Document:

exv10w1

 

Exhibit 10.1

AGREEMENT

THIS AGREEMENT (this “Agreement”) is entered into as of                                         , 2007 (the “Effective
Date”), between NCI Building Systems, Inc., a Delaware corporation (the “Company”), and its
wholly-owned subsidiary, NCI Group, L.P., a Texas limited partnership (“Employer”), and
                                        , a resident of the State of Texas (“Employee”). The Company, Employer and
Employee are sometimes hereinafter collectively referred to as the “Parties.”

BACKGROUND

Employer hires and retains in its employment such personnel as are required by the Company and its
other Affiliates, and makes its employees so retained available to provide services to the Company
and its Affiliates.

This Agreement sets forth the terms and conditions of the employment of Employee by Employer, and
the duties and responsibilities of Employee, on the one hand, and of Employer and the Company, on
the other hand, to each other.

Capitalized terms not defined in the body of this Agreement have the meanings set forth on the
attached Appendix “A.”

AGREEMENT AMONG PARTIES

In consideration of the foregoing and of the mutual covenants and agreements set forth in this
Agreement, and subject to the terms and conditions set forth herein, the Parties agree as follows:

     1. Employment. Employer hereby agrees to continue Employee in its employ, and Employee hereby
agrees to remain in the employ of Employer, pursuant to the terms and conditions set forth herein.

     2. Duties and Authority. Employee shall serve as the                                          of the
Company, with those authorities, duties and responsibilities customary to that position and such
other authorities, duties and responsibilities as the Board of Directors of the Company (the
“Board”) or the Chief Executive Officer or his designee may reasonably assign Employee from time to
time. Employee shall use his best efforts, including the highest standards of professional
competence and integrity, and shall devote substantially all of his business time and effort, in
and to his employment hereunder, and shall not engage in any other business activity which would
conflict with the rendition of his services hereunder, except that Employee may hold directorships
or related positions in charitable, educational or not-for-profit organizations, or directorships
in business organizations if expressly approved by the Board, and make passive investments, which
do not unreasonably interfere with Employee’s day-to-day performance of his responsibilities to the
Company.

			
	 	 	 
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     3. Term. This Agreement shall be effective as of the Effective Date, and shall remain in
effect until                     , 2008 subject to earlier termination or extension as described below. The
period from the Effective Date until this Agreement shall have expired in accordance with this
Section or been terminated in accordance with Section 5 is hereafter referred to as “the term
hereof” or “the term of this Agreement.” The term hereof shall be extended automatically for an
additional year as of                      1, 2008 and as of each subsequent annual anniversary of such date
(each such extension date is referred to herein as a “Renewal Date”) unless at least one hundred
twenty (120) days prior to any such Renewal Date either Party shall have given notice to the other
Party that the term of this Agreement shall not be so extended. Notwithstanding any provision of
this Agreement to the contrary, if a Change in Control or Potential Change in Control occurs, the
term of this Agreement shall be extended for a period of two (2) years after the date of the
occurrence of the Change in Control or Potential Change in Control, and the last day of such
extended term shall become the applicable Renewal Date.

     4. Compensation.

     a. Base Salary. Employer shall pay Employee a base salary at his current annualized
rate, payable in accordance with Employer’s normal payroll procedures. The salary of
Employee will be reviewed at least once annually by the Company and/or, to the extent
required, the Compensation Committee of the Board. In the event that Employee’s salary is
required to be approved by the Compensation Committee of the Board, such review shall be
conducted by the Compensation Committee at the same time as it reviews the salaries of
other senior executives of the Company, and any adjustment shall be solely within the
discretion of the Compensation Committee of the Board.

     b. Annual Bonus. Employee shall participate under the currently existing NCI Building
Systems, Inc. Bonus Program, as amended and restated (the “Bonus Plan”) or, if the Bonus
Plan is amended, replaced or superseded, under any amended, replacement or successor bonus
program adopted for senior executives of the Company and its Affiliates. Bonuses, if any,
paid to Employee pursuant to the Bonus Plan shall be paid after the end of each fiscal year
of the Company at the same time as bonuses are paid to other participants, but no later
than March 15 of the following calendar year. Employee understands that bonuses cannot be
earned under the Bonus Plan except as specifically set forth therein based on the level of
participation specified by the Compensation Committee in its discretion and, if the
employment of a participant terminates for any reason prior to certain dates specified in
the Bonus Plan, no bonus shall be payable thereunder. In the event Employee terminates
employment, for any reason other than Cause, after the end of the fiscal year but before
payment of the bonus, Employee shall be entitled to receive the amount of the bonus that
would have otherwise

			
	 	 	 
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been payable under the Bonus Plan, as determined by the Compensation Committee, on the
date bonuses are paid to other participants. Employee also understands that the Bonus Plan
may be amended, replaced, superseded or terminated at any time and from time to time by the
Board of Directors in its sole discretion.

     c. Health and Welfare Benefits. Employee shall be entitled to participate in and
receive the health, hospitalization, medical, dental, life insurance, accidental death,
disability and other insurance plans and benefits provided by Employer and the Company, and
to participate in the 401(k) and other qualified profit-sharing, deferred compensation,
pension, savings and other similar plans of Employer and the Company, as and to the extent
Employer and the Company provide such benefits generally to other employees of Employer and
the Company or to executive employees of the Company. It is understood and agreed that
such benefits may be changed or discontinued from time to time in the sole discretion of
Employer and the Company.

     5. Termination Payments.

     a. Minimum Termination Compensation. Employee shall serve in an at-will capacity and
the Company and/or Employer may terminate the employment of Employee at any time with or
without Cause. Upon any termination of employment of Employee for any reason other than as
set forth in Section 5(b), whether on, before or after the expiration of the term of this
Agreement (including any extension of the term hereof pursuant to the provisions of this
Agreement), Employee shall be entitled to receive (i) that portion of his annual base
salary, at the rate then in effect, earned by him or accrued for his account through the
date of the termination of his employment hereunder or for which he is entitled to payment
for events or circumstances occurring on or through the date of termination of his
employment, and (ii) any bonus to which he is entitled under the Bonus Plan pursuant to
Section 4(b) for the fiscal year ending prior to the date of termination.

     b. Payment Following a Change in Control or Potential Change in Control. If
Employee’s employment is terminated by the Company without Cause or by Employee for Good
Reason within twenty-four (24) months after a Change in Control or during a Potential
Change in Control Period, then Employee shall be entitled to receive (i) ___(___) times
his annual base salary at the highest annualized rate in effect during the one (1) year
period immediately preceding the date of the Change in Control or Potential Change in
Control, as applicable, (the “Payment”) and (ii) medical and dental coverage at the active
employee rate for the period of coverage applicable to Employee (up to a maximum of
eighteen (18) months) under the Consolidated Omnibus Budget Reconciliation Act of 1985,
currently embodied in Section 4980B of the Internal Revenue Code

			
	 	 	 
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of 1986, as amended (the “Code”). The Payment shall be payable in a single lump sum
within thirty (30) days of termination, except as otherwise set forth in Section 25 hereof.

     c. Parachute Tax Limitation. Notwithstanding anything in this Agreement to the
contrary, if any amounts due to Employee under this Agreement and any other plan or program
or award of Employer, the Company or any Affiliate constitute a “parachute payment,” as
such term is defined in Section 280G(b)(2) of the Code, and the amount of the parachute
payment, reduced by the excise tax imposed pursuant to Section 4999 of the Code, is less
than the amount Employee would receive if he were paid three times his “base amount,” as
defined in Section 280G(b)(3) of the Code, less one dollar, then the aggregate of the
amounts constituting the parachute payment shall be reduced to an amount that will equal
three times his base amount less one dollar. The calculations to be made with respect to
this subsection shall be made by an accounting firm jointly selected by the Company and
Employee and paid by the Company.

     d. No Duty to Mitigate. Notwithstanding anything in this Agreement to the contrary,
if Employee’s employment is terminated following a Change in Control of the Company,
Employee shall have no duty to seek other employment nor shall any payments made or to be
made to Employee pursuant to this Agreement following such Change in Control be offset by
any amount earned from other employment.

     e. Full Satisfaction of Obligations. Payment by Employer or the Company of the
amounts owed to Employee pursuant to this Section 5 shall fully satisfy all obligations of
Employer and the Company to Employee under this Agreement if the employment of Employee is
terminated hereunder prior to the expiration of the term of this Agreement, and all
obligations of Employer and Employee to each other set forth in Sections 1 through 4 of
this Agreement shall terminate and be of no further force or effect. No termination of
employment hereunder, whether by Employer or Employee and whether with or without Cause or
Good Reason, shall terminate the provisions of Sections 6 or 7 or any subsequent sections
of this Agreement and each of such sections shall remain in full force and effect as
binding obligations of the Parties in accordance with their express terms or, if no express
term is stated, until the latest to expire of those sections having express terms.

     6. Business Disclosures. Employee acknowledges that Employee has had and will have access to
and has or will become familiar with all or substantially all of the Confidential Information of
the Company and its Affiliates. As a material inducement to the Company and Employer to enter into
this Agreement and to pay to Employee the compensation stated herein, Employee covenants and agrees
that Employee will not, at any time during or following the

			
	 	 	 
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termination of his employment with the Company, directly or indirectly divulge or disclose for
any purpose whatsoever any Confidential Information that has been obtained by or disclosed to
Employee in connection with his employment with the Company or any of its Affiliates. If Employee
is required in or pursuant to any legal, judicial or administrative proceeding (by oral questions,
interrogatories, requests for information or documents, subpoena, civil investigative demand or
similar process) to disclose any Confidential Information, Employee shall notify, as promptly as
practicable, the Company of such request or requirement so that the Company, at its expense, may
seek an appropriate protective order or waive compliance with the provisions of this Agreement,
and/or take any other action deemed appropriate by the Company. If, in the absence of a protective
order or the receipt of a waiver hereunder, Employee is compelled or required by law or the order
of any governmental, regulatory or self-regulatory body to disclose the Confidential Information,
Employee may disclose only that portion of the requested Confidential Information which he is
compelled or required to disclose, and Employee will exercise his reasonable efforts to obtain
reliable assurance that confidential treatment will be accorded the Confidential Information.

