Document:

Form of Executive Officer Change-in-Control Agreement

 Exhibit 10.46(A) 
 Keystone Automotive Industries, Inc. 
 Change-in-Control Agreement 
 THIS AGREEMENT is entered into and is effective as of _________, 2007 (the “Effective Date”), by and between Keystone Automotive Industries,
Inc., a California corporation, (the “Company”) and _______________ (the “Executive”). 
 Background Information

 A. The Executive is currently employed by the Company and possesses considerable experience and knowledge that the Company desires to
maintain. 
 B. The Company recognizes that a Change in Control of the Company is likely to cause uncertainty of the Executive’s
continued employment and such uncertainty may result in the loss of the valuable services of the Executive to the detriment of the Company and its shareholders. 
 C. The Board has determined that appropriate steps should be taken to reinforce and encourage the continued attention and dedication of members of the Company’s management to their assigned duties without
distraction in the face of potentially disturbing circumstances arising from the possibility of a Change in Control. 
 D. The Company has
therefore approved entering into this Agreement with the Executive to afford reasonable security against the altered conditions of employment which could result from any such Change in Control of the Company. 
 E. As consideration for the afforded security provided by this Agreement, the Executive agrees to certain restrictive covenants as described herein.

 AGREEMENT 
 NOW,
THEREFORE, in consideration of the foregoing and of the mutual covenants and agreements of the parties set forth in this Agreement, and of other valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree
as follows: 
 SECTION 1. DEFINITIONS. 
 1.1 “Cause” for termination by the Company of the Executive’s employment shall mean (i) the willful and continued failure by the Executive to substantially perform the Executive’s duties with the
Company (other than any such failure resulting from the Executive’s incapacity due to physical or mental illness or any such actual or anticipated failure after the issuance of a Notice of Termination for Good Reason by the Executive pursuant
to Section 3.1) that has not been cured within 30 days after a written demand for substantial performance is delivered to the Executive by the Board, which demand specifically identifies the manner in which the Board believes that the Executive
has not substantially performed the Executive’s duties; or (ii) the willful engaging by the Executive in conduct which is demonstrably and materially injurious to the Company or its subsidiaries, monetarily or otherwise; or (iii) the
conviction of, or entering a plea of guilty or “nolo contendere” to, a felony by the Executive; or (iv) a willful violation of any of the 

 
covenants contained in Section 5 of this Agreement by the Executive. For purposes of clauses (i), (ii) and (iv) of this definition, no act, or
failure to act, on the Executive’s part shall be deemed “willful” unless done, or omitted to be done, by the Executive not in good faith and without reasonable belief that the Executive’s act, or failure to act, was in the best
interest of the Company. 
 1.2 “Change in Control” shall mean the occurrence of any of the following events:

 (A) The acquisition by any person (within the meaning of Section 3(a)(9) of the Securities Exchange Act of 1934, as
amended from time to time (“Exchange Act”), as modified and used in Sections 13(d) and 14(d) thereof) (“Person”) of “Beneficial Ownership” (within the meaning set forth in Rule 13d-3 under the Exchange Act) of thirty
percent (30%) or more of the combined voting power of the then outstanding voting securities of the Company entitled to vote generally in the election of Directors (the “Outstanding Company Voting Securities”); provided, however, that
the following acquisitions shall not constitute a Change of Control: (A) any acquisition by a Person who on the Effective Date is the Beneficial Owner of thirty percent (30%) or more of the Outstanding Company Voting Securities;
(B) any acquisition directly from the Company, including without limitation, a public offering of securities; (C) any acquisition by the Company or any of its subsidiaries; or (D) any acquisition by any employee benefit plan (or
related trust) sponsored or maintained by the Company or any of its subsidiaries; provided, however, the acquisition by any Person of Beneficial Ownership of thirty percent (30%) or more of the combined voting power shall not constitute a
Change in Control if Keystone Automotive Industries, Inc. maintains a Beneficial Ownership of more than fifty percent (50%) of the then-outstanding voting securities of the Company entitled to vote generally in the election of Directors;

 (B) Individuals who constitute the Board of Directors (“Board”) of the Company as of the Effective Date hereof
(the “Incumbent Board”) cease for any reason to constitute at least a majority of the Board, provided that any individual becoming a Director subsequent to the Effective Date whose election, or nomination for election by the Company’s
shareholders, was approved by a vote of at least a majority of the Directors then comprising the Incumbent Board shall be considered as though such individual were a member of the Incumbent Board, but excluding, for this purpose, any such individual
whose initial assumption of office is in connection with an actual or threatened election contest relating to the election or removal of the Directors of the Company or other actual or threatened solicitation of proxies of consents by or on behalf
of a Person other than the Board; 
 (C) Consummation of a reorganization, merger, or consolidation to which the Company is a
party or a sale or other disposition of all or substantially all of the assets of the Company (a “Business Combination”), in each case unless, following such Business Combination: (A) all or substantially all of the individuals and
entities who were the Beneficial Owners of Outstanding Company Voting Securities immediately prior to such Business Combination beneficially own, directly or indirectly, more than fifty percent (50%) of the combined voting power of the
outstanding voting securities entitled to vote generally in the election of directors of the corporation resulting from the Business Combination (including, without limitation, a corporation which as a result of such transaction owns the Company or
all or substantially all of the Company’s assets either 

  

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directly or through one or more subsidiaries) (the “Successor Entity”) in substantially the same proportions as their ownership immediately prior
to such Business Combination of the Outstanding Company Voting Securities; (B) no Person (excluding any Successor Entity or any employee benefit plan, or related trust, of the Company or such Successor Entity) beneficially owns, directly or
indirectly, thirty percent (30%) or more of the combined voting power of the then outstanding voting securities of the Successor Entity, except to the extent that such ownership existed prior to the Business Combination; and (C) at least a
majority of the members of the board of directors of the Successor Entity were members of the Incumbent Board (including individuals deemed to be members of the Incumbent Board by reason of the proviso to paragraph (ii) of this Section) at the
time of the execution of the initial agreement or of the action of the Board providing for such Business Combination; or 
 (D) Approval by the shareholders of the Company of a complete liquidation or dissolution of the Company. 
 1.3
“Code” shall mean the Internal Revenue Code of 1986, as amended from time to time. 
 1.4 “Date of
Termination” with respect to any purported termination of the Executive’s employment after a Change in Control and during the Term, shall mean (i) if the Executive’s employment is terminated for Disability, thirty
(30) days after Notice of Termination is given (provided that the Executive shall not have returned to the full-time performance of the Executive’s duties during such thirty (30) day period), or (ii) if the Executive’s
employment is terminated for any other reason, the date specified in the Notice of Termination (which, in the case of a termination by the Company without Cause, shall not be less than thirty (30) days and, in the case of a termination by the
Executive, shall not be less than fifteen (15) days nor more than sixty (60) days, respectively, from the date such Notice of Termination is given). 
 1.5 “Disability” shall mean the Executive’s incapacity due to physical or mental illness resulting in absence from the full-time performance of the Executive’s duties with the Company
for a period of six (6) consecutive months. 
 1.6 “Good Reason” for termination by the Executive of the
Executive’s employment shall mean the occurrence (without the Executive’s prior express written consent) of any one of the following acts by the Company, or failures by the Company to act, unless, in the case of any act or failure to act
described in paragraph A, E, F or G below, such act or failure to act is corrected prior to the Date of Termination specified in the Notice of Termination given in respect thereof: 
 (A) the assignment to the Executive of any duties inconsistent with the Executive’s status as a key employee of the Company or a
substantial adverse alteration in the nature or status of the Executive’s responsibilities from those in effect immediately prior to the Change in Control, or a material adverse change in the Executive’s titles or offices or reporting
relationships as in effect immediately prior to the Change in Control; 
  

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 (B) a reduction by the Company in the Executive’s annual base salary as in effect on
the Effective Date, or as the same may be increased from time to time; 
 (C) the relocation of the Executive’s principal
place of employment to a location more than 25 miles from the Executive’s principal place of employment immediately prior to the Change in Control; 
 (D) the failure by the Company to pay to the Executive any portion of the Executive’s current compensation or to pay to the Executive any portion of an installment of deferred compensation under any deferred
compensation program of the Company, within seven (7) days following the date such compensation is due; 
 (E) the
failure by the Company to continue in effect any compensation plan in which the Executive participates immediately prior to the Change in Control which is material to the Executive’s total compensation, unless an equitable arrangement (embodied
in an ongoing substitute or alternative plan) has been made with respect to such plan, or the failure by the Company to continue the Executive’s participation therein (or in such substitute or alternative plan) on a basis not less favorable,
both in terms of the amount or timing of payment of benefits provided and the level of the Executive’s participation relative to other Executives, as existed immediately prior to the Change in Control; 
 (F) the failure by the Company to continue to provide the Executive with benefits substantially similar to those enjoyed by the Executive
under any of the Company’s pension, savings, life insurance, medical, health and accident, or disability plans in which the Executive was participating immediately prior to the Change in Control, the taking of any other action by the Company
which would directly or indirectly materially reduce any of such benefits or deprive the Executive of any material fringe benefit enjoyed by the Executive at the time of the Change in Control, or the failure by the Company to provide the Executive
with the number of paid vacation days currently awarded to Executive or to which the Executive is entitled on the basis of years of service with the Company in accordance with the Company’s normal vacation policy in effect at the time of the
Change in Control; or 
 (G) any purported termination of the Executive’s employment which is not effected pursuant to a
Notice of Termination satisfying the requirements of Section 3.1; for purposes of this Agreement, no such purported termination shall be effective. 
 The Executive’s right to terminate the Executive’s employment for Good Reason shall not be affected by the Executive’s incapacity due to physical or mental illness. The Executive’s continued
employment shall not constitute consent to, or a waiver of rights with respect to, any act or failure to act constituting Good Reason hereunder. 
 1.7 “Potential Change in Control” shall be deemed to have occurred if the Company enters into an agreement, the consummation of which would result in the occurrence of a Change in Control; the Company or any Person
publicly announces an intention to take or to consider taking actions which, if consummated, would constitute a Change in Control; any Person becomes the Beneficial Owner, directly or indirectly, of securities of the Company representing 10% or more
of the Outstanding Company Voting Securities (not including any securities acquired directly from the Company or its Affiliates); or the Board adopts a resolution to the effect that, for purposes of this Agreement, a Potential Change in Control has
occurred. 
  

