Document:

Exhibit 10.3

 

Clinical Trial Agreement

 

This Clinical Trial Agreement (“Agreement”)
is made as of this 19th day of September, 2016 (“Effective Date”) by and between Creative Medical Technologies,
Inc. with a place of business at 2017 W. Peoria Avenue, Phoenix, AZ, 85029 (“CMT”) and Los Angeles Biomedical
Research Institute at Harbor-UCLA Medical Center, a non-profit biomedical research and education institute located at 1124
W. Carson Street, Building N-14, Torrance, CA 90502 (“Institution”).

 

CMT desires to have Institution conduct a clinical
trial to be supervised by its member Jacob Rajfer, M.D., (“Principal Investigator”) under the CMT patented intellectual
property and protocol entitled, “Feasibility Study of Intra-cavernosal Administration of Non-Expanded Autologous Bone
Marrow Cells in Treatment of Erectile Dysfunction”, (“Study”). CMT wishes to provide certain support for
the Study, as is more fully described in Section 4 of this Agreement.

 

The Institution and CMT are hereinafter each
individually referred to as a “Party” and collectively referred to as the “Parties”.

 

Accordingly, the Parties agree as follows:

 

		1.	Investigators and Re se arch Staff

 

		1.1	Principal Investigator. The Study will be supervised and completed by Principal Investigator
at Institution.

 

		1.2	Obligations. Institution will ensure that Principal Investigator and any other personnel
who participate in the conduct of the Study abide by all applicable terms of this Agreement. Institution is responsible to CMT
for compliance by all personnel, including the Principal Investigator, with the terms of this Agreement.

 

     

     

    

 

 

		1.3	Delegation of Duties by Principal Investigator. Principal Investigator may delegate
duties and responsibilities to sub-investigators or research staff only to the extent permitted by Food and Drug Administration
(FDA) regulations governing the conduct of clinical investigations.

 

		1.4	Compliance with Institutional Policies. Institution will ensure that Principal Investigator
complies with Institution’s policies and procedures, including applicable financial policies. Institution will notify CMT
promptly of any conflict between the terms of this Agreement and any such policy or procedure, and the parties will attempt to
reach an appropriate accommodation.

 

		2.	Protocol

 

		2.1	Protocol. The Study will be conducted in accordance with a protocol developed by
CMT (“Protocol”).

 

		2.2	Ame ndme nts. If CMT modifies the IRB-approved final Protocol, CMT will inform Principal
Investigator in writing and seek approval from IRB for any such amendments.

 

		3.	Study Conduct

 

		3.1	Sponsorship. This is a sponsored study, CMT has designed the study and CMT is funding
the Study.

 

		3.2	Regulatory. CMT is solely responsible for any and all safety reporting and regulatory
obligations associated with the conduct of the Study.

 

		3.3	Standards. Principal Investigator will conduct the Study in accordance with the Protocol,
International Conference on Harmonization Good Clinical Practice (ICHGCP) guidelines, and all applicable governmental laws, rules,
and regulations.

 

     

     

    

 

 

		3.4	IRB Approval. If required, Principal Investigator will ensure that the Study is approved
by and subject to continuing oversight by an appropriate Institutional Review Board (IRB). Institution will provide CMT with documentation
of both the initial IRB approval and annual renewals of that approval. Institution will notify CMT promptly of any withdrawal or
suspension of IRB approval during the term of this Agreement.

 

		3.5	Informed Consent. Principal Investigator will obtain informed consent for each Study
subject in accordance with 21 Code of Federal Regulations Part 50 and will Inform Study subjects that CMT is providing support
for the Study. CMT has no obligation to participate in the development of, or to review or comment on, the informed consent form.

 

		3.6	Monitoring and Data Collection. CMT may monitor the
Study and receive any subject-level Study data, excluding the identity of any patients involved with the Study. During and
for a period of at least two years after the completion of the Study, CMT shall promptly report to the Investigator any information
that could directly affect the health or safety of past or current Study subjects or influence the conduct of the study, including
but not limited to the Study results and information in site monitoring reports and data safety monitoring committee reports as
required by the Protocol. In each case, the Investigator and Institution shall be free to communicate these findings to each Study
subject and the IRB.

 

		3.7	Duration of Study. Principal Investigator
expects to complete Study conduct by April 30, 2018.If required, the Study must be approved by CMT should an extension past
April 30, 2018 to complete the Study is needed.

 

     

     

    

 

 

		3.8	Status Updates. Principal Investigator will provide CMT with an update of Study status
at least once per quarter during the term of this Agreement, or more frequently if mutually agreed by the Parties. Each status
update will include subject enrollment, publication plans, any adjustments in estimated study completion date, and any other information
reasonably requested by CMT.

 

		4.	Research Support. CMT will provide funding in support of the Study in accordance
with the payment schedule and budget in Attachment A. This funding constitutes the CMT Financial Support for this Study. In addition,
CMT shall provide the Institution with all equipment and supplies necessary to conduct the Study as required hereby, the sufficiency
and adequacy of the equipment and supplies to be reasonably determined by the Institution. The provision of the equipment and supplies
so described and the CMT Financial Support constitutes the Research Support for this Study.

 

		4.1	Basis of Support. This financial support is not conditioned on any pre-existing or
future research or business relationship between the Principal Investigator and CMT or Institution and CMT. It is also not conditioned
on any business, research or other decisions the Principal Investigator or Institution has made, or may make, relating to CMT or
CMT Products.

 

		4.2	Use of Financial Support. The Principal Investigator and Institution will use the
financial support solely for purposes of the Study.

 

		4.3	Study Budget. Institution represents that the Institution-provided study budget upon
which the support is based reflects an informed estimate of all funds required to complete the Study.

 

		4.4	Disclosure by CMT. In the interest of transparency relating to its financial relationships
with investigators and study sites, CMT may publicly disclose the funding associated with this Agreement. Any such report by CMT
will clearly differentiate between payments made to institutions and payments made to individuals.

 

     

     

    

 

 

		5.	Study Data. Principal Investigator and Institution are free to publish the results
of the Study, subject to the provisions in Section 7 (Publications), and to use data generated from the Study for their own research
and educational purposes and programs. However, in consideration of the CMT support, Principal Investigator and Institution shall
not use or permit others to use Study data for the commercial benefit of any third party.

 

		6.	Study Report. No later than ninety (90) days after the final examination and follow-up
review of any patient included within the Study, Principal Investigator will provide CMT with a written report of the Study results
(“Study Report”). The Study Report may take the form of a manuscript for publication (see Section 7, Publications).
If the Agreement is terminated early, the Study Report shall include, at minimum, the results of the Study up until the date of
termination.

