Document:

EX-4.2

 Exhibit 4.2 

FIRST SUPPLEMENTAL INDENTURE 

This First Supplemental Indenture (the “Supplemental Indenture”) is dated as of March 14, 2011 among IMS Health
Incorporated, a Delaware corporation (the “Issuer”), the Guarantors listed on the signature pages hereto and U.S. Bank National Association, as Trustee (the “Trustee”). Capitalized terms not defined herein shall
have the meanings assigned to them in the Indenture (as defined below). 
 W I T N E S S E T H 

WHEREAS, the Issuer and the Trustee have previously become parties to an Indenture, dated as of February 26, 2010 (the
“Indenture”), providing for the issuance of the Issuer’s 12 1⁄2% Senior Notes due 2018; 

WHEREAS, the Issuer proposes to amend the Indenture as contemplated by this Supplemental Indenture (such amendments, collectively, the
“Amendments”); 
 WHEREAS, pursuant to Section 9.02 of the Indenture, the Issuer and the Trustee may amend or
supplement the Indenture as contemplated by this Supplemental Indenture with the consent of the Holders of at least a majority in aggregate principal amount of the outstanding Notes; 

WHEREAS, the Issuer has obtained the consent of the Holders of at least a majority in aggregate principal amount of the outstanding Notes,
pursuant to the Consent Solicitation Statement, dated March 3, 2011, to the Amendments upon the terms and subject to the conditions set forth therein; 

WHEREAS, the Issuer has done all things necessary to make this Supplemental Indenture a valid agreement of the Issuer in accordance with the
terms of the Indenture and has satisfied all other conditions required under Article 9 of the Indenture; and 
 WHEREAS, pursuant to
Section 9.06, the Trustee is authorized to execute and deliver this Supplemental Indenture. 
 NOW, THEREFORE, in consideration of the
foregoing and for other good and valuable consideration, the receipt of which is hereby acknowledged, in order to effect the Amendments, the parties hereto agree as follows: 

Section 1. Amendments. Effective as of the date hereof, the Indenture is hereby amended as follows: 

(a) The definition of “Incremental Facilities” is hereby deleted in its entirety and replaced with the following: 

““Incremental Facilities” means any secured incremental credit facilities pursuant to the Credit
Agreement on the terms of such incremental facility as in effect on March 16, 2011.” 

 (b) Section 4.09(a) of the Indenture is hereby amended by replacing “2.25 to 1.00”
with “2.00 to 1.00”. 
 (c) Section 4.09(b)(1) of the Indenture is hereby deleted in its entirety and replaced with the
following: 
 “the incurrence of Indebtedness under Credit Facilities by the Issuer and, subject to the proviso in this
clause (1) below, any Restricted Subsidiary of the Issuer, and the issuance and creation of letters of credit and bankers’ acceptances thereunder (with letters of credit and bankers’ acceptances being deemed to have a principal amount
equal to the face amount thereof), in an aggregate principal amount that, together with the aggregate amount of Receivables Facilities incurred pursuant to Section 4.09(b)(12) below, does not exceed at any one time outstanding (i) the sum
of (x) $2,475,000,000 plus (y) an aggregate principal amount of Incremental Facilities issued under the Credit Facilities equal to the sum of (A) $150,000,000 plus (B) an additional amount not to exceed $150,000,000, in the case
of this clause (B), to the extent the Consolidated Secured Leverage Ratio of the Issuer and its Restricted Subsidiaries as of the date of such incurrence and after giving pro forma effect thereto (including a pro forma application of
the net proceeds therefrom) would be no greater than 3.75 to 1.00, less (ii) the aggregate amount of mandatory principal payments actually made by the Issuer from the proceeds of Asset Sales consummated after the Closing Date; provided,
however that the amount of Indebtedness that may be incurred pursuant to this clause (b)(1) by Restricted Subsidiaries that are not Subsidiary Guarantors shall not exceed $200,000,000 at any one time outstanding;” 

(d) Section 4.09(b)(19) of the Indenture is hereby deleted in its entirety and replaced with the following: 