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 1.8 “Term” shall mean the period commencing on the Effective Date and ending on
December 31, 2008; provided, however, that commencing on January 1, 2009 and each January 1 thereafter, the Term shall automatically be extended for one additional year unless, not later than June 30 of the
preceding year, the Company shall have given notice to the Executive not to extend the Term; and further provided, however, that if a Change in Control shall have occurred during the Term, the Term shall expire no earlier than
twenty-four (24) months beyond the month in which such Change in Control occurred. 
 SECTION 2. BENEFITS. 
 2.1 Severance Payments. Subject to the provisions of Section 2.2, if the Executive’s employment is terminated following a Change
in Control and during the Term, other than (A) by the Company for Cause, (B) by reason of death or Disability, or (C) by the Executive without Good Reason, then the Company shall pay the Executive the amounts, and provide the
Executive the benefits, described in this Section 2.1 (“Severance Payments”). For purposes of this Agreement, the Executive’s employment shall be deemed to have been terminated following a Change in Control by the Company without
Cause or by the Executive with Good Reason, if (i) the Executive’s employment is terminated by the Company without Cause prior to a Change in Control (whether or not a Change in Control ever occurs) at the request or direction of a Person
who has entered into an agreement with the Company, the consummation of which would constitute a Change in Control, (ii) the Executive terminates his employment for Good Reason prior to a Change in Control (whether or not a Change in Control
ever occurs) and the circumstance or event which constitutes Good Reason occurs at the request or direction of such Person, or (iii) the Executive’s employment is terminated by the Company without Cause or by the Executive for Good Reason
and such termination or the circumstance or event which constitutes Good Reason is otherwise in connection with or in anticipation of a Change in Control (whether or not a Change in Control ever occurs). Severance Payments include the following:

 (A) A lump-sum cash amount equal to the Executive’s unpaid base salary, accrued vacation pay, unreimbursed business
expenses, and all other items earned by and owed to the Executive through and including the Date of Termination. 
 (B)
Notwithstanding any provision of any annual or long-term incentive plan to the contrary, a lump sum amount, in cash, equal to the prorated portion at the target award level of any unpaid incentive compensation which has been allocated or awarded to
the Executive preceding the Date of Termination under any such plan. 
 (C) A lump-sum cash amount equal to [two (2)/ one and
one-half (1.5)] times the Executive’s annual base salary at the rate in effect immediately prior to the Date of Termination or, if higher, immediately prior to the first occurrence of an event or circumstance constituting Good Reason.

  

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 (D) A lump sum cash amount equal to [two (2)/ one and one-half (1.5)] times the greater
of (i) the Executive’s target bonus percentage times the Executive’s then current annual base salary (but not less than the annual base salary for the immediately preceding year), and (ii) the average annual bonus earned by the
Executive with respect to the three fiscal years (or, if the Executive has been employed for less than three fiscal years, the average annual bonus for the number of full fiscal years of the Executive’s employment) ending immediately prior to
the fiscal year in which occurs the Date of Termination or, if higher, immediately prior to the fiscal year in which occurs the first event or circumstance constituting Good Reason. 
 (E) For the [twenty-four (24)/eighteen (18)] month period immediately following the Date of Termination, the Company shall arrange to
provide the Executive and his dependents at the exact same cost to the Executive, and at the same coverage level as in effect as of the Executive’s Date of Termination (subject to changes in coverage levels applicable to all employees
generally), continuation of the Executive’s (and the Executive’s eligible dependents’) coverage for health insurance, including, without limitation, group health care, dental, and vision coverage, and life insurance. If the Executive
becomes covered under the health insurance coverage of a subsequent employer which does not contain any exclusion or limitation with respect to any preexisting condition of the Executive or the Executive’s eligible dependents, the
Company’s obligation to provide health insurance coverage pursuant to this Section 2.1(E) shall be discontinued prior to the end of the twenty-four (24) month continuation period. In addition, if the Executive is a Specified Employee
as defined in Code Section 409A and the regulations thereunder, then, if the aggregate payments by the Company for life insurance coverage for the Executive during the six (6) month period following the Executive’s Date of Termination
exceed the applicable dollar limit under Section 402(g)(1)(B) of the Code for the year in which the Date of Termination occurs, any such excess shall be paid by the Executive and reimbursed by the Company on the date that is six (6) months
following the Executive’s Date of Termination or, if earlier, the date of the Executive’s death. 
 (F) Unless
prohibited by the terms of any plan document under which an award agreement has been issued to the Executive, as of the date of a Change in Control, all stock options, restricted stock, and performance share awards shall become immediately vested.
Unless prohibited by the terms of any plan document under which an award agreement has been issued to the Executive, performance shares vest based on the greater of: (i) the Executive’s target performance share award, and (ii) the
performance share award the Executive would receive based on the performance of the Company for the period beginning on the first day of the performance period and ending on the last day of the month immediately preceding the Date of Termination,
straight-line annualized for the remainder of the performance period. Unless prohibited by the terms of any plan document under which an award agreement has been issued to the Executive, outstanding stock options shall remain exercisable until the
earlier of the latest date upon which the stock option could have expired by its original terms under any circumstances or the tenth anniversary of the original date of grant of the stock option. 
 2.2 Section 280G Provisions. If any payment or benefit received or to be received by the Executive in connection with a Change in
Control or the termination of the Executive’s employment (whether pursuant to the terms of this Agreement or any other plan, arrangement or agreement with the Company, any Person whose actions result in a Change in Control or any Person
affiliated with the Company or such Person) (all such payments and benefits, including the Severance Payments, being hereinafter referred to as the 

  

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“Total Payments”) would be subject (in whole or part), to the excise tax imposed under Section 4999 of the Code (including any similar state
or local tax and any related interest or penalties, “Excise Tax”), the Executive will be paid an additional payment in an amount such that, after the Executive’s payment of all taxes on or otherwise as a result of the additional
payment (including any Excise Tax, income tax, related interest or penalties and effect of any disallowed deductions), the Executive retains an amount of the additional payment equal to the Excise Tax. All determinations required to be made under
this Section 2.2, including as to any underlying assumptions, will be made by an accounting firm selected by the Company and reasonably acceptable to the Executive. The accounting firm will provide the Executive and the Company with its
determination of the additional payment, if any, that is due with respect to any payment or benefit (together with reasonably detailed supporting schedules) within 15 business days after they receive notice from the Executive that the payment has
been made or benefit provided, or at such earlier time as the Company may request. Any additional payment determined due under this Section 2.2 will be paid within five days of the later of (a) the due date of the Excise Tax and
(b) the date of the accounting firm’s determination, but in no event later than the end of the Executive’s taxable year in which the Excise Tax is due. If the Executive reasonably requests and the accounting firm determines that no
Excise Tax is payable, the accounting firm will provide the Executive with a written opinion, in form and substance reasonably satisfactory to the Executive, that the Executive is not required to pay any Excise Tax and the Executive’s not
reporting any Excise Tax on his applicable federal income tax return will not result in the imposition of a negligence or similar penalty. The Company will bear all fees and expenses of the accounting firm, including any costs of retaining experts.

 2.3 Time of Payment. The Severance Payments shall be made not later than the third day following the Date of Termination, in
the case of amounts to be paid in a single lump sum. Notwithstanding the foregoing, if the Executive is a Specified Employee as defined in Code Section 409A and the regulations thereunder, then, to the extent that any of the Severance Payments
are subject to Section 409A of the Code and must not be paid or provided before six (6) months have elapsed after the date of the Executive’s Date of Termination in order to avoid the additional tax under Code Section 409A, such
payments shall not commence or be made until six (6) months following the Executive’s Date of Termination or, if earlier, the date of the Executive’s death. In the case of installment payments, if any, the first payment shall include
all installments required under this Agreement that otherwise would have been paid during such six (6) month period. 
 2.4
Legal Fees. The Company shall also pay to the Executive all reasonable legal fees and expenses incurred by the Executive in disputing in good faith any issue relating to the termination of the Executive’s employment, in seeking in good
faith to obtain or enforce any benefit or right provided by this Agreement or in connection with any tax audit or proceeding to the extent attributable to the application of Section 4999 or Section 409A of the Code to any payment or
benefit provided hereunder. This right of reimbursement shall continue for the life of the Executive. The amount of expenses eligible for reimbursement in any single calendar year shall not affect the amount of such expenses eligible for
reimbursement in any other calendar year. Such payments shall be made within five (5) business days after delivery of the Executive’s written request for payment accompanied with such evidence of fees and expenses incurred as the Company
reasonably may require, but in no event later than the last day of the calendar year following the calendar year in which the expenses were incurred. 
  

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 SECTION 3. TERMINATION PROCEDURES AND COMPENSATION DURING DISPUTE. 
 3.1 Notice of Termination. After a Change in Control and during the Term, any purported termination of the Executive’s employment
(other than by reason of death) shall be communicated by written Notice of Termination from one party to the other party in accordance with Section 6. For purposes of this Agreement, a “Notice of Termination” shall mean a notice which
shall indicate the specific termination provision in this Agreement relied upon and shall set forth in reasonable detail the facts and circumstances claimed to provide a basis for termination of the Executive’s employment under the provision so
indicated. Further, a Notice of Termination for Cause is required to include a copy of a resolution duly adopted by the affirmative vote of not less than a majority of the entire membership of the Board at a meeting of the Board which was called and
held for the purpose of considering such termination (after reasonable notice to the Executive and an opportunity for the Executive, together with the Executive’s counsel, to be heard before the Board) finding that, in the good faith opinion of
the Board, the Executive was guilty of conduct set forth in the definition of Cause. 
 3.2 Dispute Concerning Termination. If
within fifteen (15) days after any Notice of Termination is given, the party receiving such Notice of Termination notifies the other party that a dispute exists concerning the termination, the Date of Termination shall be extended until the
earlier of (i) the date on which the Term ends or (ii) the date on which the dispute is finally resolved, either by mutual written agreement of the parties or by a final judgment, order or decree of a court of competent jurisdiction (which
is not appealable or with respect to which the time for appeal therefrom has expired and no appeal has been perfected). The Date of Termination shall be extended by a notice of dispute given by the Executive only if such notice is given in good
faith and the Executive pursues the resolution of such dispute with reasonable diligence. 
 3.3 Compensation During Dispute.
If a purported termination occurs following a Change in Control and during the Term and the Date of Termination is extended in accordance with Section 3.2, the Company shall continue to pay the Executive the full compensation in effect when the
notice giving rise to the dispute was given (including, but not limited to, base salary) and continue the Executive as a participant in all compensation, benefit and insurance plans in which the Executive was participating when the notice giving
rise to the dispute was given, until the Date of Termination, as determined in accordance with Section 3.2. Amounts paid under this Section 3.3 are in addition to all other amounts due under this Agreement and shall not be offset against
or reduce any other amounts due hereunder. 
 SECTION 4. NO MITIGATION. The Company agrees that, if the Executive’s employment with the Company
terminates during the Term, the Executive is not required to seek other employment or to attempt in any way to reduce any amounts payable to the Executive by the Company pursuant to this Agreement. Further, the amount of any payment or benefit
provided for in this Agreement (other than Section 2.1(E)) shall not be reduced by any compensation earned by the Executive as the result of employment by another employer, by retirement benefits, by offset against any amount claimed to be owed
by the Executive to the Company, or otherwise. 
  

