Document:

EX-10.8

 Exhibit 10.8 

***Text Omitted and Filed Separately 

with the Securities and Exchange Commission. 

Confidential Treatment Requested 

Under 17 C.F.R. Sections 200.80(b)(4) 

and 240.24b-2. 

LICENSE AGREEMENT 

THIS LICENSE AGREEMENT (the “Agreement”) is made and entered into as of April 16, 1999, among Saul W.
Brusilow, M.D., an individual (“Brusilow”) and Brusilow Enterprises, Inc., a Maryland corporation (“BEI”), as Licensors (collectively, “Licensors”), and Medicis Pharmaceutical Corporation, a corporation organized under
the laws of Delaware, together with its Affiliates, as Licensee (“Licensee”). 
 WITNESSETH: 

WHEREAS, Licensors possess certain proprietary rights under patents relating to triglycerides and ethyl esters of
phenylalkanoic acid and phenylalkanoic acid useful in the treatment of various disorders; and 
 WHEREAS, Licensee desires
to obtain from Licensors, and Licensors desire to grant to Licensee, a license under Licensors’ proprietary rights to research, develop, manufacture, market, sell and distribute the Licensed Products (as defined below); 

NOW, THEREFORE, in consideration of the covenants, conditions, and undertakings hereinafter set forth, it is agreed by and
among the parties as follows: 
 ARTICLE 1 

DEFINITIONS 

“Affiliate” shall mean, with respect to any Person, (i) any other Person of which securities or other
ownership interests representing fifty percent (50%) or more of the voting interests are, at the time such determination is being made, owned, Controlled or held directly or indirectly, by such Person, or (ii) any other Person which, at the
time such determination is being made, is Controlling, Controlled by or under common Control with, such Person. For the purposes hereof, “Control,” whether used as a noun or verb, refers to the possession directly or indirectly, of the
power to direct, or cause the direction of, the management or policies of a Person, whether through the ownership of voting securities, by contract or otherwise. 

“Agency” shall mean the United States Food and Drug Administration. 

“Initial Licensed Product(s)” shall mean any product, the manufacture or sale of which would infringe upon any
Valid Claim in any country where such product is manufactured, used or sold, and which is indicated for the treatment of urea cycle disorder. 

“Legal Requirements” shall mean all laws, statutes, ordinances, codes, rules, regulations, published standards,
permits, judgments, decrees, writs, injunctions, rulings, orders and other requirements of all Public Authorities. 

 “Licensed Know-How” shall mean
any research and development information, inventions, know-how, pre-clinical, clinical and other technical data, in each case which are not generally known or available,
which are owned, licensed or otherwise held by one or both of the Licensors or their respective Affiliates with the right to license or sublicense the same to Licensee during the term hereof and which are necessary or useful for the improving,
making, using or selling of Licensed Products as provided in this Agreement. 
 “Licensed Product(s)” shall mean
any Initial Licensed Product or Subsequent Licensed Product. 
 “Net Sales” shall mean the gross sales to Third
Parties of any Licensed Product, less: (i) normal and customary rebates, trade discounts, and credits for returns and allowances, all to the extent actually allowed, (ii) sales or other excise taxes or duties imposed upon and paid by
Licensee, or any of its Affiliates or sublicensees with respect to such sales, and (iii) transportation charges and insurance for transportation to the extent separately invoiced or separately reported on the invoice and paid by the seller.
Notwithstanding the foregoing, Net Sales shall not include sales between or among Affiliates for resale by an Affiliate but shall include resales by Affiliates to Third Parties. 

“Patent Rights” shall mean: 

(a)        all patents and patent applications owned or controlled by
one or both Licensors or any of their respective Affiliates, or licensed to one or both Licensors (or any of their respective Affiliates) with rights to grant sublicenses thereunder, anywhere in the world at any time during the term hereof which are
(i) listed on Schedule A, (ii) which are necessary or useful for the improvement, manufacture, use or sale of products for treating urea cycle disorder, or (iii) which derive from or are based upon the patents or patent applications
described in clauses (i) or (ii) hereof and which are necessary or useful for the treatment of disease; and 

(b)        any improvement patents, reissues, confirmations,
renewals, extensions, counterparts, divisions, continuations, continuations-in-part or
patent-of-addition issued, assigned or licensed to one or both Licensors or their respective Affiliates of or relating to the patents or patent applications described in
clause (a) hereof. 
 “Person” shall mean any natural person, corporation, firm, business trust, joint
venture, association, organization, company, partnership or other business entity, or any government, or any agency or political subdivision thereof. 

“Phase I Development” shall mean the development of a formulation of the Initial Licensed Product that has
medically acceptable sensory and oral delivery characteristics. 
 “Public Authority” shall mean any
supranational, national, regional, state or local government, court, governmental agency, authority, board, bureau, instrumentality or regulatory body. 

“Subsequent Licensed Product(s)” shall mean any product, the manufacture, use or sale of which would infringe upon
any Valid Claim in any country where such product is manufactured or sold, and which product is indicated for a disease other than, or in addition to, urea cycle disorder. 

“Territory” shall mean all countries of the world. 

“Third Party” means any Person which is not an Affiliate of any party hereto. 

“Valid Claim” shall mean a claim of an issued and unexpired patent or pending patent application included within
the Patent Rights in a country, which has not been held unenforceable, 

 
unpatentable or invalid by a court or other governmental agency of competent jurisdiction from which no appeal can be or is taken, and which has not been specifically admitted to be invalid or
unenforceable through reissue, disclaimer or otherwise. 
 ARTICLE 2 

GRANT OF RIGHTS 

2.1         
License.  Subject to the terms and conditions of this Agreement, Licensors hereby grant to Licensee a right and license, with the right to grant sublicenses, under the Patent Rights and Licensed
Know-How to research, develop, make, have made, use, market, distribute, sell and have sold, the Licensed Products in the Territory, which right and license shall be exclusive, even as to Licensors. 

2.2         
Exclusivity.   In order to assure Licensee of the exclusive rights granted in Section 2.1 hereof, Licensors shall not themselves use or grant to a Third Party any rights or licenses under the Patent Rights and Licensed Know-How to make, have made, use or sell anywhere in the Territory any Licensed Product. In addition, Licensors hereby agree (on their own behalf and on behalf of their Affiliates) to use all reasonable efforts to
keep confidential all Licensed Know-How. 
 2.3         Sublicenses. 

(a)        The rights granted under Section 2.1 may be
sublicensed by Licensee to any Person. In the event that Licensee desires to sublicense any rights granted under Section 2.1 to any Third Party, Licensee shall furnish to Licensors an executed copy of any such sublicense agreement. 

(b)        An sublicenses granted hereunder shall terminate upon
termination of this Agreement; provided that upon expiration of this Agreement pursuant to Section 5.1 hereof, Licensee (or the applicable sublicensee) shall have a fully paid-up, royalty-free, non-cancelable license, subject (in the case of Licensee’s sublicensees) to the terms of the applicable sublicense. 

2.4         Disclosure
of Technology.   Upon the execution of this Agreement, and periodically thereafter as such information becomes available to Licensors, Licensors shall provide to Licensee copies of all available information and materials in
tangible form within the Licensed Know-How or related to the Patent Rights. 
 2.5         Additional Technology.       In the event that either Licensor or any of their respective Affiliates
owns or controls (including under license with a right to grant sublicenses thereunder) any technology relating to (a) the elimination or excretion of waste nitrogen which is not licensed hereunder (“Related Technology”), or
(b) the treatment of conditions that relate to other waste nitrogen disorders in respect of which no rights are licensed hereunder (“Complementary Technology” and, together with Related Technology, “New Technology”),
Licensee shall have the right of first offer and last refusal to license the New Technology from such Licensor on the following terms: 

Upon written request of Licensee, or in any event prior to offering rights to any New Technology to any Third Party, the
applicable Licensor shall offer Licensee the right to obtain a license to such New Technology, by delivering to Licensee all data available to Licensors relating to the New Technology and its safety and efficacy together with a proposal for
commercial terms, if available (the “Proposal”). Licensee shall have [...***...] following receipt of the Proposal (the “Indication of Interest Notice Period”) to 

  
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indicate whether or not it is interested in exercising an option to acquire a license under the New Technology which is the subject of the Proposal. If Licensee delivers written notice to
Licensors stating that it wishes to consider exercising an option in respect of such New Technology (an “Indication of Interest”), then for a period of [...***...] after receipt by the applicable Licensor of the Indication of
Interest (the “Exclusive Negotiation Period”), the applicable Licensor shall negotiate in good faith exclusively with Licensee concerning the terms and conditions of a license in respect of the New Technology, and during the Exclusive
Negotiation Period, the applicable Licensor shall take no other action in connection with the possible commercialization of the New Technology. The parties understand that, except as to financial terms, any license in respect of the New Technology
shall contain terms and conditions substantially similar to those contained in this Agreement. In the event that (i) Licensee fails to deliver an Indication of Interest within the Indication of Interest Notice Period, or (ii) the parties,
each acting in good faith and in a timely fashion, fail to execute a license agreement with respect to such New Technology within the Exclusive Negotiation Period, then in either case the applicable Licensor shall be free to proceed with the
Proposal without further obligation to Licensee with respect to such New Technology; provided, that (1) neither Licensor may offer a license to such New Technology on terms and conditions which are more favorable to a Third Party than
those offered to Licensee, and (2) in the event that a Third Party is willing to provide consideration to the applicable Licensor which is both superior in value to that offered by Licensee and acceptable to the applicable Licensor, such
Licensor shall, promptly upon receipt of such Third Party proposal, give Licensee written notice of the terms and conditions thereof, together with any additional information relating to the New Technology which may have arisen since the Proposal
(“Second Notice”), and for a period of [...***...] following receipt of the Second Notice, Licensee shall have the right, in its sole discretion (“Right of Last Refusal”), to match such Third Party proposal; provided
that if Licensee wishes to exercise its Right of Last Refusal to any Complementary Technology, Licensee shall exercise such right only upon payment to the Licensors of US$[...***...] (in the aggregate) for each license of Complementary
Technology offered in a Second Notice. If Licensee shall fail to exercise the Right of Last Refusal with respect to any New Technology, the applicable Licensor shall be free to proceed with the Proposal relating to such New Technology on such terms
without further obligation to Licensee with respect to such New Technology. In the event that [...***...] exercises its right to assume ownership of any New Technology developed by Brusilow pursuant to Brusilow’s existing agreements with
[...***...], Brusilow agrees to use his reasonable best efforts to cause [...***...] to offer a license to such New Technology to Licensee. Each Licensor agrees not to enter into any agreement which would interfere with or preclude the
exercise of the rights granted to Licensee hereunder in respect of New Technology. 
 ARTICLE 3 

COMPENSATION TERMS 

3.1         License
Fee. Upon the execution of this Agreement and in consideration of the licenses granted hereunder, Licensee shall pay to Licensors a license fee of [...***...] United States dollars (US$[...***...]). 

3.2         Milestone
Fees. 
 (a)        Upon [...***...], Licensee shall pay
to Licensors [...***...] United States dollars (US$[...***...]) within [...***...] following such [...***...]. 

(b)        Upon [...***...], Licensee shall pay to Licensors
[...***...] United States dollars (US$[...***...]) within [...***...] following the [...***...]. 

3.3         
Royalties. 

  
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 (a)         Licensee shall pay Licensors a royalty on [...***...] Net Sales of Initial Licensed Products by Licensee, its Affiliates and sublicensees, as follows: 

(i)         On Net Sales of each Initial Licensed Product in
respect of which [...***...], a royalty rate of [...***...] percent ([...***...]%) shall be payable; and 

(ii)        On Net Sales of each Initial Licensed Product in respect
of which [...***...], a royalty rate of [...***...] percent ([...***...]%) shall be payable. 

(b)         
Licensee shall pay Licensors a royalty equal to [...***...] percent ([...***...]%) of annual Net Sales of Subsequent Licensed Products by Licensee, its Affiliates and sublicensees. 

(c)         
Royalties payable by Licensee in any particular [...***...] shall be calculated as follows: 

(i)        Licensee shall determine Net Sales of Licensed Products
for such [...***...] on a product-by-product basis. 

(ii)        Licensee shall apply the royalty rates set forth in
paragraphs (a) and (b) above to Net Sales of each Licensed Product. 

3.4         Certain
Expenses.     With regard to out-of-pocket expenses associated with the preparation, filing, prosecution and maintenance of all patent
applications within the Patent Rights and related development costs actually incurred by Licensors prior to the effective date of this Agreement (“Sunk Patent Costs”), Licensee shall pay to Licensors, as an additional royalty within
[...***...] of Licensors’ submission of a statement and a request for payment to Licensee, together with invoices, receipts or other suitable supporting documentation for each expense set forth on such statement, an amount equal to such
Sunk Patent Costs, up to a maximum of US$[...***...]. 

3.5         Single
Royalty; Non-Royalty Sales.  It is understood that in no event shall more than one royalty be payable under this Article 3 with respect to a particular unit of Licensed Product. No royalty shall
be payable with respect to sales of Licensed Products by Licensee, its Affiliates and sublicensees in any country in which Licensors do not own, control or have a license under (with the right to sublicense) any Patent Rights. No royalty shall be
payable under this Article 3 with respect to sales of Licensed Products among Licensee and its Affiliates, or among sublicensees and their Affiliates, but a royalty shall be due upon the subsequent sale of the Licensed Product to a Third Party. No
royalty shall be payable for (i) Licensed Product used in clinical trials, (ii) Licensed Product used by Licensee, its Affiliates or sublicensees for research, or (iii) customary quantities of Licensed Product distributed as free
samples. In the event that a single Licensed Product has multiple indications, if one of the indications is for urea cycle disorder, such Licensed Product shall constitute an Initial Licensed Product. All royalties and payments described in this
Article 3 are aggregate payments. Royalties and payments payable by Licensee pursuant to Article 3 shall be allocated between Licensors as follows: (A) the license fee under Section 3.1 shall be allocated with US$[...***...] attributable
to BEI and US$[...***...] attributable to Brusilow; (B) the milestone fees under Section 3.2(a) shall be allocated with US$[...***...] attributable to BEI and US$[...***...] attributable to Brusilow; (C) the milestone fees under
Section 3.2(b) shall be allocated with US$[...***...] attributable to BEI and US$[...***...] attributable to Brusilow; and (D) all royalties under Section 3.3 shall be allocated with [...***...] percent ([...***...]%)
attributable to BEI and [...***...] percent ([...***...]%) attributable to Brusilow. 

