exv10w21









Exhibit 10.21




RESTRICTED STOCK AGREEMENT




KIPS BAY MEDICAL, INC.

2007 LONG-TERM INCENTIVE PLAN




     THIS AGREEMENT is made effective as of this ___day of                     ,
___, by and between Kips Bay Medical, Inc., a Delaware corporation (the “Company”), and
                                         (the “Participant”).



W I T N E S S E T H:



     WHEREAS, the Participant is, on the date hereof, a key employee, officer, director of or a
consultant or advisor to of the Company or one of its subsidiaries of the Company; and



     WHEREAS, the Company wishes to grant a restricted stock award to the Participant for shares of
the Company’s Common Stock pursuant to the Company’s 2007 Long-Term Incentive Plan (the “Plan”);
and



     WHEREAS, the Administrator of the Plan has authorized the grant of a restricted stock award to
the Participant;



     NOW, THEREFORE, in consideration of the premises and of the mutual covenants herein contained,
the parties hereto agree as follows:



     1. Grant of Restricted Stock Award. The Company hereby grants to the Participant on
the date set forth above a restricted stock award (the “Award”) for                                         
(                                        ) shares of Common Stock on the terms and conditions set forth herein, which
shares are subject to adjustment pursuant to Section 12 of the Plan. The Company shall cause to be
issued one or more stock certificates representing such shares of Common Stock in the Participant’s
name, and shall hold each such certificate until such time as the risk of forfeiture and other
transfer restrictions set forth in this Agreement have lapsed with respect to the shares
represented by the certificate. The Company may also place a legend on such certificates
describing the risks of forfeiture and other transfer restrictions set forth in this Agreement
providing for the cancellation of such certificates if the shares of Common Stock are forfeited as
provided in Section 2 below. Until such risks of forfeiture have lapsed or the shares subject to
this Award have been forfeited pursuant to Section 2 below, the Participant shall be entitled to
vote the shares represented by such stock certificates and shall receive all distributions
attributable to shares for which the risks of forfeiture have lapsed, but the Participant shall not
have any other rights as a shareholder with respect to such shares.



     2. Vesting of Restricted Stock. The shares of Stock subject to this Award shall
remain forfeitable until the risks of forfeiture lapse according to the following vesting schedule:



1









 





	 	 	 
	 
	 	Number
	 
	 	 
	Vesting Date
	 	of Shares Vested
	 
	 	 
	 




If the Participant’s employment with the Company (or a subsidiary of the Company) terminates at any
time prior to a Vesting Date for any reason, including the Participant’s voluntary resignation,
retirement or death, the Participant shall immediately forfeit all shares of Stock subject to this
Award which have not yet vested and for which the risks of forfeiture have not lapsed.




     3. General Provisions.



          a. Employment or Other Relationship. This Agreement shall not confer on Participant
any right with respect to continuance of employment by the Company or any of its Affiliates, nor
will it interfere in any way with the right of the Company to terminate such employment.
Participant’s employment relationship with the Company and its Affiliates shall be
employment-at-will, and nothing in this Agreement shall be construed as creating an employment
contract for any specified term between Participant and the Company or any Affiliate.




          b. Mergers, Recapitalizations, Stock Splits, Etc. Except as otherwise specifically
provided in any employment, change of control, severance or similar agreement executed by the
Participant and the Company, pursuant and subject to Section 12 of the Plan, certain changes in the
number or character of the shares of Stock of the Company (through sale, merger, consolidation,
exchange, reorganization, divestiture (including a spin-off), liquidation, recapitalization, stock
split, stock dividend, or otherwise) shall result in an adjustment, reduction, or enlargement, as
appropriate, in the number of shares subject to this Award. Any additional shares that are
credited pursuant to such adjustment shall be subject to the same restrictions as are applicable to
the shares with respect to which the adjustment relates.




          c. Shares Reserved. The Company shall at all times during the term of this Award
reserve and keep available such number of shares as will be sufficient to satisfy the requirements
of this Agreement.




          d. Withholding Taxes. To permit the Company to comply with all applicable federal and
state income tax laws or regulations, the Company may take such action as it deems appropriate to
ensure that, if necessary, all applicable federal and state payroll, income or other taxes are
withheld from any amounts payable by the Company to the Participant. If the Company is unable to
withhold such federal and state taxes, for whatever reason, the Participant hereby agrees to pay to
the Company an amount equal to the amount the Company