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 SECTION 5. PROTECTIVE COVENANTS 
 5.1 Non-competition. For purposes of this Section 5, references to the “Company” shall include, individually and collectively, the Company and its affiliates and its/their respective
successors and assigns. The Executive agrees that, during the Executive’s employment with the Company and for a period of [twenty-four (24)/eighteen (18)] months following the termination of the Executive’s employment with the Company by
the Executive or the Company for whatever reason, the Executive shall not, without the prior written consent of the Board of Directors, either directly or indirectly, as an officer, employee, director, agent, independent contractor, consultant,
volunteer, partner, member, manager, owner, shareholder, principal, or in any other capacity or otherwise on behalf of himself or any other person or entity: 
 (A) own an interest in, join, operate, control, participate in, be employed or engaged by or with, be associated, affiliated or connected
with, or perform or provide work or services to, for or on behalf of any person, company or other entity engaged in a Competing Business (as hereinafter defined). For purposes of this Agreement, a person, company or other entity shall be deemed to
be engaged in a “Competing Business” if he, she or it is engaged in any way in the aftermarket collision replacement parts industry for automobiles and light trucks including, without limitation, providing, offering, developing,
manufacturing, selling, marketing, licensing or producing any product, service or system which is competitive with, the same as, similar to, performs, serves or provides a similar function as, or can be used as a substitute or replacement for, any
product, service or system that is both (i) related to the aftermarket collision replacement parts industry and (ii) offered, sold, provided, produced or being developed by the Company during the Executive’s employment with the
Company. 
 (B) influence, encourage, solicit, persuade, induce or procure (or attempt to influence, encourage, solicit,
persuade, induce or procure), directly or indirectly, on behalf of himself or any other person or entity, any Customer of the Company to cease doing business with or otherwise terminate, limit, postpone, divert or diminish its relationship, business
dealings or patronage with the Company (except as part of the ordinary course activities of Executive permitted by the following paragraph). 
 The foregoing
restrictions: (i) shall be limited to the United States, Canada and those foreign countries within which the Company, directly or indirectly (including, without limitation, indirectly through its independent sales representatives, distributors,
partners, joint venturers or licensees), sells, offers, markets, develops, produces, manufactures, performs, provides, or solicits business for its products, systems or services at any time during the Executive’s employment with the Company;
(ii) shall not preclude the Executive from performing work for or providing services to a person, company or other entity (not primarily engaged in a Competing Business) which among his/her or its businesses includes a division, section,
sub-part, subsidiary or affiliated entity engaged in a Competing Business provided that the Executive is not directly or indirectly involved in any of the aspects, businesses, divisions, sections, sub-parts, subsidiaries or affiliated entities of
such person, company or entity which is/are engaged in a Competing Business; (iii) shall not preclude the Executive from serving as an executive officer of a company or other entity (that derives less than ten percent (10%) of its gross
revenues from a Competing Business) which among its businesses includes a division, section, sub-part, subsidiary or affiliated entity engaged in a Competing Business provided that the Executive is not the officer of the company or other 

  

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entity directly responsible for the aspects, businesses, divisions, sections, sub-parts, subsidiaries or affiliated entities of such company or entity which
is/are engaged in a Competing Business (although the Executive may supervise such officer as part of his other responsibilities) and (iv) shall not preclude the Executive from passive ownership of up to five percent (5%) of the outstanding
stock of a publicly held corporation which is engaged in a Competing Business. 
 5.2 Nondisclosure of Trade Secrets. At all
times from and after the date hereof, Executive agrees that Executive (i) shall make no use of the Trade Secrets, or any other part thereof and (ii) shall not disclose the Trade Secrets, or any part thereof, to any other person or entity.
The Executive agrees not to disclose or reveal any information, whether including in whole or in part any Trade Secrets, except: (i) in response to an order or subpoena issued by a court or government agency; or (ii) to Executive’s
attorneys, accountants or any governmental taxing authority. 
 (A) “Trade Secrets” shall mean secrets and other
confidential information, ideas, knowledge, know-how, techniques, secret processes, improvements, discoveries, methods, inventions, sales, financial information, customers, lists of customers and prospective customers, plans, concepts, strategies or
products, as well as all documents, reports, drawings, designs, plans and proposals otherwise pertaining to same or relating to the Company or an affiliated entity of which Executive has acquired knowledge and possession as an officer or employee of
the Company. 
 (B) “Trade Secrets” shall not include any (i) information which is or has become available from
a third party who learned the information independently and is not or was not bound by a confidentiality agreement with respect to such information or (ii) information readily ascertainable from public, trade or other nonconfidential sources
(other than as a result, directly or indirectly, of a disclosure or other dissemination in contravention of a confidentiality agreement). 
 5.3 Non-Solicitation. At all times from and after the date hereof and ending [three (3)/two(2)] years after Executive is no longer employed by the Company, Executive agrees not to, either directly or through others, or in the
service of or on behalf of others, entice, solicit, recruit or attempt to persuade any person to sever such person’s employment with the Company or an affiliated entity, or to devote less than all of such employee’s efforts to the Company
or an affiliated entity, or to perform services for any individual or entity other than the Company or an affiliated entity, or to obtain any Trade Secrets from such employee, whether or not such person is a full-time employee of the Company or an
affiliated entity and whether or not such employment with the Company or an affiliated entity is pursuant to a written agreement or is at-will. 
 SECTION 6.
SUCCESSORS; BINDING AGREEMENT. 
 6.1 Successors. In addition to any obligations imposed by law upon any successor to
the Company, the Company will require any successor (whether direct or indirect, by purchase, merger, consolidation or otherwise) to all or substantially all of the business and/or assets of the Company to expressly assume and agree to perform this
Agreement in the same manner and to the same extent 

  

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that the Company would be required to perform it if no such succession had taken place. Failure of the Company to obtain such assumption and agreement prior
to the effectiveness of any such succession shall be a breach of its obligations under this Agreement and shall entitle the Executive to compensation from the Company in the same amount and on the same terms as the Executive would be entitled to
hereunder if the Executive were to terminate the Executive’s employment for Good Reason after a Change in Control, except that, for purposes of implementing the foregoing, the date on which any such succession becomes effective shall be deemed
the Date of Termination. 
 6.2 Binding Agreement. The Company’s obligations under this Agreement shall inure to the
benefit of and be enforceable by the Executive’s personal or legal representatives, executors, administrators, successors, heirs, distributees, devisees and legatees. If the Executive shall die while any amount would still be payable to the
Executive hereunder if the Executive had continued to live, all such amounts (other than amounts which, by their terms, terminate upon the death of the Executive) shall be paid in accordance with the terms of this Agreement to the executors,
personal representatives or administrators of the Executive’s estate. 
 SECTION 7. NOTICES. Notices and all other communications provided for
hereunder shall be in writing and shall be deemed to have been duly given when delivered or mailed by United States registered mail, return receipt requested, postage prepaid, addressed, if to the Executive, to the most recent permanent address
shown in the personnel records of the Company and the address set forth on the signature page to this Agreement, and, if to the Company, to the address set forth below, or to such other address as either party may have furnished to the other in
writing in accordance herewith, except that notice of change of address shall be effective only upon actual receipt: 
 To the Company:

 Keystone Automotive Industries, Inc. 
 655 Grassmere Park Drive 
 Nashville, TN 37211 
 Attention: General Counsel 
 SECTION 8. AGREEMENT MODIFICATION OR TERMINATION. 
 The Agreement may be amended or terminated by the Board at any time; provided, however, that during the pendency of a Potential Change in Control and during the two
(2) year period following a Change in Control, this Agreement may not be terminated or amended without the consent of the Executive. Notwithstanding any provision to the contrary, it is the parties’ intention that the benefits and rights
to which the Executive could become entitled in connection with a termination of employment covered under this Agreement comply with Section 409A of the Code. If the Executive or the Company believes, at any time, that any such benefit or right
does not so comply, the Executive or the Company shall promptly advise the other party and shall negotiate reasonably and in good faith to amend the terms of this Agreement such that it complies with Code Section 409A (with the most limited
possible economic effect on the Executive and on the Company). The obligations of the Company and the Executive under this Agreement, which by their nature may require either partial or total performance after the expiration of the Term (including,
without limitation, those under Sections 2, 3 and 5 hereof) shall survive such expiration. 
  

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 SECTION 9. GENERAL PROVISIONS. 
 9.1 Any payments provided for hereunder shall be paid net of any applicable withholding required under federal, state or local law and any additional withholding to which the Executive has agreed and is
permitted by applicable law. 
 9.2 Neither the establishment of this Agreement, nor any modification thereof, nor the creation of any
fund, trust or account, nor the payment of any benefits shall be construed as giving the Executive the right to be retained in the service of the Company, or to limit the ability of the Company to discharge the Executive at any time. 
 9.3 The headings and captions herein are provided for reference and convenience only, shall not be considered part of the Agreement, and shall not
be employed in the construction of the Agreement. 
 9.4 The obligations under this Agreement shall not be funded. The Executive shall
have no right to, or interest in, any assets of the Company which may be applied by the Company to the payment of benefits or other rights under this Agreement. 
 9.5 The invalidity or unenforceability of any provision of this Agreement shall not affect the validity or enforceability of any other provision of this Agreement, which shall remain in full force and effect.

 9.6 The validity, interpretation, construction and performance of this Agreement shall be governed by the laws of the State of
Tennessee, without reference to principles of conflict of laws. The parties hereto irrevocably agree to submit to the jurisdiction and venue of the courts of the State of Tennessee in any action or proceeding brought with respect to or in connection
with this Agreement. Notwithstanding any provision of this Agreement to the contrary, the Executive shall be entitled to seek specific performance of the Executive’s right to be paid until the Date of Termination during the pendency of any
dispute or controversy arising under or in connection with this Agreement. 
 {SIGNATURES APPEAR ON THE FOLLOWING PAGE.} 
  

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 IN WITNESS WHEREOF, the undersigned have set their hands to this Change-in-Control Agreement for Keystone
Automotive Industries, Inc., effective as of the date first written above. 
  

