Document:

Letter Agreement

 Exhibit 10.4 
 September 10, 2007 
 ETHOS GLOBAL MANAGEMENT 
 c/o Jacques Matte 
 Matte Bouchard Law Firm 
 1, Westmount Square, Suite 2000 
 Westmount (Quebec) 
 Canada, H3Z 2P9 
  

			
	 Re:
	  	Compensation Arrangements

 Gentlemen: 
 We are writing to confirm our understanding. 
  

	1.	Compensation for Services 

 In consideration
of the services provided by Ethos Global Management, a trust organized under the laws of Antigua (“ EGM ”) in support of the offering and sale of at least $3,000,000 and not more than $11,000,000 of Series C stock by
Avicena Group, Inc. (the “ Company ”), including making introductions of funding sources to certain current, off-shore stockholders, the Company’s Board of Directors has approved the payment to your firm of a one-time fee in
the minimum amount of $786,000 and the maximum amount of $1,350,000 (the “ Success Fee ”). The minimum Success Fee shall be due in connection with a sale of at least $3,000,000 of Series C stock, and an additional $100,000 shall be
due for each $1,000,000 of additional gross sales proceeds, up to the maximum Success Fee, which shall be due if the Company sells $11,000,000 or more of Series C stock . Payment of the Success Fee will be in full and complete discharge of all
obligations which the Company owes or may owe to EGM, its directors, officers, employees, stockholders, trustees, settlors, beneficiaries and all other EGM affiliates and associates (collectively, the “ EGM Parties ”) in connection
with any efforts by any of them relating to, but not limited to, the investment in the Company’s securities by Jacques Matte in trust, Martin Doane in trust, Oussama Salam, Essam Alamdar, Oleander Marketing Corp., or H.K. Properties. None of
the EGM Parties shall be entitled to any options, warrants or other equity-based compensation in connection with their services, and the Company shall not be responsible for the reimbursement of any expenses incurred by or on behalf of any of the
EGM Parties beyond $10,000. 
  

	2.	Representations of EGM 

  

	 	2.1.	Power and Authority 

  

 43 

 Ethos Global Management 
 September 10, 2008 
 Page 2 
  

 EGM has all requisite power and authority to enter into this Agreement and perform the services. This
Agreement has been duly and validly authorized, executed and delivered by EGM and constitutes the legal, valid and binding agreement of EGM, enforceable against EGM in accordance with its terms, subject to bankruptcy law and general principles of
equity. 
  

	 	2.2.	General Solicitation 

 In conducting its services,
the EGM Parties employed no form of general solicitation or general advertising in connection with any of the Company’s securities. 
  

	 	2.3.	Offering Circulars 

 Neither EGM nor its
representatives included any non-public information about the Company in any offering circular or private placement memorandum used in connection with EGM’s provision of its services. 
  

	 	2.4.	Non-Related Parties 

 No director, officer or
stockholder of the Company, and no member of the immediate family (including children, step-children, parents, step-parents, spouses, siblings, in-laws, and persons sharing the household) of any of the foregoing persons (collectively, the
“Avicena Parties”), is a director, officer, employee, trustee, settler, beneficiary or equity owner of EGM, and no Avicena Party has any interest, directly or indirectly, in the Success Fee. 
  

	3.	Representations of the Company 

 The Company
has all requisite power and authority to enter into this Agreement and perform its obligations hereunder. This Agreement has been duly and validly authorized, executed and delivered by the Company and constitutes the legal, valid and binding
agreement of the Company, enforceable against the Company in accordance with its terms, subject to bankruptcy law and general principles of equity. 
  

	4.	Indemnification 

 EGM and the Company each
agree to indemnify, defend and hold the other harmless from all losses (including reasonable attorneys fees) arising out of, based upon or relating to, in whole or in part, any breach of the forgoing representations. 
  

	5.	Miscellaneous 

  

	 	5.1.	Parties in Interest, Successors and Assigns 

 This
Agreement is made solely for the benefit of EGM and the Company and their respective directors and officers. No other person shall acquire or have any right under or by virtue of this Agreement. Neither party may assign its rights or delegate its
duties hereunder without the prior written consent of the other party. This Agreement shall inure to the benefit of and be binding upon any permitted successors and assigns of each of the parties. 
  

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 Ethos Global Management 
 September 10, 2008 
 Page 3 
  

	 	5.2.	Counterparts 

 This Agreement may be executed by the
parties hereto in separate counterparts, each of which when so executed shall be deemed to be an original and all of which taken together shall constitute one and the same agreement. 
  

