Document:

Form of Director and Executive Officer Indemnification Agreement

 EXHIBIT 10.3 
 ACOLOGIX, INC. 
 INDEMNIFICATION AGREEMENT 
 This Indemnification Agreement (“Agreement”) is effective as of
                            , 2006 by and between Acologix, Inc., a Delaware corporation (the
“Company”), and the indemnitee listed on the signature page hereto (“Indemnitee”). 
 WHEREAS, the Company
desires to attract and retain the services of highly qualified individuals, such as Indemnitee, to serve the Company and its related entities; 
 WHEREAS, in order to induce Indemnitee to continue to provide services to the Company, the Company wishes to provide for the indemnification of, and the advancement of expenses to, Indemnitee to the maximum extent permitted by Delaware law;

 WHEREAS, the Company and Indemnitee recognize the continued difficulty in obtaining liability insurance for the Company’s directors,
officers, employees, agents and fiduciaries, the significant increases in the cost of such insurance and the general reductions in the coverage of such insurance; 
 WHEREAS, the Company and Indemnitee further recognize the substantial increase in corporate litigation in general, subjecting directors, officers, employees, agents and fiduciaries to expensive litigation risks at the
same time as the availability and coverage of liability insurance has been severely limited; and 
 WHEREAS, the Company and Indemnitee
desire to continue to have in place the additional protection provided by an indemnification agreement and to provide indemnification and advancement of expenses to the Indemnitee to the maximum extent permitted by Delaware law. 
 NOW, THEREFORE, in consideration for Indemnitee’s services to the Company, the Company and Indemnitee hereby agree as follows: 
 1.    Certain Definitions. 
 (a)    “Change of Control” shall mean: 
 (1)    The acquisition by any individual, entity or group (within the meaning of Section 13(d)(3) or 14(d)(2) of the Exchange Act (a “Person”) of beneficial ownership (within the meaning of
Rule 13d-3 promulgated under the Exchange Act) of 30% or more of either (i) the then outstanding shares of common stock of the Company (the “Outstanding Company Common Stock”) or (ii) the combined voting power of the
then outstanding voting securities of the Company entitled to vote generally in the election of directors (the “Outstanding Company Voting Securities”); provided, however, that for purposes of this part (1), the
following acquisitions shall not constitute a Change of Control: (i) any acquisition directly from the Company or any acquisition from other stockholders where (A) such acquisition was approved in advance by the Board of Directors of the
Company and (B) such acquisition would not constitute a change of control under 

 
part (3) of this definition, (ii) any acquisition by the Company, (iii) any acquisition by any employee benefit plan (or related trust)
sponsored or maintained by the Company or any corporation controlled by the Company or (iv) any acquisition by any corporation pursuant to a transaction which complies with clauses (i), (ii) and (iii) of part (3) of this
definition; or 
 (2)    Individuals who, as of the date hereof, constitute the Board of Directors (the
“Incumbent Board”) cease for any reason to constitute at least a majority of the Board of Directors; provided, however, that any individual becoming a director subsequent to the date hereof whose election, or nomination for
election by the stockholders, was approved by a vote of at least two thirds (2/3) of the directors then comprising the Incumbent Board shall be considered as though such individual were a member of the Incumbent Board, but excluding, for this
purpose, any such individual whose initial assumption of office occurs as a result of an actual or threatened election contest with respect to the election or removal of directors or other actual or threatened solicitation of proxies or consents by
or on behalf of a Person other than the Board of Directors; or 
 (3)    Consummation of a
reorganization, merger or consolidation or sale or other disposition of all or substantially all of the assets of the Company (a “Business Combination”), in each case, unless, following such Business Combination, (i) all or
substantially all of the individuals and entities who were the beneficial owners, respectively, of the Outstanding Company Common Stock and Outstanding Company Voting Securities immediately prior to such Business Combination beneficially own,
directly or indirectly, more than 80% of, respectively, the then outstanding shares of common stock and the combined voting power of the then outstanding voting securities entitled to vote generally in the election of directors, as the case may be,
of the Company resulting from such Business Combination (including, without limitation, a corporation which as a result of such transaction owns the Company or all or substantially all of the Company’s assets either directly or through one or
more subsidiaries) in substantially the same proportions as their ownership, immediately prior to such Business Combination of the Outstanding Company Common Stock and Outstanding Company Voting Securities, as the case may be, and (ii) at least
a majority of the members of the Board of Directors of the corporation resulting from such Business Combination were members of the Incumbent Board at the time of the execution of the initial agreement, or of the action of the Board of Directors,
providing for such Business Combination; or 
 (4)    Approval by the stockholders of a complete
liquidation or dissolution of the Company. 
 (b)    “Claim” shall mean with respect to
a Covered Event: any threatened, pending or completed action, suit, proceeding or alternative dispute resolution mechanism, or any hearing, inquiry or investigation that Indemnitee in good faith believes might lead to the institution of any such
action, suit, proceeding or alternative dispute resolution mechanism, whether civil, criminal, administrative, investigative or other. 
 (c)    References to the “Company” shall include, in addition to the Company, any constituent corporation (including any constituent of a constituent) absorbed in a consolidation or
merger to which the Company (or any of its wholly owned subsidiaries) is a party which, if its separate existence had continued, would have had power and authority to indemnify its directors, officers, employees, agents or fiduciaries, so that if
Indemnitee is or was a director, officer, 

  

