Document:

Exhibit 4.2

      

       

        

      
        CENTENE CORPORATION

         

        as Issuer

         

        $2,200,000,000

         

        3.00% Senior Notes due 2030

         

        THE BANK OF NEW YORK MELLON TRUST COMPANY, N.A.

         

        as Trustee

         

        
          

         

        FIRST SUPPLEMENTAL INDENTURE

         

        Dated as of October 7, 2020

         

        TO THE INDENTURE

         

        Dated as of October 7, 2020

         

        
          
            

        

        
        TABLE OF CONTENTS

         

        Page

         

        	
                ARTICLE 1

              
	 	 
	
                APPLICATION OF SUPPLEMENTAL INDENTURE AND DEFINITIONS

              
	 	 
	
                Section 1.01. Application of this Supplemental Indenture.

              	
                1

              
	
                Section 1.02. Definition of Terms; Interpretation

              	
                2

              
	
                Section 1.03. Additional Definitions.

              	
                2

              
	
                Section 1.04. Other Definitions.

              	
                13

              
	 	 
	
                ARTICLE 2

              
	 	 
	
                THE NOTES

              
	 	 
	
                Section 2.01. Form Generally.

              	
                13

              
	
                Section 2.02. Terms of Securities.

              	
                14

              
	
                Section 2.03. Issuance of Additional Notes.

              	
                16

              
	 	 
	
                ARTICLE 3

              
	 	 
	
                REDEMPTION AND PREPAYMENT

              
	 	 
	
                Section 3.01. Optional Redemption.

              	
                16

              
	
                Section 3.02. Mandatory Redemption.

              	
                17

              
	
                Section 3.03. Change of Control Offer.

              	
                17

              
	 	 
	
                ARTICLE 4

              
	 	 
	
                ADDITIONAL COVENANTS

              
	 	 
	
                Section 4.01. SEC Reports.

              	
                20

              
	
                Section 4.02. Taxes.

              	
                21

              
	
                Section 4.03. Stay, Extension and Usury Laws.

              	
                21

              
	
                Section 4.04. Liens.

              	
                21

              
	
                Section 4.05. Designation of Restricted and Unrestricted Subsidiaries.

              	
                21

              
	
                Section 4.06. Repurchase at the Option of Holders Upon a Change of Control.

              	
                22

              
	 	 
	
                ARTICLE 5

              
	 	 
	
                DEFAULTS AND REMEDIES

              
	 	 
	
                Section 5.01. Events of Default.

              	
                22

              
	
                Section 5.02. Acceleration.

              	
                24

              

        

        

        
          i

          
            

        

        	
                ARTICLE 6

              
	 	 
	
                LEGAL DEFEASANCE AND COVENANT DEFEASANCE

              
	 	 
	
                Section 6.01. Covenant Defeasance.

              	
                25

              
	 	 
	
                ARTICLE 7

              
	 	 
	
                AMENDMENT, SUPPLEMENT AND WAIVER

              
	 	 
	
                Section 7.01. Without Consent of Holders of Notes.

              	
                26

              
	
                Section 7.02. With Consent of Holders of Notes.

              	
                27

              
	 	 
	
                ARTICLE 8

              
	 	 
	
                MISCELLANEOUS

              
	 	 
	
                Section 8.01. Ratification of Base Indenture; No Adverse Interpretation of Other Agreements.

              	
                28

              
	
                Section 8.02. Trust Indenture Act Controls.

              	
                28

              
	
                Section 8.03. Governing Law.

              	
                28

              
	
                Section 8.04. Successors.

              	
                29

              
	
                Section 8.05. Severability.

              	
                29

              
	
                Section 8.06. Counterpart Originals; Electronic Signatures.

              	
                29

              
	
                Section 8.07. Table of Contents, Headings, etc.

              	
                29

              
	
                Section 8.08. Waiver of Jury Trial.

              	
                29

              
	
                Section 8.09. Submission to Jurisdiction.

              	
                29

              
	
                Section 8.10. FATCA Withholding.

              	
                30

              
	 	 
	
                APPENDIX AND EXHIBITS

              
	 	 
	
                EXHIBIT A Form of Note

              	
                Exhibit A

              

         

          

        NOTE: This Table of Contents shall not, for any purpose, be deemed to be a part of this Supplemental Indenture.

         

        
          ii

          
            

        

        
        FIRST SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”) dated as of October 7, 2020, is by and between Centene Corporation, a Delaware corporation (the
          “Company”), and The Bank of New York Mellon Trust Company, N.A., a national banking association, as trustee.

         

        WHEREAS, the Company has executed and delivered to the Trustee an indenture, dated as of October 7, 2020 (the “Base Indenture” and, together with this
          Supplemental Indenture, the “Indenture”) providing for the issuance from time to time of one or more Series of the Company’s debentures, notes or other debt instruments.

        

        

        WHEREAS, Section 9.01 of the Base Indenture provides for the Company and the Trustee to supplement the Base Indenture without the consent of any Holder to provide for the issuance of and establish the form and terms
          and conditions of debentures, notes or other debt instruments of any Series as permitted by the Base Indenture.

        

        

        WHEREAS, pursuant to Section 2.02 of the Base Indenture, Centene wishes to provide for the issuance of 3.00% Senior Notes due 2030 (the “Notes”), the form,
          terms and conditions thereof to be set forth as provided in this Supplemental Indenture.

         

        WHEREAS, the Company has requested that the Trustee execute and deliver this Supplemental Indenture, and all requirements necessary to make this Supplemental Indenture a valid, binding and enforceable instrument in
          accordance with its terms, and to make the Notes, when executed by the Company and authenticated by the Trustee, the valid, binding and enforceable obligations of the Company, have been done and performed, and the execution and delivery of this
          Supplemental Indenture has been duly authorized in all respects.

         

        NOW, THEREFORE, in consideration of the covenants and agreements set forth herein and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto hereby
          agree as follows:

         

        ARTICLE 1

         

        

        APPLICATION OF SUPPLEMENTAL INDENTURE AND DEFINITIONS

         

        Section 1.01.  Application of this Supplemental Indenture.

         

        The terms and provisions contained in the Base Indenture will constitute, and are hereby expressly made, a part of this Supplemental Indenture and the Company and the Trustee, by their execution and delivery of this
          Supplemental Indenture, expressly agree to such terms and provisions and to be bound thereby. However, to the extent any provision of the Base Indenture conflicts with the express provisions (including the definitions set forth in Sections 1.03
          and 1.04) of this Supplemental Indenture, the provisions of this Supplemental Indenture will govern and be controlling in respect of the Notes (and only with respect to the Notes). For the avoidance of doubt, notwithstanding any other provision
          of this Supplemental Indenture, the provisions of this Supplemental Indenture and any amendments or modifications to the terms of the Base Indenture made herein are expressly and solely for the benefit of the Holders of the Notes (and not for the
          benefit of any other Series of Notes (as defined in the Base Indenture)). Unless otherwise expressly specified, references in this Supplemental Indenture to specific Article numbers or Section numbers refer to Articles and Sections contained in
          this Supplemental Indenture, and not the Base Indenture or any other document.

        

        

        
          1

          
            

        

        Section 1.02.  Definition of Terms; Interpretation

         

        Unless the context otherwise requires:

        

        

        (a)          capitalized terms used but not otherwise defined herein have the meanings set forth in the Base Indenture; and

         

        (b)          the provisions of general application in Sections 1.03 and 1.04 of the Base Indenture shall apply herein as if set forth herein.

         

        Section 1.03.  Additional Definitions.

         

        For purposes of this Supplemental Indenture and the Notes, the following terms shall have the following meanings:

         

        “Acquired Debt” means, with respect to any specified Person:

         

        (1)          Indebtedness of any other Person existing at the time such other Person is merged with or into or became a Subsidiary of such specified Person, whether or not such Indebtedness is
          incurred in connection with, or in contemplation of, such other Person merging with or into, or becoming a Subsidiary of, such specified Person; and

         

        (2)          Indebtedness secured by a Lien encumbering any asset acquired by such specified Person.

         

        “Additional Notes” has the meaning assigned to such term in Section 2.03 of this Supplemental Indenture.

         

        “Base Indenture” has the meaning assigned to such term in the preamble to this Supplemental Indenture.

         

        “Beneficial Owner” has the meaning assigned to such term in Rule 13d-3 and Rule 13d-5 under the Exchange Act, except that in calculating the beneficial
          ownership of any particular “person” or “group” (as those terms are used in Section 13(d)(3) and Section 14(d) of the Exchange Act, respectively), such “person” or “group,” as the case may be, will be deemed to have beneficial ownership of all
          securities that such “person” or “group” has the right to acquire by conversion or exercise of other securities, whether such right is currently exercisable or is exercisable only upon the occurrence of a subsequent condition.

         

        “BMOH Loan” means a certain construction loan, as amended, restated, replaced, supplemented or otherwise modified from time to time, in the original
          principal amount of $200,000,000, by and among BMO Harris Bank N.A., as administrative agent, lenders party thereto and Centene Forsyth Subsidiary.

         

        
          2

          
            

        

        “Business Day” means each day that is not a Saturday, Sunday or other day on which banking institutions in New York, New York,
          St. Louis, Missouri or in the jurisdiction of the place of any payment are permitted or required by law to close.

         

        “Cash Equivalents” means:

         

        (1)          Dollars;

         

        (2)          securities issued or directly and fully guaranteed or insured by the United States government or any agency or instrumentality of the United States government (provided that the full faith and credit of the United States is pledged in support of those securities) having maturities of not more than one year from the date of acquisition;

         

        (3)          certificates of deposit, demand deposits and eurodollar time deposits with maturities of one year or less from the date of acquisition, bankers’ acceptances with maturities not
          exceeding one year and overnight bank deposits, in each case, with any commercial bank having capital and surplus in excess of $250.0 million;

         

        (4)          repurchase obligations with a term of not more than seven days for underlying securities of the types described in clauses (2), (3), (5) and (6) of this definition entered into with
          any financial institution meeting the qualifications specified in clause (3) of this definition;

         

        (5)          commercial paper rated at least A-1 by S&P or at least P-1 by Moody’s or at least F-1 by Fitch, and in each case maturing within one year after the date of acquisition;

         

        (6)          readily marketable direct obligations issued by any state of the United States or any political subdivision thereof having one of the two highest rating categories obtainable from
          either Moody’s, S&P or Fitch (or, if at any time none of Moody’s, S&P or Fitch shall be rating such obligations, an equivalent rating from another internationally recognized ratings agency) with maturities of one year or less from the
          date of acquisition; and

         

        (7)          money market or mutual funds substantially all of the assets of which constitute Cash Equivalents of the kinds described in clauses (1) through (6) of this definition.

         

        “Change of Control” means the occurrence of any of the following:

         

        (1)          the consummation of a transaction giving rise to the direct or indirect sale, transfer, conveyance or other disposition (other than by way of merger or consolidation), in one or a
          series of related transactions, of all or substantially all of the properties or assets of the Company and its Restricted Subsidiaries, taken as a whole, to any “person” or “group” (as such terms are used in Sections 13(d)(3) and 14(d) of the
          Exchange Act, respectively);

         

        (2)          the adoption of a plan relating to the liquidation or dissolution of the Company;

         

        (3)          the consummation of any transaction (including any merger or consolidation) the result of which is that any “person” or “group” (as defined above) becomes the Beneficial Owner,
          directly or indirectly, of more than 35.0% of the Voting Stock of the Company, measured by voting power rather than number of shares; or

         

        
          3

          
            

        

        (4)          the Company consolidates with, or merges with or into, any Person, or any Person consolidates with, or merges with or into, the Company, in any such event pursuant to a transaction in
          which any of the outstanding Voting Stock of the Company or such other Person is converted into or exchanged for cash, securities or other property, other than any such transaction where the Voting Stock of the Company outstanding immediately
          prior to such transaction is converted into or exchanged for Voting Stock (other than Disqualified Stock) of the surviving or transferee Person constituting a majority of the outstanding shares of such Voting Stock of such surviving or transferee
          Person (immediately after giving effect to such issuance).

         

        Notwithstanding the above in this definition, the following shall not constitute a Change of Control: a transaction or series of transactions in which (x) the Company becomes a direct or indirect wholly-owned
          subsidiary of a holding company and (y) the direct or indirect Beneficial Owners of the Voting Stock of such holding company immediately following such transaction or transactions are substantially the same as the Beneficial Owners of the Voting
          Stock of the Company immediately prior to such transaction or transactions.

         

        “Consolidated Total Assets” means, as of the date of any determination thereof, the total assets of the Company and its Restricted Subsidiaries calculated
          in accordance with GAAP on a consolidated basis as of such date.

         

        “Equity Interests” means Capital Stock and all warrants, options or other rights to acquire Capital Stock (but excluding any debt security that is
          convertible into, or exchangeable for, Capital Stock).

         

        “Fair Market Value” means the price that would be negotiated in an arm’s-length transaction for
          cash between a willing seller and a willing and able buyer, neither of which is under any compulsion to complete the transaction, as such price is determined in good faith by an officer of Centene.

         

        “Fitch” means Fitch, Inc. or any successor to the rating agency business thereof.

         

        “Foreign Restricted Subsidiary” means any Restricted Subsidiary that is not formed under the laws of the United States of America or any State thereof.

         

        “GAAP” means generally accepted accounting principles set forth in the opinions and pronouncements of the Accounting Principles Board of the American
          Institute of Certified Public Accountants and statements and pronouncements of the Financial Accounting Standards Board or in such other statements by such other entity as have been approved by a significant segment of the accounting profession,
          which are in effect on the Issue Date.

         

        “Increased Amount” means, with respect to any Indebtedness, any increase in the amount of such Indebtedness in connection with any accrual of interest, the
          accretion of accreted value, the amortization of original issue discount, the payment of interest in the form of additional Indebtedness with the same terms, accretion of original issue discount or liquidation preference and increases in the
          amount of Indebtedness outstanding solely as a result of fluctuations in the exchange rate of currencies or increases in the value of property securing Indebtedness.

         

        
          4

          
            

        

        “Indenture” has the meaning assigned to such term in the preamble to this Supplemental Indenture.

         

        “Indirect Obligation” means, with respect to any Person, each obligation and liability of such Person, and all such obligations and liabilities of such
          Person, incurred pursuant to any agreement, undertaking or arrangement by which such Person: (a) Guarantees, endorses or otherwise becomes or is contingently liable upon (by direct or indirect agreement, contingent or otherwise, to provide funds
          for payment, to supply funds to, or otherwise to invest in, a debtor, or otherwise to assure a creditor against loss) the indebtedness, dividend, obligation or other liability of any other Person in any manner (other than by endorsement of
          instruments in the course of collection), including any indebtedness, dividend or other obligation which may be issued or incurred at some future time; (b) Guarantees the payment of dividends or other distributions upon the Capital Stock of any
          other Person; (c) undertakes or agrees (whether contingently or otherwise): (i) to purchase, repurchase, or otherwise acquire any indebtedness, obligation or liability of any other Person or any property or assets constituting security therefor,
          (ii) to advance or provide funds for the payment or discharge of any indebtedness, obligation or liability of any other Person (whether in the form of loans, advances, stock purchases, capital contributions or otherwise), or to maintain solvency,
          assets, level of income, working capital or other financial condition of any other Person, or (iii) to make payment to any other Person other than for value received; (d) agrees to lease property or to purchase securities, property or services
          from such other Person with the purpose or intent of assuring the owner of such indebtedness or obligation of the ability of such other Person to make payment of the indebtedness or obligation; (e) to induce the issuance of, or in connection with
          the issuance of, any letter of credit for the benefit of such other Person; or (f) undertakes or agrees otherwise to assure a creditor against loss.  The amount of any Indirect Obligation shall (subject to any limitation set forth herein) be
          deemed to be the outstanding principal amount (or maximum permitted principal amount, if larger) of the indebtedness, obligation or other liability Guaranteed or supported thereby.

         

        “Initial Notes” means the first $2,200,000,000 aggregate principal amount of Notes issued under this Supplemental Indenture on the Issue Date.

         

        “Interest Payment Dates” shall have the meaning set forth in paragraph 1 of each Note.

         

        “Investments” means, with respect to any Person, all direct or indirect investments by such Person in other Persons (including Affiliates) in the forms of
          loans (including Guarantees or other obligations), advances or capital contributions (excluding commission, travel and similar advances, fees and compensation paid to officers, directors and employees made in the ordinary course of business),
          purchases or other acquisitions for consideration of Indebtedness, Equity Interests or other securities, together with all items that are or would be classified as investments on a balance sheet prepared in accordance with GAAP.

         

        
          “Issue Date” means October 7, 2020.
            

            

          

        

        
          5

          
            

        

        “Limited Originator Recourse” means a reimbursement obligation of the Company in connection with a drawing on a letter of credit, revolving loan commitment,
          cash collateral account or other such credit enhancement issued to support Indebtedness of a Securitization Subsidiary that the Company’s Board of Directors (or a duly authorized committee thereof) determines is necessary to effectuate a
          Qualified Securitization Transaction; provided that the available amount of any such form of credit enhancement at any time shall not exceed 10.0% of the aggregate principal amount of such Indebtedness
          at such time.

         

        “Moody’s” means Moody’s Investors Service, Inc. or any successor to the rating agency business thereof.

         

        “NML Loan” means a certain loan in the original principal amount of $80,000,000 from The Northwestern Mutual Life Insurance Company to the Centene Plaza
          Subsidiary secured by various collateral, including but not limited to the interest of the Centene Plaza Subsidiary in the Centene Plaza Project.

         

        “Non-Recourse Debt” means Indebtedness:

         

        (1)  as to which neither the Company nor any of its Restricted Subsidiaries (a) provides credit support of any kind (including any undertaking, agreement or instrument that would constitute
          Indebtedness), (b) is directly or indirectly liable as a guarantor or otherwise, or (c) constitutes the lender;

         

        (2)  no default with respect to which (including any rights that the holders thereof may have to take enforcement action against an Unrestricted Subsidiary) would permit upon notice, lapse of time
          or both, any holder of any other Indebtedness (other than the Notes) of the Company or any of its Restricted Subsidiaries to declare a default on such other Indebtedness or cause the payment thereof to be accelerated or payable prior to its
          Stated Maturity; and

         

        (3)  as to which the lenders have been notified in writing that they will not have any recourse to the stock or assets of the Company or any of its Restricted Subsidiaries.

         

        “Notes” has the meaning assigned to it in the preamble to this Supplemental Indenture. The Notes include the Initial Notes and Additional Notes, if any,
          unless the context otherwise requires.

         

        “Permitted Liens” means:

         

        (1)  Liens in favor of the Company or any of its Restricted Subsidiaries;

         

        (2)  Liens on any property or assets of a Person existing at the time such Person is merged, amalgamated or consolidated with or into the Company or any Restricted Subsidiary of the Company; provided that such Liens were in existence prior to such merger, amalgamation or consolidation and not incurred in contemplation of such merger, amalgamation or consolidation and do not extend to any property
          or assets other than those of the Person merged, amalgamated or consolidated with or into the Company or the Restricted Subsidiary;

         

        
          6

          
            

        

        (3)  Liens for taxes or other governmental charges not at the time delinquent or thereafter payable without penalty or being contested in good faith by appropriate proceedings; provided, in each case, that appropriate reserves required pursuant to GAAP have been made in respect thereof;

         

        (4)  Liens on any property or assets existing at the time of the acquisition thereof by the Company or any Restricted Subsidiary of the Company; provided that

          such Liens were in existence prior to such acquisition and not incurred or assumed in connection with, or in contemplation of, such acquisition and do not extend to any property or assets of the Company or the Restricted Subsidiary;

         

        (5)  Liens to secure the performance of statutory Obligations, surety or appeal bonds, government contracts, performance bonds or other obligations of a like nature incurred in the ordinary course
          of business, including (i) Liens of landlords, carriers, warehousemen, mechanics and materialmen and other similar Liens imposed by law and (ii) Liens in the form of deposits or pledges incurred in connection with worker’s compensation,
          unemployment compensation and other types of social security (excluding Liens arising under Employee Retirement Income Security Act of 1974);

         

        (6)  Liens existing on the Issue Date;

         

        (7)  Liens arising from Uniform Commercial Code financing statement filings regarding operating leases entered into by the Company and its Restricted Subsidiaries in the ordinary course of
          business;

         

        (8)  [Reserved];

         

        (9)  Liens securing Hedging Obligations of the Company or any of its Restricted Subsidiaries, which transactions or obligations are incurred in the ordinary course of business for bona fide hedging
          purposes (and not for speculative purposes) of the Company or its Restricted Subsidiaries (as determined in good faith by the Board of Directors or senior management of the Company);

         

        (10)  Liens to secure Indebtedness (including Capital Lease Obligations) of the Company or any of its Restricted Subsidiaries represented by Capital Lease Obligations, mortgage financings or
          purchase money obligations, in each case incurred for the purpose of financing all or any part of the purchase price or cost of construction or improvement of property, plant or equipment used in the business of the Company or such Restricted
          Subsidiary in an aggregate principal amount not to exceed the greater of (x) $1,200.0 million and (y) 2.5% of Consolidated Total Assets at any time outstanding; provided that any such Lien (i) covers
          only the assets acquired, constructed or improved with such Indebtedness and (ii) is created within 270 days of such acquisition, construction or improvement;

         

        (11)  Liens to secure Indebtedness of the Company’s Foreign Restricted Subsidiaries which, when aggregated with the principal amount of all other Indebtedness incurred pursuant to this clause (11)
          and then outstanding, does not exceed the greater of (x) $1,500.0 million and (y) 3.25% of the Company’s Consolidated Total Assets; provided that any such Lien covers only the assets of such Foreign
          Restricted Subsidiaries;

         

        
          7

          
            

        

        (12)  Liens securing (a) Real Estate Indebtedness not to exceed in the aggregate at any one time outstanding the greater of (x) $2,400.0 million or (y) 5.0% of the Company’s Consolidated Total
          Assets or (b) Indebtedness in respect of secured or unsecured letters of credit incurred by the Company or any Restricted Subsidiary of the Company in an aggregate principal amount not to exceed $750.0 million;

         

        (13)  Liens required by any regulation, or order of or arrangement or agreement with any regulatory body or agency, so long as such Liens do not secure Indebtedness;

         

        (14)  Liens on assets transferred to a Securitization Subsidiary or on assets of a Securitization Subsidiary, in either case, incurred in connection with a Qualified Securitization Transaction;

         

        (15)  other Liens incurred in the ordinary course of business of the Company and its Restricted Subsidiaries with respect to Indebtedness in an aggregate principal amount, together with all
          Indebtedness incurred to refund, refinance or replace such Indebtedness (or refinancings, refundings or replacements thereof), that does not exceed 20.0% of the Company’s Consolidated Total Assets at any one time outstanding;

         

        (16)  [Reserved];

         

        (17)  Liens securing Acquired Debt or other Indebtedness, which, in the case of other Indebtedness, is incurred reasonably contemporaneously to finance an acquisition, merger, consolidation or
          amalgamation; provided, however, that any such Liens are limited to all or part of the same property or assets (plus improvements, accessions, proceeds or
          dividends or distributions in respect thereof, or replacements of any thereof), (a) acquired, or (b) of any Person acquired by or merged, amalgamated or consolidated with or into the Company or any Restricted Subsidiary of the Company, in each
          case in any transaction to which such Indebtedness relates;

         

        (18)  Liens on earnest money deposits of cash or Cash Equivalents, escrow arrangements or similar arrangements made by the Company or any Restricted Subsidiary of the Company in connection with any
          letter of intent or purchase agreement in respect of any Investment permitted under the Indenture;

         

        (19)  Liens to secure any modification, refinancing, refunding, restatement, exchange, extension, renewal or replacement (or successive refinancings, refundings, restatements, exchanges,
          extensions, renewals or replacements) as a whole, or in part, of any Indebtedness secured by any Lien referred to in clauses (2), (4), (6), (10), (11), (12), (15), (17), (18), (24), (29) and (31) of this definition; provided, however, that (a) any such new Lien shall be limited to all or part of the same property that secured the original Lien, plus accessions, additions and improvements on such
          property, including (i) after-acquired property that is affixed or incorporated into the property covered by such Lien, and (ii) after-acquired property subject to a Lien securing such Indebtedness, the terms of which Indebtedness require or
          include a pledge of after-acquired property (it being understood that such requirement shall not be permitted to apply to any property to which such requirement would not have applied but for such acquisition) and (b) the Indebtedness secured by
          such Lien at such time is not increased to any amount greater than the sum of (i) the outstanding principal amount or, if greater, committed amount of the Indebtedness described under clauses (2), (4), (6), (10), (11), (12), (15), (17), (18),
          (24), (29) and (31) of this definition at the time the original Lien became a Permitted Lien under the Indenture, and (ii) an amount necessary to pay accrued but unpaid interest on such Indebtedness and any dividend, premium (including tender
          premiums), defeasance costs, underwriting discounts and any fees, costs and expenses (including original issue discount, upfront fees or similar fees) incurred in connection with such modification, refinancing, refunding, restatement, exchange,
          extension, renewal or replacement;

         

        
          8

          
            

        

        (20)  Liens given to a public utility or any municipality, regulatory or governmental authority when required by such utility or authority in connection with the operations of that Person;

         

        (21)  Liens securing Indebtedness in an aggregate principal amount not to exceed 1.50% of Consolidated Total Assets at any one time outstanding;

         

        (22)  Liens relating to the honoring by a bank or other financial institution of a check, draft or similar instrument drawn against insufficient funds or relating to pooled deposit or sweep
          accounts to permit satisfaction of overdraft or similar obligations incurred in the ordinary course of business;

         

        (23)  Liens of a collection bank arising under Section 4-210 of the Uniform Commercial Code or any comparable or successor provision on items in the course of collection;

         

        (24)  Liens to secure Indebtedness of any Subsidiary that is not a Guarantor, permitted to be incurred by the Indenture, covering only the assets and properties of such Subsidiary;

         

        (25)  Liens deemed to exist in connection with Investments in repurchase obligations permitted under clause (4) of the definition of “Cash Equivalents”;

         

        (26)  Liens arising by operation of law or contract on insurance policies and the proceeds thereof to secure the premiums with respect thereto, and Liens, pledges or deposits in the ordinary course
          of business securing liabilities for premiums or reimbursements or indemnification obligations of (including obligations in respect of letters of credit or bank guaranty for the benefits of) insurance carriers;

         

        (27)  Liens on trusts, cash, Cash Equivalents or Investments used to satisfy and discharge, defease, repurchase or redeem Indebtedness or similar obligations; provided,
          however, that such satisfaction and discharge, defeasance, repurchase or redemption is otherwise permitted by the Indenture;

         

        (28)  Leases, licenses, subleases or sublicenses granted to others that do not (a) interfere in any material respect with the operation of the business of the Company or any of its Restricted
          Subsidiaries, taken as a whole, or (b) secure any Indebtedness;

         

        (29)  Liens securing the Notes and any Subsidiary Guarantees;

         

        
          9

          
            

        

        (30)  Liens securing judgments, orders or awards for the payment of money attachments (or appeal or other surety bonds relating to such judgments) not giving rise to an Event of Default; and

         

        (31)  prior to the date on which an Investment is consummated, Liens arising from any escrow arrangement pursuant to which the proceeds of any equity issuance, debt issuance or Indebtedness or
          other funds (including any prefunded interest) used to finance all or a portion of such Investment are required to be held in escrow pending release to consummate such Investment.