	 	5.3.	Headings 

 The headings in this Agreement are for
convenience of reference only and shall not limit or otherwise affect the meaning hereof. 
  

	 	5.4.	Entire Agreement 

 The Parties intend this Agreement
to be the final expression of, and a complete and exclusive statement of, the agreement and understanding of the parties hereto in respect of the subject matter contained herein. There are no restrictions, promises, warranties or undertakings, other
than those set forth or referred to herein. This Agreement supersedes all prior agreements and understandings between the parties with respect to such subject matter. 
  

	 	5.5.	Notices 

 Any notice, demand, or other communication
required or permitted to be given hereunder shall be in writing and shall be effective (a) upon actual delivery by hand or nationally recognized overnight courier (if delivered on a business day during normal business hours where such notice is
to be received), or the first business day following such delivery (if delivered other than on a business day during normal business hours where such notice is to be received) or (b) on the third business day following the date it is mailed, by
certified mail, return receipt requested, to the other party at the address specified in this Section. Notices to EGM shall be sent to the address indicated on page 1. Notices to the Company shall be sent to the attention of the Chief Executive
Officer at 228 Hamilton Avenue, 3rd Floor, Palo Alto, CA 94301, with a copy to Barack Ferrazzano Kirschbaum & Nagelberg LLP, 200 W. Madison Street, Suite 3900, Chicago, Illinois 60606, Attn: Lance R. Rogers 
  

	 	5.6.	Survival The parties agree that the representations, warranties and agreements made by each of them in this Agreement shall remain in full force and effect and shall survive
the delivery of, and payment for, the Company’s securities. 

  

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 Ethos Global Management 
 September 10, 2008 
 Page 4 
  

 If this Agreement is satisfactory to you, please so indicate by signing the acceptance of this
Agreement and deliver such counterpart, whereupon this Agreement will become binding between us in accordance with its terms. 
  

			
	Very truly yours,
	
	 AVICENA GROUP, INC.

		
	By:	 	 /s/ Nasser Menhall

	Print Name:	 	Nasser Menhall
	Title:	 	Chairman

  

			
	AGREED AND ACCEPTED THIS 10th DAY OF SEPTEMBER, 2007
	
	 ETHOS GLOBAL MANAGEMENT

		
	By:	 	 /s/ Jacques Matte

	Print Name:	 	Jacques Matte
	Title:	 	Lawyer

  

 46Exhibit 4.3

 EXHIBIT 4.3 
 QUADRAMED CORPORATION 
 2008 EMPLOYEE STOCK PURCHASE PLAN 
 ARTICLE ONE 
 GENERAL PROVISIONS

 I. PURPOSE OF THE PLAN 
 This
Employee Stock Purchase Plan is intended to promote the interests of QuadraMed Corporation (the “Company”) by providing eligible employees with the opportunity to acquire a proprietary interest in the Company through participation in a
payroll deduction-based employee stock purchase plan designed to qualify under Section 423 of the Code. 
 Capitalized terms herein
shall have the meanings assigned in the attached Exhibit A. 
 II. ADMINISTRATION OF THE PLAN 
 The Plan Administrator shall have full authority to interpret and construe any provision of the Plan and to adopt such rules and regulations for
administering the Plan as it may deem necessary in order to comply with the requirements of Code Section 423. Decisions of the Plan Administrator shall be final and binding on all parties having an interest in the Plan. 
 III. STOCK SUBJECT TO PLAN 
 A. The stock purchasable
under the Plan may be shares of authorized but unissued or reacquired Common Stock, including shares of Common Stock purchased on the open market. The maximum number of shares of Common Stock which may be issued over the term of the Plan shall not
exceed One Hundred Fifty Thousand (150,000) shares. 
 B. Should any change be made to the Common Stock by reason of any stock split,
reverse stock split, stock dividend, recapitalization, combination of shares, exchange of shares or other change affecting the outstanding Common Stock as a class without the Company’s receipt of consideration, appropriate adjustments shall be
made to (i) the maximum number and class of securities issuable under the Plan, (ii) the maximum number and class of securities purchasable per Participant on any one Purchase Date and (iii) the number and class of securities and the
price per share in effect under each outstanding purchase right in order to prevent the dilution or enlargement of benefits thereunder. 
 IV. OFFERING
PERIODS 
 A. Shares of Common Stock shall be offered for purchase under the Plan through a series of successive offering periods until
such time as (i) the maximum number of shares of Common Stock available for issuance under the Plan shall have been purchased or (ii) the Plan shall have been sooner terminated. 
 B. Each offering period shall be of such duration (not to exceed twenty-four (24) months) as determined by the Plan Administrator prior to the
start date. The Initial Offering Period shall commence on the first business day in September and terminate on the last business day in February. The next offering period shall commence on the first business day in March and subsequent offering
periods shall commence as designated by the Plan Administrator. 
 C. Each offering period shall be comprised of a series of one or more
successive Purchase Intervals. Purchase Intervals shall run from the first business day in March each year to the last business day in August of the same year and from the first business day in September each year to the last business day in
February of the following year. The first Purchase Interval in effect under the Initial Offering Period, however, shall commence on the first business day in September 2008 and terminate on the last business day in February 2009. 
 D. Should the Fair Market Value per share of Common Stock on any Purchase Date within an offering period be less than the Fair Market Value per share of
Common Stock on the start date of that offering period, then that offering period shall automatically terminate immediately after the purchase of shares of Common Stock on such Purchase Date, and a new offering period shall commence on the next
business day following such Purchase Date. 