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employee, agent or fiduciary of such constituent corporation, or is or was serving at the request of such constituent corporation as a director, officer,
employee, agent or fiduciary of another corporation, partnership, joint venture, employee benefit plan, trust or other enterprise, Indemnitee shall stand in the same position under the provisions of this Agreement with respect to the resulting or
surviving corporation as Indemnitee would have with respect to such constituent corporation if its separate existence had continued. 
 (d)    “Covered Event” shall mean any event or occurrence related to the fact that Indemnitee is or was a director, officer, employee, agent or fiduciary of the Company, or any
subsidiary of the Company, or is or was serving at the request of the Company as a director, officer, employee, agent or fiduciary of another corporation, partnership, joint venture, trust or other enterprise, or by reason of any action or inaction
on the part of Indemnitee while serving in such capacity. 
 (e)    “Disinterested
Director” shall mean a director of the Company who is not and was not a party to the matter in respect of which indemnification is sought by the Indemnitee. 
 (f)    “Expenses” shall mean any and all expenses (including attorneys’ fees and all other
costs, expenses and obligations incurred in connection with investigating, defending, being a witness in or participating in (including on appeal), or preparing to defend, to be a witness in or to participate in, any action, suit, proceeding,
alternative dispute resolution mechanism, hearing, inquiry or investigation), judgments, fines, penalties and amounts paid in settlement, actually and reasonably incurred, of any Claim and any federal, state, local or foreign taxes imposed on the
Indemnitee as a result of the actual or deemed receipt of any payments under this Agreement. 
 (g)    “Expense Advance” shall mean a payment to Indemnitee pursuant to Section 3 of Expenses in advance of the settlement of or final judgment in any action, suit, proceeding or alternative dispute
resolution mechanism, hearing, inquiry or investigation which constitutes a Claim; provided however, that Indemnitee shall have no right to any payment of Expense Advances in the event Indemnitee pleads guilty to willful misconduct.

 (h)    “Independent Legal Counsel” shall mean a law firm, a member of a law firm, or
an independent practitioner, that is experienced in matters of corporation law and shall include any person who, under the applicable standards of professional conduct then prevailing, would not have a conflict of interest in representing either the
Company or the Indemnitee in an action to determine the Indemnitee’s rights under Section 2(d) hereof and is not otherwise representing a party in connection with a Claim. 
 (i)    References to “other enterprises” shall include employee benefit plans; references to
“fines” shall include any excise taxes assessed on Indemnitee with respect to an employee benefit plan; and references to “serving at the request of the Company” shall include any service as a director, officer, employee, agent
or fiduciary of the Company which imposes duties on, or involves services by, such director, officer, employee, agent or fiduciary with respect to an employee benefit plan, its participants or its beneficiaries; and if Indemnitee acted in good faith
and in a manner Indemnitee reasonably believed to be in the interest of the participants and beneficiaries 

  

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of an employee benefit plan, Indemnitee shall be deemed to have acted in a manner “not opposed to the best interests of the Company” as referred to
in this Agreement. 
 (j)    “Reviewing Party” shall have the meanings as set forth in
Section 2(d). 
 (k)    “Section” refers to a section of this Agreement unless
otherwise indicated. 
 2.    Indemnification. 
 (a)     Indemnification of Expenses. Subject to the provisions of Section 2(b) below, the Company shall
indemnify Indemnitee for Expenses to the fullest extent permitted by Delaware law if Indemnitee was or is or becomes a party to or witness or other participant in, or is threatened to be made a party to or witness or other participant in, any Claim
(whether by reason of or arising in part out of a Covered Event), including all interest, assessments and other charges paid or payable in connection with or in respect of such Expenses. 
 (b)    Review of Indemnification Obligations. Notwithstanding the foregoing, in the event any Reviewing Party
shall have determined (in a written opinion, in any case in which Independent Legal Counsel is the Reviewing Party) that Indemnitee is not entitled to be indemnified hereunder under applicable law, (i) the Company shall have no further
obligation under Section 2(a) to make any payments to Indemnitee not made prior to such determination by such Reviewing Party, and (ii) the Company shall be entitled to be reimbursed by Indemnitee (who hereby agrees to reimburse the
Company) for all Expenses theretofore paid in indemnifying Indemnitee; provided, however, that if Indemnitee has commenced or thereafter commences legal proceedings in a court of competent jurisdiction to secure a determination that Indemnitee is
entitled to be indemnified hereunder under applicable law, any determination made by any Reviewing Party that Indemnitee is not entitled to be indemnified hereunder under applicable law shall not be binding and Indemnitee shall not be required to
reimburse the Company for any Expenses theretofore paid in indemnifying Indemnitee until a final judicial determination is made with respect thereto (as to which all rights of appeal therefrom have been exhausted or lapsed). Indemnitee’s
obligation to reimburse the Company for any Expenses shall be unsecured and no interest shall be charged thereon. 
 (c)    Indemnitee Rights on Unfavorable Determination; Binding Effect. If any Reviewing Party determines that Indemnitee substantively is not entitled to be indemnified hereunder in whole or in part under
applicable law, Indemnitee shall have the right to commence litigation, within one (1) year of the Reviewing Party’s determination, seeking an initial determination by the court or challenging any such determination by such Reviewing Party
or any aspect thereof, including the legal or factual bases therefor, and, subject to the provisions of Section 15, the Company hereby consents to service of process and to appear in any such proceeding. Absent such litigation, any
determination by any Reviewing Party shall be conclusive and binding on the Company and Indemnitee. 
 (d) Reviewing
Party; Change of Control. The determination of Indemnitee’s entitlement hereunder shall be made by the Reviewing Party as follows: (1) if requested by the Indemnitee, by Independent Legal Counsel, or (2) if no request is made by
the Indemnitee for a determination by Independent Legal Counsel, (i) by the Board of Directors by a majority vote of a 

