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                    MEDICAL
      AUDIT RESOURCE SERVICES, INC.

     

                
      Proposal for Comprehensive Review Services

     

                                                                                       
      SERVICES AGREEMENT

     

    This
      Services Agreement ("Agreement") is made this 07 day of May 2008 by and between
      Medical Audit Resources, Inc. ("MARSI"), and Inform Worldwide Holdings, Inc.,
      its affiliates and subsidiaries ("IWWI"). MARSI and IWWI may be referred to
      herein each as a "Party" and collectively as the "Parties".

     

    I.              RECITALS

     

    
      	
              A.  

            	
              MARSI
                is in the business of providing coding, quality of care and physician
                documentation reviews and services to the health care
                industry.

            

    

     

    
      	
              B.  

            	
              IWWI,
                for itself and on behalf of its affiliates, subsidiaries and other
                related
                entities (including PrimaCare Corporation and Medical Resources,
                LLC), and
                other entities that IWWI may hereafter acquire, and on behalf of
                the
                health care providers identified in Exhibit A hereto that are managed
                by
                IWWI or an affiliate thereof and which have given their consent to
                be
                bound by this Agreement (providers which give their consent are referred
                to herein as the "Contracted Providers"), desires to obtain from
                MARS I
                certain services and materials on the terms and conditions set forth
                below.

            

    

     

    II.              About
      MARSI

     

    Medical
      Audit Resource Services, Inc. (MARSI) has fifteen years of experience working
      with physicians, managed care entities and a variety of other health care
      professionals, with a focus on accurate, defensible coding and clinical
      documentation components and how they relate to reimbursement and quality of
      care.

     

    The
      experts at MARSI can provide assistance with the intricate complexities of
      coding rules and regulations, and assist management in its efforts to guide
      and
      educate its physicians in proper, efficient, accurate and comprehensive
      documentation.

     

    We
      have provided these services to clients nationwide for nearly fifteen years.
      MARSI has utilized the expertise of many professionals, and experience with
      many
      healthcare systems to develop the most comprehensive review programs available.
      Additionally, MARSI has assembled a core team of physicians to aid in the
      education of physicians from a peer perspective. MARSI believes the interrelated
      areas of physician documentation, coding compliance and quality of patient
      care
      must be evaluated as a group.

     

    We
      propose to educate, train, monitor and report on all aspects of ongoing efforts
      to change documentation habits of IWWI' s physicians to achieve the following
      results:

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    
      	
              ·  

            	
              Improved
                patient care

            

    

    
      	
              ·  

            	
              Increased
                revenue

            

    

    
      	
              ·  

            	
              Decreased
                risk of over-coding

            

    

    
      	
              ·  

            	
              Increased
                identification of HCCs

            

    

    
      	
              ·  

            	
              Improved
                physician documentation

            

    

    
      	
              ·  

            	
              Improved
                team support of individual patient
                visits

            

    

     

    MARSI's
      goal is to deliver more than is expected. During the course of this engagement
      we will:

    
      	
              ·  

            	
              Compare
                all aspects of the physician documentation with the existing diagnosis
                codes

            

    

    
      	
              ·  

            	
              Make
                recommendations for accurate correction of incorrectly coded
                patients

            

    

    
      	
              ·  

            	
              Educate
                physicians on how to improve accurate and comprehensive documentation
                skills

            

    

     

    
      	
              ·  

            	
              Reinforce
                to the physicians the financial considerations of accurate and
                comprehensive documentation

            

    

     

    
      	
              ·  

            	
              Consult
                with the plan or group to initiate permanent solutions to documentation
                and quality of care problems

            

    

    
      	
              ·  

            	
              Help
                migrate the plan or group into Comprehensive Disease
                Management

            

    

     

    III.              Scope
      of Work

     

    MARSI
      will perform statistical and algorithmic analysis of data provided by IWWI
      to
      aid in the identification of potential outlier trends. MARSI will provide
      specific data parameters and elements for inclusion in this data. Through the
      results of this analysis, MARSI will identify specific encounters for review.
      Additional encounters will also be selected by MARSI for inclusion in the review
      based on our experience and areas known to be problematic.

