EXHIBIT 10.4


 


THIS WARRANT AND THE SECURITIES ISSUABLE
UPON THE EXERCISE HEREOF HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED.  THEY MAY NOT BE SOLD,
OFFERED FOR SALE, PLEDGED, HYPOTHECATED, OR OTHERWISE TRANSFERRED EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER
THE SECURITIES ACT OF 1933, AS AMENDED OR AN OPINION OF COUNSEL SATISFACTORY TO THE COMPANY THAT REGISTRATION IS NOT REQUIRED.


 


COMMON STOCK PURCHASE WARRANT


 


NUO THERAPEUTICS, INC.


 


	
        Shares: _______
	Issue Date: May 5, 2016


 


THIS COMMON STOCK PURCHASE WARRANT (the
“Warrant”) certifies that, for value received, [_____________] or its assigns (the “Holder”)
is entitled, upon the terms and subject to the limitations on exercise and the conditions hereinafter set forth, at any time on
or after November 5, 2016 (the “Initial Exercise Date”) and on or prior to the close of business on the May
5, 2021 five (5) year anniversary of the Initial Exercise Date (the “Termination Date”) but not thereafter,
to subscribe for and purchase from NUO THERAPEUTICS, INC., a Delaware corporation (the “Company”), up
to [______] shares (the “Shares”) of Common Stock, par value $0.0001 per share, of the Company (“Common
Stock”). The purchase price of one share of Common Stock under this Warrant shall be equal to the Exercise Price, as
defined in Section 2(b).


 


1.           Purchase
of Shares.  Subject to the terms and conditions hereinafter set forth, the Holder is entitled, upon surrender of
this Warrant at the principal office of the Company (or at such other place as the Company shall notify the Holder in writing),
to purchase from the Company up to [______________] fully paid and nonassessable Shares at the Exercise Price.


 


2.           Definitions.


 


(a)          Capitalized
terms used and not otherwise defined herein shall have the meanings set forth in that certain Common Stock Subscription Agreement
(the “Purchase Agreement”), dated on or about April 25, 2016, by and among the Company and the purchasers signatory
thereto.


 


(b)          Exercise
Price.  The exercise price for the Shares initially shall be $[____] per share, as adjusted from time to time (such
price, as adjusted from time to time, is herein referred to as the “Exercise Price”).


 


(c)          Exercise
Period.  This Warrant shall be exercisable, in whole or in part, during the term commencing on the date hereof and
ending on the Termination Date.


 


3.          Method
of Exercise.  While this Warrant remains outstanding and exercisable in accordance with the terms hereof, the Holder
may exercise, in whole or in part, the purchase rights evidenced hereby.  Such exercise shall be effected by:


 


(i)          the
surrender of the Warrant, together with a notice of exercise in substantially the form attached hereto as Exhibit A to the
Secretary of the Company at its principal offices; and


 


(ii)         the
payment to the Company of an amount equal to the aggregate Exercise Price for the number of Shares being purchased, in cash (through
a check payable to the Company or by wire transfer to an account designated by the Company).


 


4.          Certificates
for Shares.  Upon the exercise of the purchase rights evidenced by this Warrant, one or more certificates for the
number of Shares so purchased shall be issued as soon as practicable thereafter, and in any event within thirty (30) days of the
delivery of the subscription notice.


 




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5.          Issuance
of Shares.  The Company covenants that the Shares, when issued pursuant to the exercise of this Warrant, will be
duly and validly issued, fully paid and nonassessable and free from all taxes, liens, and charges with respect to the issuance
thereof. The Company shall at all times reserve and keep available solely for the issuance and delivery upon the exercise of this
Warrant, such number of Shares sufficient to permit the exercise in full of this Warrant.