  

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quorum consisting of Disinterested Directors, or (ii) if a quorum of the Board of Directors consisting of Disinterested Directors is not obtainable or,
even if obtainable, such quorum of Disinterested Directors so directs, by Independent Legal Counsel in a written opinion to the Board of Directors, a copy of which shall be delivered to the Indemnitee, or (iii) if a quorum of Disinterested
Directors so directs, by the stockholders of the Company. In the event the determination of entitlement to indemnification is to be made by Independent Legal Counsel at the request of the Indemnitee, the Independent Legal Counsel shall be selected
by the Board of Directors unless there shall have occurred within two years prior to the date of the commencement of the proceeding for which indemnification is claimed a “Change of Control” (as defined in Section 1(a)), in which case
the Independent Legal Counsel shall be selected by the Indemnitee unless the Indemnitee shall request that such selection be made by the Board of Directors. Such counsel, among other things, shall render its written opinion to the Company and
Indemnitee as to whether and to what extent Indemnitee would be entitled to be indemnified hereunder under applicable law and the Company agrees to abide by such opinion. The Company agrees to pay the reasonable fees of the Independent Legal Counsel
referred to above and to indemnify fully such counsel against any and all expenses (including attorneys’ fees), claims, liabilities and damages arising out of or relating to this Agreement or its engagement pursuant hereto. Notwithstanding any
other provision of this Agreement, the Company shall not be required to pay Expenses of more than one Independent Legal Counsel in connection with all matters concerning a single Indemnitee, and such Independent Legal Counsel shall be the
Independent Legal Counsel for any or all other Indemnitees unless (i) the Company otherwise determines or (ii) any Indemnitee shall provide a written statement setting forth in detail a reasonable objection to such Independent Legal
Counsel representing other Indemnitees. If it is so determined that Indemnitee is entitled to indemnification, payment to the Indemnitee shall be made within ten (10) days after such determination. 
 (e)    Mandatory Payment of Expenses. Notwithstanding any other provision of this Agreement other than
Section 10 hereof, to the extent that Indemnitee has been successful on the merits or otherwise, including, without limitation, the dismissal of an action without prejudice, in defense of any Claim, Indemnitee shall be indemnified against all
Expenses incurred by Indemnitee in connection therewith. 
 3.    Expense Advances. 
 (a)    Obligation to Make Expense Advances. Upon receipt of a written undertaking by or on behalf of the
Indemnitee to repay such amounts if it shall ultimately be determined that the Indemnitee is not entitled to be indemnified therefor by the Company, the Company shall make Expense Advances to Indemnitee. 
 (b)    Form of Undertaking. Any written undertaking by the Indemnitee to repay any Expense Advances hereunder
shall be unsecured and no interest shall be charged thereon. 
 (c)    Determination of Reasonable
Expense Advances. The parties agree that for the purposes of any Expense Advance for which Indemnitee has made written demand to the Company in accordance with this Agreement, all Expenses included in such Expense Advance that are certified by
affidavit of Indemnitee’s counsel as being reasonable shall be presumed conclusively to be reasonable. 
  

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 4. Procedures for Indemnification and Expense Advances. 
 (a)    Timing of Payments. All payments of Expenses (including without limitation Expense Advances) by the
Company to the Indemnitee pursuant to this Agreement shall be made to the fullest extent permitted by Delaware law as soon as practicable after written demand by Indemnitee therefor is presented to the Company, but in no event later than thirty
(30) days after such written demand by Indemnitee is presented to the Company; unless the Reviewing Party has given a written opinion to the Company that Indemnitee is not entitled to indemnification under applicable law. 
 (b)    Notice/Cooperation by Indemnitee. Indemnitee shall, as a condition precedent to Indemnitee’s right
to be indemnified or Indemnitee’s right to receive Expense Advances under this Agreement, give the Company notice in writing as soon as practicable of any Claim made against Indemnitee for which indemnification will or could be sought under
this Agreement. Notice to the Company shall be directed to the Secretary of the Company at the address shown on the signature page of this Agreement (or such other address as the Company shall designate in writing to Indemnitee). In addition,
Indemnitee shall give the Company such information and cooperation as it may reasonably require and as shall be within Indemnitee’s power. 
 (c)    Right of Indemnitee to Bring Suit. If Indemnitee is not paid in full by the Company within thirty (30) days after a written notice has been received by the Company, the
Indemnitee may, at any time within one (1) year following the thirty (30) days of notice, bring suit in any court in the State of California or the State of Delaware against the Company to recover the unpaid amount of the Expenses and, if
successful in whole or in part, the Indemnitee shall be entitled to be paid also the expense (including attorneys’ fees) of prosecuting such claim. It shall be a defense to any such action that the Indemnitee has not met the standards of
conduct that make it permissible under the Delaware General Corporation Law for the Company to indemnify the Indemnitee for the amount claimed. The burden of proving such a defense shall be on the Company. Neither the failure of the Company
(including its Board of Directors, Independent Legal Counsel, or its stockholders) to have made a determination prior to the commencement of such action that indemnification of the Indemnitee is proper under the circumstances because he has met the
applicable standard of conduct set forth in the Delaware General Corporation Law, nor an actual determination by the Company (including its Board of Directors, Independent Legal Counsel, or its stockholders) that the Indemnitee had not met such
applicable standard of conduct, shall be a defense to the action or create a presumption that Indemnitee has not met the applicable standard of conduct. 
 (d)    No Presumptions; Burden of Proof. For purposes of this Agreement, the termination of any Claim by judgment, order, settlement (whether with or without court approval) or conviction,
or upon a plea of nolo contendere, or its equivalent, shall not create a presumption that Indemnitee did not meet any particular standard of conduct or have any particular belief or that a court has determined that indemnification is not
permitted by this Agreement or applicable law; provided, however that the Company’s obligation to pay Expense Advances shall terminate upon a conviction, plea of nolo contendere or its equivalent. In addition, neither the
failure of any Reviewing Party to have made a determination as to whether Indemnitee has met any particular standard of conduct or had any particular belief, nor an actual determination by any Reviewing Party that Indemnitee has not met such
standard of conduct or did not have such belief, prior to the 

