Document:

exv4w05

Exhibit 4.05

No.                     

PAYCYCLE, INC.

1999 EQUITY INCENTIVE PLAN

STOCK OPTION AGREEMENT

          This Stock Option Agreement (the “Agreement”) is made and entered into as of the date of grant
set forth below (the “Date of Grant”) by and between PayCycle, Inc., a Delaware corporation (the
“Company”), and the participant named below (the “Participant”). Capitalized terms not defined
herein shall have the meaning ascribed to them in the Company’s 1999 Equity Incentive Plan, as
amended (the “Plan”).

	 	 	 	 	 
	Participant:
	 	 	 	 
	Social Security Number:
	 	 	 	 
	Address:
	 	 	 	 
	 
	 	 	 	 
	Total Option Shares:
	 	 	 	 
	Exercise Price Per Share:

	 	$	 	 
	Date of Grant:
	 	 	 	 
	First Vesting Date:
	 	 	 	 
	First Exercisable Date:
	 	 	 	 
	Expiration Date:
	 	 	 	 
	 

	 	(unless earlier terminated under Section 5.6 of the Plan)

	 
	 	 	 	 
	Type of Stock Option
	 	 	 	 
	(Check one):

	 	o Incentive Stock Option

	 

	 	o Nonqualified Stock Option

     1. Grant of Option. The Company hereby grants to Participant an option (this “Option”)
to purchase the total number of shares of Common Stock, $0.00001 par value per share, of the
Company set forth above as Total Option Shares (the “Shares”) at the Exercise Price Per Share set
forth above (the “Exercise Price”), subject to all of the terms and conditions of this Agreement
and the Plan. If designated as an Incentive Stock Option above, the Option is intended to qualify
as an “incentive stock option” (the “ISO”) within the meaning of Section 422 of the Internal
Revenue Code of 1986, as amended (the “Code”).

1

 

     2. Exercise Period.

          2.1 Exercise Period of Option. Provided Participant continues to provide services to the
Company or to any Parent or Subsidiary of the Company, this Option will become vested and
exercisable with respect to one-quarter (1/4th) of the Shares on the First Vesting Date set forth
on the first page of this Agreement (the “First Vesting Date”) and thereafter at the end of each
full succeeding month after the First Vesting Date this Option will become vested and exercisable
with respect to an additional one-forty-eighth (1/48th) of the Shares until this Option is vested
and has become exercisable with respect to one hundred percent (100%) of the Shares. If application
of the vesting percentage causes a fractional share, such share shall be rounded down to the
nearest whole share for each month except for the last month in such vesting period, at the end of
which last month this Option shall become vested for the full remainder of the Shares.

          2.2 Expiration. The Option shall expire on the Expiration Date set forth above or earlier
as provided in Section 3 below or pursuant to Section 5.6 of the Plan.

     3. Termination.

          3.1 Termination for Any Reason Except Death, Disability or Cause. If Participant is
Terminated for any reason, except death, Disability or for Cause, the Option, to the extent (and
only to the extent) that it would have been exercisable by Participant on the Termination Date, may
be exercised by Participant no later than three (3) months after the Termination Date, but in any
event no later than the Expiration Date.

          3.2 Termination Because of Death or Disability. If Participant is Terminated because of
death or Disability of Participant (or Participant dies within three (3) months of Termination when
Termination is for any reason other than Participant’s Disability or for Cause), the Option, to the
extent that it is exercisable by Participant on the Termination Date, may be exercised by
Participant (or Participant’s legal representative) no later than twelve (12) months after the
Termination Date, but in any event no later than the Expiration Date. Any exercise beyond (i)
three (3) months after the Termination Date when the Termination is for any reason other than the
Participant’s death or disability, within the meaning of Section 22(e)(3) of the Code; or (ii)
twelve (12) months after the Termination Date when the termination is for Participant’s disability,
within the meaning of Section 22(e)(3) of the Code, is deemed to be an NQSO.

          3.3 Termination for Cause. If Participant is Terminated for Cause, then the Option will
expire on Participant’s Termination Date, or at such later time and on such conditions as are
determined by the Committee.

          3.4 No Obligation to Employ. Nothing in the Plan or this Agreement shall confer on
Participant any right to continue in the employ of, or other relationship with, the Company or any
Parent or Subsidiary of the Company, or limit in any way the right of the Company or any Parent or
Subsidiary of the Company to terminate Participant’s employment or other relationship at any time,
with or without Cause.