     

    MARSI
      will provide team members on-site at the facility to scan the medical records
      into MARSI's server. From there, our team of professionals will review the
      medical record and physician documentation focusing on the following
      areas/components:

     

    IV.              Services

     

    A.
      HCC /
      Risk Adjustment

    
      	
              1.  

            	
              Expert
                review

            

    

    
      	
              2.  

            	
              Patient
                specific recommendation to be placed in
                chart

            

    

    
      	
              3.  

            	
              Reporting
                for each physician and total

            

    

    
      	
              4.  

            	
              Full
                reporting, including ROI

            

    

     

    B.
      Quality of Care

    1.
      Does
      the physician:

    
      	
              a)  

            	
              Identify
                all patient problems?

            

    

    
      	
              b)  

            	
              Consider
                possible diagnosis

            

    

    
      	
              c)  

            	
              Develop
                a plan for each problem?

            

    

    
      	
              d)  

            	
              Follow-up
                on each problem?

            

    

    
      	
              2.  

            	
              Is
                the physician thorough?

            

    

    
      	
              3.  

            	
              5%
                will be reviewed by MARSI
                physicians

            

    

     

    C.
      Physician Education and
      Documentation Improvement, specifically;

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    C.  

    I.   Quality
      promoted by documentation

    
      	
              2.  

            	
              Identification
                of diagnoses: facilitated by
                documentation.

            

    

    
      	
              3.  

            	
              Disease
                management: plans and documentation

            

    

    
      	
              4.  

            	
              Medical
                necessity supported by
                documentation

            

    

    
      	
              a)  

            	
              Meds,
                procedures

            

    

    
      	
              b)  

            	
              CPT
                (fee for service)

            

    

     

    D.
      Ongoing Physician Compliance Program

    I.    Provide
      physician "help line" to increase physician compliance

     

    
      	
              2.  

            	
              Monitor
                physician compliance: monthly compliance report showing action taken
                on
                recommendations

            

    

    
      	
              3.  

            	
              Promote
                physician compliance: follow-up by MARSI and IWWI staff to insure
                that
                appropriate action taken on recommendations by
                physicians

            

    

    
      	
              4.  

            	
              Personal
                communication with physicians to increase
                compliance

            

    

     

    E.
      Independent Audit Committee

    
      	
              I.  

            	
              MARSI
                will chair and provide members to an independent audit committee
                which

            

    

    will
      provide the following functions:

    
      	
              a)  

            	
              Compliance
                review

            

    

    
      	
              b)  

            	
              Quality
                review

            

    

    
      	
              c)  

            	
              Utilization
                review

            

    

    
      	
              d)  

            	
              Medical
                management / Disease management

            

    

    
      	
              2.  

            	
              MARSI
                and the committee will identify needs/problem areas as
                above

            

    

    
      	
              3.  

            	
              Report
                of Findings

            

    

    
      	
              4.  

            	
              MARSI
                will generate a monthly report of
                findings

            

    

    
      	
              5.  

            	
              Physician/Provider
                Training

            

    

     

    a)
      MARSI will assist in training/retraining of physicians and
      providers

     

    6.
      Independent Audit Committee Ongoing Audit

    
      	
              a)  

            	
              MARSI
                will audit for ongoing improvement based on the corrective action
                plan
                generated by the Independent Audit
                Committee

            

    

     

    V.              Other
      Services

     

    
      	
               

            	
              A.
                Non-Risk / Fee for Service: as mutually agreed upon I. CPT
                review

            

    

    
      	
              2.  

            	
              Medical
                necessity reviews

            

    

    
      	
              3.  

            	
              Documentation
                Improvement

            

    

    
      	
              4.  

            	
              Physician
                education (over codes &
                under codes)

            

    

     

    VI.              Methods
      &
      Processes

     

    A.
      Scanning records

    
      	
              1.  

            	
              Teams

            

    

    
      	
              2.  

            	
              In-office

            

    

     

    B.
      Review by MARSI experts

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    C.
      Reports

    
      	
              1.  

            	
              Patient
                report to office

            

    

    
      	
              2.  

            	
              Placed
                in each reviewed chart

            

    

     

    D.
      Compilation to PrimaCare monthly

     

    E.
      MARSI
      physician review

    
      	
              1.  

            	
              Quality,
                etc.

            

    

    
      	
              2.  