  
 The new offering period shall have a
duration of twenty four (24) months, unless a shorter duration is established by the Plan Administrator within five (5) business days following the start date of that offering period. 
 V. ELIGIBILITY 
 A. Each individual who is an Eligible
Employee on the start date of any offering period under the Plan may enter that offering period on such start date or on any subsequent Semi-Annual Entry Date within that offering period, provided he or she remains an Eligible Employee. 

B. Each individual who first becomes an Eligible Employee after the start date of an offering period may enter that offering period on any subsequent
Semi-Annual Entry Date within that offering period on which he or she is an Eligible Employee. 
 C. The date an individual enters an
offering period shall be designated his or her Entry Date for purposes of that offering period. 
 D. To participate in the Plan for a
particular offering period, the Eligible Employee must complete the enrollment forms prescribed by the Plan Administrator (including a stock purchase agreement and a payroll deduction authorization) and file such forms with the Plan Administrator
(or its designate) on or before his or her scheduled Entry Date. 
 VI. PAYROLL DEDUCTIONS 
 A. The payroll deduction authorized by the Participant for purposes of acquiring shares of Common Stock during an offering period may be any multiple of
one percent (1%) of the Base Salary paid to the Participant during each Purchase Interval within that offering period, up to a maximum of ten percent (10%). The deduction rate so authorized shall continue in effect throughout the offering
period, except to the extent such rate is changed in accordance with the following guidelines: 
 (i) The Participant may, at
any time during the offering period, reduce his or her rate of payroll deduction to become effective as soon as possible after filing the appropriate form with the Plan Administrator. The Participant may not, however, effect more than one
(1) such reduction per Purchase Interval. 
 (ii) The Participant may, prior to the commencement of any new Purchase
Interval within the offering period, increase the rate of his or her payroll deduction by filing the appropriate form with the Plan Administrator. The new rate (which may not exceed the ten percent (10%) maximum) shall become effective on
the start date of the first Purchase Interval following the filing of such form. 
 B. Payroll deductions shall begin on the first pay day
following the Participant’s Entry Date into the offering period and shall (unless sooner terminated by the Participant) continue through the pay day ending with or immediately prior to the last day of that offering period. The amounts so
collected shall be credited to the Participant’s book account under the Plan, but no interest shall be paid on the balance from time to time outstanding in such account. The amounts collected from the Participant shall not be held in any
segregated account or trust fund and may be commingled with the general assets of the Company and used for general corporate purposes. 
 C.
Payroll deductions shall automatically cease upon the termination of the Participant’s purchase right in accordance with the provisions of the Plan. 
 D. The Participant’s acquisition of Common Stock under the Plan on any Purchase Date shall neither limit nor require the Participant’s acquisition of Common Stock on any subsequent Purchase Date, whether
within the same or a different offering period. 
 VII. PURCHASE RIGHTS 
 A. GRANT OF PURCHASE RIGHT. A Participant shall be granted a separate purchase right for each offering period in which he or she participates. The purchase right shall be granted on the Participant’s Entry
Date into the offering period and shall provide the Participant with the right to purchase shares of Common Stock, in a series of successive installments over the remainder of such offering period, upon the terms set forth below. The Participant
shall execute a stock purchase agreement embodying such terms and such other provisions (not inconsistent with the Plan) as the Plan Administrator may deem advisable. 
  