 

 

     4. Manner of Exercise.

          4.1 Stock Option Exercise Agreement. To exercise this Option, Participant (or in the case
of exercise after Participant’s death or incapacity, Participant’s executor, administrator, heir or
legatee, as the case may be) must deliver to the Company an executed stock option exercise
agreement in the form attached hereto as Exhibit A, or in such other form as may be
approved by the Committee from time to time (the “Exercise Agreement”), which shall set forth,
inter alia, (i) Participant’s election to exercise the Option, (ii) the number of
Shares being purchased, (iii) any restrictions imposed on the Shares and (iv) any representations,
warranties and agreements regarding Participant’s investment intent and access to information as
may be required by the Company to comply with applicable securities laws. If someone other than
Participant exercises the Option, then such person must submit documentation reasonably acceptable
to the Company verifying that such person has the legal right to exercise the Option and such
person shall be subject to all of the restrictions contained herein as if such person were the
Participant.

          4.2 Limitations on Exercise. The Option may not be exercised unless such exercise is in
compliance with all applicable federal and state securities laws, as they are in effect on the date
of exercise. The Option may not be exercised as to fewer than one hundred (100) Shares unless it
is exercised as to all Shares as to which the Option is then exercisable.

          4.3 Payment. The Exercise Agreement shall be accompanied by full payment of the Exercise
Price for the shares being purchased in cash (by check), or where permitted by law:

	 	(a)	 	by cancellation of indebtedness of the Company to the
Participant;
	 
	 	(b)	 	by surrender of shares of the Company’s Common Stock that (i)
either (A) have been paid for within the meaning of SEC Rule 144 (and, if such
shares were purchased from the Company by use of a promissory note, such note
has been fully paid with respect to such shares); or (B) were obtained by
Participant in the open public market; and (ii) are clear of all liens, claims,
encumbrances or security interests;
	 
	 	(c)	 	by waiver of compensation due or accrued to Participant for
services rendered;
	 
	 	(d)	 	provided that a public market for the Company’s stock exists:
(i) through a “same day sale” commitment from Participant and a
Company-designated broker-dealer (a “Dealer”) whereby Participant irrevocably
elects to exercise the Option and to sell a portion of the Shares so purchased
sufficient to pay for the total Exercise Price and whereby the Dealer
irrevocably commits upon receipt of such Shares to forward the total Exercise
Price directly to the Company, or (ii) through a “margin” commitment from
Participant and a Dealer whereby Participant irrevocably elects to exercise the
Option and to pledge the Shares so

 

 

	 	 	 	purchased to the Dealer in a margin account
as security for a loan from the
Dealer in the amount of the total Exercise Price, and whereby the Dealer
irrevocably commits upon receipt of such Shares to forward the total
Exercise Price directly to the Company; or

	 	(e)	 	any other form of consideration approved by the Committee; or
	 
	 	(f)	 	by any combination of the foregoing.

          4.4 Tax Withholding. Prior to the issuance of the Shares upon exercise of the Option,
Participant must pay or provide for any applicable federal, state and local withholding obligations
of the Company. If the Committee permits, Participant may provide for payment of withholding taxes
upon exercise of the Option by requesting that the Company retain the minimum number of Shares with
a Fair Market Value equal to the minimum amount of taxes required to be withheld; but in no event
will the Company withhold Shares if such withholding would result in adverse accounting
consequences to the Company. In such case, the Company shall issue the net number of Shares to the
Participant by deducting the Shares retained from the Shares issuable upon exercise.

          4.5 Issuance of Shares. Provided that the Exercise Agreement and payment are in form and
substance satisfactory to counsel for the Company, the Company shall issue the Shares registered in
the name of Participant, Participant’s authorized assignee, or Participant’s legal representative,
and shall deliver certificates representing the Shares with the appropriate legends affixed
thereto.

     5. Notice of Disqualifying Disposition of ISO Shares. If the Option is an ISO, and if
Participant sells or otherwise disposes of any of the Shares acquired pursuant to the ISO on or
before the later of (i) the date two (2) years after the Date of Grant, and (ii) the date one (1)
year after transfer of such Shares to Participant upon exercise of the Option, Participant shall
immediately notify the Company in writing of such disposition. Participant agrees that Participant
may be subject to income tax withholding by the Company on the compensation income recognized by
Participant from the early disposition by payment in cash or out of the current wages or other
compensation payable to Participant.