 

		7.	Publications. CMT supports the exercise of academic freedom and encourages Principal
Investigator to publish the results of the Study, whether or not the results are favorable to CMT or any CMT product.

 

		7.1	Pre-Publication Review. Principal Investigator will provide CMT an opportunity (a
minimum of 30 days before submission or other public disclosure) to prospectively review any proposed publication, abstract, or
other type of disclosure that reports the results of the Study (collectively, “Publication”). CMT further recognizes
and accepts that under Institution’s mission as a non-profit, responsible medical center, Institution and its investigators
must have a meaningful right to publish research results without CMT’s approval or editorial control, regardless of the Study’s
outcome; provided, however, that if reasonably requested by CMT, Institution shall not publish or publicly disclose any confidential
information belonging to CMT. If CMT reasonably determines that the proposed publication or public disclosure contains patentable
subject matter which requires protection, CMT may request the delay of publication or public disclosure for a period of time not
to exceed ninety (90) days for the purpose of filing patent applications. If no written response is received from CMT within the
applicable review period, it may be conclusively presumed that publication or public disclosure may proceed without delay.

 

     

     

    

 

		7.2	Standards. For all Publications, Principal Investigator will comply with recognized
ethical standards concerning publications and authorship, including the Uniform Requirements for Manuscripts Submitted to Biomedical
Journals, established by the International Committee of Medical Journal Editors.

 

		7.3	Disclosure of Support. Principal Investigator will disclose CMT support of the Study
in any Publication of Study results.

 

		8.	Indemnification;
                                         Insurance ; Subject Injury.

 

		8.1	CMT will indemnify and hold harmless the County of Los Angeles, the Institution, Site, Principal
Investigator, and Institution and Site’s trustees, directors, officers members and employees (collectively, “Indemnified
Parties”) against any and all liabilities, losses, damages, costs, and expenses including reasonable attorneys’ fees
and costs (collectively, “Losses”) they may suffer in connection with any claim or lawsuit brought by a third party:
(a) for bodily injury, including death, arising out of the conduct of the Study in accordance with the Protocol and the Agreement,
(b) that arises out of CMT’s use of the Study results, or (c) that arises out of the negligence, recklessness, or willful
misconduct of CMT or its directors, officers, employees, or agents. Notwithstanding the foregoing, CMT will not be obligated to
indemnify the Institution Indemnitees to the extent that such Losses arise from (i) negligence, recklessness, or willful misconduct
on the part of any of the Institution Indemnitees or the Study Personnel, or (ii) a breach of the Institution’s obligations,
representations, or certifications under this Agreement.

 

		8.2	Institution agrees to indemnify, defend, and hold harmless CMT and CMT’s (the “CMT
Indemnitees”) from any and all Losses they may suffer in connection with any claim or lawsuit brought by a third party
arising out of: (a) the negligence, recklessness, or willful misconduct on the part of the Institution or Institution’s officers,
employees, agents, and subcontractors (including Study Personnel), or (b) a breach of the Institution’s obligations, representations,
or certifications under this Agreement. Notwithstanding the foregoing, Institution will not be obligated to indemnify the Sponsor
Indemnitees to the extent that such Losses arise from (i) the negligence, recklessness, or willful misconduct on the part of any
of the Sponsor Indemnitees, or (ii) a breach of the Sponsor’s obligations, representations, or certifications under this
Agreement.

 

     

     

    

 

		8.3	Each party’s agreement to indemnify, defend, and hold the other party and its respective
indemnitees harmless is conditioned upon the indemnified party: (a) providing written notice to the indemnifying party of any claim,
demand, or action arising out of the indemnified activities within thirty (30) days after the indemnified party has knowledge of
such claim, demand, or action, provided that any failure on the part of an indemnified party to notify the indemnifying party of
receipt of notice of a claim will relieve the indemnifying party of its obligation to indemnify the indemnified party for such
claim under this Agreement only to the extent that the indemnifying party has been prejudiced by the lack of timely and adequate
notice; (b) permitting the indemnifying party to assume full responsibility and authority to investigate, prepare for, defend against,
and settle any such claim or demand; and (c) assisting the indemnifying party, at the indemnifying party’s reasonable expense,
in the investigation of, preparation for, and defense of any such claim or demand. If the indemnifying party assumes the defense
of a third party claim, the indemnifying party will not be subject to any liability for any settlement of such claim made by the
indemnified party without the indemnifying party’s consent, which consent may not be unreasonably withheld or delayed.

 

		8.4.	During the term of this Agreement and for at least one (1) year thereafter, Institution will, at
its own expense, carry and maintain medical professional liability insurance with limits of not less than one million dollars ($1,000,000)
per incident and there million dollars ($3,000,000) per aggregate for each person and entity peforming services under this Agreement,
including but not limited to Institution and Investigator. These policies will provide coverage for incidents, claims, and suits
arising from activities performed in connection with this Agreement and reported during the term of this Agreement, as well as
those incidents, claims, and suits arising from such activities but reported after the expiration or termination of this Agreement.

 

     

     

    

 

		8.5	During the term of this Agreement and for at least one (1) year thereafter, Sponsor will, at its
own expense, carry and maintain in full force insurance coverage to support its obligations under the indemnification, liability
and related provisions of this Agreement, with limits of not less than one million dollars ($1,000,000) per incident and three
million dollars ($3,000,000) per aggregate. These policies will provide coverage for incidents, claims, and suits arising from
activities performed in connection with this Agreement and reported during the term of this Agreement, as well as those incidents,
claims, and suits arising from such activities but reported after the expiration or termination of this Agreement.

 

Either Party will at the request
of other party, have its insurance carrier for such insurance furnish to the requesting party, a certificate that such insurance
is in force, such certificate to indicate any deductible and/or self-insured retention and stipulate that such insurance will not
be canceled while this Agreement is in effect without at least thirty (30) days prior written notice to requesting party.

 

		8.6	CMT will reimburse Institution for reasonable and necessary medical expenses, including hospitalization,
it incurs in providing necessary medical treatment to a Study subjects who are injured or have adverse reactions directly resulting
from any research procedure performed in accordance with the Protocol, provided that such adverse reactions, or research procedures
performed, are in no way attributable to: (a) a failure of the Institution and/or Investigator to adhere to the Protocol, (b) the
negligence or misconduct of any agents, contractors, or employees of Site or Institution or, (c) the natural progression of a subject’s
underlying, re-existing medical condition or disease. For clarity, CMT will not pay for the treatment of medical complications
that are a part of the natural course of the primary disease, but will reimburse Institution for reasonable and necessary medical
expenses incurred for the treatment by Institution of aggravations of existing conditions that directly result from any research
procedures performed in accordance with the Protocol.