  
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 ARTICLE 4 

CERTAIN OBLIGATIONS OF LICENSORS 

4.1         Services and
Obligations of Licensors.   Brusilow and/or BEI, as the case may be, will provide services and render assistance to Licensee as follows: 

(a)        Licensee understands and agrees that Brusilow is presently
a Professor Emeritus of Johns Hopkins University and the parties intend that he shall continue in such capacity subsequent to the consummation of the transactions contemplated by this Agreement, subject to compliance with the terms of this
Agreement. Brusilow agrees that he will make himself available to consult with an independent contract research organization (“CRO”) selected by Licensors and assigned to the task of developing the Patent Rights and obtaining Agency
approval for use of Initial Licensed Products and Subsequent Licensed Products. Brusilow will provide the following scope of services to the CRO: (i) consultation in connection with medical, pharmacological and other scientific aspects of the
Patent Rights; and (ii) consultation in connection with obtaining Agency approval of the use of the Initial Products and the Subsequent Licensed Products. Brusilow’s undertakings under this Section 4.1(a) shall be limited to
[...***...] per [...***...]. Brusilow shall be compensated by the CRO at the rate of not less than $[...***...] per [...***...] for services rendered under this Section 4.1(a). 

(b)        In addition, Brusilow shall provide all assistance that
Licensee deems necessary or desirable to prosecute and defend the Patent Rights. In the event that Licensee requests such assistance from Brusilow, Brusilow shall be compensated by Licensee at the rate of not less than $[...***...] per
[...***...] for services rendered under this Section 4.1(b), subject to Section 6.3 hereof. 

(c)        Licensors shall execute all documents as may be needed to
perfect Licensee’s rights under this Agreement. 

(d)        Immediately following execution hereof, Brusilow agrees to
convey to Licensee (or its designee) any and all orphan drug designations which he holds relating to sodium phenylbutyrate. Such transfer shall be for [...***...] consideration (US$[...***...]), and shall be pursuant to a transfer
agreement, substantially in the form attached hereto as Exhibit I. 
 ARTICLE 5 

TERM AND TERMINATION 

5.1         Term.
This Agreement shall become effective as of the date hereof and, unless earlier terminated pursuant to the other provisions of this Article 5, shall continue in full force and effect until the later of (a) the last to expire of the Patent
Rights for any Licensed Product or (b) ten (10) years from the date of this Agreement (the “Term”). Except in the event of termination of the Term of this Agreement under Section 5.2 or 5.3, upon the expiration of the Term of
this license, Licensee will have a fully paid, royalty-free, freely sublicensable license to research, develop, make, have made, use, market, distribute, sell and have sold, the Licensed Products in the Territory, and Licensee shall have no further
payment obligation to Licensors, other than in respect of any amounts which accrued prior to the expiration of the Term and remain unpaid. 

  
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5.2         Termination
for Breach.  In the event of a material breach of this Agreement (including the breach of a representation or warranty), which breach is not cured within [...***...] after written notice is given by the non-breaching party to the breaching party specifying the breach, the non-breaching party, in addition to any other remedy which it may have, shall be entitled to terminate
this Agreement forthwith. 

5.3         Termination
by Licensee.     Any provision herein notwithstanding, Licensee may terminate this Agreement at any time by giving Licensors at least [...***...]’ prior written notice. In the event of a termination pursuant
to this Section 5.3, all rights granted herein to Licensee shall forthwith revert to Licensors. 
 5.4         Rights on Termination. 

(a)        Termination of this Agreement for any reason shall not
release either party hereto from any liability which at the time of such termination has already accrued to the other party. 

(b)        In the event that this Agreement is terminated due to a
breach by either Licensor and subject to the terms of any Third Party Agreement, (i) Licensee shall be free to sell all Licensed Products in its inventory (including all
work-in-process) and (ii) Licensee shall have the rights set forth in Section 8.3 in respect of such breach. 

(c)        In the event that this Agreement is terminated due to a
breach by Licensee, (i) all licenses granted hereunder shall terminate, (ii) subject to Article 7 hereof, any Licensed Know-How provided to Licensee in written form shall be promptly returned to
Licensors or destroyed, at Licensors’ option and (iii) Licensors shall have the rights set forth in Section 8.3 in respect of such breach. 

(d)        Articles 7 and 11, and Sections 2.3, 5.1, 5.4, 5.5, 8.3,
10.3 and 10.4, shall survive the expiration and any termination of this Agreement. Except as otherwise provided in this Section 5.4(d), all rights and obligations of the parties under this Agreement shall terminate upon the expiration or termination
of this Agreement. 

5.5         Further
Licensee Agreement Upon Termination.  In the event that Licensee’s rights and licenses under this Agreement are terminated, Licensee agrees not to make, use or sell Licensed Products, or use in any manner the Licensed Know-How, for so long as such manufacture, use or sale would infringe upon any Valid Claim of Patent Rights. 

5.6         Termination
Upon Bankruptcy.  Licensee or Licensors may terminate this Agreement upon written notice to the other party if the other party makes a general assignment for the benefit of creditors, is the subject of proceedings in voluntary or
involuntary bankruptcy or has a receiver or trustee appointed for substantially all of its property; provided that in the case of an involuntary bankruptcy proceeding such right to terminate shall only become effective if the other party
consents thereto or such proceeding is not dismissed within [...***...] after the filing thereof. Each of the parties hereto acknowledges and agrees that this Agreement (i) constitutes a license of Intellectual Property (as such term is
defined in the United States Bankruptcy Code, as amended (the “Code”)), and (ii) is an executory contract, with significant obligations to be performed by each party hereto. The parties agree that Licensee may fully exercise all of
its rights and elections under the Code, including, without limitation, those set forth in Section 365(n) of the Code. The parties further agree that, in the event that Licensee elects to retain its rights as a licensee under the Code, Licensee
shall be entitled to complete access to any technology licensed to it hereunder and all embodiments of such technology. Such embodiments of the 

  
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technology shall be delivered to Licensee not later than (x) [...***...], or (y) if not delivered under (x) above, [...***...]. 

ARTICLE 6 
 PATENTS AND
INFRINGEMENTS 

6.1         Pursuit and
Maintenance of Patent Rights. Licensee shall, at its own expense, file, prosecute and maintain Patent Rights in those countries of the Territory set forth on Schedule C hereto, and in accordance with the time schedule therefor set forth
in Schedule C. Licensee agrees to keep Licensors reasonably informed as to the status of the Patent Rights in the Territory. Except as provided in Section 4.1 hereof, Licensors shall have no obligation to make any payments that are not
reimbursed by Licensee in connection with filing, prosecuting and maintaining the Patent Rights. 
 6.2         Notice of Infringement. Each party shall promptly notify the other of any conflicting use or any act of infringement or appropriation of any
Patent Right by unauthorized Persons which comes to its attention; provided that Licensors will not notify a Third Party of the infringement of any Patent Rights without first obtaining the written consent of Licensee. 

6.3         Enforcement
and Defense. 
 (a)        Subject to the limitations described
in this Section 6.3, Licensee shall, at its own expense, have the right but not the obligation to engage in proceedings involving infringement or appropriation of any Patent Right and to name Licensors as parties in such proceedings. Licensee
shall have the right to take such steps as it deems necessary in order to terminate such infringement or appropriation, and may settle any dispute with any Third Party at any time regarding such infringements and appropriations; provided that
Licensee shall not have the right to settle, compromise or take any action in such litigation which diminishes, limits or inhibits the scope, validity or enforceability of the Patent Rights without the express written consent of Licensors. In the
event that Licensee exercises its rights under this Section 6.3, Licensee agrees to keep Licensors fully informed of all developments in connection with any settlements and negotiations and to consult with Licensors prior to making any final
settlement, consent judgment or other voluntary disposition of the matter. The value of any recovery actually received by Licensee in connection with any litigation, arbitration or settlement under this Section 6.3(a), net of any reasonable expenses
or costs incurred by Licensee in obtaining such recovery (including, without limitation, reasonable legal and expert fees), shall be [...***...]; provided, that [...***...]. 

(b)        If Licensee does not wish to take or continue any action
to terminate such infringement or appropriation, Licensors shall have the right to engage in negotiations and proceedings involving infringement or appropriation of any Patent Right solely at its own expense; provided that it keeps Licensee
fully informed of the progress of such negotiations and proceedings and consults with Licensee and obtains Licensee’s written consent, which consent shall not be unreasonably withheld, prior to making any final settlement, consent judgment or
other voluntary disposition of the matter. Each party agrees to cooperate with the other to the fullest extent possible with respect to any negotiations or proceedings under this Section 6.3. 

6.4         Patent Term
Restoration. 
 (a)        Licensee shall notify Licensors of
(i) the issuance of each United States patent included within the Patent Rights, giving the date of issue and patent number for each such 

  
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patent and (ii) each notice pertaining to any patent included within the Patent Rights which it receives as patent owner pursuant to the United States Drug Price Competition and Patent Term
Restoration Act of 1984 (the “Act”), including notices pursuant to Sections 101 and 103 of the Act from Persons who have filed an abbreviated NDA. Such notices shall be given promptly, but in any event within [...***...] of each such
patent’s date of issue or receipt of each such notice pursuant to the Act, whichever is applicable. Licensee shall notify Licensors of each filing for patent term restoration under the Act, any allegations of failure to show due diligence and
all awards of patent term restoration (extensions) with respect to the Patent Rights. 

(b)        Likewise, Licensors or Licensee, as the case may be, shall
inform the other party of patent extensions and periods of data exclusivity in the rest of the world regarding any Licensed Products and more generally the parties shall diligently cooperate with respect to any procedures for patent and period of
data exclusivity extensions, such as but not limited to, Supplementary Protection Certificates, the above-mentioned patent term restoration and corresponding GATT regulations. 

ARTICLE 7 
 CONFIDENTIALITY

7.1         Confidential
Information.   Except as expressly set forth in this Article 7, each party shall, and shall cause its Affiliates and its and their respective officers, directors, employees, agents and subcontractors (collectively,
“Representatives”) to, keep confidential any and all technical, commercial, scientific and other proprietary data, processes, documents or other information (whether in oral, written or electronic form) or physical object (including,
without limitation, intellectual property, marketing data, agreements between any party and a third party, license applications, and business plans and projections of any party) acquired from the other party, its Affiliates or any of their
respective Representatives in respect of the transactions contemplated by this Agreement and which relate (in the case of a party) to the other party or any of its Affiliates or their respective businesses or products (“Confidential
Information”), and each party shall not disclose directly or indirectly, and shall cause its respective Affiliates and Representatives not to disclose directly or indirectly, any Confidential Information to anyone outside such Person, such
Affiliates and their respective Representatives, except that the foregoing restriction shall not apply to any information disclosed hereunder to any party if such Person (the “Receiving Person”) can demonstrate that such Confidential
Information: 
 (a)        is or hereafter becomes generally
available to the trade or public other than by reason of any breach hereof; 

(b)        was already known to the Receiving Person or such
Affiliate or Representative as shown by written records; 

(c)        is disclosed to the Receiving Person or such Affiliate or
Representative by a third party who has the right to disclose such information; 

(d)        is developed by or on behalf of the Receiving Person or
any of its Affiliates independently, without reliance on Confidential Information received hereunder; or 

(e)        based on such Person’s good faith judgment with the
advice of counsel, is otherwise required to be disclosed in compliance with applicable Legal Requirements by a Public 

  
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Authority and such information shall remain Confidential Information for all other purposes unless subparagraphs (a) through (d) above otherwise apply. 

7.2         Use of
Confidential Information.   Except in furtherance of their respective rights and obligations hereunder, each party agrees that it shall not (and shall not permit any of its Affiliates to) at any time use any Confidential
Information in the conduct of its businesses without the prior written consent of the other party. The obligations set forth in this Article 7 shall extend to copies, if any, of Confidential Information made by any of the Persons referred to in
Section 7.1 and to documents prepared by such Persons which embody or contain Confidential Information, and to any electronic data files containing Confidential Information. 

7.3         Protection
of Confidential Information.      Each party shall deal with Confidential Information so as to protect it from disclosure with a degree of care not less than that used by it in dealing with its own information
intended to remain exclusively within its knowledge and shall take reasonable steps to minimize the risk of disclosure of Confidential Information. 

7.4         Survival of
Obligations.     The obligations set forth in this Article 7 shall survive the expiration, termination or assignment of this Agreement for a period of [...***...]. 

7.5         Return of
Confidential Information.   Within [...***...] after the termination of this Agreement, the Receiving Person shall (and shall cause its Affiliates and Representatives to), at the option of the Person making disclosure (the
“Disclosing Person”), return to the Disclosing Person or destroy all Confidential Information in its or their possession; provided, however, that the Receiving Person may, upon notice to the Disclosing Person, retain in its
legal files or in the office of outside legal counsel one copy of any document solely for use in any pending legal proceeding to which such document relates. Such notice shall set forth, in reasonable detail, a list of the documents so retained.

 ARTICLE 8 

REPRESENTATIONS, WARRANTIES AND COVENANTS 

8.1         
Representations and Warranties of Licensee. 

(a)        Licensee is a corporation duly incorporated and validly
existing and in good standing under the laws of the State of Delaware, with the corporate power to own, lease and operate its properties and to carry on its business as now conducted. 

(b)        Licensee has all necessary corporate power and authority
to enter into this Agreement and to consummate the transactions contemplated hereby. 

(c)        The execution, delivery and performance of this Agreement
by Licensee does not conflict with or contravene the certificate of incorporation or by-laws of Licensee, nor will the execution, delivery or performance of this Agreement conflict with or result in a breach
of, or entitle any party thereto to terminate, any material agreement or instrument to which Licensee is a party, or by which any of its assets or properties is bound. 

(d)        This Agreement has been duly authorized, executed and
delivered by Licensee and constitutes a legal, valid and binding agreement of Licensee, enforceable against Licensee in accordance with its terms, except as enforceability may be limited by bankruptcy, insolvency, moratorium, reorganization or other
similar laws affecting creditors’ rights generally. 

  
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8.2         
Representations, Warranties and Covenants of Licensors. 

(a)        BEI is a corporation duly incorporated and validly
existing as a corporation and in good standing under the laws of Maryland, with the corporate power to own, lease and operate its properties and to carry on its business as now conducted. 

(b)        BEI has all necessary corporate power and authority to
enter into this Agreement and to consummate the transactions contemplated hereby. 

(c)        The execution, delivery and performance of this Agreement
by BEI does not conflict with or contravene its articles or certificate of incorporation or by-laws, nor will the execution, delivery or performance of this Agreement by either Licensor conflict with or result
in a breach of, or entitle any party thereto to terminate, any material agreement or instrument to which either Licensor is a party, or by which any of any of their respective assets or properties is bound. No Third Party has any right, title or
interest in or to the Patent Rights or the Licensed Know-How, including, without limitation, Johns Hopkins University or its Affiliates. Licensors have provided to Licensee a true, complete and correct copy of
every agreement between either Licensor or its/his Affiliates, on the one hand, and Johns Hopkins University or its Affiliates, on the other hand, which relates to or could affect either Licensor’s right, title or interest in the Patent Rights
or Licensed Know-How (including any amendments thereto), and all such agreements are listed on Schedule B hereto. Licensors have carried out all requirements under each such agreement necessary to
enable each Licensor to grant the license granted to Licensee hereunder, and there are no other requirements necessary for either Licensor to grant such license. All such agreements are in full force and effect, and neither Licensor has received nor
delivered any notice of default thereunder. There are no circumstances known to either Licensor which, with notice or lapse of time or both, could result in a default under any of such agreements. 