            	
              5%
                of charts

            

    

    
      	
              3.  

            	
              Monthly
                summary

            

    

    
      	
              4.  

            	
              Discussed
                monthly

            

    

     

    F.
      Physician education

    
      	
              1.  

            	
              Seminars

            

    

    
      	
              2.  

            	
              One-on-One

            

    

     

    MARSI
      will utilize highly skilled coding experts for the majority of the reviews,
      except:

     

    
      	
              A.  

            	
              Any
                chart that the coders have determined are medically questionable will
                be referred to a MARSI physician;

            

    

     

    
      	
              B.  

            	
              A
                sampling of charts (5%) may be reviewed by MARSI physicians to augment
                the
                above.

            

    

    A
      larger
      sampling needs to agree upon in advance.

     

    MARSI
      will utilize expert outpatient physician reviewers/educators with PCP experience
      and expertise. MARSI also can provide expert ER, Inpatient and specialty
      physician reviewers.

     

    Provide
      tools to improve efficiencies in diagnosis reporting (HCC capture), therefore
      assuring the most appropriate reimbursement reporting.

     

    MARSI
      will provide detailed reports of our findings.

     

    MARSI
      will provide follow-up on physician queries.

     

    VII.              Payments

     

    A.
      Fee
      Minus

    
      	
              1.  

            	
              A
                combination of contingency fee and front-end
                reimbursement.

            

    

    
      	
              2.  

            	
              The
                front-end amounts are subtracted from the contingency
                fee.

            

    

    
      	
              3.  

            	
              The
                beginning of the contingency fee is not paid until the end of the
                first
                quarter after the initial review is
                complete.

            

    

    

    B.
      Front-End Payments

    
      	
              1.  

            	
              Escrow
                $100,000 for every 1000 charts for
                review

            

    

    
      	
              2.  

            	
              Monthly
                invoicing for actual costs (minus any portion already paid, i.e.
                50% of
                estimated cost for each invoice from
                above).

            

    

    
      	
              3.  

            	
              Specifically:

            

    

    a)
      $45/chart - coding review/reporting.

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    

     

    
      	
              b)  

            	
              Approximately
                $1 O/chart - scanning fee, to be billed at actual costs plus
                20%

            

    

    
      	
              c)  

            	
              $1,500/month
                - Physician education, (approx 6 hours per
                month).

            

    

     

    
      	
              d)  

            	
              $1
                0,670/month - Physician review (5% of charts)
                $250/hour

            

    

     

    C.
      Final Payment

     

    
      	
              1.  

            	
              18.5%
                of the absolute value of MARS I recommendations for each reporting
                period,
                both undercodes and overcodes, not to exceed 30% of expected
                recovery.

            

    

     

    
      	
              2.  

            	
              Client
                will not pledge MARSI's portion of funds with out written
                consent.

            

    

    
      	
              3.  

            	
              Payment
                is made once funds are received from HMO's. Client will on a "Best
                Efforts
                Basis" contact the HMO's about reimbursement from them as
                well.

            

    

     

    Example/estimate:

    $26.6
      million increase for 8,000 covered lives $21.3 million to IWWI

    30%
      =
      $6.4 million

     

    Total
      to IWWI: $16.6 million from an investment of approximately $530,000, for a
      3,121% ROI per 8,000 lives

     

    D
      Other payments and fees

     

    
      	
              1.  

            	
              Expert
                testimony and preparation-coder
                $140/hr

            

    

     

    
      	
              2.  

            	
              Expert
                testimony and preparation-physician
                $250/hr

            

    

    
      	
              3.  

            	
              A
                late fee equal to 8% will assessed on any unpaid and invoiced balance
                which remains unpaid 30 days after due, a late fee equal to 12% will
                assessed on any unpaid and invoiced balance which remains unpaid
                60 days
                after due, a late fee equal to 15% will assessed on any unpaid and
                invoiced balance which remains unpaid 90 days after
                due.

            

    

     

    
      	
              4.  

            	
              Other
                mutually agreed upon services and
                fees.

            

    

     

    VIII.              IWWl's
      Obligations

     

    A.
      IWWI agrees to:

    
      	
              1.  

            	
              Provide
                MARSI access to your information, billing records, patient records
                and any
                other information necessary for our
                review.