 

     

     

    

 

 

		9.	Adverse Experiences. CMT shall promptly notify Investigator of any findings of new and unexpected
serious adverse events rising from CMT’s monitoring of the Study that could affect the safety of subjects, and trends or
patterns of non-serious or expected adverse events that occur at a specificity or severity that is inconsistent with prior observations
all in accordance with the obligations set forth in 21 C.F.R. 312.32(c), 21 C.F.R. 312.55
(b), 21 C.F.R. 56.108 (b) and FDA’s Guidance on Adverse Event Reporting to Institutional Review Boards in Clinical Trials
(January 2009). In the event that any adverse reactions associated with the Study Drug indicate the possibility of significant
health hazards, Institution and Investigator shall notify Sponsor within twenty-four (24) hours of making such discovery. Institution
and Investigator shall at all times have the right to provide information regarding such adverse events to Study subjects if it
is determined that such adverse events may have an effect on the Study subject’s health.

 

		10.	Use of Name. The use by any Party of the name, trademark, trade name, logo or any
adaption thereof, of any other Party in any publication, press release, advertisement, announcement, promotional material, or promotional
activity relating to the Study requires the prior written consent of the other Party, subject, however, to the following:

 

a. CMT may, without prior consent,
identify Institution as the entity conducting the Study, and identify the Principal Investigator as conducting the Study at the
Institute. This paragraph does not apply to information of Sub-investigators or other study personnel.

 

b. Institute and Principal Investigator
may, without prior consent, disclose their participation in the Study (Including the name of CMT, name of the Study, protocol number,
funding amount, and any information available in a public registry) as required by law, court order, or state regulation; or in
(1) C.V.s, (2) their website, (3) industry directories, (4) presentations, (7) grant applications to non-commercial funding sources,
(8) government reports and filings, and (9) conflict-of-interest reports. This paragraph applies to Sub-investigators and other
study personnel.

 

     

     

    

 

 

c. CMT, as required by law or regulation,
may disclose and make public the terms and conditions of this Agreement, including, but not limited to, the name of Institution
and Principal Investigator and the amount of payments under this Agreement.

 

		11.	Intellectual Property. Intellectual Property that either Party owned prior to execution
of this Agreement, or develops independently of the Study and other Party’s confidential information is that Party’s
separate property. It is not affected by this Agreement. Neither Party has any claims to or rights in such Intellectual Property
of other Party.

 

		10.1	Inventorship. Inventorship shall be determined under federal patent laws.

 

		10.2	Institution Intellectual Property. All individual or collective inventions, improvements
or discoveries, whether or not patentable or copyrightable which are conceived or made solely by one or more employees or members
of the Institution (“Institution Intellectual Property”) in performance of the Study during the term of this Agreement
shall be considered Institution Intellectual Property. All rights and title to Institution Intellectual Property created pursuant
to the Study shall belong to Institution and shall be subject to the terms and conditions of this Agreement.

 

Notwithstanding
the foregoing, however, Institution acknowledges and agrees that it shall not under any circumstance make commercial use of Institution
Intellectual Property in such a way as to compete with any business of CMT, including any of its productions whether existing or
prospective, or gain commercial advantage over any such business of CMT as a result thereof. In consideration of CMT's support
of Institution in performance of any such clinical testing or other services provided under this Agreement, Institution hereby
grants to CMT an option for an exclusive license to said Institution Intellectual Property, which shall expire six months after
Institution has provided written notice to CMT of any such invention, improvement or discovery made by Institution ("Option
Period"). Upon exercise of the option in writing, the Parties will meet within thirty (30) days to begin negotiating the terms
of the license. The Parties agree to negotiate in good faith. In the event a license is not executed within six (6) months from
the exercise of the option, or the option is not exercised within the Option Period, the Institution shall be free to license the
Institution Intellectual Property to others at the Institution's sole discretion with no further obligation to the CMT.

 

     

     

    

 

		10.3	CMT Intellectual Property. All individual or collective inventions, improvements
or discoveries, whether or not patentable or copyrightable which are conceived or made solely by one or more employees of CMT (“CMT
Intellectual Property”) in performance of the Study during the term of this Agreement shall be considered CMT Intellectual
Property. All rights and title to CMT Intellectual Property created pursuant to the Study shall belong to CMT and shall be subject
to the terms and conditions of this Agreement.

 

		10.4	Joint Intellectual Property. All individual or collective inventions, improvements
or discoveries, whether or not patentable or copyrightable which are conceived and reduced to practice jointly by one or more employees
or members of each Party (“Joint Intellectual Property”) in performance of the Study during the term of this Agreement
shall be considered Joint Intellectual Property. All rights and title to Joint Intellectual Property created pursuant to the Study
shall belong jointly to Institution and CMT and shall be subject to the terms and conditions of this Agreement.

 

		a.	Each Party will promptly notify the other when Joint Intellectual Property is created. Inventions
made jointly by CMT and Institution will be owned jointly by CMT and Institution CMT shall accordingly have the right, at its option
and expense, and through patent attorneys or agents of its choice, to make all decisions with respect to, and to otherwise control
preparation, filing and prosecution (including any proceedings relating to reissues, reexaminations, protests, interferences, and
requests for patent extensions or supplementary protection certificates) of any patent application with respect to any Joint Intellectual
Property and to maintain any patents issuing therefrom. CMT shall provide Institution an opportunity to review decisions related
to the prosecution of any patent application based upon Joint Intellectual Property.

 

     

     

    

 

		b.	CMT shall not retain patent attorneys or agents if such representatives pose a conflict of interest
with respect to the Institution’s rights in Institution Intellectual Property and Joint Intellectual Property..

 

		c.	If CMT elects not to exercise its rights in the Joint Intellectual Property or CMT decides to discontinue
or refrain from providing the financial support for the prosecution or maintenance of patents or patent applications claiming Joint
Intellectual Property, then CMT shall be deemed to have irrevocably assigned its rights in such patents and patent applications
to the Institution and, as a result, the Institution shall be free to file or continue prosecution or maintain any such application(s)
and to maintain any protection issuing thereon in the United States of America and in any foreign country at the Institution’s
sole expense and all rights in the applicable patent or patent applications shall thereupon be transferred to the Institution.