         

        For purposes of determining compliance with this definition, (A) a Lien need not be incurred solely by reference to one category of Permitted Liens described in this definition but is permitted to
          be incurred under any combination of categories (including in part under one such category and in part under any other such category), (B) in the event that a Lien (or any portion thereof) meets the criteria of one or more of the categories of
          Permitted Liens, the Company shall, in its sole discretion, classify or reclassify such Lien (or any portion thereof) in any manner that complies with this definition and (C) the amount of Indebtedness outstanding as of any date shall be (1) the
          accreted value thereof, in the case of any Indebtedness issued with original issue discount, (2) the principal amount thereof, in the case of any other Indebtedness, (3) in the case of the Guarantee by the specified Person of any indebtedness of
          any other Person, the maximum liability to which the specified Person may be subject upon the occurrence of the contingency giving rise to the obligation and (4) in the case of Indebtedness of others Guaranteed by means of a Lien on any asset of
          the specified Person, the lesser of (x) the Fair Market Value of such asset on the date on which Indebtedness is required to be determined pursuant to the Indenture and (y) the amount of the Indebtedness so secured.

         

        “Prospectus Supplement” means the Prospectus Supplement dated September 23, 2020 related to the offer and sale of the Initial Notes.

         

        “Qualified Securitization Transaction” means any transaction or series of transactions that may be entered into by the Company or any Restricted Subsidiary
          of the Company pursuant to which (a) the Company or such Restricted Subsidiary may sell, convey or otherwise transfer to a Securitization Subsidiary its interests in Receivables and Related Assets and (b) such Securitization Subsidiary transfers
          to any other Person, or grants a security interest in, such Receivables and Related Assets, pursuant to a transaction which is customarily used to achieve a transfer of financial assets under GAAP.

         

        “Real Estate Indebtedness” means (a) any debt or obligations of the Company or any of its Subsidiaries in whole or in part secured by interests in real
          property, including, but not limited to, the NML Loan, the BMOH Loan and extensions, renewals and refinancings of such Indebtedness and (b) Indirect Obligations of the Company with respect to any debt or obligations of the Centene Plaza
          Subsidiary, the Centene Forsyth Subsidiary or the Centene Plaza Phase II Subsidiary and extensions, renewals and refinancings of such Indebtedness of the Centene Plaza Subsidiary, the Centene Forsyth Subsidiary or the Centene Plaza Phase II
          Subsidiary; provided that such Indebtedness of the Centene Plaza Subsidiary, the Centene Forsyth Subsidiary or the Centene Plaza Phase II Subsidiary (with respect to which the Company has Indirect
          Obligations) is used solely to finance the Centene Plaza Project, the Centene Forsyth Project or the Centene Plaza Phase II Project, as applicable.

         

        
          10

          
            

        

        “Receivables and Related Assets” means any account receivable (whether now existing or arising thereafter) of the Company or any Restricted Subsidiary of
          the Company, and any assets related thereto including all collateral securing such accounts receivable, all contracts and contract rights and all Guarantees or other obligations in respect of such accounts receivable, proceeds of such accounts
          receivable and other assets which are customarily transferred or in respect of which security interests are customarily granted in connection with asset securitization transaction involving accounts receivable.

         

        “Regular Record Date” for the interest payable on any Interest Payment Date means the applicable date specified as a “Record Date” on the face of the Note.

         

        “S&P” means Standard & Poor’s Ratings Services or any successor to the rating agency business thereof.

         

        “Securitization Subsidiary” means a wholly-owned Subsidiary of the Company:

         

        (1)  that is designated a “Securitization Subsidiary” by the Board of Directors of the Company (or a duly authorized committee thereof);

         

        (2)  that does not engage in any activities other than Qualified Securitization Transactions and any activity necessary or incidental thereto;

         

        (3)  no portion of the Indebtedness or any other obligation, contingent or otherwise, of which:

         

        (a)  is Guaranteed by the Company or any Subsidiary of the Company in any way other than pursuant to Standard Securitization Undertakings or Limited Originator Recourse,

         

        (b)  is recourse to or obligates the Company or any other Subsidiary of the Company in any way other than pursuant to Standard Securitization Undertakings or Limited Originator Recourse, or

         

        (c)  subjects any property or asset of the Company or any other Subsidiary of the Company, directly or indirectly, contingently or otherwise, to the satisfaction thereof other than pursuant to
          Standard Securitization Undertakings or Limited Originator Recourse;

         

        (4)  with respect to which neither the Company nor any other Subsidiary of the Company has any obligation to maintain or preserve its financial condition or cause such entity to achieve certain
          levels of operating results; and

         

        (5)  with which neither the Company nor any Subsidiary of the Company has any material contract, agreement, arrangement or understanding other than on terms no less favorable to the Company or such
          Subsidiary than those that might be obtained at the time from Persons that are not Affiliates of the Company, other than Standard Securitization Undertakings and fees payable in the ordinary course of business in connection with servicing
          accounts receivable of such entity.

         

        
          11

          
            

        

        Any designation of a Subsidiary as a Securitization Subsidiary shall be evidenced to the Trustee by filing with the Trustee a certified copy of the resolution of the Board of Directors of the Company giving effect to the designation and an
          Officers’ Certificate certifying that the designation complied with the preceding conditions.

         

        “Significant Subsidiary” means any Subsidiary that would be a “significant subsidiary” as defined in Article 1, Rule 1-02 of Regulation S-X, promulgated
          pursuant to the Securities Act, as such regulation is in effect on the Issue Date.

         

        “Standard Securitization Undertakings” means representations, warranties, covenants and indemnities entered into by the Company or any Subsidiary of the
          Company that are reasonably customary in accounts receivable securitization transactions, as the case may be.

         

        “Stated Maturity” means, with respect to any installment of interest or principal on any series of Indebtedness, the date on which the payment of interest
          or principal was scheduled to be paid in the documentation governing such Indebtedness as of the Issue Date, and will not include any contingent obligations to repay, redeem or repurchase any such interest or principal prior to the date
          originally scheduled for the payment thereof.

         

        “Statistical Release’’ means that statistical release designated ‘‘H.15’’ or any successor publication published daily by the Board of Governors of the
          Federal Reserve System and which establishes yields on actively traded U.S. Treasury securities adjusted to constant maturity, or, if such release (or any successor publication) is no longer published at the time of any calculation under the
          Indenture, then such other reasonably comparable index the Company designates.

         

        “Supplemental Indenture” has the meaning assigned to it in the preamble to this Supplemental Indenture.

         

        “Treasury Rate” means, the arithmetic mean (rounded to the nearest one-hundredth of one percent) of the yields displayed for each of the five most recent
          days published in the most recent Statistical Release under the caption ‘‘Treasury constant maturities’’ for the maturity (rounded to the nearest month) corresponding to the remaining life to maturity of the Notes (assuming the notes mature on
          the Par Call Date) as of the Redemption Date. If no maturity exactly corresponds to such remaining life to maturity, yields for the two published maturities most closely corresponding to such remaining life to maturity shall be calculated
          pursuant to the immediately preceding sentence and the Treasury Rate shall be interpolated or extrapolated from such yields on a straight-line basis, rounding in each of such relevant periods to the nearest month. The Treasury Rate will be
          calculated on the third business day preceding the date the applicable notice of redemption is given. For the purpose of calculating the Treasury Rate, the most recent Statistical Release published prior to the date of calculation of the Treasury
          Rate shall be used.

         

        “Trustee” means the Person named as the “trustee” in the Recitals of this Supplemental Indenture, and its successors and assigns, until a successor trustee
          shall have become such pursuant to the applicable provisions of the Indenture, and thereafter “Trustee” shall mean such successor trustee.

         

        
          12

          
            

        

        “Unrestricted Subsidiary” means any Subsidiary of the Company that is designated by the Board of Directors of the Company as an Unrestricted Subsidiary
          pursuant to a Board Resolution of the Company, but only to the extent that such Subsidiary:

         

        (1)  has no Indebtedness other than Non-Recourse Debt;

         

        (2)  is a Person with respect to which neither the Company nor any of its Restricted Subsidiaries has any direct or indirect obligation (a) to subscribe for additional Equity Interests or (b) to
          maintain or preserve such Person’s financial condition or to cause such Person to achieve any specified levels of operating results; and

         

        (3)  has not Guaranteed or otherwise directly or indirectly provided credit support for any Indebtedness of the Company or any of its Restricted Subsidiaries.

         

        “Voting Stock” of any Person as of any date means all classes of Capital Stock of such Person then outstanding and normally entitled to vote in the election
          of the Board of Directors of such Person.

         

        Section 1.04.  Other Definitions.

        

          
            	Term

                     	
                    Defined in 

                    Section

                       

                  
	
                    Acceleration Notice

                  	
                    5.02

                  
	
                    Applicable Law

                  	
                    8.10

                  
	
                    Change of Control Offer 

                  	
                    4.06(a)

                  
	
                    Change of Control Payment

                  	
                    4.06(a)

                  
	
                    Change of Control Payment Date

                  	
                    3.03(d)

                  
	
                    Company

                  	
                    Preamble

                  
	
                    Covenant Defeasance

                  	
                    6.01

                  
	
                    Event of Default

                  	
                    5.01

                  
	
                    Notes

                  	
                    Recitals

                  
	
                    Offer Amount

                  	
                    3.03(c)(2)

                  
	
                    Offer Period

                  	
                    3.03(d)

                  
	
                    Par Call Date

                  	
                    3.01(a)

                  
	
                    Payment Default

                  	
                    5.01(g)(A)

                  
	
                    Purchase Price

                  	
                    3.03(c)(2)

                  

          

        

         

        

         ARTICLE 2

         

        

        THE NOTES

         

        Section 2.01.  Form Generally.

         

        The Notes shall be substantially in the form of Exhibit A hereto, with such appropriate insertions, omissions, substitutions and other variations (including, for the avoidance of doubt, transfer restriction
          legends) as are required or permitted by the Indenture, and may have such letters, numbers or other marks of identification and such legends or endorsements placed thereon as may be required to comply with the rules of any securities exchange or
          as may, consistently herewith, be determined by the Officers executing such Notes as evidenced by their execution of the Notes.

         

        
          13

          
            

        

        The certificated Notes shall be printed, lithographed or engraved or produced by any combination of these methods or may be produced in any other manner, provided that such
          method is permitted by the rules of any securities exchange on which such Notes may be listed, all as determined by the Officers executing such Notes as evidenced by their execution of such Notes.

         

        Section 2.02.  Terms of Securities.

         

        Pursuant to Section 2.02 of the Base Indenture, the following terms relating to the Notes are hereby established:

        

        

        (a)          The Notes shall constitute a Series of Notes having the title “3.00% Senior Notes due 2030.”

         

        (b)          The initial aggregate principal amount of the Notes is $2,200,000,000. There is no limit upon the aggregate principal amount of Notes
            that may be authenticated and delivered under the Indenture, subject to the terms of the Base Indenture.

         

        (c)          The entire outstanding principal of the Notes shall be payable as set forth in the Notes.

         

        (d)          The rate at which the Notes shall bear interest and other terms relating to the payment of interest on the Notes shall be as set forth
            in the Notes.

         

        (e)          The principal of and interest on the Notes shall be payable at the place and in the manner set forth in the Notes.

         

        (f)          The provisions of Section 3.01 of this Supplemental Indenture shall be applicable to the Notes.

         

        (g)          The provisions of Section 3.02, 3.03 and 4.06 of this Supplemental Indenture shall be applicable to the Notes.

         

        (h)          Not applicable.

         

        (i)          The Notes shall be issuable in denominations of $2,000 and integral multiples of $1,000 in excess thereof.

         

        (j)          The Notes shall be issued at 100.00% of principal amount.

         

        (k)          Not applicable.

         

        (l)          Not applicable.

         

        
          14

          
            

        

        (m)          Not applicable.

         

        (n)          The Notes shall be issuable as Registered Global Notes, and shall bear a legend substantially in the following form:

         

        “UNLESS THIS CERTIFICATE IS PRESENTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITORY TRUST COMPANY, A NEW YORK CORPORATION (“DTC”), NEW YORK, NEW YORK, TO THE ISSUER OR ITS AGENT FOR REGISTRATION OF TRANSFER,
          EXCHANGE OR PAYMENT, AND ANY CERTIFICATE ISSUED IS REGISTERED IN THE NAME OF CEDE & CO. OR SUCH OTHER NAME AS IS REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF DTC (AND ANY PAYMENT IS MADE TO CEDE & CO., OR TO 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.

         

        THIS NOTE IS A REGISTERED GLOBAL NOTE WITHIN THE MEANING OF THE INDENTURE HEREINAFTER REFERRED TO AND IS REGISTERED IN THE NAME OF A DEPOSITARY OR A NOMINEE OF THE DEPOSITARY. THIS NOTE IS
          EXCHANGEABLE FOR NOTES REGISTERED IN THE NAME OF A PERSON OTHER THAN THE DEPOSITARY OR ITS NOMINEE ONLY IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE, AND MAY NOT BE TRANSFERRED EXCEPT AS A WHOLE BY THE DEPOSITARY TO A NOMINEE OF THE
          DEPOSITARY, 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 DEPOSITARY OR A NOMINEE OF SUCH A SUCCESSOR DEPOSITARY.”

         

        (o)          Not applicable.

         

        (p)          Not applicable.

         

        (q)          The Trustee, Depositary, Paying Agent and Registrar with respect to the Notes shall be as set forth in the Indenture.

         

        (r)          The Events of Default with respect to the Notes shall be as set forth in Section 5.01 of this Supplemental Indenture. The additional
            covenants contained in Article 4 of this Supplemental Indenture shall be applicable to the Notes.

         

        (s)          Not applicable.

         

        (t)          Not applicable.

         

        (u)          The Notes shall be issued at a price of 100.00% of principal amount.

         

        
          (v)          Not applicable.

        

         

        

        
          15

          
            

        

        (w)        Not applicable.

         

        (x)          The Notes may be defeasible pursuant to Sections 8.02 and 8.03 of the Base Indenture, as amended by this Supplemental Indenture.

         

        (y)          The CUSIP number assigned to the Notes is 15135B AW1. The ISIN assigned to the Notes is US15135BAW19.

         

        (z)          The additional definitions contained in Sections 1.03 and 1.04 of this Supplemental Indenture shall be applicable to the Notes.

         

        Section 2.03.  Issuance of Additional Notes.

         

        The Company shall be entitled to issue additional notes under the Indenture which shall have identical terms as the Initial Notes issued on the date hereof, other than with respect to the date of issuance and issue
          price (any such additional notes, the “Additional Notes”).  The Initial Notes issued on the date hereof and any Additional Notes subsequently issued under the Indenture shall be treated
          as a single class for all purposes under the Indenture, including waivers, amendments, redemptions and offers to purchase; provided, however, that in the event
          that any Additional Notes are not fungible with the Initial Notes for federal income tax purposes, such non-fungible Additional Notes shall be issued with a separate CUSIP number and ISIN so they are distinguishable from the Initial Notes.

         

        With respect to any Additional Notes, the Company shall set forth in an Officers’ Certificate, a copy of which shall be delivered to the Trustee, the following information:

         

        (1)          the aggregate principal amount of such Additional Notes to be authenticated and delivered pursuant to the Indenture;
            and

         

        (2)          the issue price, the issue date and the CUSIP number and/or ISIN of such Additional Notes.

         

        ARTICLE 3

         

        REDEMPTION AND PREPAYMENT

         

        Section 3.01.  Optional Redemption.

         

        (a)          Prior to July 15, 2030 (the “Par Call Date”), the Notes will be redeemable
            at any time or from time to time in whole or in part at the Company’s option at a Redemption Price equal to the greater of:

         

        (1)          100% of the principal amount of the Notes being redeemed on that Redemption Date, and

         

        (2)          the sum of the present values of the remaining scheduled payments of principal and interest on the Notes being
            redeemed (exclusive of interest accrued to, but excluding, the applicable Redemption Date) that would be due if such Notes matured on the Par Call Date, discounted to such Redemption Date on a semi-annual basis (assuming a 360-day year
            consisting of twelve 30-day months) at the Treasury Rate plus 50 basis points,

         

        
          16

          
            

        

        plus, in each case, accrued and unpaid interest on the Notes being redeemed to, but excluding, the Redemption Date.

         

        (b)          On or after the Par Call Date, the Notes will be redeemable at any time in whole or from time to time in part at the Company’s option,
            at a Redemption Price equal to 100% of the principal amount of the Notes being redeemed, plus accrued and unpaid interest thereon to, but excluding, the Redemption Date.

         

        (c)          Notwithstanding the foregoing, installments of interest on the Notes that are due and payable on any Interest Payment Date falling on or
            prior to a Redemption Date for the Notes shall be payable on such Interest Payment Dates to the Persons who were registered Holders of such Notes at the close of business on the applicable record dates.

         

        (d)          Any redemption of the Notes may, at the Company’s discretion, be subject to one or more conditions precedent. In addition, if such
            redemption or notice is subject to satisfaction of one or more conditions precedent, such notice shall state that, in the Company’s discretion, the Redemption Date may be delayed until such time as any or all of such conditions shall be
            satisfied (or waived by the Company in its sole discretion), or such redemption may not occur and such notice may be rescinded in the event that any or all such conditions shall not have been satisfied (or waived by the Company in its sole
            discretion) by the Redemption Date, or by the Redemption Date so delayed.

         

        (e)          Other than as specifically provided in this Section 3.01, any redemption pursuant to this Section 3.01 shall be made in accordance with
            the provisions of Section 3.01 through 3.06 of the Base Indenture.

         

        Section 3.02.  Mandatory Redemption.

         

        Except as set forth in 4.06, the Company shall not be required to make mandatory redemption or sinking fund payments with respect to, or offer to purchase, the Notes.

         

        Section 3.03.  Change of Control Offer.

         

        (a)          In the event that, pursuant to Section 4.06 hereof, the Company shall be required to commence a Change of Control Offer, it shall follow
            the procedures specified in this Section 3.03.

         

        (b)          The Company shall cause a notice of the Change of Control Offer to be sent at least once to the Dow Jones News Service or similar
            business news service in the United States.

         

        (c)          The Company shall commence the Change of Control Offer by sending by electronic transmission (for Global Notes) or first-class mail,
            with a copy to the Trustee, to each Holder of the Notes at such Holder’s address appearing in the Note Register, a notice the terms of which shall govern the Change of Control Offer stating:

         

        
          17

          
            

        

        (1)          that the Change of Control Offer is being made pursuant to this Section 3.03 and Section 4.06, that a Change of
            Control has occurred and the circumstances and relevant facts regarding the Change of Control;

         

        (2)          the principal amount of Notes required to be purchased pursuant to Section 4.06 (the “Offer Amount”), the purchase price set forth in Section 4.06 (the “Purchase Price”), the Offer
            Period and the Change of Control Payment Date (each as defined below);

         

        (3)          except as provided in clause (9), that all Notes validly tendered and not withdrawn shall be accepted for payment;

         

        (4)          that any Note not tendered or accepted for payment shall continue to accrue interest;

         

        (5)          that, unless the Company defaults in making such payment, any Note accepted for payment pursuant to the Change of
            Control Offer shall cease to accrue interest after the Change of Control Payment Date;

         

        (6)          that Holders electing to have a Note purchased pursuant to a Change of Control Offer may elect to have Notes
            purchased equal to $2,000 or in integral multiples of $1,000 only;

         

        (7)          that Holders electing to have a Note purchased pursuant to any Change of Control Offer shall be required to surrender
            the Note, with the form entitled “Option of Holder to Elect Purchase” on the reverse of the Note completed, or transfer by book-entry transfer, to the Company, the Depositary, if appointed by the Company, or a Paying Agent at the address
            specified in the notice before the close of business on the third Business Day before the Change of Control Payment Date;

         

        (8)          that Holders shall be entitled to withdraw their election if the Company, the Depositary or the Paying Agent, as the
            case may be, receives, not later than the expiration of the Offer Period, a telegram, facsimile transmission, letter or electronic transmission setting forth the name of the Holder, the principal amount of the Note (or portions thereof) the
            Holder delivered for purchase and a statement that such Holder is withdrawing his election to have such Note purchased;

         

        (9)          [Reserved];

         

        (10)        that Holders whose Notes were purchased in part shall be issued new Notes equal in principal amount to the
            unpurchased portion of the Notes surrendered (or transferred by book-entry transfer); and

         

        (11)        any other procedures the Holders must follow in order to tender their Notes (or portions thereof) for payment and the
            procedures that Holders must follow in order to withdraw an election to tender Notes (or portions thereof) for payment.

         

        
          18

          
            

        

        (d)          The Change of Control Offer shall remain open for a period of at least five (5) Business Days but no more than 60 days following its
            commencement, except to the extent that a longer period is required by applicable law (the “Offer Period”).  No later than five (5) Business Days (and in any
            event no later than the 60th day following the Change of Control) after the termination of the Offer Period (the “Change of Control Payment Date”), the Company shall purchase the Offer
            Amount or, if less than the Offer Amount has been tendered, all Notes tendered in response to the Change of Control Offer.  Payment for any Notes so purchased shall be made in the same manner as interest payments are made.  The Company shall
            publicly announce the results of the Change of Control Offer on or as soon as practicable after the Change of Control Payment Date.

         

        (e)          On or prior to the Change of Control Payment Date, the Company shall, to the extent lawful:

         

        (1)          accept for payment the Offer Amount of Notes or portions of Notes validly tendered and not withdrawn pursuant to the
            Change of Control Offer or, if less than the Offer Amount has been tendered, all Notes tendered;

         

        (2)          deposit with the Paying Agent funds in an amount equal to the Purchase Price in respect of all Notes or portions of
            Notes validly tendered and not withdrawn; and

         

        (3)          deliver or cause to be delivered to the Trustee the Notes properly accepted together with an Officers’ Certificate
            stating the aggregate principal amount of the Notes or portions of such Notes being purchased by the Company and that such Notes or portions thereof were accepted for payment by the Company in accordance with the terms of this Section 3.03.

         

        (f)          The Paying Agent (or the Company, if acting as the Paying Agent) shall promptly (but not later than 60 days from the date of the Change
            of Control) send to each Holder of Notes validly tendered the Purchase Price deposited with the Paying Agent by the Company.  In the event that any portion of the Notes surrendered is not purchased by the Company, the Company shall promptly
            execute and issue a new Note in a principal amount equal to such unpurchased portion of the Note surrendered, and, upon receipt of a Company Order in accordance with Section 2.03 of the Base Indenture, the Trustee shall promptly authenticate
            and mail (or cause to be transferred by book-entry) to each Holder a new Note equal in principal amount to the unpurchased portion of the Note surrendered; provided, however,
            that each such new Note shall be in a principal amount of $2,000 or an integral multiple of $1,000 in excess thereof.  Any Note not so accepted shall be promptly mailed or delivered by the Company to the Holder thereof.

