EX-4.3



 Exhibit 4.3 

THESE SECURITIES HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED. THEY MAY NOT BE SOLD, OFFERED FOR SALE, PLEDGED OR HYPOTHECATED IN
THE ABSENCE OF A REGISTRATION STATEMENT IN EFFECT WITH RESPECT TO THESE SECURITIES UNDER SUCH ACT OR AN OPINION OF COUNSEL SATISFACTORY TO THE COMPANY THAT SUCH REGISTRATION IS NOT REQUIRED OR UNLESS SOLD PURSUANT TO RULE 144 OR RULE 144A OF SUCH
ACT. 
 COMMON STOCK PURCHASE WARRANTS 

HEALTHEQUITY, INC. 

Incorporated Under the Laws of the State of Delaware 
  

			
	 No.—___________
	 	_______ Common Stock
		 	Purchase Warrants

 CERTIFICATE FOR COMMON STOCK 

PURCHASE WARRANTS 

HEALTHEQUITY, INC., a Delaware corporation (the “Company”), for value received, hereby certifies that ___________, or registered
assigns (the “Holder”), is the registered owner of the above indicated number of Warrants. One (1) Warrant entitles the Holder to purchase one (1) share of the Company’s common stock, $.0001 par value (the “Common
Stock”). The Common Stock issuable upon an exercise of this Warrant is sometimes herein referred to as the “Warrant Stock.” 

1.     Purchase Price. The purchase price (the “Exercise Price”) per share for the Warrant Stock shall be
$1.00 per share tendered to the Company in good United States funds. 
 2.     Rights to Exercise. The Holder
shall have the right (but not the obligation) to exercise the Warrant to receive the Warrant Stock (subject to adjustment as hereinafter provided) at any time on or before ____________, 2015. 

3.     Manner of Exercise. In order to exercise this Warrant, the Holder shall surrender this Warrant certificate
at the office of the Company, as set forth below, or at such other address as the Company shall designate in writing, together with a duly executed exercise form in the form attached hereto and simultaneous payment in full (in cash or by certified
or official bank or bank cashier’s check payable to the order of the Company or by offset of obligations then owed by the Company to the Holder) of the purchase price for the Warrant Stock. 

Upon surrender of this Warrant certificate in conformity with the foregoing provisions, the Company shall promptly deliver to or upon the
written order of the Holder a stock certificate or certificates representing the Warrant Stock. 
 4.     Adjustments
upon Certain Events. 
 4.1     Stock Splits, Stock Combinations and Certain Stock Dividends. If the Company
shall at any time subdivide or combine its outstanding Common Stock, or declare a dividend in Common Stock or other securities of the Company convertible into or exchangeable for Common Stock, a Warrant shall, after such subdivision or combination
or after the record date for such dividend, be exercisable for 







 
that number of shares of Common Stock and other securities of the Company that the Holder would have owned immediately after such event with respect to the Common Stock and other securities for
which a Warrant may have been exercised immediately before such event had the Warrant been exercised immediately before such event. Any adjustment under this Section 4.1 shall become effective at the close of business on the date the
subdivision, combination or dividend becomes effective. 
 4.2     Adjustment for Reorganization, Consolidation,
Merger. In case of any reorganization of the Company (or any other corporation the stock or other securities of which are at the time receivable upon exercise of a Warrant) or in case the Company (or any such other corporation) shall merge into
or with or consolidate with another corporation or convey all or substantially all of its assets to another corporation or enter into a business combination of any form as a result of which the Common Stock or other securities receivable upon
exercise of a Warrant are converted into other stock or securities of the same or another corporation, then and in each such case, the Holder of a Warrant, upon exercise of the purchase right at any time after the consummation of such
reorganization, consolidation, merger, conveyance or combination, shall be entitled to receive, in lieu of the shares of Common Stock or other securities to which such Holder would have been entitled had he exercised the purchase right immediately
prior thereto, such stock and securities which such Holder would have owned immediately after such event with respect to the shares Common Stock and other securities for which a Warrant may have been exercised immediately before such event had the
Warrant been exercised immediately prior to such event. 
 4.3     Notice. In each case of an adjustment in the
Common Stock or other securities receivable upon the exercise of a Warrant, the Company shall promptly notify the Holder of such adjustment. Such notice shall set forth the facts upon which such adjustment is based. 