            

    

     

    
      	
              2.  

            	
              Fully
                cooperate with MARSI so we are able to perform our
                review.

            

    

     

    
      	
              3.  

            	
              Sign
                a letter stating that all the information we received is, to the
                best of
                your knowledge, complete, truthful and accurate and that all pertinent
                information at your disposal that is relevant and material to our
                review
                has been disclosed to us.

            

    

     

    
      	
              4.  

            	
              Timely
                pay our fees.

            

    

     

    
      	
              5.  

            	
              Follow
                our recommendations after proper discussion and
                agreement.

            

    

     

    IX.           Miscellaneous

     

    
      	
               

            	
              A
                The Term of the Agreement will be such that either party may cancel
                at
                anytime, upon ninety (90) days written
                notice.

            

    

     

    
      	
               

            	
              B
                MARSI will notify the IWWI immediately of any areas of concern identified.
                MARSI will further change the parameters of the review if necessary,
                as
                mutually agreed

            

    

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    

     

    
      	
               

            	
              C
                This contract begins on this day noted above and below and expires
                at
                12:01 AM on the one-year anniversary
                date.

            

    

     

    
      	
               

            	
              D
                Each Party agrees that it will not, without the prior express written
                consent and approval of content by and of the other, issue any press
                release or announcement or otherwise disclose the existence or nature
                of
                this Agreement and/or proposed business arrangement. Each Party agrees
                to
                obtain written approval and consent from the other for the content
                of any
                press release or announcement
                issued.

            

    

     

    
      	
               

            	
              E
                This Agreement terminates and supersedes all prior understandings
                or
                agreements on the subject matter hereof. Only a further writing that
                is
                duly executed by both Parties may modify this
                Agreement

            

    

     

    
      	
               

            	
              F
                This Agreement contains the entire understanding of the parties hereto
                with regard to the subject matter contained herein or therein, and
                supersedes all prior written or oral agreements, understandings or
                letters
                of intent between or among any of the parties hereto. This Agreement
                shall
                not be amended, modified or supplemented except by a written instrument
                signed by an authorized representative of each of the parties
                hereto.

            

    

     

    
      	
               

            	
              G
                This Agreement has been mutually prepared, negotiated and drafted
                by each
                of the parties hereto and thereto. The parties agree that the terms
                of
                this Agreement shall be construed and interpreted against each party
                in
                the same manner and that no such provisions shall be construed or
                interpreted more strictly against one party on the assumption that
                an
                instrument is to be construed more strictly against the party which
                drafted the agreement. The failure of any party hereto to enforce
                at any
                time any provision of this Agreement shall not be construed to be
                a waiver
                of such provision, nor in any way to affect the validity of this
                Agreement
                or any part hereof or the right of any party thereafter to enforce
                each
                and every such provision. No waiver of any breach of this Agreement
                shall
                be held to constitute a waiver of any other or subsequent
                breach.

            

    

     

    
      	
               

            	
              H
                Wherever possible, each provision hereof shall be interpreted in
                such
                manner as to be effective and valid under applicable law, but in
                case
                anyone or more of the provisions contained herein shall, for any
                reason,
                be held to be invalid, illegal or unenforceable in any respect, such
                provision shall be ineffective to the extent, but only to the extent,
                of
                such invalidity, illegality or unenforceability without invalidating
                the
                remainder of such invalid, illegal or unenforceable provision or
                provisions or any other provisions hereof, unless such a construction
                would be unreasonable.

            

    

     

    
      	
               

            	
              I
                This Agreement shall be binding upon and shall inure to the benefit
                of the
                parties hereto, their respective successors, assigns, legal
                representatives, estates, executors, administrators and heirs; without
                limitation of the foregoing upon any merger of IWWI in which IWWI
                is not
                the surviving entity.

            

    

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    
      	
               

            	
              J
The
                obligations of IWWI hereunder shall be primary obligations, unconditional,
                absolute, and, without limiting the generality of the foregoing,
                shall not
                be released, discharged or otherwise affected
                by:

            

    

     

    
      	
              1.  