“Indebtedness (including Acquired Indebtedness), Disqualified Stock or Preferred Stock of (a) Persons that are
acquired by the Issuer or any Restricted Subsidiary or merged or amalgamated with or into the Issuer or a Restricted Subsidiary in accordance with the terms of this Indenture, or (b) the Issuer or any Subsidiary Guarantor incurred in connection
with or in contemplation of, or to provide all or any portion of the funds or credit support utilized to consummate, the acquisition by the Issuer or a Restricted Subsidiary of all of the Capital Stock of any Person engaged in a Similar Business or
of any division, line of business or business unit engaged in a Similar Business (whether through the direct purchase of assets or the purchase of Capital Stock of, or merger, amalgamation or consolidation with, any Person owning such assets);
provided that (in case of each clause (a) and (b) above), (A) immediately after giving pro forma effect to such acquisition and the incurrence of such Indebtedness, the Issuer would have had, for the most recently ended
four fiscal quarters for which internal financial statements are available immediately preceding the date on which such Indebtedness is incurred, a Fixed Charge Coverage Ratio of not less than either (x) 2.00 to 1.00 or (y) both
(i) the Fixed Charge Coverage Ratio immediately prior to acquisition and the incurrence of such Indebtedness and (ii) 1.75 to 1.00, (B) all such Indebtedness has a final maturity date later

 
than the final maturity date of, and has a Weighted Average Life to Maturity at the time such Indebtedness is incurred which is not less than the remaining Weighted Average Life to Maturity of,
the Notes and (C) such Indebtedness is issued, acquired or guaranteed by the Issuer and/or one or more of the Subsidiary Guarantors and is subordinated (or such guarantee is subordinated) to the Notes (and any such Subsidiary Guarantor’s
guarantee thereof) on terms customary for senior subordinated notes issued in Rule 144A offerings (as reasonably determined in good faith pursuant to an Officer’s Certificate);” 

(e) Section 4.09(b)(20) of the Indenture is hereby amended by replacing “$150,000,000” with “$250,000,000”. 

(f) Section 4.12 of the Indenture is hereby amended by replacing “3.00 to 1.00” with “3.25 to 1.00”. 

Section 2. Governing Law. THIS SUPPLEMENTAL INDENTURE WILL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK. 

Section 3. Successors. All agreements of the Issuer in this Supplemental Indenture shall bind its successors. All agreements of the Trustee in
this Supplemental Indenture shall bind its successors. All agreements of each Guarantor in this Supplemental Indenture shall bind its successors, except as otherwise provided in Section 11.06 of the Indenture. 

Section 4. 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 5. Counterpart Originals. The
parties may sign any number of copies of this Supplemental Indenture. Each signed copy shall be an original, but all of them together represent the same agreement. 

Section 6. Indenture Continues In Force and Effect. Except as specifically amended hereby, the Indenture shall continue in full force and effect,
and from and after the date hereof, the Indenture and this Supplemental Indenture shall constitute one instrument. 
 Section7. Effect of Headings.
The Section headings herein are for convenience only, are not to be considered part of this Supplemental Indenture and shall in no way modify or restrict any of the terms or provisions hereof. 

Section 8. Trustee. The Trustee shall not be responsible for and makes no representation as to the validity or adequacy of this Supplemental
Indenture and it shall not be responsible for any the recitals contained herein. 
 [Signature pages to follow.] 

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

					
	IMS HEALTH INCORPORATED,
	as Issuer
		
	By:	 	 /s/ Jeffrey J. Ford

		 	Name:	 	Jeffrey J. Ford
		 	Title:	 	Vice President and Treasurer
	
	 HEALTHCARE TECHNOLOGY INTERMEDIATE HOLDINGS, INC.,

as Holdings

		
	By:	 	 /s/ Jeffrey J. Ford

		 	Name:	 	Jeffrey J. Ford
		 	Title:	 	Vice President and Treasurer

  
 Signature Page to
Supplemental Indenture 

 
					
	IMS HEALTH TRANSPORTATION SERVICES CORPORATION
	IMS SOFTWARE SERVICES LTD.
		
