Document:

dxcm06302014ex1032

[*****] = CERTAIN CONFIDENTIAL INFORMATION CONTAINED IN THIS DOCUMENT, MARKED BY BRACKETS AND ASTERISKS, HAS BEEN OMITTED AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION PURSUANT TO RULE 24b-2 OF THE SECURITIES EXCHANGE ACT OF 1934, AS AMENDED. CONFIDENTIAL TREATMENT HAS BEEN REQUESTED WITH RESPECT TO THE OMITTED INFORMATION.

Exhibit 10.32

Amendment Number Five to Non-Exclusive Distribution Agreement

This Amendment Number Five to the Non-Exclusive Distribution Agreement (“Amendment Number Five”) is made as of this 14th day of  March, 2014, by and between DexCom, Inc., a Delaware corporation, with a principal place of business at 6340 Sequence Drive, San Diego, California 92121 (the "Company") and BYRAM HEALTHCARE and all subsidiaries, a New Jersey corporation with offices located at 120 Bloomingdale Road, Suite 301, White Plains, NJ (the “Distributor”). 

WITNESSETH

WHEREAS, Company and Distributor previously entered into a Non-Exclusive Distribution Agreement, effective October 12, 2009, as amended on September 30, 2010, and October 11, 2011, November 14, 2012, November 1, 2013 and pursuant to the consent to the assignment of the Non-Exclusive Distribution Agreement to Byram Healthcare dated May 2, 2012 (the “Agreement”). 

WHEREAS, Company and Distributor wish to amend the Agreement as set forth herein in accordance with Section 2.2 and 17.10 of the Agreement. 

THEREFORE, Company and Distributor agree as follows:  

 1.  SECTION 4.  A new Section 4.1.37 shall be added as follows:

4.1.37    To adjudicate Product through the correct channel as determined by Product and benefit type.  Distributor shall only adjudicate Retail Product (as defined in SCHEDULE 1) via a Pharmacy Benefit (a healthcare benefit that allows for reimbursement for products and supplies that is submitted via retail and/or pharmacy channels).  All other Product shall be adjudicated via a Medical Benefit (a healthcare benefit other than a Pharmacy Benefit). 

2.  SECTION 4.  A new Section 4.1.38 shall be added as follows:

4.1.38    Not to dispense or adjudicate Products in any manner that might expose Company to financial risk via duplicate discounting of product.  Distributor shall 

1

only adjudicate Retail Products listed in Schedule 1 through the pharmacy benefit and acknowledges that adjudication of other Products in that manner would expose Company to financial risk. Company may validate managed care claim submissions to ensure that dispensed Retail Product utilization does not exceed Distributor’s purchased quantities of Company’s Retail Product as listed in Schedule 1 over the same period. If such excess is found, Distributor shall pay Company within [*****] of request, the difference between [*****]. The forgoing does not limit any other remedies that Company may have at law or in equity. Furthermore, shipment of product may be withheld until such time as Distributor has paid Company in full.

3.  SCHEDULE 1.  Schedule 1 is amended to include the following Products:  

Retail Product

	
				
	Product
	Description
	NDC
	Transfer Price*

	STK-RX-001
	DEXCOM G4 PLATINUM RECEIVER KIT (RETAIL)
	08627-0020-11
	[*****]

	STK-RX-PNK
	DEXCOM G4 PLATINUM RECEIVER KIT (RETAIL)
	08627-0020-21
	[*****]

	STK-RX-BLU
	DEXCOM G4 PLATINUM RECEIVER KIT (RETAIL)
	08627-0020-31
	[*****]

	STK-KX-001
	DEXCOM G4 PLATINUM (PEDIATRIC) RECEIVER KIT (RETAIL)
	08627-0030-11
	[*****]

	STK-KX-PNK
	DEXCOM G4 PLATINUM (PEDIATRIC) RECEIVER KIT (RETAIL)
	08627-0030-21
	[*****]

	STK-KX-BLU
	DEXCOM G4 PLATINUM (PEDIATRIC) RECEIVER KIT (RETAIL)
	08627-0030-31
	[*****]

	STT-RX-001
	G4 PLATINUM TRANSMITTER KIT (RETAIL)
	08627-0013-01
	[*****]

	STS-RX-041
	G4 PLATINUM SENSORS –     4 PACK (RETAIL)
	08627-0051-04
	[*****]

*[*****] 

In addition, if Distributor stocks Company’s Products, it shall deliver to Company a daily written Sales Tracing Report.  The Sales Tracing Report shall include the information identified in SCHEDULE 3, as well as any other information reasonably requested by Company.  

2

In the instance Distributor does not provide the Eligibility Report and, if applicable, the Sales Tracing Report within the required timeframe, the Transfer Price for Retail Products shall immediately revert to List Price with no discount for services rendered.