  

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commencement of legal proceedings by Indemnitee to secure a judicial determination that Indemnitee should be indemnified under this Agreement or applicable
law, shall be a defense to Indemnitee’s claim or create a presumption that Indemnitee has not met any particular standard of conduct or did not have any particular belief. In connection with any determination by any Reviewing Party or otherwise
as to whether the Indemnitee is entitled to be indemnified hereunder, the burden of proof shall be on the Company to establish that Indemnitee is not so entitled. 
 (e)    Notice to Insurers. If, at the time of the receipt by the Company of a notice of a Claim pursuant to
Section 4(b) hereof, the Company has liability insurance in effect which may cover such Claim, the Company shall give prompt notice of the commencement of such Claim to the insurers in accordance with the procedures set forth in the respective
policies. The Company shall thereafter take all necessary or desirable action to cause such insurers to pay, on behalf of the Indemnitee, all amounts payable as a result of such Claim in accordance with the terms of such policies. 
 (f)    Selection of Counsel. In the event the Company shall be obligated hereunder to provide indemnification
for or make any Expense Advances with respect to the Expenses of any Claim, the Company, if appropriate, shall be entitled to assume the defense of such Claim with counsel approved by Indemnitee (which approval shall not be unreasonably withheld)
upon the delivery to Indemnitee of written notice of the Company’s election to do so. After delivery of such notice, approval of such counsel by Indemnitee and the retention of such counsel by the Company, the Company will not be liable to
Indemnitee under this Agreement for any fees or expenses of separate counsel subsequently employed by or on behalf of Indemnitee with respect to the same Claim; provided that, (i) Indemnitee shall have the right to employ Indemnitee’s
separate counsel in any such Claim at Indemnitee’s expense and (ii) if (A) the employment of separate counsel by Indemnitee has been previously authorized by the Company, (B) Indemnitee shall have reasonably concluded that there
may be a conflict of interest between the Company and Indemnitee in the conduct of any such defense, or (C) the Company shall not continue to retain such counsel to defend such Claim, then the fees and expenses of Indemnitee’s separate
counsel shall be Expenses for which Indemnitee may receive indemnification or Expense Advances hereunder. 
 5.    Additional Indemnification Rights; Nonexclusivity. 
 (a)    Scope. The Company hereby agrees to indemnify the Indemnitee to the fullest extent permitted by Delaware law, notwithstanding that such indemnification is not specifically authorized by the other provisions
of this Agreement, the Company’s Certificate of Incorporation, the Company’s Bylaws or by statute. In the event of any change after the date of this Agreement in any applicable law, statute or rule which expands the right of a Delaware
corporation to indemnify a member of its board of directors or an officer, employee, agent or fiduciary, it is the intent of the parties hereto that Indemnitee shall enjoy by this Agreement the greater benefits afforded by such change. In the event
of any change in any applicable law, statute or rule which narrows the right of a Delaware corporation to indemnify a member of its board of directors or an officer, employee, agent or fiduciary, such change, to the extent not otherwise required by
such law, statute or rule to be applied to this Agreement, shall have no effect on this Agreement or the parties’ rights and obligations hereunder except as set forth in Section 10(a) hereof. 
  

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 (b)    Nonexclusivity. The indemnification and the payment of
Expense Advances provided by this Agreement shall be in addition to any rights to which Indemnitee may be entitled under the Company’s Certificate of Incorporation, its Bylaws, any other agreement, any vote of stockholders or disinterested
directors, the General Corporation Law of the State of Delaware, or otherwise; provided, however that this Agreement shall supersede any prior indemnification agreement between the Company and Indemnitee. The indemnification and the
payment of Expense Advances provided under this Agreement shall continue as to Indemnitee for any action taken or not taken while serving in an indemnified capacity even though subsequent thereto Indemnitee may have ceased to serve in such capacity.

