERIDIAN LIMITED PARTNERSHIP

  
	
   

  	
   

  	
   

  	
  By:

  	
  Meridian Healthcare, Inc. and Meridian Health, Inc.,
  its general partners

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  LAKE WASHINGTON, LTD.

  
	
   

  	
   

  	
   

  	
  By:

  	
  Lake Manor, Inc., its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  MCKERLEY HEALTH CARE CENTER-CONCORD LIMITED
  PARTNERSHIP

  
	
   

  	
   

  	
   

  	
  By:

  	
  McKerley Health Care Center-Concord, Inc., its
  general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  MERIDIAN/CONSTELLATION LIMITED

  PARTNERSHIP

  
	
   

  	
   

  	
   

  	
  By:

  	
  Meridian Healthcare, Inc., its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  MERIDIAN EDGEWOOD LIMITED PARTNERSHIP

  
	
   

  	
   

  	
   

  	
  By:

  	
  Meridian Healthcare, Inc., its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  MERIDIAN PERRING LIMITED PARTNERSHIP

  
	
   

  	
   

  	
   

  	
  By:

  	
  Meridian Healthcare, Inc., its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  

 

 

Signature Page to 2.5% Notes
Supplemental Indenture

 

	
  

  	
   

  	
  MERIDIAN VALLEY LIMITED PARTNERSHIP

  
	
   

  	
   

  	
   

  	
  By:

  	
  Meridian Healthcare, Inc., its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  MERIDIAN VALLEY VIEW LIMITED PARTNERSHIP

  
	
   

  	
   

  	
   

  	
  By:

  	
  Meridian Healthcare, Inc., its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  MIDDLETOWN (RI) ASSOCIATES OF RHODE ISLAND, L.P.

  
	
   

  	
   

  	
   

  	
  By:

  	
  Health Resources of Middletown (RI), Inc., its

  general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  MILLVILLE MERIDIAN LIMITED PARTNERSHIP

  
	
   

  	
   

  	
   

  	
  By:

  	
  Meridian Healthcare, Inc., its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  NORTH CAPE CONVALESCENT CENTER

  ASSOCIATES, L.P.

  
	
   

  	
   

  	
   

  	
  By:

  	
  Geriatric and Medical Services, Inc., its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  PHILADELPHIA AVENUE ASSOCIATES

  
	
   

  	
   

  	
   

  	
  By:

  	
  Philadelphia Avenue Corporation, its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  POINT PLEASANT HAVEN LIMITED PARTNERSHIP

  
	
   

  	
   

  	
   

  	
  By:

  	
  Glenmark Associates, Inc. and GMA Partnership
  Holding Company, Inc., its general partners

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  RALEIGH MANOR LIMITED PARTNERSHIP

  
	
   

  	
   

  	
   

  	
  By:

  	
  Glenmark Associates, Inc., its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  RIVER STREET ASSOCIATES

  
	
   

  	
   

  	
   

  	
  By:

  	
  Genesis Health Ventures of Wilkes-Barre, Inc., its
  general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  ROMNEY HEALTH CARE CENTER, LTD., LIMITED PARTNERSHIP

  
	
   

  	
   

  	
   

  	
  By:

  	
  Glenmark Associates, Inc., its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  SEMINOLE MERIDIAN LIMITED PARTNERSHIP 

  
	
   

  	
   

  	
   

  	
  By:

  	
  Meridian Health, Inc., its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  SISTERVILLE HAVEN LIMITED PARTNERSHIP

  
	
   

  	
   

  	
   

  	
  By:

  	
  Glenmark Associates, Inc., its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  STAFFORD ASSOCIATES OF N.J., L.P.

  
	
   

  	
   

  	
   

  	
  By:

  	
  Southern Ocean GP, LLC, its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  STATE STREET ASSOCIATES, L.P.

  
	
   

  	
   

  	
   

  	
  By:

  	
  State Street Associates, Inc., its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  TEAYS VALLEY HAVEN LIMITED PARTNERSHIP

  
	
   

  	
   

  	
   

  	
  By:

  	
  Glenmark Associates, Inc., its general partner

  

 

 

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  THE APPLE VALLEY LIMITED PARTNERSHIP

  
	
   

  	
   

  	
   

  	
  By:

  	
  The Apple Valley Partnership Holding Company, Inc.
  and Apple Valley Operating Corp., its general partners

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  THE STRAUS GROUP-HOPKINS HOUSE, L.P.

  
	
   

  	
   

  	
   

  	
  By:

  	
  Encare of Wyncote, Inc., its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  THE STRAUS GROUP-QUAKERTOWN MANOR, L.P.

  
	
   

  	
   

  	
   

  	
  By:

  	
  Encare of Quakertown, Inc., its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  THERAPY CARE SYSTEMS, L.P.

  
	
   

  	
   

  	
   

  	
  By:

  	
  Genesis ElderCare Rehabilitation Services, Inc., its
  general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  VOLUSIA MERIDIAN LIMITED PARTNERSHIP

  
	
   

  	
   

  	
   

  	
  By:

  	
  Meridian Health, Inc., its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  WALLINGFORD ASSOCIATES OF CONNECTICUT, L.P.

  
	
   

  	
   

  	
   

  	
  By:

  	
  Health Resources of Wallingford, Inc., its general
  partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  WARWICK ASSOCIATES OF RHODE ISLAND, L.P.

  
	
   

  	
   

  	
   

  	
  By:

  	
  Health Resources of Warwick, Inc., its general
  partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  WESTFORD NURSING AND RETIREMENT CENTER, LIMITED
  PARTNERSHIP

  
	
   

  	
   

  	
   

  	
  By:

  	
  Westford Nursing and Retirement Center, Inc., its
  general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
   

  	
  Name:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
   

  	
  Title:

  	
  Chief Executive Officer of the

  respective general partners of

  each of the foregoing entities

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HOLLY MANOR ASSOCIATES OF NEW JERSEY, L.P.