 

		12.	Grant of Rights . Institution hereby grants to CMT, an exclusive option at CMT’s
sole election, to negotiate for an exclusive license to Institution’s interest in any Joint Intellectual Property. Terms
and conditions of these licenses are to be negotiated in good faith and agreed upon between Institution and CMT. CMT shall notify
Institution by written notice within ninety (90) days of agreement of the Parties whether or not CMT elects to exercise the option.
If CMT either (i) elects not to exercise its option or (ii) fails to provide written notice within such ninety (90) day period,
then CMT shall automatically be deemed to have relinquished any rights it may have to any Intellectual Property or license described
in this section. If CMT provides Institution written notice of its exercise of the option, the parties shall exclusively negotiate
in good faith, for a period of ninety (90) days, a license to the applicable Institution Intellectual Property and Joint Intellectual
Property on terms consistent with the terms of this paragraph. If, after good faith negotiations, no agreement is reached by the
parties within such ninety (90) day period, Institution shall be free to enter into a license agreement with any third party for
any Institution Intellectual Property and to license its rights in any Joint Intellectual Property to any third party.

 

     

     

    

 

		13.	Termination.

 

		12.1	Termination Events. Termination of this Agreement will be triggered by the earlier
of any of the following events.

 

		a.	Study Completion. The Agreement will terminate with the Study is complete, which
means the completion of all Protocol-required activities for all enrolled subjects and receipt, by CMT, of a final Study Report.

 

		b.	Early Termination by Institution. If Institution terminates the Study early, for
any reason, Institution may terminate the Agreement on the conditions that (i) thirty (30) days written notice of termination is
provided to CMT, and (ii) in the event that any patients remain enrolled in the Study as of the date of Institution’s decision
to termination, then Institution shall, notwithstanding its termination of the Agreement, continue to comply with the requirements
of both the IRB and federal regulations affecting clinical study patient follow-up examination and care.

 

		c.	Early Termination by CM T. CMT may terminate the Agreement early in any of the following
circumstances:

 

		i.	The Protocol is modified in a way unacceptable to CMT (see section 2.2, Amendments);

 

     

     

    

 

		ii.	Study conduct is not completed within six months after the target date ( see Section 3.7, Duration
of Study);

 

		iii.	The Study does not start within six months of the Effective Date of this Agreement.

 

		iv.	The Study design or objectives are no longer scientifically relevant.

 

		d.	Termination for Cause. Either Party may terminate the Agreement immediately upon
notification for cause, including but not limited to uncured material breach of the terms of this Agreement by the other Party.

 

		e.	Effective Date of Termination. If termination is triggered by events described in
Sections 10.1 a. b. or c above, termination will be effective after completion by both parties of any remaining applicable Agreement
obligations.

 

		f.	Payment upon Termination. If the Agreement is terminated early for any reason other
than an uncured material breach of this Agreement by Principal Investigator or Institution, CMT will pay a pro rata portion of
the total funding, less payments already made.

 

		12.2	Miscellaneous

 

		a.	Debarment and Exclusion. Institution certifies that neither it nor Principal Investigator
is debarred under subsections 306(a) or (b) of the Federal Food, Drug, and Cosmetic Act and that it has not and will not use in
any capacity the services of any person debarred under such law with respect to services to be performed under this Agreement.
Institution also certifies that neither it nor Principal Investigator is excluded from any federal health care program, including
but not limited to Medicare and Medicaid. Institution will notify CMT promptly if either of these certifications needs to be amended
in light of new information.

 

		b.	Warranty. INSTITUTION MAKES NO WARRANTIES OR REPRESENTATIONS INCLUDING, BUT NOT LIMITED
TO, WARRANTIES OF FITNESS FOR A PARTICULAR PURPOSE OR MERCHANTABILITY REGARDING THE RESULTS OF THE STUDY.

 

     

     

    

 

		c.	Governing Law. This Agreement shall be governed by and construed under the laws of
the State of California, without regard for its conflict of law provisions.

 

		d.	Notice. All notices required under this Agreement will be in writing and be deemed
to have been given when hand delivered, sent by overnight courier or certified mail, as follows, provided that all urgent matters,
such as safety reports, will be promptly communicated via telephone, and confirmed in writing:

 

	 	If for Institution:	Los Angeles Biomedical Research Institution at
	 	 	Harbor-UCLA Medical Center 
	 	 	Grants and Contracts Administration 
	 	 	1124 W. Carson St.
	 	 	Torrance, CA 90502
	 	 	Phone: (424) 571-7631
	 	 	Attention: Patrick Rosal
	 	 	 
	 	If for CMT:	Creative Medical Health, Inc.
	 	 	2007 West Peoria Avenue
	 	 	Phoenix, Arizona 85029
	 	 	 
	 	 	Phone: (480) 789-9939
	 	 	Attention: Timothy Warbington, President & CEO

 

		e.	Entire Agreement. This agreement and its attachments constitute the entire agreement
between the parties with respect to this subject matter. All express or implied representations, agreements and understandings,
either oral or written, heretofore made are expressly superseded by this Agreement. This Agreement may be amended, or any term
hereof modified, only by a written instrument duly executed by both parties.

 

		f.	Independent contractors. Each party hereby acknowledges that the parties shall be
independent contractors and that the relationship between the parties shall not constitute a partnership, joint venture or agency.
Neither party shall have the authority to make any statements, representations or commitments of any kind, or to take any action,
which shall be binding on the other party, without the prior consent of the other party to do so.

 

     

     

    

 

		g.	Waive r. The waiver by a party of any right hereunder, or of any failure to perform
or breach by the other party hereunder, shall not be deemed a waiver of any other right hereunder or of any other breach or failure
by the other party hereunder whether of a similar nature or otherwise.

 

		h.	Conflict with Attachments. If there is any conflict between this agreement and any
Attachments to it, or between the Agreement and the Protocol, the terms of this Agreement will control.

 

		i.	Counterparts. This Agreement may be executed in separate counterparts, and by facsimile
or electronically as a portable document format (pdf) file or similar electronic file, each of which will be deemed an original,
and when executed separately or together, will constitute a single original instrument, effective in the same manner as if the
parties had executed one and the same instrument.

 

IN WITNESS WHEREOF, the parties have caused
this Agreement to be executed by their duly authorized representatives.

 

	CREATIVE MEDICAL HEALTH, INC.	 	LOS ANGLES BIOMEDICAL RESEARCH
	 	 	 	INSTITUTE AT HARBOR-UCLA MEDICAL CENTER
	 	 	 	 
	By: 	/s/ Timothy Warbington 	 	By: 	/s Allison Weber
	Name: 	Timothy Warbington	 	Name: Allison Weber
	Title: 	President & Chief Executive Officer	 	Title: Director, Research Administration
	Date: 	 	 	Date: 9/20/16
	 	 	 	 
	READ AND ACKNOWLEDGED:	 	 
	 	 	 	 
	By:	/s/ Jacob Rajfer, MD	 	 
	Name:	Jacob Rajfer, MD	 	 
	Title:	Principal Investor	 	 
	Date: 	9/19/2016	 	 

 

     

     

    

 

Attachment A

 

Payment Schedule

 

Site will send payment requests to:

 

ATTN:

Creative Medical Technologies, Inc.