 2 

  
 Under no circumstances shall
purchase rights be granted under the Plan to any Eligible Employee if such individual owns or holds, or would, immediately after the grant, own (within the meaning of Code Section 424(d)) or hold, outstanding options or other rights to
purchase, stock possessing five percent (5%) or more of the total combined voting power or value of all classes of stock of the Company or any Corporate Affiliate. 
 B. EXERCISE OF THE PURCHASE RIGHT. Each purchase right shall be automatically exercised in installments on each successive Purchase Date within the offering period, and shares of Common Stock shall accordingly
be purchased on behalf of each Participant (other than Participants whose payroll deductions have previously been refunded pursuant to the Termination of Purchase Right provisions below) on each such Purchase Date. The purchase shall be effected by
applying the Participant’s payroll deductions for the Purchase Interval ending on such Purchase Date to the purchase of whole shares of Common Stock at the purchase price in effect for the Participant for that Purchase Date. 
 C. PURCHASE PRICE. The purchase price per share at which Common Stock will be purchased on the Participant’s behalf on each Purchase Date
within the offering period shall be equal to eighty-five percent (85%) of the lower of (i) the Fair Market Value per share of Common Stock on the Participant’s Entry Date into that offering period or (ii) the Fair Market Value
per share of Common Stock on that Purchase Date. 
 D. NUMBER OF PURCHASABLE SHARES. The number of shares of Common Stock purchasable
by a Participant on each Purchase Date during the offering period shall be the number of whole shares obtained by dividing the amount collected from the Participant through payroll deductions during the Purchase Interval ending with that Purchase
Date by the purchase price in effect for the Participant for that Purchase Date. However, the maximum number of shares of Common Stock purchasable per Participant on any one Purchase Date shall not exceed Two Hundred (200) shares, subject to
periodic adjustments in the event of certain changes in the Company’s capitalization. 
 E. EXCESS PAYROLL DEDUCTIONS. Any
payroll deductions not applied to the purchase of shares of Common Stock on any Purchase Date because they are not sufficient to purchase a whole share of Common Stock shall be held for the purchase of Common Stock on the next Purchase Date.
However, any payroll deductions not applied to the purchase of Common Stock by reason of the limitation on the maximum number of shares purchasable by the Participant on the Purchase Date shall be promptly refunded. 
 F. TERMINATION OF PURCHASE RIGHT. The following provisions shall govern the termination of outstanding purchase rights: 
 (i) A Participant may, at any time prior to the next scheduled Purchase Date in the offering period, terminate his or her outstanding
purchase right by filing the appropriate form with the Plan Administrator (or its designate), and no further payroll deductions shall be collected from the Participant with respect to the terminated purchase right. Any payroll deductions collected
during the Purchase Interval in which such termination occurs shall, at the Participant’s election, be immediately refunded or held for the purchase of shares on the next Purchase Date. If no such election is made at the time such purchase
right is terminated, then the payroll deductions collected with respect to the terminated right shall be refunded as soon as possible. 
 (ii) The termination of such purchase right shall be irrevocable, and the Participant may not subsequently rejoin the offering period for which the terminated purchase right was granted. In order to resume
participation in any subsequent offering period, such individual must re-enroll in the Plan (by making a timely filing of the prescribed enrollment forms) on or before his or her scheduled Entry Date into that offering period. 
 (iii) Should the Participant cease to remain an Eligible Employee for any reason (including death, disability or change in status) while
his or her purchase right remains outstanding, then that purchase right shall immediately terminate, and all of the Participant’s payroll deductions for the Purchase Interval in which the purchase right so terminates shall be promptly refunded.
However, should the Participant remain an Eligible Employee but cease to remain in active service by reason of an approved unpaid leave of absence, then the Participant shall have the right, exercisable up until the last business day of the Purchase
Interval in which such leave commences, to (a) withdraw all the payroll deductions collected to date on his or her behalf for that Purchase Interval or (b) have such funds held for the purchase of shares on his or her behalf on the next
scheduled Purchase Date. In no event, however, shall any further payroll deductions be collected on the 

  

 3 

  
 
