Document:

Exhibit

	
			
	RIGHTS CERTIFICATE #:
	 
	NUMBER OF RIGHTS

THE TERMS AND CONDITIONS OF THE RIGHTS OFFERING ARE SET FORTH IN THE COMPANY'S PROSPECTUS DATED _____ __, 2015 (THE "PROSPECTUS") AND ARE INCORPORATED HEREIN BY REFERENCE. COPIES OF THE PROSPECTUS ARE AVAILABLE UPON REQUEST FROM SM BERGER & COMPANY, THE INFORMATION AGENT, BY EMAIL AT ANDREW@SMBERGER.COM, BY TELEPHONE AT (216) 464-6400 OR BY MAIL AT SM BERGER & COMPANY, 3201 ENTERPRISE PARKWAY, SUITE 460, BEACHWOOD, OH  44122.

Hooper Holmes, Inc.
Incorporated under the laws of the State of New York
NON - TRANSFERABLE SUBSCRIPTION RIGHTS CERTIFICATE
Evidencing Non - Transferable Subscription Rights to Purchase Shares of Common Stock of Hooper Holmes, Inc.
Subscription Price: $____ per Share
THE SUBSCRIPTION RIGHTS WILL EXPIRE IF NOT EXERCISED ON OR BEFORE _____ P.M., CENTRAL TIME, ON _______ __, 2016, UNLESS EXTENDED BY THE COMPANY

REGISTERED
OWNER:

THIS CERTIFIES THAT the registered owner whose name is inscribed hereon is the owner of the number of non-transferable subscription rights (“Rights”) set forth above.  Each whole Right entitles the holder thereof to subscribe for and purchase ________ shares of Common Stock, with a par value of $0.04 per share, of Hooper Holmes, Inc., a New York corporation, at a subscription price of $____ per share (the “Basic Subscription Right”), pursuant to a rights offering (the “Rights Offering”), on the terms and subject to the conditions set forth in the Prospectus and the “Instructions for Use of Subscription Rights Certificate” accompanying this Subscription Rights Certificate. If any shares of Common Stock available for purchase in the Rights Offering are not purchased by other holders of Rights pursuant to the exercise of their Basic Subscription Right (the “Excess Shares”), any Rights holder that exercises its Basic Subscription Right in full may subscribe for a number of Excess Shares pursuant to the terms and conditions of the Rights Offering (the “Over-Subscription Privilege”). The Rights represented by this Subscription Rights Certificate may be exercised by completing Form 1 and any other appropriate forms on the reverse side hereof and by returning the full payment of the subscription price for each share of Common Stock in accordance with the “Instructions for Use of Subscription Rights Certificate” that accompany this Subscription Rights Certificate.

This Subscription Rights Certificate is not valid unless countersigned by the subscription agent and registered by the registrar.

Witness the seal of Hooper Holmes, Inc. and the signatures of its duly authorized officers.

Dated:

	
			
	_________________________________
	 
	_________________________________

	President
	 
	Secretary

	 
	 
	 

	
			
	 
	 
	WA 7481643.1

DELIVERY OPTIONS FOR SUBSCRIPTION RIGHTS CERTIFICATE
Delivery other than in the manner or to the address listed below will not constitute valid delivery.
If delivering by mail, hand or overnight courier:
Broadridge Financial Solutions, Inc.
Attn: Jay Garcia
51 Mercedes Way
Edgewood, NY 11717

PLEASE PRINT ALL INFORMATION CLEARLY AND LEGIBLY.