C/O Timothy
Warbington

2017 W. Peoria Ave.

Phoenix, AZ 85029

Email: ceo@creativemedicalhealth.com

 

CMT will send payments to:

 

	Payee:	Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
	 	 
	Institution:	Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center 
	 	 
	Address: 	PO Box 60637
	 	Terminal Annex
	 	Los Angeles, CA 90060
	 	 
	C/O:	021760-01-00/J. Rajer, MD
	 	 
	Taxpayer ID: 95-2138184Exhibit 4.1

 

THIS WARRANT AND THE SHARES ISSUABLE HEREUNDER HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), OR THE SECURITIES LAWS OF ANY STATE AND, EXCEPT AS SET FORTH IN SECTIONS 5.3 AND 5.4 BELOW, MAY NOT BE OFFERED, SOLD, PLEDGED OR OTHERWISE TRANSFERRED UNLESS AND UNTIL REGISTERED UNDER SAID ACT AND LAWS OR, IN THE OPINION OF LEGAL COUNSEL IN FORM AND SUBSTANCE SATISFACTORY TO THE ISSUER, SUCH OFFER, SALE, PLEDGE OR OTHER TRANSFER IS EXEMPT FROM SUCH REGISTRATION.

 

WARRANT TO PURCHASE STOCK

 

Company: Axsome Therapeutics, Inc., a Delaware corporation

Number of Shares: As set forth in Paragraph A below

Type/Series of Stock: Common Stock, $0.0001 par value per share

Warrant Price: $7.408333 per Share, subject to adjustment

Issue Date: November 9, 2016

Expiration Date: November 8, 2023                                         See also Section 5.1(b).

Credit Facility:  This Warrant to Purchase Stock (“Warrant”) is issued in connection with that certain Loan and Security Agreement of even date herewith between Silicon Valley Bank and the Company (as amended and/or modified and in effect from time to time, the “Loan Agreement”).

 

THIS WARRANT CERTIFIES THAT, for good and valuable consideration, SILICON VALLEY BANK (together with any successor or permitted assignee or transferee of this Warrant or of any shares issued upon exercise hereof, “Holder”) is entitled to purchase up to such number of fully paid and non-assessable shares of the above-stated Type/Series of Stock (the “Class”) of the above-named company (the “Company”) as determined pursuant to Paragraph A below, at the above-stated Warrant Price, all as set forth above and as adjusted pursuant to Section 2 of this Warrant, subject to the provisions and upon the terms and conditions set forth in this Warrant.  Reference is made to Section 5.4 of this Warrant whereby Silicon Valley Bank shall transfer this Warrant to its parent company, SVB Financial Group.

 

A.                                    Number of Shares.       This Warrant shall be exercisable for the Initial Shares, plus the Additional Shares, if any (collectively, and as may be adjusted from time to time in accordance with the provisions of this Warrant, the “Shares”).

 

(1)                                 Initial Shares.  As used herein, “Initial Shares” means 32,614 shares of the Class, subject to adjustment from time to time in accordance with the provisions of this Warrant.

 

(2)                                 Additional Shares.       All shares, if any, for which this Warrant shall become exercisable pursuant to this Paragraph A(2) and as may be adjusted from time to time in accordance with the provisions of this Warrant, are referred to herein collectively as the “Additional Shares.”

 

(a)                                 Upon the making (if any) of the Term B Loan Advance (as defined in the Loan Agreement) to the Company, this Warrant automatically shall become exercisable for 6,989 additional shares of the Class, as such number may be adjusted from time to time in accordance with the provisions of this Warrant (including, without limitation, adjustments in respect of events occurring prior to the date, if any, on which this Warrant becomes exercisable for such additional shares as if they were “Shares” hereunder at all times from and after the Issue Date).

 

 

(b)                                 Upon the making (if any) of the Term C Loan Advance (as defined in the Loan Agreement) to the Company, this Warrant automatically shall become exercisable for 6,988 additional shares of the Class, as such number may be adjusted from time to time in accordance with the provisions of this Warrant (including, without limitation, adjustments in respect of events occurring prior to the date, if any, on which this Warrant becomes exercisable for such additional shares as if they were “Shares” hereunder at all times from and after the Issue Date).

 

SECTION 1. EXERCISE.

 

1.1                               Method of Exercise.  Holder may at any time and from time to time exercise this Warrant, in whole or in part, by delivering to the Company the original of this Warrant together with a duly executed Notice of Exercise in substantially the form attached hereto as Appendix 1 and, unless Holder is exercising this Warrant pursuant to a cashless exercise set forth in Section 1.2, a check, wire transfer of same-day funds (to an account designated by the Company), or other form of payment acceptable to the Company for the aggregate Warrant Price for the Shares being purchased.

 

1.2                               Cashless Exercise.  On any exercise of this Warrant, in lieu of payment of the aggregate Warrant Price in the manner as specified in Section 1.1 above, but otherwise in accordance with the requirements of Section 1.1, Holder may elect to receive Shares equal to the value of this Warrant, or portion hereof as to which this Warrant is being exercised.  Thereupon, the Company shall issue to the Holder such number of fully paid and non-assessable Shares as are computed using the following formula:

 

X = Y(A-B)/A

 

where:

 

X =                             the number of Shares to be issued to the Holder;

 

Y =                             the number of Shares with respect to which this Warrant is being exercised (inclusive of the Shares surrendered to the Company in payment of the aggregate Warrant Price);

 

A =                             the Fair Market Value (as determined pursuant to Section 1.3 below) of one Share; and

 

B =                             the Warrant Price.

 

1.3                               Fair Market Value.  If shares of the Class are then traded or quoted on a nationally recognized securities exchange, inter-dealer quotation system or over-the-counter market (a “Trading Market”), the fair market value of a Share shall be the closing price or last sale price of a share of the Class reported for the Business Day immediately before the date on which Holder delivers this Warrant together with its Notice of Exercise to the Company.  If shares of the Class are not then traded in a Trading Market, the Board of Directors of the Company shall determine the fair market value of a Share in its reasonable good faith judgment.

 

1.4                               Delivery of Certificate and New Warrant.  Within a reasonable time after Holder exercises this Warrant in the manner set forth in Section 1.1 or 1.2 above, the Company shall deliver, or

 

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cause to be delivered, to Holder a certificate, or evidence of a book-entry interest, representing the Shares issued to Holder upon such exercise and, if this Warrant has not been fully exercised and has not expired, a new warrant of like tenor representing the Shares not so acquired.