     7. Non-Competition.

     a. Employee shall not, directly or indirectly and whether on his own behalf or on
behalf of any other person, partnership, association, corporation or other entity, engage
in or be an owner, director, officer, employee, agent, consultant or other representative
of or for, or lend money or equipment to or otherwise support, any business that
manufactures, engineers, markets, sells or provides, within a 250-mile radius of any then
existing manufacturing facility of the Company and its subsidiaries and affiliates, metal
building systems or components (including, without limitation, primary and secondary
framing systems, roofing systems, end or side wall panels, sectional or roll-up doors,
windows, or other metal components of a building structure), coated or painted steel or
metal coils, coil coating or coil painting services, or any other products or services that
are the same as or similar to those manufactured, engineered, marketed, sold or provided by
the Company or its subsidiaries and affiliates during the period of employment of Employee.
Ownership by Employee of equity securities of the Company, or of equity securities in
other public or privately-owned companies that compete with the Company constituting less
than 1% of the voting securities in such companies, shall be deemed not to be a breach of
this covenant. Employee agrees and stipulates that in any action or claim brought by him
or in any action or claim brought against him involving the provisions of this Section 7,
Employee hereby waives any claim or defense that the above non-competition covenants are
unenforceable, void or voidable, for any reason, including, but not limited to, fraud,
misrepresentation, illegality, unenforceable restraint of trade, failure of consideration,
illusory contract, mistake, or any other substantive legal defense.

			
	 	 	 
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The foregoing covenant in this Section 7.a shall remain in effect (i) during the period of
employment of Employee by the Company and Employer, and (ii) in the event that Employee
receives payment under Section 5.b hereof, for the period of years following Employee’s
termination that is equal to the multiple of annual base salary to which Employee is
entitled under Section 5.b hereof.

     b. Employee shall not, directly or indirectly and whether on his own behalf or on
behalf of any other person, partnership, association, corporation or other entity, either
(i) seek to hire or solicit the employment or service of any employee, agent or consultant
of the Company or its Affiliates in a commercial capacity; (ii) in any manner attempt to
influence or induce any employee, agent or consultant of the Company or its Affiliates to
leave the employment or service of the Company or its Affiliates; (iii) use or disclose to
any person, partnership, association, corporation or other entity any information
concerning the names and addresses of any employees, agents or consultants of the Company
or its Affiliates unless such use or disclosure is of a personal nature, is requested by
the Company or is required by due process of law; or (iv) call upon, solicit, divert or
attempt to call upon, solicit or divert the business of any customer, vendor or acquisition
prospect of the Company or any of its Affiliates with whom Employee dealt, directly or
indirectly, during his engagement with the Company or its Affiliates. Employee shall not
be prohibited from hiring or soliciting the employment or service of an agent or consultant
of the Company for purposes which do not violate Section 7 of this Agreement. Employee
agrees and stipulates that in any action or claim brought by him or in any action or claim
brought against him involving the provisions of this Section 7, Employee hereby waives any
claim or defense that the above non-solicitation covenants are unenforceable, void or
voidable, for any reason, including, but not limited to, fraud, misrepresentation,
illegality, unenforceable restraint of trade, failure of consideration, illusory contract,
mistake, or any other substantive legal defense.

The foregoing covenant in this Section 7.b shall remain in effect during the period of
employment of Employee by the Company and Employer and, after such employment terminates
for any reason whatsoever, for a period of three (3) years immediately following the longer
of (i) the termination of such employment or (ii) the period during which Employee is
entitled to receive payments under this Agreement.

     8. Consideration for Covenants; Reasonableness. Employee acknowledges and agrees as follows:

     a. The Confidential Information of the Company and its Affiliates is unique and was
developed or acquired by them through the expenditure of valuable time and resources; that
Employer, the Company

			
	 	 	 
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and their Affiliates derive independent economic value from this Confidential
Information not being generally known to the public or to other persons who can obtain
economic value from its disclosure or use; that Employer, the Company and their Affiliates
have taken all prudent and necessary measures to preserve the proprietary and confidential
nature of its Confidential Information, and that the covenants set forth in Sections 6 and
7 are the most reasonable, efficient and practical means to protect the Confidential
Information.

     b. The covenants set forth in Sections 6 and 7 are necessary to protect the goodwill
of the Company and its Affiliates during the employment of Employee hereunder, and to
ensure that such goodwill will be preserved and continued for the benefit of the Company
and its Affiliates after his employment terminates.

     c. Due to the nature of the business as heretofore conducted by the Company and its
Affiliates and as contemplated to be continued and conducted by the Company and its
Affiliates, the scope and the duration of the covenants set forth in Sections 6 and 7 of
this Agreement are in all respects reasonable.

     d. The covenants set forth in Sections 6 and 7 each constitute a separate agreement
independently supported by good and adequate consideration and that each such agreement
shall be severable from the other provisions of this Agreement and shall survive this
Agreement. The existence of any claim or cause of action of Employee against Employer or
the Company, whether predicated on this Agreement or otherwise, shall not constitute a
defense to the enforcement by Employer and the Company of the covenants and agreements of
Employee set forth in Sections 6 and 7.

     9. Surrender of Books and Records. Employee shall on the termination of his employment in any
manner immediately surrender to the Company all lists, books, and records and other documents
incident to the business of the Company and its Affiliates, and all other property belonging to any
of them, it being understood that all such lists, books, records and other documents are the
property of the Company and its Affiliates.

     10. Waiver of Breach. The failure of the Company, Employer or Employee at any time to require
performance by the other of any provision hereof shall in no way affect any of their respective
rights thereafter to enforce the same, nor shall the waiver by the Company, Employer or Employee of
any breach of any provision hereof be taken or held to be a waiver of any succeeding breach of any
provision or as a waiver of the provision itself.

     11. Remedies. In the event of Employee’s breach, or threatened breach, of any term or
provision contained in Section 6 or 7 of this Agreement,

			
	 	 	 
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Employee agrees that the Company and its Affiliates shall suffer irreparable harm not
compensable by damages or other legal remedies, and that accordingly the Company and/or Employer
shall be entitled to both temporary and permanent injunctive relief without the necessity of
independent proof by it as to the inadequacy of legal remedies or the nature or extent of the
irreparable harm suffered by it. The right of the Company and/or Employer to such relief shall not
be construed to prevent it from pursuing, either consecutively or concurrently, any and all other
legal or equitable remedies available to it for such breach or threatened breach, specifically
including, without limitation, the recovery of monetary damages.

     12. Severability. It is the desire and intent of the Parties that the provisions of Sections
6 and 7 be enforced to the fullest extent permissible under the laws and public policies of each
jurisdiction in which enforcement is sought. If any provision of Sections 6 or 7 relating to the
time period, scope of activities or geographic area of restrictions is declared by a court of
competent jurisdiction to exceed the maximum permissible time period, scope of activities or
geographic area, the same shall be reduced to the maximum which such court deems enforceable. If
any provision of Sections 6 and 7 other than those described in the preceding sentence are
adjudicated to be invalid or unenforceable, the invalid or unenforceable provisions shall be deemed
amended (with respect only to the jurisdiction in which such adjudication is made) in such manner
as to render them enforceable and to effectuate as nearly as possible the intentions and agreement
of the Parties. Furthermore, if any other provision contained in this Agreement should be held
illegal, invalid or unenforceable in whole or in part by a court of competent jurisdiction, then it
is the intent of the Parties hereto that the balance of this Agreement be enforced to the fullest
extent permitted by applicable law and, in lieu of such illegal, invalid or unenforceable
provision, there shall be added automatically as part of this Agreement, a provision as similar in
its terms to such invalid provision as may be possible and be legal, valid, and enforceable.

     13. Attorneys’ Fees. In the event of any suit or judicial proceeding (other than an
arbitration proceeding) between the Parties hereto with respect to this Agreement, the prevailing
Party shall, in addition to such other relief as the court may award, be entitled to reasonable
attorneys’ fees and costs, all as actually incurred and including, without limitation, attorneys’
fees and costs incurred in appellate proceedings; provided, however, that following a Change in
Control of the Company, only Employee will be entitled to recover the attorneys’ fees and costs
described in this Section.

     14. Survival. Notwithstanding anything to the contrary contained herein, the provisions of
Sections 5, et seq. hereof shall survive the termination of this Agreement.

     15. Notice. All notices hereunder shall be in writing and shall be delivered personally, sent
by facsimile transmission or sent by certified, registered or overnight mail, postage prepaid.
Such notices shall be deemed to

			
	 	 	 
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have been duly given upon receipt, if personally delivered, upon telephonic confirmation of
receipt if sent by facsimile transmission, and if mailed, five days after the date of mailing (two
days in the case of overnight mail), in each case addressed to the Parties at the following
addresses or at such other addresses as shall be specified in writing and in accordance with this
Section:

	 	 	 
	If to Employee:
	 	Address shown on the employment records of
the Company

	 	 	 

	If to the Company or
Employer
	 	NCI Building Systems, Inc.
 