(d)        This Agreement has been duly authorized, executed and
delivered by Licensors and constitutes a legal, valid and binding agreement of Licensors, enforceable against Licensors in accordance with its terms, except as enforceability may be limited by bankruptcy, insolvency, moratorium, reorganization or
other similar laws affecting creditors’ rights generally. 

(e)        All Patent Rights have been registered in, filed in or
issued by the appropriate patent offices of each jurisdiction listed on Schedule A hereto, and in each case is currently in effect and all maintenance fees and renewals thereof have been duly made with respect thereto. Licensors own or have
full and exclusive rights to use and exploit under licenses (and to license or sublicense) all their rights under the Patent Rights and Licensed Know-How. The Patent Rights are not encumbered in any way, such
as by claims, liens, mortgages or security interests (perfected or otherwise). There have been no material claims made against either Licensor asserting the invalidity or unenforceability of, or with respect to the Patent Rights, the misuse of, the
Patent Rights or Licensed Know-How, nor is either Licensor aware that any such claims exist. Neither Licensor has received a notice of conflict of the Patent Rights or Licensed
Know-How with the asserted rights of others, or otherwise challenging their rights to use any of the Patent Rights or Licensed Know-How. None of the rights of either
Licensor under the Patent Rights or Licensed Know-How will be adversely affected by the execution, delivery or performance of this Agreement, or the consummation of the transactions contemplated herein.
Licensors have taken all action reasonably necessary, using its current standard business practices, to protect the Patent Rights and Licensed Know-How. 

(f)        EXCEPT AS SET FORTH IN PARAGRAPHS (a) THROUGH (e) OF
THIS SECTION 8.2, LICENSORS MAKE NO WARRANTIES, EXPRESS OR IMPLIED, OF 

 
MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OF ANY SUBJECT MATTER DEFINED IN THE CLAIMS OF THE PATENT RIGHTS OR TANGIBLE MATERIALS RELATED THERETO. 

8.3        Indemnification. 

(a)     Indemnity by
Licensee.   Licensee hereby agrees to indemnify, defend and hold harmless Licensors, their Affiliates, officers, directors, employees and agents from and against any liabilities, claims, damages, costs, expenses (including reasonable
attorneys’ fees), judgments (collectively, “Damages”) arising out of, based upon or resulting from (i) the development, manufacture, sale or use of any Licensed Product, or (ii) a breach of this Agreement (including the
breach of a representation or warranty) by Licensee, except to the extent that in either case any such Damages arise out of, are based upon or result from (A) a breach of this Agreement (including the breach of a representation or warranty) by
either Licensor, or (B) the negligence or willful misconduct of either Licensor. 
 (b)         Indemnity by Licensors.    Licensors hereby agree, jointly and severally, to indemnify, defend and hold harmless
Licensee, its Affiliates, sublicensees, officers, directors, employees and agents from and against any Damages arising out of, based upon or resulting from (i) a breach of this Agreement (including the breach of a representation or warranty) by
either Licensor, or (ii) the negligence or willful misconduct of either Licensor; provided, however, that the liability of each Licensor under this Section 8.3(b) shall be limited to [...***...]; provided,
further, that in the event that Licensee, its Affiliates, sublicensees, officers, directors, employees or agents shall have any Damages in excess of [...***...], as of the date that such Licensor’s liability for such Damages has
been determined, Licensee shall have the right to [...***...]. 
 (c)         Indemnification Procedures. 

(i)          Any party entitled to indemnification under
paragraph (a) or (b) of this Section 8.3 (an “Indemnified Party”) shall promptly notify the party potentially responsible for such indemnification (the “Indemnifying Party”) upon becoming aware of any claim or claims
asserted or threatened against such Indemnified Party which could give rise to a right of indemnification under this Agreement; provided, however, that the failure to give such notice shall not relieve the Indemnifying Party of its
indemnity obligation hereunder except to the extent that such failure substantially prejudices its rights hereunder. 

(ii)         The Indemnifying Party shall have the right to
defend, at its sole cost and expense, such claim by all appropriate proceedings, which proceedings shall be prosecuted diligently by the Indemnifying Party to a final conclusion or settled at the discretion of the Indemnifying Party;
provided, however, that the Indemnifying Party may not enter into any compromise or settlement unless (A) the Indemnified Party consents thereto, which consent shall not be unreasonably withheld, and (B) such compromise or
settlement includes as an unconditional term thereof, the giving by each claimant or plaintiff to the Indemnified Party of a release from all liability in respect of such claim. 

(iii)        The Indemnified Party may participate in, but not
control, any defense or settlement of any claim controlled by the Indemnifying Party pursuant to this Section 8.3 and shall bear its own costs and expenses with respect to such participation; provided, however, that the
Indemnifying Party shall bear such costs and expenses if counsel for the Indemnifying Party shall have reasonably determined that such counsel may not properly represent both the Indemnifying Party and the Indemnified Party. 

  
 ***Confidential
Treatment Requested 

 (iv)        If the
Indemnifying Party fails to notify the Indemnified Party within [...***...] after receipt of notice of a claim in accordance with Section 8.3(c)(i) hereof that it elects to defend the Indemnified Party pursuant to this Section 8.3(c), or if the
Indemnifying Party elects to defend the Indemnified Party but fails to prosecute or settle the claim diligently and promptly, then the Indemnified Party shall have the right to defend, at the sole cost and expense of the Indemnifying Party, the
claim by all appropriate proceedings, which proceedings shall be promptly and vigorously prosecuted by the Indemnified Party to a final conclusion or settled; provided, however, that in no event shall the Indemnifying Party be required
to indemnify the Indemnified Party for any amount paid or payable by the Indemnified Party in the settlement of any such claim agreed to without the consent of the Indemnifying Party, which shall not be unreasonably withheld. 

ARTICLE 9 
 DUE DILIGENCE

 9.1        General.  Licensee shall use commercially
reasonable efforts to register, market and sell and to continue to market and sell the Initial Licensed Product in the United States. Without in any way limiting the generality of the foregoing, Licensee agrees to use commercially reasonable efforts
to accomplish [...***...] and shall be required to spend up to US$[...***...] to complete [...***...]. Licensee shall use commercially reasonable efforts to register, market and sell and to continue to market and sell any
Subsequent Licensed Product(s). Upon a failure by Licensee to meet its obligations under this Section 9.1 with respect to any Licensed Product, Licensors shall have the right, upon [...***...]’ written notice to Licensee, to
terminate Licensee’s right to manufacture or have manufactured and/or market such Licensed Product. Upon any such termination, the rights granted hereunder with respect to such Licensed Product in such country or countries shall revert to
Licensors. Licensors shall use commercially reasonable efforts to support externally-sponsored research concerning the use of phenylbutyrate and the technology embodied in the Patent Rights. 

9.2        Development Plan; Semi-Annual Reports.  Following
execution hereof, Licensee agrees to provide to Licensors with its then-current development plan for the Licensed Products, and to provide updated development plans to Licensors as such plans become available. The parties agree that all such
development plans shall constitute Confidential Information of Licensee. In addition, at least [...***...] every [...***...] prior to first commercial sale of a Licensed Product, Licensee agrees to provide to a representative of
Licensors upon request (i) a report, which may be oral or written, of its progress to such date with respect to the development and commercialization of the Licensed Products, and (ii) an opportunity to discuss with representatives of
Licensee Licensee’s progress toward first commercial sale of Licensed Products. 

9.3        Option to Extend License.  In the event that Licensee has
neither (i) filed an NDA with the Agency on or before [...***...], or (ii) made its first commercial sale of a Licensed Product on or before [...***...], Licensee shall have the right, at its sole option, to either (a) commence
making aggregate [...***...] royalty payments to Licensors of US$[...***...] for the [...***...] period beginning [...***...], and US$[...***...] for each successive [...***...] period thereafter (“Extension Payments”),
and thereby maintain its rights under this Agreement, or (b) terminate this Agreement and deliver to Licensors all research and development information, know-how,
pre-clinical, clinical and other technical data it has developed in connection with 

  
 ***Confidential
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the development of Licensed Products. Licensee’s right to terminate this Agreement may be exercised at any time, regardless of whether Licensee has previously made any Extension Payment.

 9.4         Notification.    Licensee shall
promptly notify Licensors in writing if at any time Licensee does not intend to continue to obtain regulatory approval for and/or market and sell any Licensed Product. Upon delivery by Licensee of such a notice, the rights and licenses granted to
Licensee hereunder with respect to such Licensed Product shall terminate and shall revert to Licensors. 
 ARTICLE 10 

ACCOUNTING AND RECORDS 

10.1       Reports.     Beginning with [...***...]
ending [...***...], Licensee shall provide [...***...] written reports to Licensors within [...***...] after the end of [...***...] during the Term of this Agreement, stating in each such report in the case of Licensed
Products, the number, description, and aggregate Net Sales of Licensed Products sold during the [...***...] and upon which a royalty is payable under Article 3 above or, if Licensee has opted to make Extension Payments (or royalties are not
otherwise due for such period), the written report shall so state. The royalty report shall be certified as correct by an authorized officer of Licensee and shall include a reasonably detailed description of all deductions from gross sales made to
determine Net Sales. In the event that Licensee sublicenses any of the rights licensed by Licensors hereunder, Licensee shall provide Licensors with copies of any reports it receives from its sublicensees which may be pertinent to royalty accounting
hereunder. 
 10.2       Payment.  [...***...] the making of each
such report of Section 10.1, Licensee shall pay to Licensors the royalties at the rate specified in Section 3.3, if any such royalties are due. All payments by Licensee to Licensors hereunder shall be made in United States dollars. If any
currency conversion shall be required in connection with the calculation of royalties or the payment of other compensation hereunder, such conversion shall be made by using the rate of exchange published in The Wall Street Journal for the last
business day of the applicable calendar quarter. The parties hereto agree that Licensee’s failure to pay royalties when due shall constitute a material breach of this Agreement. 

10.3       Withholding Taxes.    Any withholding or other taxes
that Licensee or any of its Affiliates are required by law to withhold and pay on behalf of Licensors with respect to the royalties payable to Licensors under this Agreement shall be deducted from such royalties and other compensation and paid
contemporaneously with the remittance to Licensors; provided, however, that in regard to any tax so deducted Licensee shall furnish Licensors with proper evidence of the taxes paid on its behalf. Licensors will furnish Licensee with
appropriate documents to secure application of the favorable rate of withholding tax under applicable tax treaties. 

10.4       Records; Inspection. 

(a)        Licensee shall keep complete, true and accurate books of
account and records for the purpose of determining the amounts payable to Licensors under this Agreement. Such books and records shall be kept at Licensee’s principal place of business for at least [...***...] following the end of [...***...]
to which they pertain, and will be open for inspection during such [...***...] period by a “Big Five” independent public accountant not providing accounting services to Licensors, Licensee or any of their respective Affiliates, which is
reasonably acceptable to both parties, for the purpose of verifying Licensee’s [...***...] written reports. Such inspections may be made no more than [...***...] each calendar year, during normal business hours and upon [...***...]’
prior notice. Such accountant shall be permitted access only to the books and records which Licensee 

  
 ***Confidential
Treatment Requested 

 
determines are necessary for verifying the [...***...] written reports. Any such information shall be considered to be Confidential Information of Licensee. 

(b)        Inspections conducted under this Section 10.4 shall
be at the expense of [...***...], unless an underpayment exceeding [...***...] percent ([...***...]%) of the amount paid for the period covered by the inspection is established in the course of any such inspection, whereupon all
costs relating thereto will be paid by [...***...], as well as any unpaid royalties due and owing to Licensors within the [...***...] after the notification by [...***...] to [...***...] that an underpayment has been
discovered. 
 ARTICLE 11 

MISCELLANEOUS 

11.1      Publicity.   Licensee and Licensors shall cooperate in the
preparation of a mutually-agreeable press release and other publicity disclosing the existence of this Agreement and their business relationship. Except for the information disclosed in such press release or publicity, neither Licensee nor Licensors
shall disclose the existence or any terms of this Agreement without the prior written consent of the other party (which consent shall not be unreasonably withheld), except for such limited disclosure as may be reasonably necessary to either
party’s bankers, investors, attorneys or other professional advisors, or in connection with a merger or acquisition, or as may be required by law in the offering of securities or in securities regulatory filings or otherwise. 

11.2      Waiver.  It is agreed that no waiver by any party hereto of any
breach or default of any of the covenants or agreements herein set forth shall be deemed a waiver as to any subsequent and/or similar breach or default. 

11.3      Independent Contractors.   The relationship of the parties
hereto is that of independent contractors. None of Licensors or Licensee hereto is an agent, partner or joint venturer of the other for any purpose. 

11.4      Notices.   Any notice required or permitted to be given to the
parties hereto shall be deemed to have been properly given if delivered in person or when received if mailed by first class certified mail or sent by facsimile to the other party at the address or facsimile number, as applicable, indicated below or
to such other addresses or facsimile numbers as may be designated in writing by the parties from time to time during the term of this Agreement. Licensors agree that notice to BEI shall constitute notice to Licensors for all purposes hereunder. 

 

					
		 	BEI:	 	 Brusilow Enterprises, Inc.
 4804 Keswick
Road
 Baltimore, Maryland 21210
 Attention: Saul W. Brusilow,
M.D.
 Telephone:
 Facsimile:

 
 with a copy to:
  

Thomsen and Burke LLP
 One North Charles Street

Suite 400
 Baltimore, Maryland 21201

Attention: John B. Ward, Jr.
 Telephone: (410) 539-2595

  
 ***Confidential
Treatment Requested 

					
		 		 	 Facsimile: (410) 783-0710

 

		 	Licensee:	 	 Medicis Pharmaceutical Corporation
 4343 East
Camelback Road
 Suite 250
 Phoenix, Arizona 85018-2700

Attention: Jin Sun Kim, Esq.
 Telephone: (602) 808-8800
 Facsimile: (602) 808-3874

 
 with a copy to:
  

Akin, Gump, Strauss, Hauer & Feld, L.L.P.
 590 Madison
Avenue
 New York, New York 10022
 Attention: L. Kevin
O’Mara, Jr., Esq.
 Telephone: (212) 872-1000

Facsimile: (212) 872-1002

 11.5      Complete
Agreement.     It is understood and agreed among the parties that this Agreement constitutes the entire agreement with respect to the subject matter of this Agreement, both written and oral, among the parties, and that
all prior agreements respecting the subject matter hereof, either written or oral, expressed or implied, shall be abrogated, canceled, and are null and void and of no effect, unless such other agreement, by its written terms, is an exception to this
provision. No amendment or change hereof or addition hereto shall be effective or binding on any of the parties hereto unless reduced to writing and executed by the respective duly authorized representatives of each of the parties hereto. 

11.6      Severability.  In the event that any provision of this Agreement
becomes or is declared by a court of competent jurisdiction to be illegal, unenforceable or void, this Agreement shall continue in full force and effect without said provision and the parties shall exert their best efforts to amend this Agreement to
include a provision which is valid, legal and enforceable and which carries out the original intent of the parties. 