 6.    No Duplication of Payments. The Company shall not be liable under this Agreement to make any payment in
connection with any Claim made against Indemnitee to the extent Indemnitee has otherwise actually received payment (under any insurance policy, provision of the Company’s Certificate of Incorporation, Bylaws or otherwise) of the amounts
otherwise payable hereunder. 
 7.    Partial Indemnification. If Indemnitee is entitled under any provision of
this Agreement to indemnification by the Company for some or a portion of Expenses incurred in connection with any Claim, but not, however, for all of the total amount thereof, the Company shall nevertheless indemnify Indemnitee for the portion of
such Expenses to which Indemnitee is entitled. 
 8.    Mutual Acknowledgement. Both the Company and Indemnitee
acknowledge that in certain instances, federal law or applicable public policy may prohibit the Company from indemnifying its directors, officers, employees, agents or fiduciaries under this Agreement or otherwise. Indemnitee understands and
acknowledges that the Company has undertaken or may be required in the future to undertake with the Securities and Exchange Commission to submit the question of indemnification to a court in certain circumstances for a determination of the
Company’s right under public policy to indemnify Indemnitee. 
 9.    Liability Insurance. To the extent the
Company maintains liability insurance applicable to directors, officers, employees, agents or fiduciaries, Indemnitee shall be covered by such policies in such a manner as to provide Indemnitee the same rights and benefits as are provided to the
most favorably insured of the Company’s directors, if Indemnitee is a director; or of the Company’s officers, if Indemnitee is not a director of the Company but is an officer; or of the Company’s key employees, agents or fiduciaries,
if Indemnitee is not an officer or director but is a key employee, agent or fiduciary. 
 10.    Exceptions.
Notwithstanding any other provision of this Agreement, the Company shall not be obligated pursuant to the terms of this Agreement: 
 (a)     Excluded Action or Omissions. To indemnify Indemnitee for Expenses resulting from acts, omissions or transactions for which Indemnitee is prohibited from receiving indemnification under this Agreement or
applicable law. 
 (b)     Claims Initiated by Indemnitee. To indemnify or make Expense Advances
to Indemnitee with respect to Claims initiated or brought voluntarily by Indemnitee and not by way of 

  

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defense, counterclaim or cross-claim, except (i) with respect to actions or proceedings brought to establish or enforce a right to indemnification under
this Agreement or any other agreement or insurance policy or under the Company’s Certificate of Incorporation or Bylaws now or hereafter in effect relating to Claims for Covered Events, (ii) in specific cases if the Board of Directors has
approved the initiation or bringing of such Claim, or (iii) as otherwise required under Section 145 of the Delaware General Corporation Law, regardless of whether Indemnitee ultimately is determined to be entitled to such indemnification
or insurance recovery, as the case may be. 
 (c) Lack of Good Faith. To indemnify Indemnitee for any Expenses
incurred by the Indemnitee with respect to any action instituted (i) by Indemnitee to enforce or interpret this Agreement, if a court having jurisdiction over such action determines as provided in Section 13 that each of the material
assertions made by the Indemnitee as a basis for such action was not made in good faith or was frivolous, or (ii) by or in the name of the Company to enforce or interpret this Agreement, if a court having jurisdiction over such action
determines as provided in Section 13 that each of the material defenses asserted by Indemnitee in such action was made in bad faith or was frivolous. 
 (d) Insured Claims. To indemnify Indemnitee for expenses or liabilities of any type whatsoever (including, but not limited to, judgments, fines, ERISA excise taxes or penalties, and amounts paid in settlement)
that have been paid directly to Indemnitee by an insurance carrier under a policy of officers’ and directors’ liability insurance maintained by the Company. 
 (e) Claims Under Section 16(b). To indemnify Indemnitee for expenses and the payment of profits arising from the purchase and
sale by Indemnitee of securities in violation of Section 16(b) of the Securities Exchange Act of 1934, as amended, or any similar successor statute. 
 (f) Settlement of Claims. To indemnify Indemnitee under this Agreement or otherwise for any amounts paid in settlement of any proceeding effected without the Company’s written consent, such consent not to
be unreasonably withheld; provided, however that if a Change of Control has occurred (other than a Change of Control approved by a majority of the directors on the Board who were directors immediately prior to such Change of Control),
the Company shall be liable for indemnification of Indemnitee for amounts paid in settlement if Independent Legal Counsel has approved the settlement. The Company shall not be liable to indemnify the Indemnitee under this Agreement with regard to
any judicial award if the Company was not given a reasonable and timely opportunity, at its expense, to participate in the defense of such action; the Company’s liability hereunder shall not be excused if participation in the proceeding by the
Company was barred by this Agreement. 
 For purposes of clarity, references to the Indemnitee above in paragraphs (a) through
(f) of this Section 10 shall not be deemed to include other indemnitees of the Company, unless specifically so stated or unless the context otherwise requires. 
 11.    Counterparts. This Agreement may be executed in one or more counterparts, each of which shall constitute an original. 
  

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 12.    Binding Effect; Successors and Assigns. This Agreement shall be binding
upon and inure to the benefit of and be enforceable by the parties hereto and their respective successors, assigns (including any direct or indirect successor by purchase, merger, consolidation or otherwise to all or substantially all of the
business or assets of the Company), spouses, heirs and personal and legal representatives. This Agreement shall continue in effect regardless of whether Indemnitee continues to serve as a director, officer, employee, agent or fiduciary (as
applicable) of the Company or of any other enterprise at the Company’s request. 
 13.    Expenses Incurred in
Action Relating to Enforcement or Interpretation. In the event that any action is instituted by Indemnitee under this Agreement or under any liability insurance policies maintained by the Company to enforce or interpret any of the terms hereof
or thereof, Indemnitee shall be entitled to be indemnified for all Expenses incurred by Indemnitee with respect to such action (including without limitation attorneys’ fees), regardless of whether Indemnitee is ultimately successful in such
action, unless as a part of such action a court having jurisdiction over such action makes a final judicial determination (as to which all rights of appeal therefrom have been exhausted or lapsed) that each of the material assertions made by
Indemnitee as a basis for such action was not made in good faith or was frivolous. In the event of an action instituted by or in the name of the Company under this Agreement to enforce or interpret any of the terms of this Agreement, Indemnitee
shall be entitled to be indemnified for all Expenses incurred by Indemnitee in defense of such action (including without limitation costs and expenses incurred with respect to Indemnitee’s counterclaims and cross-claims made in such action),
unless as a part of such action a court having jurisdiction over such action makes a final judicial determination (as to which all rights of appeal therefrom have been exhausted or lapsed) that each of the material defenses asserted by Indemnitee in
such action was made in bad faith or was frivolous. 
 14.    Notice. All notices, requests, demands and other
communications under this Agreement shall be in writing and shall be deemed duly given (i) if delivered by hand and signed for by the party addressed, on the date of such delivery, or (ii) if mailed by domestic certified or registered mail
with postage prepaid, on the third business day after the date postmarked. Addresses for notice to either party are as shown on the signature page of this Agreement, or as subsequently modified by written notice. 
 15.    Consent to Jurisdiction. The Company and Indemnitee each hereby irrevocably consent to the jurisdiction of the courts
of the State of Delaware for all purposes in connection with any action or proceeding which arises out of or relates to this Agreement and agree that any action instituted under this Agreement shall be commenced, prosecuted and continued only in the
Court of Chancery of the State of Delaware in and for New Castle County, which shall be the exclusive and only proper forum for adjudicating such a claim. 
 16.     Severability. The provisions of this Agreement shall be severable in the event that any of the provisions hereof (including any provision within a single section, paragraph or
sentence) are held by a court of competent jurisdiction to be invalid, void or otherwise unenforceable, and the remaining provisions shall remain enforceable to the fullest extent permitted by Delaware law. Furthermore, to the fullest extent
possible, the provisions of this Agreement (including without limitation each portion of this Agreement containing any provision held to be invalid, void or 