10943 North Sam Houston Parkway West

Houston, Texas 77064

Telecopier: (281) 477-9670

Attention: Chief Executive Officer

     16. Entire Agreement. This Agreement, together with the execution copies of the agreements
attached as exhibits hereto, supersedes any and all other agreements, either oral or written,
between the Parties hereto with respect to the subject matter hereof, and contains all of the
covenants and agreements between the Parties with respect thereto. The specific arrangements
referred to herein are not intended to exclude or limit Employee’s participation in other benefits
available to Employee or personnel of the Company generally, or to preclude or limit other
compensation or benefits as may be authorized by the Board at any time, or to limit or reduce any
compensation or benefits to which Employee would be entitled but for the Agreement.

     17. Modification. No change or modification of this Agreement shall be valid or binding upon
the Parties hereto, nor shall any waiver of any term or condition in the future be so binding,
unless such change or modification or waiver shall be in writing and signed by the Parties hereto.

     18. Governing Law and Venue. This Agreement, and the rights and obligations of the Parties
hereunder, shall be governed by and construed in accordance with the laws of the State of Texas and
venue for any action pursuant hereto shall be in the appropriate state or federal court in Harris
County, Texas.

     19. Acknowledgment Regarding Counsel. Each of the Parties to this Agreement acknowledges that
he or it has had the opportunity to seek and has sought counsel to review this Agreement and to
obtain and has obtained the advice of such counsel relating thereto.

     20. Counterparts. This Agreement may be executed in counterparts, each of which shall
constitute an original, but all of which shall constitute one and the same document.

			
	 	 	 
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     21. Assignment. Subject to compliance with the provisions of this Agreement, each of the
Company and Employer shall have the right to assign this Agreement and its obligations hereunder to
any of their Affiliates. No such assignment shall operate to relieve Employer, the Company or any
successor assignor from liability hereunder, and this Agreement shall remain an enforceable
obligation of Employer, the Company and each such successor. The rights, duties and benefits to
Employee hereunder are personal to him, and no such right or benefit may be assigned by him. For
purposes of this Agreement, all references herein to Employer and the Company is deemed to be also
a reference to any Affiliate of Employer or the Company that either has or is required to assume
the obligations of the Company pursuant to this section.

     22. Tax Withholding. The Company and/or Employer, as appropriate, may withhold from any
payments or benefits payable under this Agreement all federal, state, city or other taxes that will
be required pursuant to any law or governmental regulation or ruling.

     23. Joint and Several Obligations. The duties and obligations of Employer and the Company set
forth herein shall be the joint and several obligations of each of them.

     24. Estate. If Employee dies prior to termination of employment, any monies that may be due
him under this Agreement as of the date of his death will be paid to his estate.

     25. Section 409A.

     a. If Employee is a “specified employee,” as such term is defined in Section 409A and
determined as described below in this Section 25(a), and if the Payment under Section 5(b)
hereof is subject to Section 409A, the character and timing of the Payment shall be as
determined in this Section 25(a). It is hereby specified that the amount of the Payment
under Section 5(b) that does not exceed the limit specified in Treasury Regulation Section
1.409A-1(b)(9)(iii)(A) is considered a separate payment and shall be paid at the time
specified in Section 5(b). To the extent that the Payment under Section 5(b) exceeds the
limit specified in Treasury Regulation Section 1.409A-1(b)(9)(iii)(A), such excess amount
shall not be payable before the earlier of (i) the date that is six months after Employee’s
termination, (ii) the date of Employee’s death, or (iii) the date that otherwise complies
with the requirements of Section 409A. Employee shall be a “specified employee” for the
twelve-month period beginning on April 1 of a year if Employee is a “key employee” as
defined in Section 416(i) of the Code (without regard to Section 416(i)(5)) as of December
31 of the preceding year or using such dates as designated by the Compensation Committee of
the Board in accordance with Section 409A and in a manner that is consistent with respect
to all of the Company’s nonqualified deferred compensation plans. For purposes

			
	 	 	 
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of determining the identity of specified employees, the Compensation Committee of the
Board may establish procedures as it deems appropriate in accordance with Section 409A.

     b. Employee and the Company agree that this Agreement is intended to comply with
Section 409A and that any ambiguous provisions will be construed in a manner that is
compliant with or exempt from the application of Section 409A.

     26. Captions. The captions, headings, and arrangements used in this Agreement are for
convenience only and do not in any way affect, limit, amplify, or modify the terms and provisions
hereof.

     27. Binding Effect. This Agreement shall be binding upon the Parties hereto, together with
their respective executors, administrators, successors, personal representatives, heirs and
assigns.

IN WITNESS WHEREOF, the undersigned have executed this Agreement effective as of the date set forth
herein.

EMPLOYEE

	 	 	 	 	 
	By:

	 	 	 	 
	 

	 	 
	 	 

Date:____________, 2007

NCI BUILDING SYSTEMS, INC.

	 	 	 	 	 
	By:

	 	 	 	 
	 

	 	 

Norman C. Chambers	 	 
	 

	 	Chief Executive Officer	 	 

NCI GROUP, L.P.

	 	 	 	 	 
	By:

	 	 	 	 
	 

	 	 

Norman C. Chambers	 	 
	 

	 	Chief Executive Officer	 	 

			
	 	 	 
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APPENDIX A

DEFINITIONS

The following terms have the indicated meanings for purposes of this Agreement:

(a) “Affiliate” means any entity controlled by, controlling or under common control with a person
or entity.

(b) “Bonus Plan” means the Company’s Bonus Program, as amended and restated and as may be amended,
restated, extended, supplemented or otherwise modified in writing from time to time in the sole
discretion of the Board of Directors of the Company or the Compensation Committee of the Board of
Directors of the Company.

(c) “Cause” shall mean: (i) Employee’s willful and continued failure to substantially perform his
duties and other obligations under this Agreement and such failure continues for a period of thirty
(30) days after written notice by the Company of the existence of such failure; provided, however,
that only one such notice by the Company need be sent and, if such failure re-occurs thereafter, no
further notice and opportunity to cure such failure shall be required; (ii) the willful engaging by
Employee in gross misconduct materially and demonstrably injurious to the Company, as determined by
the Company; or (iii) Employee’s conviction for committing an act of fraud, embezzlement, theft or
other act constituting a felony (which shall not include any act or offense involving the operation
of a motor vehicle); provided, however, that the Board of Directors of the Company or the then
current Chairman of the Board must first provide to Employee written notice clearly and fully
describing the particular acts or omissions which the Board or the then current Chairman of the
Board reasonably believes in good faith constitutes Cause hereunder and an opportunity, within
thirty (30) days following the receipt of such notice, to meet in person with the Board of
Directors or the then current Chairman of the Board to explain the alleged acts or omissions relied
upon by the Board of Directors and, to the extent practicable, to cure such acts or omissions. For
purposes of this Agreement, any termination of Employee’s employment for Cause shall be effective
only upon delivery to Employee of a certified copy of a resolution of the Board of Directors of the
Company, adopted by the affirmative vote of a majority of the entire membership of the Board of
Directors following a meeting at which Employee was given an opportunity to be heard on at least
five (5) business days’ advance written notice, finding that Employee was guilty of the conduct
constituting Cause, and specifying the particulars thereof. Further, for the purposes of this
Agreement, no act or failure to act on Employee’s part shall be considered willful unless done, or
omitted from being done, by Employee not in good faith and without reasonable belief that his
action or omission was in the best interest of the Company.

(d) “Change in Control” of the Company means the occurrence of any of the following events:

			
	 	 	 
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     (i) any “person” (as such term is used in Sections 13(d) and 14(d) of the
Securities Exchange Act of 1934) is or becomes the “beneficial owner” (as defined
in Rule 13d-3 under the Exchange Act), directly or indirectly, of securities of
the Company representing 20 percent or more of the combined voting power of the
Company’s then outstanding securities;

     (ii) as a result of, or in connection with, any tender offer or exchange
offer, merger, or other business combination (a “Transaction”), the persons who
were directors of the Company immediately before the Transaction shall cease to
constitute a majority of the Board of Directors of the Company or any successor to
the Company;

     (iii) the Company is merged or consolidated with another corporation or
transfers substantially all of its assets to another corporation and as a result
of the merger, consolidation or transfer less than 50 percent of the outstanding
voting securities of the surviving or resulting corporation shall then be owned in
the aggregate by the former stockholders of the Company; or

     (iv) a tender offer or exchange offer is made and consummated for the
ownership of securities of the Company representing 30 percent or more of the
combined voting power of the Company’s then outstanding voting securities.

(e) “Common Stock” means the common stock, $.01 par value, of the Company.

(f) “Confidential Information” means all information, whether oral or written, previously or
hereafter developed, that relates to the business as heretofore conducted by the Company, or which
is hereafter otherwise acquired or used by the Company or its subsidiaries and Affiliates that is
not generally known to others in the Company’s area of business or, if known, was obtained
wrongfully by such other person or entity or with knowledge that it was proprietary or confidential
information of or relating to the business as heretofore conducted by the Company or of or relating
to the business of the Company or its subsidiaries and Affiliates. Confidential Information shall
include, without limitation, trade secrets, methods or practices, financial results or plans,
customer or client lists, personnel information, information relating to negotiations with clients
or prospective clients, proprietary software, databases, programming or data transmission methods,
or copyrighted materials (including without limitation, brochures, layouts, letters, art work,
copy, photographs or illustrations). It is expressly understood that the foregoing list shall be
illustrative only and is not intended to be an exclusive or exhaustive list of Confidential
Information.