	By:	 	 /s/ Sean Ascher

		 	Name:	 	Sean Ascher
		 	Title:	 	President
	
	INTERCONTINENTAL MEDICAL STATISTICS INTERNATIONAL, LTD.
		
	By:	 	 /s/ Sean Ascher

		 	Name:	 	Sean Ascher
		 	Title:	 	Vice President and Treasurer
	
	MARKET RESEARCH MANAGEMENT, INC.
		
	By:	 	 /s/ Sean Ascher

		 	Name:	 	Sean Ascher
		 	Title:	 	Vice President
	
	IMS HEALTH LICENSING ASSOCIATES, L.L.C.
		
	By:	 	 /s/ Sean Ascher

		 	Name:	 	Sean Ascher
		 	Title:	 	Responsible Officer

  
 Signature Page to
Supplemental Indenture 

 
					
	ARSENAL HOLDING COMPANY
	ARSENAL HOLDING (II) COMPANY
	DATA NICHE ASSOCIATES, INC.
	IMS HEALTH INDIA HOLDING CORPORATION
	IMS HEALTH TRADING CORPORATION
	RX INDIA CORPORATION
	VALUEMEDICS RESEARCH, LLC
	IMS HEALTH HOLDING CORPORATION
	IMS HEALTH INVESTING CORPORATION
	IMS HEALTH INVESTMENTS, INC.
	IMS HEALTH PURCHASING, INC.
	IMS HEALTH FINANCE, INC.
	IMS SERVICES, LLC
	IMS TRADING MANAGEMENT, INC.
		
	By:	 	 /s/ Jeffrey J. Ford

		 	Name:	 	Jeffrey J. Ford
		 	Title:	 	President
	
	ENTERPRISE ASSOCIATES L.L.C.
		
	By:	 	 /s/ Jeffrey J. Ford

		 	Name:	 	Jeffrey J. Ford
		 	Title:	 	Vice President

  
 Signature Page to
Supplemental Indenture 

 
					
	COORDINATED MANAGEMENT HOLDINGS, L.L.C.
	COORDINATED MANAGEMENT SYSTEMS, INC.
	SPARTAN LEASING CORPORATION
		
	By:	 	 /s/ Margaret F. Cupp

		 	Name:	 	Margaret F. Cupp
		 	Title:	 	President
	
	IMS CHINAMETRIK INCORPORATED
		
	By:	 	 /s/ Margaret F. Cupp

		 	Name:	 	Margaret F. Cupp
		 	Title:	 	Vice President
	
	IMS HOLDING INC.
		
	By:	 	 /s/ Margaret F. Cupp

		 	Name:	 	Margaret F. Cupp
		 	Title:	 	Vice President and Secretary

  
 Signature Page to
Supplemental Indenture 

 
					
	IMS CONTRACTING & COMPLIANCE, INC.
		
	By:	 	 /s/ Alex Guizzetti

		 	Name:	 	Alex Guizzetti
		 	Title:	 	President

  
 Signature Page to
Supplemental Indenture 

 
					
	IMS GOVERNMENT SOLUTIONS, INC.
		
	By:	 	 /s/ George Rollins

		 	Name:	 	George Rollins
		 	Title:	 	President

  
 Signature Page to
Supplemental Indenture 

 
					
	PHARMETRICS, INC.
		
	By:	 	 /s/ Daniel Malloy

		 	Name:	 	Daniel Malloy
		 	Title:	 	President

  
 Signature Page to
Supplemental Indenture 

 
					
	HEALTH BENCHMARKS, INC.
	HEALTH VANGUARD, INC.
		