5.     Loss, Theft, Destruction, or Mutilation. Upon receipt by the Company of evidence reasonably satisfactory to
it of the ownership of and the loss, theft, destruction or mutilation of this Warrant and (in the case of loss, theft, or destruction) of indemnity satisfactory to it (in the exercise of its reasonable discretion), and (in the case of mutilation)
upon surrender and cancellation thereof, the Company will execute and deliver, in lieu thereof, a new Warrant in the same form and tenor. 

6.     Reservation of Shares Issuable on Exercise of Warrant. The Company will at all times reserve and keep
available out of its authorized shares, solely for issuance upon the exercise of the Warrant, such shares of its Common Stock and other securities as from time to time shall be issuable upon the exercise of the Warrant. 

7.     Miscellaneous. 

7.1     Governing Law. This Warrant shall be construed in accordance with, and governed by the substantive laws of,
the State of Delaware. 
 7.2     Assignment. The benefit of this Warrant and of the Warrant Stock represented
hereby may be assigned and transferred by the Holder and its assigns in accordance with any applicable securities laws and regulations; however, the obligations of the Company and its successors may not be delegated without the prior written consent
of the Holder hereof. Subject to the foregoing, this Warrant shall be binding upon and inure to the benefit of the parties and their respective legal representatives, successors, agents, heirs and assigns. 

7.3     Enforcement. In the event of a dispute between the parties arising under this Warrant, the party prevailing
in such dispute shall be entitled to collect such party’s costs and expenses from the other party, including without limitation court costs and reasonable attorneys’ fees. 

  
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 7.4     Notices. Any notice or demand which is required or provided to
be given under this Warrant shall be deemed to have been sufficiently given and received for all purposes when delivered by hand or by telecopy, e-mail or other method of electronic transmission (provided such transmission generates evidence of
delivery), or five days after being sent by certified or registered mail, postage and charges prepaid, return receipt requested, or two days after being sent by overnight delivery providing receipt of delivery, to the following addresses: 

if to the Company: 

HealthEquity, Inc. 
 Attn:
Secretary 
 1276 S. 820 E., Suite 201 

American Fork, UT 84003 
 Phone:
(801) 642-0500 
 Facsimile: (801) 642-0505 

E-mail: secretary@healthequity.com 

if to the Holder, to Holder’s address as stated on the books and records of the Company. 

7.5     Restrictive Legend. Each Warrant Certificate and each certificate representing Common Stock issued upon
exercise of a Warrant, unless such Common Stock is then registered under the Securities Act of 1933, as amended (the “Act”), shall bear a legend in substantially the following form: 

THESE SECURITIES HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED. THEY MAY NOT BE SOLD, OFFERED FOR SALE, PLEDGED OR
HYPOTHECATED IN THE ABSENCE OF A REGISTRATION STATEMENT IN EFFECT WITH RESPECT TO THESE SECURITIES UNDER SUCH ACT OR AN OPINION OF COUNSEL SATISFACTORY TO THE COMPANY THAT SUCH REGISTRATION IS NOT REQUIRED OR UNLESS SOLD PURSUANT TO RULE 144 OR RULE
144A OF SUCH ACT. 
 7.6     Payment of Taxes. The Holder shall pay all documentary, stamp or similar taxes and
other government charges that may be imposed with respect to the issuance, transfer or delivery of any Warrant Stock on exercise of the Warrants. In the event the Warrant Stock are to be delivered in a name other than the name of the Holder of the
Warrant Certificate, no such delivery shall be made unless the person requesting the same has paid the amount of any such taxes or charges incident thereto. 

7.7     Reduction in Exercise Price at Company’s Option. The Company’s Board of Directors may, at its
sole discretion, reduce the Exercise Price of the Warrants in effect at any time either for the life of the Warrants or any shorter period of time determined by the Company’s Board of Directors. The Company shall promptly notify the Registered
Holders of any such reduction in the Exercise Price. 
 7.8     Securities Purchase Agreement. This Warrant is
one of a series of warrants of like tenor, issued by the Company pursuant to and entitled to the benefits of a certain Securities Purchase Agreement among the Company and the Holder (as the same may be amended from time to time, hereinafter referred
to as the “Securities Purchase Agreement”). The Holder, by his acceptance hereof, agrees to be bound by the provisions of the Securities Purchase Agreement. Any permitted transfer of this Warrant will be effected only in accordance with
the terms of the Securities Purchase Agreement and by surrender of this Warrant to the Company and reissuance of a new warrant to the transferee. 