			
	 	 	 
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	 	Initials:___
	Page 13
	 	___

 

 

(g) “Good Reason” means any of the following events that occurs after a Change in Control or within
thirty (30) days prior to a Change in Control without Employee’s prior written consent:

     (i) any reduction in the amount of Employee’s then current base salary in
excess of ten percent (10%) in any twelve month period;

     (ii) a significant reduction of Employee’s duties, position, or
responsibilities relative to Employee’s duties, position or responsibilities in
effect immediately prior to such reduction;

     (iii) breach or failure by the Company or Employer to perform any of its
material covenants contained in this Agreement;

     (iv) any relocation of Employee’s principal place of employment outside the
Houston, Texas metropolitan area;

provided, however, that no act or omission shall constitute “Good Reason” for purposes of this
Agreement unless Employee provides to the Board of Directors of the Company or the Chairman of the
Board a written notice clearly and fully describing the particular acts or omissions which Employee
reasonably believes in good faith constitutes “Good Reason” within ninety (90) days of the first
date of such acts or omissions, and an opportunity, within thirty (30) days following its receipt
of such notice, to cure such acts or omissions.

(h) “Potential Change in Control” of the Company shall be deemed to have occurred, if:

     (i) the Company enters into an agreement, the consummation of which would
result in the occurrence of a Change in Control of the Company;

     (ii) any person (including the Company) publicly announces an intention to
take or to consider taking actions which if consummated would constitute a Change
in Control of the Company; or

     (iii) the Board adopts a resolution to the effect that, for purposes of this
Agreement, a Potential Change in Control has occurred.

(i) “Potential Change in Control Period” means the period beginning on the date the Potential
Change in Control occurs and ending as of the earlier of (i) the end of the month in which a Change
in Control occurs or (ii) the date the Board makes a good faith determination that the risk of a
Change in Control has terminated.

(j) “Section 409A” means Section 409A of the Internal Revenue Code of 1986, as amended, and the
regulations promulgated thereunder.

			
	 	 	 
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	 	Initials:___
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	 	___exv4w6

 

Exhibit 4.6

CHOLESTECH CORPORATION

1997 STOCK INCENTIVE PROGRAM

(As amended as of August 1998)

     1. Purposes of the 1997 Stock Incentive Program (the “Plan”). The purposes of this
Plan are:

	 	•	 	to attract and retain the best available personnel for positions of substantial
responsibility,
	 
	 	•	 	to provide additional incentive to Employees, Directors and Consultants, and
	 
	 	•	 	to promote the success of the Company’s business.

     Options granted under the Plan may be Incentive Stock Options or Nonstatutory Stock Options,
as determined by the Administrator at the time of grant. Stock Purchase Rights may also be granted
under the Plan. The Plan also provides for automatic grants of Nonstatutory Stock Options to
certain Outside Directors.

     2. Definitions. As used herein, the following definitions shall apply:

          (a) “Administrator” means the Board or any of its Committees as shall be administering
the Plan, in accordance with Section 4 of the Plan.

          (b) “Applicable Laws” means the requirements relating to the administration of stock
option plans under U. S. state corporate laws, U.S. federal and state securities laws, the Code,
any stock exchange or quotation system on which the Common Stock is listed or quoted and the
applicable laws of any foreign country or jurisdiction where Options or Stock Purchase Rights are,
or will be, granted under the Plan.

          (c) “Board” means the Board of Directors of the Company.

          (d) “Code” means the Internal Revenue Code of 1986, as amended.

          (e) “Committee” means a committee of Directors appointed by the Board in accordance
with Section 4 of the Plan.

          (f) “Common Stock” means the common stock of the Company.

          (g) “Company” means Cholestech Corporation, a California corporation.

 

 

          (h) “Consultant” means any person, including an advisor, engaged by the Company or a
Parent or Subsidiary to render services to such entity.

          (i) “Director” means a member of the Board.

          (j) “Disability” means total and permanent disability as defined in Section 22(e)(3)
of the Code.

          (k) “Employee” means any person, including Officers and Directors, employed by the
Company or any Parent or Subsidiary of the Company. A Service Provider shall not cease to be an
Employee in the case of (i) any leave of absence approved by the Company or (ii) transfers between
locations of the Company or between the Company, its Parent, any Subsidiary, or any successor. For
purposes of Incentive Stock Options, no such leave may exceed ninety days, unless reemployment upon
expiration of such leave is guaranteed by statute or contract. If reemployment upon expiration of
a leave of absence approved by the Company is not so guaranteed, on the 181st day of such leave any
Incentive Stock Option held by the Optionee shall cease to be treated as an Incentive Stock Option
and shall be treated for tax purposes as a Nonstatutory Stock Option. Neither service as a
Director nor payment of a director’s fee by the Company shall be sufficient to constitute
“employment” by the Company.

          (l) “Exchange Act” means the Securities Exchange Act of 1934, as amended.

          (m) “Fair Market Value” means, as of any date, the value of Common Stock determined as
follows:

               (i) If the Common Stock is listed on any established stock exchange or a national market
system, including without limitation the Nasdaq National Market or The Nasdaq SmallCap Market of
The Nasdaq Stock Market, its Fair Market Value shall be the closing sales price for such stock (or
the closing bid, if no sales were reported) as quoted on such exchange or system for the last
market trading day prior to the time of determination, as reported in The Wall Street Journal or
such other source as the Administrator deems reliable;

               (ii) If the Common Stock is regularly quoted by a recognized securities dealer but selling
prices are not reported, the Fair Market Value of a Share of Common Stock shall be the mean between
the high bid and low asked prices for the Common Stock on the last market trading day prior to the
day of determination, as reported in The Wall Street Journal or such other source as the
Administrator deems reliable; or

               (iii) In the absence of an established market for the Common Stock, the Fair Market Value
shall be determined in good faith by the Administrator.

          (n) “Incentive Stock Option” means an Option intended to qualify as an incentive stock
option within the meaning of Section 422 of the Code and the regulations promulgated thereunder.

          (o) “Inside Director” means a Director who is an Employee.

-2-

 

          (p) “Nonstatutory Stock Option” means an Option not intended to qualify as an
Incentive Stock Option.

          (q) “Notice of Grant” means a written or electronic notice evidencing certain terms
and conditions of an individual Option or Stock Purchase Right grant. The Notice of Grant is part
of the Option Agreement.

          (r) “Officer” means a person who is an officer of the Company within the meaning of
Section 16 of the Exchange Act and the rules and regulations promulgated thereunder.

          (s) “Option” means a stock option granted pursuant to the Plan.

          (t) “Option Agreement” means an agreement between the Company and an Optionee
evidencing the terms and conditions of an individual Option grant. The Option Agreement is subject
to the terms and conditions of the Plan.

          (u) “Option Exchange Program” means a program whereby outstanding Options are
surrendered in exchange for Options with a lower exercise price.

          (v) “Optioned Stock” means the Common Stock subject to an Option or Stock Purchase
Right.

          (w) “Optionee” means the holder of an outstanding Option or Stock Purchase Right
granted under the Plan.

          (x) “Outside Director” means a Director who is not an Employee.

          (y) “Parent” means a “parent corporation,” whether now or hereafter existing, as
defined in Section 424(e) of the Code.

          (z) “Plan” means this 1997 Stock Incentive Program.

          (aa) “Restricted Stock” means shares of Common Stock acquired pursuant to a grant of
Stock Purchase Rights under Section 11 of the Plan.

          (bb) “Restricted Stock Purchase Agreement” means a written agreement between the
Company and the Optionee evidencing the terms and restrictions applying to stock purchased under a
Stock Purchase Right. The Restricted Stock Purchase Agreement is subject to the terms and
conditions of the Plan and the Notice of Grant.

          (cc) “Rule 16b-3” means Rule 16b-3 of the Exchange Act or any successor to Rule 16b-3,
as in effect when discretion is being exercised with respect to the Plan.

          (dd) “Section 16(b) “ means Section 16(b) of the Exchange Act.

-3-

 

          (ee) “Service Provider” means an Employee, Director or Consultant; provided, however,
that such term shall not include those individuals who are representatives of shareholders owning
more than one percent (1%) of the outstanding Shares of the Company.

          (ff) “Share” means a share of the Common Stock, as adjusted in accordance with Section
14 of the Plan.

          (gg) “Stock Purchase Right” means the right to purchase Common Stock pursuant to
Section 11 of the Plan, as evidenced by a Notice of Grant.

          (hh) “Subsidiary” means a “subsidiary corporation”, whether now or hereafter existing,
as defined in Section 424(f) of the Code.

     3. Stock Subject to the Plan. Subject to the provisions of Section 14 of the Plan,
the maximum aggregate number of Shares which may be optioned and sold under the Plan is 900,000
Shares (the “Pool”). The Shares may be authorized, but unissued, or reacquired Common Stock.

     If an Option or Stock Purchase Right expires or becomes unexercisable without having been
exercised in full, or is surrendered pursuant to an Option Exchange Program, the unpurchased Shares
which were subject thereto shall become available for future grant or sale under the Plan (unless
the Plan has terminated); provided, however, that Shares that have actually been
issued under the Plan, whether upon exercise of an Option or Right, shall not be returned to the
Plan and shall not become available for future distribution under the Plan, except that if Shares
of Restricted Stock are repurchased by the Company at their original purchase price, such Shares
shall become available for future grant under the Plan.

     4. Administration of the Plan.

          (a) Procedure.