 


6.          Adjustment
of Exercise Price and Number of Shares.  The number of and kind of securities purchasable upon exercise of this Warrant
and the Exercise Price shall be subject to adjustment from time to time as follows:


 


(a)          Subdivisions,
Combinations and Other Issuances.  If the Company shall at any time prior to the expiration of this Warrant subdivide
the Shares, by split-up or otherwise, or combine its Shares, or issue additional shares as a dividend, the number of Shares issuable
on the exercise of this Warrant shall forthwith be proportionately increased in the case of a subdivision or stock dividend, or
proportionately decreased in the case of a combination.  Appropriate adjustments shall also be made to the purchase price
payable per share, but the aggregate purchase price payable for the total number of Shares purchasable under this Warrant (as adjusted)
shall remain the same.  Any adjustment under this Section 6(a) shall become effective at the close of business on the
date the subdivision or combination becomes effective, or as of the record date of such dividend, or in the event that no record
date is fixed, upon the making of such dividend.


 


(b)          Reclassification,
Reorganization and Consolidation.  In case of any reclassification, capital reorganization, or change in the capital
stock of the Company (other than as a result of a subdivision, combination, or stock dividend provided for in Section 6(a) above),
then the Company shall make appropriate provision so that the Holder shall have the right at any time prior to the expiration of
this Warrant to purchase, at a total price equal to that payable upon the exercise of this Warrant, the kind and amount of shares
of stock and other securities and property receivable in connection with such reclassification, reorganization, or change by a
holder of the same number of Shares as were purchasable by the Holder immediately prior to such reclassification, reorganization,
or change.  In any such case appropriate provisions shall be made with respect to the rights and interest of the Holder
so that the provisions hereof, including Sections 6(a), shall thereafter be applicable with respect to any shares of stock or other
securities and property deliverable upon exercise hereof, and appropriate adjustments shall be made to the purchase price per share
payable hereunder, provided the aggregate purchase price shall remain the same.


 


(c)          Notice
of Adjustment.  When any adjustment is required to be made in the number or kind of shares purchasable upon exercise
of the Warrant, or in the Exercise Price, the Company shall promptly notify the Holder of such event and of the number of Shares
or other securities or property thereafter purchasable upon exercise of this Warrant, and furnish the Holder with a certificate
of its Chief Financial Officer, including computations of such adjustment in the number or kind of shares purchasable upon exercise
of the Warrant, or in the Exercise Price.


 


7.            No
Fractional Shares or Scrip.  No fractional shares or scrip representing fractional shares shall be issued upon the
exercise of this Warrant, but in lieu of such fractional shares the Company shall make a cash payment therefor on the basis of
the Exercise Price then in effect.


 


8.            Restrictive
Legend. The Shares (unless registered under the Securities Act of 1933, as amended (the “Act”)) shall be
stamped or imprinted with a legend in substantially the following form:


 


THE SHARES REPRESENTED BY THIS
CERTIFICATE HAVE BEEN ACQUIRED FOR INVESTMENT AND NOT WITH A VIEW TO, OR IN CONNECTION WITH, THE SALE OR DISTRIBUTION THEREOF,
AND HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED.  SUCH SHARES MAY NOT BE SOLD OR TRANSFERRED
IN THE ABSENCE OF SUCH REGISTRATION OR AN EXEMPTION THEREFROM UNDER THE ACT AND ANY APPLICABLE STATE SECURITIES LAWS.  COPIES
OF THE AGREEMENT COVERING THE PURCHASE OF THESE SHARES AND RESTRICTING THEIR TRANSFER MAY BE OBTAINED AT NO COST BY WRITTEN REQUEST
MADE BY THE HOLDER OF RECORD OF THIS CERTIFICATE TO THE SECRETARY OF THE COMPANY AT THE PRINCIPAL EXECUTIVE OFFICES OF THE COMPANY.


 




