Document:

Amendment No. 1 to Standstill Agreement

 Exhibit 10.1 
 WARBURG PINCUS PRIVATE EQUITY IX, L.P. 
 466 Lexington Avenue 
 New York, NY 10017 
 August 4, 2009 
 Inspire Pharmaceuticals, Inc. 
 4222 Emperor Boulevard, Suite 200 

Durham, North Carolina 
 Attention: Chief Executive Officer 
  

	 	Re:	Amendment No. 1 to Standstill Agreement 

 Ladies and
Gentlemen: 
 In connection with the acquisition of shares of Common Stock, par value $0.001 per share (the “Common Stock”),
of Inspire Pharmaceuticals, Inc., a Delaware corporation (the “Company”), by Warburg Pincus Private Equity IX, L.P., a Delaware limited partnership (the “Purchaser”), in relation to the Company’s public
offering of Common Stock pursuant to the Prospectus Supplement dated August 4, 2009 (including any related free writing prospectus and any amendment thereof or supplement thereto dated on or prior to September 30, 2009, and excluding any
thereafter) and the related Registration Statement (File No. 333-141169) (the “Public Offering”), the Company and the Purchaser agree as follows: 
 1. Definitions. For purposes of the Standstill Agreement, dated July 20, 2007, the term “Standstill Period” shall be amended and restated to have the meaning set forth below: 
 “Standstill Period” shall mean the period commencing on the date of the Standstill Agreement, and ending on the third
anniversary of this Amendment No. 1 to Standstill Agreement. 
 Notwithstanding anything herein to the contrary, if the closing of the
Public Offering has not occurred by September 30, 2009, this Section 1 shall be of no further force or effect and the term Standstill Period shall have the meaning set forth in the Standstill Agreement. 
 2. Waiver of Section 203. The Company represents and warrants to the Purchaser that the Board has heretofore taken all necessary action to
approve, and has approved, for purposes of Section 203 of the DGCL (including any successor statute thereto “Section 203”) the Purchaser becoming, together with its affiliates and associates, an “interested
stockholder” within the meaning of Section 203 by virtue of the purchase of shares of Common Stock in the Public Offering (the “Waiver”), such that, as of and from the date of the closing of the Public Offering,
Section 203 will not be applicable to the Purchaser or any “business combination” 

  

 Amendment No. 1 to Standstill Agreement 

 
within the meaning of Section 203 that may take place between the Purchaser and/or its affiliates and associates, on the one hand, and the Company, on
the other, as a result of its purchase of shares of Common Stock in the Public Offering; provided, however, that such Waiver provides that, it shall no longer be applicable if, subsequent to becoming an “interested
stockholder” (as defined in Section 203), the Purchaser no longer has beneficial ownership of 15% or more of the Common Stock as a result of any sale or disposition of beneficial ownership of Common Stock by the Purchaser together with its
affiliates and associates. 
 3. Subscription Right. Each of the parties hereby waives all of its rights pursuant to Section 5.4
of the Securities Purchase Agreement (the “Purchase Agreement”), dated July 17, 2007, between the Purchaser and the Company as they relate to the Public Offering. 
 4. Expense Reimbursement. Subject to the closing of the Public Offering, the Company hereby agrees to reimburse the Purchaser for up to $500,000
for out-of-pocket due diligence and related expenses incurred by the Purchaser in connection with its investment in the Company, upon submission of reasonable documentation regarding such expenses to the Company. 
 5. Counterparts. This Amendment No. 1 to Standstill Agreement may be executed in counterparts (including by facsimile), each of which shall
be deemed an original. 
 [The remainder of this page is intentionally left blank.] 
  

 Amendment No. 1 to Standstill Agreement 
 - 2 - 

 If you are in agreement with the terms set forth above, please sign this Amendment No. 1 to
Standstill Agreement in the space provided below and return an executed copy to the undersigned. 
  

			
	Very truly yours,
	
	 WARBURG PINCUS PRIVATE EQUITY IX, L.P.