**[*****]
4.  SCHEDULE 3.  Schedule 3 is amended and restated in its entirety as follows:

Sales Tracing Report Format
 
Required Reporting Frequency:    Daily
Format:                .csv (comma-delimited file)
		
	Delivery Method:
	Dexcom controlled secure file transfer protocol site specific to Distributor

	
				
	Dexcom, Inc. 

	 
	 
	 

	Sales Tracings Requirements
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	Field
	Format
	Desired State
	Comments

	Dexcom drop ship info included
	Text
	No
	 

	Frequency
	Text
	Daily
	 

	Format
	Text
	CSV
	 

	Delivery method
	Text
	sftp
	 

	Customer ID Number
	Text
	Unique identifier
	A unique identifying number for each customer

	Customer First Name
	Text
	Separate field for first
	 

	Customer Last Name
	Text
	Separate field for last
	 

	Customer Street Address
	Text
	Customer Street Address
	 

	Customer City
	Text
	Customer City
	 

	Customer State
	Text
	Customer State
	 

	Customer ZIP Code
	Text
	Customer ZIP Code
	5-character; text so leading zeros are included; no Zip + 4 numbers

3

	
				
	Customer DOB
	Text
	Customer DOB
	MM/DD/YYYY

	Customer Phone
	Text
	Text
	 

	Customer Email
	Text
	Text
	 

	Physician First Name
	Text
	Separate field for first
	 

	Physician Last Name
	Text
	Separate field for last
	 

	Physician Street Address
	Text
	Physician Street Address
	 

	Physician City
	Text
	Physician City
	 

	Physician State
	Text
	Physician State
	 

	Physician ZIP Code
	Text
	Physician ZIP Code
	5-character; text so leading zeros are included; no Zip + 4 numbers

	Physician NPI
	Text
	Physician NPI
	 

	Medical Facility Name
	Text
	Medical Facility Name
	 

	Medical Facility Street Address
	Text
	Medical Facility Street Address
	 

	Medical Facility City
	Text
	Medical Facility City
	 

	Medical Facility State
	Text
	Medical Facility State
	 

	Medical Facility ZIP Code
	Text
	Medical Facility ZIP Code
	 

	Insurance Name
	Text
	Insurance Name
	 

	Item Number
	Text
	Item Number
	 

	Quantity
	Text
	Quantity
	Unit quantity - e.g. 1 box of sensors is '1', and not the number of individual sensors included

	Benefit Type
	Text
	Benefit Type
	DME or Pharmacy

	H/W Lot Number
	 
	H/W Lot Number
	Where distributor stocks and ships hardware

	H/W Serial Number
	 
	H/W Serial Number
	Where distributor stocks and ships hardware

	Date of Sale
	 
	Date of Sale
	MM/DD/YYYY

	Shipper
	 
	Dexcom or distributor name
	Dexcom or Distributor, where distributor provides tracings including shipments from both locations

4

5.  SCHEDULE 5.  Schedule 5 is amended and restated in its entirety as follows:  

SCHEDULE 5

Quality Agreement
		
	1.0
	SCOPE

		
	1.1
	This Quality Agreement (the “Quality Agreement”) is incorporated within the Distribution Agreement dated October 12, 2009, as amended on September 30, 2010, and October 11, 2011, November 14, 2012, November 1, 2013 and pursuant to the consent to the assignment of the Non-Exclusive Distribution Agreement to Byram Healthcare dated May 2, 2012 (the “Agreement”) between Distributor and Company pertaining to the distribution and sale of Products.  Capitalized terms not otherwise defined herein shall have the meaning assigned to them in the Agreement.

		
	1.2
	This Quality Agreement shall be effective on the Effective Date and shall remain in effect until the Agreement expires, is terminated or the Quality Agreement is modified.

		
	2.0
	DEFINITIONS / ACRONYMS

		
	2.1
	“Applicable Documents”:  Documents used to develop a specific document (i.e. standards, regulations) and documents referenced in the text of the specific document.

		
	2.2
	"Government Agency" means any body which has the authority to act on behalf of the government of the Union or State to ensure that the requirements of all laws applicable to the Products and Distributor are carried out and adhered to in the State.

		
	2.3
	"Customer Complaint" means any written, electronic or oral communication that alleges deficiencies related to the identity, quality, durability, reliability, safety or performance of a medical device that has been placed on the market.

		
	2.4
	“CGM”: Continuous Glucose Monitoring.

5

		
	2.5
	“Correction” means repair, modification, adjustment, relabeling, destruction, or inspection (including patient monitoring) of a product without its physical removal to some other location.

		
	2.6
	“Document” means any information, either written or stored electronically, including specifications, procedures, standards, methods, instructions, plans, files, forms, notes, reviews, analyses, and reports.