	By:	 	 /s/ Hossam Sadek

		 	Name:	 	Hossam Sadek
		 	Title:	 	President

  
 Signature Page to
Supplemental Indenture 

 
					
		 	 U.S. BANK NATIONAL ASSOCIATION,
 as
Trustee

		
	By:	 	 /s/ Donald T. Hurrelbrink

		 	Name:	 	Donald T. Hurrelbrink
		 	Title:	 	Vice President

  
 Signature Page to
Supplemental IndentureEX-4.3

 Exhibit 4.3 

Execution Version 
 SECOND
SUPPLEMENTAL INDENTURE 
 This Second Supplemental Indenture (the “Supplemental Indenture”) is dated as of July 8,
2011 among Med-Vantage, Inc. (the “Guaranteeing Subsidiary”), a subsidiary of IMS Health Incorporated, a Delaware corporation (the “Issuer”), and U.S. Bank National Association, as trustee (the
“Trustee”). 
 W I T N E S S E T H 

WHEREAS, each of the Issuer and the Guarantors (as defined in the Indenture referred to below) has heretofore executed and delivered to the
Trustee an indenture (the “Indenture”), dated as of February 26, 2010, providing for the issuance of up to $1,000,000,000 aggregate principal amount of 12 1⁄2% Senior Notes due 2018 (the “Notes”); 
 WHEREAS, the Indenture provides that under
certain circumstances the Guaranteeing Subsidiary shall execute and deliver to the Trustee a supplemental indenture pursuant to which the Guaranteeing Subsidiary shall unconditionally guarantee all of the Issuer’s Obligations under the Notes
and the Indenture on the terms and conditions set forth herein and under the Indenture (the “Guarantee”); and 
 WHEREAS,
pursuant to Section 9.01 of the Indenture, the Trustee is authorized to execute and deliver this Supplemental Indenture. 
 NOW
THEREFORE, in consideration of the foregoing and for other good and valuable consideration, the receipt of which is hereby acknowledged, the parties mutually covenant and agree for the equal and ratable benefit of the Holders of the Notes as
follows: 
 (1) Capitalized Terms. Capitalized terms used herein without definition shall have the meanings assigned to them in the
Indenture. 
 (2) Agreement to Guarantee. The Guaranteeing Subsidiary hereby agrees as follows: 

(a) Along with all Guarantors named in the Indenture, subject to Article 11, to jointly and severally unconditionally guarantee
to each Holder of a Note authenticated and delivered by the Trustee and to the Trustee and its successors and assigns, irrespective of the validity and enforceability of the Indenture, the Notes or the obligations of the Issuer hereunder or under
the Indenture, that: 
 (i) the principal of and interest and Special Interest, if any, premium, if any, on the Notes will be
promptly paid in full when due, whether at maturity, by acceleration, redemption or otherwise, and interest on the overdue principal of and interest on the Notes, if any, if lawful, and all other Obligations of the Issuer to the Holders or the
Trustee hereunder or thereunder will be promptly paid in full or performed, all in accordance with the terms hereof and thereof; and 

(ii) in case of any extension of time of payment or renewal of any Notes or any of such other obligations, that same will be
promptly paid in full when due or performed in accordance with the terms of the extension or renewal, whether at stated maturity, by acceleration or otherwise. Failing payment by the Issuer when due of any amount so guaranteed or any performance so
guaranteed for whatever reason, the Guarantors and the Guaranteeing Subsidiary shall be jointly and severally obligated to pay the same immediately. This is a guarantee of payment and not a guarantee of collection. 

 (b) The obligations hereunder shall be unconditional, irrespective of the
validity, regularity or enforceability of the Notes or the Indenture, the absence of any action to enforce the same, any waiver or consent by any Holder of the Notes with respect to any provisions hereof or thereof, the recovery of any judgment
against the Issuer, any action to enforce the same or any other circumstance which might otherwise constitute a legal or equitable discharge or defense of a guarantor (other than payment in full of all of the Obligations of the Issuer hereunder and
under the Indenture). 
 (c) The following is hereby waived to the fullest extent permitted by law: diligence, presentment,
demand of payment, filing of claims with a court in the event of insolvency or bankruptcy of the Issuer, any right to require a proceeding first against the Issuer, protest, notice and all demands whatsoever. 

(d) This Guarantee shall not be discharged except by complete performance of the obligations contained in the Notes, the
Indenture and this Supplemental Indenture or by release in accordance with the provisions of this Indenture, and the Guaranteeing Subsidiary accepts all obligations of a Guarantor under the Indenture. 

