Document:

Exhibit 10.1

[Urologix letterhead]

April 23, 2012

 

 

Dear [___________]:

Although your employment is “at will” and may be terminated
by you or Urologix at any time for any reason, Urologix has agreed to provide you with a particular severance pay benefit following
a Change in Control in the event your employment is terminated without Cause, or by you for Good Reason. Terms not otherwise defined
in this letter (the “Letter Agreement”) shall have the meaning given such terms on Schedule 1, which is incorporated
herein by reference.

Specifically, we have agreed as follows:

1.                  
Change in Control. If a Change in Control shall occur and your employment is terminated
without Cause, or by you for Good Reason, within twelve months of a Change in Control, Urologix shall pay you a severance payment
in cash in a single sum sixty (60) days of the date of termination equal to [150/100%/100%/100%]% of the sum of your annual target
compensation (base salary and bonus) in effect on such date. For purposes of this Letter Agreement, “termination of employment”
shall be interpreted consistent with the term “separation from service” within the meaning of Treas. Reg. §1.409A-1(h).
In addition, Urologix shall continue the health, dental and life insurance benefits substantially similar to those you are receiving
or are entitled to receive prior to your termination for a period of [eighteen (18)/twelve (12) /twelve (12) /twelve (12)] months.
You shall pay the employee’s share of the premiums for such benefits. 

2.                  
Arbitration. All disputes or claims arising out of or in any way related to this Letter
Agreement, including the making of this Letter Agreement, shall be submitted to and determined by final and binding arbitration
under the Rules of the American Arbitration Association. Arbitration proceedings may be initiated by either of us upon notice to
the other and to the American Arbitration Association, and shall be conducted by three arbitrators under the Rules of the American
Arbitration Association in Minneapolis, Minnesota, unless we agree to have the person or persons to serve as arbitrators within
thirty (30) days of delivery of the list of proposed arbitrators by the American Arbitration Association, then, at the request
of either of us, the three arbitrators shall be selected at the discretion of the American Arbitration Association. 

3.                  
Entire Agreement. This Letter Agreement constitutes our entire agreement and supersedes
[the [December 29, 2008/ December 29, 2008/April 27, 2010] letter agreement and] all prior discussions, understandings and agreements
with respect to the severance benefits which Urologix has agreed to provide to you. This Letter Agreement shall be governed and
construed by the laws of the State of Minnesota and may be amended only in writing signed by both of us. 

    	 

    	 

    

 

April 23, 2012

Page 2

 

 

4.                  
Successors. This Letter Agreement shall not be assignable, in whole or in part, by
you. This Letter Agreement shall be binding upon and inure to the benefit of Urologix and its successors and assigns and upon any
person acquiring, by merger, consolidation, purchase of assets or otherwise, all or substantially all of the assets and business
of Urologix, and the successor shall be substituted for Urologix under this Letter Agreement.

5.                  
 Compliance with Code §409A. It is the intention of the parties that this Letter
Agreement be exempt from Code §409A to the greatest extent possible. Accordingly, all provisions herein shall be construed
and interpreted consistent with that intent, but that, to the extent any payment constitutes nonqualified deferred compensation,
Urologix shall amend any such provision pertaining to such payment to comply with Code §409A and the regulations thereunder,
in the least restrictive manner necessary without any diminution in the value of the payments to you. Notwithstanding the foregoing,
if on the date of your “separation from service” (within the meaning of Treas. Reg. §1.409A-1(h)), you are a “specified
employee” within the meaning of Treas. Reg. §1.409-1(i), then payment of any amount under this Agreement that constitutes
nonqualified deferred compensation shall be delayed until: (i) the later of: (A) the first day of the seventh month following your
separation from service, and (B) the first date on which such payment would not be non-deductible as a result of Section 162(m)
of the Code, or (ii) your death, if earlier. In the event any such payment is so delayed, the amount of the first payment shall
be increased for interest earned on the delayed payment based upon interest for the period of delay, compounded annually, equal
to the prime rate (as published in the Wall Street Journal) in effect as of the date the payment should otherwise have been provided.

If this Letter Agreement accurately sets
forth our agreement and understanding in regard to these matters, will you please sign this Letter Agreement where indicated below
and return the executed letter to me for our files. A separate copy is enclosed for your records.