									
	 COMPANY:
  
 KEYSTONE AUTOMOTIVE INDUSTRIES, INC.
	 		 	EXECUTIVE:
					
	By:	 	  	 		 	Signature:	 	  
					
	Printed name: 	 	  	 		 	Printed Name: 	 	  
					
	Title:	 		 		 		 	

  

 13Chelsea Therapeutics, Inc. 2004 Stock Plan

 Exhibit 10.4 
 CHELSEA THERAPEUTICS INTERNATIONAL, LTD. 
 2004 STOCK PLAN

 (As amended June 8, 2007) 
 1. Purpose. The purpose of the Amended and Restated 2004 Stock Plan (the “Plan”) of Chelsea Therapeutics International, Ltd. (the “Company”) is to increase shareholder value
and to advance the interests of the Company by furnishing a variety of economic incentives (“Incentives”) designed to attract, retain and motivate employees, directors and consultants. Incentives may consist of opportunities to
purchase or receive shares of Common Stock, $0.0001 par value, of the Company (“Common Stock”) on terms determined under this Plan. 
 2. Administration. The Plan shall be administered by a committee of the Board of Directors of the Company (the “Committee”). The Committee shall consist of not less than two directors of the
Company who shall be appointed from time to time by the board of directors of the Company. Each member of the Committee shall be a “non-employee director” within the meaning of Rule 16b-3 of the Exchange Act of 1934, as amended (together
with the rules and regulations promulgated thereunder, the “Exchange Act”), and an “outside director” as defined in Section 162(m) of the Internal Revenue Code of 1986, as amended (the “Code”). The
Committee shall have complete authority to determine all provisions of all Incentives awarded under the Plan (as consistent with the terms of the Plan), to interpret the Plan, and to make any other determination which it believes necessary and
advisable for the proper administration of the Plan. The Committee’s decisions and matters relating to the Plan shall be final and conclusive on the Company and its participants. No member of the Committee will be liable for any action or
determination made in good faith with respect to the Plan or any Incentives granted under the Plan. The Committee will also have the authority under the Plan to amend or modify the terms of any outstanding Incentives in any manner; provided,
however, that the amended or modified terms are permitted by the Plan as then in effect and that any recipient of an Incentive adversely affected by such amended or modified terms has consented to such amendment or modification. No amendment or
modification to an Incentive, however, whether pursuant to this Section 2 or any other provision of the Plan, will be deemed to be a re-grant of such Incentive for purposes of this Plan (notwithstanding that such amendment or modification may
be deemed to be a new grant of an incentive stock option, as such term is defined in Section 422 of the Code, under the Code). If at any time there is no Committee, then for purposes of the Plan the term “Committee” shall mean the
Company’s Board of Directors. 
 3. Eligible Participants. Employees of the Company or its subsidiaries (including officers and
employees of the Company or its subsidiaries), directors and consultants, advisors or other independent contractors who provide services to the Company or its subsidiaries (including members of the Company’s scientific advisory board) shall
become eligible to receive Incentives under the Plan when designated by the Committee. Participants may be designated individually or by groups or categories (for example, by pay grade) as the Committee deems appropriate. Participation by officers
of the Company or its subsidiaries and any performance objectives relating to such officers must be approved by the Committee. Participation by others and any performance objectives relating to others may be approved by groups or categories (for
example, by pay grade) and authority to designate participants who are not officers and to set or modify such targets may be delegated. 

 4. Types of Incentives. Incentives under the Plan may be granted in any one or a combination of
the following forms: (a) incentive stock options and non-statutory stock options (Section 6); (b) stock appreciation rights (“SARs”) (Section 7); (c) stock awards (Section 8); (d) restricted stock (Section 8);
and (e) performance shares (Section 9). Only employees of the Company shall be entitled to receive incentive stock options under Section 422 of the Code. 
 5. Shares Subject to the Plan. 
 5.1. Number of Shares. Subject to adjustment
as provided in Section 11.6, the number of shares of Common Stock which may be issued under the Plan is 4,145,000 shares of Common Stock. Of such aggregate number of shares of Common Stock that may be issued under the Plan, the maximum number
of shares that may be issued as incentive stock options under Section 422 of the Code is 4,145,000. Any shares of Common Stock available for issuance as incentive stock options may be alternatively issued as other types of Incentives under the
Plan. Shares of Common Stock that are issued under the Plan or that are subject to outstanding Incentives will be applied to reduce the maximum number of shares of Common Stock remaining available for issuance under the Plan. 
 5.2. Cancellation. To the extent that cash in lieu of shares of Common Stock is delivered upon the exercise of an SAR pursuant to
Section 7.4, the Company shall be deemed, for purposes of applying the limitation on the number of shares, to have issued the greater of the number of shares of Common Stock which it was entitled to issue upon such exercise or on the exercise
of any related option. In the event that a stock option or SAR granted hereunder expires or is terminated or canceled unexercised or unvested as to any shares of Common Stock, such shares may again be issued under the Plan either pursuant to stock
options, SARs or otherwise. In the event that shares of Common Stock are issued as restricted stock or pursuant to a stock award and thereafter are forfeited or reacquired by the Company pursuant to rights reserved upon issuance thereof, such
forfeited and reacquired shares may again be issued under the Plan, either as restricted stock, pursuant to stock awards or otherwise. Shares of Common Stock which are withheld to pay the exercise price of an option and/or any related withholding
obligations shall again be available for issuance under the Plan. The Committee may also determine to cancel, and agree to the cancellation of, stock options in order to make a participant eligible for the grant of a stock option at a lower price
than the option to be canceled. 
 6. Stock Options. A stock option is a right to purchase shares of Common Stock from the Company.
The Committee may designate whether an option is to be considered an incentive stock option or a non-statutory stock option. To the extent that any incentive stock option granted under the Plan ceases for any reason to qualify as an “incentive
stock option” for purposes of Section 422 of the Code, such incentive stock option will continue to be outstanding for purposes of the Plan but will thereafter be deemed to be a non-statutory stock option. Each stock option granted by the
Committee under this Plan shall be subject to the following terms and conditions: 
 6.1. Price. The option price per
share shall be determined by the Committee, subject to adjustment under Section 11.6. 
  

 2 

 6.2. Number. The number of shares of Common Stock subject to the option shall be
determined by the Committee, subject to adjustment as provided in Section 11.6. The number of shares of Common Stock subject to a stock option shall be reduced in the same proportion that the holder thereof exercises a SAR if any SAR is granted
in conjunction with or related to the stock option. 
 6.3. Duration and Time for Exercise. Subject to earlier
termination as provided in Section 11.4 and except for incentive stock options which shall be subject to the provisions of Section 6.5, the term of each stock option shall be determined by the Committee but shall not exceed ten years from
the date of grant. Each stock option shall become exercisable at such time or times during its term as shall be determined by the Committee at the time of grant. The Committee may accelerate the exercisability of any stock option. 
 6.4. Manner of Exercise. Subject to the conditions contained in this Plan and in the agreement with the recipient evidencing such
option, a stock option may be exercised, in whole or in part, by giving written notice to the Company, specifying the number of shares of Common Stock to be purchased and accompanied by the full purchase price for such shares. The exercise price
shall be payable (a) in United States dollars upon exercise of the option and may be paid by cash; uncertified or certified check; bank draft; (b) at the discretion of the Committee, by delivery of shares of Common Stock that are already
owned by the participant in payment of all or any part of the exercise price, which shares shall be valued for this purpose at the Fair Market Value on the date such option is exercised; or (c) at the discretion of the Committee, by instructing
the Company to withhold from the shares of Common Stock issuable upon exercise of the stock option shares of Common Stock in payment of all or any part of the exercise price and/or any related withholding tax obligations, which shares shall be
valued for this purpose at the Fair Market Value or in such other manner as may be authorized from time to time by the Committee. The shares of Common Stock delivered by the participant pursuant to Section 6.4(b) must have been held by the
participant for a period of not less than six months prior to the exercise of the option, unless otherwise determined by the Committee. Prior to the issuance of shares of Common Stock upon the exercise of a stock option, a participant shall have no
rights as a shareholder. Except as otherwise provided in the Plan, no adjustment will be made for dividends or distributions with respect to such stock options as to which there is a record date preceding the date the participant becomes the holder
of record of such shares, except as the Committee may determine in its discretion. 
 6.5. Incentive Stock Options.
Notwithstanding anything in the Plan to the contrary, the following additional provisions shall apply to the grant of stock options which are intended to qualify as incentive stock options (as such term is defined in Section 422 of the Code):

  

 3 

 (a) To the extent that the aggregate Fair Market Value (determined as of the time the
option is granted) of the shares of Common Stock with respect to which incentive stock options are exercisable for the first time by any participant during any calendar year (under the Plan and any other incentive stock option plans of the Company
or any subsidiary or parent corporation of the Company) shall exceed $100,000, such excess portion of the incentive stock options will be treated as Non-Statutory Stock Options; provided that this provision shall have no force or effect to the
extent that its inclusion in the Plan is not necessary for the Incentive to qualify as incentive stock options pursuant to Section 422 of the Code. The determination will be made by taking incentive stock options into account in the order in
which they were granted. 
 (b) Any incentive stock option certificate authorized under the Plan shall contain such other
provisions as the Committee shall deem advisable, but shall in all events be consistent with and contain all provisions required in order to qualify the options as incentive stock options. 
 (c) All incentive stock options must be granted within ten years from the earlier of the date on which this Plan was adopted by board of
directors or the date this Plan was approved by the Company’s shareholders. 
 (d) Unless sooner exercised, all incentive
stock options shall expire no later than 10 years after the date of grant. No incentive stock option may be exercisable after ten (10) years from its date of grant (or five (5) years from its date of grant if, at the time the incentive
stock option is granted, the Participant owns, directly or indirectly, more than 10% of the total combined voting power of all classes of stock of the Company or any parent or subsidiary corporation of the Company). 
 (e) The exercise price for incentive stock options shall be not less than 100% of the Fair Market Value of the Common Stock subject
thereto on the date of grant; provided that the exercise price shall be 110% of the Fair Market Value if, at the time the incentive stock option is granted, the participant owns, directly or indirectly, more than 10% of the total combined voting
power of all classes of stock of the Company or any parent or subsidiary corporation of the Company. 
 7. Stock Appreciation Rights.
An SAR is a right to receive, without payment to the Company, a number of shares of Common Stock, cash or any combination thereof, the amount of which is determined pursuant to the formula set forth in Section 7.4. An SAR may be granted
(a) with respect to any stock option granted under this Plan, either concurrently with the grant of such stock option or at such later time as determined by the Committee (as to all or any portion of the shares of Common Stock subject to the
stock option), or (b) alone, without reference to any related stock option. Each SAR granted by the Committee under this Plan shall be subject to the following terms and conditions: 
 7.1. Number; Exercise Price. Each SAR granted to any participant shall relate to such number of shares of Common Stock as shall be
determined by the Committee, 

  