 

1.5                               Replacement of Warrant.  On receipt of evidence reasonably satisfactory to the Company of the loss, theft, destruction or mutilation of this Warrant and, in the case of loss, theft or destruction, on delivery of an indemnity agreement reasonably satisfactory in form, substance and amount to the Company or, in the case of mutilation, on surrender of this Warrant to the Company for cancellation, the Company shall, within a reasonable time, execute and deliver to Holder, in lieu of this Warrant, a new warrant of like tenor and amount.

 

1.6                               Treatment of Warrant Upon Acquisition of Company.

 

(a)                                 Acquisition.  For the purpose of this Warrant, “Acquisition” means any transaction or series of related transactions involving: (i) the sale, lease, exclusive license (other than a license permitted under Section 7.1 of the Loan Agreement), or other disposition of all or substantially all of the assets of the Company; (ii) any merger or consolidation of the Company into or with another person or entity (other than a merger or consolidation effected exclusively to change the Company’s domicile), or any other corporate reorganization, in which the stockholders of the Company in their capacity as such immediately prior to such merger, consolidation or reorganization, own less than a majority of the Company’s (or the surviving or successor entity’s) outstanding voting power immediately after such merger, consolidation or reorganization (or, if such Company stockholders beneficially own a majority of the outstanding voting power of the surviving or successor entity as of immediately after such merger, consolidation or reorganization, such surviving or successor entity is not the Company); or (iii) any sale or other transfer by the stockholders of the Company of shares representing at least a majority of the Company’s then-total outstanding combined voting power.

 

(b)                                 Treatment of Warrant at Acquisition.  In the event of an Acquisition in which the consideration to be received by the Company’s stockholders consists solely of cash, solely of Marketable Securities or a combination of cash and Marketable Securities (a “Cash/Public Acquisition”), and the fair market value of one Share as determined in accordance with Section 1.3 above would be greater than the Warrant Price in effect on such date immediately prior to such Cash/Public Acquisition, and Holder has not exercised this Warrant pursuant to Section 1.1 or Section 1.2 above as to all Shares, then this Warrant shall automatically be deemed to be Cashless Exercised pursuant to Section 1.2 above as to all Shares not previously exercised effective immediately prior to and contingent upon the consummation of a Cash/Public Acquisition.  In connection with such Cashless Exercise, Holder shall be deemed to have restated each of the representations and warranties in Section 4 of the Warrant as of the date thereof and the Company shall promptly notify the Holder of the number of Shares (or such other securities) issued upon exercise.  In the event of a Cash/Public Acquisition where the fair market value of one Share as determined in accordance with Section 1.3 above would be less than the Warrant Price in effect immediately prior to such Cash/Public Acquisition, then this Warrant will expire immediately prior to the consummation of such Cash/Public Acquisition.

 

(c)                                  Upon the closing of any Acquisition other than a Cash/Public Acquisition, the acquiring, surviving or successor entity shall assume the obligations of this Warrant, and this Warrant shall thereafter be exercisable for the same securities and/or other property as would have been paid for the Shares issuable upon exercise of the unexercised portion of this Warrant as if such Shares were outstanding on and as of the closing of such Acquisition, subject to further adjustment from time to time in accordance with the provisions of this Warrant.

 

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(d)                                 As used in this Warrant, “Marketable Securities” means securities meeting all of the following requirements: (i) the issuer thereof is then subject to the reporting requirements of Section 13 or Section 15(d) of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), and is then current in its filing of all required reports and other information under the Act and the Exchange Act; (ii) the class and series of shares or other security of the issuer that would be received by Holder in connection with the Acquisition were Holder to exercise this Warrant on or prior to the closing thereof is then traded in a Trading Market, and (iii) following the closing of such Acquisition, Holder would not be restricted from publicly re-selling all of the issuer’s shares and/or other securities that would be received by Holder in such Acquisition were Holder to exercise this Warrant in full on or prior to the closing of such Acquisition, except to the extent that any such restriction (x) arises solely under federal or state securities laws, rules or regulations, and (y) does not extend beyond six (6) months from the closing of such Acquisition.

 

SECTION 2. ADJUSTMENTS TO THE SHARES AND WARRANT PRICE.

 

2.1                               Stock Dividends, Splits, Etc.  If the Company declares or pays a dividend or distribution on the outstanding shares of the Class payable in additional shares of the Class or other securities or property (other than cash), then upon exercise of this Warrant, for each Share acquired, Holder shall receive, without additional cost to Holder, the total number and kind of securities and property which Holder would have received had Holder owned the Shares of record as of the date the dividend or distribution occurred.  If the Company subdivides the outstanding shares of the Class by reclassification or otherwise into a greater number of shares, the number of Shares purchasable hereunder shall be proportionately increased and the Warrant Price shall be proportionately decreased.  If the outstanding shares of the Class are combined or consolidated, by reclassification or otherwise, into a lesser number of shares, the Warrant Price shall be proportionately increased and the number of Shares shall be proportionately decreased.

 

2.2                               Reclassification, Exchange, Combinations or Substitution.  Upon any event whereby all of the outstanding shares of the Class are reclassified, exchanged, combined, substituted, or replaced for, into, with or by Company securities of a different class and/or series, then from and after the consummation of such event, this Warrant will be exercisable for the number, class and series of Company securities that Holder would have received had the Shares been outstanding on and as of the consummation of such event, and subject to further adjustment thereafter from time to time in accordance with the provisions of this Warrant.  The provisions of this Section 2.2 shall similarly apply to successive reclassifications, exchanges, combinations, substitutions, replacements or other similar events.

 

2.3                               No Fractional Share.  No fractional Share shall be issuable upon exercise of this Warrant and the number of Shares to be issued shall be rounded down to the nearest whole Share.  If a fractional Share interest arises upon any exercise of the Warrant, the Company shall eliminate such fractional Share interest by paying Holder in cash the amount computed by multiplying the fractional interest by (i) the fair market value (as determined in accordance with Section 1.3 above) of a full Share, less (ii) the then-effective Warrant Price.

 

2.4                               Notice/Certificate as to Adjustments.  Upon each adjustment of the Warrant Price, Class and/or number of Shares, the Company, at the Company’s expense, shall notify Holder in writing within a reasonable time setting forth the adjustments to the Warrant Price, Class and/or number of Shares and facts upon which such adjustment is based.  The Company shall, upon written request from

 

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Holder, furnish Holder with a certificate of its Chief Financial Officer or other Company officer having similar duties, including computations of such adjustment and the Warrant Price, Class and number of Shares in effect upon the date of such adjustment.