  
	
   

  	
   

  	
   

  	
  By:

  	
  Encare of Mendham, L.L.C., its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  MERCERVILLE ASSOCIATES OF NEW JERSEY, L.P.

  
	
   

  	
   

  	
   

  	
  By:

  	
  Breyut Convalescent Center, L.L.C., its general
  partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  POMPTON ASSOCIATES, L.P.

  
	
   

  	
   

  	
   

  	
  By:

  	
  Pompton Care, L.L.C., its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  THE STRAUS GROUP-OLD BRIDGE, L.P.

  
	
   

  	
   

  	
   

  	
  By:

  	
  Health Resources of Emery, L.L.C., its general

  partner

  

 

 

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  THE STRAUS GROUP-RIDGEWOOD, L.P.

  
	
   

  	
   

  	
   

  	
  By:

  	
  Health Resources of Ridgewood, L.L.C., its general
  partner

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  By:

  	
  Century Care Management, Inc., the manager of the
  respective general partners of each of the foregoing entities

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  By:

  	
  /s/ George V.
  Hager, Jr.

  
	
   

  	
   

  	
   

  	
  Name:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
  Title:

  	
  Chief Executive Officer of each

  of the foregoing entities

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  SOMERSET RIDGE LIMITED PARTNERSHIP

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  By:

  	
  Somerset Ridge LLC, its general partner

  
	
   

  	
   

  	
   

  	
  By:

  	
  Somerset Ridge General Partnership, its Manager

  
	
   

  	
   

  	
   

  	
  By:

  	
  Solomont Family Fall River Venture, Inc., its

  
	
   

  	
   

  	
   

  	
   

  	
  general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  By:

  	
  /s/ George
  V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
  Name:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
  Title:

  	
  Chief Executive Officer

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  ARCADIA ASSOCIATES

  
	
   

  	
   

  	
   

  	
  By:

  	
  ADS/Multicare, Inc., its managing partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  By:

  	
  /s/ George
  V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
  Name:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
  Title:

  	
  Chief Executive Officer

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  MCKERLEY HEALTH FACILITIES

  
	
   

  	
   

  	
   

  	
  By:

  	
  Meridian Healthcare, Inc. and Meridian Health, Inc., its partners

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  By:

  	
  /s/ George
  V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
  Name:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
  Title:

  	
  Chief Executive Officer

  
	
   

  	
   

  	
   

  	
   

  	
   

  
								

 

 

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  SARAH BRAYTON GENERAL PARTNERSHIP

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  By:

  	
  ADS Multicare Inc. and The Sarah Brayton Partnership Holding Company,
  Inc., its general partners

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
  Name:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
  Title:

  	
  Chief Executive Officer

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  SOMERSET RIDGE GENERAL
  PARTNERSHIP

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  By:

  	
  Solomont Family Fall River Venture, Inc. and The Somerset Partnership
  Holding Company, Inc., its general partners

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
  Name:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
  Title:

  	
  Chief Executive Officer

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  BREYUT CONVALESCENT CENTER, L.L.C.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  ENCARE OF MENDHAM, L.L.C.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF BRIDGETON, L.L.C.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF CINNAMINSON, L.L.C.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF CRANBURY, L.L.C.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF EATONTOWN, L.L.C.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF EMERY, L.L.C.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF ENGLEWOOD, L.L.C.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF EWING, L.L.C.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF FAIR LAWN, L.L.C.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF JACKSON, L.L.C.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF RIDGEWOOD, L.L.C.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF SOUTH BRUNSWICK, L.L.C.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  HEALTH RESOURCES OF WEST ORANGE, L.L.C.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  POMPTON CARE, L.L.C.

  
						

 

 

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Supplemental Indenture

 

 

	
  

  	
   

  	
   

  
	
   

  	
   

  	
  ROEPHEL CONVALESCENT CENTER,
  L.L.C.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  By:

  	
  Century Care Management, Inc., the manager of each of the foregoing entities

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
  Name:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
  Title:

  	
  Chief Executive Officer

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  GENESIS-GEORGETOWN SNF/JV, LLC

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  GLENMARK LIMITED LIABILITY COMPANY I

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  MILFORD ALF, LLC

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  RESPIRATORY HEALTH SERVICES LLC

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  RIVERVIEW RIDGE LIMITED LIABILITY COMPANY

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  SOUTHERN OCEAN GP, L.L.C.

  
	
   

  	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
  Name:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
  Title:

  	
  Chief Executive Officer

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  SOMERSET RIDGE L.L.C.

  
	
   

  	
   

  	
  By:

  	
  Somerset Ridge General Partnership, its Manager

  
	
   

  	
   

  	
   

  	
  By:

  	
  Solomont Family Fall River Venture, Inc., its general partner

  
	
   

  	
   

  	
   

  	
  By:

  	
  The Somerset Partnership Holding Company, Inc., its general partner

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  By:

  	
  /s/ George V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
   

  	
  Name:

  	
  George V. Hager, Jr.

  
	
   

  	
   

  	
   

  	
   

  	
  Title:

  	
  Chief Executive Officer

  
							

 

 

Signature Page to 2.5% Notes
Supplemental Indenture

 

 

	
  

  	
   

  	
  THE
  BANK OF NEW YORK, as Trustee

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  By:

  	
  /s/ Mary LaGumina

  
	
   

  	
   

  	
   

  	
  Name:

  	
  Mary LaGumina

  
	
   

  	
   

  	
   

  	
  Title:

  	
  Vice President

  

 

 

Signature Page to 2.5% Notes
Supplemental Indenture

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00125-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00125-of-00352.parquet"}]]