2









 







would otherwise be required to withhold under federal or state law prior to the transfer of any
certificates for the shares of Stock subject to this Award. Subject to such rules as the
Administrator may adopt, the Administrator may, in its sole discretion, permit Participant to
satisfy such withholding tax obligations, in whole or in part, by delivering shares of Common Stock
received pursuant to this Award having a Fair Market Value, as of the date the amount of tax to be
withheld is determined under applicable tax law, equal to the minimum amount required to be
withheld for tax purposes. Participant’s request to deliver shares for purposes of such
withholding tax obligations shall be made on or before the date that triggers such obligations or,
if later, the date that the amount of tax to be withheld is determined under applicable tax law.




          e. 2007 Long-Term Incentive Plan. The Award evidenced by this Agreement is granted
pursuant to the Plan, a copy of which Plan has been made available to the Participant and is hereby
incorporated into this Agreement. This Agreement is subject to and in all respects limited and
conditioned as provided in the Plan. All defined terms of the Plan shall have the same meaning
when used in this Agreement. The Plan governs this Award and, in the event of any questions as to
the construction of this Agreement or in the event of a conflict between the Plan and this
Agreement, the Plan shall govern, except as the Plan otherwise provides.




          f. Stock Subject to Agreement. Participant specifically acknowledges and understands
that any shares of Common Stock acquired by Participant pursuant to this Agreement or otherwise
owned by Participant shall be subject to a shareholder control agreement which, among other
matters, shall include provisions restricting the pledge, encumbrance, sale, assignment, transfer,
gift, or disposition of any such stock and provisions protecting any election the Company may have
in place to be taxed as an S corporation under the Code whenever such election is in effect.




          g. Stock Legend. The Administrator may require that the certificates for any shares
of Common Stock purchased by Participant (or, in the case of death, Participant’s successors) shall
bear an appropriate legend to reflect the restrictions of Paragraph 3(f) of this Agreement;
provided, however, that failure to so endorse any of such certificates shall not render invalid or
inapplicable Paragraph 3(f).




          h. Scope of Agreement. This Agreement shall bind and inure to the benefit of the
Company and its successors and assigns and of the Participant and any successor or successors of
the Participant.




          i. Arbitration. Any dispute arising out of or relating to this Agreement or the
alleged breach of it, or the making of this Agreement, including claims of fraud in the inducement,
shall be discussed between the disputing parties in a good faith effort to arrive at a mutual
settlement of any such controversy. If, notwithstanding, such dispute cannot be resolved, such
dispute shall be settled by binding arbitration. Judgment upon the award rendered by the
arbitrator may be entered in any court having jurisdiction thereof. The arbitrator shall be a
retired state or federal judge or an attorney who has practiced securities or business litigation
for at least 10 years. If the parties cannot agree on an arbitrator within 20 days, any party may
request that the chief judge of the District Court for Hennepin County, Minnesota, select an




3









 




arbitrator. Arbitration will be conducted pursuant to the provisions of this Agreement, and the
commercial arbitration rules of the American Arbitration Association, unless such rules are
inconsistent with the provisions of this Agreement. Limited civil discovery shall be permitted
only for the production of documents. Unresolved discovery disputes may be brought to the
attention of the arbitrator who may dispose of such dispute. The arbitrator shall have the
authority to award any remedy or relief that a court of this state could order or grant; provided,
however, that punitive or exemplary damages shall not be awarded. The arbitrator may award to the
prevailing party, if any, as determined by the arbitrator, all of its costs and fees, including the
arbitrator’s fees, administrative fees, travel expenses, out-of-pocket expenses and reasonable
attorneys’ fees. Unless otherwise agreed by the parties, the place of any arbitration proceedings
shall be Hennepin County, Minnesota.




     IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed on the day
and year first above written.



	 	 	 	 	 
	 	KIPS BAY MEDICAL, INC.

 	 
	 	By:  	 	 
	 	 	Its: 	 	 
	 	 	 	 
	 
	 	Participant
 	 




4