		
	2.7
	“Government Agency” means a federal (e.g. FDA) or state (Health and Human Services Food and Drug Branch) organization that has the power to provide services for conformity assessment on the conditions set out in the Federal Food, Drug, and Cosmetic Act (FD&C Act) and United States Code (U.S.C) as part for the sale of medical device products. This normally means assessing the manufacturers conformity to the essential requirements listed in each directive. 

		
	2.8
	 “Lot” or “Batch” means one or more components or finished devices that consist of a single type, model, class, size, composition, or software version that are manufactured under essentially the same conditions and that are intended to have uniform characteristics and quality within specified limits.

		
	2.9
	“Label” means a display of written, printed, or graphic matter upon the immediate container of any article.  Any word, statement, or other information appearing on the immediate container must also appear “on the outside container or wrapper, if any there be, of the retain package of such article, or is easily legible through the outside container of wrapper.”

		
	2.10
	“Labeling” means any  Labels and other written, printed, or graphic matter (1) upon any article or any of its containers or wrappers, or (2) displaying such article” at any time while a device is held for sale after shipment or delivery for shipment in interstate commerce.

		
	2.11
	 “Quality Records” means Documents containing recorded information, regardless of the medium or characteristic, which demonstrate the effectiveness of the quality management system and that provide evidence that products meet regulatory requirements and comply with specified product requirements.

		
	2.12
	“Removal” means the physical removal of a device from its point of use to some other location for repair, modification, adjustment, relabeling, destruction, or inspection.

		
	2.13
	“Stock Recovery” means the correction or removal of a device that has not been marketed or that has not left the direct control of the manufacturer, i.e., the device is located on the premises owned, or under the control of, the manufacturer, and no portion of the lot, model, code, or other relevant unit involved in the corrective or removal action has been released for sale or use.

6

		
	2.14
	"Recall" means when there is a risk of death or serious deterioration to the state of health, the return of a medical device to the supplier, its modification by the supplier at the site of installation, its exchange or its destruction, in accordance with the instructions contained in the advisory notice.

		
	2.15
	"Medical Device Reporting System" is a system of incident reporting to the Federal Food and Drug Administration (FDA), for all medical devices which are approved for inter-state commerce, where such incidents lead to corrective action relevant to medical devices.  Medical Device Reporting Systems maintained by the Distributor shall comply with all applicable laws, the rules and regulations promulgated by the Federal or any State. This system is intended to allow data to be correlated between the FDA and manufactures to improve the protection of health and safety of patients, users and others by reducing the likelihood of the same type of adverse incident being repeated in different places at different times. 

		
	3.0
	PROCESS CONTROLS

		
	3.1
	Both parties shall be responsible for all process control activities relative to the Products, including but not limited to, assurance of receipt, identification, traceability, storage, handling, inventory control, contamination control, complaint handling and trending and process validations, as required by Title 21 of United States Code of Federal Regulations, and other applicable regulations, and governmental laws.

		
	3.2
	Both parties shall maintain appropriate documented procedures.

		
	3.3
	Company shall provide evidence that packaging containers maintain the integrity, quality, function, and sterility of the product for the entire shelf life, and not produce toxic residues during storage.  Packaging must prevent or indicate the occurrence of tampering.

		
	4.0
	TRAINING AND DOCUMENT CHANGE CONTROL

		
	4.1
	Distributor shall be responsible for managing an effective employee training program and document change control system relative to the receipt, identification, traceability, storage, handling, inventory control, contamination control and complaint handling and trending at the location of Distributor and its third party suppliers.

		
	4.2
	Distributor must train its employees to perform their job function and to this Quality Agreement as required.

		
	5.0
	VALIDATION

7

		
	5.1
	Distributor shall be responsible for managing qualified processes and systems as required of suppliers (e.g. computer system) by law.

		
	5.2
	Both parties shall be responsible for managing an effective product and process validation system relative to the distribution of the Products at the location of the Distributor and its third party suppliers.

		
	5.3
	Both parties shall develop and implement validation or qualification protocols for significant processes, equipment, and computer systems.

		
	5.4
	Company shall be responsible for managing an effective product and process validation system relative to the manufacture of the Products at the location of the Company and its third party suppliers.

		
	6.0
	DISTRIBUTION AND HANDLING

		
	6.1
	Products shipped by the Distributor must be shipped using documented procedures for the handling, storage, packaging, preservation, and delivery of the Products.  

		
	6.2
	Distributor shall deliver Products to its customers using documented procedures for handling, storage, packing, preservation, and delivery of the Products.

		
	6.3
	Disposables must have at least three months of expiration dating left, unless specific variance by lot number has been agreed to by both parties, before being shipped to any end-user customer.  

		
	6.4
	The Distributor will not modify any product packaging that it receives from the Company.  Shipping containers shall be validated to ensure that the safety and integrity of the Product is maintained during transit, including shipping methods that conform with the Product’s acceptable temperature and humidity ranges.