FORM 1-EXERCISE OF SUBSCRIPTION RIGHTS
To subscribe for shares pursuant to your Basic Subscription Right, please complete lines (a) and (c) and sign under Form 3 below. To subscribe for shares pursuant to your Over-Subscription Privilege, please also complete line (b) and sign under Form 3 below. To the extent you subscribe for more Shares than you are entitled under either the Basic Subscription Right or the Over-Subscription Privilege, you will be deemed to have elected to purchase the maximum number of shares for which you are entitled to subscribe under the Basic Subscription Right or Over-Subscription Privilege, as applicable.
(a) EXERCISE OF BASIC SUBSCRIPTION RIGHT:
I apply for ______________ shares x $ ____ = $_______________
(no. of new shares) (subscription price) (amount enclosed)
(b) EXERCISE OF OVER-SUBSCRIPTION PRIVILEGE
If you have exercised your Basic Subscription Right in full and wish to subscribe for additional shares pursuant to your Over-Subscription Privilege:
I apply for ______________ shares x $ ____ = $_______________
(no. of new shares) (subscription price) (amount enclosed)
(c) Total Amount of Payment Enclosed = $__________________
METHOD OF PAYMENT (CHECK ONE)
	
			
	 
	☐
	   Check or bank draft payable to “Broadridge Financial Solutions, Inc., as Subscription Agent.”

	 
	☐
	 Wire transfer of immediately available funds directly to the account maintained by Broadridge Financial Solutions, Inc., as Subscription Agent, for purposes of accepting subscriptions in this Rights Offering at [__________], ABA #[_______], Account # [_______].

FORM 2-DELIVERY TO DIFFERENT ADDRESS
If you wish for the Common Stock underlying your subscription rights, a certificate representing unexercised subscription rights or the proceeds of any sale of subscription rights to be delivered to an address different from that shown on the face of this Subscription Rights Certificate, please enter the alternate address below, sign under Form 3 and have your signature guaranteed under Form 4.

FORM 3-SIGNATURE
TO SUBSCRIBE: I acknowledge that I have received the Prospectus for this Rights Offering and I hereby irrevocably subscribe for the number of shares indicated above on the terms and conditions specified in the Prospectus. By signing below, I confirm that the Company has the right to void and cancel (and treat as if never exercised) any exercise of Rights, and shares issued pursuant to an exercise of Rights, if any of the agreements, representations or warranties of mine in the subscription documents are false. 

Under penalties of perjury, I certify that the information contained herein is true, complete and correct.
	
		
	Signature(s):
	 

	
			
	 
	2
	WA 7481643.1

IMPORTANT: The signature(s) must correspond with the name(s) as printed on the reverse of this Subscription Rights Certificate in every particular, without alteration or enlargement, or any other change whatsoever.

FORM 4-SIGNATURE GUARANTEE
This form must be completed if you have completed any portion of Form 2.
	
				
	Signature Guaranteed:
	 

	 
	(Name of Bank or Firm)

	By:
	 
	 

	 
	 
	(Signature of Officer)

IMPORTANT: The signature(s) should be guaranteed by an eligible guarantor institution (bank, stock broker, savings & loan association or credit union) with membership in an approved signature guarantee medallion program pursuant to Securities and Exchange Commission Rule 17Ad-15.
FOR INSTRUCTIONS ON THE USE OF HOOPER HOLMES, INC. SUBSCRIPTION RIGHTS CERTIFICATES, CONSULT SM BERGER & COMPANY, THE INFORMATION AGENT, AT (216) 464-6400 OR BY E-MAIL AT [_________________].

	
			
	 
	3
	WA 7481643.1Exhibit

CONSULTING SERVICES AGREEMENT
Contract # JGF 2015-HH 01
    

This Agreement dated this August 13, 2015, by and between Hooper Holmes, Inc. ("The Company"), a New York corporation, with its principal place of business located at 560 North Rogers Road, Olathe KS, 66062 and Steven R. Balthazor (the "Consultant"), whose address is 3092 Noble Court, Boulder, CO  80301.