11.7      Counterparts and Headings.  This Agreement may be executed in
counterparts, each of which shall be deemed to be an original and both together shall be deemed to be one and the same agreement. All headings are inserted for convenience of reference only and shall not affect its meaning or interpretation. 

11.8      Governing Law.    All matters affecting the
interpretation, validity and performance under this Agreement shall be governed by the internal laws of the State of Delaware, without regard for its conflict of laws principles. 

11.9      Force Majeure.  No party shall be liable to the other, or be in
default under the terms of this Agreement, for its failure to fulfill its obligations hereunder to the extent such failure arises for any reason beyond its control including, without limitation, strikes, lockouts, labor disputes, acts of God, acts
of nature, acts of governments or their agencies, fire, flood, storm, power shortages or power failure, war, sabotage, inability to obtain sufficient labor, raw materials, fuel or utilities, or inability to obtain transportation (each, an
“Event of Force Majeure”); provided that the party relying on the provisions of this Section 11.9 shall forthwith give to the other notice of its inability to observe or perform the provisions of this Agreement and the reasons
therefor; and provided further that the suspension of the 

 
obligations of the party so affected will continue only for so long as such Event of Force Majeure continues. 

11.10    Adverse Experience Reporting.    During the Term, each party shall
notify the other immediately of any information (howsoever obtained and from whatever source) concerning any unexpected side effect, injury, toxicity or sensitivity reaction, or any unexpected incidence, and the severity thereof, associated with the
clinical uses, studies, investigations, tests and marketing of a Licensed Product. For purposes of this Section 11.10, “unexpected” shall mean (i) for a non-marketed Licensed Product, an
experience that is not identified in nature, severity or frequency in the current clinical investigator’s confidential information brochure, and (ii) for a marketed Licensed Product, an experience which is not listed in the current
labeling for such Licensed Product, and includes an event that may be symptomatically and patho-physiologically related to an event listed in the labeling but differs from the event because of increased frequency or greater severity or specificity.
Each party further shall immediately notify the other of any information received regarding any threatened or pending action by a government agency which may affect the safety and efficacy claims of a Licensed Product. Upon receipt of any such
information, the parties shall [...***...]; provided, however, that nothing contained herein shall be construed as restricting either party’s right to make a timely report of such matter to any government agency or take
other action that it deems to be appropriate or required by applicable law or regulation. 

11.11    Assignment.    This Agreement shall not be assignable by any party
without the prior written consent of the other (which consent shall not be unreasonably withheld, conditioned or delayed), except that Licensee may assign this Agreement to an Affiliate or to a successor in interest or transferee of all or
substantially all of its assets. 
 11.12    Successors.   Subject to the
limitations on assignment herein, this Agreement shall be binding upon and inure to the benefit of the successors in interest and assigns of Licensors and Licensee. In order for such assignment to be effective any such successor or assignee of
a party’s interest shall expressly assume in writing the performance of all the terms and conditions of this Agreement to be performed by said party and such assignment shall not relieve the assignor of any of its obligations under this
Agreement. 
 11.13    Expenses. Except as set forth in Section 3.4 hereof, Licensee and
Licensors shall each bear its own expenses, including, without limitation, the fees and disbursements of its respective counsel and accountants, in connection with the negotiation and execution of this Agreement and the consummation of the
transactions contemplated hereby. 
 11.14    Dispute Resolution. All disputes respecting this
Agreement, including, inter alia, the termination of, or any other matter relating to or arising from, this Agreement, shall be resolved in binding arbitration in a proceeding administered by and in accordance with the rules and regulations of the
American Arbitration Association. The action will take place in Delaware, unless the parties to the dispute agree otherwise. The judgment of the arbitrator shall be final, binding and conclusive and a judgment shall be entered pursuant to the
Federal Arbitration Act in any federal court in the State of Delaware. The arbitrator shall not have authority to modify or change any of the terms of this Agreement. The parties and the arbitrator will treat the arbitration process and the
activities which occur in the proceedings as confidential. 

  
 ***Confidential
Treatment Requested 

 IN WITNESS WHEREOF, the parties hereto have executed this Agreement, in
duplicate originals, by their respective officers hereunto duly authorized, the day and year first above written. 
  

			
		 	MEDICIS PHARMACEUTICAL CORPORATION
		
		 	By: /s/ Mark A. Prygocki,
Sr.                                
		 	Name: Mark A. Prygocki, Sr.
		 	Title: Chief Financial Officer
		
		 	BRUSILOW ENTERPRISES, INC.
		
		 	By: /s/ Saul Brusilow,
M.D.                                   
		 	Name:
		 	Title:
		
		 	  /s/ Saul Brusilow,
M.D.                                        

		 	SAUL W. BRUSILOW, M.D.

 SCHEDULE A 

PATENT RIGHTS 
  

			
	International Application Number:	 	 PCT/US96/00940
 (copy attached)

 

 
 PCT

WORLD INTELLECTUAL PROPERTY ORGANIZATION International Bureau

INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT)

(51) International Patent Classification 6 : C07C 59/00, 57/30, 69/76 
A1

(11) International Publication Number: 
(43) International Publication Date:
WO 96/24571 
15 August 1996 (15.08.96) 
(21) International
Application Number: PCT/US96/00940 
(22) International Filing Date: 6 February 1996 (06.02.96) 
(30) Priority Date: 08/384,935 7 February 1995 (07.02.95) US 
(71)(72) Applicant and Inventor:
BRUSILOW, Saul, W. [US/US]; 4804 Keswick Road, Baltimore, MD 21201 (US). 
(74) Agents: MURRAY, Robert, B. et al.; Nikaido, Marmelstein, Murray & Oram,
Metropolitan Square, Suite 330 - G Street Lobby, 655 15th Street, NW, Washington, DC 20005-5701 (US). 
(81) Designated States: AL, AM, AT, AU, AZ, BB, BG, BR, BY,
CA, CH, CN, CZ, DE, DK, EE, ES, FI, GB, GE, HU, IS, JP, KE, KG, KP, KR, KZ, LK, LR, LS, LT, LU, LV, MD, MG, MK, MN, MW, MX, NO, HZ, PL, PT, RO, RU, SD, SE, SG, SI, SK, TJ, TM, TR, TT, UA, UG, US, UZ, VN, ARIPO patent (KE, LS, MW, SD, SZ, UG),
Eurasian patent (AZ, BY, KG, KZ, RU, TJ, TM), European patent (AT, BE, CH, DE, DK, ES, FR, GB, GR, IE, IT, LU, MC, NL, PT, SE), OAPI patent (BF, BJ, CF, CG, CI, CM, GA, GN, ML, MR, NE, SN, TD, TG). 
Published With international search report. Before the expiration of the time limit for amending the claims and to be republished in the event of the receipt of amendments.

(54) Title: TRIGLYCERIDES AND ETHYL ESTERS OF PHENYLALKANOIC ACID AND PHENYLALKENOIC ACID USEFUL IN TREATMENT OF VARIOUS DISORDERS 
(57) Abstract 
Two new forms of prodrug for phenylacetate, of even congeners of phenylalkanoic
acid and phenylalkenoic acids, which are the phenylalkanoic or phenylalkenoic esters of glycerol, or the ethyl esters of phenylalkanoic acid or phenylalkenoic acids. These forms of the drugs provide a convenient dosage form of the drugs. The
prodrugs of the invention are useful to treat patients with diseases of nitrogen accumulation, patients with certain ß-hemoglobinopathies, anemia, and cancer. 

  

													
	  

FOR THE PURPOSES OF INFORMATION ONLY

	  

Codes used to identify States party to the PCT on the front pages of pamphlets publishing international applications under the PCT.

 

	 	 	AM	 	Armenia	 	GB	 	United Kingdom	 	MW	 	Malawi
	 	 	AT	 	Austria	 	GE	 	Georgia	 	MX	 	Mexico
	 	 	AU	 	Australia	 	GN	 	Guinea	 	NE	 	Niger
	 	 	BB	 	Barbados	 	GR	 	Greece	 	NL	 	Netherlands
	 	 	BE	 	Belgium	 	HU	 	Hungary	 	NO	 	Norway
	 	 	BF	 	Burkina Faso	 	IE	 	Ireland	 	NZ	 	New Zealand
	 	 	BG	 	Bulgaria	 	IT	 	Italy	 	PL	 	Poland
	 	 	BJ	 	Benin	 	JP	 	Japan	 	PT	 	Portugal
	 	 	BR	 	Brazil	 	KE	 	Kenya	 	RO	 	Romania
	 	 	BY	 	Belarus	 	KG	 	Kyrgystan	 	RU	 	Russian Federation
	 	 	CA	 	Canada	 	KP	 	Democratic People’s Republic	 	SD	 	Sudan
	 	 	CF	 	Central African Republic	 		 	of Korea	 	SE	 	Sweden
	 	 	CG	 	Congo	 	KR	 	Republic of Korea	 	SG	 	Singapore
	 	 	CH	 	Switzerland	 	KZ	 	Kazakhstan	 	SI	 	Slovenia
	 	 	CI	 	Cete d’Ivoire	 	LI	 	Liechtenstein	 	SK	 	Slovakia
	 	 	CM	 	Cameroon	 	LK	 	Sri Lanka	 	SN	 	Senegal
	 	 	CN	 	China	 	LR	 	Liberia	 	SZ	 	Swaziland
	 	 	CS	 	Czechoslovakia	 	LT	 	Lithuania	 	TD	 	Chad
	 	 	CZ	 	Czech Republic	 	LU	 	Luxembourg	 	TG	 	Togo
	 	 	DE	 	Germany	 	LV	 	Latvia	 	TJ	 	Tajikistan
	 	 	DK	 	Denmark	 	MC	 	Monaco	 	‘TT	 	Trinidad and Tobago
	 	 	EE	 	Estonia	 	MD	 	Republic of Moldova	 	UA	 	Ukraine
	 	 	ES	 	Spain	 	MG	 	Madagascar	 	UG	 	Uganda
	 	 	FI	 	Finland	 	ML	 	Mali	 	US	 	United States of America
	 	 	FR	 	France	 	MN	 	Mongolia	 	UZ	 	Uzbekistan
	 	 	GA	 	Gabon	 	MR	 	Mauritania	 	VN	 	Viet Nam
	 	 	 	 	 	 	 	 	 	 	 	 	 

 TRIGLYCERIDES AND ETHYL ESTERS OF PHENYLALKANOIC ACID AND PHENYLALKENOIC ACID USEFUL IN TREATMENT
OF VARIOUS DISORDERS 
 Background of the Invention 

The present invention relates to compounds, pharmaceutical compositions, and methods for treating several conditions with
prodrugs for phenylacetate as therapeutics agents. 
 Field of the Invention 

Phenylalkanoic acids are known therapeutic agents for a variety of disorders. Phenylacetate is used for the treatment of
nitrogen metabolism disorders, beta-hemoglobinopathies, anemia and cancer. Various phenylalkenoic acids can be used in the treatment of the same disorders. The prodrugs disclosed in the present invention arc useful therapeutic agents for a number of
disorders, and possess some advantages over the forms of the drugs administered in the prior art. 
 Nitrogen Metabolism Disorders 

In a healthy person, the potentially toxic nitrogenous compounds which accumulate as the body degrades proteins are
synthesized into urea which is rapidly excreted into the urine. However, for those who suffer kidney failure, liver failure or inborn errors of urea synthesis, this pathway is defective. The accumulation of nitrogenous compounds resulting from such
a blockage leads to considerable morbidity and mortality. 
 In the case of an inborn error of urea synthesis, the major
metabolic abnormality is the inability of the body to convert waste nitrogen into urea. As a consequence, various nitrogenous metabolites accumulate in the body, the most toxic being ammonium, 

 2 
  

 
although other materials, such as glutamine and alanine also increase. 

Previous therapeutic approaches for treating patients with urea cycle enzymopathies (as well as other nitrogen accumulation
diseases cited earlier) have been designed to reduce the requirement for urea synthesis by quantitative and qualitative manipulation of dietary protein, amino acids and/or their nitrogen free analogues. Generally speaking, however, the mortality of
inborn errors of the urea-cycle remained high and success was measured in terms of increased survival time. Thus, for example, even with the above-cited therapeutic approaches, children with the neonatal form of these diseases rarely survive past
one year of age (Maestri, et al., The Journal of Pediatrics, Vol. 119, No. 6, 923-928 (1991)). 

Description of Related Art 
 A
more recent approach to remedy this pervasive problem is described in U.S. Pat. No. 4,284,647 to Saul W. Brusilow, wherein benzoic acid, phenylacetic acid, or the salts thereof, convert the waste nitrogen into amino acid acylation products
which the body can successfully excrete as urinary nitrogen. More specifically, the patent teaches that phenylacetate reacts with the nitrogen to form phenylacetylglutamine which is subsequently excreted by the body. Since such a reaction is in no
way dependent on the urea synthesis or excretion, it is an effective treatment for those suffering from nitrogen accumulation diseases. See also “Treatment of Inborn Errors of Urea synthesis,” New England Journal of Medicine, 306;
1387-1392 (1982). 
 U.S. Pat. No. 4,457,942, also to Saul W. Brusilow, discloses that even-numbered phenylalkanoic
acids can be advantageously used for the treatment of nitrogen accumulation diseases. 
 When administered to humans, even
numbered phenylalkanoic acids, such as phenylbutyrate, can be 

 3 
  

 
broken down by beta-oxidation, two carbon atoms at a time, to eventually yield phenylacetate which, as described above, has been found useful for removing waste nitrogen from the blood stream.
The administration of even numbered phenylalkanoic acids such as phenylbutyrate has the advantage that the higher molecular weight compounds do not have the offensive odor which phenylbutyrate has. 

The above treatments, although effective, have a substantial disadvantage. The dose of sodium phenylbutyrate for an adult with
a urea cycle disorder is 20 grams/day. This requires that the patient take forty (40) tablets of 0.5 grams each, per day. Problems of patient compliance arise when such large daily doses are required. The administration of sodium phenylbutyrate has
a second disadvantage to many patients – patients who should restrict their daily dose of sodium. The above daily dose of sodium phenylbutyrate provides 2.5 gm of sodium per day, every day (it is recommended that adults consume less than 2.4
grams/day total sodium). 
 The substitution in therapy of phenylacetate or phenylbutyrate, by the compounds of the present
invention, provides the therapeutic compound in a more convenient dosage form. In addition, the compounds of the present invention may eliminate the peaks and valleys in drug levels since the breakdown of these higher molecular weight compounds by
beta-oxidation is a gradual process. In addition, the Na component of the prior art is replaced with glycerol, which is a normal product of metabolism. 

Cancer 
 Phenylbutyrate and
phenylacetate are being investigated as a treatment for various malignant diseases. The exact mechanism by which this therapy causes improvement in the patient is not entirely clear. 