UROLOGIX, INC.

	 	 
	By	 
	Its:	 
	 	 
	READ AND AGREED:
	 	 
	 
	[Stryker Warren, Jr./Gregory J. Fluet/
 Brian J. Smrdel/Lisa A. Ackermann]

 

 

 

 

    	 

    	 

    

SCHEDULE 1

Definition of “Cause”:

1.                  
The failure by you to use your best efforts to perform the material duties and responsibilities
of your position or to comply with any material policy or directive Urologix has in effect from time to time.

2.                  
Any act on your part which is harmful to the reputation or business of Urologix, including,
but not limited to, conduct which is inconsistent with federal or state law respecting harassment of, or discrimination against,
any Urologix employee. 

3.                  
A material breach of your fiduciary responsibilities to Urologix, such as embezzlement or
misappropriation of Urologix funds or properties.

4.                  
Your indictment for, conviction of, or guilty plea or nolo contendere plea to a felony
or any crime involving moral turpitude, fraud or misrepresentation.

Definition of “Change in Control”:

Change in Control of Urologix shall mean a change in control which would
be required to be reported in response to Item 1 of Form 8-K promulgated under the Securities Exchange Act of 1934, as amended
(the “Exchange Act”), whether or not Urologix is then subject to such reporting requirement, including without limitation,
if:

 

		(a)	any “person”
(as such term is used in Sections 13(d) and 14(d) of the Exchange Act) becomes the “beneficial owner” (as defined
in Rule 13d-3 under the Exchange Act), directly or indirectly of securities of Urologix representing 20% or more of the combined
voting power of Urologix’ then outstanding securities;
	 	 	 
		(b)	there ceases to be a majority
of the Board of Directors comprised of (A) individuals who, on the date of this Letter Agreement, constituted the Board of Directors
of Urologix; and (B) any new director who subsequently was elected or nominated for election by a majority of the directors who
held such office prior to a Change in Control; or
	 	 	 
		(c)	Urologix disposes of at
least 75% of its assets, other than to an entity owned 50% or greater by Urologix or any of its subsidiaries.

Definition of “Good Reason”:

Good Reason shall mean, without your express written consent, any of the
following:

 

		(a)	a material diminution of your authority, duties or responsibilities with respect to your position
immediately prior to the Change in Control, or 
	 	 	 
		(b)	a material reduction in
your base compensation as in effect immediately prior to the Change in Control;
	 	 	 

 

	

    	 

    	 

    
		(c)	a material reduction in
the authority of the person to whom you report (or a change in your reporting directly to the Board of Directors, if applicable);
	 	 	 
		(d)	a material change in the
geographic location at which you must perform services for Urologix; and
	 	 	 
		(e)	any other action or inaction
that constitutes a material violation of this Agreement by Urologix;

provided that no such termination for Good Reason shall be effective unless:
(i) you provide written notice to the Chair of the Board of Directors of the existence of a condition specified in paragraphs (a)
through (e) above within 90 days of the initial existence of the condition; (ii) Urologix does not remedy such condition within
30 days of the date of such notice; and (iii) you terminate your employment within 90 days following the last day of the remedial
period described above.banr2012resstockplan.htm

 

Exhibit 10.1

 

BANNER CORPORATION

 

2012 RESTRICTED STOCK PLAN

 

RESTRICTED STOCK AWARD AGREEMENT

RS No. _______________                                                                Grant Date: _______________

This Restricted Stock Award of Shares ("Restricted Stock") is granted by Banner Corporation ("Company") to [Name] ("Grantee") in accordance with the terms of this Restricted Stock Award Agreement ("Agreement") and subject to the provisions of the Banner Corporation 2012 Restricted Stock Plan, as amended from time to time ("Plan").  The Plan is incorporated herein by reference.

	
1.  

	
Restricted Stock Award.  The Company makes this Restricted Stock Award of [Number] Shares to Grantee [in exchange for a payment of $________].  These Shares are subject to forfeiture and to limits on transferability until they vest, as provided in Sections 2, 3 and 4 of this Agreement and in Article VII of the Plan.

 

	
2.  

	
Restriction Period (Vesting Dates):  The Shares shall be subject to a Restricted Period based on the following Vesting Date Schedule:

 

	Vesting Date	 	Number of Shares Vesting
	 	 	 
	
[At least a 3 year period.]