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9.          Warrants
Transferable.  Subject to compliance with the terms and conditions of this Section 9, this Warrant and all rights
hereunder are transferable, in whole or in part, without charge to the Holder (except for transfer taxes), upon surrender of this
Warrant properly endorsed or accompanied by written instructions of transfer.  With respect to any offer, sale or other
disposition of this Warrant or any Shares acquired pursuant to the exercise of this Warrant prior to registration of such Warrant
or Shares, the Holder agrees to give written notice to the Company prior thereto, describing briefly the manner thereof, together
with a written opinion of such holder’s counsel, or other evidence, if requested by the Company, to the effect that such
offer, sale or other disposition may be effected without registration or qualification (under the Act as then in effect or any
federal or state securities law then in effect) of this Warrant or the Shares and indicating whether or not under the Act certificates
for this Warrant or the Shares to be sold or otherwise disposed of require any restrictive legend as to applicable restrictions
on transferability in order to ensure compliance with such law; provided, however, the Company shall not require an opinion of
counsel in any transaction in compliance with Rule 144 promulgated by the SEC under the Act.  Upon receiving such written
notice and reasonably satisfactory opinion or other evidence, if so requested, the Company, as promptly as practicable, shall notify
the Holder that such person may sell or otherwise dispose of this Warrant or such Shares, all in accordance with the terms of the
notice delivered to the Company.  If a determination has been made pursuant to this Section 9 that the opinion of counsel
for the Holder or other evidence is not reasonably satisfactory to the Company, the Company shall so notify the Holder promptly
with details thereof after such determination has been made.  Each certificate representing this Warrant or the Shares
transferred in accordance with this Section 9 shall bear a legend as to the applicable restrictions on transferability in order
to ensure compliance with such laws, unless in the aforesaid opinion of counsel for the Holder, such legend is not required in
order to ensure compliance with such laws.  The Company may issue stop transfer instructions to its transfer agent in
connection with such restrictions.


 


10.         Rights
of Stockholders.  No holder of this Warrant shall be entitled, as a Warrant holder, to vote or receive dividends
or be deemed the holder of the Shares or any other securities of the Company which may at any time be issuable on the exercise
hereof for any purpose, nor shall anything contained herein be construed to confer upon the Holder, as such, any of the rights
of a stockholder of the Company or any right to vote for the election of directors or upon any matter submitted to stockholders
at any meeting thereof, or to give or withhold consent to any corporate action (whether upon any recapitalization, issuance of
stock, reclassification of stock, change of par value, consolidation, merger, conveyance, or otherwise) or to receive notice of
meetings, or to receive dividends or subscription rights or otherwise until the Warrant shall have been exercised and the Shares
purchasable upon the exercise hereof shall have become deliverable, as provided herein.


 


11.         Amendments
and Waivers.  This Warrant may be modified or amended or the provisions hereof waived only with the written consent
of the Company and the Holder.


 


12.         Notices
of Certain Transactions.  In case (a) the Company shall take a record of the holders of its outstanding stock of
the same class as the Shares purchasable under this Warrant (or other stock or securities at the time deliverable upon the exercise
of this Warrant) for the purpose of entitling or enabling them to receive any dividend or other distribution, or to receive any
right to subscribe for or purchase any shares of stock of any class or any other securities, or to receive any other right, to
subscribe for or purchase any shares of stock of any class or any other securities, or to receive any other right, (b) of any capital
reorganization of the Company, any reclassification of the capital stock of the Company, any consolidation or merger of the Company
with or into another corporation (other than a consolidation or merger in which the shares of capital stock of the Company outstanding
immediately prior to such merger or consolidation continue to represent, or are converted into or exchanged for shares of capital
stock that represent, immediately following such merger or consolidation, at least a majority, by voting power, of the capital
stock of the surviving corporation), or any transfer of all or substantially all of the assets of the Company, or (c) of the voluntary
or involuntary dissolution, liquidation or winding-up of the Company, then, and in each such case, the Company will mail or cause
to be mailed to the Holder a notice specifying, as the case may be, (i) the date on which a record is to be taken for the purpose
of such dividend, distribution or right, and stating the amount and character of such dividend, distribution or right, or (ii)
the effective date on which such reorganization, reclassification, consolidation, merger, transfer, dissolution, liquidation, redemption
or conversion is to take place, and the time, if any is to be fixed, as of which the holders of record of the Company’s outstanding
stock of the same class as the Shares purchasable under this Warrant (or such other stock or securities at the time deliverable
upon such reorganization, reclassification, consolidation, merger, transfer, dissolution, liquidation, redemption or conversion)
are to be determined. Such notice shall be mailed at least ten (10) days prior to the record date or effective date for the event
specified in such notice.