It has been observed that primary central nervous system tumors are reminiscent of immature brain, and the immature brain is
known to be more vulnerable to 

 4 
  

 
damage by phenylacetate than the mature brain (as is observed in phenylketonuria). Sodium phenylacetate appears to promote the differentiation of cultured human glioblastoma cell lines with
reduced expression of malignant phenotype. 
 Systemic treatment of rats bearing intracranial gliomas with phenylacetate
resulted in significant tumor suppression with no apparent toxicity to the host. Early clinical results suggest that phenylacetate may become an important tool in the management of certain tumors in light of its demonstrated efficacy, and lack of
toxicity (Samid et al., Cancer Research, 54, 891-895, 1994, and Cinatl et al., Cancer Letters, 70, 15-24, 1993). 

A similar theory may be applied in treating prostate cancer with phenylacetate. The phenylacetate is thought to act as a
differentiation inducer of leukemic and other less differentiated tumor cells, such as hormone refractory prostate cancer. 

Cultured cells of androgen dependent prostate cell lines with sodium phenylacetate show inhibition of cell proliferation. In
addition, such cells show reversion to non-malignant phenotype by in vivo and in vitro assessments (Samid et al., The Journal of Clinical Investigation, Vol. 19, 2288-2295, 1993). 

Phenylacetate may exert an anti-tumor affect by another mechanism. Glutamine is the major nitrogen source for nucleic acid and
protein synthesis, and substrate for energy in rapidly dividing normal and tumor cells. Compared to normal tissue, most tumors, due to decreased synthesis of glutamine along with accelerated utilization and catabolism, operate at limiting levels of
glutamine availability and consequently are sensitive to further glutamine depletion. In the body, phenylacetate conjugates with glutamine, with subsequent renal excretion of phenylacetylglutamine. This pathway is the reason that phenylacetate
administration is useful in the treatment of nitrogen accumulation diseases. Because phenylacetate removes glutamine, administration of phenylacetate may 

 5 
  

 
limit the growth rate of rapidly dividing cells such as tumor cells. 

By one or more of the above mechanisms, phenylacetate causes a decrease in tumor characteristics of a variety of tumor cells.
Because of its known non-toxicity, phenylacetate is a promising therapeutic agent, either alone or in combination with other anti-tumor agents. 

Hemoglobinopathies 

Sodium phenylbutyrate is thought to cause improvement in certain
ß-hemoglobinopathies because the sodium phenylbutyrate induces the expression of fetal hemoglobin. Thus the absent or aberrant ß-hemoglobin is substituted
with fetal hemoglobin. 
 Numerous agents which induce the expression of fetal hemoglobin have been used to treat sickle
cell anemia and ß-thalassemias. Some of the agents which increase the production of fetal hemoglobin however, have serious side effects that are not consistent with their use as long term therapeutic
agents. However, sodium phenylacetate and sodium phenylbutyrate have been previously used to treat urea cycle disorders and are known to be very well tolerated and free of adverse reactions in clinical use. Preliminary clinical studies of patients
with beta thalassemia indicate that treatment with sodium phenylbutyrate results in a response in many patients. The response is particularly good in patients with relatively high erythropoietin levels. Thus, combination therapy of the
phenylbutyrate and erythropoietin may be effective. Hydroxyurea given orally has also been shown to increase hemoglobin levels in some thalassemia patients. Clinical studies of thalassemia patients treated with a combination of hydroxyurea and
sodium phenylbutyrate has produced increased hemoglobin levels in some patients. 

 6 
  

 Summary of the Invention 

The compounds of the present invention, triglycerides of phenylalkanoic acids or phenylalkenoic acids, and ethyl esters of
phenylalkanoic acids or phenylalkenoic acids, provide a more convenient dosage form of drugs for treatment of nitrogen accumulation disorders, cancer, anemia and hemoglobinopathies. The compounds of the invention are oils or soft fats. Where the
prior art dose for an adult would have been forty 0.5 g tables/day, the present invention provides the same amount of active compound in approximately four (4) teaspoonfuls per day. The dosage form of the present invention also decreases sodium
intake in patients, which is advantageous in certain patients, and may also provide the active component of the drug, the phenylalkanoic or phenylalkenoic acid, at a more constant level. 

The compounds of the invention may be used for the treatment of nitrogen accumulation disorders, portal systemic
encephalopathy, and diseases involving impaired hepatic function. Additionally, the use of triglycerides and/or the esters of the present invention alone or in combination with hydroxyurea and/or erythropoietin, may be used for the treatment of beta
chain hemoglobinopathies. The compounds of the invention are suitable for the treatment for various leukemias and solid tumors. 

The compounds of the invention can be produced by standard esterification procedures. Additionally, many of the compounds of
the invention are commercially available. 

 7 
  

 Description of the Preferred Embodiments 

The present invention utilizes compounds of the formula: 

 
  
 

 
 wherein R1, R2, and R3 are independently, H, 
  

  

 , and n is zero or an even number, m is an even number and at least one of R1, R2, and R3, is not H. 
 The most preferred compounds are those wherein none of R1, R2 and R3 is H. The advantage over the prior art of decreased dosage is greater
with such triglycerides. 
 The present invention also utilizes ethyl esters of the formula II 

 
  

			
	

	 	(II)

 wherein R4 is

 and n is zero or an even number, and m is an even number. 
 The compounds of the
invention include compounds with substituents of even numbered congeners of phenylalkanoic and phenylalkenoic acids. Preferably the substituents contain 24 or fewer carbon atoms. Most preferably, n and m are 0, 2, 4 or 6. 

The compounds of the present invention can be used separately or in the form of mixtures. The amount of the compounds of the
present invention which is administered to patients for the present purposes can vary 

 8 
  

 
widely from case to case. Normally, however, the daily dosage for the compounds should fall in the range of 450 to 600 mg/kg body weight for children, and from 9.9 to 13 grams for adults. The
size and frequency of the dosages given at any time may be varied as described provided the indicated total daily does is not significantly modified. Preferably the compounds of the invention are administered orally, although in some circumstances,
administration may be other routes such as topically or parenterally. 
 Metabolic Fates of the Compounds of the Invention 

Pancreatic lipase is able to hydrolyse the triglyceride compounds of the invention to produce glycerol and phenylalkanoic
acids or phenylalkenoic acids. The glycerol is then metabolized in the usual manner. 
 In their experiments with dogs,
Raper and Wagner (Biochem Journal 22:188 (1928)) demonstrated that phenylalkanoic acids are oxidized at the beta carbon during metabolism to cause cleavage of two carbons at a time. Thus, they found that 80% of the phenylbutyrate administered to
dogs appeared in the urine as the glycine conjugate of phenylacetate. Unlike dogs, man only produces an acetylation product of glutamine from phenylacetate. Thus, when phenylbutyrate is administered to a human as either a fatty acid or a salt
thereof, the phenylacetate formed as a result of beta oxidation will acetylate the glutamine thus causing the formation of phenylacetylglutamine which will be excreted by the kidney. The beta oxidation process is not limited to phenylbutyrate. In
fact, any even numbered phenylalkanoate can be metabolized to phenylacetate. Thus phenylhexanoate, phenyloctanoate and phenyldecanoate are also effective to control waste nitrogen levels. 

Unsaturated fatty acids are oxidized by the same general pathway as saturated fatty acids. Two additional enzymes may be used,
one which can reversibly shift the double bond from cis to trans configurations, and one 

 9 
  

 
which hydrates the double bond to form hydroxy fatty acids. The compounds are then substrates for the beta oxidation enzymes. 

The ethyl esters of formula II are thought to be metabolized by spontaneous degradation in the intestine. 

It is anticipated that the toxicity of tri-glycerides of phenylbutyrate and other
compounds of this invention to patients would be low when these compounds are administered to patients because the fate of such compounds is phenylbutyrate which is beta oxidized to form phenylacetate. Glycerol is also produced, but it is a normal
body constituent which is either converted to glucose or oxidized. For the ethyl esters, ethanol is produced, but in such small quantities as to be non-harmful. The phenylacetate metabolic product, on the
other hand, has no known toxicity and is approved for investigational use in humans (IND #17123). 

 10 
  

 CLAIMS 

We claim: 

1.    A compound of the formula I 

 

			
	

                	 	 (I)    

 

 wherein R1, R2, and R3 are independently, H, 
  

  

  , 
 and n is zero or an even number, m is an even number and at least one of R1, R2, and R3, is not H. 

2.    A pharmaceutical composition suitable for the treatment of nitrogen metabolism disorders, ß-hemoglobinopathies, anemia and cancer comprising a compound of the formula I 
  

			
	

                	 	 (I)    

 

 wherein R1, R2, and R3 are independently, H, 
   

  , 
 and n is zero or an even number, m is an even number and at least one of R1, R2, and R3, is not H. 

 11 
  

 3. A pharmaceutical composition suitable for the treatment of nitrogen
metabolism disorders, ß- hemoglobinopathies, anemia and cancer comprising ethyl esters of the formula II 
  

			
	

      	  	(II)

 wherein R4 is

  , and n is zero or an even number, and m is an even number, together with at least one pharmaceutically acceptable excipient. 

4.    A method for the treatment of nitrogen metabolism disorders comprising administering to a patient
in need of such treatment an effective amount of a compound of formula I 
  

			
	 

	  	(I)    

 wherein R1, R2, and R3 are independently, H, 

  , and n is zero or an even number, m is an even number and at least one of R1, R2, and R3 is not H. 

 12 
  

 5.    A method for the treatment of nitrogen
accumulation diseases comprising administering to a patient in need of such treatment an effective amount of a compound of formula II 
  

			
	     

	  	(II)

 wherein R4 is 

, wherein n is zero or an even number and m is an even number. 

6.    A method for the treatment of tumors comprising administering to a patient in need of such
treatment an anti-tumor effective amount of a compound of formula I 
  

			
	     

	  	(I)    

 wherein R1, R2, and R3 are independently, H, 

  

 , and n is zero or an even number, m is an even number and at least one of R1, R2, and R3 is not H. 

 13 
  

 7.    A method for the treatment of tumors comprising
administering to a patient in need of such treatment an anti-tumor effective amount of a compound of formula II 
  

			
	

          	  	(II)

 wherein R4 is 

wherein n is zero or an even number and m is an even number. 
 8.    A
method for the treatment of beta-hemoglobinopathies comprising administering to a patient in need of such treatment an effective amount of a compound of formula I 
  

			
	 

	  	(I)    

 wherein R1, R2, and R3 are independently, H, 

  

  , and n is zero or an even number, m is an even number and at least one of R1, R2, and R3 is not H. 
 9.    A method for the treatment of
beta-hemoglobinopathies comprising administering to a patient in need of such treatment an effective amount of a compound of formula II 
  

			
	

          	  	(II)

 14 
  

 wherein R4 is 

 wherein n is zero or an even number and m is an even number. 

10.    The compound of claim 1 wherein none of
R1, R2, and R3 is H. 

11.    The composition of claim 2 wherein none of
R1, R2, and R3 is H. 

 

 
 INTERNATIONAL SEARCH REPORT International application No. PCT/US96/00940 
A. CLASSIFICATION OF SUBJECT MATTER IPC(6) :C07C 59/00, 57/30, 69/76 US CL :554/218, 220, 227; 560/8, 76 
According to International Patent Classification (IPC) or to both national classification and IPC 
B. FIELDS SEARCHED 
Minimum documentation searched (classification system followed by
classification symbols) 
U.S. : 554/218, 220, 227; 560/8, 76 
Documentation
searched other than minimum documentation to the extent that such documents are included in the fields searched Electronic data base consulted during the international search (name of data base and, where practicable, search terms used) 
APS, CAS ONLINE 
C. DOCUMENTS CONSIDERED TO BE RELEVANT 
Category* X X,P 
Citation of document, with indication, where appropriate, of the relevant
passages Chem. abstr., Vol. 112, No. 25, 18 June 1990(Columbus, OH, USA), page 270, column 1, the abstract No. 231744t, WALSH, J.P. ‘SN-1,2-Diacylglycerol
kinase of Esherichia Coli. Diacylglycerol analogs define specificity and mechanism.” Journal of Biological Chemistry. 1990, 265(8)(Eng). 
Chem. abstr. Vol.
123, No. 15, 09 October 1995(Columbus, OH, USA), page1315, column 1, the abstract No. 199405x, DEGRADO, W F. “Preparation of radiolabeled platelet GPIIb/IIIa receptor antagonist as imaging agents for the diagnosis of thromboembolic
disorders.” WO 94-22494. 
Relevant to claim No. 1, 2, 10, 11 4 
Further documents are listed in the continuation of Box C. See patent family annex. 
*
“A” “E” “L” “O” “P” 
Special categories of cited documents: 
document defining the general state of the art which is not considered to be of particular relevance 
earlier document published on or after the international filing date 
document which may throw
doubts on priority claim(s) or which is cited to establish the publication date of another citation or other special reason (as specified) 
document referring to an
oral disclosure, use, exhibition or other means 
document published prior to the international filing date but later than the priority date claimed 
“T” “X” “Y” “&” 
later document published after the
international filing date or priority date and not in conflict with the application but cited to understand the principle or theory underlying the invention

document of particular relevance; the claimed invention cannot be considered novel or cannot be considered to involve an inventive step when the document is taken
alone 
document of particular relevance; the claimed invention cannot be considered to involve an inventive step when the document is combined with one or more
other such documents, such combination being obvious to a person skilled in the art 
document member of the same patent family 
Date of the actual completion of the international search 16 MAY 1996 
Name and mailing
address of the ISA/US Commissioner of Patents and Trademarks Box PCT 
Washington, D.C. 20231 
Facsimile No. (703) 305-3230 
Form PCT/ISA/210 (second
sheet)(July 1992)* 
Date of mailing of the international search report 
13 JUN
1996 
Authorized officer 
DEBORAH D. CARR 
Telephone No. (703)308-1235 

 SCHEDULE B 

THIRD PARTY AGREEMENTS 

The Johns Hopkins University Intellectual Property Policy (copy attached) 

 Intellectual Property Guidelines 

THE JOHNS HOPKINS UNIVERSITY 
 INTELLECTUAL PROPERTY
POLICY 
  
 October 27, 1992 

I. Intellectual Property: Definition 
 II. University
Responsibilities 
 III. Faculty Responsibilities 

IV. Ownership of Intellectual Property 
 V. Revenue from
Intellectual Property 
 VI. Additional Provisions 

Appendix I 
 Appendix II 

 
  

The Johns Hopkins University strives to support its faculty and employees in securing commercial development of intellectual and other property resulting from
their research so that the benefits of that research may reach society at the earliest opportunity. This is consistent with the University’s mission of developing new knowledge and facilitating the practical application of such knowledge to the
benefit of the public. The University has developed policies and guidelines that provide incentives for its researchers while protecting the integrity of research emanating from this institution. Moreover, the University provides an array of
administrative services to its Inventors to assist them in protecting rights to University Intellectual Property and fostering commercial development. 