         

        (g)          If the Change of Control Payment Date is on or after a Regular Record Date and on or before the related Interest Payment Date, any
            accrued and unpaid interest shall be paid to the Person in whose name a Note is registered at the close of business on such Regular Record Date.

         

        (h)          The Company shall comply with the requirements of Rule 14e-1 under the Exchange Act and any other securities laws and regulations
            thereunder to the extent those laws and regulations are applicable in connection with the Change of Control Offer.  To the extent that the provisions of any securities laws or regulations conflict with Section 4.06, this Section 3.03 or any
            other provisions of the Indenture, the Company shall comply with applicable securities laws and regulations and shall not be deemed to have breached its obligations under Section 4.06, this Section 3.03 or such other provision by virtue of such
            compliance.

         

        
          19

          
            

        

        (i)          If Holders of not less than 90.0% of the aggregate principal amount of the outstanding Notes validly tender and do not withdraw such
            Notes in a Change of Control Offer and the Company (or any third party making a Change of Control Offer in lieu of the Company as described in Section 4.06(b)) purchases all of the Notes validly tendered and not withdrawn by such Holders, the
            Company or such third party, as the case may be, shall have the right, upon at least 15 but not more than 60 days prior notice, given not more than 30 days following such initial purchase, to purchase all of the Notes that remain outstanding
            following such initial purchase at a price equal to the price offered to each other Holder in the applicable Change of Control Offer, plus accrued and unpaid interest, if any, to, but excluding, the date of such second purchase (subject to the
            rights of Holders of the Notes of record on the relevant record date to receive interest due on an Interest Payment Date falling prior to such second purchase date).

         

        (j)          Other than as specifically provided in this Section 3.03, any purchase pursuant to this Section 3.03 shall be made in accordance with
            the provisions of Sections 3.01 through 3.06 of the Base Indenture.

         

        ARTICLE 4

         

        ADDITIONAL COVENANTS

         

        Section 4.01.  SEC Reports.

         

        (a)          Whether or not required, so long as the Notes are outstanding, the Company will file with the SEC (unless the SEC will not accept such
            filing), within the time periods specified in the SEC’s rules and regulations and deliver to the Trustee within 15 days after the filing of the same would be required by the SEC, copies of the quarterly and annual reports and of the
            information, documents and other reports, if any, which the Company would be required to file with the SEC if subject to the reporting requirements of Section 13 or 15(d) of the Exchange Act.  Notwithstanding that the Company may not be subject
            to the reporting requirements of Section 13 or 15(d) of the Exchange Act, so long as the Notes are outstanding the Company will file with the SEC, to the extent permitted, and provide the Trustee with such annual reports and such information,
            documents and other reports specified in Sections 13 and 15(d) of the Exchange Act within the time periods specified in the SEC’s rules and regulations.  The Company will be deemed to have furnished such reports referred to in this section to
            the Trustee and the Holders of the Notes if the Company has filed such reports with the SEC via the EDGAR filing system or any successor system and such reports are publicly available.

         

        (b)          Delivery of such reports, information and documents to the Trustee is for informational purposes only and the Trustee’s receipt of such
            shall not constitute constructive notice of any information contained therein or determinable from information contained therein, including the Company’s compliance with any of its covenants hereunder (as to which the Trustee is entitled to
            rely exclusively on Officers’ Certificates).

         

        
          20

          
            

        

        Section 4.02.  Taxes.

         

        The Company shall pay, and shall cause each of its Subsidiaries to pay, prior to delinquency, all material taxes, assessments and governmental levies, except such as are being contested in good faith and by
          appropriate proceedings or where the failure to effect such payment is not adverse in any material respect to the Holders.

         

        Section 4.03.  Stay, Extension and Usury Laws.

         

        The Company covenants (to the extent that it may lawfully do so) that it shall not at any time insist upon, plead, or in any manner whatsoever claim or take the benefit or advantage of, any stay, extension or usury
          law wherever enacted, now or at any time hereafter in force, that may affect the covenants or the performance of the Indenture; and the Company (to the extent that it may lawfully do so) hereby expressly waives all benefit or advantage of any
          such law, and covenants that it shall not, by resort to any such law, hinder, delay or impede the execution of any power herein granted to the Trustee, but shall suffer and permit the execution of every such power as though no such law has been
          enacted.

         

        Section 4.04.  Liens.

         

        (a)          The Company will not, and will not permit any of its Restricted Subsidiaries to, directly or indirectly, create, incur or assume or
            otherwise cause or suffer to exist or become effective any consensual Liens of any kind (other than Permitted Liens) against or upon any of their respective properties or assets, now owned or hereafter acquired, or any proceeds, income or
            profit therefrom or assign or convey any right to receive income therefrom, to secure any Indebtedness of the Company unless prior to, or contemporaneously therewith, the Notes are equally and ratably secured by a Lien on such property, assets,
            proceeds, income or profit; provided, however, that if such Indebtedness is expressly subordinated to the Notes, the Lien securing such Indebtedness will be
            subordinated and junior to the Lien securing the Notes with the same relative priority as such Indebtedness has with respect to the Notes.

         

        (b)          Any Lien created for the benefit of the Holders of the Notes pursuant to Section 4.04(a) shall provide by its terms that such Lien
            should be automatically and unconditionally released and discharged upon the release and discharge of the Lien that gave rise to the obligation to secure the Notes.

         

        (c)          With respect to any Lien securing Indebtedness that was permitted under this Section 4.04 to secure such Indebtedness at the time of the
            incurrence of such Indebtedness, such Lien shall also be permitted to secure any Increased Amount of such Indebtedness.

         

        Section 4.05.  Designation of Restricted and Unrestricted Subsidiaries.

         

        (a)          The Board of Directors of the Company may designate any of its Restricted Subsidiaries to be an Unrestricted Subsidiary if that
            designation would not cause a Default and if that designation otherwise is consistent with the definition of an Unrestricted Subsidiary.

         

        
          21

          
            

        

        (b)          Any designation of a Subsidiary of the Company as an Unrestricted Subsidiary will be evidenced to the Trustee by filing with the Trustee
            a certified copy of a Board Resolution of the Company giving effect to such designation and an Officers’ Certificate certifying that such designation complied with the preceding conditions.  If, at any time, any Unrestricted Subsidiary would
            fail to meet the preceding requirements as an Unrestricted Subsidiary, it will thereafter cease to be an Unrestricted Subsidiary for purposes of the Indenture.  The Board of Directors of the Company may at any time designate any Unrestricted
            Subsidiary to be a Restricted Subsidiary of the Company; provided that such designation will only be permitted if no Default or Event of Default would be in existence following such designation.

         

        (c)          Any Subsidiary of an Unrestricted Subsidiary shall also be deemed an Unrestricted Subsidiary.

         

        Section 4.06.  Repurchase at the Option of Holders Upon a Change of Control.

         

        (a)          Upon the occurrence of a Change of Control, the Company shall, within 30 days following the date upon which a Change of Control
            occurred, make an offer (the “Change of Control Offer”) pursuant to the procedures set forth in Section 3.03.  Each Holder shall have the right to
            accept such offer and require the Company to repurchase all or any portion (equal to $2,000 or an integral multiple of $1,000 in excess thereof) of such Holder’s Notes pursuant to the Change of Control Offer at a purchase price, in cash (the “Change of Control Payment”), equal to 101.0% of the aggregate principal amount of Notes repurchased, plus accrued and unpaid interest, if any, on
            the Notes repurchased, to, but excluding, the Change of Control Payment Date (subject to the right of Holders of record on the relevant record date to receive interest due on an Interest Payment Date falling prior to the Change of Control
            Payment Date).

         

        (b)          The Company will not be required to make a Change of Control Offer with respect to the Notes upon a Change of Control if (i) a third
            party makes the Change of Control Offer with respect to the Notes in the manner, at the times and otherwise in compliance with the requirements set forth in the Indenture applicable to a Change of Control Offer made by the Company and purchases
            all Notes validly tendered and not withdrawn under the Change of Control Offer or (ii) a notice of redemption of all outstanding Notes has been given pursuant to the Indenture as provided in Section 3.03 of the Base Indenture, unless and until
            there is a Default in the payment of the Redemption Price on the applicable Redemption Date or the redemption is not consummated due to the failure of a condition precedent contained in the applicable redemption notice to be satisfied.  A
            Change of Control Offer may be made in advance of a Change of Control and may be conditional upon the occurrence of a Change of Control, if a definitive agreement is in place for the Change of Control at the time the Change of Control Offer is
            made.

         

        ARTICLE 5

         

        DEFAULTS AND REMEDIES

         

        Section 5.01.  Events of Default.

         

        Section 6.01 of the Base Indenture shall be amended and restated in its entirety with respect to the Notes as follows:

        

        

        
          22

          
            

        

        “Section 6.01.  Events of Default.

        

        

        Each of the following constitutes an “Event of Default” with respect to the Notes:

         

        (a)          default for 30 consecutive days in the payment when due and payable of interest on the Notes;

         

        (b)          default in the payment when due and payable of the principal of or premium, if any, on the Notes (upon maturity, redemption, required
            repurchase or otherwise);

         

        (c)          failure by the Company or any of its Restricted Subsidiaries to comply with Section 5.01 of the Base Indenture;

         

        (d)          failure by the Company or any of its Restricted Subsidiaries for 30 consecutive days after notice to comply with the provisions
            described in Section 4.06 of the Supplemental Indenture;

         

        (e)          failure by the Company for 120 days after notice to comply with the provisions described in Section 4.01 of the Supplemental Indenture;

         

        (f)          failure by the Company or any of its Restricted Subsidiaries for 60 consecutive days after notice to the Company by the Trustee or the
            Holders of at least 25.0% in aggregate principal amount of the Notes then outstanding voting as a single class to comply with any of its other covenants or agreements in the Indenture or the Notes;

         

        (g)          default under any mortgage, indenture or instrument under which there may be issued or by which there may be secured or evidenced any
            Indebtedness for money borrowed by the Company or any of its Restricted Subsidiaries (or the payment of which is Guaranteed by the Company or any of its Restricted Subsidiaries), whether such Indebtedness or Guarantee now exists, or is created
            after the Issue Date, if that default:

         

        (A)          is caused by a failure to pay principal of such Indebtedness at its express maturity prior to the
            expiration of any applicable grace period (a “Payment Default”); or

         

        (B)          results in the acceleration of such Indebtedness prior to its express maturity,

         

        and, in each case, the principal amount of any such Indebtedness, together with the principal amount of any other such Indebtedness under which there has been a Payment Default or the maturity of which has been so
          accelerated, aggregates to $300.0 million or more;

         

        (h)          failure by the Company or any of its Restricted Subsidiaries to pay final non-appealable judgments entered by a court or courts of
            competent jurisdiction aggregating in excess of $300.0 million, which judgments are not paid, discharged or stayed for a period of 90 days;

         

        
          23

          
            

        

        (i)          the Company or any Significant Subsidiary or any group of its Subsidiaries that, taken together, would constitute a Significant
            Subsidiary pursuant to or within the meaning of any Bankruptcy Law:

         

        (A)          commences a voluntary case or gives notice of intention to make a proposal under any Bankruptcy Law;

         

        (B)          consents to the entry of an order for relief against it in an involuntary case or consents to its
            dissolution or winding up;

         

        (C)          consents to the appointment of a receiver, interim receiver, receiver and manager, liquidator, trustee or
            custodian of it or for all or substantially all of its property;

         

        (D)          makes a general assignment for the benefit of its creditors; or

         

        (E)          admits in writing its inability to pay its debts as they become due or otherwise admits its insolvency; and

         

        (j)          a court of competent jurisdiction enters an order or decree under any Bankruptcy Law that:

         

        (A)          is for relief against the Company or any of its Significant Subsidiaries or any group of its Subsidiaries
            that, when taken together, would constitute a Significant Subsidiary in an involuntary case; or

         

        (B)          appoints a receiver, interim receiver, receiver and manager, liquidator, trustee or custodian of the
            Company or any of its Significant Subsidiaries or any group of Subsidiaries that, when taken together, would constitute a Significant Subsidiary or for all or substantially all of the property of the Company or any of its Significant
            Subsidiaries or any group of Subsidiaries that, when taken together, would constitute a Significant Subsidiary; or

         

        (C)          orders the liquidation of the Company or any of its Significant Subsidiaries or any group of Subsidiaries
            that, when taken together, would constitute a Significant Subsidiary;

         

        and such order or decree remains unstayed and in effect for 90 consecutive days.”

         

        Section 5.02.  Acceleration.

         

        Section 6.02 of the Base Indenture shall be amended and restated in its entirety with respect to the Notes as follows:

        

        

        “Section 6.02.  Acceleration.

         

        
          24

          
            

        

        If any Event of Default (other than those of the type described in Section 6.01(i) or (j)) occurs and is continuing, the Trustee may, and the Trustee upon the request of Holders of 25.0% in
          aggregate principal amount of the outstanding Notes shall, or the Holders of at least 25.0% in aggregate principal amount of outstanding Notes may, declare the principal, premium, if any, and accrued and unpaid interest, if any, of all the
          outstanding Notes, to be due and payable by notice in writing to the Company and the Trustee specifying the respective Event of Default and that such notice is a notice of acceleration (the “Acceleration

            Notice”), and the same shall become immediately due and payable.

         

        In the case of an Event of Default specified in Section 6.01(i) or (j), the principal, premium, if any, and accrued and unpaid interest, if any, of all of the outstanding Notes shall become due and payable
          immediately without any further action or notice on the part of the Trustee or the Holders. Holders may not enforce this Indenture or the Notes except as provided in this Indenture.”

         

        ARTICLE 6

         

        LEGAL DEFEASANCE AND COVENANT DEFEASANCE

         

        Section 6.01.  Covenant Defeasance.

         

        Section 8.03 of the Base Indenture shall be amended and restated in its entirety with respect to the Notes as follows:

        

        

        “Section 8.03.  Covenant Defeasance.

        

        

        Upon the Company’s exercise under Section 8.01 of the option applicable to this Section 8.03, the Company shall, subject to the satisfaction of the conditions set forth in Section 8.04, be released from its
          Obligations under the covenants contained in Sections 4.04 and 4.06 of the Supplemental Indenture, with respect to the outstanding Notes on and after the date the conditions set forth in Section 8.04 are satisfied (hereinafter, “Covenant Defeasance”) and each Guarantor, if any, shall be released from all of its Obligations under its Subsidiary Guarantee with respect to such
          covenants in connection with such outstanding Notes and the Notes shall thereafter be deemed not “outstanding” for the purposes of any direction, waiver, consent or declaration or act of Holders (and the consequences of any thereof) in connection
          with such covenants, but shall continue to be deemed “outstanding” for all other purposes hereunder (it being understood that such Notes shall not be deemed outstanding for accounting purposes).  For this purpose, Covenant Defeasance means that,
          with respect to the outstanding Notes, the Company may omit to comply with and shall have no liability in respect of any term, condition or limitation set forth in any such covenant, whether directly or indirectly, by reason of any reference
          elsewhere herein to any such covenant or by reason of any reference in any such covenant to any other provision herein or in any other document and such omission to comply shall not constitute a Default or an Event of Default under Section 6.01,
          but, except as specified above in this Section 8.03, the remainder of this Indenture and such Notes shall be unaffected thereby.  If the Company exercises under Section 8.01 the option applicable to this Section 8.03, subject to the satisfaction
          of the conditions set forth in Section 8.04, payment of the Notes may not be accelerated because of an Event of Default specified in clause (d) (with respect to the covenants contained in Section 4.06 of the Supplemental Indenture), clause (f)
          (with respect to the covenants contained in Section 4.04 of the Supplemental Indenture), and clauses (g), (h), (i) and (j) (but in the case of (i) and (j) of Section 6.01, with respect to Significant Subsidiaries only) of Section 6.01.”

         

        
          25

          
            

        

        ARTICLE 7

         

        AMENDMENT, SUPPLEMENT AND WAIVER

         

        Section 7.01.  Without Consent of Holders of Notes.

         

        Section 9.01 of the Base Indenture shall be amended and restated in its entirety with respect to the Notes as follows:

        

        

        “Section 9.01.  Without Consent of Holders of Notes.

        

        

        Notwithstanding Section 9.02 of this Indenture, the Company and the Trustee may amend or supplement this Indenture or the Notes without notice to or the consent of any Holder:

         

        (1)          to cure any ambiguity, omission, mistake, defect, error or inconsistency;

         

        (2)          to provide for uncertificated Notes in addition to or in place of certificated Notes;

         

        (3)          to provide for the assumption of the Company’s obligations to Holders of Notes in the case of a merger or
            consolidation or sale of all or substantially all of the Company’s assets or any other transaction that complies with this Indenture;

         

        (4)          to make any change that would provide any additional rights or benefits to the Holders of Notes or that the Company
            determines in good faith (as certified in an Officers’ Certificate) does not materially and adversely affect the legal rights under this Indenture of any such Holder;

         

        (5)          to provide for the issuance of Additional Notes in accordance with this Indenture;

         

        (6)          to comply with requirements of the SEC in order to effect or maintain the qualification of this Indenture under the
            Trust Indenture Act;

         

        (7)          to allow any Guarantor to execute a supplemental indenture and/or a Subsidiary Guarantee with respect to the Notes;

         

        (8)          to evidence and provide the acceptance of the appointment of a successor trustee under this Indenture;

         

        (9)          to mortgage, pledge, hypothecate or grant a security interest in favor of the trustee for the benefit of the Holders
            as additional security for the payment and performance of the Company’s or a Guarantor’s Obligations under this Indenture in any property or assets;

         

        
          26

          
            

        

        (10)        to comply with the rules of any applicable Depositary;

         

        (11)        to release a Guarantor from its Subsidiary Guarantee pursuant to the terms of any applicable supplemental indenture
            and/or Subsidiary Guarantee with respect to the Notes;

         

        (12)        to conform the text of this Indenture, the Notes or the Subsidiary Guarantees, if any, to the corresponding provision
            of the “Description of the Notes” in the Prospectus Supplement or the “Description of Debt Securities” in the accompanying prospectus to the extent that such provision in the “Description of the Notes” or the “Description of Debt Securities” in
            the accompanying prospectus was intended to be a substantially verbatim recitation of a provision of this Indenture, the Notes or the Subsidiary Guarantees, if any; or

         

        (13)       to comply with Section 5.01.”

         

        Section 7.02.  With Consent of Holders of Notes.

         

        The first paragraph of Section 9.02 of the Base Indenture shall be amended and restated in its entirety with respect to the Notes as follows:

        

        

        “Except as provided below in this Section 9.02, the Company and the Trustee may amend or supplement this Indenture and the Notes with the consent of the Holders of at least a majority in aggregate principal amount of
          the Notes then outstanding voting as a single class (including consents obtained in connection with a purchase of or tender offer or exchange offer for the Notes), and, subject to Sections 6.04 and 6.07, any existing Default or Event of Default
          or compliance with any provision of this Indenture or the Notes may be waived with the consent of the Holders of at least a majority in aggregate principal amount of the Notes then outstanding voting as a single class (including consents obtained
          in connection with a purchase of or tender offer or exchange offer for the Notes).  Without the consent of each Holder affected, an amendment, supplement or waiver may not (with respect to any Notes held by a non-consenting Holder):

         

        (1)          reduce the principal amount of the Notes whose Holders must consent to an amendment, supplement or waiver;

         

        (2)          reduce the principal of or change the Stated Maturity of the Notes or alter the provisions with respect to the
            redemption or repurchase of the Notes (other than provisions and applicable definitions relating to Section 4.06 of the Supplemental Indenture);

         

        (3)          reduce the rate of or change the time for payment of interest on the Notes;

         

        (4)          waive a Default or Event of Default in the payment of principal of, or interest or premium, if any, on the Notes
            (except a rescission of acceleration of the Notes by the Holders of at least a majority in aggregate principal amount of the then outstanding Notes and a waiver of the Payment Default that resulted from such acceleration);

         

        
          27

          
            

        

        
        (5)          make any such Note payable in money other than that stated in such Note;

         

        (6)          make any change in the provisions (including applicable definitions) of this Indenture relating to waivers of past
            Defaults or the rights of Holders of Notes to receive payments of principal of, or interest or premium, if any, on the Notes (other than provisions relating to Section 4.06 of the Supplemental Indenture);

         

        (7)          waive a redemption or repurchase payment with respect to any Note (other than a payment required by Section 4.06 of
            the Supplemental Indenture); or

         

        (8)          make any change in the preceding amendment and waiver provisions.”

         

        ARTICLE 8

         

        MISCELLANEOUS

         

        Section 8.01.  Ratification of Base Indenture; No Adverse Interpretation of Other Agreements.

         

        The Base Indenture, as supplemented by this Supplemental Indenture, is in all respects ratified and confirmed, and this Supplemental Indenture shall be deemed part of the Indenture in the manner and to the extent
          herein and therein provided. The Indenture may not be used to interpret any other indenture, loan or debt agreement of the Company or its Subsidiaries or of any other Person.  Any such indenture, loan or debt agreement may not be used to
          interpret this Indenture.

        

        

        Section 8.02.  Trust Indenture Act Controls.

         

        If any provision of this Supplemental Indenture limits, qualifies or conflicts with another provision which is required to be included in this Supplemental Indenture by the TIA, the provision required by the TIA
          shall control.

         

        Section 8.03.  Governing Law.

         

        THE INTERNAL LAW OF THE STATE OF NEW YORK SHALL GOVERN AND BE USED TO CONSTRUE THIS SUPPLEMENTAL INDENTURE AND THE NOTES WITHOUT GIVING EFFECT TO APPLICABLE PRINCIPLES OF CONFLICTS OF LAW TO THE EXTENT THAT THE
          APPLICATION OF THE LAWS OF ANOTHER JURISDICTION WOULD BE REQUIRED THEREBY.

         

        
          28

          
            

        

        
        Section 8.04.  Successors.

         

        All covenants and agreements of the Company in this Supplemental Indenture and the Notes shall bind its successors.  All covenants and agreements of the Trustee in this Supplemental Indenture shall bind its
          successors.

         

        Section 8.05.  Severability.

         

        In case any provision in this Supplemental Indenture or in the Notes shall be invalid, illegal or unenforceable, the validity, legality and enforceability of the remaining provisions shall not in any way be affected
          or impaired thereby.

         

        Section 8.06.  Counterpart Originals; Electronic Signatures.

         

        The parties may sign any number of copies of this Supplemental Indenture.  Each signed copy shall be an original, but all of them together represent the same agreement. Any such counterparts may be executed manually,
          electronically or by facsimile. This Supplemental Indenture, the Trustee’s certificate of authentication on the Notes, and any other document delivered in connection with this Supplemental Indenture or the issuance and delivery of the Notes may
          be signed by or on behalf of the Company and the Trustee by manual, PDF or other electronically imaged signature.

         

        Section 8.07.  Table of Contents, Headings, etc.

         

        The Table of Contents and Headings in this Supplemental Indenture have been inserted for convenience of reference only, are not to be considered a part of this Supplemental Indenture and shall in no way modify or
          restrict any of the terms or provisions hereof.

         

        Section 8.08.  Waiver of Jury Trial.

         

        EACH OF THE ISSUER, THE HOLDERS AND THE TRUSTEE HEREBY IRREVOCABLY WAIVES, TO THE FULLEST EXTENT PERMITTED BY APPLICABLE LAW, ANY AND ALL RIGHT TO TRIAL BY JURY IN ANY LEGAL PROCEEDING ARISING OUT OF OR RELATING TO
          THIS SUPPLEMENTAL INDENTURE, THE NOTES OR THE TRANSACTION CONTEMPLATED HEREBY.

         

        Section 8.09.  Submission to Jurisdiction.

         

        The parties irrevocably submit to the non-exclusive jurisdiction of any New York State or federal court sitting in the Borough of Manhattan, City of New York, over any suit, action or proceeding arising out of or
          relating to this Supplemental Indenture.  To the fullest extent permitted by applicable law, the parties irrevocably waive and agree not to assert, by way of motion, as a defense or otherwise, any claim that it is not subject to the jurisdiction
          of any such court, any objection that it may now or hereafter have to the laying of the venue of any such suit, action or proceeding brought in any such court and any claim that any such suit, action or proceeding brought in any such court has
          been brought in an inconvenient forum.

         

        
          29

          
            

        

        
        Section 8.10.  FATCA Withholding.

         

        In order to comply with applicable tax laws, rules and regulations (inclusive of directives, guidelines and interpretations promulgated by competent authorities) in effect from time to time (“Applicable Law”) that a foreign financial institution, the Company, Trustee, Paying Agent, Holder or other institution is or has agreed to be subject to related to this Indenture and the
          Notes, the Company agrees (a) to provide to the Trustee and/or any other Paying Agent upon its request information in the Company’s possession about applicable parties and/or transactions (including any modification to the terms of such
          transactions) so that the Trustee or any other Paying Agent can determine whether it has tax related obligations under Applicable Law, and (b) that the Trustee and/or any other Paying Agent shall be entitled to make any withholding or deduction
          from payments under this Indenture to the extent necessary to comply with Applicable Law for which the Trustee or any other Paying Agent shall not have any liability to the Company for its withholding or deduction from payment under this
          Indenture to the extent necessary to comply with Applicable Law.