		
	6.5
	Distributor must maintain storage & handling as follows:

G4 Platinum Product
	
			
	Product Name
	Storage Temperature
	Humidity

	Sensor
	2-25°C (36-77°F)
	0-95% Relative

	Transmitter
	0-45°C (32-113°F)
	10-95% Relative

	Receiver
	0-45°C (32-113°F)
	10-95% Relative

G4 Platinum Product - Retail

8

	
			
	Product Name
	Storage Temperature
	Humidity

	Sensor
	2-25°C (36-77°F)
	0-95% Relative

	Transmitter
	0-45°C (32-113°F)
	10-95% Relative

	Receiver
	0-45°C (32-113°F)
	10-95% Relative

G4 Platinum Product - Pediatric
	
			
	Product Name
	Storage Temperature
	Humidity

	Sensor
	2-25°C (36-77°F)
	0-95% Relative

	Transmitter
	0-45°C (32-113°F)
	10-95% Relative

	Receiver
	0-45°C (32-113°F)
	10-95% Relative

		
	7.0
	LOT TRACEABILITY

		
	7.1
	Distributor shall establish and maintain procedures for identifying the Products by suitable means from receipt and during all stages of production and delivery.  This shall include procedures to provide full lot traceability for each unit, lot, or batch of finished Products during all stages of production and delivery to the Distributor.  

		
	7.2
	Distributor shall establish and maintain procedures to provide traceability to the first consignee.

		
	7.3
	Distributor shall establish and maintain procedures to provide traceability to the end user.

		
	7.4
	Both parties shall use reasonable efforts to assist the other in maintaining respective lot traceability.

		
	7.5
	Both parties are required to track the following information detailed in the table to the end user. 

9

		
	8.0
	G4 Platinum Product

	
			
	Product
	Description
	Lot traceability Tracking Requirement

	STK-GL-001
	G4 Platinum Receiver Kit – BLK
	Lot Number identified on the box

	STK-GL-PNK
	G4 Platinum Receiver Kit – PNK
	Lot Number identified on the box

	STK-GL-BLU
	G4 Platinum Receiver Kit – BLU
	Lot Number identified on the box

	STT-GL-003
	G4 Transmitter Kit
	Lot Number identified on the box

	STR-GL-001
	G4 Platinum Replacement Receiver Kit – BLK
	Lot Number identified on the box

	STR-GL-PNK
	G4 Platinum Replacement Receiver Kit – PNK
	Lot Number identified on the box

	STR-GL-BLU
	G4 Platinum Replacement Receiver Kit – BLU
	Lot Number identified on the box

	STS-GL-011
	G4 Platinum Sensors Kit (package of one (1))
	Lot Number identified on the box

	STS-GL-041
	G4 Platinum Sensors Kit (package of four (4))
	Lot Number identified on the box

		
	9.0
	G4 Platinum Product - Pediatric

10

	
			
	Product
	Description
	Lot traceability Tracking Requirement

	STK-KD-001
	G4 Platinum Pediatric Receiver Kit – BLK
	Lot Number identified on the box

	STK-KD-PNK
	G4 Platinum Pediatric Receiver Kit – PNK
	Lot Number identified on the box

	STK-KD-BLU
	G4 Platinum Pediatric Receiver Kit – BLU
	Lot Number identified on the box

	STT-GL-003
	G4 Transmitter Kit
	Lot Number identified on the box

	STR-KD-001
	G4 Platinum Replacement Receiver Kit – BLK
	Lot Number identified on the box

	STR-KD-PNK
	G4 Platinum Replacement Receiver Kit – PNK
	Lot Number identified on the box

	STR-KD-BLU
	G4 Platinum Replacement Receiver Kit – BLU
	Lot Number identified on the box

	STS-GL-011
	G4 Platinum Sensors Kit (package of one (1))
	Lot Number identified on the box

	STS-GL-041
	G4 Platinum Sensors Kit (package of four (4))
	Lot Number identified on the box

		
	10.0
	G4 Platinum Product - Retail

	
			
	Product
	Description
	Lot traceability Tracking Requirement

	STK-RX-001
	DEXCOM G4 PLATINUM RECEIVER KIT (RETAIL)
	Lot Number identified on the box

	STK-RX-PNK
	DEXCOM G4 PLATINUM RECEIVER KIT (RETAIL)
	Lot Number identified on the box

	STK-RX-BLU
	DEXCOM G4 PLATINUM RECEIVER KIT (RETAIL)
	Lot Number identified on the box

	STK-KX-001
	DEXCOM G4 PLATINUM (PEDIATRIC) RECEIVER KIT (RETAIL)
	Lot Number identified on the box

	STK-KX-PNK
	DEXCOM G4 PLATINUM (PEDIATRIC) RECEIVER KIT (RETAIL)
	Lot Number identified on the box

	STK-KX-BLU
	DEXCOM G4 PLATINUM (PEDIATRIC) RECEIVER KIT (RETAIL)
	Lot Number identified on the box

	STT-RX-001
	G4 PLATINUM TRANSMITTER KIT (RETAIL)
	Lot Number identified on the box

	STS-RX-041
	G4 PLATINUM SENSORS –     4 PACK (RETAIL)
	Lot Number identified on the box

11

		
	11.0
	PACKAGING AND LABELING

		
	11.1
	Company shall provide packaging and labeling specifications that call out clear labeling requirements. 

		
	11.2
	Company shall ensure that the labels, inserts and accompanying documentation satisfy the requirements of the applicable regulations.