Participant’s behalf during such leave. Upon the Participant’s return to active service, his or her payroll deductions under the Plan shall
automatically resume at the rate in effect at the time the leave began, unless the Participant withdraws from the Plan prior to his or her return. 
 G. CORPORATE TRANSACTION. Each outstanding purchase right shall automatically be exercised, immediately prior to the effective date of any Corporate Transaction, by applying the payroll deductions of each Participant for the Purchase
Interval in which such Corporate Transaction occurs to the purchase of whole shares of Common Stock at a purchase price per share equal to eighty-five percent (85%) of the lower of (i) the Fair Market Value per share of Common Stock on the
Participant’s Entry Date into the offering period in which such Corporate Transaction occurs or (ii) the Fair Market Value per share of Common Stock immediately prior to the effective date of such Corporate Transaction. However, the
applicable limitation on the number of shares of Common Stock purchasable per Participant shall continue to apply to any such purchase. 
 The Company shall use its best efforts to provide at least ten (10) days prior written notice of the occurrence of any Corporate Transaction, and Participants shall, following the receipt of such notice, have the right to terminate
their outstanding purchase rights prior to the effective date of the Corporate Transaction. 
 H. PRORATION OF PURCHASE RIGHTS. Should
the total number of shares of Common Stock to be purchased pursuant to outstanding purchase rights on any particular date exceed the number of shares then available for issuance under the Plan, the Plan Administrator shall make a pro-rata allocation
of the available shares on a uniform and nondiscriminatory basis, and the payroll deductions of each Participant, to the extent in excess of the aggregate purchase price payable for the Common Stock pro-rated to such individual, shall be refunded.

 I. ASSIGNABILITY. The purchase right shall be exercisable only by the Participant and shall not be assignable or transferable by
the Participant. 
 J. STOCKHOLDER RIGHTS. A Participant shall have no stockholder rights with respect to the shares subject to his or
her outstanding purchase right until the shares are purchased on the Participant’s behalf in accordance with the provisions of the Plan and the Participant has become a holder of record of the purchased shares. 
 VIII. ACCRUAL LIMITATIONS 
 A. No Participant shall be
entitled to accrue rights to acquire Common Stock pursuant to any purchase right outstanding under this Plan if and to the extent such accrual, when aggregated with (i) rights to purchase Common Stock accrued under any other purchase right
granted under this Plan and (ii) similar rights accrued under other employee stock purchase plans (within the meaning of Code Section 423) of the Company or any Corporate Affiliate, would otherwise permit such Participant to purchase more
than Twenty-Five Thousand Dollars ($25,000) worth of stock of the Company or any Corporate Affiliate (determined on the basis of the Fair Market Value per share on the date or dates such rights are granted) for each calendar year such rights are at
any time outstanding. 
 B. For purposes of applying such accrual limitations to the purchase rights granted under the Plan, the following
provisions shall be in effect: 
 (i) The right to acquire Common Stock under each outstanding purchase right shall accrue in
a series of installments on each successive Purchase Date during the offering period on which such right remains outstanding. 
 (ii) No right to acquire Common Stock under any outstanding purchase right shall accrue to the extent the Participant has already accrued in the same calendar year the right to acquire Common Stock under one (1) or more other purchase
rights at a rate equal to Twenty-Five Thousand Dollars ($25,000) worth of Common Stock (determined on the basis of the Fair Market Value per share on the date or dates of grant) for each calendar year such rights were at any time outstanding.

 C. If by reason of such accrual limitations, any purchase right of a Participant does not accrue for a particular Purchase Interval, then
the payroll deductions which the Participant made during that Purchase Interval with respect to such purchase right shall be promptly refunded. 
 D. In the event there is any conflict between the provisions of this Article and one or more provisions of the Plan or any instrument issued thereunder, the provisions of this Article shall be controlling. 
  