               (i) Multiple Administrative Bodies. The Plan may be administered by different
Committees with respect to different groups of Service Providers.

               (ii) Section 162(m). To the extent that the Administrator determines it to be
desirable to qualify Options granted hereunder as “performance-based compensation” within the
meaning of Section 162(m) of the Code, the Plan shall be administered by a Committee of two or more
“outside directors” within the meaning of Section 162(m) of the Code.

               (iii) Rule 16b-3. To the extent desirable to qualify transactions hereunder as exempt
under Rule 16b-3, the transactions contemplated hereunder shall be structured to satisfy the
requirements for exemption under Rule 16b-3.

               (iv) Grants to Outside Directors. All grants of Options to Outside Directors made
pursuant to Section 12 of the Plan shall be automatic and nondiscretionary.

-4-

 

               (v) Other Administration. Other than as provided above, the Plan shall be
administered by (A) the Board or (B) a Committee, which committee shall be constituted to satisfy
Applicable Laws.

          (b) Powers of the Administrator. Subject to the provisions of the Plan, and in the
case of a Committee, subject to the specific duties delegated by the Board to such Committee, the
Administrator shall have the authority, in its discretion:

               (i) to determine the Fair Market Value;

               (ii) to select the Service Providers to whom Options and Stock Purchase Rights may be granted
hereunder;

               (iii) to determine the number of shares of Common Stock to be covered by each Option and Stock
Purchase Right granted hereunder;

               (iv) to approve forms of agreement for use under the Plan;

               (v) to determine the terms and conditions, not inconsistent with the terms of the Plan, of any
Option or Stock Purchase Right granted hereunder. Such terms and conditions include, but are not
limited to, the exercise price, the time or times when Options or Stock Purchase Rights may be
exercised (which may be based on performance criteria), any vesting acceleration or waiver of
forfeiture restrictions, and any restriction or limitation regarding any Option or Stock Purchase
Right of the shares of Common Stock relating thereto, based in each case on such factors as the
Administrator, in its sole discretion, shall determine;

               (vi) to reduce the exercise price of any Option or Stock Purchase Right to the then current
Fair Market Value if the Fair Market Value of the Common Stock covered by such Option or Stock
Purchase Right shall have declined since the date the Option or Stock Purchase Right was granted;

               (vii) to institute an Option Exchange Program;

               (viii) to construe and interpret the terms of the Plan and awards granted pursuant to the
Plan;

               (ix) to prescribe, amend and rescind rules and regulations relating to the Plan, including
rules and regulations relating to sub-plans established for the purpose of qualifying for preferred
tax treatment under foreign tax laws;

               (x) to modify or amend each Option or Stock Purchase Right (subject to Section 16(c) of the
Plan), including the discretionary authority to extend the post-termination exercisability period
of Options longer than is otherwise provided for in the Plan;

               (xi) to allow Optionees to satisfy withholding tax obligations by electing to have the Company
withhold from the Shares to be issued upon exercise of an Option or Stock

-5-

 

Purchase Right that number of Shares having a Fair Market Value equal to the amount required
to be withheld. The Fair Market Value of the Shares to be withheld shall be determined on the date
that the amount of tax to be withheld is to be determined. All elections by an Optionee to have
Shares withheld for this purpose shall be made in such form and under such conditions as the
Administrator may deem necessary or advisable;

               (xii) to authorize any person to execute on behalf of the Company any instrument required to
effect the grant of an Option or Stock Purchase Right previously granted by the Administrator;

               (xiii) to make all other determinations deemed necessary or advisable for administering the
Plan.

          (c) Effect of Administrator’s Decision. The Administrator’s decisions, determinations
and interpretations shall be final and binding on all Optionees and any other holders of Options or
Stock Purchase Rights.

     5. Eligibility. Nonstatutory Stock Options and Stock Purchase Rights may be granted
to Service Providers. Incentive Stock Options may be granted only to Employees.

     6. Limitations.

          (a) Each Option shall be designated in the Option Agreement as either an Incentive Stock
Option or a Nonstatutory Stock Option. However, notwithstanding such designation, to the extent
that the aggregate Fair Market Value of the Shares with respect to which Incentive Stock Options
are exercisable for the first time by the Optionee during any calendar year (under all plans of the
Company and any Parent or Subsidiary) exceeds $100,000, such Options shall be treated as
Nonstatutory Stock Options. For purposes of this Section 6(a), Incentive Stock Options shall be
taken into account in the order in which they were granted. The Fair Market Value of the Shares
shall be determined as of the time the Option with respect to such Shares is granted.

          (b) Neither the Plan nor any Option or Stock Purchase Right shall confer upon an Optionee any
right with respect to continuing the Optionee’s relationship as a Service Provider with the
Company, nor shall they interfere in any way with the Optionee’s right or the Company’s right to
terminate such relationship at any time, with or without cause.

     7. Term of Plan. Subject to Section 20 of the Plan, the Plan shall become effective
upon its adoption by the Board. It shall continue in effect for a term of ten (10) years unless
terminated earlier under Section 16 of the Plan.

     8. Term of Option. The term of each Option shall be stated in the Option Agreement.
In the case of an Incentive Stock Option, the term shall be ten (10) years from the date of grant
or such shorter term as may be provided in the Option Agreement. Moreover, in the case of an
Incentive Stock Option granted to an Optionee who, at the time the Incentive Stock Option is
granted, owns stock representing more than ten percent (10%) of the total combined voting power of
all classes of stock of the Company or any Parent or Subsidiary, the term of the Incentive Stock
Option shall be

-6-

 

five (5) years from the date of grant or such shorter term as may be provided in the Option
Agreement.

     9. Option Exercise Price and Consideration.

          (a) Exercise Price. The per share exercise price for the Shares to be issued pursuant
to exercise of an Option shall be determined by the Administrator, subject to the following:

               (i) In the case of an Incentive Stock Option

                    (A)granted to an Employee who, at the time the Incentive Stock Option is granted, owns stock
representing more than ten percent (10%) of the voting power of all classes of stock of the Company
or any Parent or Subsidiary, the per Share exercise price shall be no less than 110% of the Fair
Market Value per Share on the date of grant.

                    (B)granted to any Employee other than an Employee described in paragraph (A) immediately
above, the per Share exercise price shall be no less than 100% of the Fair Market Value per Share
on the date of grant.

               (ii) In the case of a Nonstatutory Stock Option, the per Share exercise price shall be
determined by the Administrator. In the case of a Nonstatutory Stock Option intended to qualify as
“performance-based compensation” within the meaning of Section 162(m) of the Code, the per Share
exercise price shall be no less than 100% of the Fair Market Value per Share on the date of grant.

               (iii) Notwithstanding the foregoing, Options may be granted with a per Share exercise price of
less than 100% of the Fair Market Value per Share on the date of grant pursuant to a merger or
other corporate transaction.

          (b) Waiting Period and Exercise Dates. At the time an Option is granted, the
Administrator shall fix the period within which the Option may be exercised and shall determine any
conditions which must be satisfied before the Option may be exercised.

          (c) Form of Consideration. The Administrator shall determine the acceptable form of
consideration for exercising an Option, including the method of payment. In the case of an
Incentive Stock Option, the Administrator shall determine the acceptable form of consideration at
the time of grant. Such consideration may consist entirely of:

               (i) cash;

               (ii) check;

               (iii) promissory note;

               (iv) other Shares which (A) in the case of Shares acquired upon exercise of an option, have
been owned by the Optionee for more than six months on the date of surrender, and

-7-

 

(B) have a Fair Market Value on the date of surrender equal to the aggregate exercise price of
the Shares as to which said Option shall be exercised;

               (v) consideration received by the Company under a cashless exercise program implemented by the
Company in connection with the Plan;

               (vi) a reduction in the amount of any Company liability to the Optionee, including any
liability attributable to the Optionee’s participation in any Company-sponsored deferred
compensation program or arrangement;

               (vii) any combination of the foregoing methods of payment; or

               (viii) such other consideration and method of payment for the issuance of Shares to the extent
permitted by Applicable Laws.

     10. Exercise of Option.

          (a) Procedure for Exercise; Rights as a Shareholder. Any Option granted hereunder
shall be exercisable according to the terms of the Plan and at such times and under such conditions
as determined by the Administrator and set forth in the Option Agreement. Unless the Administrator
provides otherwise, vesting of Options granted hereunder shall be tolled during any unpaid leave of
absence. An Option may not be exercised for a fraction of a Share.

     An Option shall be deemed exercised when the Company receives: (i) written or electronic
notice of exercise (in accordance with the Option Agreement) from the person entitled to exercise
the Option, and (ii) full payment for the Shares with respect to which the Option is exercised.
Full payment may consist of any consideration and method of payment authorized by the Administrator
and permitted by the Option Agreement and the Plan. Shares issued upon exercise of an Option shall
be issued in the name of the Optionee or, if requested by the Optionee, in the name of the Optionee
and his or her spouse. Until the Shares are issued (as evidenced by the appropriate entry on the
books of the Company or of a duly authorized transfer agent of the Company), no right to vote or
receive dividends or any other rights as a shareholder shall exist with respect to the Optioned
Stock, notwithstanding the exercise of the Option. The Company shall issue (or cause to be issued)
such Shares promptly after the Option is exercised. No adjustment will be made for a dividend or
other right for which the record date is prior to the date the Shares are issued, except as
provided in Section 14 of the Plan.

     Exercising an Option in any manner shall decrease the number of Shares thereafter available,
both for purposes of the Plan and for sale under the Option, by the number of Shares as to which
the Option is exercised.