		
	11.3
	Distributor shall not modify the labels, primary or secondary packaging, inserts or accompanying documentation without the written approval of the Company.

		
	12.0
	 FINISHED PRODUCT NON-CONFORMANCES

		
	12.1
	Any nonconforming finished product requires written approval from Company’s Quality Assurance before shipment to any Customer by Distributor. 

		
	13.0
	COMPLAINT HANDLING AND REPORTING

		
	13.1
	Distributor shall be responsible for the establishment and maintenance of a system for handling all Tier I Complaints pertaining to Products distributed under the Agreement.  "Complaint" means any written, electronic, telephone call and/or oral communication that alleges deficiencies related to the identity, quality, durability, reliability, safety, effectiveness, or performance of a device after it is released to distribution.  A complaint is any indication of the failure of a device to meet customer or user expectations for quality or to meet performance specifications.  A “Tier I Complaint” includes complaints that pertain to the purchase, payment, billing, delivery, packaging and customer service.  This system shall include receipt, review, corrective/preventative action and maintenance of files.  Distributor will not perform any Tier II Complaint Handling, as defined below.  

		
	13.2
	Company shall be responsible for the establishment and maintenance of a system for handling Tier II Complaints pertaining to Products distributed under the Agreement.  A “Tier II Complaint” includes complaints that pertain to product functionality, trouble shooting, or adverse events.  This system shall include receipt, review, investigation, corrective/preventative action and maintenance of files.  It shall also include adverse event reporting to the appropriate governmental authorities as required by regulations in the applicable jurisdictions.

		
	13.3
	Company shall notify Distributor in writing of legal and regulatory matters relating to the Products, including:

12

		
	13.3.1
	Any regulatory actions by governmental authorities (e.g., inspection citations, warning letters, or other non-conformance notices).

		
	13.3.2
	Regulatory enforcement actions such as injunctions or seizures.

		
	13.3.3
	FDA registration activity (e.g., non-conformance notices, hold points).

		
	13.3.4
	Complaints received from Customers within the Territory that have not been processed through the Company’s complaint handling system.

		
	13.3.5
	Adverse incidents relating to customers within the Territory (e.g., MDR’s.).

		
	13.4
	Distributor shall notify Company in writing of the following:

		
	13.4.1
	Any serious regulatory action relating to the Products.

		
	13.4.2
	Tier I Complaints regarding Products or Instruments. Distributor shall code, trend and report monthly all phone call inquiries and Tier I Complaint data pertaining to Products.  

		
	13.4.3
	If an adverse incident is received that may be subject to FDA’s Medical Device Reporting regulation that pertain to Products and Instruments, then Distributor shall notify Company  no later than 24 hours following Distributor’s initial receipt of the adverse event.

		
	13.4.4
	  Distributor shall forward all complaints pertaining to Products and Instruments to Company no later than 5 working days following Distributor’s initial receipt of the complaint.

		
	14.0
	FIELD ACTIONS

		
	14.1
	The Company will be responsible for the initiation of any recalls or other field actions related to the Products.

		
	14.2
	Both parties will comply with recalls or general corrective actions, provided such recalls or general corrective actions do not, in the opinion of Company violate or cause Company to violate the laws of any jurisdiction affected by the recalls or corrective action.

		
	14.3
	If Distributor and Company do not agree on a course of action, Company may initiate field actions related to the Products, but may not use field action to cause Distributor to lose Customers. 

		
	15.0
	AUDITS

		
	15.1
	  Company shall have the right to conduct audits of Distributor’s facilities and operations during normal business hours at its own expense and upon thirty (30) days notice to Distributor in order to assess compliance with all applicable 

13

regulations, procedures and this Quality Agreement.  Any such audits will be conducted by a national “big four” independent accounting firm (or other independent accounting firm whose audit department is a separate stand alone function of its business and which possesses liability insurance with coverage of at least $3,000,000), subject to such firm’s execution of a confidentiality agreement in form reasonably acceptable to Distributor. Company shall be permitted to conduct one audit per calendar year or more frequently in the instance there exists a material difference between the inventory records of Distributor and Company.
		