  

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otherwise unenforceable, that is not itself invalid, void or unenforceable) shall be construed so as to give effect to the intent manifested by the provision
held invalid, illegal or unenforceable. 
 17.    Choice of Law. This Agreement, and all rights, remedies,
liabilities, powers and duties of the parties to this Agreement, shall be governed by and construed in accordance with the laws of the State of Delaware without regard to principles of conflicts of laws. 
 18.    Subrogation. In the event of payment under this Agreement, the Company shall be subrogated to the extent of such
payment to all of the rights of recovery of Indemnitee, who shall execute all documents required and shall do all acts that may be necessary to secure such rights and to enable the Company effectively to bring suit to enforce such rights.

 19.    Amendment and Termination. No amendment, modification, termination or cancellation of this Agreement
shall be effective unless it is in writing signed by both of the parties hereto. No waiver of any of the provisions of this Agreement shall be deemed to be or shall constitute a waiver of any other provisions hereof (whether or not similar), nor
shall such waiver constitute a continuing waiver, except as specifically provided herein. 
 20.    Integration and
Entire Agreement. This Agreement sets forth the entire understanding between the parties hereto and supersedes and merges all previous written and oral negotiations, commitments, understandings and agreements relating to the subject matter
hereof between the parties hereto. 
 21.    No Construction as Employment Agreement. Nothing contained in this
Agreement shall be construed as giving Indemnitee any right to be retained in the employ of the Company or any of its subsidiaries or affiliated entities. 
 * * * 
  

 11 

 IN WITNESS WHEREOF, the parties hereto have executed this Indemnification Agreement as of the date first
above written. 
  

			
	ACOLOGIX, INC.
		
	By:	 	  
		
	Name:	 	  
		
	Title:	 	  

  

	Address:	3960 Point Eden Way
 Hayward, California 94545 

  

	
	AGREED TO AND ACCEPTED
	
	  
	 (Signature)

	
	  
	 (Print Name)

	
	  
	 (Address)

	
	  

  

 12Form of Change of Control Agreement between the Registrant and its VP and CFO

 EXHIBIT 10.4 
 ACOLOGIX, INC. 
 CHANGE OF CONTROL AGREEMENT 
 This Change of Control Agreement (the “Agreement”) is made and entered into by and between
                                        
         (the “Executive”) and Acologix, Inc., a Delaware corporation (the “Company”), effective as of
                                , 2006. 
 R E C I T A L S 
 A. It is expected
that the Company from time to time will consider the possibility of an acquisition by another company or other change of control. The Board of Directors of the Company (the “Board”) recognizes that such consideration can be a
distraction to the Executive and can cause the Executive to consider alternative employment opportunities. The Board has determined that it is in the best interests of the Company and its stockholders to assure that the Company will have the
continued dedication and objectivity of the Executive, notwithstanding the possibility, threat or occurrence of a Change of Control of the Company. 
 B. The Board believes that it is in the best interests of the Company and its stockholders to provide the Executive with an incentive to continue his employment and to motivate the Executive to maximize the value of the Company upon a
Change of Control for the benefit of its stockholders. 
 C. Certain capitalized terms used in the Agreement are defined in Section 5
below. 
 NOW, THEREFORE, for good and valuable consideration, the receipt and sufficiency of which is acknowledged, the parties hereto agree
as follows: 
 1. Term of Agreement. This Agreement shall terminate upon the date that all obligations of the parties hereto with
respect to this Agreement have been satisfied. 
 2. At-Will Employment. The Company and the Executive acknowledge that the
Executive’s employment is and shall continue to be at-will, as defined under applicable law. If the Executive’s employment terminates for any reason, including (without limitation) any termination prior to a Change of Control, the
Executive shall not be entitled to any payments, benefits, damages, awards or compensation other than as provided by this Agreement, or as may otherwise be available in accordance with the Company’s established Executive plans and practices or
pursuant to other agreements with the Company. 
 3. Benefits. 
 (a) Termination Following A Change of Control. In the event that a Change of Control of the Company occurs and during the period beginning on the
closing date of the transaction giving rise to such Change of Control and ending twelve (12) months after such closing date, the Executive’s employment with the Company (or the successor entity in such Change of Control transaction) is
either (a) terminated by the Company (or its successor entity) without Cause 