This document describes University policy relevant to Intellectual Property and lists the available University-wide
resources. The policy shall be interpreted in a manner consistent with applicable federal and state statutes and implementing regulations. It shall apply to all students receiving remuneration for services, faculty, and staff of the University (with
the exception of those covered under the Invention Policy of The Johns Hopkins University Applied Physics Laboratory). Faculty, staff and students shall be referred to as “faculty” throughout the remainder of this document. (For further
definitions of terms, refer to Appendix II, Glossary.) 
 This revised Intellectual Property Policy supersedes that which was adopted by the Board of
Trustees on October 13, 1988. It shall be effective on the date of its approval by the Board of Trustees. It shall apply to all new Inventions disclosed to the University after the effective date, as well as to those Inventions
licensed after the policy’s effective date regardless of date of disclosure. Inventions covered by the terms of a previous assignment remain subject to the policy under which they were negotiated. Inventors may elect in writing to
receive royalties for those Inventions disclosed but not licensed prior to the date of Board approval as allowed under the previous University Invention Policy provided that such election was received by the appropriate Divisional office
by the close of business on July 30, 1992. An Inventor choosing royalty distribution under the former policy shall be governed by all other provisions of the new policy 

 
including the opportunity to benefit from ownership of equity. For any Invention licensed after the effective date of this policy, regardless of choice of option,
University costs for patent prosecution, licensing, and license maintenance shall be reimbursed from Gross Revenues. 
 I. Intellectual Property:
Definition 
 For purposes of this policy, Intellectual Property is defined as any new and useful process, machine, composition of matter, life form,
article of manufacture, software, copyrighted work (see IV, E), or tangible property. It includes such things as new or improved devices, circuits, chemical compounds, drugs, genetically engineered biological organisms, data sets, software,
musical processes, or unique and innovative uses of existing Inventions. Intellectual Property may or may not be patentable or copyrightable. It is created when something new and useful has been conceived or developed, or when unusual,
unexpected, or non-obvious results, obtained with an existing Invention, can be practiced for some useful purpose. Intellectual Property can be created by one or more individuals each of whom, to be an
Inventor, must have conceived of an essential element or have contributed substantially to its conceptual development. 
 II. University Responsibilities

 The University acknowledges the importance of transferring its Intellectual Property in an appropriate and
cost-effective manner. To that end, the University shall establish efficient mechanisms for technology transfer, so as to maximize the value of the technology to the faculty and the University. 

A. The University Administration shall: 
 1.
Provide oversight of Intellectual Property management and technology transfer to ensure adherence to University policies; 
 2. Assist the
Divisions in establishing and maintaining effective technology transfer mechanisms and Divisional policies and procedures consistent with University policies; 

3. Provide legal services and cooperate with the Divisions in promoting and licensing Intellectual Property; and 

4. Take appropriate actions to protect the University’s Intellectual Property. 

B. Divisional Administrations shall: 
 1. Promote
technology transfer in a manner consistent with the Division’s objectives and academic environment; 
 2. Establish policies and
procedures for technology transfer and the avoidance of conflicts of interests, consistent with University policies; and 
 3. Review
and approve all agreements that convey or affect the University’s rights to Intellectual Property originating in that Division. 
 III. Faculty
Responsibilities 
 Faculty members who create Intellectual Property shall: 

A. Disclose to appropriate University or Division officials the creation of Intellectual Property; 

 B. Conduct technology transfer activities in a manner consistent with University and Divisional policies and
procedures, including those governing conflicts of commitment and conflicts of interest; and 
 C. Cooperate with the University in defending and prosecuting
patents and in legal actions taken in response to infringement. 
 IV. Ownership of Intellectual Property 

A. In general, the University has the right to obtain title to Intellectual Property developed as a result of support either directly from or channeled through
the University. 
 B. University support is defined as financial or other support, regardless of origin, which is used in the discovery or development of
Intellectual Property and is provided through University channels. 
 In the absence of University support, rights of ownership of Intellectual Property
remain with the Inventor. Provision of an appointment shall not in and of itself be construed as University support for purposes of this definition. 
 C.
The University may decline to accept any rights of ownership by assignment or otherwise, in which case all rights revert to the Inventor. 
 D. When software
or other unpatented tangible research property (e.g., cell lines and data sets) is developed by faculty using University support, the University will own all rights to such property, including copyright (subject to agreements with appropriate
funding sources). 
 E. Copyright to, and royalty from, literary or scholarly works in tangible or electronic form (e.g., textbooks and other curricular
materials, reference works, journal articles, novels, music, photographs, etc.) produced by faculty members as a part of their usual teaching, service, and research activities, and which do not result directly as a specified deliverable from
projects funded in whole or in part by the University or a sponsored research agency shall belong to the faculty who prepared such works and may be assigned or retained by them. 

V. Revenue from Intellectual Property 
 A. General
Principles 
 Revenues received as a result of Licensing Agreements in the form of cash royalties and/or equity holdings shall be distributed in such a
manner as to encourage technology development within and technology transfer from the University. “Revenues” shall not include funds received for research support. 

1. University costs for patent prosecution, licensing, and license maintenance, shall be reimbursed from Gross Revenues. 

 2. All shares of revenue, including the Inventor’s, should contribute to the reimbursement
of University costs for patent infringement actions. The manner and amount of such reimbursement will be determined by consultation between the Division Dean and the President so as to maintain fairness and adequate incentives in the
distribution of revenue. 
 3. The schedule for distribution of Net Revenues shall be designed to provide personal incentives to Inventors.

 4. The support and further development of technology transfer offices and functions shall be augmented fro5. m the distribution of Net
Revenues to the Schools. 
 5. The portion of revenues distributed to the Inventors’ laboratory(s) shall be limited to avoid imbalance
within the Inventors’ department(s). 
 6. Continued sensitivity to conflicts of interest require that certain types of research on a
licensed Invention by its Inventor(s) and/or the University may be disallowed whatever the funding source. Sponsored research to advance the state of the art of existing Inventions is encouraged under those circumstances where the
Inventor’s participation presents little, if any, opportunity to compromise the integrity of the Inventor and the University. For review of cases involving potential Conflicts of Interest, the Division should create a faculty committee or
committees to review and make recommendations to the Dean. 
 B. Net Royalty Revenue Distribution Schedule: see Appendix B 

C. Equity Holdings 
 With careful safeguards, Licensing Agreements
involving equity participation by the University and its faculty are permitted. Under appropriate circumstances, research sponsored by companies in which faculty and/or the University have equity holdings may also be permitted. Establishment
and execution of specific rules and procedures for implementing the policy guidelines provided below are the responsibility of the Divisions. 

1. University contracts with licensees must be negotiated by the appropriate University or Divisional office and not directly by the Inventor.

 2. The Inventors’ and the Institution’s equity interest will not be traded until after a stipulated Trigger Date. 

3. The Inventors’ equity interest will be held in escrow for the benefit of the Inventor by the University. 

4. Any association of the Inventor(s) with the licensee will be subject to disclosure, including compensation, prior approval, and annual
reporting. 
 5. Divisions from which the Intellectual Property originates must have adequate policies and procedures for conflict of
interest consistent with those outlined in section V.A.5. 

 D. Distribution of Equity Revenue 

 

									
	   Inventors’

  Personal
   Share
	  	 Inventors’

Laboratory(s)
 Share
	  	 Inventors’

Department(s)
 Share
	  	 School

Share
	  	 University

Share

	   35%
	  	15%	  	10%	  	30%	  	10%

 Unlike royalty revenue, equity revenue distribution is sporadic and likely to occur only once. Cash received from the sale of
shares allocated to the Inventors’ Laboratory(s) Share will be apportioned in equal amounts annually to the appropriate laboratory(s) over the remaining life of the relevant U.S. Patent or the remaining years under the relevant License
Agreement, whichever is shorter, unless the Dean of the School of the Inventor(s) and the Inventor(s) agree to another method of distribution. 

E. Distribution After Termination or Death 

1. The Inventors’ personal share shall survive termination of affiliation with the University and, in the event of death of the Inventor,
shall inure to his/her estate. 
 2. Upon termination of the Inventor’s affiliation with the University, the Inventors’ Laboratory
Share, both the unspent portion and future allocations, will be reallocated to the Inventors’ Department, School and University portions according to the applicable royalty distribution policy. 

VI. Additional Provisions 
 A. Research

 The University shall only enter into a research contract or other binding commitment to perform work that can reasonably be expected to be publishable,
provide educational opportunities, and/or be in the public interest. 
 B. Use of the University’s Name 

All written or broadcast material containing the University’s name for advertising, marketing, or other promotional purposes shall be submitted for
approval to the Divisional Public Affairs Officer, and the Dean, prior to use of such material. A statement on the use of the University’s name shall be included in all appropriate contracts between industry (company) and the University.

 C. Publication 
 The University shall enter
into contracts or other binding commitments to conduct research and training only if they permit the disclosure and publication of research. Delays in publication up to 120 days may be agreed to in order to permit time for filing of patent
applications. 

 D. Confidentiality 

The faculty shall not undertake research in which the sponsor: 

1. prohibits the faculty member from disclosing the existence of the agreement; or 

2. restricts the faculty member’s public disclosure of information developed by that faculty member (see section C. above). 

E. Avoidance of Conflict of Interest and Conflict of Commitment 

1. Trust, good faith, and open discussion of controversial issues among colleagues have always been central to the life of the University. The
activities of faculty members must be governed by thoughtful consideration of individual circumstances, rather than rigid rules. The requirement for reporting as outlined in the following paragraph is meant to ensure that conflicts of commitment and
conflicts of interest will be considered openly and fairly, and that appropriate action will be taken to resolve those conflicts. Reporting thus serves to protect individual faculty members, The Johns Hopkins University, and academic freedom in
general. 
 2. In cases where faculty enjoy rights to Intellectual Property under this policy, they have an obligation to report fully any
outside activities and interests related to their teaching, research, or service to their Department Chair, Dean or other designated University official and obtain their prior approval before the activity begins. The report must be in writing
and must include the names of companies for whom he/she consults, the number of days committed to each consulting agreement and a copy of any proposed consulting agreements associated with Intellectual Property. Consulting agreements must be
reviewed for compliance with University policies and government regulations and approved by the appropriate Divisional office before the consultation can begin. 

3. The holding of equity interest in a Commercial Venture by the University and faculty Inventor, and the receipt of royalties and acceptance
of consultant fees, places a burden on the Inventor to report such financial interests in all relevant papers prepared for publication or oral presentation, in order to avoid later accusation that adverse results had been suppressed in order to
enhance the marketability of the Invention. 
 F. Grievances 

In the event an Inventor has a grievance about the University’s handling of his/her Intellectual Property, he/she may appeal to the appropriate Divisional
mechanism. An Investigator may take a grievance to the Office of the Provost if: his/her Division has no appeals mechanism or; he/she wishes to appeal a Divisional decision. 
  

 

 APPENDIX I 

Limits on Inventors’ Laboratory Share Of Net Revenues 

See Appendix B 
  

 
 APPENDIX II 

Glossary 
 Commercial Venture: 

A Commercial Venture shall mean a start-up company, limited partnership, joint venture, or any other
entity that has obtained a License to a Division’s technology that involves equity. Ownership of a company’s stock by the University in the endowment investment pool (EIP) will not alone define the company as a Commercial Venture. 

Copyright: 
 Works of authorship in
any tangible medium of expression can be copyrighted. Copyright does not protect mere ideas; it is the reproduction of the particular expression of the idea that receives protection by the federal statute known as the 1976 Copyright Act. A copyright
gives an author or creator of an original expression (or in certain instances, the author’s employer) the exclusive right to reproduce such expression; to distribute the expression (the right to control the first sale of an embodiment of a
copyright); to display the original embodiment; and to prepare derivative works. To establish copyright it is necessary, prior to first Publication, to mark the work with the copyright symbol, ©, as well as the date and the name of the
copyright owner. 
 Equity or Equity shares: 

Equity or equity shares shall mean shares of common or preferred stock, warrants, options, convertible instruments, units of a limited
partnership, or any other instrument conveying ownership interest in a Commercial Venture. 
 Gross Revenues: 

Gross Revenues shall mean all income received by the University under a License Agreement. Excluded from Income shall be research funds (unless
the research funds offset future royalty obligations) and maintenance fees received under the License agreement. 
 Income: 

Income is the revenue paid as consideration for a License. Income includes one time payment or
on-going revenues such as License fees, maintenance fees, minimum annual royalties, earned royalties, reimbursement of Patent expenses, and equity. 

 Intellectual Property: 

Intellectual Property is any new and useful process, machine, composition of matter, life form, article of manufacture, software,
copyrighted work, or tangible property. It includes such things as new or improved devices, circuits, chemical compounds, drugs, genetically engineered bacteria, data sets, software, musical processes, or unique and innovative uses of
existing Inventions. Intellectual Property may or may not be patentable or copyrightable. Intellectual Property is created when something new and useful has been conceived or developed, or when unusual, unexpected, or
non-obvious results have been obtained with an existing Invention which can be practiced for some useful purpose. Intellectual Property can be created by one or more individuals, each of whom to be an Inventor
must have conceived of an essential element or have contributed substantially to its conceptual development. 
 Inventor: 

An Inventor is one who makes a creative input to the conception of the Invention. U.S. Patent statutes require that only the true
Inventor(s) be named on the Patent. A coauthor or one who merely reduces the Invention to practice (i.e., successfully uses the Invention in its intended manner) is not an Inventor unless he makes a creative input to the
conception. 
 Inventors’ Laboratory : 

The Inventors’ Laboratory is defined as the facilities which provide the opportunity for experimentation, observation and/or practice of
the Inventors’ particular field of study. 
 Invention: 

A creation of Intellectual Property which did not exist previously. 

License: 
 A License is a contract
which awards to a party other than the owner(s) of the Intellectual Property the right to make, use, or sell the Intellectual Property. Licenses may be awarded on an exclusive or
non-exclusive basis and may provide for payment of fees, royalties, or other income to the owner(s) of the Intellectual Property. 

License Agreement: 
 A License
Agreement shall mean an agreement conveying rights in a School’s technology to the Commercial Venture, and under which equity is received as partial or full consideration. 

Net Revenue: 
 Net Revenue shall
mean Gross Revenue less unreimbursed Patent prosecution expenses, licensing expenses associated with a particular License Agreement. 
 Patent:

 A U.S. Patent is a grant which gives the owner of the Invention covered by the Patent the right to exclude all others from
making, using, or selling the Invention in the United States. In the United States, a Patent provides that exclusive right for 17 years. To qualify 

 
for U.S. Patent protection, an Invention must be deemed new, useful, and non-obvious to one skilled in the art, and must not have been in public use or on
sale in the United States or described in a printed Publication as defined below, anywhere in the world for more than one year prior to the filing date of the U.S. Patent application. 