	16.0
	RECORD RETENTION

		
	16.1
	Both parties shall retain all sales and medical records as required by law.  

		
	16.2
	Prior to any record destruction pertaining to Company Products and Instruments, the Distributor will notify the Company in writing.  If the record destruction is not approved the Company will assume responsibility of the records.

		
	17.0
	REGULATORY AND REGISTRATION ADMINISTRATION

		
	17.1
	Distributor, at its expense, is responsible for registration responsibilities, and for agreed upon domestic registration costs in accordance with Federal and State regulations.  Distributor shall provide sufficient data and information to support domestic registrations.

		
	17.2
	Company, at its expense, is responsible for registration responsibilities, and for agreed upon registration costs of Products in the Territory.  Company shall provide sufficient data and information to support such registrations.

		
	18.0
	QUALITY SYSTEM COMPLIANCE

		
	18.1
	Distributor shall establish and maintain a quality system in compliance with Title 21, United States Code of Federal Regulations and other applicable regulations, and governmental laws. Distributor shall also ensure that its contract vendors maintain a quality system in compliance with current Title 21, United States Code of Federal Regulations and other applicable regulations, and governmental laws.

		
	18.2
	Distributor acknowledges that without registering as an out-of-state home medical device retail facility, an out-of-state home medical device retail facility shall not sell or distribute prescription devices in this state through any person or media other than a wholesaler who is licensed pursuant to Chapter 9 (commencing with Section 4000) of Division 2 of the California Business and Professions Code.  

14

		
	19.0
	ADDITIONAL DISTRIBUTOR REQUIREMENTS

		
	19.1
	Distributor agrees to comply with all applicable laws and regulations. Distributor agrees to obtain the necessary licenses to meet its obligations under this agreement.

		
	19.2
	Records should be accurate, indelible and legible. Entries must be dated and the person performing a documented task must be identified. Records must provide a complete history of the work performed. Products identified in this Quality Agreement are not in conflict with the laws of the importing country.

6.   SCHEDULE 6.  A new Schedule 6 shall be added as follows:  

SCHEDULE 6

The Eligibility Report

Required Reporting Frequency:        Monthly
Format:                    .csv (comma-delimited file)
		
	Delivery Method:
	Dexcom controlled secure file transfer protocol site specific to Distributor

The Eligibility Report will include the following fields:

Territory
Patient Name

15

Customer Number
Patient DOB
Patient Gender
Patient Address
Patient Zip
Patient Contact Info
Clinic
Physician
Physician Zip
Primary Insurance
Primary Insurance Member
Secondary Insurance
Secondary Insurance Member
Employer Group No (Primary)
Policy Holder Name (Primary)
Relationship to Patient (Primary)
PBM (Primary)
RxBin (Primary)
RxGroup (Primary)
Rxld (Primary)
PCN (Primary)
Pharmacy Deductible Remaining
Receiver (Primary) Pharmacy Coverage Copay (No Coverage or Copay Amount)
Transmitter (Primary) Pharmacy Coverage Copay (No Coverage or Copay Amount)
Sensor (Primary) Pharmacy Coverage Copay (No Coverage or Copay Amount)
Receiver (Secondary) Pharmacy Coverage Copay (No Coverage or Copay Amount)
Transmitter (Secondary) Pharmacy Coverage Copay (No Coverage or Copay Amount)
Sensor (Secondary) Pharmacy Coverage Copay (No Coverage or Copay Amount)

7.   All other terms and conditions of the Agreement shall remain in full force and effect.  

16

IN WITNESS WHEREOF, authorized representatives of the parties have executed this Amendment Number Five as of date first set out above.

Signed by:    /s/ Jess Roper            
Jess Roper
Title:      V.P. and Chief Financial Officer

for and on behalf of
DexCom, Inc.

Signed by:        /s/ Perry Bernocchi         
Name: Perry Bernocchi
Title:  CEO        

for and on behalf of 
Byram

17EX-10.3

 Exhibit 10.3 

2014 STOCK OPTION PLAN OF SS&C TECHNOLOGIES HOLDINGS, INC. 

STOCK OPTION AGREEMENT 
  

	1.	Grant of Option. 

 This agreement evidences the grant by the Company on the Grant Date to
the Participant, of an option to purchase, in whole or in part, on the terms provided herein and in the Plan, an aggregate of the Shares set forth in the Stock Option Grant Notice at an Exercise Price per Share set forth in the Stock Option Grant
Notice (without commission or other charge). 
 It is intended that the option (“Option”) evidenced by this agreement shall
[not] be an incentive stock option (“Incentive Stock Option”) as defined in Section 422 of the Internal Revenue Code of 1986, as amended, and any regulations promulgated thereunder (the “Code”). Except as
otherwise indicated by the context, the term “Participant,” as used in this Option, shall be deemed to include any person who acquires the right to exercise this Option validly under its terms. 