         

        [Signatures on following page]

         

        
          30

          
            

        

        IN WITNESS WHEREOF, the parties have caused this Supplemental Indenture to be duly executed.

         

        
           

          	 	
                  Issuer:

                  CENTENE CORPORATION

                
	 	 	 	 
	
                  Dated:   October 7, 2020

                	
                  By:

                	
                  /s/ Jeffrey A. Schwaneke

                
	 	 	
                  Name:

                	
                  Jeffrey A. Schwaneke

                
	 	 	
                  Title:

                	
                  Executive Vice President and Chief Financial Officer

                

           

          

        

        
          
            

        

        
          	 	
                  Trustee:

                  THE BANK OF NEW YORK MELLON TRUST COMPANY, N.A.

                
	 	 	 	 
	
                  Dated:  October 7, 2020

                	
                  By:

                	
                  /s/ Julie Hoffman-Ramos

                
	 	 	
                  Name:

                	
                  Julie Hoffman-Ramos

                
	 	 	
                  Title:

                	
                  Vice President

                

        

        

        

        
          
            

        

        
        EXHIBIT A

         

        [Form of Face of Note]

         

        [UNLESS THIS CERTIFICATE IS PRESENTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITORY TRUST COMPANY, A NEW YORK CORPORATION (“DTC”), NEW YORK, NEW YORK, TO THE ISSUER OR ITS AGENT FOR REGISTRATION OF TRANSFER,
          EXCHANGE OR PAYMENT, AND ANY CERTIFICATE ISSUED IS REGISTERED IN THE NAME OF CEDE & CO. OR SUCH OTHER NAME AS IS REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF DTC (AND ANY PAYMENT IS MADE TO CEDE & CO., OR TO 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.

         

        THIS NOTE IS A REGISTERED GLOBAL NOTE WITHIN THE MEANING OF THE INDENTURE HEREINAFTER REFERRED TO AND IS REGISTERED IN THE NAME OF A DEPOSITARY OR A NOMINEE OF THE DEPOSITARY. THIS NOTE IS EXCHANGEABLE FOR NOTES
          REGISTERED IN THE NAME OF A PERSON OTHER THAN THE DEPOSITARY OR ITS NOMINEE ONLY IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE, AND MAY NOT BE TRANSFERRED EXCEPT AS A WHOLE BY THE DEPOSITARY TO A NOMINEE OF THE DEPOSITARY, 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 DEPOSITARY OR A NOMINEE OF SUCH A SUCCESSOR DEPOSITARY.]1

         

        
          

        1 Note:  To be included in a Global Note.

         

        

        
          A-1

          
            

        

         

         
          
            	GLOBAL NOTE

                  

          

        

         

          

        3.00% SENIOR NOTES DUE 2030

         

        
          	CUSIP

                	
                   

                
	

                	
                   

                
	ISIN

                	
                   

                

        

         

        

        No. _______ $

         

        CENTENE CORPORATION

         

        

        promises to pay to CEDE & CO., INC. or registered assigns, the principal sum of ___________Dollars ($________) on October 15, 2030.

         

        Interest Payment Dates: April 15 and October 15, commencing April 15, 2021.

         

        Record Dates: April 1 and October 1

         

          
            	Dated:	
                     

                  	, 20	
                     

                  	
                     

                  

          

          

        

        
          A-2

          
            

        

         
        
          
            IN WITNESS WHEREOF, the Company has caused this Note to be signed manually, electronically or by facsimile by its duly authorized officer.

             

          

          	
                   

                	
                  CENTENE CORPORATION

                
	
                   

                	
                   

                	
                   

                
	
                   

                	
                  By:

                	
                   

                
	
                   

                	
                   

                	
                  Name: 

                
	
                   

                	
                   

                	
                  Title:

                

           

          

          	
                   

                	
                  By:

                	
                   

                
	
                   

                	
                   

                	
                  Name: 

                
	
                   

                	
                   

                	
                  Title:

                
	
                   

                	
                   

                	
                   

                

           

          

        

        
          A-3

          
            

        

        This is one of the

        Notes referred to in the

        within-mentioned Supplemental Indenture:

         

        THE BANK OF NEW YORK MELLON TRUST COMPANY, N.A. as Trustee

         

        	 
	
                By:

                

              	 	 
	
                

                

              	
                Authorized Signatory

              	 

        
          
             

            

            	Dated	
                     

                  	 	 	, 20	
                     

                  	
                     

                  

             

            

          

        

        
          A-4

          
            

        

        (Back of Note)

         

        3.00% Senior Notes due 2030

         

        Capitalized terms used herein shall have the meanings assigned to them in the Indenture referred to below unless otherwise indicated.

         

        1.          Interest.  Centene Corporation, a Delaware corporation (the “Company”), promises to pay interest on the
          principal amount of this Note at 3.00% per annum until maturity.  The Company shall pay interest semi-annually on April 15 and October 15 of each year, commencing April 15, 2021, or, if any such day is not a Business Day, on the next succeeding
          Business Day (each, an “Interest Payment Date”).  Interest shall accrue from the most recent date to which interest has been paid on the Notes (or one or more Predecessor Notes) or, if no interest has been
          paid, from October 7, 2020.  The Company shall pay interest (including post-petition interest in any proceeding under any Bankruptcy Law) on overdue principal and premium, if any, from time to time at a rate that is 1.0% per annum in excess of
          the interest rate then in effect under the Indenture and this Note; it shall pay interest (including post-petition interest in any proceeding under any Bankruptcy Law) on overdue installments of interest (without regard to any applicable grace
          periods), from time to time at the same rate to the extent lawful. Interest shall be computed on the basis of a 360-day year of twelve 30-day months.

         

        2.          Method of Payment.  The Company shall pay interest on the Notes (except defaulted interest) to the Persons in whose name this Note (or one or
          more Predecessor Notes) is registered at the close of business on the April 1 or October 1 next preceding the Interest Payment Date, even if such Notes are cancelled after such record date and on or before such Interest Payment Date, except as
          provided in Section 2.13 of the Base Indenture with respect to defaulted interest.  The Notes shall be payable as to principal, premium, if any, and interest at the office or agency of the Company maintained for such purpose, or, at the option of
          the Company, payment of interest may be made by check mailed to the Holders at their addresses set forth in the Note Register; provided, however, that payment by
          wire transfer of immediately available funds shall be required with respect to principal of and interest and premium, if any, on, all Global Notes and all other Notes the Holders of which shall have provided wire transfer instructions to the
          Company or the Paying Agent.  Such payment shall be 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.

         

        3.          Paying Agent and Registrar.  Initially, The Bank of New York Mellon Trust Company, N.A., the Trustee under the Indenture, shall act as Paying
          Agent and Registrar.  The Company may change any Paying Agent or Registrar without notice to any Holder.  The Company or any of its Restricted Subsidiaries may act in any such capacity.

         

        
          
            

        

        
        4.          Indenture.  The Company issued the Notes under the First Supplemental Indenture, dated as of October 7, 2020 (the “First Supplemental Indenture”), to the Indenture dated as of October 7, 2020 (the “Base Indenture” and, together with the First Supplemental Indenture, the “Indenture”),

          each between the Company and the Trustee.  The terms of the Notes include those stated in the Indenture and those made part of the Indenture by reference to the Trust Indenture Act of 1939, as amended (15 U.S. Code §§77aaa-77bbbb). The Notes are
          subject to all such terms, and Holders are referred to the Indenture and such Act for a statement of such terms.  To the extent any provision of this Note conflicts with the express provisions of the Indenture, the provisions of the Indenture
          shall govern and be controlling.

         

        5.          Optional Redemption.

         

        (a)          Prior to July 15, 2030 (the “Par Call Date”), the Notes will be redeemable at any time or from time to time in whole or in part at the Company’s option, upon
          notice as described in Section 3.03 of the Base Indenture, at a Redemption Price equal to the greater of (1) 100% of the principal amount of the Notes being redeemed on that Redemption Date, and (2) the sum of the present values of the remaining
          scheduled payments of principal and interest on the Notes being redeemed (exclusive of interest accrued to, but excluding, the applicable Redemption Date) that would be due if such Notes matured on the Par Call Date, discounted to such Redemption
          Date on a semi-annual basis (assuming a 360-day year consisting of twelve 30-day months) at the Treasury Rate plus 50 basis points, plus, in each case, accrued and unpaid interest on the Notes being redeemed to, but excluding, the Redemption
          Date.

         

        (b)          On or after the Par Call Date, the Notes will be redeemable at any time in whole or from time to time in part at the Company’s option,
            upon notice as described in Section 3.03 of the Base Indenture, at a Redemption Price equal to 100% of the principal amount of the Notes being redeemed, plus accrued and unpaid interest thereon to, but excluding, the Redemption Date.

         

        (c)          Notwithstanding the foregoing, installments of interest on the Notes that are due and payable on any Interest Payment Date falling on or
            prior to a Redemption Date for the Notes shall be payable on such Interest Payment Dates to the persons who were registered Holders of such Notes at the close of business on the applicable record dates.

         

        6.          Mandatory Redemption.

         

        Except as set forth in Section 4.06 of the First Supplemental Indenture, the Company shall not be required to make mandatory redemption or sinking fund payments with respect to the Notes.

         

        7.          Repurchase at Option of Holder Upon a Change of Control.

         

        Upon the occurrence of a Change of Control, Section 3.03 and Section 4.06 of the First Supplemental Indenture shall apply to the extent applicable.

         

        
          A-2

          
            

        

        
        8.          Notice of Redemption.

         

        Notice of redemption shall be sent at least 15 days but not more than 60 days before the Redemption Date to each Holder whose Notes are to be redeemed at its registered address (or electronically for Global Notes). 
          Notes in denominations larger than $2,000 may be redeemed in part but only in whole multiples of $1,000, unless all of the Notes held by a Holder are to be redeemed.  On and after the Redemption Date interest ceases to accrue on Notes or portions
          thereof called for redemption.

         

        9.          Denominations, Transfer, Exchange.  The Notes are in registered form without coupons in denominations of $2,000 and integral multiples of
          $1,000.  This Note shall represent the aggregate principal amount of outstanding Notes from time to time endorsed hereon and the aggregate principal amount of Notes represented hereby may from time to time be reduced or increased, as appropriate,
          to reflect exchanges and redemptions.  The transfer of Notes may be registered and Notes may be exchanged as provided in the Indenture.  The Registrar and the Trustee may require a Holder, among other things, to furnish appropriate endorsements
          and transfer documents and the Company may require a Holder to pay any taxes and fees required by law or permitted by the Indenture.  The Company need not exchange or register the transfer of any Note or portion of a Note selected for redemption,
          except for the unredeemed portion of any Note being redeemed in part.  Also, the Company need not exchange or register the transfer of any Notes for a period of 15 days before a selection of Notes to be redeemed or during the period between a
          record date and the corresponding Interest Payment Date.

         

        10.         Persons Deemed Owners.  The registered Holder of a Note may be treated as its owner for all purposes.

         

        11.         Amendment, Supplement and Waiver.  The Company and the Trustee may amend or supplement the Indenture or the Notes in accordance with Article 9
          of the Base Indenture (as amended by Article 7 of the First Supplemental Indenture).

         

        12.         [Reserved].

         

        13.         Trustee Dealings with the Company.  Subject to certain limitations, the Trustee in its individual or any other capacity may become the owner or
          pledgee of Notes and may otherwise deal with the Company or any Affiliate of the Company with the same rights it would have if it were not Trustee.

         

        14.         No Recourse Against Others.  No past, present or future director, officer, employee, incorporator, stockholder, member, manager or partner of
          the Company or any Guarantor, as such, shall have any liability for any Obligations of the Company or of the Guarantors, if any, under this Note, the Indenture, any supplemental indenture, the Subsidiary Guarantees, if any, or for any claim based
          on, in respect of, or by reason of, such Obligations or their creation.  Each Holder by accepting a Note waives and releases all such liability.

         

        15.         Authentication.  This Note shall not be valid until authenticated by manual, facsimile or electronic signature of the Trustee or an
          authenticating agent.

         

        
          A-3

          
            

        

        16.         Abbreviations.  Customary abbreviations may be used in the name of a Holder or an assignee, such as: TEN COM (= tenants in common), TEN ENT (=
          tenants by the entireties), JT TEN (= joint tenants with right of survivorship and not as tenants in common), CUST (= Custodian), and U/G/M/A (= Uniform Gifts to Minors Act).

         

        17.         CUSIP Numbers.  Pursuant to a recommendation promulgated by the Committee on Uniform Security Identification Procedures, the Company has caused
          CUSIP numbers to be printed on the Notes and has directed the Trustee to use CUSIP numbers in notices of redemption as a convenience to Holders.  No representation is made as to the accuracy of such numbers either as printed on the Notes or as
          contained in any notice of redemption and reliance may be placed only on the other identification numbers placed thereon.

         

        18.         Governing Law.  THE INTERNAL LAW OF THE STATE OF NEW YORK SHALL GOVERN AND BE USED TO CONSTRUE THIS NOTE WITHOUT GIVING
          EFFECT TO APPLICABLE PRINCIPALS OF CONFLICTS OF LAW TO THE EXTENT THAT THE APPLICATION OF THE LAWS OF ANOTHER JURISDICTION WOULD BE REQUIRED THEREBY.

         

        The Company shall furnish to any Holder upon written request and without charge a copy of the Indenture.  Requests may be made to:

         

        Centene Corporation

        7700 Forsyth Boulevard

        St. Louis, MO 63105

        Attention: General Counsel

         

        
          A-4

          
            

        

        OPTION OF HOLDER TO ELECT PURCHASE

         

        If you want to elect to have all or part of this Note purchased by the Company pursuant to Section 4.06 of the First Supplemental Indenture, state the amount you elect to have purchased: $__________

         

        	
                Date: 

                

              	 	 	
                Your Signature:

                

              
	 	 	 	 
	 	
                (Sign exactly as your name appears on the Note)

              
	 	 
	 	
                Tax Identification No.:

              
	 	 
	 	
                SIGNATURE GUARANTEE

              
	 	
                Signatures must be guaranteed by an “eligible guarantor institution” meeting the requirements of the Registrar, which requirements include membership or participation in the Security Transfer Agent Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Registrar in addition to, or in substitution for, STAMP, all in accordance with the Securities
                  Exchange Act of 1934, as amended.

              

        

        

        
          A-5

          
            

        

        ASSIGNMENT FORM

         

        To assign this Note, fill in the form below:

         

        I or we assign and transfer this Note to

         

        	 
	
                (Print or type assignee’s name, address and zip code)

              
	 
	 
	
                (Insert assignee’s soc. sec. or tax I.D. No.)

              

        

        

        and irrevocably appoint                                 agent to transfer this Note on the books of the Company.  The agent may substitute another to act for him.

        

        

        	
                Date:

              	 	 	
                Your signature:

              	 
	 	 	 	 	
                Sign exactly as your name appears on the other side of this Note.

              

        

        

        	
                Signature Guarantee:

              
	 	 
	
                (Signature must be guaranteed)

              

        

        

        Signatures must be guaranteed by an “eligible guarantor institution” meeting the requirements of the Registrar, which requirements include membership or participation in the Security Transfer Agent Medallion Program (“STAMP”) or such other
          “signature guarantee program” as may be determined by the Registrar in addition to, or in substitution for, STAMP, all in accordance with the Securities Exchange Act of 1934, as amended.

         

        
          A-6

          
            

        

        SCHEDULE OF EXCHANGES OF INTERESTS IN THE GLOBAL NOTE

         

        The following exchanges of a part of this Global Note for an interest in another Global Note or for a definitive Note, or exchanges of a part of another Global Note or definitive Note for an interest in this Global
          Note, have been made:

         

        	
                
                  Date of Exchange

                

              	 	
                
                  Amount of 

                  decrease in

                  Principal 

                  Amount of

                  this Global 

                  Note

                

              	 	
                
                  Amount of 

                  increase in

                  Principal 

                  Amount of

                  this Global 

                  Note

                

              	 	
                
                  Principal 

                  Amount of

                  this Global 

                  Note

                  following 

                  such 

                  decrease

                  (or increase)

                

              	 	
                
                  Signature of 

                  authorized

                  signatory of 

                  Trustee or

                  Custodian

                

              
	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 

         

        

         

        

        
          A-7EX-4.2

 Exhibit 4.2 

FINAL 
 AMENDED AND RESTATED

 INVESTORS’ RIGHTS AGREEMENT 

 TABLE OF CONTENTS 

 

									
	 	 	 	 	 	  	Page	 
			
	 1.
	 	 Definitions
	  	 	1	 
			
	 2.
	 	 Registration Rights
	  	 	5	 
		 	 2.1
	 	Demand Registration	  	 	5	 
		 	 2.2
	 	Company Registration	  	 	7	 
		 	 2.3
	 	Underwriting Requirements	  	 	7	 
		 	 2.4
	 	Obligations of the Company	  	 	8	 
		 	 2.5
	 	Furnish Information	  	 	9	 
		 	 2.6
	 	Expenses of Registration	  	 	10	 
		 	 2.7
	 	Delay of Registration	  	 	10	 
		 	 2.8
	 	Indemnification	  	 	10	 
		 	 2.9
	 	Reports Under Exchange Act	  	 	12	 
		 	 2.10
	 	Limitations on Subsequent Registration Rights	  	 	12	 
		 	 2.11
	 	“Market Stand-off” Agreement	  	 	13	 
		 	 2.12
	 	Restrictions on Transfer	  	 	14	 
		 	 2.13
	 	Termination of Registration Rights	  	 	15	 
			
	 3.
	 	 Information and Observer Rights
	  	 	16	 
		 	 3.1
	 	Delivery of Financial Statements	  	 	16	 
		 	 3.2
	 	Inspection	  	 	17	 
		 	 3.3
	 	Observer Rights	  	 	17	 
		 	 3.4
	 	Termination of Information	  	 	19	 
		 	 3.5
	 	Confidentiality	  	 	19	 
			
	 4.
	 	 Rights to Future Stock Issuances
	  	 	19	 
		 	 4.1
	 	Right of First Offer	  	 	19	 
		 	 4.2
	 	Termination	  	 	20	 
			
	 5.
	 	 Additional Covenants
	  	 	21	 
		 	 5.1
	 	Insurance	  	 	21	 
		 	 5.2
	 	Employee Agreements	  	 	21	 
		 	 5.3
	 	Employee Stock	  	 	21	 
		 	 5.4
	 	Matters Requiring Preferred Director Approval	  	 	21	 
		 	 5.5
	 	Board Matters	  	 	23	 
		 	 5.6
	 	Successor Indemnification	  	 	23	 
		 	 5.7
	 	Right to Conduct Activities	  	 	23	 
		 	 5.8
	 	Investment by the European Investment Fund	  	 	24	 
		 	 5.9
	 	ESG compliance	  	 	24	 
		 	 5.10
	 	Certified Public Accounting Firm	  	 	25	 
		 	 5.11
	 	Termination of Covenants	  	 	25	 
			
	 6.
	 	 Miscellaneous
	  	 	26	 
		 	 6.1
	 	Successors and Assigns	  	 	26	 
		 	 6.2
	 	Governing Law	  	 	26	 
		 	 6.3
	 	Counterparts	  	 	26	 
		 	 6.4
	 	 Titles and Subtitles
	  	 	27	 

  
 i 

									
		 	 6.5
	 	Notices	  	 	27	 
		 	 6.6
	 	Amendments and Waivers	  	 	27	 
		 	 6.7
	 	Severability	  	 	28	 
		 	 6.8
	 	Aggregation of Stock	  	 	28	 
		 	 6.9
	 	Additional Investors	  	 	28	 
		 	 6.10
	 	Entire Agreement	  	 	28	 
		 	 6.11
	 	Dispute Resolution	  	 	29	 
		 	 6.12
	 	Delays or Omissions	  	 	29	 

  

					
	 Schedule A
	 	-	  	Schedule of Investors
	 Schedule B
	 	-	  	Founders

  
 ii 

 AMENDED AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

THIS AMENDED AND RESTATED INVESTORS’ RIGHTS AGREEMENT (this “Agreement”), is made as of the 25th day of September, 2020,
by and among Galecto, Inc., a Delaware corporation (the “Company”), and each of the stockholders listed on Schedule A hereto, each of which is referred to in this Agreement as an “Investor”. 

RECITALS 

WHEREAS, certain of the Investors (the “Existing Investors”) hold shares of the Company’s Series B-1 Preferred Stock, Series B-2 Preferred Stock, Series B-3 Preferred Stock, Series B-4
Preferred Stock, Series C-1 Preferred Stock, Series C-2 Preferred Stock, Series C-3 Preferred Stock, Series C-4 Preferred Stock and Series C-5 Preferred Stock and/or shares of Common Stock issued upon conversion thereof and possess registration rights, information rights, rights of
first offer, and other rights pursuant to that certain Investors’ Rights Agreement dated as of December 31, 2019, by and among the Company and such Existing Investors (the “Prior Agreement”); 

WHEREAS, the Existing Investors are holders of at least seventy-five percent (75%) of the Registrable Securities (as defined in the
Prior Agreement), including the Requisite Holders, and desire to amend and restate the Prior Agreement in its entirety and to accept the rights created pursuant to this Agreement in lieu of the rights granted to them under the Prior Agreement; and

 WHEREAS, certain of the Investors are parties to that certain Series D Preferred Stock Purchase Agreement of even date herewith by
and among the Company and such Investors (the “Purchase Agreement”), under which certain of the Company’s and such Investors’ obligations are conditioned upon the execution and delivery of this Agreement by such Investors,
Existing Investors holding at least seventy-five percent (75%) of the Registrable Securities, including the Requisite Holders, and the Company. 

NOW, THEREFORE, the Existing Investors hereby agree that the Prior Agreement is hereby amended and restated in its entirety by this
Agreement, and the parties to this Agreement further agree as follows: 
 1.    Definitions. For purposes
of this Agreement: 
 1.1    “Affiliate” means, with respect to any specified Person, any other Person
who, directly or indirectly, controls, is controlled by, or is under common control with such Person, including without limitation any general partner, managing member, officer, director or trustee of such Person, or any venture capital fund,
investment fund or registered investment company now or hereafter existing that is controlled by one or more general partners, managing members or investment adviser of, or shares the same management company or investment adviser with, such Person.

 1.2    “Board” means the board of directors of the Company. 

1.3    “Canica” means Canica Holding AG. 

1.4    “CFIUS” means the Committee on Foreign Investment in the United States, or any member agency
thereof acting in such capacity. 
 1.5    “Common Stock” means shares of the Company’s common
stock, par value $0.00001 per share. 

 1.6    “Competitor” means a Person engaged, directly or
indirectly (including through any partnership, limited liability company, corporation, joint venture or similar arrangement (whether now existing or formed hereafter)), in the research and development for commercial sale, of galectin
modulators for the treatment of severe diseases, including fibrosis and cancer, but shall not include any financial investment firm or collective investment vehicle that, together with its Affiliates, holds less than twenty percent (20%) of the
outstanding equity of any Competitor and does not, nor do any of its Affiliates, have a right to designate any members of the board of directors of any Competitor. For the avoidance of doubt, none of Novo, HBM, Ysios, Sunstone, Sphera, Eir or Soleus
shall be deemed a Competitor for purposes of this Agreement. 
 1.7    “Damages” means any loss,
damage, claim or liability (joint or several) to which a party hereto may become subject under the Securities Act, the Exchange Act, or other federal or state law, insofar as such loss, damage, claim or liability (or any action in respect thereof)
arises out of or is based upon: (i) any untrue statement or alleged untrue statement of a material fact contained in any registration statement of the Company, including any preliminary prospectus or final prospectus contained therein or any
amendments or supplements thereto; (ii) an omission or alleged omission to state therein a material fact required to be stated therein, or necessary to make the statements therein not misleading; or (iii) any violation or alleged violation
by the indemnifying party (or any of its agents or Affiliates) of the Securities Act, the Exchange Act, any state securities law, or any rule or regulation promulgated under the Securities Act, the Exchange Act, or any state securities
law. 
 1.8    “Derivative Securities” means any securities or rights convertible into, or exercisable
or exchangeable for (in each case, directly or indirectly), Common Stock, including options and warrants. 

1.9    “DPA” means Section 721 of the Defense Production Act of 1950, as amended (50 U.S.C. §
4565), and all rules and regulations thereunder, including as codified at 31 C.F.R. Part 800 and Part 801. 

1.10    “Eir” means Eir Ventures Partners AB. 

1.11    “Exchange Act” means the Securities Exchange Act of 1934, as amended, and the rules and
regulations promulgated thereunder. 
 1.12    “Excluded Registration” means (i) a registration
relating to the sale or grant of securities to employees of the Company or a subsidiary pursuant to a stock option, stock purchase, equity incentive or similar plan; (ii) a registration relating to an SEC Rule 145 transaction; (iii) a
registration on any form that does not include substantially the same information as would be required to be included in a registration statement covering the sale of the Registrable Securities; or (iv) a registration in which the only Common
Stock being registered is Common Stock issuable upon conversion of debt securities that are also being registered. 