WITNESSETH

WHEREAS, the Consultant has Corporate Finance expertise in areas relevant to The Company’s business;

WHEREAS, the Consultant desires to provide consulting services to The Company that draw upon such expertise as an Interim Chief Financial Officer; and

WHEREAS, The Company desires to employ the Consultant to render functional  knowledge, skills, abilities, advice and other services to The Company that draw upon the Consultant's expertise as an Interim CFO;

NOW THEREFORE, in consideration of the mutual promises and covenants herein contained, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, and intending to be legally bound hereby, the parties hereto agree as follows:

ARTICLE 1 ‐ SCOPE

(1)    The Consultant shall furnish professional consulting services and advice to The Company in the capacity as an Interim CFO, at such reasonable times as are mutually agreeable to the parties.  All services provided by Consultant hereunder shall be performed with the authorization of and under the direction of The Company’s CEO or another authorized representative of The Company.

(2)    Consultant shall not create or enter into any other business relationship during the term of this Agreement that is, or is reasonably likely to constitute, a conflict of interest with respect to Consultant’s services to The Company or are otherwise detrimental to the interests of The Company.  Consultant has previously entered into a Non-Disclosure Agreement with The Company, the terms of which are incorporated herein by reference.  In addition, Consultant acknowledges and agrees that The Company from time to time receives information from its customers that is subject to confidentiality and/or privacy obligations under applicable laws, regulations and contracts, and Consultant agrees that to the extent such information is provided to Consultant in connection with the services provided hereunder, Consultant shall fully comply with the confidentiality and/or privacy obligations of The Company associated with that information.  Upon The Company’s reasonable request, Consultant will execute a customary form of “Business Associate Agreement” as provided for in the HIPAA/HITECH regulations.

(3)    The Consultant verifies that he is an independent contractor and will be required to invoice The Company on appropriate business letterhead.  As an independent contractor, the Consultant is not an employee of The Company.  Without limiting the foregoing, Consultant is not 

Hooper Holmes Consultant Contract                         Confidential    August 14, 2015

CONSULTING SERVICES AGREEMENT
Contract # JGF 2015-HH 01
    

entitled to the health, insurance, unemployment and workers compensation coverage, 401(k) and other benefits provided or offered to employees of The Company, and Consultant shall be solely responsible for paying such federal, state and local taxes and other withholdings as are applicable to Consultant’s compensation hereunder.

ARTICLE 2 ‐ TERM

This Agreement shall commence on August 13, 2015, and continue unless and until terminated by one of the parties in accordance with Article 5. 

ARTICLE 3 – CONSIDERATION

(1)    The Company and Consultant hereby agree to the Fees, Terms and Conditions included in Attachment #1 to this contract, regarding compensation for work performed by Consultant.

(2)    The Company shall reimburse the Consultant for reasonable expenses incurred by the Consultant for authorized travel outside a fifty (50) mile radius of the Consultant's office, when approved or authorized in advance by The Company.  Expenses shall include reasonable transportation and room and board expenses associated with such travel, subject to The Company’s policies for reimbursement of business travel.  An accounting of such travel and expenses, including all receipts, shall be submitted along with the invoices presented in accordance with Article 4.    

(3)    “The Consultant shall have authority to purchase goods and services, and enter into contracts, for or on behalf of The Company under the terms of this agreement consistent with his title, subject to any restrictions imposed by the Company’s CEO or Board of Directors.”  

ARTICLE 4 ‐ INVOICING

The Consultant shall present a summary for professional services rendered for each calendar month or portion thereof, referencing the appropriate charge number (if applicable) and Consulting Agreement number on the invoice.  Payment terms shall be net fifteen (15) days from the date of receipt of an acceptable invoice submitted by the Consultant and shall be directed to:

Hooper Holmes, Inc.
560 North Rogers Road
Olathe, KS 66062
Attention: Henry Dubois

ARTICLE 5 ‐ TERMINATION

Hooper Holmes Consultant Contract                         Confidential    August 14, 2015

CONSULTING SERVICES AGREEMENT
Contract # JGF 2015-HH 01
    

Either Party may terminate this Agreement at any time with 30 days prior written notice.  In the event of a termination by The Company without cause, The Company shall be subject to the terms and conditions in Attachment #1 to the contract.  

ARTICLE 6 ‐ GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of New York.