		
	By:	 	 Warburg Pincus IX LLC, its general partner

		
	By:	 	 Warburg Pincus Partners, LLC, its sole member

		
	By:	 	 Warburg Pincus & Co., its managing member

		
	By:	 	 /s/ Scott Arenare

	Name:	 	Scott Arenare
	Title:	 	Partner
	
	WARBURG PINCUS IX LLC
		
	By:	 	 Warburg Pincus Partners, LLC, its sole member

		
	By:	 	 Warburg Pincus & Co., its managing member

		
	By:	 	 /s/ Scott Arenare

	Name:	 	Scott Arenare
	Title:	 	Partner
	
	WARBURG PINCUS PARTNERS, LLC
		
	By:	 	 Warburg Pincus & Co., its managing member

		
	By:	 	 /s/ Scott Arenare

	Name:	 	Scott Arenare
	Title:	 	Partner
	
	WARBURG PINCUS & CO.
		
	By:	 	 /s/ Scott Arenare

	Name:	 	Scott Arenare
	Title:	 	Partner

  

 Amendment No. 1 to Standstill Agreement 
 - 3 - 

			
	Confirmed and Agreed:
	
	INSPIRE PHARMACEUTICALS, INC.
		
	By:	 	 /s/ Joseph M. Spagnardi

	Name:	 	Joseph M. Spagnardi
	Title:	 	 Senior Vice President, General Counsel and Secretary

  

 Amendment No. 1 to Standstill Agreement 
 - 4 -Letter Agreement

 Exhibit 10.4 
 April 16, 2009 
 VIA FACSIMILE TO (954) 888-7310 
 & DHL EXPRESS 
 DHL Network Operations (USA), Inc. 
 1200 South Pine Island Road 
 Plantation, Florida 33324 
 Attention: Jon E. Olin – EVP, General Counsel & Secretary 
  

	Re:	Base and Incremental Markup for the Second Quarter of 2009 under the ACMI Service Agreement, by and between DHL Network Operations (USA), Inc., as successor in interest to
Airborne, Inc. (“Groundco”) and ABX Air, Inc. (“Airco”), dated August 15, 2003, as amended on April 27, 2004 and November 9, 2009 (the “ACMI Agreement”). 

 Dear Jon: 
 Unless otherwise defined herein, all capitalized
terms used herein shall have the meanings ascribed thereto in the ACMI Agreement or the . 
 In accordance with paragraph (c) of the
Second Amendment to the ACMI Agreement, dated November 9, 2008, Groundco and Airco hereby agree as follows: 
 (a) The Base Markup,
quarterly cost component and twenty-five percent (25%) of the annual cost and service components of the Incremental Markup to be paid to Airco in exchange for the services provided by Airco to Groundco under the ACMI Agreement during the second
quarter of 2009 shall total $3,616,331, consisting of the following: 
  

			
	$ 1,824,000	  	Base Markup for second quarter of 2009
	$    684,000	  	Quarterly cost component of Incremental Markup for second quarter of 2009
	$    889,686	  	25% of annual cost component of Incremental Markup for 2009
	$    218,645	  	25% of annual service component of Incremental Markup for 2009

 (b) Groundco will pay the Base Compensation and Incremental Markup for the second quarter of 2009
weekly, in advance, by wire transfer to Airco on Monday of each week (or, if such day is not a Business Day, on the immediately succeeding Business Day), consisting of the Cost Recovery Amount for the forthcoming week plus the applicable Base
Markup. Both the quarterly cost component and twenty-five percent (25%) of the annual cost and service components of the Incremental Markup will be paid by DHL no later than July 15, 2009, in accordance with the terms of the ACMI
Agreement. 

 Jon E. Olin 
 April 16,
2009 
 2 of 2 
 Groundco and Airco further agree
that the allocation of overhead costs attributable to Airco’s provision of (i) Third Party Services under the ACMI Agreement, and (ii) Ancillary Services under the Hub and Line-Haul Services Agreement, by and between DHL Express
(USA), Inc., as successor in interest to Airborne, Inc., and Airco, dated August 15, 2003, as amended from time to time, shall not exceed $800,000 in total for the second quarter of 2009. 
 Except to the extent provided herein, the terms and conditions of the ACMI Agreement shall remain in full force and effect. 
 Please acknowledge Groundco’s acceptance of the foregoing by having an authorized representative of DHL Network Operations (USA), Inc. sign and date
both counterparts of this letter in the space provided below and returning one counterpart to me for my records. 
  