1.13    “Form S-1” means such form under the Securities
Act as in effect on the date hereof or any successor registration form under the Securities Act subsequently adopted by the SEC. 

1.14    “Form S-3” means such form under the Securities
Act as in effect on the date hereof or any registration form under the Securities Act subsequently adopted by the SEC that permits forward incorporation of substantial information by reference to other documents filed by the Company with the SEC.

  
 2 

 1.15    “Founder” means the founders of the Company, in
each case as listed on Schedule B to this Agreement. 
 1.16    “GAAP” means generally accepted
accounting principles in the United States as in effect from time to time. 
 1.17    “Hadean” means
collectively Hadean Capital I AS and Hventures Capital I AB. 
 1.18    “Holder” means any holder of
Registrable Securities who is a party to this Agreement. 
 1.19    “Immediate Family Member” means a
child, stepchild, grandchild, parent, stepparent, grandparent, spouse, sibling, mother-in-law,
father-in-law, son-in-law, daughter-in-law, brother-in-law, or
sister-in-law, including, adoptive relationships, of a natural person referred to herein. 

1.20    “Initiating Holders” means, collectively, Holders who properly initiate a registration request
under this Agreement. 
 1.21    “IPO” means the Company’s first underwritten public offering of
its Common Stock under the Securities Act. 
 1.22    “Major Investor” means any Series B Major
Investor, any Series C Major Investor and any Series D Major Investor. 
 1.23    “New Securities”
means, collectively, equity securities of the Company, whether or not currently authorized, as well as rights, options, or warrants to purchase such equity securities, or securities of any type whatsoever that are, or may become, convertible or
exchangeable into or exercisable for such equity securities. 
 1.24    “Person” means any individual,
corporation, partnership, trust, limited liability company, association or other entity. 
 1.25    “Preferred
Director” means any director of the Company that the holders of record of the Preferred Stock are entitled to elect, exclusively and as a separate class, pursuant to the Restated Certificate. 

1.26    “Preferred Stock” means, collectively, shares of the Company’s Series B-1 Preferred Stock, Series B-2 Preferred Stock, Series B-3 Preferred Stock, Series B-4
Preferred Stock, Series C-1 Preferred Stock, Series C-2 Preferred Stock, Series C-3 Preferred Stock, Series C-4 Preferred Stock, Series C-5 Preferred Stock and Series D Preferred Stock. 

1.27    “Registrable Securities” means (i) the Common Stock issuable or issued upon conversion of
the Preferred Stock; (ii) any Common Stock, or any Common Stock issued or issuable (directly or indirectly) upon conversion and/or exercise of any other securities of the Company, acquired by the
Investors after the date hereof; and (iii) any Common Stock issued as (or issuable upon the conversion 

  
 3 

 
or exercise of any warrant, right, or other security that is issued as) a dividend or other distribution with respect to, or in exchange for or in replacement of, the shares referenced in clauses
(i) and (ii) above; excluding in all cases, however, any Registrable Securities sold by a Person in a transaction in which the applicable rights under this Agreement are not assigned pursuant to Subsection 6.1, and excluding for
purposes of Section 2 any shares for which registration rights have terminated pursuant to Subsection 2.13 of this Agreement. 

1.28    “Registrable Securities then outstanding” means the number of shares determined by adding the
number of shares of outstanding Common Stock that are Registrable Securities and the number of shares of Common Stock issuable (directly or indirectly) pursuant to then exercisable and/or convertible securities that are Registrable
Securities. 
 1.29    “Restated Certificate” means the Company’s Amended and Restated Certificate
of Incorporation, as amended and/or restated from time to time. 
 1.30    “Restricted Securities”
means the securities of the Company required to be notated with the legend set forth in Subsection 2.12(b) hereof. 

1.31    “SEC” means the Securities and Exchange Commission. 

1.32    “SEC Rule 144” means Rule 144 promulgated by the SEC under the Securities Act. 

1.33    “SEC Rule 145” means Rule 145 promulgated by the SEC under the Securities Act. 

1.34    “Securities Act” means the Securities Act of 1933, as amended, and the rules and regulations
promulgated thereunder. 
 1.35    “Selling Expenses” means all underwriting discounts, selling
commissions, and stock transfer taxes applicable to the sale of Registrable Securities, and fees and disbursements of counsel for any Holder, except for the fees and disbursements of the Selling Holder Counsel borne and paid by the Company as
provided in Subsection 2.6. 
 1.36    “Series B-1 Preferred
Stock” means shares of the Company’s Series B-1 Preferred Stock, par value $0.000001 per share. 

1.37    “Series B-2 Preferred Stock” means shares of the
Company’s Series B-2 Preferred Stock, par value $0.000001 per share. 

1.38    “Series B-3 Preferred Stock” means shares of the
Company’s Series B-3 Preferred Stock, par value $0.000001 per share. 

1.39    “Series B-4 Preferred Stock” means shares of the
Company’s Series B-4 Preferred Stock, par value $0.000001 per share. 

  
 4 

 1.40    “Series B Major Investor” means each of Novo
Holdings A/S (“Novo”), Merck Ventures BV (“Merck”) and Sunstone Life Science Ventures Fund III K/S (“Sunstone”), in each case, so long as such Investor holds shares of Registrable Securities. 

1.41    “Series C-1 Preferred Stock” means shares of the
Company’s Series C-1 Preferred Stock, par value $0.000001 per share. 

1.42    “Series C-2 Preferred Stock” means shares of the
Company’s Series C-2 Preferred Stock, par value $0.000001 per share. 

1.43    “Series C-3 Preferred Stock” means shares of the
Company’s Series C-3 Preferred Stock, par value $0.000001 per share. 

1.44    “Series C-4 Preferred Stock” means shares of the
Company’s Series C-4 Preferred Stock, par value $0.000001 per share. 

1.45    “Series C-5 Preferred Stock” means shares of the
Company’s Series C-5 Preferred Stock, par value $0.000001 per share. 

1.46    “Series C Major Investor” means each of HBM Healthcare Investments (Cayman) Ltd.
(“HBM”), Ysios BioFund II Innvierte FCR (“Ysios”), OrbiMed Private Investments VII, LP. (“OrbiMed”) and OrbiMed Israel Partners II, LP (“OrbiMed Israel”), in each case, so long as
such Investor holds shares of Registrable Securities. 
 1.47    “Series D Preferred Stock” means
shares of the Company’s Series D Preferred Stock, par value $0.000001 per share. 
 1.48    “Series D Major
Investor” means each of Soleus, Eir, Cormorant Global Healthcare Master Fund, LP, Cormorant Private Healthcare Fund II, LP, Cormorant Private Healthcare Fund III, LP, CRMA SPV, L.P., Hadean, Canica and Sphera, in each case, so long as such
Investor holds, individually or together with such Investor’s Affiliates, at least 50% of the shares of Common Stock issuable or issued upon conversion of the Series D Preferred Stock held as of the date hereof 

1.49    “Soleus” means Soleus Private Equity Fund I, L.P. 

1.50     “Sphera” means, collectively, Sphera Global Healthcare Master Fund (a Cayman Islands
Corporation) and Sphera Biotech Master Fund, Lp (a Cayman Islands Partnership). 
 2.    Registration Rights. The
Company covenants and agrees as follows: 
 2.1    Demand Registration. 

(a)    Form S-1 Demand. If at any time after the earlier of (i) five
(5) years after the date of this Agreement or (ii) one hundred eighty (180) days after the effective date of the registration statement for the IPO, the Company receives a request from the Requisite Holders (as defined in the Restated
Certificate) that the Company file a Form S-1 registration statement with respect to at least forty percent (40%) of the Registrable Securities then outstanding (or a lesser percent if the anticipated
aggregate offering price, net of Selling Expenses, would exceed $10 million) having an anticipated aggregate offering 

  
 5 

 
price, net of Selling Expenses, of at least $5 million, then the Company shall (x) within ten (10) days after the date such request is given, give notice thereof (the
“Demand Notice”) to all Holders other than the Initiating Holders; and (y) as soon as practicable, and in any event within sixty (60) days after the date such request is given by the Initiating Holders, file a Form S-1 registration statement under the Securities Act covering all Registrable Securities that the Initiating Holders requested to be registered and any additional Registrable Securities requested to be
included in such registration by any other Holders, as specified by notice given by each such Holder to the Company within twenty (20) days of the date the Demand Notice is given, and in each case, subject to the limitations of Subsections
2.1(c) and 2.3. 
 (b)    Form S-3 Demand. If at any
time when it is eligible to use a Form S-3 registration statement, the Company receives a request from Holders of at least twenty-five percent (25%) of the Registrable Securities then outstanding that the
Company file a Form S-3 registration statement with respect to outstanding Registrable Securities of such Holders having an anticipated aggregate offering price, net of Selling Expenses, of at least
$3 million, then the Company shall (i) within ten (10) days after the date such request is given, give a Demand Notice to all Holders other than the Initiating Holders; and (ii) as soon as practicable, and in any event within
forty-five (45) days after the date such request is given by the Initiating Holders, file a Form S-3 registration statement under the Securities Act covering all Registrable Securities requested to be
included in such registration by any other Holders, as specified by notice given by each such Holder to the Company within twenty (20) days of the date the Demand Notice is given, and in each case, subject to the limitations of Subsections
2.1(c) and 2.3. 
 (c)    Notwithstanding the foregoing obligations, if the Company furnishes to Holders
requesting a registration pursuant to this Subsection 2.1 a certificate signed by the Company’s chief executive officer stating that in the good faith judgment of the Board it would be materially detrimental to the Company and its
stockholders for such registration statement to either become effective or remain effective for as long as such registration statement otherwise would be required to remain effective, because such action would (i) materially interfere with a
significant acquisition, corporate reorganization, or other similar transaction involving the Company; (ii) require premature disclosure of material information that the Company has a bona fide business purpose for preserving as confidential;
or (iii) render the Company unable to comply with requirements under the Securities Act or Exchange Act, then the Company shall have the right to defer taking action with respect to such filing for a period of not more than ninety
(90) days after the request of the Initiating Holders is given; provided, however, that the Company may not invoke this right more than once in any twelve (12) month period; and provided further that the Company
shall not register any securities for its own account or that of any other stockholder during such ninety (90) day period other than an Excluded Registration. 

(d)    The Company shall not be obligated to effect, or to take any action to effect, any registration pursuant to
Subsection 2.1(a) (i) during the period that is sixty (60) days before the Company’s good faith estimate of the date of filing of, and ending on a date that is one hundred eighty (180) days after the effective date
of, a Company-initiated registration, provided that the Company is actively employing in good faith commercially reasonable efforts to cause such registration statement to become effective; (ii) after the Company has effected two
registrations pursuant to Subsection 2.1(a); or (iii) if the Initiating Holders propose to dispose of shares of Registrable Securities that may be immediately registered on Form S-3 pursuant to a
request made pursuant to Subsection 2.1(b). The Company shall not be obligated to effect, or to take any action to effect, any registration pursuant to Subsection 2.1(b) (i) during the period that is thirty (30) days before
the Company’s good faith estimate of the date of filing of, and ending on a date that is ninety (90) days after the effective date of, a Company-initiated registration, provided that the Company is actively employing in good faith
commercially reasonable efforts to cause 

  
 6 

 
such registration statement to become effective; or (ii) if the Company has effected two registrations pursuant to Subsection 2.1(b) within the twelve (12) month period
immediately preceding the date of such request. A registration shall not be counted as “effected” for purposes of this Subsection 2.1(d) until such time as the applicable registration statement has been declared effective by
the SEC, unless the Initiating Holders withdraw their request for such registration, elect not to pay the registration expenses therefor, and forfeit their right to one demand registration statement pursuant to Subsection 2.6, in which case
such withdrawn registration statement shall be counted as “effected” for purposes of this Subsection 2.1(d); provided, that if such withdrawal is during a period the Company has deferred taking action pursuant to
Subsection 2.1(c), then the Initiating Holders may withdraw their request for registration and such registration will not be counted as “effected” for purposes of this Subsection 2.1(d). 

2.2    Company Registration. If the Company proposes to register (including, for this purpose, a registration
effected by the Company for stockholders other than the Holders) any of its securities under the Securities Act in connection with the public offering of such securities solely for cash (other than in an Excluded Registration), the Company shall, at
such time, promptly give each Holder notice of such registration. Upon the request of each Holder given within twenty (20) days after such notice is given by the Company, the Company shall, subject to the provisions of Subsection 2.3,
cause to be registered all of the Registrable Securities that each such Holder has requested to be included in such registration. The Company shall have the right to terminate or withdraw any registration initiated by it under this Subsection
2.2 before the effective date of such registration, whether or not any Holder has elected to include Registrable Securities in such registration. The expenses (other than Selling Expenses) of such withdrawn registration shall be borne by the
Company in accordance with Subsection 2.6. 
 2.3    Underwriting Requirements. 

(a)    If, pursuant to Subsection 2.1, the Initiating Holders intend to distribute the Registrable
Securities covered by their request by means of an underwriting, they shall so advise the Company as a part of their request made pursuant to Subsection 2.1, and the Company shall include such information in the Demand Notice. The
underwriter(s) will be selected by the Company and shall be reasonably acceptable to a majority in interest of the Initiating Holders. In such event, the right of any Holder to include such Holder’s Registrable Securities in such registration
shall be conditioned upon such Holder’s participation in such underwriting and the inclusion of such Holder’s Registrable Securities in the underwriting to the extent provided herein. All Holders proposing to distribute their securities
through such underwriting shall (together with the Company as provided in Subsection 2.4(e)) enter into an underwriting agreement in customary form with the underwriter(s) selected for such underwriting. Notwithstanding any other provision of
this Subsection 2.3, if the underwriter(s) advise(s) the Initiating Holders in writing that marketing factors require a limitation on the number of shares to be underwritten, then the Initiating Holders shall so advise all Holders of
Registrable Securities that otherwise would be underwritten pursuant hereto, and the number of Registrable Securities that may be included in the underwriting shall be allocated among such Holders of Registrable Securities, including the Initiating
Holders, in proportion (as nearly as practicable) to the number of Registrable Securities owned by each Holder or in such other proportion as shall mutually be agreed to by all such selling Holders; provided, however, that the number
of Registrable Securities held by the Holders to be included in such underwriting shall not be reduced unless all other securities are first entirely excluded from the underwriting 

(b)    In connection with any offering involving an underwriting of shares of the Company’s capital stock pursuant
to Subsection 2.2, the Company shall not be required to include any of the Holders’ Registrable Securities in such underwriting unless the Holders accept the terms of the 

  
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underwriting as agreed upon between the Company and its underwriters, and then only in such quantity as the underwriters in their sole discretion determine will not jeopardize the success of the
offering by the Company. If the total number of securities, including Registrable Securities, requested by stockholders to be included in such offering exceeds the number of securities to be sold (other than by the Company) that the underwriters in
their reasonable discretion determine is compatible with the success of the offering, then the Company shall be required to include in the offering only that number of such securities, including Registrable Securities, which the underwriters and the
Company in their sole discretion determine will not jeopardize the success of the offering. If the underwriters determine that less than all of the Registrable Securities requested to be registered can be included in such offering, then the
Registrable Securities that are included in such offering shall be allocated among the selling Holders in proportion (as nearly as practicable to) the number of Registrable Securities owned by each selling Holder or in such other proportions as
shall mutually be agreed to by all such selling Holders. To facilitate the allocation of shares in accordance with the above provisions, the Company or the underwriters may round the number of shares allocated to any Holder to the nearest one
hundred (100) shares. Notwithstanding the foregoing, in no event shall (i) the number of Registrable Securities included in the offering be reduced unless all other securities (other than securities to be sold by the Company) are first
entirely excluded from the offering, or (ii) the number of Registrable Securities included in the offering be reduced below twenty percent (20%) of the total number of securities included in such offering, unless such offering is the IPO, in
which case the selling Holders may be excluded further if the underwriters make the determination described above and no other stockholder’s securities are included in such offering. For purposes of the provision in this Subsection
2.3(b) concerning apportionment, for any selling Holder that is a partnership, limited liability company, or corporation, the partners, members, retired partners, retired members, stockholders, and Affiliates of such Holder, or the estates and
Immediate Family Members of any such partners, retired partners, members, and retired members and any trusts for the benefit of any of the foregoing Persons, shall be deemed to be a single “selling Holder,” and any pro rata reduction with
respect to such “selling Holder” shall be based upon the aggregate number of Registrable Securities owned by all Persons included in such “selling Holder,” as defined in this sentence. 

2.4    Obligations of the Company. Whenever required under this Section 2 to effect the
registration of any Registrable Securities, the Company shall, as expeditiously as reasonably possible: 

(a)    prepare and file with the SEC a registration statement with respect to such Registrable Securities and use its
commercially reasonable efforts to cause such registration statement to become effective and, upon the request of the Holders of a majority of the Registrable Securities registered thereunder, keep such registration statement effective for a period
of up to one hundred twenty (120) days or, if earlier, until the distribution contemplated in the registration statement has been completed; provided, however, that such one hundred twenty (120) day period shall be extended
for a period of time equal to the period the Holder refrains, at the request of an underwriter of Common Stock (or other securities) of the Company, from selling any securities included in such registration; 

(b)    prepare and file with the SEC such amendments and supplements to such registration statement, and the prospectus
used in connection with such registration statement, as may be necessary to comply with the Securities Act in order to enable the disposition of all securities covered by such registration statement; 

(c)    furnish to the selling Holders such numbers of copies of a prospectus, including a preliminary prospectus, as
required by the Securities Act, and such other documents as the Holders may reasonably request in order to facilitate their disposition of their Registrable Securities; 

  
 8 

 (d)    use its commercially reasonable efforts to register and qualify
the securities covered by such registration statement under such other securities or blue-sky laws of such jurisdictions as shall be reasonably requested by the selling Holders; provided that the
Company shall not be required to qualify to do business or to file a general consent to service of process in any such states or jurisdictions, unless the Company is already subject to service in such jurisdiction and except as may be required by
the Securities Act; 
 (e)    in the event of any underwritten public offering, enter into and perform its obligations
under an underwriting agreement, in usual and customary form, with the underwriter(s) of such offering; 
 (f)    use
its commercially reasonable efforts to cause all such Registrable Securities covered by such registration statement to be listed on a national securities exchange or trading system and each securities exchange and trading system (if any) on which
similar securities issued by the Company are then listed; 
 (g)    provide a transfer agent and registrar for all
Registrable Securities registered pursuant to this Agreement and provide a CUSIP number for all such Registrable Securities, in each case not later than the effective date of such registration; 

(h)    promptly make available for inspection by the selling Holders, any underwriter(s) participating in any disposition
pursuant to such registration statement, and any attorney or accountant or other agent retained by any such underwriter or selected by the selling Holders, all financial and other records, pertinent corporate documents, and properties of the
Company, and cause the Company’s officers, directors, employees, and independent accountants to supply all information reasonably requested by any such seller, underwriter, attorney, accountant, or agent, in each case, as necessary or advisable
to verify the accuracy of the information in such registration statement and to conduct appropriate due diligence in connection therewith; 

(i)    notify each selling Holder, promptly after the Company receives notice thereof, of the time when such registration
statement has been declared effective or a supplement to any prospectus forming a part of such registration statement has been filed; and 

(j)    after such registration statement becomes effective, notify each selling Holder of any request by the SEC that the
Company amend or supplement such registration statement or prospectus. 
 In addition, the Company shall ensure that, at all times after any
registration statement covering a public offering of securities of the Company under the Securities Act shall have become effective, its insider trading policy shall provide that the Company’s directors may implement a trading program under
Rule 10b5-1 of the Exchange Act. 
 2.5    Furnish Information. It shall
be a condition precedent to the obligations of the Company to take any action pursuant to this Section 2 with respect to the Registrable Securities of any selling Holder that such Holder shall furnish to the Company such
information regarding itself, the Registrable Securities held by it, and the intended method of disposition of such securities as is reasonably required to effect the registration of such Holder’s Registrable Securities. 

  
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 2.6    Expenses of Registration. All expenses (other than Selling
Expenses) incurred in connection with registrations, filings, or qualifications pursuant to Section 2, including all registration, filing, and qualification fees; printers’ and accounting fees; fees and disbursements
of counsel for the Company; and the reasonable fees and disbursements, not to exceed an amount to be determined by the Company and the selling Holders, negotiating in good faith at the time of such registration, filing or qualification pursuant to
Section 2, of one counsel for the selling Holders (“Selling Holder Counsel”), shall be borne and paid by the Company; provided, however, that the Company shall not be required to pay for any expenses of any
registration proceeding begun pursuant to Subsection 2.1 if the registration request is subsequently withdrawn at the request of the Holders of a majority of the Registrable Securities to be registered (in which case all selling Holders shall
bear such expenses pro rata based upon the number of Registrable Securities that were to be included in the withdrawn registration), unless the Holders of a majority of the Registrable Securities agree to forfeit their right to one registration
pursuant to Subsections 2.1(a) or 2.1(b), as the case may be. All Selling Expenses relating to Registrable Securities registered pursuant to this Section 2 shall be borne and paid by the Holders pro
rata on the basis of the number of Registrable Securities registered on their behalf. 
 2.7    Delay of
Registration. No Holder shall have any right to obtain or seek an injunction restraining or otherwise delaying any registration pursuant to this Agreement as the result of any controversy that might arise with respect to the interpretation or
implementation of this Section 2. 
 2.8    Indemnification. If any Registrable
Securities are included in a registration statement under this Section 2: 
 (a)    To the
extent permitted by law, the Company will indemnify and hold harmless each selling Holder, and the partners, members, officers, directors, and stockholders of each such Holder; legal counsel and accountants for each such Holder; any underwriter (as
defined in the Securities Act) for each such Holder; and each Person, if any, who controls such Holder or underwriter within the meaning of the Securities Act or the Exchange Act, against any Damages, and the Company will pay to each such Holder,
underwriter, controlling Person, or other aforementioned Person any legal or other expenses reasonably incurred thereby in connection with investigating or defending any claim or proceeding from which Damages may result, as such expenses are
incurred; provided, however, that the indemnity agreement contained in this Subsection 2.8(a) shall not apply to amounts paid in settlement of any such claim or proceeding if such settlement is effected without the
consent of the Company, which consent shall not be unreasonably withheld, nor shall the Company be liable for any Damages to the extent that they arise out of or are based upon actions or omissions made in reliance upon and in conformity with
written information furnished by or on behalf of any such Holder, underwriter, controlling Person, or other aforementioned Person expressly for use in connection with such registration. 

(b)    To the extent permitted by law, each selling Holder, severally and not jointly, will indemnify and hold harmless
the Company, and each of its directors, each of its officers who has signed the registration statement, each Person (if any), who controls the Company within the meaning of the Securities Act, legal counsel and accountants for the Company, any
underwriter (as defined in the Securities Act), any other Holder selling securities in such registration statement, and any controlling Person of any such underwriter or other Holder, against any Damages, in each case only to the extent that such
Damages arise out of or are based upon actions or omissions made in reliance upon and in conformity with written information furnished by or on behalf of such selling Holder expressly for use in connection with such registration; and each such
selling Holder will pay to the Company and each other aforementioned Person any legal or other expenses reasonably incurred thereby in connection with investigating or 

  
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defending any claim or proceeding from which Damages may result, as such expenses are incurred; provided, however, that the indemnity agreement contained in this Subsection
2.8(b) shall not apply to amounts paid in settlement of any such claim or proceeding if such settlement is effected without the consent of the Holder, which consent shall not be unreasonably withheld; and provided further
that in no event shall the aggregate amounts payable by any Holder by way of indemnity or contribution under Subsections 2.8(b) and 2.8(d) exceed the proceeds from the offering received by such Holder (net of any Selling Expenses paid
by such Holder), except in the case of fraud or willful misconduct by such Holder. 
 (c)    Promptly after receipt by
an indemnified party under this Subsection 2.8 of notice of the commencement of any action (including any governmental action) for which a party may be entitled to indemnification hereunder, such indemnified party will, if a claim in
respect thereof is to be made against any indemnifying party under this Subsection 2.8, give the indemnifying party notice of the commencement thereof. The indemnifying party shall have the right to participate in such action and, to the
extent the indemnifying party so desires, participate jointly with any other indemnifying party to which notice has been given, and to assume the defense thereof with counsel mutually satisfactory to the parties; provided, however,
that an indemnified party (together with all other indemnified parties that may be represented without conflict by one counsel) shall have the right to retain one separate counsel, with the fees and expenses to be paid by the indemnifying party, if
representation of such indemnified party by the counsel retained by the indemnifying party would be inappropriate due to actual or potential differing interests between such indemnified party and any other party represented by such counsel in such
action. The failure to give notice to the indemnifying party within a reasonable time of the commencement of any such action shall relieve such indemnifying party of any liability to the indemnified party under this Subsection 2.8, to the
extent that such failure materially prejudices the indemnifying party’s ability to defend such action. The failure to give notice to the indemnifying party will not relieve it of any liability that it may have to any indemnified party otherwise
than under this Subsection 2.8. 
 (d)    To provide for just and equitable contribution to joint liability
under the Securities Act in any case in which either: (i) any party otherwise entitled to indemnification hereunder makes a claim for indemnification pursuant to this Subsection 2.8 but it is judicially determined (by the entry of a
final judgment or decree by a court of competent jurisdiction and the expiration of time to appeal or the denial of the last right of appeal) that such indemnification may not be enforced in such case, notwithstanding the fact that this
Subsection 2.8 provides for indemnification in such case, or (ii) contribution under the Securities Act may be required on the part of any party hereto for which indemnification is provided under this Subsection 2.8, then, and in
each such case, such parties will contribute to the aggregate losses, claims, damages, liabilities, or expenses to which they may be subject (after contribution from others) in such proportion as is appropriate to reflect the relative fault of each
of the indemnifying party and the indemnified party in connection with the statements, omissions, or other actions that resulted in such loss, claim, damage, liability, or expense, as well as to reflect any other relevant equitable considerations.
The relative fault of the indemnifying party and of the indemnified party shall be determined by reference to, among other things, whether the untrue or allegedly untrue statement of a material fact, or the omission or alleged omission of a material
fact, relates to information supplied by the indemnifying party or by the indemnified party and the parties’ relative intent, knowledge, access to information, and opportunity to correct or prevent such statement or omission; provided,
however, that, in any such case (x) no Holder will be required to contribute any amount in excess of the public offering price of all such Registrable Securities offered and sold by such Holder pursuant to such registration statement,
and (y) no Person guilty of fraudulent misrepresentation (within the meaning of Section 11(f) of the Securities Act) will be entitled to contribution from any Person who was not guilty of such fraudulent misrepresentation; and
provided further that in no event shall a Holder’s liability pursuant to this Subsection  

  
 11 

 
2.8(d), when combined with the amounts paid or payable by such Holder pursuant to Subsection 2.8(b), exceed the proceeds from the offering received by such Holder (net of any
Selling Expenses paid by such Holder), except in the case of willful misconduct or fraud by such Holder. 