 4 

  
 IX. EFFECTIVE DATE AND TERM OF THE PLAN

 A. The Plan was adopted by the Board on August 6, 2008 and became effective on September 1, 2008, provided no purchase rights
granted under the Plan shall be exercised, and no shares of Common Stock shall be issued hereunder, until the Company shall have complied with all applicable requirements of the 1933 Act (including the registration of the shares of Common Stock
issuable under the Plan on a Form S-8 registration statement filed with the U.S. Securities and Exchange Commission), all applicable listing requirements of any stock exchange on which the Common Stock is listed for trading and all other applicable
requirements established by law or regulation. In accordance with Code Section 423, the Company intends to present the Plan for approval by the stockholders of the Company at the next annual meeting of stockholders of the Company. In the event
such stockholder approval is not obtained, or such compliance is not effected, within twelve (12) months after the date on which the Plan was adopted by the Board, the Plan shall terminate and have no further force or effect, and all amounts
credited to the Participant’s book account, which have not yet been used to purchase shares of Common Stock pursuant to the terms of the Plan, shall be promptly refunded. 
 B. Unless sooner terminated by the Board, the Plan shall terminate upon the earliest of (i) the last business day in August 2018, (ii) the date
on which all shares available for issuance under the Plan shall have been sold pursuant to purchase rights exercised under the Plan or (iii) the date on which all purchase rights are exercised in connection with a Corporate Transaction. No
further purchase rights shall be granted or exercised, and no further payroll deductions shall be collected under the Plan following such termination. 
 X. AMENDMENT OF THE PLAN 
 The Board may alter, amend, suspend or terminate the Plan, or any part thereof, at any time and
for any reason. If the Board terminates the Plan prior to the close of a Purchase Interval, all amounts credited to the Participant’s book account for such Purchase Interval, which have not been used to purchase shares of the Common Stock,
shall be promptly refunded. The Board may not, without the approval of the Company’s stockholders, (i) materially increase the number of shares of Common Stock issuable under the Plan or the maximum number of shares purchasable per
Participant on any one Purchase Date, except for permissible adjustments in the event of certain changes in the Company’s capitalization, (ii) alter the purchase price formula so as to reduce the purchase price payable for the shares of
Common Stock purchasable under the Plan or (iii) materially increase the benefits accruing to Participants under the Plan or materially modify the requirements for eligibility to participate in the Plan. 
 XI. GENERAL PROVISIONS 
 A. All costs and expenses
incurred in the administration of the Plan shall be paid by the Company. 
 B. Nothing in the Plan shall confer upon the Participant any
right to continue in the employ of the Company or any Corporate Affiliate for any period of specific duration or interfere with or otherwise restrict in any way the rights of the Company (or any Corporate Affiliate employing such person) or of the
Participant, which rights are hereby expressly reserved by each, to terminate such person’s employment at any time for any reason, with or without cause. 
 C. The provisions of the Plan shall be governed by the laws of the State of Delaware without resort to that State’s conflict-of-laws rules. 
  

 5 

  
 EXHIBIT A 

DEFINITIONS 
 The following
definitions shall be in effect under the Plan: 
 (A) BASE SALARY shall mean the (i) regular base salary paid to a Participant by one or
more Participating Corporations during such individual’s period of participation in one or more offering periods under the Plan plus (ii) any pre-tax contributions made by the Participant to any Code Section 401(k) salary deferral
plan or any Code Section 125 cafeteria benefit program now or hereafter established by the Company or any Corporate Affiliate. The following items of compensation shall NOT be included in Base Salary: (i) all overtime payments, bonuses,
commissions (other than those functioning as base salary equivalents), profit-sharing distributions and other incentive-type payments and (ii) any and all contributions (other than Code Section 401(k) or Code Section 125
contributions) made on the Participant’s behalf by the Company or any Corporate Affiliate under any employee benefit or welfare plan now or hereafter established. 
 (B) BOARD shall mean the Company’s Board of Directors. 
 (C) CODE shall mean the Internal Revenue Code
of 1986, as amended. 
 (D) COMMON STOCK shall mean the Company’s common stock. 
 (E) CORPORATE AFFILIATE shall mean any parent or subsidiary corporation of the Company (as determined in accordance with Code Section 424), whether
now existing or subsequently established. 
 (F) CORPORATE TRANSACTION shall mean either of the following stockholder-approved transactions
to which the Company is a party: 
 (i) a merger, consolidation or other transaction in which securities possessing more than
fifty percent (50%) of the total combined voting power of the Company’s outstanding securities are transferred to a person or persons different from the persons holding those securities immediately prior to such transaction, or 

(ii) the sale, transfer or other disposition of all or substantially all of the assets of the Company in complete liquidation or
dissolution of the Company. 
 (G) COMPANY shall mean QuadraMed Corporation, a Delaware corporation, and any corporate successor to all or
substantially all of the assets or voting stock of QuadraMed Corporation which shall by appropriate action adopt the Plan. 
 (H) EFFECTIVE
TIME shall mean September 1, 2008. Any Corporate Affiliate that becomes a Participating Corporation after such Effective Time shall designate a subsequent Effective Time with respect to its employee-Participants. 
 (I) ELIGIBLE EMPLOYEE shall mean any person who is employed by a Participating Corporation on a basis under which he or she is regularly expected to
render more than twenty (20) hours of service per week for more than five (5) months per calendar year for earnings considered wages under Code Section 3401(a). 
 (J) ENTRY DATE shall mean the date an Eligible Employee first commences participation in the offering period in effect under the Plan. The earliest Entry
Date under the Plan shall be the Effective Time. 
 (K) FAIR MARKET VALUE per share of Common Stock on any relevant date shall be determined
in accordance with the following provisions: 
 (i) If the Common Stock is at the time traded on a Stock Exchange, the Fair
Market Value shall be the closing selling price per share of Common Stock on the date in question on the Stock Exchange determined by the Plan Administrator to be the primary market for the Common Stock, as such price is officially quoted in the
composite tape of transactions on such exchange. If there is no closing selling price for the Common Stock on the date in question, then the Fair Market Value shall be the closing selling price on the last preceding date for which such quotation
exists. 
  