     6. Compliance with Laws and Regulations. The Plan and this Agreement are intended to
comply with Section 25102(o) of the California Corporations Code and any regulations relating
thereto. Any provision of this Agreement which is inconsistent with Section 25102(o) or any
regulations relating thereto shall, without further act or amendment by the Company or the Board,
be reformed to comply with the requirements of Section 25102(o) and any regulations relating
thereto. The exercise of the Option and the issuance and transfer of Shares shall be subject to
compliance by the Company and Participant with all applicable requirements of federal and state
securities laws and with all applicable requirements of any stock exchange on which the Company’s
Common Stock may be listed at the time of such issuance or transfer. Participant understands that
the Company is under no obligation to register or qualify the Shares with the SEC, any state
securities commission or any stock exchange to effect such compliance.

 

 

     7. Nontransferability of Option. The Option may not be transferred in any manner other
than by will or by the laws of descent and distribution, and, with respect to NQSOs, by instrument
to an inter vivos or testamentary trust in which the options are to be passed to beneficiaries upon
the death of the trustor (settlor), or by gift to “immediate family” as that term is defined in 17
C.F.R. 240.16a-1(e), and may be exercised during the lifetime of Participant only by Participant or
in the event of Participant’s incapacity, by Participant’s legal representative. The terms of the
Option shall be binding upon the executors, administrators, successors and assigns of Participant.

     8. Company’s Right of First Refusal. Before any Shares held by Participant or any
transferee of such Shares may be sold or otherwise transferred (including without limitation a
transfer by gift or operation of law), the Company and/or its assignee(s) shall have an assignable
right of first refusal to purchase the Shares to be sold or transferred on the terms and conditions
set forth in the Exercise Agreement (the “Right of First Refusal”). The Company’s Right of First
Refusal will terminate when the Company’s securities become publicly traded.

     9. Tax Consequences. Set forth below is a brief summary as of the Effective Date of the
Plan of some of the federal and California tax consequences of exercise of the Option and
disposition of the Shares. THIS SUMMARY IS NECESSARILY INCOMPLETE, AND THE TAX LAWS AND
REGULATIONS ARE SUBJECT TO CHANGE. PARTICIPANT SHOULD CONSULT A TAX ADVISER BEFORE EXERCISING THE
OPTION OR DISPOSING OF THE SHARES.

          9.1 Exercise of ISO. If the Option qualifies as an ISO, there will be no regular federal
or California income tax liability upon the exercise of the Option, although the excess, if any, of
the Fair Market Value of the Shares on the date of exercise over the Exercise Price will be treated
as a tax preference item for federal alternative minimum tax purposes and may subject the
Participant to the alternative minimum tax in the year of exercise.

          9.2 Exercise of Nonqualified Stock Option. If the Option does not qualify as an ISO,
there may be a regular federal and California income tax liability upon the exercise of the Option.
Participant 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 Shares on the date of exercise
over the Exercise Price. If Participant is a current or former employee of the Company, the
Company may be required to withhold from Participant’s compensation or collect from Participant and
pay to the applicable taxing authorities an amount equal to a percentage of this compensation
income at the time of exercise.

          9.3 Disposition of Shares. The following tax consequences may apply upon disposition of
the Shares.

               (a) Incentive Stock Options. If the Shares are held for more than twelve (12) months
after the date of purchase of the Shares pursuant to the exercise of an ISO and are disposed of
more than two (2) years after the Date of Grant, any gain realized on disposition of the Shares
will be treated as long term capital gain for federal and California income tax purposes. If
Shares purchased under an ISO are disposed of within the applicable

 

 

one (1) year or two (2) year period, 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
Fair Market Value of the Shares on the date of exercise over the Exercise Price.

               (b) Nonqualified Stock Options. If the Shares are held for more than twelve (12) months
after the date of purchase of the Shares pursuant to the exercise of an NQSO, any gain realized on
disposition of the Shares will be treated as long term capital gain.

               (c) Withholding. The Company may be required to withhold from the Participant’s
compensation or collect from the Participant and pay to the applicable taxing authorities an amount
equal to a percentage of this compensation income.