 
or (b) is Constructively Terminated by the Executive, then (i) one hundred percent (100%) of all unvested Stock Rights as of such date shall
become fully vested on the date of such termination, (ii) Executive will be entitled to receive an additional twelve (12) months salary and one hundred percent (100%) of the Executive’s target bonus for one year (“Cash
Benefits”) following termination of Executive’s employment and (iii) Executive will be entitled to receive an additional twelve (12) months of Company benefits following termination of Executive’s employment in
accordance with the Company’s existing written benefits plans and practices. The Cash Benefits shall be paid to the Executive in equal monthly installments over a twelve (12) month period and otherwise in accordance with the Company’s
existing payroll procedures. 
 (b) Termination For Cause. If the Executive’s employment terminates by reason of the
Executive’s voluntary resignation (and is not a Constructive Termination), or if the Executive is terminated for Cause, then the Executive shall not be entitled to receive the accelerated vesting of Stock Rights, severance payments or benefits
set forth in Section 3(a) above. 
 (c) Termination Apart from Change of Control. In the event the Executive’s employment is
terminated for any reason, either prior to the occurrence of a Change of Control or after the twelve (12) month period following a Change of Control, then the Executive will be entitled to receive severance and any other benefits only as may
then be established under the Company’s existing written severance and benefits plans and practices or pursuant to other written agreements with the Company. 
 4. Release of Claims. The delivery to the Executive of the benefits described in Section 3 following a termination will be subject to Executive’s signing and not revoking a standard separation
agreement and release of claims in a form reasonably acceptable to the Company and the Executive. Such separation agreement shall include, among other things, (a) a customary non-disparagement agreement by the Executive pursuant to which the
Executive agrees not to disparage, criticize or otherwise make derogatory statements regarding the Company, its directors or its officers, or to tortiously interfere with the contracts, relationships and prospective economic advantage of the
Company, and (b) a customary non-solicitation agreement pursuant to which the Executive agrees for a period of twelve (12) months not to directly or indirectly solicit, induce, attempt to hire, recruit, encourage, take away, hire any
employee of the Company or cause an employee to leave his or her employment either to work for the Executive or for any other entity or person. 
 5. Definition of Terms. The following terms referred to in this Agreement shall have the following meanings: 
 (a)
“Cause” means (i) any act of dishonesty taken in connection with the Executive’s responsibilities as an Executive that is intended to result in such Executive’s personal enrichment; (ii) the Executive’s
conviction or plea of no contest to a crime that negatively reflects on the Executive’s fitness to perform Executive’s duties or harms the Company’s (or the successor corporation’s) reputation or business; (iii) willful
misconduct by the Executive that is injurious to the Company’s (or the successor corporation’s) reputation or business; or (iv) the Executive’s willful violation of a material Company employment policy. For purposes of this
definition, an act or 

  

 2 

 
failure to act will be deemed “willful” if effected not in good faith or without reasonable belief that such action or failure to act was in the
best interests of the Company (or the successor corporation). 
 (b) “Change in Control” means the occurrence of any of the
following events: 
 (i) Any “person” (as such term is used in Sections 13(d) and 14(d) of the Exchange Act) becomes the
“beneficial owner” (as defined in Rule 13d-3 of the Exchange Act), directly or indirectly, of securities of the Company representing fifty percent (50%) or more of the total voting power represented by the Company’s then
outstanding voting securities; or 
 (ii) The approval by stockholders of the sale or disposition by the Company of all or substantially all
of the Company’s assets; or 
 (iii) A change in the composition of the Board occurring within a two-year period, as a result of which
fewer than a majority of the directors are Incumbent Directors. “Incumbent Directors” means directors who either (A) are Directors as of the effective date of the Plan, or (B) are elected, or nominated for election, to the
Board with the affirmative votes of at least a majority of the Incumbent Directors at the time of such election or nomination (but will not include an individual whose election or nomination is in connection with an actual or threatened proxy
contest relating to the election of directors to the Company); or 
 (iv) The approval by stockholders of a merger or consolidation of the
Company with any other corporation, other than a merger or consolidation which would result in the voting securities of the Company outstanding immediately prior thereto continuing to represent (either by remaining outstanding or by being converted
into voting securities of the surviving entity or its parent) at least fifty percent (50%) of the total voting power represented by the voting securities of the Company or such surviving entity or its parent outstanding immediately after such
merger or consolidation. 
 For purposes of clauses (i) and (iii) above, such Change of Control shall be deemed to have occurred on
the date on which the transaction closes; for the purpose of clauses (ii) and (iv) above, such Change of Control shall be deemed to have occurred on the date on which the Company’s stockholders approve a transaction described in that
clause. 
 (c) “Constructive Termination” shall mean the occurrence of any of the following without the Executive’s
express written consent (i) the assignment to the Executive of any duties or the reduction of the Executive’s duties, either of which results in a significant diminution in the Executive’s position or responsibilities in effect
immediately prior to such assignment, or the removal of the Executive from such position and responsibilities, provided, however that changes in the circumstances of employment which are solely the result of changes in corporate legal structure
resulting directly from the Change of Control shall not constitute a basis for Constructive Termination; (ii) a substantial reduction, without good business reasons, of the facilities and perquisites available to the Executive immediately prior
to such reduction, unless the facilities and perquisites available to all executives of the Company are similarly reduced; (iii) a material reduction by the Company in the cash compensation of the Executive as in effect immediately prior to
such reduction; (iv) a material reduction by the Company in the kind or level of employee benefits 