(e)    Notwithstanding the foregoing, to the extent that the provisions on indemnification and contribution contained in
the underwriting agreement entered into in connection with the underwritten public offering are in conflict with the foregoing provisions, the provisions in the underwriting agreement shall control, save in respect of the foregoing provisions which
serve to limit the liability of a Holder to, in aggregate, the proceeds from the offering received by a Holder (net of any Selling Expenses paid by a Holder). 

(f)    Unless otherwise superseded by an underwriting agreement entered into in connection with the underwritten public
offering, the obligations of the Company and Holders under this Subsection 2.8 shall survive the completion of any offering of Registrable Securities in a registration under this Section 2, and otherwise shall
survive the termination of this Agreement. 
 2.9    Reports Under Exchange Act. With a view to making available
to the Holders the benefits of SEC Rule 144 and any other rule or regulation of the SEC that may at any time permit a Holder to sell securities of the Company to the public without registration or pursuant to a registration on Form S-3, the Company shall: 
 (a)    make and keep available adequate current public
information, as those terms are understood and defined in SEC Rule 144, at all times after the effective date of the registration statement filed by the Company for the IPO; 

(b)    use commercially reasonable efforts to file with the SEC in a timely manner all reports and other documents
required of the Company under the Securities Act and the Exchange Act (at any time after the Company has become subject to such reporting requirements); and 

(c)    furnish to any Holder, so long as the Holder owns any Registrable Securities, forthwith upon request (i) to
the extent accurate, a written statement by the Company that it has complied with the reporting requirements of SEC Rule 144 (at any time after ninety (90) days after the effective date of the registration statement filed by the Company for the
IPO), the Securities Act, and the Exchange Act (at any time after the Company has become subject to such reporting requirements), or that it qualifies as a registrant whose securities may be resold pursuant to Form
S-3 (at any time after the Company so qualifies, and (ii) such other information as may be reasonably requested in availing any Holder of any rule or regulation of the SEC that permits the selling of any
such securities without registration (at any time after the Company has become subject to the reporting requirements under the Exchange Act) or pursuant to Form S-3 (at any time after the Company so qualifies
to use such form). The Company shall facilitate resales of securities of the Company by Holders pursuant to a sale that is compliant with Rule 144 by instructing its transfer agent to remove applicable restrictive legends in connection with any such
Rule 144-compliant sale. 
 2.10    Limitations on Subsequent Registration
Rights. From and after the date of this Agreement, the Company shall not, without the prior written consent of the Requisite Holders, enter into any agreement with any holder or prospective holder of any securities of the Company that would
(i) provide to such holder or prospective holder the right to include securities in any registration on other than either a pro rata basis with respect to the Registrable Securities or on a subordinate basis after all Holders

  
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have had the opportunity to include in the registration and offering all shares of Registrable Securities that they wish to so include; or (ii) allow such holder or prospective holder to
initiate a demand for registration of any securities held by such holder or prospective holder; provided that this limitation shall not apply to Registrable Securities acquired by any additional Investor that becomes a party to this Agreement
in accordance with Subsection 6.9. 
 2.11    “Market
Stand-off” Agreement. Each Holder hereby agrees that it will not, without the prior written consent of the managing underwriter, during the period commencing on the date of the
final prospectus relating to the registration by the Company of shares of its Common Stock or any other equity securities under the Securities Act on a registration statement on Form S-1 or Form S-3,
and ending on the date specified by the Company and the managing underwriter (such period not to exceed one hundred eighty (180) days in the case of the IPO, or such other period as may be requested by the Company or an underwriter to
accommodate regulatory restrictions on (1) the publication or other distribution of research reports, and (2) analyst recommendations and opinions, including, but not limited to, the restrictions contained in FINRA Rule 2711(f)(4) or NYSE
Rule 472(f)(4), or any successor provisions or amendments thereto), or ninety (90) days in the case of any registration other than the IPO, or such other period as may be requested by the Company or an underwriter to accommodate regulatory
restrictions on (1) the publication or other distribution of research reports and (2) analyst recommendations and opinions, including, but not limited to, the restrictions contained in FINRA Rule 2711(f)(4) or NYSE Rule 472(f)(4), or any
successor provisions or amendments thereto), (i) lend; offer; pledge; sell; contract to sell; sell any option or contract to purchase; purchase any option or contract to sell; grant any option, right, or warrant to purchase; or otherwise transfer or
dispose of, directly or indirectly, any shares of Common Stock or any securities convertible into or exercisable or exchangeable (directly or indirectly) for Common Stock held immediately before the effective date of the registration statement for
such offering or (ii) enter into any swap or other arrangement that transfers to another, in whole or in part, any of the economic consequences of ownership of such securities, whether any such transaction described in clause (i) or
(ii) above is to be settled by delivery of Common Stock or other securities, in cash, or otherwise. The foregoing provisions of this Subsection 2.11 shall not apply to (a) the sale of any shares to an underwriter pursuant to an
underwriting agreement; (b) the transfer of any shares to any trust for the direct or indirect benefit of the Holder or the immediate family of the Holder, provided that the trustee of the trust agrees to be bound in writing by the
restrictions set forth herein, and provided further that any such transfer shall not involve a disposition for value; or (c) the sale of any shares acquired in the offering or on the open market following the effectiveness of the
registration statement for the offering, and shall be applicable to the Holders only if all officers and directors are subject to the same restrictions and the Company uses commercially reasonable efforts to obtain a similar agreement from all
stockholders individually owning more than one percent (1%) of the Company’s outstanding Common Stock (after giving effect to conversion into Common Stock of all outstanding Preferred Stock). The underwriters in connection with such
registration are intended third-party beneficiaries of this Subsection 2.11 and shall have the right, power and authority to enforce the provisions hereof as though they were a party hereto. Each Holder
further agrees to execute such agreements as may be reasonably requested by the underwriters in connection with such registration that are consistent with this Subsection 2.11 or that are necessary to give further effect thereto. Any
discretionary waiver or termination of the restrictions of any or all of such agreements by the Company or the underwriters shall apply pro rata to all Company stockholders that are subject to such agreements, based on the number of shares subject
to such agreements, except that, notwithstanding the foregoing, the Company and the underwriters may, in their sole discretion, waive or terminate these restrictions with respect to up to ten thousand (10,000) shares of the Common Stock. 

  
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 2.12    Restrictions on Transfer. 

(a)    The Preferred Stock and the Registrable Securities shall not be sold, pledged, or otherwise transferred, and the
Company shall not recognize and shall issue stop-transfer instructions to its transfer agent with respect to any such sale, pledge, or transfer, except upon the conditions specified in this Agreement, which conditions are intended to ensure
compliance with the provisions of the Securities Act. A transferring Holder will cause any proposed purchaser, pledgee, or transferee of the Preferred Stock and the Registrable Securities held by such Holder to agree to take and hold such securities
subject to the provisions and upon the conditions specified in this Agreement. 
 (b)    Each certificate, instrument,
or book entry representing (i) the Preferred Stock, (ii) the Registrable Securities, and (iii) any other securities issued in respect of the securities referenced in clauses (i) and (ii), upon any stock split, stock dividend,
recapitalization, merger, consolidation, or similar event, shall (unless otherwise permitted by the provisions of Subsection 2.12(c)) be notated with a legend substantially in the following form: 

THE SECURITIES REPRESENTED HEREBY HAVE BEEN ACQUIRED FOR INVESTMENT AND HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933. SUCH SHARES
MAY NOT BE SOLD, PLEDGED, OR TRANSFERRED IN THE ABSENCE OF SUCH REGISTRATION OR A VALID EXEMPTION FROM THE REGISTRATION AND PROSPECTUS DELIVERY REQUIREMENTS OF SAID ACT. 

THE SECURITIES REPRESENTED HEREBY MAY BE TRANSFERRED ONLY IN ACCORDANCE WITH THE TERMS OF AN AGREEMENT BETWEEN THE COMPANY AND THE STOCKHOLDER,
A COPY OF WHICH IS ON FILE WITH THE SECRETARY OF THE COMPANY. 
 The Holders consent to the Company making a notation in its records and
giving instructions to any transfer agent of the Restricted Securities in order to implement the restrictions on transfer set forth in this Subsection 2.12. 

(c)    The holder of such Restricted Securities, by acceptance of ownership thereof, agrees to comply in all respects
with the provisions of this Section 2. Before any proposed sale, pledge, or transfer of any Restricted Securities, unless there is in effect a registration statement under the Securities Act covering the proposed
transaction, the Holder thereof shall give notice to the Company of such Holder’s intention to effect such sale, pledge, or transfer. Each such notice shall describe the manner and circumstances of the proposed sale, pledge, or transfer in
sufficient detail and, if reasonably requested by the Company, shall be accompanied at such Holder’s expense by either (i) a written opinion of legal counsel who shall, and whose legal opinion shall, be reasonably satisfactory to the
Company, addressed to the Company, to the effect that the proposed transaction may be effected without registration under the Securities Act; (ii) a “no action” letter from the SEC to the effect that the proposed sale, pledge, or
transfer of such Restricted Securities without registration will not result in a recommendation by the staff of the SEC that action be taken with respect thereto; or (iii) any other evidence reasonably satisfactory to counsel to the Company to
the effect that the proposed sale, pledge, or transfer of the Restricted Securities may be effected without registration under the Securities Act, whereupon the Holder of such Restricted Securities shall be entitled to sell, pledge, or transfer such
Restricted Securities in accordance with the terms of the notice given by the Holder to the Company. The Company will not require such a legal opinion or “no 

  
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action” letter (x) in any transaction in compliance with SEC Rule 144; or (y) in any transaction in which such Holder distributes Restricted Securities to (1) an Affiliate of
such Holder or (2) for a Holder that is a partnership, limited liability company or corporation to a partner, limited partner, retired partner, member, retired member or stockholder of a Holder, in case for clauses (1) and (2) for no
consideration; provided that each transferee agrees in writing to be subject to the terms of this Subsection 2.12. Each certificate, instrument, or book entry representing the Restricted Securities transferred as above provided shall
be notated with, except if such transfer is made pursuant to SEC Rule 144, the appropriate restrictive legend set forth in Subsection 2.12(b), except that such certificate instrument, or book entry shall not be notated with such restrictive
legend if, in the opinion of counsel for such Holder and the Company, such legend is not required in order to establish compliance with any provisions of the Securities Act. 

(d)    Notwithstanding the provisions of Subsections 2.12(a) and 2.12(c) above, no such registration
statement or opinion of counsel or “no action” letter shall be necessary for the transfer of Restricted Securities by a Holder exercising its co-sale rights under the Amended and Restated Right of
First Refusal and Co-Sale Agreement of even date herewith among the Company, the Investors and the other parties named therein (the “Right of First Refusal and
Co-Sale Agreement”), if in each such transfer the prospective transferee agrees in all such instances in writing to be subject to the terms hereof to the same extent as if he, she or it were an
original Holder hereunder. 
 (e)    Notwithstanding anything to the contrary contained herein, in no event will the
restrictions set forth in Section 2.12 be applicable to any shares purchased in connection with a public offering by the Company or on the open market. 

2.13    Termination of Registration Rights. The right of any Holder to request registration or inclusion of
Registrable Securities in any registration pursuant to Subsections 2.1 or 2.2 shall terminate upon the earliest to occur of: 

(a)    the closing of a Deemed Liquidation Event, as such term is defined in the Restated Certificate in which the
consideration received by the Investors in such Deemed Liquidation Event is in the form of cash and/or publicly traded securities, or if the Investors receive registration rights from the acquiring company or other successor to the Company
reasonably comparable to those set forth in this Section 2; 
 (b)    such time after consummation of the IPO as
Rule 144 or another similar exemption under the Securities Act is available for the sale of all of such Holder’s shares without limitation during a three-month period without registration; 

(c)    the third anniversary of the IPO. 

  
 15 

 3.    Information and Observer Rights. 

3.1    Delivery of Financial Statements. The Company shall deliver to each Major Investor, to each of Seed Capital
Denmark II K/S, BMS (as defined below), Canica (so long as such Investor continues to hold Registrable Securities) and Hadean (so long as such Investor continues to hold Registrable Securities) and, in the event they are no longer deemed to be Major
Investors but continue to hold any shares of Series D Preferred Stock (or Common Stock issued upon conversion thereof), Soleus and Eir (or their respective transferees), provided that the Board has not reasonably determined that such Major
Investor is a competitor of the Company: 
 (a)    as soon as practicable, but in any event by March 15th of each calendar year (i) an audited balance sheet as of the end of such year, (ii) audited statements of income and of cash flows for such year, and (iii) an audited statement of
stockholders’ equity as of the end of such year; 
 (b)    as soon as practicable, but in any event within twenty
(20) days after the end of each of the first three (3) quarters of each fiscal year of the Company, (i) unaudited statements of income and cash flows for such fiscal quarter, and an unaudited balance sheet as of the end of such fiscal
quarter, all prepared in accordance with GAAP (except that such financial statements may (x) be subject to normal year-end audit adjustments; (y) not contain all notes thereto that may be required in
accordance with GAAP); (ii) an unaudited statement of income and of cash flows on a monthly rolling basis; and (iii) a follow-up report on the Technical Development Plan; 

(c)    as soon as practicable, but in any event twenty (20) days after the end of each month, (i) unaudited
statements of income and cash flows for such month, and an unaudited balance sheet as of the end of such month, all prepared in accordance with GAAP (except that such financial statements may (x) be subject to normal year-end audit adjustments; (y) not contain all notes thereto that may be required in accordance with GAAP); (ii) a management report summarizing the most important developments as of such month; and
(iii) anticipated warning envisaged by management; 
 (d)    as soon as practicable, but in any event by December
1st of each calendar year, a budget and business plan for the next fiscal year (collectively, the “Budget”), prepared on a monthly basis, including balance sheets, income
statements, and statements of cash flow for such months and, promptly after prepared, any other budgets or revised budgets prepared by the Company. The Budget will contain a detailed technical development plan for such year (the “Technical
Development Plan”); and 
 (e)    promptly, but in any event within forty-five (45) days after the end of
each quarter of each fiscal year of the Company, a statement showing the number of shares of each class and series of capital stock and securities convertible into or exercisable for shares of capital stock outstanding at the end of the period, the
Common Stock issuable upon conversion or exercise of any outstanding securities convertible or exercisable for Common Stock and the exchange ratio or exercise price applicable thereto, and the number of shares of issued stock options and stock
options not yet issued but reserved for issuance, if any, all in sufficient detail as to permit the Major Investors to calculate their respective percentage equity ownership in the Company. 

If, for any period, the Company has any subsidiary whose accounts are consolidated with those of the Company, then in respect of such period
the financial statements delivered pursuant to the foregoing sections shall be the consolidated and consolidating financial statements of the Company and all such consolidated subsidiaries. 

Notwithstanding anything else in this Subsection 3.1 to the contrary, the Company may cease providing the information set forth in this
Subsection 3.1 during the period starting with the date sixty (60) days before the Company’s good-faith estimate of the date of filing of a registration statement if it reasonably concludes it must do so to comply with the SEC rules
applicable to such registration statement and related offering; provided that the Company’s covenants under this Subsection 3.1 shall be reinstated at such time as the Company is no longer actively employing its commercially
reasonable efforts to cause such registration statement to become effective. 

  
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 3.2    Inspection. The Company shall permit each Major Investor
(provided that the Board has not reasonably determined that such Major Investor is a competitor of the Company), at the Company’s expense, to visit and inspect the Company’s properties; examine its books of account and records; and
discuss the Company’s affairs, finances, and accounts with its officers, during normal business hours of the Company as may be reasonably requested by the Major Investor with reasonable advance notice to the Company; provided,
however, that the Company shall not be obligated pursuant to this Subsection 3.2 to provide access to any information that it reasonably and in good faith considers to be a trade secret or confidential information (unless covered by an
enforceable confidentiality agreement, in form acceptable to the Company) or the disclosure of which would adversely affect the attorney-client privilege between the Company and its counsel. 

3.3    Observer Rights. 

(a)    As long as Bristol-Myers Squibb Company, Tax ID No: 22-0190350
(“BMS”) owns shares of the Series C-2 Preferred Stock (or an equivalent amount of Common Stock issued upon conversion thereof), the Company shall invite a representative of BMS to attend all
meetings of the Board in a nonvoting observer capacity and, in this respect, shall give such representative copies of all notices, minutes, consents, and other materials that it provides to its directors at the same time and in the same manner as
provided to such directors; provided, however, that such representative shall agree to hold in confidence and trust and to act in a fiduciary manner with respect to all information so provided; and provided further, that
the Company reserves the right to withhold any information and to exclude such representative from any meeting or portion thereof if access to such information or attendance at such meeting could adversely affect the attorney-client privilege
between the Company and its counsel or result in disclosure of trade secrets or a conflict of interest, or if such Investor or its representative is a Competitor of the Company to the extent such information or portion of such meeting involves
competitive sensitive information. 
 (b)    As long as Merck Ventures BV, Reg. No. 601910929
(“Merck”) owns shares of the Series C-2 Preferred Stock (or an equivalent amount of Common Stock issued upon conversion thereof), the Company shall invite a representative of Merck to attend
all meetings of the Board in a nonvoting observer capacity and, in this respect, shall give such representative copies of all notices, minutes, consents, and other materials that it provides to its directors at the same time and in the same manner
as provided to such directors; provided, however, that such representative shall agree to hold in confidence and trust and to act in a fiduciary manner with respect to all information so provided; and provided further,
that the Company reserves the right to withhold any information and to exclude such representative from any meeting or portion thereof if access to such information or attendance at such meeting could adversely affect the attorney-client privilege
between the Company and its counsel or result in disclosure of trade secrets or a conflict of interest, or if such Investor or its representative is a Competitor of the Company to the extent such information or portion of such meeting involves
competitive sensitive information. 
 (c)    So long as Soleus owns shares of Series D Preferred Stock (or Common Stock
issued upon conversion thereof) and an Affiliate of Soleus is not a member of the Board, the Company shall invite a representative of Soleus to attend all meetings of the Board of Directors in a nonvoting observer capacity and, in this respect,
shall give such representative copies of all notices, minutes, consents, and other materials that it provides to its directors at the same time and in the same manner as provided to such directors; provided, however, that such

  
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representative shall agree to hold in confidence all information so provided; and provided further, that the Company reserves the right to withhold any information and to exclude such
representative from any meeting or portion thereof if access to such information or attendance at such meeting could adversely affect the attorney-client privilege between the Company and its counsel or result in disclosure of trade secrets or a
conflict of interest, or if such Investor or its representative is a Competitor of the Company to the extent such information or portion of such meeting involves competitive sensitive information. 

(d)    So long as Eir owns shares of Series D Preferred Stock (or Common Stock issued upon conversion thereof) and an
Affiliate of Eir is not a member of the Board, the Company shall invite a representative of Eir to attend all meetings of the Board of Directors in a nonvoting observer capacity and, in this respect, shall give such representative copies of all
notices, minutes, consents, and other materials that it provides to its directors at the same time and in the same manner as provided to such directors; provided, however, that such representative shall agree to hold in confidence all
information so provided; and provided further, that the Company reserves the right to withhold any information and to exclude such representative from any meeting or portion thereof if access to such information or attendance at such meeting could
adversely affect the attorney-client privilege between the Company and its counsel or result in disclosure of trade secrets or a conflict of interest, or if such Investor or its representative is a Competitor of the Company to the extent such
information or portion of such meeting involves competitive sensitive information. 
 (e)    So long as Hadean owns
shares of Series D Preferred Stock (or Common Stock issued upon conversion thereof) and an Affiliate of Hadean is not a member of the Board, the Company shall invite a representative of Hadean to attend all meetings of the Board of Directors in a
nonvoting observer capacity and, in this respect, shall give such representative copies of all notices, minutes, consents, and other materials that it provides to its directors at the same time and in the same manner as provided to such directors;
provided, however, that such representative shall agree to hold in confidence all information so provided; and provided further, that the Company reserves the right to withhold any information and to exclude such representative from
any meeting or portion thereof if access to such information or attendance at such meeting could adversely affect the attorney-client privilege between the Company and its counsel or result in disclosure of trade secrets or a conflict of interest,
or if such Investor or its representative is a Competitor of the Company. 
 (f)    Any Investor that may from time to
time designate a member of the Board pursuant to the Voting Agreement, dated of even date herewith, by and among the Company and the other parties thereto (the “Voting Agreement”) may, at such Investor’s sole discretion, elect
to keep such seat vacant, and may, in place of such Board designee, invite a representative of such Investor to attend all meetings of the Board in a nonvoting observer capacity and, in this respect, the Company shall give such representative copies
of all notices, minutes, consents, and other materials that it provides to its directors at the same time and in the same manner as provided to such directors; provided that if such Board designee is nominated by such Investor, the observer
rights set forth in this Subsection 3.3 shall be suspended for so long as the Board designee shall remain on the Board. 

  
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 3.4    Termination of Covenants . The covenants set forth in
Subsection 3.1, Subsection 3.2 and Subsection 3.3 shall terminate and be of no further force or effect (i) immediately before the consummation of an IPO, (ii) when the Company first becomes subject to the periodic
reporting requirements of Section 12(g) or 15(d) of the Exchange Act, or (iii) upon the closing of a Deemed Liquidation Event, whichever event occurs first. 

3.5    Confidentiality. Each Investor agrees that such Investor will keep confidential and will not disclose,
divulge, or use for any purpose (other than to monitor its investment in the Company) any confidential information obtained from the Company pursuant to the terms of this Agreement (including notice of the Company’s intention to file a
registration statement), unless such confidential information (a) is known or becomes known to the public in general (other than as a result of a breach of this Subsection 3.5 by such Investor), (b) is or has been independently developed
or conceived by such Investor without use of the Company’s confidential information, or (c) is or has been made known or disclosed to such Investor by a third party without a breach of any obligation of confidentiality such third party may
have to the Company; provided, however, that an Investor may disclose confidential information (i) to its attorneys, accountants, consultants, and other professionals to the extent necessary to obtain their services in connection
with monitoring its investment in the Company; (ii) to any prospective purchaser of any Registrable Securities from such Investor, if such prospective purchaser agrees to be bound by the provisions of this Subsection 3.5; (iii) to
any existing or prospective Affiliate, partner, member, stockholder, or wholly owned subsidiary of such Investor in the ordinary course of business, provided that such Investor informs such Person that such information is confidential and directs
such Person to maintain the confidentiality of such information; or (iv) as may otherwise be required by law, regulation, rule, court order or subpoena, provided that such Investor promptly notifies the Company of such disclosure and
takes reasonable steps to minimize the extent of any such required disclosure. 
 4.    Rights to Future Stock
Issuances. 
 4.1    Right of First Offer. Subject to the terms and conditions of this Subsection 4.1
and applicable securities laws, if the Company proposes to offer or sell any New Securities, the Company shall first offer such New Securities to each Investor. An Investor shall be entitled to apportion the right of first offer hereby granted to it
in such proportions as it deems appropriate, among (i) itself, (ii) its Affiliates and (iii) its beneficial interest holders, such as limited partners, members or any other Person having “beneficial ownership,” as such term
is defined in Rule 13d-3 promulgated under the Exchange Act, of such Investor (“Investor Beneficial Owners”); provided that each such Affiliate or Investor Beneficial Owner
(x) is not a Competitor or FOIA Party, unless such party’s purchase of New Securities is otherwise consented to by the Board, (y) agrees to enter into this Agreement and each of the Voting Agreement and the Right of First Refusal and Co-Sale Agreement, as an “Investor” under each such agreement (provided that any Competitor or FOIA Party shall not be entitled to any rights as an Investor under Subsections 3.1,
3.2 and 4.1 hereof), and (z) agrees to purchase at least such number of New Securities as are allocable hereunder to the Investor holding the fewest number of Preferred Stock and any other Derivative Securities. 