 




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13.         Notices.  All
notices and other communications given or made hereunder shall be in writing and shall be deemed effectively given: (a) upon personal
delivery to the party to be notified, (b) when sent by confirmed electronic mail or facsimile if sent during normal business hours
of the recipient, and if not so confirmed, then on the next business day, with a copy to be sent by United States first class mail,
postage prepaid, (c) five (5) days after being sent by registered or certified mail, return receipt required, postage prepaid,
or (d) one (1) day after deposit with a nationally recognized overnight courier, specifying next day delivery, with written verification
of receipt.  All communications shall be sent to the respective parties at their address or fax number as set forth on
the signature page to the Purchase Agreement or to such electronic mail address, facsimile number or address as subsequently modified
by written notice given in according with this Section 13.


 


14.         No
Impairment.  The Company shall not, by amendment of its certificate of incorporation or through reorganization, consolidation,
merger, dissolution, sale of assets or any other voluntary action, avoid or seek to avoid the observance or performance of any
of the terms of this Warrant, but shall at all times in good faith assist in the carrying out of all such terms and in the taking
of all such action as may be necessary or appropriate in order to protect the rights of the Holder against impairment.


 


15.         Governing
Law.  This Warrant and all actions arising out of or in connection with this Warrant shall be governed by and construed
in accordance with the laws of the State of Delaware, without regard to the conflicts of law provisions of the State of Delaware
or of any other state.


 


16.         Rights
and Obligations Survive Exercise of Warrant.  Unless otherwise provided herein, the rights and obligations of the
Company, of the Holder and of the holder of the Shares issued upon exercise of this Warrant, shall survive the exercise of this
Warrant.


 


[Signature Page Follows]


 




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IN WITNESS WHEREOF, the Company has caused
this Warrant to be executed by its officer thereunto duly authorized as of the date first above indicated.


 


	 	NUO THERAPEUTICS, INC.
	 	 	 
	 	By:	 
	 	 	Name:
	 	 	 
	 	 	Title:


 


	 	Address:	
        207A Perry Parkway, Suite 1

         

        Gaithersburg, MD 20877



 


	Accepted and agreed:	 
	 	 
	 	 
	 	 
	 	 
	Name and Position	 
	 	 
	Address:	 


 


[Signature Page to Form of Warrant]


 




     


     


    

 


EXHIBIT A


 


NOTICE OF EXERCISE


  


	TO:	NUO THERAPEUTICS, INC.	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 


 


Attention: Chief Executive Officer


 


1.          The
undersigned hereby elects to purchase __________ Shares of Nuo Therapeutics, Inc. common stock pursuant to the terms of the attached
Warrant.


 


2.          Please
issue a certificate or certificates representing said Shares in the name of the undersigned or in such other name as is specified
below:


 


	
         

	(Name)
	 
	 
	 
	(Address)


 


3.          The
undersigned hereby represents and warrants that the aforesaid Shares are being acquired for the account of the undersigned for
investment and not with a view to, or for resale, in connection with the distribution thereof, and that the undersigned has no
present intention of distributing or reselling such shares and all representations and warranties of the undersigned set forth
in Section 10 of the attached Warrant are true and correct as of the date hereof.


 


	
         
	 	 
	 	 	(Signature)
	 	 	 
	 	 	(Name)
	 	 	 
	(Date)	 	(Title)


 




     


     


    

 


FORM OF TRANSFER


 


(To be signed only upon transfer of Warrant)


 


FOR VALUE RECEIVED,
the undersigned hereby sells, assigns and transfers unto _______________________________________________ the right represented
by the attached Warrant to purchase ____________ shares of  ________________________ of NUO THERAPEUTICS, INC..
to which the attached Warrant relates, and appoints ______________ Attorney to transfer such right on the books of __________,
with full power of substitution in the premises.


 


	
        Dated: ____________________



 


	 	 	 
	 	 	(Signature must conform in all respects to name of Holder as specified on the face of the Warrant)
	 	 	 
	 	 	Address:	 
	 	 	 	 
	 	 	 	 
	 	 	 	 
	 	 	 	 
	 	 	 	 
	Signed in the presence of: