Document:

ex10-1.htm

Exhibit 10.1

 

 

EXECUTIVE EMPLOYMENT AGREEMENT

 

THIS EMPLOYMENT AGREEMENT (“Agreement”) is made and entered into as of June 2, 2017 (the “Effective Date”) by and between NovaBay Pharmaceuticals, Inc. (“Company”) and Mark Sieczkarek (“Executive”).

 

RECITAL

 

The Company and Executive desire to formalize and reflect Executive’s employment under the terms and conditions of this Agreement. 

 

NOW, THEREFORE, in consideration of the foregoing recital, the mutual covenants herein contained and for other good and valuable consideration, the parties hereby agree as follows:

 

I.           EMPLOYMENT.

 

A.     Position and Responsibilities. The Company hereby employs the Executive as its Chief Executive Officer (“CEO”). Executive shall do and perform all such services and acts as are necessary or advisable to fulfill the duties and obligations of said position and/or such other and/or additional responsibilities as are reasonably delegated to Executive by the Company’s Board of Directors (the “Board”), consistent with the Company’s Bylaws. 

 

B.     Term. Executive’s employment with the Company is at-will and shall be governed by the terms of this Agreement, commencing on June 1, 2017 and continuing for one (1) year (the “Term”), unless this Agreement is terminated at some earlier time in accordance with the terms of this Agreement. 

 

C.     Devotion. During the term of this Agreement, Executive (i) shall devote the necessary skill, vision, and time and attention to the foregoing responsibilities; (ii) Executive will continue to render commercial and professional services as CEO of Fe3 Medical Inc., a privately-held company, with full knowledge and approval by the Board of Directors, but shall not engage in any other business or other activity which may materially interfere with Executive’s performance of said responsibilities without the prior written consent of the Company's Board of Directors; and (iii) except as to any investment made in a publicly-traded entity not amounting to more than one percent (1%) of its outstanding equity, shall not, directly or indirectly, as an employee, consultant, partner, principal, director or in any other capacity, engage or participate in any business that is in competition with the Company.

 

II.           PROPRIETARY RIGHTS, CONFIDENTIAL INFORMATION, NONSOLICITATION, ETC. 

 

Executive has executed an agreement relating to the treatment of (and Executive’s obligations as to) proprietary rights, confidential information, and certain non-solicitation and other matters. It is further understood and agreed that said agreement is deemed to continue in full force and effect, binding and not affected, in any manner, by the terms in this Agreement.

 

 

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III.           COMPENSATION AND BENEFITS.

 

Executive’s compensation and bonus rights are as follows:

 

A.     Salary. Executive shall be entitled to an annual cash salary of $440,000 (the “Base Salary”), subject to such deductions, withholding and other charges as required by law, payable in accordance with the Company’s standard payroll schedule. 

 

B.     Stock Option Grant. At the first scheduled Board meeting after the later of (1) the Effective Date of this Agreement; and, (2) such time as the pool of stock options under the Company’s 2017 Omnibus Incentive Plan (the “Option Plan”) is replenished to provide a sufficient pool from which to draw, the Board shall approve a stock option grant to purchase 250,000 shares of the Company's Common Stock at fair market value on the date of grant (the “Option”). One-fourth (1/4) of the shares subject to the Option will vest on January 31, 2018 in direct proportion to the percentage achievement of the stated 2017 corporate goals, as approved and determined by the Board of Directors. The remaining three fourths (3/4) of the shares subject to the Option shall vest in equal parts on January 31, 2019, January 31, 2020, and January 31, 2021 in direct proportion to the percentage achievement of the stated corporate goals for the previous fiscal year. The Option will be fully vested and exercisable on January 31, 2021, subject to Executive continuing to be an Employee (or otherwise providing services to the Company) through the relevant vesting dates. The Option will be subject to the terms, definitions and provisions of the Company's Option Plan and the stock option agreement by and between Executive and the Company (the “Option Agreement”), both of which documents will be presented to Executive at the time of grant. Executive acknowledges and agrees that he must execute the Company’s standard form of Option Agreement as an additional condition precedent to being eligible for the Option.

 

D.     Annual Bonus. In addition to the Base Salary, for each fiscal year ending during the Term, Executive shall have the opportunity to earn an annual performance bonus (the "Annual Bonus") in an amount up to fifty percent (50%) of Executive's Base Salary. The exact amount and composition of the Annual Bonus will be determined by the Board of Directors or its Compensation Committee in consultation with Executive, based upon mutually agreed, written performance objectives, both personal and corporate. Such goals will be mutually agreed upon by Executive and the Board at the beginning of each calendar year. The Compensation Committee of the Board of Directors shall have the sole discretion to pay any or all of the Annual Bonus in the form of equity compensation. Any such equity compensation shall be issued from the Option Plan and shall be fully vested upon payment.

 

E.     Long-Term Bonus. In addition to the Annual Bonus, for each fiscal year ending during the Term, Executive shall have the opportunity to earn a performance bonus (the "Long-Term Bonus"). The exact amount and composition of the Long-Term Bonus will be determined by the Board of Directors or its Compensation Committee in consultation with Executive, based upon mutually agreed, written performance objectives of the Company. The objectives for the Long-Term Bonus shall be distinct from those of the Annual Bonus and shall be derived from the Company’s long-term strategic plan. The Compensation Committee of the Board of Directors shall have the sole discretion to pay any or all of the Long-Term Bonus in the form of equity compensation. Any such equity compensation shall be issued from the Option Plan and shall be fully vested upon payment.

 

 

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F.     Other Benefits. Executive shall be entitled to six (6) weeks of paid vacation for each calendar year, which must be taken pursuant to the Company’s vacation benefits policy. Executive, in lieu of benefits generally available to the Company’s other similar, high-level executives, consisting of such medical, retirement and similar benefits, will receive a car allowance of $13,500 annually, paid in equal monthly installments.

 

IV.          TERMINATION.

 

A.          At-Will Employment. It is understood and agreed by the Company and Executive that this Agreement does not contain any promise or representation concerning the duration of Executive's employment with the Company. Executive specifically acknowledges that his employment with the Company is at-will and may be altered or terminated by either Executive or the Company at any time, with or without cause and with or without notice. In addition, the fact that rate of salary, any bonuses, paid time off, other compensation, or vesting schedules are stated in units of years or months or weeks does not alter the at-will nature of the employment, and does not mean and should not be interpreted to mean that Executive is guaranteed employment to the end of any period of time or for any period of time. In the event of conflict between this provision and any other statement, oral or written, present or future, concerning terms and conditions of employment, the at-will relationship confirmed by this provision shall control. This at-will status cannot be altered, except in a writing signed by Executive and formally approved by the Company’s Board of Directors.

 

B.           Termination of Employment. Although Executive’s employment hereunder shall be deemed “at-will,” the following definitions will apply to any termination:

 

1.     For Cause. In the event that Executive is Terminated For Cause (as hereinafter defined), Executive shall only be entitled to Executive’s earned wages through the date his employment with the Company is terminated, his accrued but unused vacation, reimbursements of his outstanding expenses incurred and submitted in compliance with Company policies and any other portion of his compensation earned through the termination date.

 

2.     Change of Control. In the event that Executive is terminated in connection with a Change of Control (as hereinafter below), in exchange for Executive signing and not revoking a general release of claims in a form acceptable to the Company, Executive shall be entitled to (i) an amount equal to twice Executive’s Base Salary (“CoC Severance”) and (ii) an amount equal to the cash portion of Executive's target Annual Bonus for the fiscal year in which the termination occurs (with it deemed that all performance goals have been met at one hundred percent (100%) of budget or plan) multiplied by one hundred fifty percent (150%). For a period of eighteen (18) months, Executive may elect coverage for, and the Company shall reimburse Executive for, the amount of his premium payments for group health coverage, if any, elected by Executive pursuant to the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended ("COBRA"); provided, however, that Executive shall be solely responsible for all matters relating to his continuation of coverage pursuant to COBRA, including (without limitation) his election of such coverage and his timely payment of premiums.

 

 

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a.     A "Change of Control" means the occurrence of any of the following events: (i) any sale or exchange of the capital stock by the shareholders of the Company in one transaction or series of related transactions where more than fifty percent (50%) of the outstanding voting power of the Company is acquired by a person or entity or group of related persons or entities; or (ii) any reorganization, consolidation or merger of the Company where the outstanding voting securities of the Company immediately before the transaction represent or are converted into less than fifty percent (50%) of the outstanding voting power of the surviving entity (or its parent corporation) immediately after the transaction; or (iii) the consummation of any transaction or series of related transactions that results in the sale of all or substantially all of the assets of the Company; or (iv) a reverse merger; or (v) any "person" or "group" (as defined in the Securities Exchange Act of 1934, as amended (the "Exchange Act")) becoming the "beneficial owner" (as defined in Rule 13d-3 under the Exchange Act) directly or indirectly of securities representing more than fifty percent (50%) of the voting power of the Company then outstanding; or (vi) less than a majority of the current Board of Directors are persons who were either nominated for election by the current Board of Directors or were elected by the current Board of Directors.

 

3.           Termination Apart from Change of Control.

 

a.            Termination. If Executive's employment with the Company terminates as a result of a Termination Without Cause (as hereinafter defined), Executive will be entitled to receive the following severance and other benefits:

 

(i) Severance Pay. The Company shall pay to Executive an amount equal to (a) eighteen (18) months of Executive's then-current Base Salary, plus (b) an amount equal to the cash portion of Executive's target Annual Bonus for the fiscal year in which the termination occurs (with it deemed that all performance goals have been met at one hundred percent (100%) of budget or plan). Such severance payment shall be paid in one lump sum thirty (30) calendar days following the date of Executive's termination. In addition, Executive shall be eligible for reimbursement of his COBRA premium for a period of eighteen (18) months following Executive's termination; provided, however, that Executive shall be solely responsible for all matters relating to his continuation of coverage pursuant to COBRA, including (without limitation) his election of such coverage and his timely payment of premiums; provided, further, that upon the earlier to occur of (c) the time that Executive no longer is a Qualified Beneficiary (as such term is defined in Section 4980(B)(g)(l) of the Code) and (d) the date eighteen (18) months following Executive's termination, the Company’s obligations to reimburse Executive under this subsection shall cease.

 

(ii) Equity Award Acceleration. The vesting and exercisability of any outstanding equity awards shall be automatically accelerated as to the amount of the unvested shares subject thereto at the time of the termination that would have vested had the Executive remained employed by the Company for eighteen (18) months following the date of such termination. The foregoing provision is hereby deemed to be a part of each agreement evidencing any equity award and to supersede any contrary provision in any agreement relating thereto.

 

 

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C.           Related Provisions. The following terms, conditions and definitions shall apply to the termination of Executive:

 

1.          “Termination Without Cause.” For purposes of Section IV.B above, a Termination Without Cause shall be deemed to constitute any termination of Executive’s employment hereunder by the Company other than a Termination For Cause, as defined below. Notwithstanding any contrary provision herein, it is understood that a Termination Without Cause also shall include a termination which:

 

(a)     occurs due to the death of Executive or to any physical or mental Long-Term Disability (as hereinafter defined) that would prevent the performance of Executive’s duties under this Agreement. For the purposes of this Agreement, a “Long-Term Disability” shall mean a disability that, after consideration and implementation of reasonable accommodations (provided that no accommodation that imposes undue hardship on the Company will be required), renders or will render Executive unable to perform his essential job functions for one hundred eighty (180) calendar days out of any three hundred sixty-five (365) calendar day period or for four consecutive months. The determination of Executive’s Long-Term Disability shall be made by Executive’s attending physician unless the Board disagrees with such determination, in which case Executive’s Long-Term Disability shall be determined by a majority of three physicians qualified to practice medicine in the state of Executive’s residence: one to be selected by each of Executive (or his authorized representative) and the Board, and the third to be selected by such two designated physicians; or

 

(b)     is a Constructive Termination (as hereinafter defined) initiated by Executive. "Constructive Termination" shall mean (i) the assignment or partial assignment of any duties or responsibilities materially inconsistent in any respect with those customarily associated with the position or those actually provided in this Agreement (including status, offices, titles and reporting requirements) to be held by Executive during the Term, or any other action by the Company that results in a significant diminution or other material reduction or any substantially adverse change in Executive’s position, title, authority, duties or responsibilities; (ii) any failure by the Company to comply with any material provision of this Agreement; (iii) a relocation of Executive’s principal place of employment more than thirty-five (35) miles from its current location; (iv) any material reduction in Executive’s Base Salary, target Annual Bonus or target Long-Term Bonus, unless such reduction is part of a program reducing the base salary and/or bonus opportunity of all C-level employees; (v) a material reduction in the kind or level of benefits to which Executive was entitled immediately prior to such reduction; (vi) a material reduction of the facilities and perquisites (including office space and location) or secretarial and administrative support available to Executive immediately prior to such reduction; or (viii) the failure of any successor-in-interest to assume all of the obligations of the Company under this Agreement. In order for Executive to resign due to a Constructive Termination and be eligible for severance benefits, he must provide the Company with written notification of the basis for his belief that he is being Constructively Terminated and provide the Company with an opportunity to cure any perceived deficiency as set forth below in Section IV.E. 

 

 

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2.           “Termination For Cause.” Subject to the notice requirement as provided in Section IV.E below, for purposes of Section IV.B.2 (and Section IV.C.1) above, a Termination For Cause shall be a termination of Executive’s employment hereunder made:

 

(a)          by the Company, if Executive:

 

(i) materially breaches any material terms of this Agreement; (ii) commits willful gross acts of dishonesty, fraud, misrepresentation, or other acts of moral turpitude in connection with Executive’s responsibilities as an employee, provided that no act or failure to act shall be considered "willful" under this definition unless Executive acted, or failed to act, with an absence of good faith and without a reasonable belief that his action, or failure to act, was in the best interest of the Company; (iii) is convicted of any felony or any crime involving moral turpitude; or (iv) fails to achieve the stated milestones and tasks as requested in writing by the Board, including, but not limited to, failure to perform or continuing to neglect the performance of duties assigned to Executive, which failure or neglect will significantly and adversely affect the Company’s business or business prospects and which failure is due to circumstances within Executive’s reasonable control.

 

(b)          by Executive, unless such termination by Executive is for Constructive Termination.

 

D.     Company Actions. All relevant determinations to be made by the Company under paragraph IV.C.2(a) above shall be made in the reasonable discretion of the Board (or, if so delegated by said Board, by a committee of the Board), acting in good faith, and, except as otherwise specified herein, shall be conclusive and binding, but shall be subject to arbitration in accordance with Section V below. This Agreement is intended to comply with the requirements of Internal Revenue Code Section 409A (“Section 409A”) and the Board or the Board committee will interpret its provisions accordingly. If, at the time of Executive’s termination, any stock of the Company is publicly-traded and the Company determines that Executive is a “specified employee” within the meaning of Section 409A of the Code at such time, then (i) the salary continuation payments specified herein (to the extent that they are subject to Section 409A of the Code) will commence on the earlier of (A) the first business day following expiration of the six (6)-month period measured from Executive’s separation or (B) the date of Executive’s death, and (ii) the installments that otherwise would have been paid prior to such date will be paid in a lump sum when the salary continuation payments commence. Executive understands and agrees that the Company makes no assurances with respect to the tax consequences arising as a result of this Agreement, and the payment of any tax liabilities or related penalties arising out of this Agreement are solely and exclusively the responsibility of Executive, without any expectation or understanding that the Company will pay or reimburse Executive for such taxes or other items. Concerning any Section 409A taxes or related penalties, the Company will use its best efforts, in good faith, to reduce or eliminate such tax liabilities or penalties, including, but not limited to, a delay of such payments for the minimum time necessary to avoid tax liabilities or penalties. If any payment is delayed pursuant to this paragraph, on the date of payment the Company shall pay in a lump sum all payments that otherwise would have been paid during the period of the delayed payments.

 

 

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E.     Notice and Remedy. In the event that any reason for Termination For Cause by the Company under paragraph IV.C.2(a) above, or by Executive in the case of a Constructive Termination, may be cured by Executive or the Company, as the case may be, then the Company or Executive, as applicable, shall first give a written notice to the other party (by mail, email, or fax, to the last known address of the recipient; said notice being deemed given, if by mail, as of the earlier of four (4) calendar days after mailing or the date when actually received, or, if by email or fax, when sent), specifying the reason for Termination For Cause or Constructive Termination, as applicable, and providing a period of thirty (30) calendar days to cure the fault or reason specified. Lacking such cure within said thirty (30) calendar days, or if the notified party earlier refuses to effect the cure, the Termination For Cause or Constructive Termination, as applicable, shall then be deemed effective. If such cure is so made, the Termination For Cause or Constructive Termination, as applicable, shall not then be deemed effective, but any later conduct of a similar nature constituting a reason for Termination For Cause or Constructive Termination, as applicable, shall allow the Company or Executive, as the case may be, the right to cause the Termination For Cause or Constructive Termination, as applicable, to become effective without need for any further period of time to cure. All communications shall be sent to the address as set forth on the signature page hereof, or to such other address as a party may designate by ten (10) calendar days’ advance written notice to the other party hereto. 

 

V.           ARBITRATION.

 

A.     Arbitration. Any controversy or claim arising out of or relating to this Agreement, or the breach thereof, or any of the rights, benefits or obligations resulting from its terms, shall be settled by binding arbitration in San Francisco, California. Except for the right of the Company and Executive to seek injunctive relief in court, any controversy, claim or dispute of any type arising out of or relating to Executive’s employment or the provisions of this Agreement shall be resolved in accordance with this Section V of the Agreement, which will be the sole and exclusive procedure for the resolution of any such disputes. This Agreement shall be enforced in accordance with the Federal Arbitration Act, the enforcement provisions of which are incorporated herein by reference. Matters subject to these provisions include, without limitation, any and all claims or disputes whatsoever, including those claims based on statute, contract, common law and tort and will include, for example, matters pertaining to termination, discrimination, harassment, compensation and benefits. Matters to be resolved under these procedures also include claims and disputes arising out of statutes such as the Fair Labor Standards Act, Title VII of the Civil Rights Act, the Age Discrimination in Employment Act, the California Labor Code, and the California Fair Employment and Housing Act. Nothing in this provision is intended to restrict Executive from submitting any matter to an administrative agency with jurisdiction over such matter.

 

 

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Executive and the Company agree that any disputes related to or arising out of Executive’s employment with the Company will be determined by arbitration in accordance with the then-current JAMS employment arbitration rules and procedures, except as modified herein. The arbitration will be conducted by a sole neutral arbitrator. If the Company and Executive cannot agree on an arbitrator, then the arbitrator will be selected by JAMS in accordance with the JAMS employment arbitration rules and procedures. Reasonable discovery will be permitted by both parties, and the arbitrator may decide any issue as to discovery. The arbitrator may decide any issue as to whether or as to the extent to which any dispute is subject to arbitration in this Section V and may award any relief permitted by law. The arbitrator must render the award in writing, including an explanation of the reasons for the award. Judgment upon the award may be entered by any court having jurisdiction of the matter, and the decision of the arbitrator will be final and binding. The parties hereby waive, to the fullest extent permitted by law, any rights to appeal or to review of such award by any court. The statute of limitations applicable to the commencement of a lawsuit will apply to the commencement of arbitration under this Section V of this Agreement. At the request of any party, the arbitrator, attorneys, parties to the arbitration, witnesses, experts, court reporters or other persons present at the arbitration shall agree in writing to maintain the strict confidentiality of the arbitration proceedings. The arbitrator’s fees and cost of the Arbitration will be paid in full by the Company.

 

B.     Acknowledgement. EXECUTIVE HAS READ AND UNDERSTANDS THIS SECTION V, WHICH DISCUSSES ARBITRATION. EXECUTIVE UNDERSTANDS THAT BY SIGNING THIS AGREEMENT, EXECUTIVE AGREES TO SUBMIT ANY CLAIMS ARISING OUT OF, RELATING TO, OR IN CONNECTION WITH, THIS AGREEMENT, OR THE INTERPRETATION, VALIDITY, CONSTRUCTION, PERFORMANCE, BREACH OR TERMINATION THEREOF, TO ARBITRATION, AND THAT THE PROVISIONS SET FORTH IN THIS SECTION V CONSTITUTE A WAIVER OF EXECUTIVE’S RIGHT TO A JURY TRIAL.

 

C.     No Duty to Mitigate. Executive is under no contractual or legal obligation to mitigate Executive’s damages in order to receive the severance benefits provided in this Agreement.

 

VI.          LEGAL ADVICE.

 

Executive acknowledges that an opportunity has been afforded to Executive to consult with legal counsel with respect to this Agreement and that no individual representing the Company has given legal advice with respect to this Agreement.

 

VII.         MISCELLANEOUS AND CONSTRUCTION.

 

Except as otherwise specifically provided herein, this Agreement:

 

A.     and any benefits or obligations herein may not be assigned or delegated by Executive (but may be so assigned or delegated by the Company);

 

B.     contains the entire understanding of the parties as to its subject matter, and replaces and supersedes any existing employment agreement and any and all contrary prior understandings or agreements, whether written or verbal;

 

C.     may be amended or modified only by a written amendment or modification signed by the Company and Executive that expressly references this Agreement;

 

 

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D.     is made in, and shall be construed under, the laws of the State of California;

 

E.     inures to the benefit of, and is binding upon, the permitted successors, assigns, distributees, personal representatives, heirs and other successors-in-interest to and of the parties hereto;

 

F.     shall not be interpreted by reference to any of the captions or headings of the paragraphs herein, which captions or headings have been inserted for convenience purposes only;

 

G.     shall be fully effectuated in accordance with its tenor, effect and purposes by each of the parties hereto by executing such further documents or taking such other actions as may be reasonably requested by the other party hereto; 

 

H.     shall be interpreted, as to its remaining provisions, to be fully lawful and operative, to the extent reasonably required to fulfill its principal tenor, effect and purposes, in the event that any provision either is found by any court of competent jurisdiction to be unlawful or inoperative or to violate any statutory or legal requirement, and the balance of the Agreement shall be interpreted as if such provision were so excluded and shall be enforceable in accordance with its terms; and

 

I.     may be executed in more than one counterpart, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument.

 

 

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IN WITNESS WHEREOF, the Company and Executive have executed this Agreement as of the day and year first above written.

 

	
 
	COMPANY:
	 	 	 
	
 
	NOVABAY PHARMACEUTICALS, INC.
	 	 	 
	 	 	 
	 	By:	/s/ Paul E. Freiman                                           
	 	Name:	Paul E. Freiman
	 	Title:	Chairman of the Compensation Committee
	 	Address:	2000 Powell Street, Suite 1150
	 	 	Emeryville, CA 94608
	 	E-mail:	At the email address most recently on the books and records of the Company.
	 	 	 
	
 
	EXECUTIVE:	
 

	 	 	 
	 	 	 
	 	By:	/s/ Mark Sieczkarek                                         
	 	Name:	Mark Sieczkarek
	 	Address:	At the address most recently on the books and records of the Company.
	 	Telephone No.	At the telephone number most recently on the books and records of the Company.
	 	E-mail:	At the email address most recently on the books and records of the Company.

 

 

10Form of Medium-Term Notes, Series K

 Exhibit 4.1 

[Face of Note] 

Unless this certificate is presented by an authorized representative of The Depository Trust Company, a New York corporation
(“DTC”), to the Company or its agent for registration of transfer, exchange or payment, and any certificate issued is registered in the name of Cede & Co. or in such other name as requested by an authorized representative
of DTC (and any payment is made to Cede & Co. or such other entity as is requested by an authorized representative of DTC), ANY TRANSFER, PLEDGE OR OTHER USE HEREOF FOR VALUE OR OTHERWISE BY OR TO ANY PERSON IS WRONGFUL inasmuch as the
registered owner hereof, Cede & Co., has an interest herein. 
  

					
	 CUSIP NO. 94986R5X5
	  	 	FACE AMOUNT: $                  	 
	 REGISTERED NO.       
	  			

 WELLS FARGO & COMPANY 

MEDIUM-TERM NOTE, SERIES K 

Due Nine Months or More From Date of Issue 

Principal at Risk Securities Linked to the EURO STOXX 50® Index 

due December 6, 2021 

WELLS FARGO & COMPANY, a corporation duly organized and existing under the laws of the State of Delaware (hereinafter
called the “Company,” which term includes any successor corporation under the Indenture hereinafter referred to), for value received, hereby promises to pay to CEDE & Co., or registered assigns, an amount equal to the
Redemption Amount (as defined below), in such coin or currency of the United States of America as at the time of payment is legal tender for payment of public and private debts, on the Stated Maturity Date. The “Initial Stated Maturity
Date” shall be December 6, 2021. If the Calculation Day (as defined below) is not postponed, the Initial Stated Maturity Date will be the “Stated Maturity Date.” If the Calculation Day is postponed, the “Stated
Maturity Date” shall be the later of (i) the Initial Stated Maturity Date and (ii) the third Business Day (as defined below) after the Calculation Day as postponed. This Security shall not bear any interest. 

Any payments on this Security at Maturity will be made against presentation of this Security at the office or agency of the
Company maintained for that purpose in the City of Minneapolis, Minnesota and at any other office or agency maintained by the Company for such purpose. 

“Face Amount” shall mean, when used with respect to this Security, the amount set forth on the face of this
Security as its “Face Amount.” 

 Determination of Redemption Amount 

The “Redemption Amount” of this Security will equal: 

 

	 	•	 	if the Ending Level is greater than or equal to the Starting Level: the Face Amount plus: 

  

																			
		 	 	 	  Face Amount x    	 	 	 	 Ending Level – Starting Level

Starting Level
	 	 	 	    x Participation Rate	 	 	 	  ;
	 	

  

	 	•	 	if the Ending Level is less than the Starting Level, but greater than or equal to the Threshold Level: the Face Amount; or 

  

	 	•	 	if the Ending Level is less than the Threshold Level: the Face Amount minus: 

  

											
		 	 	 	  Face Amount x    	 	 Starting Level – Ending Level

Starting Level
	 	 	 	

 All calculations with respect to the Redemption Amount will be rounded to the nearest one hundred-thousandth,
with five one-millionths rounded upward (e.g., 0.000005 would be rounded to 0.00001); and the Redemption Amount will be rounded to the nearest cent, with one-half cent rounded upward. 

“Index” shall mean the EURO STOXX 50® Index. 

The “Pricing Date” shall mean May 30, 2017. 

The “Starting Level” is 3561.22, the Closing Level of the Index on the Pricing Date. 

The “Closing Level” of the Index on any Trading Day means the official closing level of the Index reported by
the Index Sponsor on such Trading Day, as obtained by the Calculation Agent on such Trading Day from the licensed third-party market data vendor contracted by the Calculation Agent at such time; in particular, taking into account the decimal
precision and/or rounding convention employed by such licensed third-party market data vendor on such date, subject to the provisions set forth below under “Discontinuance of The Index; Alteration of Method of Calculation” and “Market
Disruption Events.” 
 The “Ending Level” will be the Closing Level of the Index on the Calculation
Day. 
 The “Threshold Level” is 2492.854, which is equal to 70% of the Starting Level. 

The “Participation Rate” is 180%. 

“Index Sponsor” shall mean STOXX Limited. 

  
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 “Business Day” shall mean a day, other than a Saturday or
Sunday, that is neither a legal holiday nor a day on which banking institutions are authorized or required by law or regulation to close in New York, New York. 

A “Trading Day” means a day, as determined by the Calculation Agent, on which (i) the Index Sponsor is
scheduled to publish the level of the Index and (ii) each Related Futures or Options Exchange is scheduled to be open for trading for its regular trading session. 

The “Related Futures or Options Exchange” for the Index means an exchange or quotation system where trading
has a material effect (as determined by the Calculation Agent) on the overall market for futures or options contracts relating to the Index. 

The “Relevant Stock Exchange” for any security underlying the Index means the primary exchange or quotation
system on which such security is traded, as determined by the Calculation Agent. 
 The “Calculation Day”
shall be November 29, 2021. If such day is not a Trading Day, the Calculation Day will be postponed to the next succeeding Trading Day. The Calculation Day is also subject to postponement due to the occurrence of a Market Disruption Event (as
defined below). If a Market Disruption Event occurs or is continuing on the Calculation Day, such Calculation Day will be postponed to the first succeeding Trading Day on which a Market Disruption Event has not occurred and is not continuing;
however, if such first succeeding Trading Day has not occurred as of the eighth Trading Day after the originally scheduled Calculation Day, that eighth Trading Day shall be deemed to be the Calculation Day. If the Calculation Day has been postponed
eight Trading Days after the originally scheduled Calculation Day and a Market Disruption Event occurs or is continuing on such eighth Trading Day, the Calculation Agent will determine the Closing Level of the Index on such eighth Trading Day in
accordance with the formula for and method of calculating the Closing Level of the Index last in effect prior to commencement of the Market Disruption Event, using the closing price (or, with respect to any relevant security, if a Market Disruption
Event has occurred with respect to such security, its good faith estimate of the value of such security at the time at which the official Closing Level of the Index is calculated and published by the Index Sponsor) on such date of each security
included in the Index. As used herein, “closing price” means, with respect to any security on any date, the Relevant Stock Exchange traded or quoted price of such security as of the time at which the official Closing Level of the
Index is calculated and published by the Index Sponsor. 
 “Calculation Agent Agreement” shall mean the
Calculation Agent Agreement dated as of March 18, 2015 between the Company and the Calculation Agent, as amended from time to time. 

“Calculation Agent” shall mean the Person that has entered into the Calculation Agent Agreement with the
Company providing for, among other things, the determination of the Ending Level and the Redemption Amount, which term shall, unless the context otherwise requires, include its successors under such Calculation Agent Agreement. The initial
Calculation Agent shall be Wells Fargo Securities, LLC. Pursuant to the Calculation Agent Agreement, the Company may appoint a different Calculation Agent from time to time after the initial issuance

  
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of this Security without the consent of the Holder of this Security and without notifying the Holder of this Security. 

Discontinuance Of The Index; Alteration Of Method Of Calculation 

If the Index Sponsor discontinues publication of the Index, and the Index Sponsor or another entity publishes a successor or
substitute equity index that the Calculation Agent determines, in its sole discretion, to be comparable to the Index (a “Successor Equity Index”), then, upon the Calculation Agent’s notification of that determination to the
Trustee and the Company, the Calculation Agent will substitute the Successor Equity Index as calculated by the Index Sponsor or any other entity and calculate the Ending Level as described above. Upon any selection by the Calculation Agent of a
Successor Equity Index, the Company will cause notice to be given to the Holder of this Security. 
 In the event that the
Index Sponsor discontinues publication of the Index prior to, and the discontinuance is continuing on, the Calculation Day and the Calculation Agent determines that no Successor Equity Index is available at such time, the Calculation Agent will
calculate a substitute Closing Level for the Index in accordance with the formula for and method of calculating the Index last in effect prior to the discontinuance, but using only those securities that comprised the Index immediately prior to that
discontinuance. If a Successor Equity Index is selected or the Calculation Agent calculates a level as a substitute for the Index, the Successor Equity Index or level will be used as a substitute for the Index for all purposes, including the purpose
of determining whether a Market Disruption Event exists. 
 If on the Calculation Day the Index Sponsor fails to
calculate and announce the level of the Index, the Calculation Agent will calculate a substitute Closing Level of the Index in accordance with the formula for and method of calculating the Index last in effect prior to the failure, but using only
those securities that comprised the Index immediately prior to that failure; provided that, if a Market Disruption Event occurs or is continuing on such day, then the provisions set forth above under the definition of “Calculation
Day” shall apply in lieu of the foregoing. 
 If at any time the Index Sponsor makes a material change in the
formula for or the method of calculating the Index, or in any other way materially modifies the Index (other than a modification prescribed in that formula or method to maintain the Index in the event of changes in constituent stock and
capitalization and other routine events), then, from and after that time, the Calculation Agent will, at the close of business in New York, New York, on each date that the Closing Level of the Index is to be calculated, calculate a substitute
Closing Level of the Index in accordance with the formula for and method of calculating the Index last in effect prior to the change, but using only those securities that comprised the Index immediately prior to that change. Accordingly, if the
method of calculating the Index is modified so that the level of the Index is a fraction or a multiple of what it would have been if it had not been modified, then the Calculation Agent will adjust the Index in order to arrive at a level of the
Index as if it had not been modified. 

  
 4 

 Market Disruption Events 

A “Market Disruption Event” means any of (A), (B), (C) or (D) below, as determined by the
Calculation Agent in its sole discretion: 
  

	 	(A)	 Any of the following events occurs or exists with respect to any security included in the Index or any
Successor Equity Index (as defined below), and the aggregate of all securities included in the Index or Successor Equity Index with respect to which any such event occurs comprise 20% or more of the level of the Index or Successor Equity Index:

  

	 	●	 	 a material suspension of or limitation imposed on trading by the Relevant Stock Exchange for such security or
otherwise at any time during the one-hour period that ends at the Scheduled Closing Time for the Relevant Stock Exchange for such security on that day, whether by reason of movements in price exceeding limits permitted by the Relevant Stock Exchange
or otherwise; 

  

	 	●	 	 any event, other than an early closure, that materially disrupts or impairs the ability of market participants
in general to effect transactions in, or obtain market values for, such security on its Relevant Stock Exchange at any time during the one-hour period that ends at the Scheduled Closing Time for the Relevant Stock Exchange for such security on that
day; or 

  

	 	●	 	 the closure on any Exchange Business Day of the Relevant Stock Exchange for such security prior to its
Scheduled Closing Time unless the earlier closing is announced by such Relevant Stock Exchange at least one hour prior to the earlier of (i) the actual closing time for the regular trading session on such Relevant Stock Exchange and
(ii) the submission deadline for orders to be entered into the Relevant Stock Exchange system for execution at the Scheduled Closing Time for such Relevant Stock Exchange on that day. 

 

	 	(B)	 Any of the following events occurs or exists with respect to futures or options contracts relating to the
Index or any Successor Equity Index: 

  

	 	●	 	 a material suspension of or limitation imposed on trading by any Related Futures or Options Exchange or
otherwise at any time during the one-hour period that ends at the close of trading on such Related Futures or Options Exchange on that day, whether by reason of movements in price exceeding limits permitted by the Related Futures or Options Exchange
or otherwise; 

  

	 	●	 	 any event, other than an early closure, that materially disrupts or impairs the ability of market participants
in general to effect transactions in, or obtain market values for, futures or options contracts relating to the Index or Successor Equity Index on any Related Futures or Options Exchange at any time during the one-hour period that ends at the close
of trading on such Related Futures or Options Exchange on that day; or 

  
 5 

	 	●	 	 the closure on any Exchange Business Day of any Related Futures or Options Exchange prior to its Scheduled
Closing Time unless the earlier closing time is announced by such Related Futures or Options Exchange at least one hour prior to the earlier of (i) the actual closing time for the regular trading session on such Related Futures or Options
Exchange and (ii) the submission deadline for orders to be entered into the Related Futures or Options Exchange system for execution at the close of trading for such Related Futures or Options Exchange on that day. 

 

	 	(C)	 The relevant index sponsor fails to publish the level of the Index or any Successor Equity Index (other than
as a result of the relevant index sponsor having discontinued publication of the Index or Successor Equity Index and no Successor Equity Index being available). 

 

	 	(D)	 Any Related Futures or Options Exchange fails to open for trading during its regular trading session.

 For purposes of determining whether a Market Disruption Event has occurred: 

 

	 	(1)	 the relevant percentage contribution of a security included in the Index or any Successor Equity Index to the
level of such index will be based on a comparison of (x) the portion of the level of such index attributable to that security to (y) the overall level of such index, in each case using the official opening weightings as published by the
relevant index sponsor as part of the market opening data; 

  

	 	(2)	 the “Scheduled Closing Time” of any Relevant Stock Exchange or Related Futures or Options
Exchange on any Trading Day means the scheduled weekday closing time of such Relevant Stock Exchange or Related Futures or Options Exchange on such Trading Day, without regard to after hours or any other trading outside the regular trading session
hours; and 

  

	 	(3)	 an “Exchange Business Day” means any Trading Day on which (i) the relevant index sponsor
publishes the level of the Index or any Successor Equity Index and (ii) each Related Futures or Options Exchange is open for trading during its regular trading session, notwithstanding any Related Futures or Options Exchange closing prior to
its Scheduled Closing Time. 

 Calculation Agent 

The Calculation Agent will determine the Redemption Amount and the Ending Level. In addition, the Calculation Agent will
(i) determine if adjustments are required to the Closing Level of the Index under the circumstances described in this Security, (ii) if publication of the Index is discontinued, select a Successor Equity Index or, if no Successor Equity
Index is available, determine the Closing Level of the Index under the circumstances described in this Security, and (iii) determine whether a Market Disruption Event or non-Trading Day has occurred. 

  
 6 

 The Company covenants that, so long as this Security is Outstanding, there shall
at all times be a Calculation Agent (which shall be a broker-dealer, bank or other financial institution) with respect to this Security. 

All determinations made by the Calculation Agent with respect to this Security will be at the sole discretion of the
Calculation Agent and, in the absence of manifest error, will be conclusive for all purposes and binding on the Company and the Holder of this Security. 

Tax Considerations 

The Company agrees, and by acceptance of a beneficial ownership interest in this Security each Holder of this Security will be
deemed to have agreed (in the absence of a statutory, regulatory, administrative or judicial ruling to the contrary), for United States federal income tax purposes to characterize and treat this Security as a prepaid derivative contract that is an
“open transaction.” 
 Redemption and Repayment 

This Security is not subject to redemption at the option of the Company or repayment at the option of the Holder hereof prior
to December 6, 2021. This Security is not entitled to any sinking fund. 
 Acceleration 

If an Event of Default, as defined in the Indenture, with respect to this Security shall occur and be continuing, the
Redemption Amount (calculated as set forth in the next sentence) of this Security may be declared due and payable in the manner and with the effect provided in the Indenture. The amount payable to the Holder hereof upon any acceleration permitted
under the Indenture will be equal to the Redemption Amount hereof calculated as provided herein as though the date of acceleration was the Calculation Day. 
  

 

Reference is hereby made to the further provisions of this Security set forth on the reverse hereof, which further provisions
shall for all purposes have the same effect as if set forth at this place. 
 Unless the certificate of authentication
hereon has been executed by the Trustee referred to on the reverse hereof by manual signature or its duly authorized agent under the Indenture referred to on the reverse hereof by manual signature, this Security shall not be entitled to any benefit
under the Indenture or be valid or obligatory for any purpose. 
 [The remainder of this page has been left intentionally blank] 

  
 7 

 IN WITNESS WHEREOF, the Company has caused this instrument to be duly executed
under its corporate seal. 
 DATED:
  

					
	WELLS FARGO & COMPANY
		
	By:	 	 
		
		 	
		 	 Its:
	 	

 [SEAL] 
  

					
	Attest:	 	 
			
		 		 	
		 	 Its:
	 	

 TRUSTEE’S CERTIFICATE OF 

AUTHENTICATION 
 This is one of the Securities of the 

series designated therein described 
 in the within-mentioned Indenture. 
 CITIBANK, N.A., 

as Trustee 
  

			
		
	By:	 	 
		 	 Authorized Signature

 OR 
  

			
	 WELLS FARGO BANK, N.A.,

  as Authenticating Agent for the Trustee

		
	By:	 	 
		 	 Authorized Signature

  
 8 

 [Reverse of Note] 

WELLS FARGO & COMPANY 

MEDIUM-TERM NOTE, SERIES K 

Due Nine Months or More From Date of Issue 

Principal at Risk Securities Linked to the EURO STOXX 50® Index 

due December 6, 2021 

This Security is one of a duly authorized issue of securities of the Company (herein called the
“Securities”), issued and to be issued in one or more series under an indenture dated as of July 21, 1999, as amended or supplemented from time to time (herein called the “Indenture”), between the Company and
Citibank, N.A., as Trustee (herein called the “Trustee,” which term includes any successor trustee under the Indenture), to which Indenture and all indentures supplemental thereto reference is hereby made for a statement of the
respective rights, limitations of rights, duties and immunities thereunder of the Company, the Trustee and the Holders of the Securities, and of the terms upon which the Securities are, and are to be, authenticated and delivered. This Security is
one of the series of the Securities designated as Medium-Term Notes, Series K, of the Company, which series is limited to an aggregate principal amount or face amount, as applicable, of $25,000,000,000 or the equivalent thereof in one or more
foreign or composite currencies. The amount payable on the Securities of this series may be determined by reference to the performance of one or more equity-, commodity- or currency-based indices, exchange traded funds, securities, commodities,
currencies, statistical measures of economic or financial performance, or a basket comprised of two or more of the foregoing, or any other market measure or may bear interest at a fixed rate or a floating rate. The Securities of this series may
mature at different times, be redeemable at different times or not at all, be repayable at the option of the Holder at different times or not at all and be denominated in different currencies. 

Article Sixteen of the Indenture shall not apply to this Security. 

The Securities are issuable only in registered form without coupons and will be either
(a) book-entry securities represented by one or more Global Securities recorded in the book-entry system maintained by the Depositary or (b) certificated
securities issued to and registered in the names of, the beneficial owners or their nominees. 
 The Company agrees, to the
extent permitted by law, not to voluntarily claim the benefits of any laws concerning usurious rates of interest against a Holder of this Security. 

Modification and Waivers 

The Indenture permits, with certain exceptions as therein provided, the amendment thereof and the modification of the rights
and obligations of the Company and the rights of the Holders of the Securities of each series to be affected under the Indenture at any time by the Company and the Trustee with the consent of the Holders of a majority in principal amount of the
Securities at the 

  
 9 

 
time Outstanding of all series to be affected, acting together as a class. The Indenture also contains provisions permitting the Holders of a majority in principal amount of the Securities of all
series at the time Outstanding affected by certain provisions of the Indenture, acting together as a class, on behalf of the Holders of all Securities of such series, to waive compliance by the Company with those provisions of the Indenture. Certain
past defaults under the Indenture and their consequences may be waived under the Indenture by the Holders of a majority in principal amount of the Securities of each series at the time Outstanding, on behalf of the Holders of all Securities of such
series. Solely for the purpose of determining whether any consent, waiver, notice or other action or Act to be taken or given by the Holders of Securities pursuant to the Indenture has been given or taken by the Holders of Outstanding Securities in
the requisite aggregate principal amount, the principal amount of this Security will be deemed to be equal to the amount set forth on the face hereof as the “Face Amount” hereof. Any such consent or waiver by the Holder of this Security
shall be conclusive and binding upon such Holder and upon all future Holders of this Security and of any Security issued upon the registration of transfer hereof or in exchange herefor or in lieu hereof, whether or not notation of such consent or
waiver is made upon this Security. 
 Defeasance 

Section 403 and Article Fifteen of the Indenture and the provisions of clause (ii) of Section 401(1)(B) of the
Indenture, relating to defeasance at any time of (a) the entire indebtedness on this Security and (b) certain restrictive covenants and certain Events of Default, upon compliance by the Company with certain conditions set forth therein,
shall not apply to this Security. The remaining provisions of Section 401 of the Indenture shall apply to this Security. 
 Authorized
Denominations 
 This Security is issuable only in registered form without coupons in denominations of $1,000 or any
amount in excess thereof which is an integral multiple of $1,000. 
 Registration of Transfer 

Upon due presentment for registration of transfer of this Security at the office or agency of the Company in the City of
Minneapolis, Minnesota, a new Security or Securities of this series, with the same terms as this Security, in authorized denominations for an equal aggregate Face Amount will be issued to the transferee in exchange herefor, as provided in the
Indenture and subject to the limitations provided therein and to the limitations described below, without charge except for any tax or other governmental charge imposed in connection therewith. 

This Security is exchangeable for definitive Securities in registered form only if (x) the Depositary notifies the
Company that it is unwilling or unable to continue as Depositary for this Security or if at any time the Depositary ceases to be a clearing agency registered under the Securities Exchange Act of 1934, as amended, and a successor depositary is not
appointed within 90 days after the Company receives such notice or becomes aware of such ineligibility, (y) the Company in its sole discretion determines that this Security shall be exchangeable for definitive Securities in registered form
and notifies the Trustee thereof or (z) an Event of Default with respect to the Securities represented hereby has occurred and is continuing. If this Security is exchangeable pursuant to the preceding sentence, it shall be exchangeable for
definitive Securities in registered 

  
 10 

 
form, having the same date of issuance, Stated Maturity Date and other terms and of authorized denominations aggregating a like amount. 

This Security may not be transferred except as a whole by the Depositary to a nominee of the Depositary or by a nominee of the
Depositary to the Depositary or another nominee of the Depositary or by the Depositary or any such nominee to a successor of the Depositary or a nominee of such successor. Except as provided above, owners of beneficial interests in this Global
Security will not be entitled to receive physical delivery of Securities in definitive form and will not be considered the Holders hereof for any purpose under the Indenture. 

Prior to due presentment of this Security for registration of transfer, the Company, the Trustee and any agent of the Company
or the Trustee may treat the Person in whose name this Security is registered as the owner hereof for all purposes, whether or not this Security be overdue, and neither the Company, the Trustee nor any such agent shall be affected by notice to the
contrary. 
 Obligation of the Company Absolute 

No reference herein to the Indenture and no provision of this Security or the Indenture shall alter or impair the obligation
of the Company, which is absolute and unconditional, to pay the Redemption Amount at the times, place and rate, and in the coin or currency, herein prescribed, except as otherwise provided in this Security. 

No Personal Recourse 

No recourse shall be had for the payment of the Redemption Amount, or for any claim based hereon, or otherwise in respect
hereof, or based on or in respect of the Indenture or any indenture supplemental thereto, against any incorporator, stockholder, officer or director, as such, past, present or future, of the Company or any successor corporation, whether by virtue of
any constitution, statute or rule of law, or by the enforcement of any assessment or penalty or otherwise, all such liability being, by the acceptance hereof and as part of the consideration for the issuance hereof, expressly waived and released.

 Defined Terms 

All terms used in this Security which are defined in the Indenture shall have the meanings assigned to them in the Indenture
unless otherwise defined in this Security. 
 Governing Law 

This Security shall be governed by and construed in accordance with the law of the State of New York, without regard to
principles of conflicts of laws. 

  
 11 

 ABBREVIATIONS 

The following abbreviations, when used in the inscription on the face of this instrument, shall be construed as though they
were written out in full according to applicable laws or regulations: 
  

					
	 TEN COM
	  	 --
	  	 as tenants in common

			
	 TEN ENT
	  	 --
	  	 as tenants by the entireties

			
	 JT TEN
	  	 --
	  	 as joint tenants with right

of survivorship and not
 as
tenants in common

  

							
	
UNIF GIFT MIN ACT --  
	  	 	  	 Custodian  
	  	 
		  	(Cust)	  		  	(Minor)

 Under Uniform Gifts to Minors Act 
  

 
 (State)

 Additional abbreviations may also be used though not in the above list. 

FOR VALUE RECEIVED, the undersigned hereby sell(s) and transfer(s) unto 

Please Insert Social Security or 
 Other Identifying Number of
Assignee 
  
  

 

	
	
	 
	
	 
	
	 
	(PLEASE PRINT OR TYPE NAME AND ADDRESS INCLUDING POSTAL ZIP
CODE OF ASSIGNEE)

  
 12 

 the within Security of WELLS FARGO & COMPANY and does hereby irrevocably constitute and
appoint                                      attorney to
transfer the said Security on the books of the Company, with full power of substitution in the premises. 
  

			
		
	Dated:	 	 
		 	

  

	
	
	 
	
	 

 NOTICE: The signature to this assignment must correspond with the name as written upon the face of the
within instrument in every particular, without alteration or enlargement or any change whatever. 

  
 13

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