          (b) Termination of Relationship as a Service Provider. If an Optionee ceases to be a
Service Provider, other than upon the Optionee’s death or Disability, the Optionee may exercise his
or her Option within such period of time as is specified in the Option Agreement to the extent that
the Option is vested on the date of termination (but in no event later than the expiration of the
term of such Option as set forth in the Option Agreement). In the absence of a specified time in
the

-8-

 

Option Agreement, the Option shall remain exercisable for three (3) months following the
Optionee’s termination. If, on the date of termination, the Optionee is not vested as to his or
her entire Option, the Shares covered by the unvested portion of the Option shall revert to the
Plan. If, after termination, the Optionee does not exercise his or her Option within the time
specified by the Administrator, the Option shall terminate, and the Shares covered by such Option
shall revert to the Plan.

          (c) Disability of Optionee. If an Optionee ceases to be a Service Provider as a
result of the Optionee’s Disability, the Optionee may exercise his or her Option within such period
of time as is specified in the Option Agreement to the extent the Option is vested on the date of
termination (but in no event later than the expiration of the term of such Option as set forth in
the Option Agreement). In the absence of a specified time in the Option Agreement, the Option
shall remain exercisable for twelve (12) months following the Optionee’s termination. If, on the
date of termination, the Optionee is not vested as to his or her entire Option, the Shares covered
by the unvested portion of the Option shall revert to the Plan. If, after termination, the
Optionee does not exercise his or her Option within the time specified herein, the Option shall
terminate, and the Shares covered by such Option shall revert to the Plan.

          (d) Death of Optionee. If an Optionee dies while a Service Provider, the Option may
be exercised within such period of time as is specified in the Option Agreement (but in no event
later than the expiration of the term of such Option as set forth in the Notice of Grant), by the
Optionee’s estate or by a person who acquires the right to exercise the Option by bequest or
inheritance, but only to the extent that the Option is vested on the date of death. In the absence
of a specified time in the Option Agreement, the Option shall remain exercisable for twelve (12)
months following the Optionee’s termination. If, at the time of death, the Optionee is not vested
as to his or her entire Option, the Shares covered by the unvested portion of the Option shall
immediately revert to the Plan. The Option may be exercised by the executor or administrator of
the Optionee’s estate or, if none, by the person(s) entitled to exercise the Option under the
Optionee’s will or the laws of descent or distribution. If the Option is not so exercised within
the time specified herein, the Option shall terminate, and the Shares covered by such Option shall
revert to the Plan.

          (e) Buyout Provisions. The Administrator may at any time offer to buy out for a
payment in cash or Shares an Option previously granted based on such terms and conditions as the
Administrator shall establish and communicate to the Optionee at the time that such offer is made.

     11. Stock Purchase Rights.

          (a) Rights to Purchase. Stock Purchase Rights may be issued either alone, in addition
to, or in tandem with other awards granted under the Plan and/or cash awards made outside of the
Plan. After the Administrator determines that it will offer Stock Purchase Rights under the Plan,
it shall advise the offeree in writing or electronically, by means of a Notice of Grant, of the
terms, conditions and restrictions related to the offer, including the number of Shares that the
offeree shall be entitled to purchase, the price to be paid, and the time within which the offeree
must accept such offer. The offer shall be accepted by execution of a Restricted Stock Purchase
Agreement in the form determined by the Administrator.

-9-

 

          (b) Repurchase Option. Unless the Administrator determines otherwise, the Restricted
Stock Purchase Agreement shall grant the Company a repurchase option exercisable upon the voluntary
or involuntary termination of the purchaser’s service with the Company for any reason (including
death or Disability). The purchase price for Shares repurchased pursuant to the Restricted Stock
Purchase Agreement shall be the original price paid by the purchaser and may be paid by
cancellation of any indebtedness of the purchaser to the Company. The repurchase option shall
lapse at a rate determined by the Administrator.

          (c) Other Provisions. The Restricted Stock Purchase Agreement shall contain such
other terms, provisions and conditions not inconsistent with the Plan as may be determined by the
Administrator in its sole discretion.

          (d) Rights as a Shareholder. Once the Stock Purchase Right is exercised, the
purchaser shall have the rights equivalent to those of a shareholder, and shall be a shareholder
when his or her purchase is entered upon the records of the duly authorized transfer agent of the
Company. No adjustment will be made for a dividend or other right for which the record date is
prior to the date the Stock Purchase Right is exercised, except as provided in Section 14 of the
Plan.

     12. Automatic Option Grants to Outside Directors.

          (a) First Option. Each Outside Director who first becomes an Outside Director within
six months after an annual meeting of the Company’s shareholders after the effective date of this
Plan shall be automatically granted a Nonstatutory Stock Option to purchase 5,000 Shares (the
“First Option”) on the date on which such person first becomes an Outside Director, whether through
election by the shareholders of the Company or appointment by the Board to fill a vacancy;
provided, however, that an Inside Director who ceases to be an Inside Director but who remains a
Director shall not receive a First Option.

          (b) Subsequent Option. Each Outside Director shall be automatically granted a
Nonstatutory Stock Option to purchase 10,000 Shares (a “Subsequent Option”) on the date of the
annual shareholder meeting of each year; provided that he or she is then an Outside Director.

          (c) Terms of Options. The terms of First Options and Subsequent Options granted
hereunder shall be as follows:

               (i) the term of each Option shall be five (5) years.

               (ii) the exercise price per Share shall be 100% of the Fair Market Value per Share on the date
of grant. In the event that the date of grant is not a trading day, the exercise price per Share
shall be the Fair Market Value on the next trading day immediately following the date of grant.

               (iii) 25% of the Shares subject to the Option shall vest each calendar quarter after the date
of grant, so that 100% of the Optioned Stock shall be exercisable one year after the date of grant,
subject to the Optionee remaining a Service Provider as of such vesting dates.

-10-

 

          (d) In the event that any Option granted under this Section 12 would cause the number of
Shares subject to outstanding Option plus the number of Shares previously purchased under Options
to exceed the Pool, then the remaining Shares available for Option grant under this Section 12
shall be granted on a pro rata basis. No further grants shall be made under this Section 12 until
such time, if any, as additional Shares become available for grant under the Plan through action of
the Board or the stockholders to increase the number of Shares which may be issued under the Plan
or through cancellation or expiration of Options previously granted hereunder.

     13. Non-Transferability of Options and Stock Purchase Rights. Unless determined
otherwise by the Administrator, an Option or Stock Purchase Right may not be sold, pledged,
assigned, hypothecated, transferred, or disposed of in any manner other than by will or by the laws
of descent or distribution and may be exercised, during the lifetime of the Optionee, only by the
Optionee. If the Administrator makes an Option or Stock Purchase Right transferable, such Option
or Stock Purchase Right shall contain such additional terms and conditions as the Administrator
deems appropriate.

     14. Adjustments Upon Changes in Capitalization, Dissolution, Merger or Asset Sale.

          (a) Changes in Capitalization. Subject to any required action by the shareholders of
the Company, the number of shares of Common Stock covered by each outstanding Option and Stock
Purchase Right, and the number of shares of Common Stock which have been authorized for issuance
under the Plan but as to which no Options or Stock Purchase Rights have yet been granted or which
have been returned to the Plan upon cancellation or expiration of an Option or Stock Purchase
Right, as well as the price per share of Common Stock covered by each such outstanding Option or
Stock Purchase Right, shall be proportionately adjusted for any increase or decrease in the number
of issued shares of Common Stock resulting from a stock split, reverse stock split, stock dividend,
combination or reclassification of the Common Stock, or any other increase or decrease in the
number of issued shares of Common Stock effected without receipt of consideration by the Company;
provided, however, that conversion of any convertible securities of the Company shall not be deemed
to have been “effected without receipt of consideration.” Such adjustment shall be made by the
Board, whose determination in that respect shall be final, binding and conclusive. Except as
expressly provided herein, no issuance by the Company of shares of stock of any class, or
securities convertible into shares of stock of any class, shall affect, and no adjustment by reason
thereof shall be made with respect to, the number or price of shares of Common Stock subject to an
Option or Stock Purchase Right.

          (b) Dissolution or Liquidation. In the event of the proposed dissolution or
liquidation of the Company, the Administrator shall notify each Optionee as soon as practicable
prior to the effective date of such proposed transaction. The Administrator in its discretion may
provide for an Optionee to have the right to exercise his or her Option until ten (10) days prior
to such transaction as to all of the Optioned Stock covered thereby, including Shares as to which
the Option would not otherwise be exercisable. In addition, the Administrator may provide that any
Company repurchase option applicable to any Shares purchased upon exercise of an Option or Stock
Purchase Right shall lapse as to all such Shares, provided the proposed dissolution or liquidation
takes place at the time

-11-

 

and in the manner contemplated. To the extent it has not been previously exercised, an Option
or Stock Purchase Right will terminate immediately prior to the consummation of such proposed
action.