     10. Section 409A Release and Reimbursement Agreement. Unless expressly determined
otherwise by the Committee, this Option is intended to be compliant with Section 409A of the Code,
including, without limitation, the Exercise Price per Share underlying this Option being set at not
less than 100% of the Fair Market Value of such Share at the Date of Grant of this Option.
Participant acknowledges that, if the Exercise Price per Share is less than the Fair Market Value
of such Share as of the Date of Grant of this Option, then Participant may have significant tax
liabilities with respect to this Option. Participant further acknowledges that, at any time
hereafter, it may be determined by the Committee, a court of law, the Internal Revenue Service or
other governmental entity that this Option is subject to Section 409A of the Code, including
without limitation because the Exercise Price per Share underlying this Option is less than the
Fair Market Value of such Share as of the Date of Grant of this Option (a “Determination”).
Participant expressly agrees, by accepting this Option and in partial consideration for the grant
of this Option to Participant, as follows:

          (a) Participant hereby irrevocably waives and releases any and all claims or causes of action
that Participant may have against the Company, its agents, officers, stockholders, employees,
directors, attorneys, subscribers, subsidiaries, affiliates, successors and assigns, for any
damages, injury or loss arising out of, related to or connected with such a Determination or
otherwise under Section 409A of the Code, including without limitation with respect to taxes,
interest and penalties that may be due from Participant with respect to this Option under Section
409A of the Code; and

          (b) Participant agrees to promptly reimburse the Company upon its request, whether by way of a
deduction from wages due (if and to the extent permitted by law) or otherwise, as determined by the
Company in its sole discretion, and regardless of whether or not Participant is then an employee,
for any taxes (together with interest due thereon) paid by the Company on Participant’s behalf in
connection with such a Determination.

     11. Privileges of Stock Ownership. Participant shall not have any of the rights of a
stockholder with respect to any Shares until the Shares are issued to Participant.

     12. Interpretation. Any dispute regarding the interpretation of this Agreement shall be
submitted by Participant or the Company to the Committee for review. The resolution of such a
dispute by the Committee shall be final and binding on the Company and Participant.

 

 

     13. Entire Agreement. The Plan is incorporated herein by reference. This Agreement and
the Plan constitute the entire agreement of the parties and supersede all prior undertakings and
agreements with respect to the subject matter hereof.

     14. Notices. Any notice required to be given or delivered to the Company under the terms
of this Agreement shall be in writing and addressed to the Corporate Secretary of the Company at
its principal corporate offices. Any notice required to be given or delivered to Participant shall
be in writing and addressed to Participant at the address indicated above or to such other address
as such party may designate in writing from time to time to the Company. All notices shall be
deemed to have been given or delivered upon: (i) personal delivery; (ii) three (3) days after
deposit in the United States mail by certified or registered mail (return receipt requested); (iii)
one (1) business day after deposit with any return receipt express courier (prepaid); or (iv) one
(1) business day after transmission by facsimile, rapifax or telecopier.

     15. Successors and Assigns. The Company may assign any of its rights under this
Agreement, including its rights to purchase Shares under the Right of First Refusal. No other
party to this Agreement may assign, whether voluntarily or by operation of law, any of its rights
and obligations under this Agreement, except with the prior written consent of the Company. This
Agreement shall be binding upon and inure to the benefit of the successors and assigns of the
Company. Subject to the restrictions on transfer set forth herein, this Agreement shall be binding
upon Participant and Participant’s heirs, executors, administrators, legal representatives,
successors and assigns.

     16. Governing Law. This Agreement shall be governed by and construed in accordance with
the laws of the State of California as such laws are applied to agreements between California
residents entered into and to be performed entirely within California. If any provision of this
Agreement is determined by a court of law to be illegal or unenforceable, then such provision will
be enforced to the maximum extent possible and the other provisions will remain fully effective and
enforceable.

     17. Acceptance. Participant hereby acknowledges receipt of a copy of the Plan and this
Agreement. Participant has read and understands the terms and provisions thereof, and accepts the
Option subject to all the terms and conditions of the Plan and this Agreement. Participant
acknowledges that there may be adverse tax consequences upon exercise of the Option or disposition
of the Shares and that Participant should consult a tax adviser prior to such exercise or
disposition.

 

 

     IN WITNESS WHEREOF, the Company has caused this Agreement to be executed in triplicate by its
duly authorized representative and Participant has executed this Agreement in triplicate, effective
as of the Date of Grant.