 

	2.	Vesting Schedule. 

 (a) This Option will become exercisable (“vest”) as to 25%
of the original number of Shares on the first anniversary of [the Grant Date] and as to an additional 1/36 of the remaining number of Shares on the day of the month of [the Grant Date] beginning with each successive month
following the first anniversary of [the Grant Date] until the fourth anniversary of [the Grant Date], provided that such vesting shall cease upon the date of a Termination of Service for any reason. 

(b) This Option shall become fully vested and exercisable immediately prior to the effective date of a Change in Control. 

(c) The right of exercise shall be cumulative so that to the extent this Option is not exercised in any period to the maximum extent
permissible it shall continue to be exercisable, in whole or in part, with respect to all Shares for which it is vested until the earlier of the Final Expiration Date or the termination of this Option under Section 3 hereof or the Plan. 

 

	3.	Exercise of Option. 

 (a) Form of Exercise. Except as otherwise provided by the
Plan Administrator, each election to exercise this Option shall be in writing (including electronic submission), signed by the Participant and received by the Company at its principal office, accompanied by this agreement, and payment in full in the
manner provided in the Plan. The Participant may purchase less than the number of shares covered hereby, provided that no partial exercise of this Option may be for any fractional share or for fewer than ten whole shares. 

 (b) Payment Upon Exercise of Options. Shares purchased upon the exercise of this Option
may be paid for using one of the methods set forth in Sections 5(f)(1)-(f)(5) of the Plan. Unless otherwise instructed by the Participant, [and unless this Option is an Incentive Stock Option, ]Shares purchased upon the exercise
of this Option shall be paid for pursuant to a “net exercise,” as a result of which the Participant will receive (i) the number of Shares underlying the portion of the Option being exercised, less (ii) such number of Shares as is
equal to (A) the aggregate exercise price for the portion of the Option being exercised divided by (B) the Fair Market Value on the date of exercise. 

(c) Continuous Relationship with the Company Required. Except as otherwise provided in this Section 3, this Option may not be
exercised unless the Participant, at the time he or she exercises this Option, is, and has been at all times since the Grant Date, an employee or officer of, or consultant or advisor to, the Company or any Company Affiliate (an “Eligible
Participant”). 
 (d) Expiration of Option. 

(1) This Option may not be exercised to any extent by anyone after the first to occur of the following events: 

(A) The Final Expiration Date; 

(B) Except as the Plan Administrator may otherwise approve, ninety (90) days following the date of the Participant’s Termination of
Service for any reason other than Cause, death or Disability; 
 (C) Except as the Plan Administrator may otherwise approve, the date of the
Participant’s Termination of Service for Cause; or 
 (D) Except as the Plan Administrator may otherwise approve, twelve months
following the Participant’s Termination of Service by reason of the Participant’s death or Disability. 
 (2) For the purposes of
this Agreement, the date of the Termination of Service shall be the last day that the Participant provides services as an employee or officer of, or consultant or advisor to, the Company or any Company Affiliate, whether such day is selected by
agreement with the Participant or unilaterally by the Company or any Company Affiliate and whether with or without advance notice. For the avoidance of doubt, no period of notice that is given or that ought to have been given under applicable law in
respect of such Termination of Service will be utilized in determining entitlement under the Plan or this Agreement. Any action by the Company or any Company Affiliate taken in accordance with the terms of the Plan and this Agreement as set out
aforesaid shall be deemed to fully and completely satisfy any liability or obligation of the Company or any Company Affiliate to the Participant in respect of the Plan or this Agreement arising from or in connection with such Termination of Service,
including in respect of any period of notice given or that ought to have been given under applicable law in respect of such Termination of Service. 

  
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	4.	Tax Matters. 

 (a) Withholding. The Participant shall pay to the Company or any
applicable Company Affiliate, or make provision satisfactory to the Company or such Company Affiliate, for payment of, any taxes required by law to be withheld in connection with the exercise of any portion of this Option, as applicable, under one
of the methods permitted by the Plan. Subject to any applicable legal conditions or restrictions, the Company shall, unless otherwise instructed by a Participant, withhold from the Shares otherwise issuable to the Participant upon the exercise of
this Option or any portion thereof a number of whole Shares having a Fair Market Value, determined as of the date of exercise, not in excess of the minimum of tax required to be withheld by law (or such lower amount as may be necessary to avoid
variable award accounting); provided that the foregoing is at such time permitted under the terms of the agreements governing any indebtedness to which the Company or any Company Affiliate may be a party; and provided, further that no fractional
Shares will be retained to satisfy any portion of the withholding tax and the Participant hereby agrees to satisfy any additional amount of withholding taxes that are not satisfied through the retention of Shares by the Company. Any Shares retained
by the Company pursuant to this Section shall be deducted from the underlying Shares to be received by such Participant upon exercise of this Option. Any adverse consequences to the Participant arising in connection with the Share withholding
procedure set forth in the preceding sentence shall be the sole responsibility of the Participant. 
 (b) Disqualifying Disposition.
If this Option is an Incentive Stock Option and the Participant disposes of Shares acquired upon exercise of this Option within two years from the Grant Date or one year after such Shares were acquired pursuant to exercise of this Option, the
Participant shall notify the Company in writing of such disposition. 
  