ARTICLE 7 ‐ ASSIGNMENT

This Agreement and the rights and obligations of the parties hereunder shall not be assigned by either party without the prior written consent of the other party.   

ARTICLE 8 ‐ SEVERABILITY

If any provision of this Agreement or the application thereof, shall, for any reason and to any extent, be invalid or unenforceable, the remainder of this Agreement and the application of such provisions to other persons or circumstances shall not be affected thereby, but rather shall be enforced to the maximum extent permissible under applicable law.

ARTICLE 9 ‐ DESIGNATION OF COMPANY AUTHORIZED REPRESENTATIVES

The representatives of The Company authorized to direct the Consultant (as referred to in Article 1) is/are:

A.    Henry Dubois
B.    Any Company employee designated by Henry Dubois to act in his stead.

ARTICLE 10 - LIMITATION OF LIABILITY

If Consultant is held liable to The Company for any matter arising out of, under, or in connection with this Agreement, whether based on an action or claim in contract, equity, negligence, intended conduct, tort, or otherwise, the amount of damages recoverable against Consultant for all events, acts or omissions shall not exceed in the aggregate the total amount of the charges paid and expenses reimbursed by The Company to Consultant under this Agreement. Consultant will not be liable for any loss of income, profit, savings or indirect, incidental, or consequential damages of any nature whatsoever in connection with, related to, arising out of, any aspect of Consultant performance under this Agreement, even if Consultant has been advised of the possibility of such damages.  The provisions of this Section will survive the term or termination of this Agreement for any reason.

Hooper Holmes Consultant Contract                         Confidential    August 14, 2015

CONSULTING SERVICES AGREEMENT
Contract # JGF 2015-HH 01
    

ARTICLE 11 – NOTICES

Notices to The Company shall be directed to: 

	
			
	Description
	The Company
	Consultant

	Company
	Hooper Holmes, Inc
	Steven R. Balthazor

	Address
	560 North Rogers Road
	3092 Noble Court

	Address
	Olathe, KS 66062
	Boulder, CO  80301

	Telephone
	 
	303.859.0264

	Facsimile
	 
	303.955.5378

	Email
	 
	Steven_Balthazor@yahoo.com 

	Attention
	Mr. Henry Dubois
	Steven Balthazor

IN WITNESS WHEREOF, each of the parties of this Agreement has caused this Agreement to be signed in its name and on its behalf by its representative thereunto duly authorized as of the day and year first above written.

Consultant                            Hooper Holmes, Inc.

_____________________________                ______________________________
Steven R. Balthazor                        Henry Dubois
Consultant                            President and CEO

Hooper Holmes Consultant Contract                         Confidential    August 14, 2015

CONSULTING SERVICES AGREEMENT
Contract # JGF 2015-HH 01
    

Attachment #1
 Fees, Terms and Conditions
Contract # JGF 2015-HH01

Fee Structure:
		
	1.
	Fees will be based on time worked and will be computed as follows based on an hourly cash compensation rate of $150/hour, such that:  

		
	a.
	no more than $ 1,200 shall be charged for any calendar day without prior approval by Mr. Dubois or his representative, and, 

		
	b.
	no more than $ 6,000 charged for any calendar week without prior approval by Mr. Dubois or his representative, and 

		
	2.
	Consultant will receive 150,000 non-qualified stock options, pursuant to a separate Stock Option Grant Agreement.  

Terms:
		
	1.
	Fee and expense invoices will be submitted to the Company’s authorized representative for approval and payment.  

		
	2.
	Consultant will use the travel vendors of preference of The Company, if any, and follow the Company’s travel policies.

		
	3.
	All customary and reasonable travel related expenses shall be reimbursed to the Consultant.  

Conditions:
		
	1.
	In accordance with Article 5 of this contract, either party may terminate this contract with 30 days written notice. The Company shall be responsible for paying any unpaid but earned Fees. 

Hooper Holmes Consultant Contract                         Confidential    August 14, 2015

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