	 	
 

 

	
3.  

	
Transferability.  The Grantee may not sell, assign, transfer, pledge or otherwise encumber any Shares that have not vested, except in the event of the Grantee’s death, by will or by the laws of descent and distribution, or pursuant to a domestic relations order as defined in the Plan.

 

	
4.  

	
Termination of Service.  If the Grantee terminates Service for any reason other than in connection with a Change in Control or the death or Disability of the Grantee, any Shares that have not vested as of the date of that Termination of Service shall be forfeited to the Company.  If the Grantee’s Termination of Service occurs on account of the Grantee’s death or Disability, the Vesting Date for all Shares that have not vested or been forfeited shall be accelerated to the date of that Termination of Service.

 

	
5.  

	
Effect of Change in Control.  Upon a Change in Control, the Vesting Date for all Shares that have not vested or been forfeited shall be accelerated to the date of the earliest event constituting a Change in Control.  [May be modified at Committee’s election for 280G planning purposes for executive officers or directors that hold 1% or more of the Company's outstanding stock.]

 

  

  

  

 

	
6.  

	
Stock Power.  The Grantee agrees to execute a stock power with respect to each stock certificate reflecting the Shares in favor of the Company.  The Shares shall not be issued by the Company until the required stock powers are delivered to the Company.

 

	
7.  

	
Certificates for Shares.  The Company shall issue stock certificates in the name of the Grantee reflecting the Shares vesting on each Vesting Date in Section 2.  The Company shall retain these certificates until the Shares represented thereby become vested.  These certificates shall bear the following legend:

 

The transferability of this certificate and the Shares of stock represented hereby are subject to the terms and conditions (including forfeiture) contained in the Banner Corporation 2012 Restricted Stock Plan and an Award Agreement between Banner Corporation and [name] dated [grant date].  Copies of such Plan are on file in the office of the Secretary of Banner Corporation, 10 South First Avenue, Walla Walla, Washington, 99362.

 

	
8.  

	
Grantee’s Rights.  As the owner of all Shares that have not vested, the Grantee shall be paid dividends by the Company with respect to those Shares at the same time as they are paid to other holders of the Company’s common stock.  The Grantee may exercise all voting rights appurtenant to the Shares.  [May be modified at Committee’s election, if desired.]

 

	
9.  

	
Delivery of Shares to Grantee.  Upon the vesting of any Shares, the restrictions in Sections 3 and 4 shall terminate, and the Company shall deliver only to the Grantee (or, if applicable, the Grantee's Beneficiary or estate) a certificate (without the legend referenced in Section 7) and the related stock power in respect of the vesting Shares.  The Company’s obligation to deliver a stock certificate for vested Shares can be conditioned upon the receipt of a representation of investment intent from the Grantee (or the Grantee's Beneficiary) in such form as the Committee requires.  The Company shall not be required to deliver stock certificates for vested Shares prior to: (a) the listing of those Shares on the Nasdaq; or (b) the completion of any registration or qualification of those Shares required under applicable law.

 

	
10.  

	
Adjustments in Shares.  In the event of any recapitalization, stock split, reorganization, merger, consolidation, spin-off, combination, exchange of securities, stock dividend, special or recurring dividend or distribution, liquidation, dissolution or other similar corporate transaction or event, the Committee shall equitably adjust the number of Shares or class of securities of the Company covered by this Agreement.  Any additional Shares or other securities received by the Grantee as a result of any such adjustment shall be subject to all restrictions and requirements applicable to Shares that have not vested.  The Grantee agrees to execute any documents required by the Committee in connection with an adjustment under this Section 10.

 

	
11.  

	
Tax Election.  The Grantee understands that an election may be made under Section 83(b) of Code to accelerate the Grantee's tax obligation with respect to receipt of the Shares from the Vesting Dates to the Grant Date by submitting an election to the Internal Revenue Service substantially in the form attached hereto.

 

  

RS-2

  

 

	
12.  

	
Tax Withholding.  The Company shall have the right to require the Grantee to pay to the Company the amount of any tax that the Company is required to withhold with respect to such Shares, or in lieu thereof, to retain or sell without notice, a sufficient number of Shares to cover the minimum amount required to be withheld.  The Company shall have the right to deduct from all dividends paid with respect to the Shares the amount of any taxes that the Company is required to withhold with respect to such dividend payments.