 6 

  
 (ii) For
purposes of the Initial Offering Period, the Fair Market Value shall be deemed to be equal to the closing selling price per share at which the Common Stock is sold on the first business day of the Initial Offering Period on such date on the Stock
Exchange determined by the Plan Administrator to be the primary market for the Common Stock. 
 (L) 1933 ACT shall mean the Securities Act of
1933, as amended. 
 (M) PARTICIPANT shall mean any Eligible Employee of a Participating Corporation who is actively participating in the
Plan. 
 (N) PARTICIPATING CORPORATION shall mean the Company and such Corporate Affiliate or Affiliates as may be authorized from time to
time by the Board to extend the benefits of the Plan to their Eligible Employees. 
 (O) PLAN shall mean the Company’s 2008 Employee
Stock Purchase Plan, as set forth in this document. 
 (P) PLAN ADMINISTRATOR shall mean the committee of two (2) or more Board members
appointed by the Board to administer the Plan. 
 (Q) PURCHASE DATE shall mean the last business day of each Purchase Interval. 

(R) PURCHASE INTERVAL shall mean each successive six (6) month period within the offering period at the end of which there shall be purchased
shares of Common Stock on behalf of each Participant. 
 (S) SEMI-ANNUAL ENTRY DATE shall mean the first business day in March and September
each year on which an Eligible Employee may first enter an offering period. 
 (T) STOCK EXCHANGE shall mean the NASDAQ Stock Exchange,
American Stock Exchange or the New York Stock Exchange. 
  

 7 

  
 QUADRAMED CORPORATION 

 2008 EMPLOYEE STOCK PURCHASE PLAN (“ESPP”) 
 ENROLLMENT/CHANGE FORM 
  

					
	 SECTION 1: ACTION
	  		  	Complete Sections:
			
	 ̈	  	New Enrollment	  	2, 3, 7 and sign attached Stock Purchase Agreement
			
	 ̈	  	Change Payroll Deductions	  	2, 4, 7
			
	 ̈	  	Terminate Payroll Deductions	  	2, 5, 7
			
	 ̈	  	Leave of Absence	  	2, 6, 7

  
  

													
	 SECTION 2: PERSONNEL
	  		  		  		  		  	
		
	 Name
	  	  

							
		  	Last	  	First	  	MI	  		  	Dept. DATA	  	
		
	 Home Address
	  	  

							
		  		  	Street	  		  		  		  	
		
		  	  

							
		  	City	  		  	State	  		  	Zip Code	  	
						
	 Social Security #:
	  	              -     
    -                   	  		  		  		  	

  
  

			
	 SECTION 3: NEW ENROLLMENT
	  	
		
	 Effective with the Purchase Interval
 Beginning:
	  	Payroll Deduction Amount:
		
		  	% of base salary*
	  ̈ March 1,
                
	  	(a maximum of 10% of base salary)
		
	  ̈ September 1,
                
	  	
		
	  ̈ Initial Offering Period—September 1, 2008
	  	

  
  

					
	 SECTION 4: CHANGE IN DEDUCTIONS
	  		  	
			
	 Effective with the
	  	  
	  	
	 Pay Period Beginning:
	  	Month, Day and Year	  	

 I authorize the following new level of payroll
deductions:             % of base salary* 
 * Must be
a multiple of 1% up to a maximum of 10% of base salary 
 NOTE: You may reduce your rate of payroll deductions once per purchase interval to
become effective as soon as possible following the filing of the change form. You may also increase your rate of payroll deductions to become effective as of the start date of the next purchase interval. 
  

 8 

  
 SECTION 5: TERMINATION OF DEDUCTIONS

  

					
	 Effective with the
	  	  
	  	
	 Pay Period Beginning:
	  	Month, Day and Year	  	

 Your election to terminate your payroll deductions for the balance of the offering period cannot
be changed, and you may not rejoin the offering period at a later date. You will not be able to resume participation in the ESPP until a new offering period begins. 
 In connection with my voluntary termination of payroll deductions, I elect the following action with respect to my ESPP payroll deductions to date in the current six (6)-month purchase interval: 
  ̈    Purchase shares of QuadraMed Corporation at end of the interval 
 OR 
  ̈    Refund ESPP payroll deductions collected 
 NOTE: If your employment terminates for any
reason or your eligibility status changes (less than 20 hrs/wk or less than 5 months/yr), you will immediately cease to participate in the ESPP, and your ESPP payroll deductions collected in that purchase interval will automatically be refunded to
you. 
  