(a)    The Company shall give notice (the “Offer Notice”) to each Investor, stating (i) its bona
fide intention to offer such New Securities, (ii) the number of such New Securities to be offered, and (iii) the price and terms, if any, upon which it proposes to offer such New Securities. 

(b)    By notification to the Company within twenty (20) days after the Offer Notice is given, each Investor may
elect to purchase or otherwise acquire, at the price and on the terms specified in the Offer Notice, up to that portion of such New Securities which equals the proportion that the Common Stock then held by such Investor (including all shares of
Common Stock then issuable (directly or indirectly) upon conversion and/or exercise, as applicable, of the Preferred Stock and any other 

  
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Derivative Securities then held by such Investor) bears to the total Common Stock of the Company then outstanding (assuming full conversion and/or exercise, as applicable, of all Preferred Stock
and any other Derivative Securities then outstanding) At the expiration of such twenty (20) day period, the Company shall promptly notify each Investor that elects to purchase or acquire all the shares available to it (each, a “Fully
Exercising Investor”) of any other Investor’s failure to do likewise. During the ten (10) day period commencing after the Company has given such notice, each Fully Exercising Investor may, by giving notice to the Company, elect to
purchase or acquire, in addition to the number of shares specified above, up to that portion of the New Securities for which Investors were entitled to subscribe but that were not subscribed for by the Investors which is equal to the proportion that
the Common Stock issued and held, or issuable (directly or indirectly) upon conversion and/or exercise, as applicable, of Preferred Stock and any other Derivative Securities then held, by such Fully Exercising Investor bears to the Common Stock
issued and held, or issuable (directly or indirectly) upon conversion and/or exercise, as applicable, of the Preferred Stock and any other Derivative Securities then held, by all Fully Exercising Investors who wish to purchase such
unsubscribed shares. The closing of any sale pursuant to this Subsection 4.1(b) shall occur within the later of ninety (90) days of the date that the Offer Notice is given and the date of initial sale of New Securities pursuant to
Subsection 4.1(c). 
 (c)    If all New Securities referred to in the Offer Notice are not elected to be
purchased or acquired as provided in Subsection 4.1(b), the Company may, during the ninety (90) day period following the expiration of the periods provided in Subsection 4.1(b), offer and sell the remaining unsubscribed portion of
such New Securities to any Person or Persons at a price not less than, and upon terms no more favorable to the offeree than, those specified in the Offer Notice. If the Company does not enter into an agreement for the sale of the New Securities
within such period, or if such agreement is not consummated within thirty (30) days of the execution thereof, the right provided hereunder shall be deemed to be revived and such New Securities shall not be offered unless first reoffered to the
Investors in accordance with this Subsection 4.1. 
 (d)    The right of first offer in this Subsection
4.1 shall not be applicable to (i) Exempted Securities (as defined in the Restated Certificate); and (ii) shares of Common Stock issued in the IPO. 

(e)    Notwithstanding any provision hereof to the contrary, in lieu of complying with the provisions of this
Subsection 4.1, the Company may elect to give notice to the Investors within thirty (30) days after the issuance of New Securities. Such notice shall describe the type, price, and terms of the New Securities. Each Investor shall have
twenty (20) days from the date notice is given to elect to purchase up to the number of New Securities that would, if purchased by such Investor, maintain such Investor’s percentage-ownership position, calculated as set forth in
Subsection 4.1(b) before giving effect to the issuance of such New Securities. 

4.2    Termination. The covenants set forth in Subsection 4.1 shall terminate and be of no
further force or effect (i) immediately before the consummation of the IPO, (ii) when the Company first becomes subject to the periodic reporting requirements of Section 12(g) or 15(d) of the Exchange Act, or (iii) upon the
closing of a Deemed Liquidation Event, whichever event occurs first and, as to each Major Investor, in accordance with Subsection 4.1(c). 

  
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 5.    Additional Covenants. 

5.1    Insurance. The Company shall obtain, within ninety (90) days of the date hereof, from financially sound
and reputable insurers Directors and Officers liability insurance each in an amount of at least $2,230,000 (which amount, subject to Board approval, shall increase to at least $5,520,000 immediately prior to the Company’s completion of an IPO)
and on terms and conditions satisfactory to the Board (including each of the Series D Co-Lead Designeee and Series D Director, each as defined in the Voting Agreement), and will use commercially reasonable
efforts to cause such insurance policy to be maintained until such time as the Board determines that such insurance should be discontinued. 

5.2    Employee Agreements. The Company will cause (i) each Person now or hereafter employed by it or by any
subsidiary (or engaged by the Company or any subsidiary as a consultant/independent contractor) with access to confidential information and/or trade secrets to enter into a nondisclosure and proprietary rights assignment agreement, substantially in
the form approved by the Board. In addition, the Company shall not amend, modify, terminate, waive, or otherwise alter, in whole or in part, any of the above-referenced agreements or any restricted stock agreement between the Company and any
employee, without the consent of the Preferred Directors. 
 5.3    Employee Stock. Unless otherwise
approved by the Board all future employees and consultants of the Company who purchase, receive options to purchase, or receive awards of shares of the Company’s capital stock after the date hereof shall be required to execute restricted stock
or option agreements, as applicable, providing for (i) vesting of shares over a four (4) year period, with the first twenty-five percent (25%) of such shares vesting following twelve (12) months of continued employment or service, and
the remaining shares vesting in equal monthly installments over the following thirty-six (36) months, and (ii) a market stand-off provision substantially
similar to that in Subsection 2.11. Without the prior approval by the Board, the Company shall not amend, modify, terminate, waive or otherwise alter, in whole or in part, any stock purchase, stock restriction or option agreement with any
existing employee or service provider if such amendment would cause it to be inconsistent with this Subsection 5.3. In addition, unless otherwise approved by the Board, the Company shall retain (and not waive) a “right of first
refusal” on employee transfers until the Company’s IPO and shall have the right to repurchase unvested shares at cost upon termination of employment of a holder of restricted stock. 

5.4    Matters Requiring Preferred Director Approval. So long as the holders of Preferred Stock are entitled to
elect the Preferred Directors, the Company hereby covenants and agrees with each of the Investors that it shall not, without approval of the Board, which approval must include the affirmative vote of (i) at least one Board member designated by
the Series B Major Investors, (ii) at least one Board member designated by the Series C Major Investors and (iii) the Series D Co-Lead Designee: 

(a)    make, or permit any subsidiary to make, any loan or advance to, or own any stock or other securities of, any
subsidiary or other corporation, partnership, or other entity unless it is wholly owned by the Company; 
 (b)    make,
or permit any subsidiary to make, any loan or advance to any Person, including, without limitation, any employee or director of the Company or any subsidiary, except advances and similar expenditures in the ordinary course of business or under the
terms of an employee stock or option plan approved by the Board; 

  
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 (c)    guarantee, directly or indirectly, or permit any subsidiary to
guarantee, directly or indirectly, any indebtedness except for trade accounts of the Company or any subsidiary arising in the ordinary course of business; 

(d)    make any investment inconsistent with any investment policy approved by the Board; 

(e)    incur any indebtedness on or subsequent to the date hereof that is in excess of $500,000 in the aggregate and that
is not already included in a budget approved by the Board, other than trade credit incurred in the ordinary course of business (for the avoidance of doubt, indebtedness incurred prior to the date hereof shall be exluded for purposes of the aggregate
indebtedness calculation under this subsection); 
 (f)    otherwise enter into or be a party to any transaction with
any director, officer, or employee of the Company or any “associate” (as defined in Rule 12b-2 promulgated under the Exchange Act) of any such Person, except for transactions contemplated by this
Agreement or transactions made in the ordinary course of business and pursuant to reasonable requirements of the Company’s business and upon fair and reasonable terms that are approved by a majority of the Board; 

(g)    hire, terminate, or change the compensation of the executive officers, including approving any option grants or
stock awards to executive officers, or amend the rules or procedures for the Board; 
 (h)    change the principal
business of the Company, enter new lines of business, or exit the current line of business; 
 (i)    sell, assign,
license, pledge, or encumber material technology or intellectual property, other than licenses granted in the ordinary course of business; 

(j)    provide security, pledge, offer as collateral or mortgage any assets or rights to an asset greater than $50,000;

 (k)    enter into any corporate strategic relationship involving the payment, contribution, or assignment by the
Company or to the Company of money or assets greater than $500,000; 
 (l)    enter into any transaction involving the
payment, contribution, issuance or assignment by the Company or to the Company of money, assets, debt, or equity securities of any nature greater than $10,000,000; 

(m)    adopt or amend the budget; 

(n)    adopt or amend the Company’s Business Plan; 

(o)    pay or declare any dividend or distribution on any shares of capital stock of the Company, or apply any assets to
the redemption, retirement, purchase or acquisition, directly or indirectly, through subsidiaries or otherwise, of any shares of capital stock of the Company, except for (a) the repurchase by the Company of capital stock held by an employee,
director or consultant of the Company at the original purchase price upon termination of their employment or services with the Company or (b) as contemplated by the Restated Certificate or by the Right of First Refusal and Co-Sale Agreement; 

  
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 (p)    initiate or settle any material disputes; 

(q)    suspend payments, or settle payments with any creditors, or enter into any voluntary or involuntary reorganization
or bankruptcy procedures, except as otherwise required by applicable law; 
 (r)    appointment of the chairman of the
Board; 
 (s)    approve exemptions from any non-compete and non-solicitation agreements by and between the Company and any other parties party thereto; or 

(t)    issue any securities of the Company (except for any securities explicitly permitted under the provisions of this
Agreement). 
 5.5    Board Matters. Unless otherwise determined by the vote of a majority of the directors then
in office, the Board shall meet in accordance with an agreed-upon schedule. The Company and the Investors agree that only the Independent Directors (as defined in the Voting Agreement) shall be offered remuneration in their capacity as directors.
The Company shall reimburse the directors, and the board observer appointed by Merck, for all reasonable, documented out-of-pocket travel expenses incurred (consistent
with the Company’s travel policy) in connection with attending meetings of the Board and other assignments conducted subject to instruction from the Board. The Company shall cause to be established, as soon as practicable after such request,
and will maintain, an audit and compensation committee, each of which shall consist solely of non-management directors. Each non-employee director shall be entitled in
such person’s discretion to be a member of any committee of the Board. 
 5.6    Successor Indemnification.
If the Company or any of its successors or assignees consolidates with or merges into any other Person and is not the continuing or surviving corporation or entity of such consolidation or merger, then to the extent necessary, proper provision shall
be made so that the successors and assignees of the Company assume the obligations of the Company with respect to indemnification of members of the Board as in effect immediately before such transaction, whether such obligations are contained in the
Company’s bylaws (the “Bylaws”), the Restated Certificate, or elsewhere, as the case may be. 

5.7    Right to Conduct Activities. The Company hereby agrees and acknowledges that the Major Investors, Bay
City Capital Fund V, L.P. and its Affiliates, Sunstone Life Science Ventures Fund III K/S and its Affiliates, Seed Capital Denmark II K/S and its Affiliates, Novo Holdings A/S and its Affiliates, Merck Ventures BV and its Affiliates,
Innovationspatent Sverige AB and its Affiliates, Bristol-Myers Squibb Company and its Affiliates, Ysios BioFund II Innvierte FCR and its Affiliates, OrbiMed Private Investments VII, LP and its Affiliates, OrbiMed Israel Partners II, LP and its
Affiliates, HBM Healthcare Investments (Cayman) Ltd. and its Affiliates, FCPI BIO SANTÉ 2016-2017 and its Affiliates, Health for life Capital II Prima S.C.A. Raif and its Affiliates, Health for life Capital II FCPI - Alpha Compartment and its
Affiliates, Maverick Ventures Investment Fund, L.P. and its Affiliates, Maverick Advisors Fund, L.P. and its Affiliates, Sphera and its Affiliates, Canica and its Affiliates, and, in the event they are no longer deemed to be Major Investors, Soleus,
Eir and Hadean and their respective Affiliates (together with their Affiliates, collectively, the “VC Sponsors”) are professional investment organizations 

  
 23 

 
in the business of venture capital and/or private equity investing, and as such invest in and review the business plans and related proprietary information of many enterprises, some of which may
compete directly or indirectly with the Company’s business (as currently conducted or as currently propose to be conducted). The Company hereby agrees that, to the extent permitted under applicable law, (A) nothing in this Agreement
shall preclude or in any way restrict any VC Sponsor (or their respective Affiliates) from investing or participating in any particular enterprise whether or not such enterprise has products or services which compete with those of the Company and
(B) the VC Sponsors (and their respective Affiliates) shall not be liable to the Company for any claim arising out of, or based upon, (i) the investment by the VC Sponsors in any entity competitive with the Company, or (ii) actions
taken by any partner, officer, employee or other representative of the VC Sponsors to assist any such competitive company, whether or not such action was taken as a member of the board of directors of such competitive company or otherwise, and
whether or not such action has a detrimental effect on the Company; provided, however, that the foregoing shall not relieve (x) any of the Investors from liability associated with the unauthorized disclosure of the Company’s
confidential information obtained pursuant to this Agreement, or (y) any director or officer of the Company from any liability associated with his or her fiduciary duties to the Company. The Company and the VC Sponsors acknowledge and agree
that certain of the VC Sponsors or their Affiliates may presently have, or may engage in the future in, internal development programs, or may receive information from third parties that relates to, and may develop and commercialize products
independently or in cooperation with such third parties, that are similar to or that are directly or indirectly competitive with, the Company’s development programs, products or services. Nothing in this Agreement or any other agreement related
to the transactions contemplated by this Agreement, shall in any way preclude or restrict such VC Sponsors or their Affiliates from conducting any development program, commercializing any product or service or otherwise engaging in any enterprise,
whether or not such development program, product, service or enterprise, competes with those of the Company, so long as such activities do not result in a violation of the confidentiality provisions of this Agreement. 

5.8    Investment by the European Investment Fund. The Company acknowledges and agrees (and the Holders confirm
their acceptance) that certain of the funds to be invested by the Investors derive from an EIF-INNOVFIN Facility SME venture capital facility with the financial backing of the European Union under Horizon 2020
financial instruments. In connection therewith, the Company acknowledges and agrees that the European Investment Fund (“EIF”), agents of the EIF, the European Court of Auditors, the Commission, the agents or contractors of the
Commission, including OLAF and/or any other European Union Institution or body will have the right, in the terms requested by the law, to have unlimited access to the premises of the Company in order to examine and inspect all relevant books and
documents of the Company and to the management of the Company (who shall diligently cooperate with the EIF, including by answering all relevant questions and providing all relevant information). Additionally, the Company acknowledges and agrees that
EIF has the right to publish information on its website regarding its investment in the Company and may request additional information to prepare a show case about the Company for EIF’s promotional materials.  

5.9    ESG compliance. The Company shall use commercially reasonable efforts to comply with applicable
environmental, social and governance (“ESG”) laws and regulations and shall foresee any known or expected future changes in the requirements and take all reasonable actions to ensure compliance. The Company shall respond diligently
to requests of information ESG matters received from the Investors. In case any ESG incident occurs, the Company shall proactively inform the Major Investors as soon as practicable. 

  
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 5.10    Certified Public Accounting Firm. The Company shall
retain a regionally or nationally recognized certified public accounting firm or a registered accounting firm as auditor. Such new auditor shall be approved by the Board. 

5.11    Termination of Covenants. The covenants set forth in this Section 5, except for
Subsection 5.6, shall terminate and be of no further force or effect (i) immediately before the consummation of a Qualified IPO (ii) when the Company first becomes subject to the periodic reporting requirements of Section 12(g)
or 15(d) of the Exchange Act, or (iii) upon a Deemed Liquidation Event, whichever event occurs first. 

5.12    Indemnification Matters. The Company hereby acknowledges that one or more of the directors nominated to
serve on the Board by the Investors (each a “Fund Director”) may have certain rights to indemnification, advancement of expenses and/or insurance provided by one or more of the Investors and certain of their Affiliates
(collectively, the “Fund Indemnitors”). The Company hereby agrees (a) that it is the indemnitor of first resort (i.e., its obligations to any such Fund Director are primary and any obligation of the Fund Indemnitors to
advance expenses or to provide indemnification for the same expenses or liabilities incurred by such Fund Director are secondary), (b) that it shall be required to advance the full amount of expenses incurred by such Fund Director and shall be
liable for the full amount of all expenses, judgments, penalties, fines and amounts paid in settlement by or on behalf of any such Fund Director to the extent legally permitted and as required by the Restated Certificate or the Company’s Bylaws
(or any agreement between the Company and such Fund Director), without regard to any rights such Fund Director may have against the Fund Indemnitors, and, (c) that it irrevocably waives, relinquishes and releases the Fund Indemnitors from any
and all claims against the Fund Indemnitors for contribution, subrogation or any other recovery of any kind in respect thereof. The Company further agrees that no advancement or payment by the Fund Indemnitors on behalf of any such Fund
Director with respect to any claim for which such Fund Director has sought indemnification from the Company shall affect the foregoing and the Fund Indemnitors shall have a right of contribution and/or be subrogated to the extent of such advancement
or payment to all of the rights of recovery of such Fund Director against the Company. 
 5.13    Marketing
Efforts. Soleus, Hadean and Ysios shall be permitted to disclose the fact of each of their investments in the Company, along with investment amount and a description of the business of the Company, in any of Soleus’, Hadean’s or
Ysios’ respective general marketing efforts, so long as such activities do not result in a violation of the confidentiality provisions of this Agreement. 

5.14    CFIUS. If and only if (i) CFIUS requests or requires that the Company or an Investor file a notice or
declaration with CFIUS pursuant to the DPA, with respect to an Investor’s investment in the Company (the “Covered Transaction”), or (ii) the Company or an Investor (each of the Investors described in (i) and (ii) a
“Non-U.S. Investor”) determine in good faith that a filing with CFIUS with respect to the Covered Transaction is advisable or required by applicable law, then in either case, (i) or (ii):
(x) the Company and such Non-U.S. Investor shall, and shall cause any affiliates to, cooperate and promptly make a CFIUS filing in the requested, required or advisable form in accordance with the DPA; and
(y) the Company and the Investors shall, and shall cause any affiliates to, use commercially reasonable efforts to obtain, as applicable, the CFIUS Satisfied Condition (as defined below). For the avoidance of doubt, a Non-U.S. Investor shall have no obligation to accept or take any action, condition or restriction with respect to the Covered Transactions in order to achieve the CFIUS Satisfied Condition. The “CFIUS
Satisfied Condition” shall be achieved when (a) the Company and the Non-U.S. Investor shall have received written notice from CFIUS stating that: (i) CFIUS has concluded that the Covered
Transactions do not constitute a “covered transaction” subject to review under the DPA; or (ii) the assessment, review or 

  
 25 

 
investigation of the Covered Transactions under the DPA has concluded, and there are no unresolved national security concerns with respect to the Covered Transaction; (b) CFIUS has sent a
report to the President of the United States requesting the President’s decision with respect to the Covered Transactions and either (i) the fifteen day period under the DPA subsequent to the President’s receipt of the CFIUS report
during which the President may announce his decision to take action to suspend, prohibit or place any limitations on the Covered Transaction has expired without any such action being taken or (ii) the President of the United States has
announced a decision not to take any action to suspend, prohibit or place any limitations on the Covered Transactions; or (c) CFIUS has provided written notice that it is not able to complete action under the DPA with respect to the Covered
Transaction on the basis of a CFIUS declaration, but CFIUS has not requested that the Company and the Non-U.S. Purchaser submit a CFIUS notice and has not initiated a unilateral CFIUS review, and the Company
and each Non-U.S. Purchaser reasonably decide that the notice from CFIUS that it is not able to complete action is sufficient to constitute the CFIUS Satisfied Condition. For the avoidance of doubt, a Non-U.S. Purchaser shall not have any obligation to accept or take any action, condition or restriction with respect to the Covered Transactions in order to achieve the CFIUS Satisfied Condition. 

6.    Miscellaneous. 

6.1    Successors and Assigns. The rights under this Agreement may be assigned (but only with all related
obligations) by a Holder to a transferee of Registrable Securities that (i) is an Affiliate of a Holder or where such transfer takes place in the context of a
distribution-in-kind to one or more of its investors; (ii) is a Holder’s Immediate Family Member or trust for the benefit of an individual Holder or one or
more of such Holder’s Immediate Family Members; or (iii) after such transfer, holds at least one percent (1%) shares of Registrable Securities (subject to appropriate adjustment for stock splits, stock dividends, combinations, and other
recapitalizations); provided, however, that (x) the Company is, within a reasonable time after such transfer, furnished with written notice of the name and address of such transferee and the Registrable Securities with respect to
which such rights are being transferred; and (y) such transferee agrees in a written instrument delivered to the Company to be bound by and subject to the terms and conditions of this Agreement, including the provisions of Subsection
2.11. For the purposes of determining the number of shares of Registrable Securities held by a transferee, the holdings of a transferee (1) that is an Affiliate or stockholder of a Holder; (2) who is a Holder’s Immediate Family
Member; or (3) that is a trust for the benefit of an individual Holder or such Holder’s Immediate Family Member shall be aggregated together and with those of the transferring Holder; provided further that all transferees who
would not qualify individually for assignment of rights shall, as a condition to the applicable transfer, establish a single attorney-in-fact for the purpose of
exercising any rights, receiving notices, or taking any action under this Agreement. The terms and conditions of this Agreement inure to the benefit of and are binding upon the respective successors and permitted assignees of the parties. Nothing in
this Agreement, express or implied, is intended to confer upon any party other than the parties hereto or their respective successors and permitted assignees any rights, remedies, obligations or liabilities under or by reason of this Agreement,
except as expressly provided herein. 
 6.2    Governing Law. This Agreement shall be governed by the internal
law of the State of Delaware, without regard to conflict of law principles that would result in the application of any law other than the law of the State of Delaware. 

6.3    Counterparts. This Agreement may be executed in two (2) or more counterparts, each of which shall be
deemed an original, but all of which together shall constitute one and the same instrument. Counterparts may be delivered via facsimile, electronic mail (including pdf or any electronic 

  
 26 

 
signature complying with the U.S. federal ESIGN Act of 2000, e.g., www.docusign.com) or other transmission method and any counterpart so delivered shall be deemed to have been duly and
validly delivered and be valid and effective for all purposes.  
 6.4    Titles and Subtitles. The
titles and subtitles used in this Agreement are for convenience only and are not to be considered in construing or interpreting this Agreement. 

6.5    Notices. 

(a)    All notices and other communications given or made pursuant to this Agreement shall be in writing and shall be
deemed effectively given upon the earlier of actual receipt or (i) personal delivery to the party to be notified; (ii) when sent, if sent by electronic mail or facsimile during the recipient’s normal business hours, and if not sent
during normal business hours, then on the recipient’s next business day; (iii) five (5) days after having been sent by registered or certified mail, return receipt requested, postage prepaid; or (iv) one (1) business day after the
business day of deposit with a nationally recognized overnight courier, freight prepaid, specifying next-day delivery, with written verification of receipt. All communications shall be sent to the respective
parties at their addresses as set forth on Schedule A hereto, or to the principal office of the Company and to the attention of the Chief Executive Officer, in the case of the Company, or to such email address, facsimile number, or address as
subsequently modified by written notice given in accordance with this Subsection 6.5. If notice is given to the Company, a copy shall also be sent to Goodwin Procter LLP, New York Times Bldg, 620
8th Avenue, New York, NY 10018 with an email a copy to Edwin O’Conner (eoconner@goodwinlaw) and if notice is given to Holders, a copy shall also be given to the Holder to be notified at the
address as set forth on the signature pages hereof or Schedule A hereto or at such other address or electronic mail address as such Holder may designate by ten (10) days advance written notice to the other parties hereto. 

(b)    Consent to Electronic Notice. Each Investor consents to the delivery of any stockholder notice pursuant to
the Delaware General Corporation Law (the “DGCL”), as amended or superseded from time to time, by electronic transmission pursuant to Section 232 of the DGCL (or any successor thereto) at the electronic mail address or the
facsimile number as on the books of the Company. Each Investor agrees to promptly notify the Company of any change in such stockholder’s electronic mail address, and that failure to do so shall not affect the foregoing. 