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

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

(i) Pursuant to Section 11.02 of the Indenture, after giving effect to all other contingent and fixed liabilities that are
relevant under any Bankruptcy Law, the Uniform Fraudulent Conveyance Act, the Uniform Fraudulent Transfer Act or any similar federal or state law to the extent that any of the foregoing are applicable to this Guarantee, and after giving effect to
any collections from, rights to receive contribution from or payments made by or on behalf of any other Guarantor in respect of the obligations of such other Guarantor under Article 11 of the Indenture, this new Guarantee shall be limited to the
maximum amount permissible such that the obligations of such Guaranteeing Subsidiary under this Guarantee will not constitute a fraudulent transfer or conveyance for purposes of such laws. 

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

(l) This Guarantee shall be a general unsecured senior obligation of such Guaranteeing Subsidiary. 

(m) Each payment to be made by the Guaranteeing Subsidiary in respect of this Guarantee shall be made without set-off,
counterclaim, reduction or diminution of any kind or nature. 
 (3) Execution and Delivery. The Guaranteeing Subsidiary agrees that
the Guarantee shall remain in full force and effect notwithstanding the absence of the endorsement of any notation of such Guarantee on the Notes. 

(4) Merger, Consolidation or Sale of All or Substantially All Assets. 

(a) Except as otherwise provided in Section 5.01(c) of the Indenture, the Guaranteeing Subsidiary may not consolidate or merge with or
into or wind up into (whether or not the Issuer or Guaranteeing Subsidiary is the surviving corporation), or sell, assign, transfer, lease, convey or otherwise dispose of all or substantially all of its properties or assets, in one or more related
transactions, to any Person unless: 
 (i) (A) the Guaranteeing Subsidiary is the surviving entity or the Person formed
by or surviving any such consolidation or merger (if other than the Guaranteeing Subsidiary) or to which such sale, assignment, transfer, lease, conveyance or other disposition will have been made is a Person organized or existing under the laws of
the jurisdiction of organization of the Guaranteeing Subsidiary, as the case may be, or the laws of the United States, any state thereof, the District of Columbia, or any territory thereof (the Guaranteeing Subsidiary or such Person, as the case may
be, being herein called the “Successor Person”); 
 (B) the Successor Person, if other than the Guaranteeing
Subsidiary, expressly assumes all the obligations of the Guaranteeing Subsidiary under the Indenture and the Guaranteeing Subsidiary’s related Guarantee pursuant to supplemental indentures or other documents or instruments in form reasonably
satisfactory to the Trustee; 
 (C) immediately after such transaction, no Default exists; and 

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

(ii) the transaction is made in compliance with clauses (1) and (2) of Section 4.10(a) of the Indenture; 

(b) In the case of section (a)(i) of this Section 4, the Successor Person will succeed to, and be substituted for, the Guaranteeing
Subsidiary under the Indenture and the Guaranteeing Subsidiary’s Guarantee. Notwithstanding the foregoing, the Guaranteeing Subsidiary may (1) merge or consolidate with or into or wind up into or transfer all or part of its properties and
assets to another Guarantor or the Issuer, (2) merge with a Restricted Subsidiary of the Issuer solely for the purpose of reincorporating the Guaranteeing Subsidiary in the United States, any state thereof, the District of Columbia or any
territory thereof or (3) convert into a corporation, partnership, limited partnership, limited liability corporation or trust organized or existing under the laws of the jurisdiction of organization of the Guaranteeing Subsidiary, in each case
without complying with section (a) of this Section 4. 
 (5) Releases. The Guarantee of the Guaranteeing Subsidiary shall
be automatically and unconditionally released and discharged, and no further action by the Guaranteeing Subsidiary, the Issuer or the Trustee is required for the release of the Guaranteeing Subsidiary’s Guarantee, upon: 