 SECTION 6: LEAVE OF ABSENCE 
 In connection with my unpaid leave of absence, I elect the following action with respect to my ESPP payroll deductions to date in the current purchase
interval: 
  ̈    Purchase shares of QuadraMed at end of the interval 
 OR 
  ̈     Refund ESPP payroll deductions collected 
 NOTE: If you take an unpaid leave of
absence, your payroll deductions will immediately cease. Upon your return to active service, your payroll deductions will automatically resume at the rate in effect for you at the time you went on leave. 
  
 SECTION 7: AUTHORIZATION 
 I hereby authorize the specific action or actions indicated above. 
  

					
	                                         
                             
	 	—	 	  

	Date	 		 	Signature of Employee

  

 9 

  
 QUADRAMED CORPORATION 

 STOCK PURCHASE AGREEMENT 
 I hereby elect to participate in the 2008 Employee Stock Purchase Plan (the “ESPP”) effective with the Entry Date specified below, and I hereby subscribe to purchase shares of common stock (“Common Stock”) of QuadraMed
Corporation (the “Company”) in accordance with the provisions of this Agreement and the ESPP. I hereby authorize payroll deductions from each of my paychecks following my entry into the ESPP in the 1% multiple of my salary (not to exceed a
maximum of 10%) specified in my attached Enrollment Form. 
 Each offering period is divided into a series of successive purchase intervals.
The initial purchase interval is to begin on the first business day of September 2008. Subsequent purchase intervals will each be of six (6) months’ duration and will run from the first business day of March to the last business day of
August each year and from the first business day of September each year until the last business of February in the following year. My participation will automatically remain in effect from one offering period to the next in accordance with this
Agreement and my payroll deduction authorization, unless I withdraw from the ESPP or change the rate of my payroll deduction or unless my employment status changes. I may reduce the rate of my payroll deductions on one occasion per purchase
interval, and I may increase my rate of payroll deduction to become effective at the beginning of any subsequent purchase interval within the offering period. 
 My payroll deductions will be accumulated for the purchase of shares of the Company’s Common Stock on the last business day of each purchase interval within the offering period. The purchase price per share shall
be equal to 85% of the lower of (i) the fair market value per share of Common Stock on my entry date into the offering period or (ii) the fair market value per share on the semi-annual purchase date. I will also be subject to ESPP
restrictions (i) limiting the maximum number of shares which I may purchase on any one purchase date to two hundred (200) shares and (ii) prohibiting me from purchasing more than twenty-five thousand dollars ($25,000) worth of Common
Stock for each calendar year my purchase right remains outstanding. 
 I may withdraw from the ESPP at any time prior to the last business
day of a purchase interval and elect either to have the Company refund all my payroll deductions for that purchase interval or to have those payroll deductions applied to the purchase of shares of the Company’s Common Stock at the end of such
interval. However, I may not rejoin that particular offering period at any later date. Upon the termination of my employment for any reason, including death or disability, or my loss of eligible employee status, my participation in the ESPP will
immediately cease and all my payroll deductions for the purchase interval in which my employment terminates or my loss of eligibility occurs will automatically be refunded. 
 If I take an unpaid leave of absence, my payroll deductions will immediately cease, and any payroll deductions for the purchase interval in which my
leave begins will, at my election, either be refunded or applied to the purchase of shares of Common Stock at the end of that purchase interval. Upon my return to active service, my payroll deductions will automatically resume at the rate in effect
when my leave began. 
 Shares purchased on my behalf at the end of each purchase interval will automatically be electronically deposited in
book-entry form in a brokerage account that the Company will open on my behalf. I will notify the Company of any sale or disposition of my ESPP shares, and I will satisfy all applicable income and employment tax withholding requirements at the time
of such sale or disposition. 
 The Company has the right, exercisable in its sole discretion, to amend or terminate the ESPP at any time.
Should the Company elect to terminate the ESPP, I will have no further rights to purchase shares of Common Stock pursuant to this Agreement; however, all my payroll deductions for the purchase interval in which the ESPP is terminated will
automatically be refunded. 
 I have received a copy of the official Plan Prospectus summarizing the major features of the ESPP. I have read
this Agreement and the Prospectus and hereby agree to be bound by the terms of both this Agreement and the ESPP. The effectiveness of this Agreement is dependent upon my eligibility to participate in the ESPP. 
  
  

			
		
	 Date:
	  	Signature of
Employee                                       
                                         
                                         
                
		
	 Entry Date:
	  	Printed
Name:                                        
                                         
                                         
                               

  

 10

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