6.6    Amendments and Waivers. Any term of this Agreement may be amended, modified or terminated and the observance
of any term of this Agreement may be waived (either generally or in a particular instance, and either retroactively or prospectively) only with the written consent of the Company and the Requisite Holders; provided that the Company may in its
sole discretion waive compliance with Subsection 2.12(c) (and the Company’s failure to object promptly in writing after notification of a proposed assignment allegedly in violation of Subsection 2.12(c) shall be deemed to be a
waiver); and provided further that any provision hereof may be waived by any waiving party on such party’s own behalf, without the consent of any other party. Notwithstanding the foregoing, (a) this Agreement may not be
amended, modified or terminated and the observance of any term hereof may not be waived with respect to any Investor without the written consent of such Investor, unless such amendment, modification, termination, or waiver applies to all Investors
in the same fashion (it being agreed that a waiver of the provisions of Section 4 with respect to a particular transaction shall be deemed to apply to all Investors in the same fashion if such waiver does so by its terms
and no Investor otherwise purchases securities in such transaction); (b) Subsections 3.1 and 3.2 and any other section of this Agreement applicable to the Major Investors (including this clause (b) of this Subsection 6.6)
may not be amended, modified, terminated or 

  
 27 

 
waived without the written consent of the holders of at least a majority of the Registrable Securities then outstanding and held by the Major Investors; and
(c) Section 4 and this clause (c) of this Subsection 6.6 may not be amended, modified, terminated or waived without the written consent of each Major Investor. Notwithstanding the foregoing,
(i) Schedule A hereto may be amended by the Company from time to time to add transferees of any Registrable Securities in compliance with the terms of this Agreement without the consent of the other parties; and Schedule A hereto
may also be amended by the Company after the date of this Agreement without the consent of the other parties to add information regarding any additional Investor who becomes a party to this Agreement in accordance with Subsection 6.9, (ii)
the provisions of Subsection 1.3, Subsection 1.5, Subsection 1.8, Subsection 5.14 and this Subsection 6.6(ii) may not be amended, modified, terminated or waived without the consent of Novo, (iii) the
provisions of Subsection 5.7, Subsection 5.12 and this Subsection 6.6(iii) may not be amended, modified, terminated or waived without the consent of each of the VC Sponsors, (iv) the provisions of Subsection 3.1,
Subsection 3.3(c), Subsection 5.13 and this Subsection 6.6(iv) may not be amended, modified, terminated or waived without the consent of Soleus, (v) the provisions of Subsection 3.3(d) and this Subsection
6.6(v) may not be amended, modified, terminated or waived without the consent of Eir, (vi) the provisions of Subsection 3.3(e) and this Subsection 6.6(vi) may not be amended, modified, terminated or waived without the consent
of Hadean, (vii) the provisions of Subsection 3.3(a) and this Subsection 6.6(vii) may not be amended, modified, terminated or waived without the consent of BMS, and (viii) the provisions of Subsection 3.3(b) and this
Subsection 6.6(viii) may not be amended, modified, terminated or waived without the consent of Merck. The Company shall give prompt notice of any amendment, modification or termination hereof or waiver hereunder to any party hereto that did
not consent in writing to such amendment, modification, termination, or waiver. Any amendment, modification, termination, or waiver effected in accordance with this Subsection 6.6 shall be binding on all parties hereto, regardless of whether
any such party has consented thereto. No waivers of or exceptions to any term, condition, or provision of this Agreement, in any one or more instances, shall be deemed to be or construed as a further or continuing waiver of any such term, condition,
or provision. 
 6.7    Severability. In case any one or more of the provisions contained in this Agreement is
for any reason held to be invalid, illegal or unenforceable in any respect, such invalidity, illegality, or unenforceability shall not affect any other provision of this Agreement, and such invalid, illegal, or unenforceable provision shall be
reformed and construed so that it will be valid, legal, and enforceable to the maximum extent permitted by law. 

6.8    Aggregation of Stock. All shares of Registrable Securities held or acquired by Affiliates shall be
aggregated together for the purpose of determining the availability of any rights under this Agreement and such Affiliated persons may apportion such rights as among themselves in any manner they deem appropriate. 

6.9    Additional Investors. Notwithstanding anything to the contrary contained herein, if the Company issues
additional shares of the Company’s Preferred Stock after the date hereof, any purchaser of such shares of Preferred Stock may become a party to this Agreement by executing and delivering an additional counterpart signature page to this
Agreement, and thereafter shall be deemed an “Investor” for all purposes hereunder. No action or consent by the Investors shall be required for such joinder to this Agreement by such additional Investor, so long as such additional Investor
has agreed in writing to be bound by all of the obligations as an “Investor” hereunder. 
 6.10    Entire
Agreement. This Agreement (including any Schedules and Exhibits hereto) together with the other Transaction Agreements (as defined in the Purchase Agreement) constitutes the full and entire understanding and agreement among the parties with
respect to the subject matter hereof, and 

  
 28 

 
any other written or oral agreement relating to the subject matter hereof existing between the parties is expressly canceled. Upon the effectiveness of this Agreement, the Prior Agreement shall
be deemed amended and restated and superseded and replaced in its entirety by this Agreement, and shall be of no further force or effect. 

6.11    Dispute Resolution. The parties hereto hereby irrevocably submit to the exclusive jurisdiction of the Court
of Chancery of the State of Delaware (unless the United States federal courts have exclusive jurisdiction over the matter, in which case the United States District Court for the District of Delaware) solely in respect of the interpretation and
enforcement of the provisions of this Agreement and of any of the documents referred to in this Agreement, and in respect of the transactions contemplated hereby and thereby and hereby waive, and agree not to assert, as a defense in any action, suit
or proceeding for the interpretation or enforcement hereof or thereof, that it is not subject thereto or that such action, suit or proceeding may not be brought or is not maintainable in said courts or that the venue thereof may not be appropriate
or that this Agreement or any such document may not be enforced in or by such courts, and the parties hereto irrevocably agree that all claims with respect to such action or proceeding shall be heard and determined in the Court of Chancery of the
State of Delaware or the United States District Court for the District of Delaware; provided that a judgment rendered by such court may be enforced in any court having competent jurisdiction. The parties hereby consent to and grant any such
court jurisdiction over the person of such parties and over the subject matter of such dispute and agree that mailing of process or other papers in connection with any such action or proceeding in the manner provided in Section 6.5 or in such
other manner as may be permitted by Law, shall be valid and sufficient service thereof. With respect to any particular action, suit or proceeding, venue shall lie solely in the State of Delaware. 

EACH PARTY HERETO ACKNOWLEDGES AND AGREES THAT ANY CONTROVERSY WHICH MAY ARISE UNDER THIS AGREEMENT IS LIKELY TO INVOLVE COMPLICATED AND
DIFFICULT ISSUES, AND THEREFORE EACH SUCH PARTY HEREBY IRREVOCABLY AND UNCONDITIONALLY WAIVES ANY RIGHT SUCH PARTY MAY HAVE TO A TRIAL BY JURY IN RESPECT OF ANY LITIGATION DIRECTLY OR INDIRECTLY ARISING OUT OF OR RELATING TO THIS AGREEMENT OR THE
TRANSACTIONS CONTEMPLATED BY THIS AGREEMENT. EACH PARTY HERETO CERTIFIES AND ACKNOWLEDGES THAT (A) NO REPRESENTATIVE, AGENT OR ATTORNEY OF ANY OTHER PARTY HAS REPRESENTED, EXPRESSLY OR OTHERWISE, THAT SUCH OTHER PARTY WOULD NOT, IN THE EVENT OF
LITIGATION, SEEK TO ENFORCE THE FOREGOING WAIVER, (B) SUCH PARTY UNDERSTANDS AND HAS CONSIDERED THE IMPLICATIONS OF THIS WAIVER, (C) SUCH PARTY MAKES THIS WAIVER VOLUNTARILY, AND (D) SUCH PARTY HAS BEEN INDUCED TO ENTER INTO THIS
AGREEMENT BY, AMONG OTHER THINGS, THE WAIVERS AND CERTIFICATIONS IN THIS SECTION 6.11. 
 6.12    Delays or
Omissions. No delay or omission to exercise any right, power, or remedy accruing to any party under this Agreement, upon any breach or default of any other party under this Agreement, shall impair any such right, power, or remedy of such
nonbreaching or nondefaulting party, nor shall it be construed to be a waiver of or acquiescence to any such breach or default, or to any similar breach or default thereafter occurring, nor shall any waiver of any single breach or default be deemed
a waiver of any other breach or default theretofore or thereafter occurring. All remedies, whether under this Agreement or by law or otherwise afforded to any party, shall be cumulative and not alternative. 

[Remainder of Page Intentionally Left Blank] 

  
 29 

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

			
	 COMPANY:

	
	 GALECTO, INC.

		
	By:	 	 /s/ Hans Schambye

		
	Name:	 	 Hans Schambye

	 	 	(print)
		
	Title:	 	 Chief Executive Officer

 SIGNATURE PAGE TO AMENDED
AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

 IN WITNESS WHEREOF, the parties have executed this Agreement as of the date first 

written above. 
  

	
	INVESTORS:
	
	HANS SCHAMBYE
	
	 /s/ Hans Schambye

	 

         

  
  
  

 
  
  

 
  
  

  
 SIGNATURE PAGE TO
AMENDED AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

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

	
	 INVESTORS:

	
	AMIT MUNSHI
	
	 /s/ Amit Munshi

	 

         

 SIGNATURE PAGE TO AMENDED
AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

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

	
	 INVESTORS:

	
	CARL GOLDFISCHER
	
	 /s/ Carl Goldfischer

	 

         

 SIGNATURE PAGE TO AMENDED
AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	 INVESTORS:

	
	 NOVO HOLDINGS A/S

		
	By:	 	 /s/ Søren Møller

	Name:	 	Søren Møller
	Title:	 	Managing Partner

 SIGNATURE PAGE TO AMENDED
AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	 INVESTORS:

	
	 ORBIMED PRIVATE INVESTMENTS VII, LP., BY ORBIMED CAPITAL GP VII, LLC, ITS GENERAL PARTNER,

BY: ORBIMED ADVISORS LLC, ITS MANAGING MEMBER

		
	By:	 	 /s/ Carl Gordon

	Name:	 	 Carl Gordon

	Title:	 	 Member

 SIGNATURE PAGE TO AMENDED
AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	INVESTORS:
	
	FOR AND ON BEHALF OF SUNSTONE LSV GENERAL PARTNER III APS ACTING AS GENERAL PARTNER FOR SUNSTONE LIFE SCIENCE VENTURES FUND III K/S
		
	By:	 	 /s/ Merete Lundbye Møller

	Name:	 	Merete Lundbye Møller
		
	By:	 	 /s/ Soren Lemønius

	Name:	 	Soren Lemønius

 SIGNATURE PAGE TO AMENDED
AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	INVESTORS:
	
	BAY CITY CAPITAL FUND V CO-INVESTMENT FUND L.P.
	
	By: Bay City Capital Management V, LLC, its General Partner
	
	By: Bay City Capital, LLC, its Manager
		
	By:	 	 /s/ Carl Goldfischer

	Name:	 	Carl Goldfischer
	Title:	 	Manager and Managing Director
	
	BAY CITY CAPITAL FUND V, L.P.
	
	By: Bay City Capital Management V, LLC, its General Partner
	
	By: Bay City Capital, LLC, its Manager
		
	By:	 	 /s/ Carl Goldfischer

	Name:	 	Carl Goldfischer
	Title:	 	Manager and Managing Director

 SIGNATURE PAGE TO AMENDED
AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	INVESTORS:
	
	YSIOS CAPITAL PARTNERS S.G.E.I.C. S.A. ON BEHALF OF YSIOS BIOFUND II INNVIERTE FCR
		
	By:	 	 /s/ Karen Wagner

	Name:	 	Karen Wagner
	Title:	 	General Partner

 SIGNATURE PAGE TO AMENDED
AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	INVESTORS:
	
	BRISTOL-MYERS SQUIBB COMPANY
		
	By:	 	 /s/ Daniel O’Connell

	Name:	 	Daniel O’Connell
	Title:	 	Executive Director, Corporate Development

 SIGNATURE PAGE TO AMENDED
AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	INVESTORS:
	
	HBM HEALTHCARE INVESTMENTS (CAYMAN) LTD.
		
	By:	 	 /s/ Jean-Marc Lesieur

	Name:	 	Jean-Marc Lesieur
	Title:	 	Managing Director

 SIGNATURE PAGE TO AMENDED
AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	INVESTORS:
	
	ORBIMED ISRAEL PARTNERS II, LP,
	BY: ORBIMED ISRAEL GP II, L.P., ITS GENERAL PARTNER,
	BY: ORBIMED ADVISORS ISRAEL II LIMITED, ITS GENERAL PARTNER
		
	By:	 	 /s/ Erez Chimovits

	Name:	 	Erez Chimovits
	Title:	 	Director

 SIGNATURE PAGE TO AMENDED
AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	INVESTORS:
	
	FCPI BIO SANTÉ 2016-2017 acting by Seventure Partners
		
	By:	 	 /s/ Isabelle de Cremoux

	Name:	 	Isabelle de Cremoux
	President & CEO of Seventure Partners
	
	Health for Life Capital II Prima S.C.A. RAIF acting by Health for Life Management
		
	By:	 	 /s/ Isabelle de Cremoux

	Name:	 	Isabelle de Cremoux
	President & CEO of Seventure Partners
	
	Health for Life Capital II FCPI – ALPHA COMPARTMENT acting by Seventure Partners
		
	By:	 	 /s/ Isabelle de Cremoux

	Name:	 	Isabelle de Cremoux
	 President & CEO of Seventure Partners

 SIGNATURE PAGE TO AMENDED
AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	INVESTORS:
	
	MAVERICK VENTURES INVESTMENT FUND, L.P.
	BY: MAVERICK CAPITAL VENTURES, LLC, ITS GENERAL PARTNER
	BY: MAVERICK CAPITAL ADVISORS, L.P., ITS MANAGER
		
	By:	 	 /s/ Giness Avila

	Name:	 	Ginessa Avila
	Title:	 	Authorized Representative
	
	MAVERICK ADVISORS FUND, L.P.
	BY: MAVERICK CAPITAL VENTURES, LLC, ITS GENERAL PARTNER
	BY: MAVERICK CAPITAL ADVISORS, L.P., ITS MANAGER
		
	By:	 	 /s/ Giness Avila

	Name:	 	Ginessa Avila
	Title:	 	Authorized Representative

 SIGNATURE PAGE TO AMENDED
AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	INVESTORS:
	
	SOLEUS PRIVATE EQUITY FUND I, L.P.
		
	By:	 	 /s/ Steven Musumeci

	Name:	 	Steven Musumeci
	Title:	 	Chief Operating Officer

 SIGNATURE PAGE TO AMENDED
AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	INVESTORS:
	
	EIR VENTURES I AB
		
	By:	 	 /s/ Stephan Christgau

	Name:	 	 Stephan Christgau

	Title:	 	 Founding Partner

 SIGNATURE PAGE TO AMENDED
AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	INVESTORS:
	
	Cormorant Global Healthcare Master Fund, LP
	By: Cormorant Global Healthcare GP, LLC
		
	By:	 	 /s/ Bihua Chen

	Bihua Chen, Managing Member of the GP
	
	Cormorant Private Healthcare Fund II, LP
	By: Cormorant Private Healthcare GP II, LLC
		
	By:	 	 /s/ Bihua Chen

	Bihua Chen, Managing Member of the GP
	Cormorant Private Healthcare Fund III, LP
	By: Cormorant Private Healthcare GP III, LLC
		
	By:	 	 /s/ Bihua Chen

	Bihua Chen, Managing Member of the GP
	
	CRMA SPV, L.P.
	By: Cormorant Asset Management, LLC
	Its: Attorney-In-Fact
		
	By:	 	 /s/ Bihua Chen

	 Bihua Chen, Managing Member

 SIGNATURE PAGE TO AMENDED
AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	INVESTORS:
	
	ORBIMED GENESIS MASTER FUND, L.P
	
	By: OrbiMed Genesis GP LLC, its general Partner
	
	By: OrbiMed Advisors LLC, its Managing Member
		
	By:	 	 /s/ C. Scotland Stevens

	Name:	 	 C. Scotland Stevens

	Title:	 	 Member

	
	THE BIOTECH GORWTH TRUST PLC
	
	By: OrbiMed Genesis GP LLC, solely in capacity as Portfolio Manager
		
	By:	 	 /s/ C. Scotland Stevens

	Name:	 	 C. Scotland Stevens

	Title:	 	 Member

 SIGNATURE PAGE TO AMENDED
AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	INVESTORS:
	
	Janus Henderson Biotech Innovation Master Fund Limited
	
	By: Janus Capital Management LLC, its investment advisor
		
	By:	 	 /s/ Andrew Acker

	Name:	 	Andrew Acker
	Title:	 	Authorized Signatory
	
	Janus Henderson Capital Funds plc on behalf of its series Janus Henderson Global Life Sciences Fund
	
	By: Janus Capital Management LLC, its investment advisor
		
	By:	 	 /s/ Andrew Acker

	Name:	 	Andrew Acker
	Title:	 	Authorized Signatory
	
	Janus Henderson Horizon Fund - Biotechnology Fund
	
	By: Janus Capital Management LLC, its investment advisor
		
	By:	 	 /s/ Andrew Acker

	Name:	 	Andrew Acker
	Title:	 	Authorized Signatory

 SIGNATURE PAGE TO AMENDED
AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  
  

					
		 	INVESTORS:	 	
			
	Hadean Capital I AS	 		 	Hadean Capital I AS
	By: Hadean Ventures AS	 		 	By: Hadean Ventures AS
			
	 /s/ Ingrid Teigland Akay
	 		 	 /s/ Walter Stockinger

	Name: Ingrid Teigland Akay	 		 	Name: Walter Stockinger
	 Title: Managing Partner
	 		 	 Title: Managing Partner

			
	Hventures Capital I AB	 		 	Hventures Capital I AB
	By: Hventures AB	 		 	By: Hventures AB
			
	 /s/ Ingrid Teigland Akay
	 		 	 /s/ Walter Stockinger

	Name: Ingrid Teigland Akay	 		 	Name: Walter Stockinger
	 Title: Managing Partner
	 		 	 Title: Managing Partner

 SIGNATURE PAGE TO AMENDED AND
RESTATED INVESTORS’ RIGHTS AGREEMENT 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	INVESTORS:
	
	SPHERA GLOBAL HEALTHCARE MASTER FUND (A CAYMAN ISLANDS CORPORATION)
		
	By:	 	 /s/ Doron Breen

	Name:	 	 Doron Breen

	Title:	 	 Director

	
	SPHERA BIOTECH MASTER FUND, LP (A CAYMAN ISLANDS PARTNERSHIP)
		
	By:	 	 /s/ Doron Breen

	Name:	 	 Doron Breen

	Title:	 	 Director

 SIGNATURE PAGE TO AMENDED
AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	INVESTORS:
	
	CANICA HOLDINGS AG
		
	By:	 	 /s/ Christer Kjos

	Name:	 	 Christer Kjos

	Title:	 	 Chief Executive Officer

 SIGNATURE PAGE TO AMENDED
AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	INVESTORS:
	
	ASYMMETRY GLOBAL HEALTHCARE (MASTER) FUND, L.P.
		
	By:	 	 /s/ Chris Zellner

	Name:	 	 Chris Zellner

	Title:	 	 COO

 SIGNATURE PAGE TO AMENDED
AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	 INVESTORS:
  

ASYMMETRY GLOBAL HEALTHCARE FUND, L.P.

		
	By:	 	 /s/ Chris Zellner

	Name:	 	 Chris Zellner

	Title:	 	 COO

 SIGNATURE PAGE TO AMENDED
AND RESTATED INVESTORS’ RIGHTS AGREEMENT 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	 INVESTORS:
  

INNOVATIONSPATENT SVERIGE AB

		
	By:	 	 /s/ Alex Molvin

	Name:	 	 Alex Molvin

	Title:	 	 CEO

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	 INVESTORS:
  

PRELUDE OPPORTUNITY FUND, LP
  

By: Asymmetry Capital Management, LP
 Its Sub-Advisor
  

		
	By:	 	 /s/ Chris Zellner

	Name:	 	 Chris Zellner

	Title:	 	 Sub-Advisor

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	 INVESTORS:
  

PORTLAND HOUSE PARTNERS LLC
  

		
	By:	 	 /s/ Ian Fair

	Name:	 	 Ian Fair

	Title:	 	 General Counsel

		
	By:	 	 /s/ Tim Collins

	Name:	 	 Tim Collins

	Title:	 	 President

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated Investors’
Rights Agreement as of the date first written above. 
  

			
	INVESTORS:
		
	By:	 	 /s/ Hans Schambye

	Name:	 	 Hans Schambye

  

 SCHEDULE A 

Investors 
  

			
	Name and Address	 	Number of Shares of Capital Stock Held
	 Ulf Nilsson

***
	 	
	 Hakon Leffler

***
	 	
	 Hans Schambye

***
	 	
	 Tariq Sethi

***
	 	
	 Sunstone Life Science Ventures Fund III K/S

***
	 	
	 Seed Capital Denmark II K/S

***
	 	
	 Novo Holdings A/S

***
	 	
	 Merck Ventures BV

***
	 	
	 Innovationspatent Sverige AB

***
	 	
	 Anders Pedersen

***
	 	
	 Magnus Persson

***
	 	
	 Bristol-Myers Squibb Company

***
	 	
	 Ysios BioFund II Innvierte FCR

***
	 	
	 OrbiMed Private Investments VII, LP

c/o Corporation Service Company

***
	 	
	 HBM Healthcare Investments (Cayman) Ltd.

***
	 	
	 OrbiMed Israel Partners II, LP
 c/o
Intertrust Corporate Services (Cayman) Limited
 ***
	 	
	 FCPI BIO SANTÉ 2016-2017

***
	 	
	 Health for life Capital II Prima S.C.A. Raif

***
	 	
	 Health for life Capital II FCPI - Alpha Compartment

***
	 	

			
	 Maverick Ventures Investment Fund, L.P.

***
	 	
	 Maverick Advisors Fund, L.P.

***
	 	
	 Gretchen Bain

***
	 	
	 Bay City Capital Fund V, L.P.

***
	 	
	 Bay City Capital Fund V Co-Investment Fund, L.P.

***
	 	
	 Celgene Corporation

***
	 	
	 Janice Darlington

***
	 	
	 Jillian Evans

***
	 	
	 Susan Hazel

***
	 	
	 Kevin Holme

***
	 	
	 John Hutchinson

***
	 	
	 Vanessa Jacoby

***
	 	
	 John H. Hutchinson living trust dated April 16, 2012 and any amendments thereto

***
	 	
	 Christopher King

***
	 	
	 David Lonergan

***
	 	
	 Natalie Williamson Family Trust, dated August 29, 2016

***
	 	
	 Patricia Prodanovich

***
	 	
	 RFW3 Revocable Trust UDT 7/12/16

***
	 	
	 Bruce Frederick Scharschmidt & Peggy Sue Crawford Family Trust Dated October 2001

***
	 	
	 Kristen Shannon

***
	 	
	 The 2012 Holme and Lapierrre-Holme Family Trust, executed Aug. 13, 2012

***
	 	
	 Daohong Yao

***
	 	
	 Carl Goldfischer
 ***
	 	
	 Amit Munshi
 ***
	 	
	 Soleus Private Equity Fund I, L.P.

***
	 	
	 EIR VENTURES I AB

***
	 	
	 Cormorant Global Healthcare Master Fund, LP

***
	 	
	 Cormorant Private Healthcare Fund II, LP

***
	 	
	 Cormorant Private Healthcare Fund III, LP

***
	 	
	 CRMA SPV, L.P.
 ***
	 	
	 OrbiMed Genesis Master Fund, L.P.

***
	 	
	 The Biotech Growth Trust PLC

***
	 	
	 JANUS HENDERSON BIOTECH INNOVATION MASTER FUND LIMITED

***
	 	
	 JANUS HENDERSON CAPITAL FUNDS PLC ON BEHALF OF ITS SERIES JANUS HENDERSON GLOBAL LIFE SCIENCES FUND

***
	 	
	 JANUS HENDERSON HORIZON FUND - BIOTECHNOLOGY FUND

***
	 	
	 Sphera Global Healthcare Master Fund (a Cayman Islands Corporation)

***
	 	
	 Sphera Biotech Master Fund, LP (a Cayman Islands partnership)

***
	 	
	 Hadean Capital I AS

***
	 	
	 Hventures Capital I AB

***
	 	
	 Canica Holding AG

***
	 	
	 PRELUDE OPPORTUNITY FUND, LP

***
	 	
	 Portland House Partners LLC

***
	 	
	 Asymmetry Global Healthcare Fund, L.P.

***
	 	
	 Asymmetry Global Healthcare (Master) Fund, L.P.

***
	 	

 SCHEDULE B 

Founders 
 Ulf Nilsson 

Hakon Leffler 
 Tariq Sethi 

Hans Schambye

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