Patent rights in many foreign countries can be lost if there has been any disclosure of the Invention, verbal or written, anywhere in the
world prior to filing the foreign Patent application. However, if the U.S. Patent application has been filed prior to any disclosure of the Invention, Patent applications may still be filed in foreign countries within one year of the U.S. filing
date in those countries which adhere to an International Convention even if there has been an intervening Publication. 
 Publication:

 As related to Inventions and Patents, a Publication is an enabling public disclosure of an Invention and may be verbal or
printed. An enabling disclosure is one which will teach one skilled in the art how to practice the Invention. Printed Publications include abstracts and, in certain instances, grant proposals, funded or unfunded. A public disclosure is a non-privileged communication to one or more individuals from outside the University community. It is important to emphasize that the issuance of a Publication may jeopardize one’s ability to secure a foreign
Patent. Questions surrounding the implications of Publication can be addressed by the Patent Management Office or the appropriate technology transfer office. 

Research Contract: 
 A Research Contract
shall mean a separate agreement to conduct research related to licensed technology. 
 Tangible Property: 

Tangible Property is anything having a physical embodiment (e.g., cell lines, software, devices, compositions of matter) whether or not
patentable or copyrightable. 
 Trigger Date: 

Trigger Date shall mean the date the equity held by the University and by Divisional faculty Inventors is no longer subject to
restrictions imposed by the University and may be traded, subject to any remaining restrictions imposed by law, the underwriters, or the Commercial Venture. 
  

 
 Next Section: Intellectual Property
Guidelines: The Johns Hopkins University Revised Royalty Distribution for the School of Medicine 
 Top of Current Section 

Intellectual Property Guidelines Navigation Page 
  

 

 

 
 Johns Hopkins School of Medicine: December, 1993 

Technical Contact: www@infonet.welch.jhu.edu 

JIIMI-InfoNet: Aug 27, 1996 

http://infonet.welch.jhu.edu/policy/intellectual_prop_guide/some_intpolA.html 

 SCHEDULE C 

PROSECUTION OF PATENT RIGHTS 

IN THE TERRITORYEX-10.1

 Exhibit 10.1 

Execution Version 

AMENDMENT NO. 5 TO CREDIT AGREEMENT 

AMENDMENT NO. 5 TO CREDIT AGREEMENT, dated as of May 25, 2017 (this “Amendment”), by and among National Mentor Holdings,
Inc., a Delaware corporation (the “Borrower”), the other Loan Parties party hereto, Barclays Bank PLC, as administrative agent (the “Administrative Agent”) under the Credit Agreement (as defined below) and the
Lenders party hereto. 
 RECITALS: 

WHEREAS, reference is hereby made to the Credit Agreement, dated as of January 31, 2014 (as amended by Amendment No. 1 to
Credit Agreement dated as of September 8, 2014, as further amended by Amendment No. 2 to Credit Agreement dated as of October 21, 2014, as further amended by Amendment No. 3 to Credit Agreement dated as of February 27, 2015,
as further amended by that certain letter agreement dated as of April 12, 2016 and as further amended, supplemented, amended and restated or otherwise modified from time to time, the “Credit Agreement”), among the Borrower, NMH
Holdings, LLC, the Administrative Agent and each Lender from time to time party thereto, and the other parties thereto (capitalized terms used but not defined herein having the meaning provided in the Credit Agreement); 

WHEREAS, the Borrower has hereby notified the Administrative Agent that it is requesting to enter into Permitted Repricing Amendment
pursuant to Section 10.1 of the Credit Agreement; 
 WHEREAS, the Lenders party hereto have indicated their willingness to
consent to the amendments to the Credit Agreement further described in Section 1 below. 
 NOW, THEREFORE, in consideration of
the premises and agreements, provisions and covenants herein contained, the parties hereto agree as follows: 
  

	1.	Amendments to the Credit Agreement. Effective as of the Effective Date (as defined below), the Credit Agreement is hereby amended as follows: 

 

	 	(a)	The definition of “Applicable Margin” set forth in Section 1.1 of the Credit Agreement is hereby amended and restated in its entirety as follows: 

“Applicable Margin”: for each Type of Loan, the rate per annum set forth under the relevant column heading below: 

 

									
	 	  	ABR Loans	 	 	Eurodollar Loans	 
	 Revolving Loans and Swingline Loans
	  	 	2.25	% 	 	 	3.25	% 
	 Tranche B Term Loans
	  	 	2.00	% 	 	 	3.00	% 

  

	 	(b)	The definition of “Eurodollar Rate” set forth in Section 1.1 of the Credit Agreement is hereby amended by replacing the reference to “1.00% per annum” therein to “0.75% per annum”.

  

	 	(c)	The definition of “Repricing Premium” set forth in Section 1.1 of the Credit Agreement is hereby amended and restated as follows: 

 “ “Repricing Premium” means, in connection with a Repricing Transaction, a
premium (expressed as a percentage of the principal amount of such Tranche B Term Loans to be prepaid) equal to the amount set forth below: 

(a) on or prior to the first anniversary of the Amendment No. 5 Effective Date, 1.0%; 

(b) thereafter, 0%.” 
  

	 	(d)	Section 1.1 of the Credit Agreement is amended by inserting the following new definitions in their correct alphabetical order: 

“Amendment No. 5” shall mean Amendment No. 5 to this Agreement, dated May [•], 2017, among Borrower, the
Administrative Agent, the other Loan Parties party thereto and the Lenders party thereto. 
 “Amendment No. 5 Effective
Date” shall mean the “Effective Date” under and as defined in Amendment No. 5. 
  

	2.	Tranche B Term Loans. 

  

	 	(a)	 Subject to the terms and conditions set forth herein (i) each existing Tranche B Term Lender (collectively,
the “Continuing Tranche B Term Lenders”) that executes and delivers a Lender Addendum (Continuing Tranche B Term Lender) in the form attached hereto as Exhibit A (a “Lender Addendum (Continuing Tranche B Term
Lender)”) thereby consents to this Amendment and (x) if checking option 1, agrees to continue via “cashless settlement” all (or such lesser amount as may be allocated by the Administrative Agent and the Borrower) of its
existing Tranche B Term Loans outstanding immediately before giving effect to this Amendment as a Tranche B Term Loan on the Effective Date in a principal amount equal to such Continuing Tranche B Term Lender’s Tranche B Term Commitment (as
defined in the Credit Agreement) or (y) if checking option 2, agrees to sell the entire principal amount of its existing Tranche B Term Loans outstanding immediately before giving effect to this Amendment via an assignment on the Effective Date
and then promptly purchase an equal amount (or such lesser amount as may be allocated by the Administrative Agent and the Borrower) of Tranche B Term Loans and (ii) each Person (other than a Continuing Tranche B Term Lender in its capacity as
such) (collectively, the “Additional Tranche B Term Lenders”) that executes and delivers a Lender Addendum (Additional Tranche B Term Lender) in the form attached hereto as Exhibit B (a “Lender Addendum (Additional Tranche B
Term Lender)” and, together with a Lender Addendum (Continuing Tranche B Term Lender), a “Lender Addendum”) agrees to take via an assignment on the Effective Date from one or more Non-Consenting Lenders a principal amount
of Tranche B Term Loans equal to such Additional Tranche B Term Lender’s Tranche B Term Commitment (as defined in the Credit Agreement). For purposes hereof, a Person shall become a party to the Credit Agreement as amended hereby and a Tranche
B Term Lender as of the Effective Date by executing and delivering to the Administrative Agent, on or prior to the Effective Date, a Lender Addendum (Additional Tranche B Term Lender) in its capacity as a Tranche B Term Lender. For the avoidance of
doubt, the existing Term Loans of a Continuing Tranche B Term Lender must be continued in whole and may not be continued in part unless otherwise notified by the Administrative Agent prior to the Effective Date to give effect to any cash prepayment
of the Tranche B Term Loans to be made by the Borrower on the Effective Date. Any Non-Consenting Lender whose Tranche B Term Loans are 

  
 2 

	 	
repaid or assigned to one or more Additional Tranche B Term Lenders on the Effective Date in accordance with this Amendment shall be entitled to the benefits of Section 2.20 of the Credit
Agreement with respect thereto. Each Continuing Tranche B Term Lender hereby waives the benefits of Section 2.20 of the Credit Agreement with respect to that portion of the Tranche B Term Loans of such Lender continued hereunder.

  

	 	(b)	Notwithstanding anything herein to the contrary, the provisions of the Credit Agreement with respect to indemnification, reimbursement of costs and expenses, increased costs and break funding payments (other than to the
extent waived pursuant to Section 2(a)) shall continue in full force and effect with respect to, and for the benefit of, each existing Tranche B Term Lender in respect of such Lender’s existing Term Loans to the same extent expressly set
forth therein. 

  

	 	(c)	Notwithstanding anything in this Amendment to the contrary, the continuation of existing Tranche B Term Loans may be implemented pursuant to other procedures specified by the Administrative Agent, including, without
limitation, by replacement of such existing Tranche B Term Loans by a deemed repayment of such existing Tranche B Term Loans of a Continuing Tranche B Term Lender followed by a subsequent deemed assignment to it of new Tranche B Term Loans in the
same amount. 

  

	 	(d)	For the avoidance of doubt, the Lenders hereby acknowledge and agree that, at the sole option of the Administrative Agent, any Lender with existing Tranche B Term Loans that are replaced as contemplated hereby (whether
by assignment of its Tranche B Term Loans to one or more Additional Tranche B Term Lenders or otherwise) shall, automatically upon receipt (or deemed receipt) of the amount necessary to purchase such Lender’s existing Tranche B Term Loans so
replaced, at par, and pay all accrued interest thereon, be deemed to have assigned such Loans pursuant to a form of Assignment and Acceptance and, accordingly, no other action by the Lenders, the Administrative Agent or the Loan Parties shall be
required in connection therewith. The Lenders hereby agree to waive any notice requirements of the Credit Agreement in connection with the replacement of existing Tranche B Term Loans contemplated hereby (whether by assignment of such Tranche B Term
Loans to one or more Additional Tranche B Term Lenders or otherwise). 

  

	3.	Effective Date Conditions. This Amendment will become effective on the date (the “Effective Date”) on which each of the following conditions have been satisfied (or waived) in accordance
with the terms therein: 

  

	 	(a)	the Administrative Agent shall have received (i) this Amendment executed and delivered by the Borrower, the other Loan Parties and the Administrative Agent and (ii) a Lender Addendum, executed and delivered by
each of the Additional Tranche B Term Lenders and the Continuing Tranche B Term Lenders; 

  

	 	(b)	the Administrative Agent shall have received a certificate of the Borrower dated as of the Effective Date signed by a Responsible Officer of the Borrower (i) (A) certifying and attaching the resolutions or
similar consents adopted by the Borrower approving or consenting to this Amendment, (B) certifying that the certificate or articles of incorporation and by-laws of the Borrower, in each case, either (x) has not been amended since the
Closing Date or (y) is attached as an exhibit to such certificate, and (C) certifying as to the incumbency and specimen signature of each officer executing this Amendment and any related documents on behalf of the Borrower and
(ii) certifying as to the matters set forth in clauses (d), (e) and (f) below; 

  
 3 

	 	(c)	all fees and out-of-pocket expenses for which invoices have been presented prior to the Effective Date (including the reasonable fees and expenses of legal counsel) required to be paid or reimbursed by the Borrower
pursuant to Section 10.5 of the Credit Agreement or any other letter agreement in connection with this Amendment shall have been paid or reimbursed; 

  

	 	(d)	each of the representations and warranties made by each Loan Party contained in the Credit Agreement and in the other Loan Documents shall be true and correct in all material respects as of the Effective Date as if made
on and as of such date (other than representations and warranties which speak only as of a certain date, which representations and warranties shall be made only on such date); 

 

	 	(e)	the representations and warranties in Section 4 of this Amendment shall be true and correct in all material respects as of the Effective Date; and 

 

	 	(f)	no Event of Default shall exist on the Effective Date immediately before and after giving effect to the effectiveness hereof. 

  

	4.	Representations and Warranties. By its execution of this Amendment, the Borrower hereby certifies that the execution, delivery and performance by the Borrower and each other Loan Party of this Amendment, and each
other Loan Document executed or to be executed by it in connection with this Amendment are within such Loan Party’s corporate or other organizational powers and have been duly authorized by all necessary corporate, limited liability company, or
other organizational action on the part of such Loan Party. This Amendment has been duly executed and delivered by each Loan Party and constitutes, and each other Loan Document to which any Loan Party is to be a party, when executed and delivered by
such Loan Party, will constitute, a legal, valid and binding obligation of such Loan Party, enforceable in accordance with its terms and the terms of the Credit Agreement, subject to applicable bankruptcy, insolvency, reorganization, moratorium or
other laws affecting creditors’ rights generally and subject to general principles of equity, regardless of whether considered in a proceeding in equity or at law and an implied covenant of good faith and fair dealing. 

 

	5.	Reaffirmation of the Loan Parties. Each Loan Party hereby consents to the amendment of the Credit Agreement effected hereby and confirms and agrees that, notwithstanding the effectiveness of this Agreement, each
Loan Document to which such Loan Party is a party is, and the obligations of such Loan Party contained in the Credit Agreement, this Amendment or in any other Loan Document to which it is a party are, and shall continue to be, in full force and
effect and are hereby ratified and confirmed in all respects, in each case as amended by this Amendment. For greater certainty and without limiting the foregoing, each Loan Party hereby confirms that the existing security interests granted by such
Loan Party in favor of the Administrative Agent for the benefit of, among others, the Lenders pursuant to the Loan Documents in the Collateral described therein shall continue to secure the obligations of the Loan Parties under the Credit Agreement
and the other Loan Documents as and to the extent provided in the Loan Documents. 

  

	6.	Amendment, Modification and Waiver. This Amendment may not be amended, modified or waived except as permitted by Section 10.1 of the Credit Agreement. 

  
 4 

	7.	Entire Agreement. This Amendment, the Credit Agreement and the other Loan Documents constitute the entire agreement among the parties with respect to the subject matter hereof and thereof and supersede all other
prior agreements and understandings, both written and verbal, among the parties or any of them with respect to the subject matter hereof. This Amendment shall not constitute a novation of any amount owing under the Credit Agreement and all amounts
owing in respect of principal, interest, fees and other amounts pursuant to the Credit Agreement and the other Loan Documents shall, to the extent not paid or exchanged on or prior to the Effective Date, shall continue to be owing under the Credit
Agreement or such other Loan Documents until paid in accordance therewith. 

  

	8.	GOVERNING LAW. THIS AMENDMENT AND THE RIGHTS AND OBLIGATIONS OF THE PARTIES HEREUNDER SHALL BE GOVERNED BY, CONSTRUED AND INTERPRETED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK, WITHOUT REGARD TO
CONFLICTS OF LAW PRINCIPLES THAT WOULD REQUIRE THE APPLICATION OF THE LAWS OF ANOTHER JURISDICTION. SECTIONS 10.12 AND 10.16 OF THE CREDIT AGREEMENT ARE HEREBY INCORPORATED BY REFERENCE INTO THIS AMENDMENT AND SHALL APPLY HERETO.

  

	9.	Severability. Any term or provision of this Amendment which is invalid or unenforceable in any jurisdiction shall, as to that jurisdiction, be ineffective to the extent of such invalidity or unenforceability
without rendering invalid or unenforceable the remaining terms and provisions of this Amendment or affecting the validity or enforceability of any of the terms or provisions of this Agreement in any other jurisdiction. 