          (c) Merger or Asset Sale. In the event of a merger of the Company with or into
another corporation, or the sale of substantially all of the assets of the Company, each
outstanding Option and Stock Purchase Right shall be assumed or an equivalent option or right
substituted by the successor corporation or a Parent or Subsidiary of the successor corporation.
In the event that the successor corporation refuses to assume or substitute for the Option or Stock
Purchase Right, the Optionee shall fully vest in and have the right to exercise the Option or Stock
Purchase Right as to all of the Optioned Stock, including Shares as to which it would not otherwise
be vested or exercisable. If an Option or Stock Purchase Right becomes fully vested and
exercisable in lieu of assumption or substitution in the event of a merger or sale of assets, the
Administrator shall notify the Optionee in writing or electronically that the Option or Stock
Purchase Right shall be fully vested and exercisable for a period of fifteen (15) days from the
date of such notice, and the Option or Stock Purchase Right shall terminate upon the expiration of
such period. For the purposes of this paragraph, the Option or Stock Purchase Right shall be
considered assumed if, following the merger or sale of assets, the option or right confers the
right to purchase or receive, for each Share of Optioned Stock subject to the Option or Stock
Purchase Right immediately prior to the merger or sale of assets, the consideration (whether stock,
cash, or other securities or property) received in the merger or sale of assets by holders of
Common Stock for each Share held on the effective date of the transaction (and if holders were
offered a choice of consideration, the type of consideration chosen by the holders of a majority of
the outstanding Shares); provided, however, that if such consideration received in the merger or
sale of assets is not solely common stock of the successor corporation or its Parent, the
Administrator may, with the consent of the successor corporation, provide for the consideration to
be received upon the exercise of the Option or Stock Purchase Right, for each Share of Optioned
Stock subject to the Option or Stock Purchase Right, to be solely common stock of the successor
corporation or its Parent equal in fair market value to the per share consideration received by
holders of Common Stock in the merger or sale of assets.

     15. Date of Grant. The date of grant of an Option or Stock Purchase Right shall be,
for all purposes, the date on which the Administrator makes the determination granting such Option
or Stock Purchase Right, or such other later date as is determined by the Administrator. Notice of
the determination shall be provided to each Optionee within a reasonable time after the date of
such grant.

     16. Amendment and Termination of the Plan.

          (a) Amendment and Termination. The Board may at any time amend, alter, suspend or
terminate the Plan.

          (b) Shareholder Approval. The Company shall obtain shareholder approval of any Plan
amendment to the extent necessary and desirable to comply with Applicable Laws.

          (c) Effect of Amendment or Termination. No amendment, alteration, suspension or
termination of the Plan shall impair the rights of any Optionee, unless mutually agreed otherwise

-12-

 

between the Optionee and the Administrator, which agreement must be in writing and signed by
the Optionee and the Company. Termination of the Plan shall not affect the Administrator’s ability
to exercise the powers granted to it hereunder with respect to Options granted under the Plan prior
to the date of such termination.

     17. Conditions Upon Issuance of Shares.

          (a) Legal Compliance. Shares shall not be issued pursuant to the exercise of an
Option or Stock Purchase Right unless the exercise of such Option or Stock Purchase Right and the
issuance and delivery of such Shares shall comply with Applicable Laws and shall be further subject
to the approval of counsel for the Company with respect to such compliance.

          (b) Investment Representations. As a condition to the exercise of an Option or Stock
Purchase Right, the Company may require the person exercising such Option or Stock Purchase Right
to represent and warrant at the time of any such exercise that the Shares are being purchased only
for investment and without any present intention to sell or distribute such Shares if, in the
opinion of counsel for the Company, such a representation is required.

     18. Inability to Obtain Authority. The inability of the Company to obtain authority
from any regulatory body having jurisdiction, which authority is deemed by the Company’s counsel to
be necessary to the lawful issuance and sale of any Shares hereunder, shall relieve the Company of
any liability in respect of the failure to issue or sell such Shares as to which such requisite
authority shall not have been obtained.

     19. Reservation of Shares. The Company, during the term of this Plan, will at all
times reserve and keep available such number of Shares as shall be sufficient to satisfy the
requirements of the Plan.

     20. Shareholder Approval. The Plan shall be subject to approval by the shareholders
of the Company within twelve (12) months after the date the Plan is adopted. Such shareholder
approval shall be obtained in the manner and to the degree required under Applicable Laws.

-13-

 

CHOLESTECH CORPORATION

1997 STOCK INCENTIVE PROGRAM

STOCK OPTION AGREEMENT

     Unless otherwise defined herein, the terms defined in the Plan shall have the same defined
meanings in this Option Agreement.

I. NOTICE OF STOCK OPTION GRANT

[Optionee’s Name and Address]

     You have been granted an option to purchase Common Stock of the Company, subject to the terms
and conditions of the Plan and this Option Agreement, as follows:

	 	 	 	 	 
	 
	 	Grant Number	 	 
	 	 	 	 	 
	 
	 	 	 	 
	 
	 	Date of Grant	 	 
	 	 	 	 	 
	 
	 	 	 	 
	 
	 	Vesting Commencement Date	 	 
	 	 	 	 	 
	 
	 	 	 	 
	 
	 	Exercise Price per Share	 	$
	 	 	 	 	 
	 
	 	 	 	 
	 
	 	Total Number of Shares Granted	 	 
	 	 	 	 	 
	 
	 	 	 	 
	 
	 	Total Exercise Price	 	$
	 	 	 	 	 
	 
	 	 	 	 
	 
	 	Type of Option:	 	      Incentive Stock Option
	 
	 	 	 	 
	 
	 	 	 	      Nonstatutory Stock Option
	 
	 	 	 	 
	 
	 	Term/Expiration Date:	 	 
	 	 	 	 	 
	 
	 	 	 	 
	 
	 	Vesting Schedule:	 	 

     This Option may be exercised, in whole or in part, in accordance with the following
schedule:

     25% of the Shares subject to the Option shall vest twelve months after the Vesting
Commencement Date, and 1/48 of the Shares subject to the Option shall vest each month
thereafter, so that 100% of the Optioned Stock shall be exercisable after four years, subject to
the Optionee continuing to be a Service Provider on such dates.

     Termination Period. This Option may be exercised for three months after Optionee ceases to
be a Service Provider. Upon the death or Disability of the Optionee, this Option may be exercised

-14-

 

for one year after Optionee ceases to be a Service Provider. In no event shall this Option be
exercised later than the Term/Expiration Date as provided above.

II. AGREEMENT

     1. Grant of Option. The Plan Administrator of the Company hereby grants to the Optionee
named in the Notice of Grant attached as Part I of this Agreement (the “Optionee”) an
option (the “Option”) to purchase the number of Shares, as set forth in the Notice of Grant, at the
exercise price per share set forth in the Notice of Grant (the “Exercise Price”), subject to the
terms and conditions of the Plan, which is incorporated herein by reference. Subject to Section
16(c) of the Plan, in the event of a conflict between the terms and conditions of the Plan and
the terms and conditions of this Option Agreement, the terms and conditions of the Plan shall
prevail.

     If designated in the Notice of Grant as an Incentive Stock Option (“ISO”), this Option is
intended to qualify as an Incentive Stock Option under Section 422 of the Code. However, if this
Option is intended to be an Incentive Stock Option, to the extent that it exceeds the $100,000
rule of Code Section 422(d) it shall be treated as a Nonstatutory Stock Option (“NSO”).

     2. Exercise of Option.

     (a) Right to Exercise. This Option is exercisable during its term in accordance with the
Vesting Schedule set out in the Notice of Grant and the applicable provisions of the Plan and
this Option Agreement.

     (b) Method of Exercise. This Option is exercisable by delivery of an exercise notice, in
the form attached as Exhibit A (the “Exercise Notice”), which shall state the election to
exercise the Option, the number of Shares in respect of which the Option is being exercised (the
“Exercised Shares”), and such other representations and agreements as may be required by
the Company pursuant to the provisions of the Plan. The Exercise Notice shall be completed by the
Optionee and delivered to Secretary of the Company. The Exercise Notice shall be accompanied by
payment of the aggregate Exercise Price as to all Exercised Shares. This Option shall be
deemed to be exercised upon receipt by the Company of such fully executed Exercise Notice
accompanied by such aggregate Exercise Price.

     No Shares shall be issued pursuant to the exercise of this Option unless such issuance and
exercise complies with Applicable Laws. Assuming such compliance, for income tax purposes the
Exercised Shares shall be considered transferred to the Optionee on the date the Option is
exercised with respect to such Exercised Shares.

     3. Method of Payment. Payment of the aggregate Exercise Price shall be by any of the
following, or a combination thereof, at the election of the Optionee:

          (a) cash;

          (b) check;

-15-

 

          (c) consideration received by the Company under a cashless exercise program implemented by
the Company in connection with the Plan; or

          (d) surrender of other Shares which (i) in the case of Shares acquired upon exercise
of an option, have been owned by the Optionee for more than six (6) months on the date of
surrender, and (ii) have a Fair Market Value on the date of surrender equal to the aggregate
Exercise Price of the Exercised Shares.

     4. Non-Transferability of Option. This Option may not be transferred in any manner otherwise
than by will or by the laws of descent or distribution and may be exercised during the lifetime of
Optionee only by the Optionee. The terms of the Plan and this Option Agreement shall be binding
upon the executors, administrators, heirs, successors and assigns of the Optionee.

     5. Term of Option. This Option may be exercised only within the term set out in the Notice
of Grant, and may be exercised during such term only in accordance with the Plan and the terms
of this Option Agreement.

     6. Tax Consequences. Some of the federal tax consequences relating to this Option, as of
the date of this Option, are set forth below. THIS SUMMARY IS NECESSARILY INCOMPLETE, AND THE TAX
LAWS AND REGULATIONS ARE SUBJECT TO CHANGE. THE OPTIONEE SHOULD CONSULT A TAX ADVISER BEFORE
EXERCISING THIS OPTION OR DISPOSING OF THE SHARES.

          (a) Exercising the Option.