 4 

 
subject to adjustment as provided in Section 11.6. In the case of an SAR granted with respect to a stock option, the number of shares of Common Stock to
which the SAR pertains shall be reduced in the same proportion that the holder of the option exercises the related stock option. The exercise price of an SAR will be determined by the Committee, in its discretion, at the date of grant but may not be
less than 100% of the Fair Market Value of the shares of Common Stock subject thereto on the date of grant. 
 7.2.
Duration. Subject to earlier termination as provided in Section 11.4, the term of each SAR shall be determined by the Committee but shall not exceed ten years and one day from the date of grant. Unless otherwise provided by the
Committee, each SAR shall become exercisable at such time or times, to such extent and upon such conditions as the stock option, if any, to which it relates is exercisable. The Committee may in its discretion accelerate the exercisability of any
SAR. 
 7.3. Exercise. An SAR may be exercised, in whole or in part, by giving written notice to the Company,
specifying the number of SARs which the holder wishes to exercise. Upon receipt of such written notice, the Company shall, within 90 days thereafter, deliver to the exercising holder certificates for the shares of Common Stock or cash or both, as
determined by the Committee, to which the holder is entitled pursuant to Section 7.4. 
 7.4. Payment. Subject to
the right of the Committee to deliver cash in lieu of shares of Common Stock (which, as it pertains to officers and directors of the Company, shall comply with all requirements of the Exchange Act), the number of shares of Common Stock which shall
be issuable upon the exercise of an SAR shall be determined by dividing: 
 (a) the number of shares of Common Stock as to
which the SAR is exercised multiplied by the amount of the appreciation in such shares (for this purpose, the “appreciation” shall be the amount by which the Fair Market Value of the shares of Common Stock subject to the SAR on the
exercise date exceeds (1) in the case of an SAR related to a stock option, the exercise price of the shares of Common Stock under the stock option or (2) in the case of an SAR granted alone, without reference to a related stock option, an
amount which shall be determined by the Committee at the time of grant, subject to adjustment under Section 11.6); by 
 (b) the Fair Market Value of a share of Common Stock on the exercise date. 
 In lieu of issuing shares of Common
Stock upon the exercise of a SAR, the Committee may elect to pay the holder of the SAR cash equal to the Fair Market Value on the exercise date of any or all of the shares which would otherwise be issuable. No fractional shares of Common Stock shall
be issued upon the exercise of an SAR; instead, the holder of the SAR shall be entitled to receive a cash adjustment equal to the same fraction of the Fair Market Value of a share of Common Stock on the exercise date or to purchase the portion
necessary to make a whole share at its Fair Market Value on the date of exercise. 
  

 5 

 8. Stock Awards and Restricted Stock. A stock award consists of the transfer by the Company to a
participant of shares of Common Stock, without other payment therefor, as additional compensation for services to the Company. The participant receiving a stock award will have all voting, dividend, liquidation and other rights with respect to the
shares of Common Stock issued to a participant as a stock award under this Section 8 upon the participant becoming the holder of record of such shares. A share of restricted stock consists of shares of Common Stock which are sold or transferred
by the Company to a participant at a price determined by the Committee (which price shall be at least equal to the minimum price required by applicable law for the issuance of a share of Common Stock) and subject to restrictions on their sale or
other transfer by the participant, which restrictions and conditions may be determined by the Committee as long as such restrictions and conditions are not inconsistent with the terms of the Plan. The transfer of Common Stock pursuant to stock
awards and the transfer and sale of restricted stock shall be subject to the following terms and conditions: 
 8.1. Number
of Shares. The number of shares to be transferred or sold by the Company to a participant pursuant to a stock award or as restricted stock shall be determined by the Committee. 
 8.2. Sale Price. The Committee shall determine the price, if any, at which shares of restricted stock shall be sold or granted to a
participant, which may vary from time to time and among participants and which may be below the Fair Market Value of such shares of Common Stock at the date of sale. 
 8.3. Restrictions. All shares of restricted stock transferred or sold hereunder shall be subject to such restrictions as the
Committee may determine, including, without limitation any or all of the following: 
 (a) a prohibition against the sale,
transfer, pledge or other encumbrance of the shares of restricted stock, such prohibition to lapse at such time or times as the Committee shall determine (whether in annual or more frequent installments, at the time of the death, disability or
retirement of the holder of such shares, or otherwise); 
 (b) a requirement that the holder of shares of restricted stock
forfeit, or (in the case of shares sold to a participant) resell back to the Company at his or her cost, all or a part of such shares in the event of termination of his or her employment or consulting engagement during any period in which such
shares are subject to restrictions; or 
 (c) such other conditions or restrictions as the Committee may deem advisable.

 8.4. Escrow. In order to enforce the restrictions imposed by the Committee pursuant to Section 8.3, the
participant receiving restricted stock shall enter into an 

  

 6 

 
agreement with the Company setting forth the conditions of the grant. Shares of restricted stock shall be registered in the name of the participant and
deposited, together with a stock power endorsed in blank, with the Company. Each such certificate shall bear a legend in substantially the following form: 
 The transferability of this certificate and the shares of Common Stock represented by it are subject to the terms and conditions (including conditions of forfeiture) contained in the 2004 Stock Plan of Chelsea
Therapeutics International, Ltd., (the “Company”), as amended from time to time, and an agreement entered into between the registered owner and the Company. A copy of the 2004 Stock Plan, as amended from time to time, and the agreement is
on file in the office of the secretary of the Company. 
 8.5. End of Restrictions. Subject to Section 11.5, at
the end of any time period during which the shares of restricted stock are subject to forfeiture and restrictions on transfer, such shares will be delivered free of all restrictions to the participant or to the participant’s legal
representative, beneficiary or heir. 
 8.6. Shareholder. Subject to the terms and conditions of the Plan, each
participant receiving restricted stock shall have all the rights of a shareholder with respect to shares of stock during any period in which such shares are subject to forfeiture and restrictions on transfer, including without limitation, the right
to vote such shares. Dividends paid in cash or property other than Common Stock with respect to shares of restricted stock shall be paid to the participant currently. 
 9. Performance Shares. A performance share consists of an award which shall be paid in shares of Common Stock, as described below. The grant of a performance share shall be subject to such terms and conditions
as the Committee deems appropriate, including the following: 
 9.1. Performance Objectives. Each performance share
will be subject to performance objectives for the Company or one of its operating units to be achieved by the participant before the end of a specified period. The number of performance shares granted shall be determined by the Committee and may be
subject to such terms and conditions, as the Committee shall determine. If the performance objectives are achieved, each participant will be paid in shares of Common Stock or cash as determined by the Committee. If such objectives are not met, each
grant of performance shares may provide for lesser payments in accordance with formulas established in the award. 
 9.2.
Not Shareholder. The grant of performance shares to a participant shall not create any rights in such participant as a shareholder of the Company, until the payment of shares of Common Stock with respect to an award. 
 9.3. No Adjustments. No adjustment shall be made in performance shares granted on account of cash dividends which may be paid or
other rights which may be issued to the holders of Common Stock prior to the end of any period for which performance objectives were established. 
  

 7 

 9.4. Expiration of Performance Share. If any participant’s employment or
consulting engagement with the Company is terminated for any reason other than normal retirement, death or disability prior to the achievement of the participant’s stated performance objectives, all the participant’s rights on the
performance shares shall expire and terminate unless otherwise determined by the Committee. In the event of termination of employment or consulting by reason of death, disability, or normal retirement, the Committee, in its own discretion may
determine what portions, if any, of the performance shares should be paid to the participant. 
 10. Change of Control. 
 10.1 Change in Control. For purposes of this Section 10, a “Change in Control” of the Company will mean the
following: 
 (a) the sale, lease, exchange or other transfer, directly or indirectly, of substantially all of the assets of
the Company (in one transaction or in a series of related transactions) to a person or entity that is not controlled by the Company; 
 (b) the approval by the shareholders of the Company of any plan or proposal for the liquidation or dissolution of the Company; 
 (c) any person not a shareholder of the Company on the date of the Plan becomes after the effective date of the Plan the “beneficial owner” (as defined in Rule 13d-3 under the Exchange Act), directly or
indirectly, of (i) 20% or more, but not 50% or more, of the combined voting power of the Company’s outstanding securities ordinarily having the right to vote at elections of directors, unless the transaction resulting in such ownership has
been approved in advance by the Continuing Directors (as defined below), or (ii) 50% or more of the combined voting power of the Company’s outstanding securities ordinarily having the right to vote at elections of directors (regardless of
any approval by the Continuing Directors); provided that a traditional institutional or venture capital financing transaction shall be excluded from this definition; or 
 (d) a merger or consolidation to which the Company is a party if the shareholders of the Company immediately prior to the effective date
of such merger or consolidation have “beneficial ownership” (as defined in Rule 13d-3 under the Exchange Act), immediately following the effective date of such merger or consolidation, of securities of the surviving corporation
representing (i) 50% or more, but less than 80%, of the combined voting power of the surviving corporation’s then outstanding securities ordinarily having the right to vote at elections of directors, unless such merger or consolidation has
been approved in advance by the Continuing Directors, or (ii) less than 50% of the combined voting power of the surviving corporation’s then outstanding securities ordinarily having the right to vote at elections of directors (regardless
of any approval by the Continuing Directors). 
  

 8 

 10.2 Continuing Directors. For purposes of this Section 10,
“Continuing Directors” of the Company will mean any individuals who are members of the Board on the effective date of the Plan and any individual who subsequently becomes a member of the Board whose election, or nomination for
election by the Company’s shareholders, was approved by a vote of at least a majority of the Continuing Directors (either by specific vote or by approval of the Company’s proxy statement in which such individual is named as a nominee for
director without objection to such nomination). 
 10.3 Acceleration of Incentives. Unless otherwise resolved by the
Committee in its sole discretion at such time, if a Change in Control of the Company occurs whereby the acquiring entity or successor to the Company does not agree to assume the Incentives or replace them with substantially equivalent incentive
awards (as determined by the Committee in its reasonable discretion), then (a) all outstanding options and SARs will vest and will become immediately exercisable in full and, if not exercised on the date of the Change of Control, will terminate
on such date regardless of whether the participant to whom such options or SARs have been granted remains in the employ or service of the Company or any subsidiary of the Company or any acquiring entity or successor to the Company; (b) the
restrictions on all shares of restricted stock awards shall lapse immediately; and (c) all performance shares criteria shall be deemed to be met and payment made immediately. 
 10.4 Cash Payment for Options. If a Change in Control of the Company occurs, then the Committee, if approved by the Committee in
its sole discretion either in an agreement evidencing an option at the time of grant or at any time after the grant of an option, and without the consent of any participant affected thereby, may determine that: 
 (a) some or all participants holding outstanding options will receive, with respect to some or all of the shares of Common Stock subject
to such options, as of the effective date of any such Change in Control of the Company, cash in an amount equal to the excess of the Fair Market Value of such shares immediately prior to the effective date of such Change in Control of the Company
over the exercise price per share of such options; and 
 (b) any options as to which, as of the effective date of any such
Change in Control, the Fair Market Value of the shares of Common Stock subject to such options is less than or equal to the exercise price per share of such options, shall terminate as of the effective date of any such Change in Control. 

If the Committee makes a determination as set forth in subparagraph (a) of this Section 10.4, then as of the effective date of any such
Change in Control of the Company such options will terminate as to such shares and the participants formerly holding such options will only have the right to receive such cash payment(s). If the Committee makes a determination as set forth in
subparagraph (b) of this Section 10.4, then as of the effective date of any such Change in Control of the Company such options will terminate, become void and expire as to all unexercised shares of Common Stock subject to such options on
such date, and the participants formerly holding such options will have no further rights with respect to such options. 
  