	5.	Nontransferability of Option. 

 This Option may not be sold, assigned, transferred,
pledged or otherwise encumbered by the Participant, either voluntarily or by operation of law, except by will or the laws of descent and distribution, and, during the lifetime of the Participant, this Option shall be exercisable only by the
Participant. 
  

	6.	Provisions of the Plan. 

 This Option is subject to the provisions of the Plan (including
the provisions relating to amendments to the Plan), a copy of which is furnished to the Participant with this Option. 
  

	7.	Definitions. 

 Whenever the following terms are used in this Agreement, they shall have
the meaning specified below unless the context clearly indicates to the contrary. Capitalized terms used in this Agreement and not defined below shall have the meaning given such terms in the Plan. The singular pronoun shall include the plural,
where the context so indicates. 
 (a) Agreement. “Agreement” shall have the meaning set forth in the Stock Option Grant
Notice. 
 (b) Cause. “Cause” shall mean, 

(1) The Plan Administrator’s determination that the Participant failed to substantially perform his or her duties (other than any such
failure resulting from the Participant’s disability) which is not remedied within ten days after receipt of written notice from the Company or any Company Affiliate, as applicable, specifying such failure; 

  
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 (2) the Plan Administrator’s determination that the Participant failed to carry out, or
comply with any lawful and reasonable directive of the Plan Administrator or the Participant’s immediate supervisor, which is not remedied within ten days after receipt of written notice from the Company or any Company Affiliate, as applicable,
specifying such failure; 
 (3) the Participant’s conviction, plea of no contest, plea of nolo contendere, or imposition of
unadjudicated probation for any felony or a crime involving moral turpitude; 
 (4) the Participant’s unlawful use (including being
under the influence) or possession of illegal drugs on the Company’s or any Company Affiliate’s, as applicable, premises or while performing the Participant’s duties and responsibilities; or 

(5) the Participant’s commission of a material act of fraud, embezzlement, misappropriation, willful misconduct or breach of fiduciary
duty against the Company or any Company Affiliate, as applicable. 
 Notwithstanding the foregoing, if the Participant is a party to a written employment or
consulting agreement with the Company (or any Company Affiliate), then “Cause” shall be as such term is defined in the applicable written employment or consulting agreement. 

(c) Change in Control. “Change in Control” shall mean the consummation of any transaction or series of transactions pursuant
to which one or more Persons or group of Persons acquires (a) capital stock of the Company possessing the voting power sufficient to elect a majority of the members of the Board or the board of directors of the successor to the Company (whether
such transaction is effected by merger, consolidation, recapitalization, sale or transfer of the Company’s capital stock or otherwise) or (b) all or substantially all of the assets of the Company and its subsidiaries. 

(d) Company. “Company” shall mean SS&C Technologies Holdings, Inc. 

(e) Disability. “Disability” shall mean “disability,” as such term is defined in Section 22(e)(3) of the Code.

 (f) Exercise Price. “Exercise Price” shall mean the per share price set forth in the Stock Option Grant Notice. 

(g) Final Expiration Date. “Final Expiration Date” shall mean the date set forth in the Stock Option Grant Notice. 

(h) Grant Date. “Grant Date” shall be the date set forth in the Stock Option Grant Notice. 

(i) Person. “Person” shall mean an individual, partnership, corporation, limited liability company, business trust, joint
stock company, trust, unincorporated association, joint venture, governmental authority or other entity of whatever nature. 

  
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 (j) Plan. “Plan” shall mean the 2014 Stock Option Plan of SS&C Technologies
Holdings, Inc. 
 (k) Stock Option Grant Notice. “Stock Option Grant Notice” shall mean the first page of this Agreement.

 (l) Termination of Service. “Termination of Service” shall mean the time when the Participant ceases to be an Eligible
Participant for any reason, including, but not by way of limitation, termination with or without Cause, by resignation, failure to be elected or appointed, discharge, death or retirement, but excluding, at the discretion of the Plan Administrator,
terminations which result in a temporary severance of the service relationship. The Plan Administrator, in its good faith judgment, shall determine the effect of all matters and questions relating to Termination of Service, including, but not by way
of limitation, the question of whether a Termination of Service resulted from discharge for Cause, and all questions of whether a particular leave of absence constitutes a Termination of Service. Notwithstanding any other provision of the Plan, the
Company or any Company Affiliate has an absolute and unrestricted right to terminate a Participant’s service at any time for any reason, with or without cause, except to the extent expressly provided otherwise in a written employment or
consulting agreement with the Company or any Company Affiliate. 

  
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