(1) (A) any sale, exchange, disposition or transfer (by merger, consolidation, amalgamation or otherwise) of the Capital Stock
of the Guaranteeing Subsidiary, after which the Guaranteeing Subsidiary is no longer a Restricted Subsidiary or all or substantially all the assets of the Guaranteeing Subsidiary which sale, exchange, disposition or transfer is made in compliance
with Sections 4.10(a)(1) and (2) of the Indenture; 
 (B) the release or discharge of the guarantee by the Guaranteeing
Subsidiary of Indebtedness under the Credit Agreement or such other guarantee which resulted in the creation of the Guarantee, except a discharge or release by or as a result of payment under such guarantee (it being understood that a release
subject to a contingent reinstatement is still a release, and that if any such guarantee is so reinstated, this Guarantee shall also be reinstated to the extent that such Guaranteeing Subsidiary would then be required to provide a Guarantee pursuant
to Section 4.15 of the Indenture); 
 (C) the designation of the Guaranteeing Subsidiary as an Unrestricted Subsidiary
in compliance with Section 4.07(c) of the Indenture; or 
 (D) the Issuer exercising its Legal Defeasance option or
Covenant Defeasance option in accordance with Article 8 of the Indenture or the Issuer’s obligations under the Indenture being discharged in accordance with Article 13 of the Indenture; and 

(2) delivery by the Guaranteeing Subsidiary to the Trustee of an Officer’s Certificate and an Opinion of Counsel, each
stating that all conditions precedent provided for in the Indenture relating to such transaction have been complied with. 
 (6) No
Recourse Against Others. No past, present or future director, officer, employee, incorporator, member, partner or stockholder of the Guaranteeing Subsidiary or any of its direct or indirect parent companies shall have any liability for any
obligations of the Issuer or the Guarantors (including the Guaranteeing Subsidiary) under the Notes, any Guarantees, the Indenture or this Supplemental Indenture or for any claim based on, in respect of, or by reason of, such obligations or their
creation. Each Holder by accepting Notes waives and releases all such liability. The waiver and release are part of the consideration for issuance of the Notes. 

 (7) Governing Law. THIS SUPPLEMENTAL INDENTURE WILL BE GOVERNED BY AND CONSTRUED IN
ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK. 
 (8) Counterparts. The parties may sign any number of copies of this
Supplemental Indenture. Each signed copy shall be an original, but all of them together represent the same agreement. 
 (9) Effect of
Headings. The Section headings herein are for convenience only, are not to be considered part of this Supplemental Indenture and shall in no way modify or restrict any of the terms or provisions hereof. 

(10) The Trustee. The Trustee shall not be responsible for and makes no representation as to the validity or adequacy of this
Supplemental Indenture and it shall not be responsible for any the recitals contained herein. 
 (11) Subrogation. The Guaranteeing
Subsidiary shall be subrogated to all rights of Holders of Notes against the Issuer in respect of any amounts paid by the Guaranteeing Subsidiary pursuant to the provisions of Section 2 hereof and Section 11.01 of the Indenture;
provided that, if an Event of Default has occurred and is continuing, the Guaranteeing Subsidiary shall not be entitled to enforce or receive any payments arising out of, or based upon, such right of subrogation until all amounts then due and
payable by the Issuer under the Indenture or the Notes shall have been paid in full. 
 (12) Benefits Acknowledged. The Guaranteeing
Subsidiary’s Guarantee is subject to the terms and conditions set forth in the Indenture. The Guaranteeing Subsidiary acknowledges that it will receive direct and indirect benefits from the financing arrangements contemplated by the Indenture
and this Supplemental Indenture and that the guarantee and waivers made by it pursuant to this Guarantee are knowingly made in contemplation of such benefits. 

(13) Successors. All agreements of the Guaranteeing Subsidiary in this Supplemental Indenture shall bind its Successors, except as
otherwise provided in Section 2(k) or elsewhere in this Supplemental Indenture. All agreements of the Trustee in this Supplemental Indenture shall bind its successors. 

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

			
	U.S. BANK NATIONAL ASSOCIATION,
	as Trustee
		
	By:	 	 /s/ Donald T. Hurrelbrink

	Name:	 	Donald T. Hurrelbrink
	Title:	 	Vice President
	
	 MED-VANTAGE, INC.,
 as Subsidiary
Guarantor

		
	By:	 	 /s/ Stefan C. Linn

	Name:	 	Stefan C. Linn
	Title:	 	President

 [Second Supplemental Indenture]

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