  
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 IN WITNESS WHEREOF, the Company has caused this Warrant Certificate to be duly executed as of the
____ day of ________________, 2005. 
  

			
	HEALTHEQUITY, INC.
		
	By:	 	 
		
	Its:	 	 



  
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 HEALTHEQUITY, INC. 

The following abbreviations, when used in the inscription on the face of this instrument, shall be construed as though they were written out in full according
to applicable laws or regulations: 
 TEN COM – as tenants in common 

TEN ENT – as tenants by the entireties 
 JR TEN – as
joint tenants with right of survivorship and not as tenants in common 
 UNIF TRANS MIN ACT – ____________ (Custodian for Minor) as custodian for
__________ (name of minor) under the Uniform Transfers to Minors Act 
 Additional abbreviations may also be used though not in the above list. 

FORM OF ASSIGNMENT 
 (To be
Executed by the Registered Holder if He or She 
 Desires to Assign Warrants Evidenced by the 

Within Warrant Certificate) 
 FOR
VALUE RECEIVED _____________________ hereby sells, assigns and transfers unto _________________________ _________________________ (_______) Warrants, evidenced by the within Warrant Certificate, and does hereby irrevocably constitute and appoint
_______________________________________ Attorney to transfer the said Warrants evidenced by the within Warrant Certificates on the books of the Company, with full power of substitution. 

 

							
				
	Dated:	 	 	 		 	 
		 		 		 	Signature

  

	 	Notice:	The above signature must correspond with the name as written upon the face of the Warrant Certificate in every particular, without alteration or enlargement or any change whatsoever. 


 

			
		
	Signature Guaranteed:	 	 

 SIGNATURE MUST BE GUARANTEED BY A COMMERCIAL BANK OR MEMBER FIRM OF ONE OF THE FOLLOWING STOCK EXCHANGES: NEW YORK STOCK
EXCHANGE, PACIFIC COAST STOCK EXCHANGE, AMERICAN STOCK EXCHANGE, OR MIDWEST STOCK EXCHANGE. 

  
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 FORM OF ELECTION TO PURCHASE 

(To be Executed by the Holder if Holder Desires to Exercise 

Warrants Evidenced by the Warrant Certificate) 

TO HEALTHEQUITY, INC. 
 The undersigned hereby
irrevocably elects to exercise ___________________________ (_______) Warrants, evidenced by the within Warrant Certificate for, and to purchase thereunder, ____________________________ (_______) full shares of Common Stock issuable upon exercise of
said Warrants and delivery of $_________ and any applicable taxes. 
 The undersigned requests that certificates for such shares be issued in the name of:

 PLEASE INSERT SOCIAL SECURITY OR TAX IDENTIFICATION NUMBER 
  

	
	   

	(Please print name and address)
	   


 If said number of Warrants shall not be all the Warrants evidenced by the within Warrant Certificate, the
undersigned requests that a new Warrant Certificate evidencing the Warrants not so exercised be issued in the name of and delivered to: 
  

	
	   

	(Please print name and address)

  
  

 

									
					
	Dated:	 	 	 		 	 Signature:
	 	 
		 		 		 		 	

  

	 	NOTICE:	The above signature must correspond with the name as written upon the face of the within Warrant Certificate in every particular, without alteration or enlargement or any change whatsoever, or if signed by any other
person the Form of Assignment hereon must be duly executed and if the certificate representing the shares or any Warrant Certificate representing Warrants not exercised is to be registered in a name other than that in which the within Warrant
Certificate is registered, the signature of the holder hereof must be guaranteed. 

  

			
		
	Signature Guaranteed:	 	 

 SIGNATURE MUST BE GUARANTEED BY A COMMERCIAL BANK OR MEMBER FIRM OF ONE OF THE FOLLOWING STOCK EXCHANGES: NEW YORK STOCK
EXCHANGE, PACIFIC COAST STOCK EXCHANGE, AMERICAN STOCK EXCHANGE, OR MIDWEST STOCK EXCHANGE. 

  
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