            	
              any
                change in the limited liability company existence, structure or ownership
                of IWWI or the Contracted Providers, or any insolvency, bankruptcy,
                reorganization, arrangement, readjustment, assignment for the benefit
                of
                creditors, composition, receivership, liquidation, marshaling of
                assets
                and liabilities or other similar events or proceedings affecting
                IWWI or
                the Contracted Providers or their assets or any resulting release
                or
                discharge of any obligation of IWWI or the Contracted Providers under
                this
                Agreement;

            

    

     

    
      	
              2.  

            	
              any
                merger or consolidation of IWWI or the Contracted Providers into
                or with
                any person or entity, or any sale, lease or transfer of any of the
                assets
                of IWWI or the Contracted Providers to any other person or
                entity.

            

    

     

    
      	
               

            	
              K
                IWWI expressly waives any and all defenses now or hereafter arising
                or
                asserted by reason of any bankruptcy, insolvency, reorganization,
                arrangement, readjustment of debt, liquidation or dissolution proceeding
                commenced by or against any person or entity, including any discharge
                of,
                or bar or stay against collecting, all or any of the payment obligations
                (or any interest thereon) in or as a result of any such
                proceeding.

            

    

     

    L
      MARSI is entitled to review all payer reimbursement information and
      documentation.

    IWWI
      agrees to make the information and documentation readily available upon
      request.

     

    
      	
               

            	
              M
                In the event either party fails to perform its obligations under
                this
                agreement, any or all elements of this contract may be immediately
                terminated, upon written notice, excepting any provision relating
                to
                payment of fees, expenses and contingency payments then due or scheduled
                to come due.

            

    

     

    
      	
               

            	
              N
                The parties shall report any and all compliance concerns to the other
                party on a timely basis, in writing. This will enable the noncompliant
                party to take necessary steps to cure any compliance issue. Neither
                party
                will discuss compliance concerns with any other entity during the
                term of
                this agreement and for one (1) year following the expiration of this
                agreement.

            

    

     

    
      	
              O.

            	
              Either
                party may terminate this agreement, excepting any obligation for
                payment
                of fees, expenses and contingency payments, immediately, upon written
                notice, if the other party does not cure any compliance concerns
                within 90
                days of the notice as defined in Section VII (N.) of this
                Agreement.

            

    

     

    
      	
               

            	
              P
                The obligations of payment as defined in Section VI of this Agreement
                shall survive any termination or cancellation of this Agreement for
                any
                reason whatsoever.

            

    

    
      
         

      

      
         

        
          

        

      

      
         

      

    

     

    OUR
      ONLY
      OBLIGATION UNDER THIS CONTRACT IS TO PROVIDE THE SERVICES AS DESCRIBED ABOVE
      AND
      COOPERATE, IF NECESSARY, WITH THE DEFENSE IN CASE OF AN AUDIT OR REGULATORY
      PROCEEDINGS.

     

    

    We
      appreciate the opportunity of providing these services to you and look forward
      to speaking with you again soon.

    

    Sincerely,

    
 

             /s/
      Todd
      Husty          .

    Todd
      M.
      Husty, Director

    Medical
      Audit Resource Services, Inc.

     

    

    The
      balance of this space is intentionally blank. Signature page
      follows.

     

    

    AGREED
      TO
      AND ACCEPTED:

    IWWI
      Corporation and Medical Resources, LLC

    

    ­­­­­­­­­­­­­­­­­

    

           /s/
      Ashvin Mascarenhas  .

    By
      : Ashvin Mascarenhas

    

         Its:
      CEO

    

    Date:
      May 7 2008

     

    

    AGREED
      TO AND ACCEPTED:

    Medical
      Audit Resource Services, Inc.

    

         /s/
      Todd
      Husty                   .