               (i) Nonstatutory Stock Option. The Optionee may incur regular federal income tax
liability upon exercise of a NSO. The Optionee will be treated as having received
compensation income (taxable at ordinary income tax rates) equal to the excess, if any, of the
Fair Market Value of the Exercised Shares on the date of exercise over their aggregate
Exercise Price. If the Optionee is an Employee or a former Employee, the Company will be
required to withhold from his or her compensation or collect from Optionee and pay to the
applicable taxing authorities an amount in cash equal to a percentage of this compensation
income at the time of exercise, and may refuse to honor the exercise and refuse to
deliver Shares if such withholding amounts are not delivered at the time of exercise.

               (ii) Incentive Stock Option. If this Option qualifies as an ISO, the Optionee will have no
regular federal income tax liability upon its exercise, although the excess, if any, of the
Fair Market Value of the Exercised Shares on the date of exercise over their aggregate
Exercise Price will be treated as an adjustment to alternative minimum taxable income for
federal tax purposes and may subject the Optionee to alternative minimum tax in the year of
exercise. In the event that the Optionee ceases to be an Employee but remains a Service Provider,
any Incentive Stock Option of the Optionee that remains unexercised shall cease to qualify
as an Incentive Stock Option and will be treated for tax purposes as a Nonstatutory Stock
Option on the date three (3) months and one (1) day following such change of status.

-16-

 

          (b) Disposition of Shares.

               (i) NSO. If the Optionee holds NSO Shares for at least one year, any gain realized on
disposition of the Shares will be treated as long-term capital gain for federal income tax
purposes.

               (ii) ISO. If the Optionee holds ISO Shares for at least one year after exercise and two
years after the grant date, any gain realized on disposition of the Shares will be treated
as long-term capital gain for federal income tax purposes. If the Optionee disposes of ISO
Shares within one year after exercise or two years after the grant date, any gain realized on
such disposition will be treated as compensation income (taxable at ordinary income rates) to the
extent of the excess, if any, of the lesser of (A) the difference between the Fair Market Value of
the Shares acquired on the date of exercise and the aggregate Exercise Price, or (B) the
difference between the sale price of such Shares and the aggregate Exercise Price. Any additional
gain will be taxed as capital gain, short-term or long-term depending on the period that the ISO
Shares were held.

          (c) Notice of Disqualifying Disposition of ISO Shares. If the Optionee sells or
otherwise disposes of any of the Shares acquired pursuant to an ISO on or before the later of (i)
two years after the grant date, or (ii) one year after the exercise date, the Optionee shall
immediately notify the Company in writing of such disposition. The Optionee agrees that he
or she may be subject to income tax withholding by the Company on the compensation income
recognized from such early disposition of ISO Shares by payment in cash or out of the current
earnings paid to the Optionee.

     7. Entire Agreement; Governing Law. The Plan is incorporated herein by reference. The Plan
and this Option Agreement constitute the entire agreement of the parties with respect to the
subject matter hereof and supersede in their entirety all prior undertakings and agreements of
the Company and Optionee with respect to the subject matter hereof, and may not be modified
adversely to the Optionee’s interest except by means of a writing signed by the Company and
Optionee. This agreement is governed by the internal substantive laws, but not the choice of law
rules, of California.

     8. NO GUARANTEE OF CONTINUED SERVICE. OPTIONEE ACKNOWLEDGES AND AGREES THAT THE VESTING OF
SHARES PURSUANT TO THE VESTING SCHEDULE HEREOF IS EARNED ONLY BY CONTINUING AS A SERVICE
PROVIDER AT THE WILL OF THE COMPANY (AND NOT THROUGH THE ACT OF BEING HIRED, BEING GRANTED AN
OPTION OR PURCHASING SHARES HEREUNDER). OPTIONEE FURTHER ACKNOWLEDGES AND AGREES THAT THIS
AGREEMENT, THE TRANSACTIONS CONTEMPLATED HEREUNDER AND THE VESTING SCHEDULE SET FORTH HEREIN DO
NOT CONSTITUTE AN EXPRESS OR IMPLIED PROMISE OF CONTINUED ENGAGEMENT AS A SERVICE PROVIDER
FOR THE VESTING PERIOD, FOR ANY PERIOD, OR AT ALL, AND SHALL NOT INTERFERE WITH OPTIONEE’S
RIGHT OR THE COMPANY’S RIGHT TO TERMINATE OPTIONEE’S RELATIONSHIP AS A SERVICE PROVIDER AT
ANY TIME, WITH OR WITHOUT CAUSE.

-17-

 

     By your signature and the signature of the Company’s representative below, you and the
Company agree that this Option is granted under and governed by the terms and conditions of the
Plan and this Option Agreement. Optionee has reviewed the Plan and this Option Agreement in
their entirety, has had an opportunity to obtain the advice of counsel prior to executing
this Option Agreement and fully understands all provisions of the Plan and Option Agreement.

     Optionee hereby agrees to accept as binding, conclusive and final all decisions or
interpretations of the Administrator upon any questions relating to the Plan and Option Agreement.
Optionee further agrees to notify the Company upon any change in the residence address indicated
below.

	 	 	 	 	 	 	 
	 	 	OPTIONEE:	 	CHOLESTECH CORPORATION
	 
	 	 	 	 	 	 
	 

	 	 
	 	 	 	 
	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 
	 

	 	Signature
	 	 	 	By
	 
	 	 	 	 	 	 
	 

	 	 
	 	 	 	 
	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 
	 

	 	Print Name
	 	 	 	Title
	 
	 	 	 	 	 	 
	 

	 	 	 	 	 	 
	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 
	 

	 	Residence Address	 	 	 	 
	 
	 	 	 	 	 	 
	 

	 	 	 	 	 	 
	 	 	 	 	 	 	 

-18-

 

CONSENT OF SPOUSE

     The undersigned spouse of Optionee has read and hereby approves the terms and conditions
of the Plan and this Option Agreement. In consideration of the Company’s granting his or her
spouse the right to purchase Shares as set forth in the Plan and this Option Agreement, the
undersigned hereby agrees to be irrevocably bound by the terms and conditions of the Plan and
this Option Agreement and further agrees that any community property interest shall be
similarly bound. The undersigned hereby appoints the undersigned’s spouse as attorney-in-fact
for the undersigned with respect to any amendment or exercise of rights under the Plan or this
Option Agreement.

	 	 	 
	 

	 	 
	 	 	 
	 
	 	 
	 

	 	Spouse of Optionee

-19-

 

EXHIBIT A

1997 STOCK INCENTIVE PROGRAM

EXERCISE NOTICE

     Cholestech Corporation

     3347 Investment Blvd.

     Hayward, CA 94545-3808

     Attention: Secretary

          1. Exercise of Option. Effective as of today,                     , 199     , the undersigned
(“Purchaser”) hereby elects to purchase                     shares (the “Shares”) of the Common Stock
of Cholestech Corporation (the “Company”) under and pursuant to the 1997 Stock Incentive
Program (the “Plan”) and the Stock Option Agreement dated       , 19      (the “Option Agreement”).
The purchase price for the Shares shall be $      , as required by the Option Agreement.

          2. Delivery of Payment. Purchaser herewith delivers to the Company the full purchase price
for the Shares.

          3. Representations of Purchaser. Purchaser acknowledges that Purchaser has received, read
and understood the Plan and the Option Agreement and agrees to abide by and be bound by their
terms and conditions.

          4. Rights as Shareholder. Until the issuance (as evidenced by the appropriate entry on
the books of the Company or of a duly authorized transfer agent of the Company) of the Shares,
no right to vote or receive dividends or any other rights as a shareholder shall exist with
respect to the Optioned Stock, notwithstanding the exercise of the Option. The Shares so acquired
shall be issued to the Optionee as soon as practicable after exercise of the Option. No
adjustment will be made for a dividend or other right for which the record date is prior to the
date of issuance, except as provided in Section 14 of the Plan.

          5. Tax Consultation. Purchaser understands that Purchaser may suffer adverse tax
consequences as a result of Purchaser’s purchase or disposition of the Shares. Purchaser
represents that Purchaser has consulted with any tax consultants Purchaser deems advisable
in connection with the purchase or disposition of the Shares and that Purchaser is not
relying on the Company for any tax advice.

          6. Entire Agreement; Governing Law. The Plan and Option Agreement are incorporated herein
by reference. This Agreement, the Plan and the Option Agreement constitute the entire
agreement of the parties with respect to the subject matter hereof and supersede in their entirety
all prior undertakings and agreements of the Company and Purchaser with respect to the subject
matter hereof, and may not be modified adversely to the Purchaser’s

-20-

 

interest except by means of a writing signed by the Company and Purchaser. This agreement is
governed by the internal substantive laws, but not the choice of law rules, of California.

	 	 	 	 	 
	 

	 	Submitted by:
	 	Accepted by:
	 
	 	 	 	 
	 

	 	PURCHASER:
	 	CHOLESTECH CORPORATION
	 
	 	 	 	 
	 

	 	 
	 	 
	 	 	 	 	 
	 
	 	 	 	 
	 

	 	Signature
	 	By
	 
	 	 	 	 
	 

	 	 
	 	 
	 	 	 	 	 
	 
	 	 	 	 
	 

	 	Print Name
	 	Its
	 
	 	 	 	 
	 

	 	Address:
	 	Address:
	 
	 	 	 	 
	 

	 	 
	 	3347 Investment Blvd.
	 	 	 	 	 
	 
	 	 	 	 
	 

	 	 
	 	Hayward, CA 94545-3808
	 	 	 	 	 
	 
	 	 	 	 
	 

	 	 	 	 
	 	 	 	 	 
	 
	 	 	 	 
	 

	 	Date Received	 	 

-21-

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