 9 

 11. General. 
 11.1. Effective Date. The Plan will become effective upon approval by the Company’s board of directors. 
 11.2. Duration. The Plan shall remain in effect until all Incentives granted under the Plan have either been satisfied by the
issuance of shares of Common Stock or the payment of cash or been terminated under the terms of the Plan and all restrictions imposed on shares of Common Stock in connection with their issuance under the Plan have lapsed. No Incentives may be
granted under the Plan after the earlier of the tenth anniversary of the date of the adoption of the Plan or the date the Plan is approved by the shareholders of the Company. 
 11.3. Non-transferability of Incentives. Except in the event of the holder’s death, by will or the laws of descent and
distribution to the limited extent provided in the Plan or the Incentive, unless approved by the Committee, no stock option, SAR, restricted stock or performance award may be transferred, pledged or assigned by the holder thereof, either voluntarily
or involuntarily, directly or indirectly, by operation of law or otherwise, and the Company shall not be required to recognize any attempted assignment of such rights by any participant. During a participant’s lifetime, an Incentive may be
exercised only by him or her or by his or her guardian or legal representative. 
 11.4. Effect of Termination or
Death. In the event that a participant ceases to be an employee of or consultant to the Company, or the participants’ other service with the Company is terminated, for any reason, including death, any Incentives may be exercised or shall
expire at such times as may be determined by the Committee in its sole discretion in the agreement evidencing an Incentive. Notwithstanding the other provisions of this Section 11.4, upon a participant’s termination of employment or other
service with the Company and all subsidiaries, the Committee may, in its sole discretion (which may be exercised at any time on or after the date of grant, including following such termination), cause options and SARs (or any part thereof) then held
by such participant to become or continue to become exercisable and/or remain exercisable following such termination of employment or service and Restricted Stock Awards, Performance Shares and Stock Awards then held by such participant to vest
and/or continue to vest or become free of transfer restrictions, as the case may be, following such termination of employment or service, in each case in the manner determined by the Committee; provided, however, that no Incentive may remain
exercisable or continue to vest beyond its expiration date. Any incentive stock option that remains unexercised more than one (1) year following termination of employment by reason of death or disability or more than three (3) months
following termination for any reason other than death or disability will thereafter be deemed to be a Non-Statutory Stock Option. 
 11.5. Additional Conditions. Notwithstanding anything in this Plan to the contrary: (a) the Company may, if it shall determine it necessary or desirable for any reason, at the time of award of any Incentive or the issuance of
any shares of Common Stock pursuant to any Incentive, require the recipient of the Incentive, as a condition to the receipt thereof or to the receipt of shares of Common Stock issued pursuant thereto, to 

  

 10 

 
deliver to the Company a written representation of present intention to acquire the Incentive or the shares of Common Stock issued pursuant thereto for his
or her own account for investment and not for distribution; and (b) if at any time the Company further determines, in its sole discretion, that the listing, registration or qualification (or any updating of any such document) of any Incentive
or the shares of Common Stock issuable pursuant thereto is necessary on any securities exchange or under any federal or state securities or blue sky law, or that the consent or approval of any governmental regulatory body is necessary or desirable
as a condition of, or in connection with the award of any Incentive, the issuance of shares of Common Stock pursuant thereto, or the removal of any restrictions imposed on such shares, such Incentive shall not be awarded or such shares of Common
Stock shall not be issued or such restrictions shall not be removed, as the case may be, in whole or in part, unless such listing, registration, qualification, consent or approval shall have been effected or obtained free of any conditions not
acceptable to the Company. Notwithstanding any other provision of the Plan or any agreements entered into pursuant to the Plan, the Company will not be required to issue any shares of Common Stock under this Plan, and a participant may not sell,
assign, transfer or otherwise dispose of shares of Common Stock issued pursuant to any Incentives granted under the Plan, unless (a) there is in effect with respect to such shares a registration statement under the Securities Act of 1933, as
amended (the “Securities Act”), and any applicable state or foreign securities laws or an exemption from such registration under the Securities Act and applicable state or foreign securities laws, and (b) there has been
obtained any other consent, approval or permit from any other regulatory body which the Committee, in its sole discretion, deems necessary or advisable. The Company may condition such issuance, sale or transfer upon the receipt of any
representations or agreements from the parties involved, and the placement of any legends on certificates representing shares of Common Stock, as may be deemed necessary or advisable by the Company in order to comply with such securities laws or
other restrictions. The Committee may restrict the rights of participants to the extent necessary to comply with Section 16(b) of the Exchange Act, the Internal Revenue Code or any other applicable law or regulation. The grant of an Incentive
award pursuant to the Plan shall not limit in any way the right or power of the Company to make adjustments, reclassifications, reorganizations or changes of its capital or business structure or to merge, exchange or consolidate or to dissolve,
liquidate, sell or transfer all or any part of its business or assets. 
 11.6. Adjustment. In the event of any
recapitalization, stock dividend, stock split, combination of shares or other change in the Common Stock, the number of shares of Common Stock then subject to the Plan, including shares subject to restrictions, options or achievements of performance
shares, shall be adjusted in proportion to the change in outstanding shares of Common Stock. In the event of any such adjustments, the purchase price of any option, the performance objectives of any Incentive, and the shares of Common Stock issuable
pursuant to any Incentive shall be adjusted as and to the extent appropriate, in the discretion of the Committee, to provide participants with the same relative rights before and after such adjustment. 
 11.7. Incentive Plans and Agreements. Except in the case of stock awards, the terms of each Incentive shall be stated in a plan or
agreement approved by the 

  

 11 

 
Committee. The Committee may also determine to enter into agreements with holders of options to reclassify or convert certain outstanding options, within the
terms of the Plan, as incentive stock options or as non-statutory stock options and in order to eliminate SARs with respect to all or part of such options and any other previously issued options. 
 11.8. Withholding. 
 (a) The Company shall have the right to (i) withhold and deduct from any payments made under the Plan or from future wages of the participant (or from other amounts that may be due and owing to the participant
from the Company or a subsidiary of the Company), or make other arrangements for the collection of, all legally required amounts necessary to satisfy any and all foreign, federal, state and local withholding and employment-related tax requirements
attributable to an Incentive, or (ii) require the participant promptly to remit the amount of such withholding to the Company before taking any action, including issuing any shares of Common Stock, with respect to an Incentive. At any time when
a participant is required to pay to the Company an amount required to be withheld under applicable income tax laws in connection with a distribution of Common Stock or upon exercise of an option or SAR, the participant may satisfy this obligation in
whole or in part by electing (the “Election”) to have the Company withhold from the distribution shares of Common Stock having a value up to the amount required to be withheld. The value of the shares to be withheld shall be based
on the Fair Market Value of the Common Stock on the date that the amount of tax to be withheld shall be determined (“Tax Date”). 
 (b) Each Election must be made prior to the Tax Date. The Committee may disapprove of any Election, may suspend or terminate the right to make Elections, or may provide with respect to any Incentive that the right to
make Elections shall not apply to such Incentive. An Election is irrevocable. 
 (c) If a participant is an officer or
director of the Company within the meaning of Section 16 of the Exchange Act, then an Election is subject to the following additional restrictions: 
 (1) No Election shall be effective for a Tax Date which occurs within six months of the grant or exercise of the award, except that this limitation shall not apply in the event death or disability of the participant
occurs prior to the expiration of the six-month period. 
 (2) The Election must be made either six months prior to the Tax
Date or must be made during a period beginning on the third business day following the date of release for publication of the Company’s quarterly or annual summary statements of sales and earnings and ending on the twelfth business day
following such date. 
 (d) If the option granted to a participant hereunder is an incentive stock option, and if the
participant sells or otherwise disposes of any 

  

 12 

 
of the shares of Common Stock acquired pursuant to the incentive stock option on or before the later of (1) the date two years after the date of grant,
or (2) the date one year after the date of exercise, the participant shall immediately notify the Company in writing of such disposition. The participant agrees that the participant may be subject to income tax withholding by the Company on the
compensation income recognized by the participant from the early disposition by payment in cash or out of the current earnings paid to the participant. 
 11.9. No Continued Employment, Engagement or Right to Corporate Assets. No participant under the Plan shall have any right, because of his or her participation, to continue in the employ of the Company for any
period of time or any right to continue his or her present or any other rate of compensation. Nothing contained in the Plan shall be construed as giving an employee, a consultant, such persons’ beneficiaries or any other person any interests of
any kind in the assets of the Company or creating a trust of any kind or a fiduciary relationship of any kind between the Company and any such person. 
 11.10. Deferral Permitted. Payment of cash or distribution of any shares of Common Stock to which a participant is entitled under any Incentive shall be made as provided in the Incentive. Payment may be
deferred at the option of the participant if provided in the Incentive. 
 11.11. Amendment of the Plan. The Board may
amend, suspend or discontinue the Plan at any time; provided, however, that no amendments to the Plan will be effective without approval of the shareholders of the Company if shareholder approval of the amendment is then required pursuant to
Section 422 of the Code, the regulations promulgated thereunder or the rules of any stock exchange or Nasdaq or similar regulatory body. No termination, suspension or amendment of the Plan may adversely affect any outstanding Incentive without
the consent of the affected participant; provided, however, that this sentence will not impair the right of the Committee to take whatever action it deems appropriate under Sections 2, 10 and 11 of the Plan. 
 11.12. Definition of Fair Market Value. For purposes of this Plan, the “Fair Market Value” of a share of Common
Stock at a specified date shall, unless otherwise expressly provided in this Plan, be the amount which the Committee or the board of directors of the Company determines in good faith in the exercise of its reasonable discretion to be 100% of the
fair market value of such a share as of the date in question; provided, however, that notwithstanding the foregoing, if such shares are listed on a U.S. securities exchange or are quoted on the Nasdaq National Market System or Nasdaq SmallCap Stock
Market (“Nasdaq”), then Fair Market Value shall be determined by reference to the last sale price of a share of Common Stock on such U.S. securities exchange or Nasdaq on the applicable date. If such U.S. securities exchange or
Nasdaq is closed for trading on such date, or if the Common Stock does not trade on such date, then the last sale price used shall be the one on the date the Common Stock last traded on such U.S. securities exchange or Nasdaq. 
 11.13 Breach of Confidentiality, Assignment of Inventions, or Non-Compete Agreements. Notwithstanding anything in the Plan to the
contrary, in the event that a 

  

 13 

 
participant materially breaches the terms of any confidentiality, assignment of inventions, or non-compete agreement entered into with the Company or any
subsidiary of the Company, whether such breach occurs before or after termination of such participant’s employment or other service with the Company or any subsidiary, the Committee in its sole discretion may immediately terminate all rights of
the participant under the Plan and any agreements evidencing an Incentive then held by the participant without notice of any kind. 
 11.13 Governing Law. The validity, construction, interpretation, administration and effect of the Plan and any rules, regulations and actions relating to the Plan will be governed by and construed exclusively in accordance with the
laws of the State of North Carolina, notwithstanding the conflicts of laws principles of any jurisdictions. 
 11.14
Successors and Assigns. The Plan will be binding upon and inure to the benefit of the successors and permitted assigns of the Company and the participants in the Plan. 
  