    By
      : Todd Husty

    

    Its
      : President

    

    Date
      May 7, 2008Filed by Bowne Pure Compliance

 

Exhibit 10.1

AMENDED AND RESTATED

COMPENSATION PLAN FOR NON-EMPLOYEE DIRECTORS

This is the Compensation Plan (the “Plan”) for Non-Employee Directors (each a
“Non-Employee Director”) of Nektar Therapeutics (the “Company”). This Plan was approved by the
Board of Directors and made effective June 1, 2006 and amended and restated by Board of
Directors and made effective March 1, 2007 and amended and restated by Board of Directors March
20, 2008 effective as of January 1, 2008. The terms and conditions of the Plan are described
below:

	 	•	 	An annual retainer of $25,000 for serving on the Board of Directors,
payable in equal quarterly installments;

	 
	 	•	 	An annual retainer of $25,000 for serving as the Chair or Lead
Director of the Board of Directors, payable in quarterly installments;

	 
	 	•	 	An annual retainer of $7,500 for serving as the Chair of the Company’s
Audit Committee, payable in equal quarterly installments;

	 
	 	•	 	An annual retainer of $5,000 for serving as Chair of any other
committee established by the Board of Directors, payable in equal
quarterly installments;

	 
	 	•	 	Each Non-Employee Director shall receive $2,000 for attending each
in-person or telephonic board meeting. Each Non-Employee Director shall
receive $1,000 for each in-person board meeting attended via conference
telephone.

	 
	 	•	 	Each Non-Employee Director shall receive $1,500 for attending each in
person or telephonic committee meeting. Each Non-Employee Director shall
receive $750 for each in-person committee meeting attended via conference
telephone.

	 
	 	•	 	Each Non-Employee Director shall be reimbursed for customary expenses
for attending Board of Director, committee and stockholder meetings;

 

 

 

	 	•	 	Upon initial appointment to the Board of Directors, each Non-Employee
Director shall receive equity compensation composed of
either (i) stock options at an exercise price equal to the closing price
of the Company’s common stock as reported by the Nasdaq Global Select
Market on the grant date, under the Company’s equity incentive plan; or
(ii) fifty percent (50%) stock options at an exercise price equal to the
closing price of the Company’s common stock as reported by the Nasdaq
Global Select Market on the grant date and fifty percent (50%) restricted
stock unit awards, each under the Company’s equity incentive plan. This
initial appointment equity compensation award will be based on one hundred
and fifty percent (150%) of the annual equity compensation grant, as
determined annually by the Board of Directors in consultation with its
professional advisors. For purposes of the foregoing, the value of stock
options will be determined based on the Black-Scholes valuation
methodology and the value of restricted stock units will be based on the
value of the Company’s common stock on the grant date;

	 
	 	•	 	In September of each year, each Non-Employee Director shall receive
equity compensation composed of either (i) stock options at an exercise
price equal to the closing price of the Company’s common stock as
reported by the Nasdaq Global Select Market on the grant date, under the
Company’s equity incentive plan; or (ii) fifty percent (50%) stock
options at an exercise price equal to the closing price of the Company’s
common stock as reported by the Nasdaq Global Select Market on the grant
date and fifty percent (50%) restricted stock unit awards, each under the
Company’s equity incentive plans. This annual equity compensation award
will be based on a review of equity compensation for non-employee
directors of comparable companies as determined annually by the Board of
Directors in consultation with its professional advisors. For purposes of
the foregoing, the value of stock options will be determined based on the
Black-Scholes valuation methodology and the value of restricted stock
units will be based on the value of the Company’s common stock on the
grant date. If any Non-Employee Director is appointed following the
annual grant of equity compensation, he or she will also be entitled to a
pro-rata portion of the most recent annual grant of equity compensation
determined by the Board of Directors; and

	 
	 	•	 	Non-Employee Directors are also eligible for discretionary grants of
options or restricted stock units under the Company’s equity incentive
plan.

 

-2-

 

Options granted to a Non-Employee Director for their annual service on the Board of Directors shall
vest monthly over a period of one year. Restricted stock unit awards granted to a Non-Employee
Director for their annual shall vest monthly over a period of one year. Options granted to a
Non-Employee Director for their initial appointment to
the Board of Directors shall vest monthly over a period of three years. Restricted stock unit
awards granted to a Non-Employee Director for their initial appointment shall vest monthly over a
period of three years. The exercise price of options granted to a Non-Employee Director shall be
equal to 100% of the fair market value of the Company’s common stock on the grant date. Following
completion of a Non-Employee Director’s service on the Board of Directors, his or her stock options
will remain exerciseable for a period of eighteen months. The term of options granted to a
Non-Employee Director is eight years. In the event of a change of control, the vesting of each
option or restricted stock unit award shall accelerate in full as of the closing of such
transaction.

 

-3-

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