	
	Sincerely,
	
	ABX Air, Inc.
	
	/s/ W. Joseph Payne
	
	W. Joseph Payne
	Vice President
	General Counsel & Secretary

  

			
	ACCEPTED AND AGREED:
	
	DHL Network Operations (USA), Inc.
	
	/s/ Jon E. Olin
		
	By:	 	Jon E. Olin
		
	Its:	 	EVP & General Counsel
		
	Date:	 	April 22, 2009Letter Agreement

 Exhibit 10.5 
 April 16, 2009 
 VIA FACSIMILE TO (954) 888-7310 
 & DHL EXPRESS 
 DHL Network Operations (USA), Inc. 
 1200 South Pine Island Road 
 Plantation, Florida 33324 
 Attention: Jon E. Olin – EVP, General Counsel & Secretary 
  

	Re:	Base and Incremental Markup for the Second Quarter of 2009 under the Hub and Line-Haul Services Agreement, by and between DHL Express (USA), Inc., as successor in interest to
Airborne, Inc. (“Groundco”) and ABX Air, Inc. (“Airco”), dated August 15, 2003, as amended on April 27, 2004, August 8, 2005 and November 9, 2008 (the “Hub Services Agreement”).

 Dear Jon: 
 Unless otherwise
defined herein, all capitalized terms used herein shall have the meanings ascribed thereto in the Hub Services Agreement. 
 In accordance
with paragraph (c) of the Third Amendment of the Hub Services Agreement, dated November 9, 2008, Groundco and Airco hereby agree as follows: 
 (a) The Base Markup, quarterly cost component and twenty-five percent (25%) of the annual cost and service components of the Incremental Markup to be paid to Airco in exchange for the services provided by Airco
to Groundco under the Hub Services Agreement during the second quarter of 2009 shall total $1,994,434, consisting of the following: 
  

			
	$ 1,112,000	  	Base Markup for second quarter of 2009
	$    150,000	  	Quarterly cost component of Incremental Markup for second quarter of 2009
	$    225,000	  	25% of annual cost component of Incremental Markup for 2009
	$    507,434	  	25% of annual service component of Incremental Markup for 2009

 (b) Groundco will pay the Compensation for the second quarter of 2009 weekly, in advance, by wire
transfer to Airco on Monday of each week (or, if such day is not a Business Day, on the immediately succeeding Business Day), consisting of the Cost Recovery Amount for the forthcoming week plus the applicable Base Markup. Both the quarterly cost
component and twenty-five percent (25%) of the annual cost and service components of the Incremental Markup will be paid by DHL no later than July 15, 2009, in accordance with the terms of the Hub Services Agreement. 

 Jon E. Olin 
 April 16,
2009 
 2 of 2 
 Groundco and Airco further agree
that the allocation of overhead costs attributable to Airco’s provision of (i) Ancillary Services under the Hub Services Agreement, and (ii) Third Party Services under the ACMI Service Agreement, by and between DHL Network Operations
(USA), Inc., as successor in interest to Airborne, Inc. and Airco, dated August 15, 2003, as amended from time to time, shall not exceed $800,000 in total for the second quarter of 2009. 
 Except to the extent provided in this letter, the terms and conditions of the Hub Services Agreement shall remain in full force and effect. 

Please acknowledge Groundco’s acceptance of the foregoing by having an authorized representative of DHL Express (USA), Inc., sign and date both
counterparts of this letter in the space provided below and returning one counterpart to me for my records. 
  

	
	Sincerely,
	
	ABX Air, Inc.
	
	/s/ W. Joseph Payne
	
	W. Joseph Payne
	Vice President
	General Counsel & Secretary

  

			
	ACCEPTED AND AGREED:
	
	DHL Express (USA), Inc.
	
	/s/ Jon E. Olin
		
	By:	 	Jon E. Olin
		
	Its:	 	EVP & General Counsel
		
	Date:	 	April 22, 2009

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