  

 3 

 
to which the Executive is entitled immediately prior to such reduction with the result that the Executive’s overall benefits package is significantly
reduced, unless the kind or level of employee benefits available to all executives of the Company are similarly reduced; or (v) the relocation of Executive’s principal place of employment to a facility or a location more than 50 miles from
the Executive’s then present location. 
 (d) “Stock Rights” shall mean all options or rights to acquire shares of
Company Common Stock, or stock appreciation rights, performance units or performance shares (whether such awards are payable in cash, shares of Company Common Stock or otherwise), under plans, agreements or arrangements which are compensatory in
nature, including, without limitation, the Company’s Amended and Restated 2000 Incentive Stock Plan and 2006 Equity Incentive Plan, and any restricted stock purchase agreement between the Company and the Executive. 
 6. Successors. 
 (a)
Company’s Successors. Any successor to the Company (whether direct or indirect and whether by purchase, merger, consolidation, liquidation or otherwise) to all or substantially all of the Company’s business and/or assets shall
assume the obligations under this Agreement and agree expressly to perform the obligations under this Agreement in the same manner and to the same extent as the Company would be required to perform such obligations in the absence of a succession.
For all purposes under this Agreement, the term “Company” shall include any successor to the Company’s business and/or assets which executes and delivers the assumption agreement described in this Section 6(a) or which becomes
bound by the terms of this Agreement by operation of law. 
 (b) Executive’s Successors. The terms of this Agreement and all
rights of the Executive hereunder shall inure to the benefit of, and be enforceable by, the Executive’s personal or legal representatives, executors, administrators, successors, heirs, distributees, devisees and legatees. 
 7. Notice. 
 (a) General.
Notices and all other communications contemplated by this Agreement shall be in writing and shall be deemed to have been duly given when personally delivered or when mailed by U.S. registered or certified mail, return receipt requested and postage
prepaid. In the case of the Executive, mailed notices shall be addressed to the Executive at his or her home address most recently communicated to the Company in writing. In the case of the Company, mailed notices shall be addressed to its corporate
headquarters, and all notices shall be directed to the attention of its Secretary. 
 (b) Notice of Termination. Any termination by
the Company for Cause or by the Executive as a result of a voluntary resignation or a Constructive Termination shall be communicated by a notice of termination to the other party hereto given in accordance with Section 7(a) of this Agreement.
Such notice shall indicate the specific termination provision in this Agreement relied upon, shall set forth in reasonable detail the facts and circumstances claimed to provide a basis for termination under the provision so indicated, and shall
specify the termination date (which shall be not more than 30 days after the giving of such notice). The failure by the 

  

 4 

 
Executive to include in the notice any fact or circumstance which contributes to a showing of Constructive Termination shall not waive any right of the
Executive hereunder or preclude the Executive from asserting such fact or circumstance in enforcing Executive’s rights hereunder. 
 8.
Miscellaneous Provisions. 
 (a) No Duty to Mitigate. The Executive shall not be required to mitigate the amount of any payment
contemplated by this Agreement, nor shall any such payment be reduced by any earnings that the Executive may receive from any other source. 
 (b) Waiver. No provision of this Agreement shall be modified, waived or discharged unless the modification, waiver or discharge is agreed to in writing and signed by the Executive and by an authorized officer of the Company (other
than the Executive). No waiver by either party of any breach of, or of compliance with, any condition or provision of this Agreement by the other party shall be considered a waiver of any other condition or provision or of the same condition or
provision at another time. 
 (c) Headings. All captions and section headings used in this Agreement are for convenient reference only
and do not form a part of this Agreement. 
 (d) Whole Agreement. No agreements, representations or understandings (whether oral or
written and whether express or implied) which are not expressly set forth in this Agreement have been made or entered into by either party with respect to the subject matter hereof. This Agreement represents the entire understanding of the parties
hereto with respect to the subject matter hereof and supersedes all prior arrangements and understandings regarding the same. No future agreements between the Company and the Executive may supersede this Agreement, unless they are in writing and
specifically mention this Section 8(d). In the event that the vesting acceleration provisions of this Agreement with respect to the Executive’s Stock Rights following a termination of employment conflict with any such provision contained
in the agreements documenting such Stock Rights (including any such provisions contained in the Company’s 2000 Incentive Stock Plan or 2006 Equity Incentive Plan), then the provisions of this Agreement shall control. 
 (e) Choice of Law. The validity, interpretation, construction and performance of this Agreement shall be governed by the laws of the State of
California (with the exception of its conflict of laws provisions). 
 (f) Severability. The invalidity or unenforceability of any
provision or provisions of this Agreement shall not affect the validity or enforceability of any other provision hereof, which shall remain in full force and effect. 
 (g) Counterparts. This Agreement may be executed in counterparts, each of which shall be deemed an original, but all of which together will constitute one and the same instrument. 
 *  *  * 
  

 5 

 IN WITNESS WHEREOF, each of the parties has executed this Change in Control Agreement, in the case of the
Company by its duly authorized officer, as of the day and year set forth below. 
  

			
	COMPANY:	  	ACOLOGIX, INC.
		
		  	By:                                      
                                        
                                
		
		  	Title:                                     
                                        
                              
		
		  	Date:                                     
                                        
                              
		
	EXECUTIVE:	  	                                      
                                        
                                      
 

  
  
  
  
  
 [Signature Page to Change of Control Agreement]

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