 

SECTION 3. REPRESENTATIONS AND COVENANTS OF THE COMPANY.

 

3.1                               Representations and Warranties.  The Company represents and warrants to, and agrees with, the Holder as follows:

 

(a)                                 The initial Warrant Price first set forth above is not greater than the average closing price of a share of the Class on the principal Trading Market in which shares of the Class are traded as of the Issue Date hereof for the thirty (30) consecutive trading days ending on the trading day immediately prior to the Issue Date hereof.

 

(b)                                 All Shares which may be issued upon the exercise of this Warrant shall, upon issuance, be duly authorized, validly issued, fully paid and non-assessable, and free of any liens and encumbrances except for restrictions on transfer provided for herein or under applicable federal and state securities laws.  The Company covenants that it shall at all times cause to be reserved and kept available out of its authorized and unissued capital stock such number of shares of the Class and other securities as will be sufficient to permit the exercise in full of this Warrant.

 

3.2                               Notice of Certain Events.  If the Company proposes at any time to:

 

(a) declare any dividend or distribution upon the outstanding shares of the Class, whether in cash, property, stock, or other securities and whether or not a regular cash dividend;

 

(b) offer for subscription or sale pro rata to the holders of the outstanding shares of the Class any additional shares of any class or series of the Company’s stock (other than pursuant to contractual pre-emptive rights);

 

(c) effect any reclassification, exchange, combination, substitution, reorganization or recapitalization of the outstanding shares of the Class; or

 

(d) effect an Acquisition or to liquidate, dissolve or wind up;

 

then, in connection with each such event, the Company shall give Holder notice thereof at the same time and in the same manner as Holder notifies the holders of the outstanding shares of the Class of such event.

 

SECTION 4. REPRESENTATIONS, WARRANTIES OF THE HOLDER.

 

The Holder represents and warrants to the Company as follows:

 

4.1                                      Purchase for Own Account.  This Warrant and the Shares to be acquired upon exercise of this Warrant by Holder are being acquired for investment for Holder’s account, not as a nominee or agent, and not with a view to the public resale or distribution within the meaning of the Act.  Holder also represents that it has not been formed for the specific purpose of acquiring this Warrant or the Shares.

 

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4.2                                      Disclosure of Information.  Holder is aware of the Company’s business affairs and financial condition and has received or has had full access to all the information it considers necessary or appropriate to make an informed investment decision with respect to the acquisition of this Warrant and its underlying securities.  Holder further has had an opportunity to ask questions and receive answers from the Company regarding the terms and conditions of the offering of this Warrant and its underlying securities and to obtain additional information (to the extent the Company possessed such information or could acquire it without unreasonable effort or expense) necessary to verify any information furnished to Holder or to which Holder has access.

 

4.3                                      Investment Experience.  Holder understands that the purchase of this Warrant and its underlying securities involves substantial risk.  Holder has experience as an investor in securities of companies in the development stage and acknowledges that Holder can bear the economic risk of such Holder’s investment in this Warrant and its underlying securities and has such knowledge and experience in financial or business matters that Holder is capable of evaluating the merits and risks of its investment in this Warrant and its underlying securities and/or has a preexisting personal or business relationship with the Company and certain of its officers, directors or controlling persons of a nature and duration that enables Holder to be aware of the character, business acumen and financial circumstances of such persons.

 

4.4                                      Accredited Investor Status.  Holder is an “accredited investor” within the meaning of Regulation D promulgated under the Act.

 

4.5                                      The Act.  Holder understands that this Warrant and the Shares issuable upon exercise hereof have not been registered under the Act in reliance upon a specific exemption therefrom, which exemption depends upon, among other things, the bona fide nature of the Holder’s investment intent as expressed herein.  Holder understands that this Warrant and the Shares issued upon any exercise hereof must be held indefinitely unless subsequently registered under the Act and qualified under applicable state securities laws, or unless exemption from such registration and qualification are otherwise available.  Holder is aware of the provisions of Rule 144 promulgated under the Act.

 

4.6                                       No Stockholder Rights.  Without limiting any provision of this Warrant, Holder agrees that as a Holder of this Warrant it will not have any rights (including, but not limited to, voting rights) as a stockholder of the Company with respect to the Shares issuable hereunder unless and until the exercise of this Warrant and then only with respect to the Shares issued on such exercise.

 

SECTION 5. MISCELLANEOUS.

 

5.1                                     Term; Automatic Cashless Exercise Upon Expiration.

 

(a)                                       Term. Subject to the provisions of Section 1.6 above, this Warrant is exercisable in whole or in part at any time and from time to time on or before 6:00 PM, Pacific time, on the Expiration Date and shall be void thereafter.

 

(b)                                       Automatic Cashless Exercise upon Expiration.  In the event that, upon the Expiration Date, the fair market value of one Share as determined in accordance with Section 1.3 above is greater than the Warrant Price in effect on such date, then this Warrant shall automatically be deemed on and as of such date to be exercised pursuant to Section 1.2 above as to all Shares for which it shall not previously have been exercised, and the Company shall, within a reasonable time, deliver a certificate representing the Shares issued upon such exercise to Holder.

 

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5.2                               Legends.                                                Each certificate evidencing Shares shall be imprinted with a legend in substantially the following form:

 

THE SHARES EVIDENCED BY THIS CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), OR THE SECURITIES LAWS OF ANY STATE AND, EXCEPT AS SET FORTH IN THAT CERTAIN WARRANT TO PURCHASE STOCK ISSUED BY THE ISSUER TO SILICON VALLEY BANK DATED NOVEMBER 9, 2016, MAY NOT BE OFFERED, SOLD, PLEDGED OR OTHERWISE TRANSFERRED UNLESS AND UNTIL REGISTERED UNDER SAID ACT AND LAWS OR, IN THE OPINION OF LEGAL COUNSEL IN FORM AND SUBSTANCE SATISFACTORY TO THE ISSUER, SUCH OFFER, SALE, PLEDGE OR OTHER TRANSFER IS EXEMPT FROM SUCH REGISTRATION.

 

5.3                               Compliance with Securities Laws on Transfer.  This Warrant and the Shares issued upon exercise of this Warrant may not be transferred or assigned in whole or in part except in compliance with applicable federal and state securities laws by the transferor and the transferee (including, without limitation, the delivery of investment representation letters and legal opinions reasonably satisfactory to the Company, as reasonably requested by the Company).  The Company shall not require Holder to provide an opinion of counsel if the transfer is to SVB Financial Group (Silicon Valley Bank’s parent company) or any other affiliate of Holder, provided that any such transferee is an “accredited investor” as defined in Regulation D promulgated under the Act.