 14 

 CHELSEA THERAPEUTICS INTERNATIONAL, LTD. 
 2004 Stock Plan, as amended to date 
 NOTICE OF STOCK OPTION GRANT

  

					
	(Optionee and address)	 		 	Grant Number
	  	 		 	
	  	 		 	

 You have been granted an option to purchase Common Stock of Chelsea Therapeutics International,
Ltd. (the “Company”), as follows: 
  

							
	Date of Grant	 	  
	  		  	
				
	Vesting Commencement Date	 	  
	  		  	
				
	Exercise Price per Share	 	  
	  		  	
				
	Total Number of Shares Granted	 	  
	  		  	
				
	Total Exercise Price	 	  
	  		  	
		
	Type of Option:	 	                     Incentive Stock Option
		
		 	                     Nonstatutory Stock Option
		
	Term/Expiration Date:	 	10 Years/                    
		
	Vesting Schedule:	 	Subject to accelerated vesting as set forth in the Plan or in the Stock Option Agreement, this Option may be exercised, in whole or in part, in accordance with the following
schedule: 25% of the shares shall vest on the first, second, third and fourth anniversaries of the Vesting Commencement Date; provided that the Optionee remains an employee or director of, or consultant to, the Company as of each such vesting
date.
		
	Termination Period:	 	Option may be exercised for up to 90 days after termination of employment or consulting relationship except as set out in Sections 7 and 8 of the Stock Option Agreement (but in no
event later than the Expiration Date. By your signature and the signature of the Company’s representative below, you and the Company agree that this option is granted under and governed by the terms and conditions of the Chelsea Therapeutics
International, Ltd. 2004 Stock Plan (as amended, the “Plan”) and the Stock Option Agreement, all of which are attached and made a part of this document.

 Effective as of the Date of Grant provided above. 
  

							
	OPTIONEE:	 		 	CHELSEA THERAPEUTICS INTERNATIONAL, LTD.
				
	  
	 		 	By:	 	  

				
	  
	 		 	Name:	 	  

	Print Name	 		 		 	
		 		 	Title:	 	  

		 		 		 	

  

 2 

 CHELSEA THERAPEUTICS INTERNATIONAL, LTD. 
 STOCK OPTION AGREEMENT 
 1. Grant of Option. Chelsea Therapeutics
International, Ltd. a Delaware corporation (the “Company”), hereby grants to the Optionee named in the Notice of Grant (the “Optionee”) an option (the “Option”) to purchase a total number of shares of Common Stock (the
“Shares”) set forth in the Notice of Grant, at the exercise price per share set forth in the Notice of Grant (the “Exercise Price”) subject to the terms, definitions and provisions of the Chelsea Therapeutics International, Ltd.
2004 Stock Plan (as amended, the “Plan”) adopted by the Company, which is incorporated herein by reference. Unless otherwise defined herein, the terms defined in the Plan shall have the same defined meanings in this Option. To the extent
of any conflict between the terms of this Stock Option Agreement and the Plan, the terms of the Plan shall control. 
 If designated an
Incentive Stock Option, this Option is intended to qualify as an Incentive Stock Option as defined in Section 422 of the Code, or any successor provision. 
 2. Exercise of Option. This Option shall be exercisable during its term in accordance with the Vesting Schedule set out in the Notice of Grant, the terms of the Plan and as follows: 
 (a) Right to Exercise. 
 (i) This
Option may not be exercised for a fraction of a share. 
 (ii) In the event of Optionee’s death, disability or other termination of
employment, the exercisability of the Option is governed by Sections 6, 7 and 8 below, subject to the limitation contained in subsection 2(a)(iii). 
 (iii) In no event may this Option be exercised after the date of expiration of the term of this Option as set forth in the Notice of Grant. 
 (b) Method of Exercise. This Option shall be exercisable by written notice (in the form attached hereto as Exhibit A) which shall
state the election to exercise the Option, the number of Shares in respect of which the Option is being exercised, and such other representations and agreements as to the holder’s investment intent with respect to such shares of Common Stock as
may be required by the Company pursuant to the provisions of the Plan. Such written notice shall be signed by the Optionee and shall be delivered in person or by certified mail to the Secretary of the Company. The written notice shall be accompanied
by payment of the Exercise Price. This Option shall be deemed to be exercised upon receipt by the Company of such written notice accompanied by the Exercise Price. 
 No Shares will be issued pursuant to the exercise of an Option unless such 

  

 1 

 
issuance and such exercise shall comply with all relevant provisions of law and the requirements of any stock exchange upon which the Shares may then be
listed. Assuming such compliance, for income tax purposes the Shares shall be considered transferred to the Optionee on the date on which the Option is exercised with respect to such Shares. 
 3. Optionee’s Representations. In the event the Shares purchasable pursuant to the exercise of this Option have not been registered under the
Securities Act of 1933, as amended (the “Securities Act”), at the time this Option is exercised, Optionee shall, if required by the Company, concurrently with the exercise of all or any portion of this Option, deliver to the Company an
Investment Representation Statement in the form attached hereto as Exhibit B. 
 4. Method of Payment. Payment of
the Exercise Price shall be by any of the following, or a combination thereof, at the election of the Optionee: 
  

	 	a.	cash; 

  

	 	b.	check; or 

  

	 	c.	at the discretion of the Board or Committee, any other method permitted by the Plan or any combination thereof. 

 5. Restrictions on Exercise. This Option may not be exercised until such time as (a) the Plan and the Shares covered by this Option have been
approved by the stockholders of the Company and (b) the issuance of such Shares upon such exercise or the method of payment of consideration for such shares does not constitute a violation of any applicable federal or state securities or other
law or regulation, including any rule under Part 207 of Title 12 of the Code of Federal Regulations (“Regulation G”) as promulgated by the Federal Reserve Board. As a condition to the exercise of this Option, the Company may
require Optionee to make any representation and warranty to the Company as may be required by any applicable law or regulation. 
 6.
Termination of Relationship. In the event of termination of Optionee’s employment or consulting relationship with the Company, Optionee may, to the extent otherwise so entitled at the date of such termination (the “Termination
Date”), exercise this Option during the Termination Period set out in the Notice of Grant. To the extent that Optionee was not entitled to exercise this Option at the date of such termination, or if Optionee does not exercise this Option within
the time specified herein, the Option shall terminate. 
 7. Disability of Optionee. Notwithstanding the provisions of Section 6
above, in the event of termination of Optionee’s consulting or employment relationship as a result of his total and permanent disability (as defined in Section 22(e)(3) of the Code or any successor provision), Optionee may, but only within
twelve (12) months from the date of termination of employment or consulting relationship (but in no event later than the date of expiration of the term of this Option as set forth in Section 10 below), exercise this Option to the extent
Optionee was entitled to exercise it at the date of such termination. To the extent that Optionee was not entitled to exercise the Option at the date of termination, or if Optionee does not exercise such Option (which Optionee was entitled to
exercise) within the time specified herein, the Option shall terminate. 
  

 2 

 8. Death of Optionee. In the event of the death of Optionee during the term of this Option and,
with respect to a Consultant, during such Consultant’s continuing consulting relationship with the Company or within 90 days of termination of Consultant’s relationship with the Company and, with respect to an employee, during such
employee’s employment relationship with the Company or within 90 days of termination of such employee’s relationship with the Company, the Option may be exercised at any time within twelve (12) months following the date of termination
(but in no event later than the date of expiration of the term of this Option as set forth in Section 10 below), by Optionee’s estate or by a person who acquired the right to exercise the Option by bequest or inheritance, but only to the
extent of the right to exercise that Optionee was entitled to at the date of death. 
 9. Nontransferability of Option. This Option
may not be transferred in any manner other than by will or by the laws of descent or distribution and may be exercised during the lifetime of Optionee only by Optionee. The terms of this Option shall be binding upon the executors, administrators,
heirs, successors and assigns of the Optionee. 
 10. Term of Option. This Option may be exercised only within the term set out in the
Notice of Grant and the Plan, and may be exercised during such term only in accordance with the Plan and the terms of this Option. 
 11.
Taxation Upon Exercise of Option. Optionee understands that, upon exercising a Nonstatutory Stock Option, he or she will recognize income for tax purposes in an amount equal to the excess of the then fair market value of the Shares over the
exercise price. If the Optionee is an employee, the Company will be required to withhold from Optionee’s compensation, or collect from Optionee and pay to the applicable taxing authorities an amount equal to a percentage of this compensation
income. Additionally, the Optionee may at some point be required to satisfy tax withholding obligations with respect to the disqualifying disposition of an Incentive Stock Option. The Optionee shall satisfy his or her tax withholding obligation
arising upon the exercise of a Nonstatutory Stock Option or a disqualifying disposition by one or some combination of the following methods: (i) by cash payment, or (ii) out of Optionee’s current compensation, or (iii) if
permitted by the Committee, in its discretion, by surrendering to the Company Shares that (a) in the case of Shares previously acquired from the Company, have been owned by the Optionee for more than six months on the date of surrender, and
(b) have a fair market value on the date of surrender equal to or greater than Optionee’s marginal tax rate times the ordinary income recognized, or (iv) if permitted by the Committee, in its discretion, and if the Option is
designated as a Nonstatutory Stock Option by electing to have the Company withhold from the Shares to be issued upon exercise of the Option that number of Shares having a fair market value equal to the amount required to be withheld. For this
purpose, the fair market value of the Shares to be withheld shall be determined on the date that the amount of tax to be withheld is to be determined (the “Tax Date”). 
 If the Optionee is subject to Section 16 of the Securities Exchange Act of 1934, as 

  

 3 

 
amended (the “Exchange Act”) (an “Insider”), any surrender of previously owned Shares to satisfy tax withholding obligations arising upon
exercise of this Option must comply with the applicable provisions of Rule 16b-3 promulgated under the Exchange Act (“Rule 16b-3”) and shall be subject to such additional conditions or restrictions as may be required thereunder to qualify
for the maximum exemption from Section 16 of the Exchange Act with respect to Plan transactions. 
 All elections by an Optionee to have
Shares withheld to satisfy tax-withholding obligations shall be made in writing in a form acceptable to the Committee and shall be subject to the following restrictions: 
 (1) the election must be made on or prior to the applicable Tax Date; 
 (2) once made, the election shall be irrevocable as to the particular Shares of the Option as to which the election is made; 