 

	
13.  

	
Plan and Committee Decisions are Controlling.  This Agreement and the award of Shares to the Grantee are subject in all respects to the provisions of the Plan, which are controlling.  Capitalized terms herein not defined in this Agreement shall have the meaning ascribed to them in the Plan.  All decisions, determinations and interpretations by the Committee respecting the Plan, this Agreement or the award of Shares shall be binding and conclusive upon the Grantee, any Beneficiary of the Grantee or the legal representative thereof.

 

	
14.  

	
Grantee’s Employment.  Nothing in this Agreement shall limit the right of the Company or any of its Affiliates to terminate the Grantee's service or employment as a director, officer or employee, or otherwise impose upon the Company or any of its Affiliates any obligation to employ or accept the services or employment of the Grantee.

 

	
15.  

	
Amendment.  The Committee may waive any conditions of or rights of the Company or modify or amend the terms of this Agreement; provided, however, that the Committee may not amend, alter, suspend, discontinue or terminate any provision of this Agreement if such action may adversely affect the Grantee without the Grantee's written consent.  To the extent permitted by applicable laws and regulations, the Committee shall have the authority, in its sole discretion, to accelerate the vesting of the Shares or remove any other restrictions imposed on the Grantee with respect to the Shares, whenever the Committee may determine that such action is appropriate by reason of any unusual or nonrecurring events affecting the Company, any Affiliate or their financial statements or any changes in applicable laws, regulations or accounting principles.

 

	
16.  

	
Grantee Acceptance.  The Grantee shall signify acceptance of the terms and conditions of this Agreement and acknowledge receipt of a copy of the Plan by signing in the space provided below and returning the signed copy to the Company.

 

  

RS-3

  

 

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

 

 

	 	
BANNER CORPORATION

	 	 
	 	 
	 	
By ________________________________

	 	Its  ________________________________ 
	 	 
	 	
 

 

	 	 
	 	
ACCEPTED BY GRANTEE

	 	 
	 	
___________________________________

	 	(Signature) 
	 	 
	 	___________________________________ 
	 	
(Print Name)

	 	 
	 	___________________________________ 
	 	
(Street Address)

	 	 
	 	___________________________________ 
	 	
(City, State & Zip Code)

 

Beneficiary Designation:

The Grantee designates the following Beneficiary to receive the Shares upon Grantee’s death:

________________________________________________________________________

Name and relationship

________________________________________________________________________

Address

________________________________________________________________________

  

RS-4

  

STOCK POWER

(One stock power for each stock certificate issued)

For value received, I hereby sell, assign, and transfer to Banner Corporation (the "Company") ____________ shares of the capital stock of the Company, standing in my name on the books and records of the aforesaid Company, represented by Certificate No. ____________ and do hereby irrevocably constitute and appoint the Secretary of the Company attorney, with full power of substitution, to transfer this stock on the books and records of the aforesaid Company.

                             ________________________________

Dated:

________________________

In the presence of:

________________________

  

  

  

83(b) ELECTION FORM

TO:           Internal Revenue Service Center

[Address where the employee files his or her personal income tax return]

ELECTION UNDER SECTION 83(b)

OF THE INTERNAL REVENUE CODE OF 1986

 

	Name: 	__________________________________________________________________ 
	Address: 	__________________________________________________________________ 
	 	
__________________________________________________________________

__________________________________________________________________ 

Social Security Number ____ - __ - ____

Property with respect to which this Election is made: _____ shares of the common stock of Banner Corporation.

Date of Grant or Transfer: ____________, _____.

Taxable Year for which Election is made:  Calendar Year _____.

Nature of the Restrictions to which the Property is Subject:  (i) a vesting schedule pursuant to which the taxpayer will not be fully vested in the property until ___________.

Fair Market Value of the Property upon receipt by taxpayer ______.

Amount Paid for the Property: ____________.

Copies of this Election have been furnished to ___________________________.

A copy of this Election also shall be attached to my IRS Form 1040 for calendar year _____.

__________                                       _____________________________________

Date                                                      Signature

 

 

 

RS-6

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