 

5.4                               Transfer Procedure.  After receipt by Silicon Valley Bank of the executed Warrant, Silicon Valley Bank will transfer all of this Warrant to its parent company, SVB Financial Group.  By its acceptance of this Warrant, SVB Financial Group hereby makes to the Company each of the representations and warranties set forth in Section 4 hereof and agrees to be bound by all of the terms and conditions of this Warrant as if the original Holder hereof.  Subject to the provisions of Section 5.3 and upon providing the Company with written notice, SVB Financial Group and any subsequent Holder may transfer all or part of this Warrant or the Shares issued upon exercise of this Warrant to any transferee, provided, however, in connection with any such transfer, SVB Financial Group or any subsequent Holder will give the Company notice of the portion of the Warrant being transferred with the name, address and taxpayer identification number of the transferee and Holder will surrender this Warrant to the Company for reissuance to the transferee(s) (and Holder if applicable); and provided further, that any subsequent transferee other than SVB Financial Group shall agree in writing with the Company to be bound by all of the terms and conditions of this Warrant.

 

5.5                               Notices.  All notices and other communications hereunder from the Company to the Holder, or vice versa, shall be deemed delivered and effective (i) when given personally, (ii) on the third (3rd) Business Day after being mailed by first-class registered or certified mail, postage prepaid, (iii) upon actual receipt if given by facsimile or electronic mail and such receipt is confirmed in writing by the recipient, or (iv) on the first Business Day following delivery to a reliable overnight courier service, courier fee prepaid, in any case at such address as may have been furnished to the Company or Holder, as the case may be, in writing by the Company or such Holder from time to time in accordance with the provisions of this Section 5.5.  All notices to Holder shall be addressed as follows until the Company receives notice of a change of address in connection with a transfer or otherwise:

 

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SVB Financial Group

Attn:  Treasury Department

3003 Tasman Drive, HC 215

Santa Clara, CA 95054

Telephone: (408) 654-7400

Facsimile:  (408) 988-8317

Email address:  derivatives@svb.com

 

Notice to the Company shall be addressed as follows until Holder receives notice of a change in address:

 

Axsome Therapeutics, Inc.

Attn: Chief Executive Officer

25 Broadway, 9th Floor

New York, NY 10004

Telephone: (212) 332-3241

Facsimile: (212) 320-0245

Email: htabuteau@axsome.com

 

With a copy (which shall not constitute notice) to:

 

DLA Piper LLP (US)

Attn:  Jeff Baglio, Esq.

4365 Executive Drive Suite 1100

San Diego, California  92121-2133

Facsimile:  (858) 638 5058

Email: jeff.baglio@dlapiper.com

 

5.6                               Waiver.  This Warrant and any term hereof may be changed, waived, discharged or terminated (either generally or in a particular instance and either retroactively or prospectively) only by an instrument in writing signed by the party against which enforcement of such change, waiver, discharge or termination is sought.

 

5.7                               Attorneys’ Fees.  In the event of any dispute between the parties concerning the terms and provisions of this Warrant, the party prevailing in such dispute shall be entitled to collect from the other party all costs incurred in such dispute, including reasonable attorneys’ fees.

 

5.8                               Counterparts; Facsimile/Electronic Signatures.  This Warrant may be executed in counterparts, all of which together shall constitute one and the same agreement.  Any signature page delivered electronically or by facsimile shall be binding to the same extent as an original signature page with regards to any agreement subject to the terms hereof or any amendment thereto.

 

5.9                               Governing Law.  This Warrant shall be governed by and construed in accordance with the laws of the State of California, without giving effect to its principles regarding conflicts of law.

 

5.10                        Headings.  The headings in this Warrant are for purposes of reference only and shall not limit or otherwise affect the meaning of any provision of this Warrant.

 

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5.11                        Business Days.  “Business Day” is any day that is not a Saturday, Sunday or a day on which Silicon Valley Bank is closed.

 

[Remainder of page left blank intentionally]

[Signature page follows]

 

9

 

IN WITNESS WHEREOF, the parties have caused this Warrant to Purchase Stock to be executed by their duly authorized representatives effective as of the Issue Date written above.

 

 

	
“COMPANY”
    	
 
    
	
 
    	
 
    
	
AXSOME   THERAPEUTICS, INC.
    	
 
    
	
 
    	
 
    
	
 
    	
 
    
	
By:
    	
/s/ Herriot Tabuteau,   M.D.
    	
 
    
	
 
    	
 
    	
 
    
	
Name:
    	
Herriot Tabuteau, M.D.
    	
 
    
	
 
    	
(Print)
    	
 
    
	
Title:
    	
Chief Executive Officer
    	
 
    

 

 

	
“HOLDER”
    	
 
    
	
 
    	
 
    
	
SILICON VALLEY BANK
    	
 
    
	
 
    	
 
    
	
 
    	
 
    
	
By:
    	
/s/ Ryan Roller
    	
 
    
	
 
    	
 
    	
 
    
	
Name:
    	
Ryan Roller
    	
 
    
	
 
    	
(Print)
    	
 
    
	
Title:
    	
Vice President
    	
 
    

 

10

 

APPENDIX 1

 

NOTICE OF EXERCISE

 

1.                                      The undersigned Holder hereby exercises its right to purchase             shares of the Common/Series        Preferred [circle one] Stock of                     (the “Company”) in accordance with the attached Warrant To Purchase Stock, and tenders payment of the aggregate Warrant Price for such shares as follows:

 

o                                                                                    check in the amount of $         payable to order of the Company enclosed herewith

 

o                                                                                    Wire transfer of immediately available funds to the Company’s account

 

o                                                                                    Cashless Exercise pursuant to Section 1.2 of the Warrant

 

o                                                                                    Other [Describe]       

 

2.                                      Please issue a certificate or certificates representing the Shares in the name specified below:

 

	
 
    	
 
    
	
Holder’s Name
    	
 
    
	
 
    	
 
    
	
 
    	
 
    
	
 
    	
 
    
	
 
    	
 
    
	
(Address)
    	
 
    
	
 
    	
 
    

3.   By its execution below and for the benefit of the Company, Holder hereby restates each of the representations and warranties in Section 4 of the Warrant to Purchase Stock as of the date hereof.

 

	
 
    	
HOLDER:
    
	
 
    	
 
    
	
 
    	
 
    
	
 
    	
 
    
	
 
    	
 
    
	
 
    	
By:
    	
 
    
	
 
    	
 
    	
 
    
	
 
    	
Name:
    	
 
    
	
 
    	
 
    	
 
    
	
 
    	
Title:
    	
 
    
	
 
    	
 
    	
 
    
	
 
    	
(Date):

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