	 	 	 	 	 
	PAYCYCLE, INC.	 	PARTICIPANT
	 
	 	 	 	 
	By:
	 	 	 	 
	 

	 	 
	 	 
	 

	 	James J. Heeger, CEO	 	 

[SIGNATURE PAGE TO STOCK OPTION AGREEMENT]exv10w3

Exhibit 10.3

2008-000065F

PHYSICAL HEALTH INSURANCE CONTRACT

AGREEMENT BETWEEN

Puerto Rico Health Insurance Administration (PRHIA) a public instrumentality of the
Commonwealth of Puerto Rico organized pursuant to Act 72, of September 7, 1993, as amended,
hereinafter referred to as the “ADMINISTRATION”, and represented by its Executive Director, Domingo
Nevárez Ramírez, MHSA;

 

And

TRIPLE-S SALUD, INC., a private corporation duly organized and authorized to do business under
the laws of the Commonwealth of Puerto Rico, with Employer Social Security Number ###-##-####,
hereinafter referred to as “INSURER”, and represented by its Chief Executive Officer, Ms. Socorro
Rivas;

 

Contractor Name

For the Provision of Health Insurance

 coverage to eligible population under the

Government
Health Insurance Plan

 

 

WITNESSETH

In consideration of the mutual covenants and agreements hereinafter set forth, the parties,
their personal representative and successors, agree as follows:

WHEREAS: The parties entered into contract number 08-065 (the Contract) to provide health insurance
coverage for the North and Southwest Area medically indigent population; enrolled in the Government
Health Insurance Plan (GHIP) for the period through November 1, 2006 until June 30, 2008.

WHEREAS: The Contract was extended through the Amendment Number 08-065-E from July 1, 2008 until
June 30, 2009.

WHEREAS: The ADMINISTRATION is in the process of preparing, drafting and issuing a Request for
Proposal, to award contracts for the physical, dental and mental health coverage for the GHIP. In
consideration of the period of time needed to prepare the RFP, the parties agree to extend the
Contract until October 31, 2009.

HENCEFORTH: The appearing Parties agree to extend the Contract #08-065 and amend the Article VIII,
Article XXIX and Appendix C, as follows:

Article I: Add the following Language at the end of Article VIII, Section 22:

For the period of the contract extension, effective from July 1, 2009 to October 31, 2009, Insurer
assures that it will provide and adequate stop-loss insurance set at five thousand dollars
($5,000.00).

Article II: To amend provision 1 in Article XXIX “Effective Date and Term” to read as follows:

	 	1.	 	This contract shall be in effect from July 1, 2008 until October 31, 2009.
	 
	 	2.	 	......
	 
	 	3.	 	.......

Article III: To amend Appendix C; to incorporate premium rates for this contract period.

 

 

All other terms and conditions of the contract number 08-065; and its amendments 08-065A through
08-065E remain unchanged. In witness whereof, the parties have duly executed this Amendment on
this ___day of                     , 2009 and affixes below their respective signature.

                                                            

Domingo Nevárez Ramírez, MHSA

Executive Director

Puerto Rico Health Insurance Administration

                                                            

SOCORRO RIVAS

Chief Executive Officer

TRIPLE-S SALUD INC.

                                                            

LUIS A. MARINI, DMD

Chief Executive Officer

Cifra 5000-212

 

 

Appendix C

TRIPLE S / TRIPLE C, INC.

The monthly premiums for all beneficiaries, including all those who are sixty-five (65) years and
older who are Medicare beneficiaries Part A or Part A and B those who are sixty-five years and
older who are not Medicare recipients is establish below on a per member per month (pmpm) rate; for
the period of July 1st, 2008 to October 31, 2009.

Monthly Premiums Rates

	 	 	 	 	 	 	 	 	 	 	 	 	 
	SSS	 	 	 	 	 	Fixed Administrative	 	 
	Region or Area	 	Premiums	 	Cost	 	Profit
	North

	 	$	87.99	 	 	$	6.30	 	 	$	2.20	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 
	Southwest

	 	$	87.71	 	 	$	6.30	 	 	$	2.19	 

The INSURER will be paid a fixed administrative cost fee and profit included in the total
premium rate paid by the Administration as detailed above. Further, the INSURER’s aggregated net
earnings (considering all INSURER’s Health Areas/Regions contracted with the ADMINISTRATION) in
excess of 2.5 of the total aggregated earned premium in this contract year period will be shared
with the ADMINISTRATION. The ADMINISTRATION share apportionment of the earnings shall be 75% and
the INSURER share shall be 25%.

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