 

	10.	Counterparts. This Amendment may be executed in counterparts (including by facsimile or other electronic transmission), each of which shall be deemed to be an original, but all of which shall constitute one and
the same agreement. 

  

	11.	WAIVER OF JURY TRIAL. EACH PARTY HERETO HEREBY IRREVOCABLY WAIVES, TO THE FULLEST EXTENT PERMITTED BY APPLICABLE LAW, ANY RIGHT IT MAY HAVE TO A TRIAL BY JURY IN ANY SUIT, ACTION, PROCEEDING OR COUNTERCLAIM
(WHETHER BASED ON CONTRACT, TORT OR ANY OTHER THEORY) DIRECTLY OR INDIRECTLY ARISING OUT OF OR RELATING TO THIS AMENDMENT OR THE TRANSACTIONS CONTEMPLATED HEREBY. 

 

	12.	Loan Document. On and after the Effective Date, this Amendment shall constitute a “Loan Document” for all purposes of the Credit Agreement and the other Loan Documents (it being understood that for the
avoidance of doubt this Amendment may be amended or waived solely by the parties hereto as set forth in Section 6 above). 

[signature pages to follow] 

  
 5 

 IN WITNESS WHEREOF, each of the undersigned has caused its duly authorized officer to
execute and deliver this Amendment as of the date first set forth above. 
  

			
	NATIONAL MENTOR HOLDINGS, INC., as Borrower
		
	By:	 	/s/ Denis Holler
		 	Name: Denis Holler
		 	Title:   Chief Financial Officer

  

			
	NMH HOLDINGS, LLC, as Holdings
		
	By:	 	/s/ Denis Holler
		 	Name: Denis Holler
		 	Title:   Chief Financial Officer
	
	SUBSIDIARY GUARANTORS:
	
	ADULT DAY HEALTH, INC.
	CALIFORNIA MENTOR FAMILY HOME         AGENCY, LLC
	CENTER FOR COMPREHENSIVE SERVICES,         INC.
	COMMUNITY REINTEGRATION SERVICES,         INC.
	CORNERSTONE LIVING SKILLS, INC.
	FAMILY ADVOCACY SERVICES, LLC
	 FIRST STEP INDEPENDENT LIVING PROGRAM,

        INC.

	HORRIGAN COLE ENTERPRISES, INC.
	ILLINOIS MENTOR, INC.
	ILLINOIS MENTOR COMMUNITY SERVICES,         INC.
	INSTITUTE FOR FAMILY CENTERED         SERVICES, INC.
	LOYD’S LIBERTY HOMES, INC.
	MASSACHUSETTS MENTOR, LLC
	MENTOR ABI, LLC
	MENTOR MANAGEMENT, INC.
	MENTOR MARYLAND, INC.
	NATIONAL MENTOR HEALTHCARE, LLC
	NATIONAL MENTOR HOLDINGS, LLC
	NATIONAL MENTOR SERVICES HOLDINGS,         LLC
	NATIONAL MENTOR SERVICES, LLC
	NATIONAL MENTOR, LLC
	NRMI, LLC
	OHIO MENTOR, INC.
	 PROGRESSIVE LIVING UNITS SYSTEMS-

        NEW JERSEY, INC.

	REM ARROWHEAD, INC.
	REM CENTRAL LAKES, INC.
	REM COMMUNITY OPTIONS, LLC

  
 [Signature Page to
Amendment No. 5 to Credit Agreement] 

 
			
	 REM CONNECTICUT COMMUNITY SERVICES,

        INC.

	REM DEVELOPMENTAL SERVICES, INC.
	REM EAST, LLC
	REM HEARTLAND, INC.
	REM HENNEPIN, INC.
	REM INDIANA COMMUNITY SERVICES, INC.
	REM INDIANA COMMUNITY SERVICES II, INC.
	REM INDIANA, INC.
	REM IOWA COMMUNITY SERVICES, INC.
	REM IOWA, INC.
	 REM MINNESOTA COMMUNITY SERVICES,

        INC.

	REM MINNESOTA, INC.
	REM NEVADA, INC.
	REM NEW JERSEY, INC.
	REM NORTH DAKOTA, INC.
	REM NORTH STAR, INC.
	REM OCCAZIO, INC.
	REM OHIO, INC.
	REM OHIO WAIVERED SERVICES, INC.
	REM OHIO II, LLC
	REM RAMSEY, INC.
	REM RIVER BLUFFS, INC.
	REM SOUTH CENTRAL SERVICES, INC.
	REM SOUTHWEST SERVICES, INC.
	REM WEST VIRGINIA, LLC
	REM WISCONSIN, INC.
	REM WISCONSIN II, INC.
	REM WISCONSIN III, INC.
	REM WOODVALE, INC.
	SOUTH CAROLINA MENTOR, INC.
	TRANSITIONAL SERVICES, LLC
	UNLIMITED QUEST, INC.

  

			
	By:	 	/s/ Denis Holler
	Name:	 	Denis Holler
	Title:	 	Chief Financial Officer
	
	CAREMERIDIAN, LLC
		
	By:	 	/s/ Denis Holler
	Name:	 	Denis Holler
	Title:	 	Treasurer

  
 [Signature Page to
Amendment No. 5 to Credit Agreement] 

 
			
	BARCLAYS BANK, PLC, as Administrative Agent
		
	By:	 	/s/ Christopher M. Aitkin
		 	Name: Christopher M. Aitkin
		 	Title: Assistant Vice President

  
 [Signature Page to
Amendment No. 5 to Credit Agreement] 

 Exhibit A to 

Amendment No. 5 to 

Credit Agreement 
 LENDER
ADDENDUM (CONTINUING TRANCHE B TERM LENDER) 
 May [●], 2017 

Reference is made to the Credit Agreement, dated as of January 31, 2014 (as amended by Amendment No. 1 to Credit Agreement dated as
of September 8, 2014, as further amended by Amendment No. 2 to Credit Agreement dated as of October 21, 2014, as further amended by Amendment No. 3 to Credit Agreement dated as of February 27, 2015, as further amended by
that certain letter agreement dated as of April 12, 2016 and as further amended, supplemented, amended and restated or otherwise modified from time to time, the “Credit Agreement” ; unless otherwise defined herein, terms
defined therein being used herein as therein defined), among National Mentor Holdings, Inc., a Delaware corporation (the “Borrower”), NMH Holdings, LLC, Barclays Bank PLC, as administrative agent (the “Administrative
Agent”) and each Lender from time to time party thereto. 
 As provided in Section 2 of that certain Amendment No. 5 to
Credit Agreement (the “Fifth Amendment”), dated as of May [●], 2017, by and among the Borrower, the other Loan Parties party thereto, the Administrative Agent and the other Lenders party thereto, upon execution and
delivery of this Lender Addendum (Continuing Tranche B Term Lender) by the undersigned, the Continuing Tranche B Term Lender named herein hereby consents to the Fifth Amendment and the amendments and other terms contained therein and, in each case,
as of the Effective Date (please check only one): 
  

	 	☐	OPTION 1: Cashless Settlement  

 (i) elects to continue its existing
Tranche B Term Loans outstanding immediately before giving effect to the Fifth Amendment as a Tranche B Term Loan under the Credit Agreement in a principal amount equal to the Tranche B Term Commitment set forth in Schedule 1 hereto,
effective as of the Effective Date (as defined in the Fifth Amendment) and (ii) represents and warrants to the Administrative Agent that it has the organizational power and authority to execute, deliver and perform its obligations under this
Lender Addendum (Continuing Tranche B Term Lender) and the Fifth Amendment (including, without limitation, with respect to any exchange contemplated hereby) and has taken all necessary corporate and other organizational action to authorize the
execution, delivery and performance of this Lender Addendum (Continuing Tranche B Term Lender) and the Fifth Amendment. 
  

	 	☐	OPTION 2: Post-Closing Settlement  

 (i) elects to have the full amount
of its existing Tranche B Term Loans outstanding immediately before giving effect to the Fifth Amendment purchased and agrees to promptly purchase an equal amount (or lesser amount, based on the allocation of the Tranche B Term Loans by the
Administrative Agent and the Borrower) of Tranche B Term Loans and (ii) represents and warrants to the Administrative Agent that it has the organizational power and authority to execute, deliver and perform its obligations under this Lender
Addendum (Continuing Tranche B Term Lender) and the Fifth Amendment (including, without limitation, with respect to any exchange contemplated hereby) and has taken all necessary corporate and other organizational action to authorize the execution,
delivery and performance of this Lender Addendum and the Fifth Amendment. 

 THIS LENDER ADDENDUM (CONTINUING TRANCHE B TERM LENDER) SHALL BE GOVERNED BY, AND CONSTRUED AND
INTERPRETED IN ACCORDANCE WITH, THE LAW OF THE STATE OF NEW YORK. 
 Delivery of an executed signature page hereof by facsimile or
electronic mail transmission shall be effective as delivery of a manually executed counterpart hereof. 
 [SIGNATURE PAGES FOLLOW] 

 IN WITNESS WHEREOF, the parties hereto have caused this Lender Addendum (Continuing Tranche B
Term Lender) to be duly executed and delivered by their proper and duly authorized officers as of the date first set forth above. 
  

	
	Name of Institution:
	
	_________________________________, as Lender

 
			
		
	By:	 	 
	Name:	 	
	Title:	 	
	
	

 For any Lender requiring a second signature line: 

 

			
	By:	 	 
	Name:	 	
	Title:	 	

  
 [Signature Page to
Amendment No. 5 Lender Addendum (Continuing Tranche B Term Lender)] 

 Schedule 1 to 

Amendment No. 5 Lender Addendum 

(Continuing Tranche B Term Lender) 

TRANCHE B TERM COMMITMENT 
 AND
NOTICE ADDRESS 
  

	1.	Name of Lender:                _______________________________ 

 

	2.	Notice Address: ______________________________ 

  

	 	      _______________________________	

  

	 	      _______________________________	

  

	 	      _______________________________	

Attention:          _______________________________ 

Telephone:        _______________________________ 

Facsimile:         _______________________________ 

 

	3.	Tranche B Term Commitment: $_________________ 

 Exhibit B to 

Amendment No. 5 to 

Credit Agreement 
 LENDER
ADDENDUM (ADDITIONAL TRANCHE B TERM LENDER) 
 May [●], 2017 

Reference is made to the Credit Agreement, dated as of January 31, 2014 (as amended by Amendment No. 1 to Credit Agreement dated as
of September 8, 2014, as further amended by Amendment No. 2 to Credit Agreement dated as of October 21, 2014, as further amended by Amendment No. 3 to Credit Agreement dated as of February 27, 2015, as further amended by
that certain letter agreement dated as of April 12, 2016 and as further amended, supplemented, amended and restated or otherwise modified from time to time, the “Credit Agreement”; unless otherwise defined herein, terms defined
therein being used herein as therein defined), among National Mentor Holdings, Inc., a Delaware corporation (the “Borrower”), NMH Holdings, LLC, Barclays Bank PLC, as administrative agent (the “Administrative
Agent”) and each Lender from time to time party thereto. 
 As provided in Section 2 of that certain Amendment No. 5 to
Credit Agreement (the “Fifth Amendment”), dated as of May [●], 2017, by and among the Borrower, the other Loan Parties party thereto, the Administrative Agent and the other Lenders party thereto, upon execution and
delivery of this Lender Addendum (Additional Tranche B Term Lender) (this “Addendum”) by the undersigned, the Additional Tranche B Term Lender named herein hereby takes by assignment from one or more Non-Consenting Lenders a
principal amount of Tranche B Term Loans equal to the Tranche B Term Commitment set forth in Schedule 1 hereto (such commitment, the “Assigned Interest”) and, as a result, effective as of the Effective Date (as defined in the
Fifth Amendment), hereby becomes a Tranche B Term Lender under the Credit Agreement. 
 The undersigned (a) represents and warrants
that (i) it has full power and authority, and has taken all action necessary, to execute and deliver this Lender Addendum (Additional Tranche B Term Lender) and to consummate the transactions contemplated hereby and to become a Lender under the
Credit Agreement, (ii) it satisfies the requirements, if any, specified in the Credit Agreement that are required to be satisfied by it in order to acquire the Assigned Interest and become a Lender, (iii) from and after the Effective Date,
it shall be bound by the provisions of the Credit Agreement as a Lender thereunder and, to the extent of the Assigned Interest, shall have the obligations of a Lender thereunder, (iv) it has received and/or had the opportunity to review a copy
of the Credit Agreement to the extent it has in its sole discretion deemed necessary, together with copies of the most recent financial statements delivered pursuant to Section 6.1 thereof, as applicable, and such other documents and
information as it has in its sole discretion deemed appropriate to make its own credit analysis and decision to enter into this Lender Addendum (Additional Tranche B Term Lender) and to purchase the Assigned Interest on the basis of which it has
made such analysis and decision independently and without reliance on the Administrative Agent or any other Lender, (v) it is not a Defaulting Lender and (vi) it is not a Disqualified Lender; and (b) agrees that (i) it will,
independently and without reliance on the Administrative Agent or any other Lender, and based on such documents and information as it shall deem appropriate at the time, continue to make its own credit decisions in taking or not taking action under
the Loan Documents, and (ii) it will perform in accordance with their terms all of the obligations which by the terms of the Loan Documents are required to be performed by it as a Lender. 

THIS LENDER ADDENDUM (ADDITIONAL TRANCHE B TERM LENDER) SHALL BE GOVERNED BY, AND CONSTRUED AND INTERPRETED IN ACCORDANCE WITH, THE LAW OF THE
STATE OF NEW YORK. 

 Delivery of an executed signature page hereof by facsimile or electronic mail transmission shall
be effective as delivery of a manually executed counterpart hereof. 
 [SIGNATURE PAGES FOLLOW] 

 IN WITNESS WHEREOF, the parties hereto have caused this Lender Addendum (Additional Tranche B
Term Lender) to be duly executed and delivered by their proper and duly authorized officers as of the date first set forth above. 
  

	
	Name of Institution:
	
	_________________________________, as Lender

 
			
		
	By:	 	 
	Name:	 	
	Title:	 	
	
	

 For any Lender requiring a second signature line: 

 

			
	By:	 	 
	Name:	 	
	Title:	 	

  
 [Signature Page to
Amendment No. 5 Lender Addendum (Additional Tranche B Term Lender)] 

 Schedule 1 to 

Fifth Amendment Lender Addendum 

(Additional Tranche B Term Lender) 

TRANCHE B TERM COMMITMENT 
 AND
NOTICE ADDRESS 
  

	1.	Name of Lender:                _______________________________ 

 

	2.	Notice Address: ______________________________ 

  

	 	      _______________________________	

  

	 	      _______________________________	

  

	 	      _______________________________	

Attention:          _______________________________ 

Telephone:        _______________________________ 

Facsimile:         _______________________________ 

 

	3.	Tranche B Term Commitment: $_________________

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00271-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00271-of-00352.parquet"}]]