(3) all elections shall be subject to the consent or disapproval of the Committee; 
 (4) if the Optionee is an Insider, the election must comply with the applicable provisions of Rule 16b-3 and shall be subject to such
additional conditions or restrictions as may be required thereunder to qualify for the maximum exemption from Section 16 of the Exchange Act with respect to Plan transactions. 
 12. Tax Consequences. Set forth below is a brief summary as of the date of this Option of some of the federal tax consequences of exercise of this
Option and disposition of the Shares. THIS SUMMARY IS NECESSARILY INCOMPLETE, AND THE TAX LAWS AND REGULATIONS ARE SUBJECT TO CHANGE. OPTIONEE SHOULD CONSULT A TAX ADVISER BEFORE EXERCISING THIS OPTION OR DISPOSING OF THE SHARES. 
 (a) Exercise of ISO. If this Option qualifies as an ISO, there will be no regular federal 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 an item of adjustment to the alternative minimum tax for federal tax purposes in the year of exercise and may
subject the Optionee to the alternative minimum tax. 
 (b) Exercise of Nonstatutory Stock Option. If this Option does not qualify as
an ISO, there may be a regular federal income tax liability upon the exercise of the Option. The Optionee will be treated as having received compensation income (taxable at ordinary income tax rates) equal to the excess, if any, of the fair market
value of the Shares on the date of exercise over the Exercise Price and the Company will qualify for a deduction in the same amount, subject to the requirement that the compensation be reasonable. If Optionee is an 

  

 4 

 
employee, the Company will be required to withhold from Optionee’s compensation or collect from Optionee and pay to the applicable taxing authorities an
amount equal to a percentage of this compensation income at the time of exercise. 
 (c) Disposition of Shares. In the case of an NSO,
if Shares are held for at least one year, any gain realized on disposition of the Shares will be treated as long-term capital gain for federal income tax purposes. In the case of an ISO, if Shares transferred pursuant to the Option are held for at
least one year after exercise and are disposed of at least two years after the Date of Grant, any gain realized on disposition of the Shares will also be treated as long-term capital gain for federal income tax purposes. If Shares purchased under an
ISO are disposed of within one-year after exercise or within two years after the Date of Grant, any gain realized on such disposition will be treated as compensation income (taxable at ordinary income rates) in an amount equal to the excess of the
lesser of (1) the fair market value of the Shares on the date of exercise, or (2) the sale price of the Shares over the Exercise Price paid for those shares. The Company will also be allowed a deduction equal to any such amount recognized,
subject to the requirement that the compensation be reasonable. 
 (d) Notice of Disqualifying Disposition of ISO Shares. If the
Option granted to Optionee herein is an ISO, and if Optionee sells or otherwise disposes of any of the Shares acquired pursuant to the ISO on or before the later of (1) the date two years after the Date of Grant, or (2) the date one year
after the date of exercise, the Optionee shall immediately notify the Company in writing of such disposition. Optionee agrees that Optionee may be subject to income tax withholding by the Company on the compensation income recognized by the Optionee
from the early disposition by payment in cash or out of the current earnings paid to the Optionee. 
 13. Restrictive Legends and Transfer
Restrictions. Unless the Shares granted hereunder have been effectively registered under the Securities Act of 1933, as now in force or hereafter amended, the Company shall be under no obligation to issue or transfer any shares covered by this
option unless the Optionee or Optionee’s successors in accordance with section 5 above, shall give a written representation and undertaking to the company and upon which, in the opinion of such counsel, the Company may reasonable rely that
Optionee is acquiring the shares for his or her own account as an investment and not with the view to, or for sale in connection with, the distribution of such shares, and that Optionee will make no transfer of the same except in compliance with any
rules and regulations in force at the time of such transfer under the Securities Act of 1933, or any other applicable law, and that if shares are issued or transferred without such registration, a legend to this effect may be placed upon the
certificate representing the Shares. 
 14. Successors and Assigns. The Company may assign any of its rights under this Agreement to
single or multiple assignees, and this Agreement shall inure to the benefit of the successors and assigns of the Company. Subject to the restrictions on transfer herein set forth, this Agreement shall be binding upon Optionee and his or her heirs,
executors, administrators, successors and assigns. 
  

 5 

 15. Interpretation. Any dispute regarding the interpretation of this Agreement shall be submitted
by Optionee or by the Company forthwith to the Company’s Board of Directors or the Committee that administers the Plan, which shall review such dispute at its next regular meeting. The resolution of such a dispute by the Board or committee
shall be final and binding on the Company and on Optionee. 
 16. Governing Law; Severability. This Agreement shall be governed by and
construed in accordance with the laws of the State of North Carolina excluding that body of law pertaining to conflicts of law. Should any provision of this Agreement be determined by a court of law to be illegal or unenforceable, the other
provisions shall nevertheless remain effective and shall remain enforceable. 
 17. Notices. Any notice required or permitted
hereunder shall be given in writing and shall be deemed effectively given upon personal delivery or upon deposit in the United States mail by certified mail, with postage and fees prepaid, addressed to the other party at its address as shown below
beneath its signature, or to such other address as such party may designate in writing from time to time to the other party. 
 18.
Further Instruments. The parties agree to execute such further instruments and to take such further action as may be reasonably necessary to carry out the purposes and intent of this Agreement. 
 19. 2004 Stock Plan. Optionee acknowledges receipt of a copy of the Plan and represents that he is familiar with the terms and provisions thereof,
and hereby accepts this Option subject to all of the terms and provisions thereof. Optionee has reviewed the Plan and this Option in their entirety, has had an opportunity to obtain the advice of counsel prior to executing this Option and fully
understands all provisions of the Option. Optionee hereby agrees to accept as binding, conclusive and final all decisions or interpretations of the Board or Committee upon any questions arising under the Plan or this Option. 
  

 6 

 EXHIBIT A 
 CHELSEA THERAPEUTICS INTERNATIONAL, LTD. 
 EXERCISE NOTICE 
  

	
	Chelsea Therapeutics International, Ltd.
	  

	  

	Attention: Secretary

 1. Exercise of Option. Effective as of today, the undersigned (“Optionee”) hereby
elects to exercise Optionee’s option to purchase                      shares of the Common Stock (the “Shares”) of Chelsea
Therapeutics International, Ltd. (the “Company”) under and pursuant to the Company’s 2004 Stock Plan (as amended, the “Plan”) and the Notice of Stock Option Grant dated
                    , 200     with its attached Stock Option Agreement (the “Option Agreement”). The
purchase price for the Shares shall be $                     as required by the Option Agreement. Optionee herewith delivers to the Company
the full Exercise Price for the Shares. 
 2. Representations of Optionee. Optionee acknowledges that Optionee has received, read and
understood the Plan and the Option Agreement and agrees to abide by and be bound by their terms and conditions. 
 3. Rights as
Stockholder. Until the stock certificate evidencing such Shares is issued (as evidenced by the appropriate entry on the books of the Company or of a duly authorized transfer agent of the Company), no right to vote or receive dividends or any
other rights as a stockholder shall exist with respect to the optioned Shares, notwithstanding the exercise of the Option. The Company shall issue (or cause to be issued) such stock certificate promptly after the Option is exercised. 
 4. Tax Consultation. Optionee understands that Optionee may suffer adverse tax consequences as a result of Optionee’s purchase or disposition
of the Shares. Optionee represents that Optionee has consulted with any tax consultants Optionee deems advisable in connection with the purchase or disposition of the Shares and that Optionee is not relying on the Company for any tax advice.

 5. Entire Agreement. The Plan and Option Agreement are incorporated herein by reference. This Exercise Notice, the Plan and the
Option Agreement and any Investment Representation statement executed and delivered to Company by Optionee shall constitute the entire agreement of the parties and supersede in their entirety all prior undertakings and agreements of the Company and
Optionee with respect to the subject matter hereof, and is governed by North Carolina law except for that body of law pertaining to conflict of laws. 

									
	Submitted by:	 		 	Accepted by:
			
	OPTIONEE:	 		 	Chelsea Therapeutics International, Ltd.
				
	  
	 		 	By:	 	  

		 		 	Name:	 	  

		 		 	Title:	 	  

					
	Address:	 	  
	 		 	Address:	 	  

	  
	 		 	  

	  
	 		 	  

  

 2 

 EXHIBIT B 
 [Form can be omitted if securities underlying option are registered under Securities Act] 
 INVESTMENT REPRESENTATION STATEMENT 
  

											
	OPTIONEE	 	:	  	  
	  		  		  	
			
	COMPANY	 	:	  	Chelsea Therapeutics International, Ltd.
			
	SECURITY	 	:	  	Common Stock
					
	AMOUNT	 	:	  	                     Shares	  		  	

 In connection with the purchase of the above-listed Securities, I, the Optionee, represent to the Company the
following. 
 1. Optionee is aware of the Company’s business affairs and financial condition and has acquired sufficient information
about the Company to reach an informed and knowledgeable decision to acquire the securities. Optionee is purchasing the securities for investment for Optionee’s own account only and not with a view to, or for resale in connection with, any
“distribution” thereof within the meaning of the Securities Act of 1933, as amended (the “Securities Act”). 
 2.
Optionee understands that the securities have not been registered under the Securities Act in reliance upon a specific exemption therefrom, which exemption depends upon, among other things, the bona fide nature of Optionee’s investment intent
as expressed herein. 
 3. Optionee further understands that the securities must be held indefinitely unless subsequently registered under
the Securities Act or unless an exemption from registration is available. Moreover, Optionee understands that the Company is under no obligation to register the securities. In addition, Optionee understands that the certificate evidencing the
securities will be imprinted with a legend that prohibits the transfer of the securities unless they are registered or such registration is not required in the opinion of counsel for the Company. 
 4. Optionee is familiar with the provisions of Rules 144, 144(k) and 701, promulgated under the Securities Act, that permit limited public resale of
“restricted securities” acquired, directly or indirectly, from the issuer thereof (or from an affiliate of such issuer) in a nonpublic offering, subject to the satisfaction of certain conditions. 
 Subject to any lock-up agreement, in the event the Company becomes subject to the reporting requirements of Section 13 or 15(d) of the Securities
Exchange Act of 1934, as amended (the “Exchange Act”), the securities exempt under Rule 701 may be resold by the 

 
Optionee 90 days thereafter, subject to the satisfaction of certain of the conditions specified by Rule 144, including: (a) the sale being made through
a broker in an unsolicited “broker’s transaction” or in transactions directly with a market maker (as that term is defined under the Exchange Act); and (b) in the case of an affiliate, the availability of certain public
information about the Company, and the amount of securities being sold during any three-month period not exceeding the limitations specified in Rule 144(e), if applicable. 
 If the purchase of the securities does not qualify under Rule 701 at the time of purchase, then the securities may be resold by the Optionee in certain
limited circumstances subject to the provisions of Rule 144, which require: (a) the availability of certain public information about the Company; (b) the resale occurring not less than one year after the party has purchased, and made full
payment (within the meaning of Rule 144) for, the securities to be sold; and (3) in the case of an affiliate, or of a nonaffiliate who has held the securities less than two years, the sale being made through a broker in an unsolicited
“broker’s transaction” or in transactions directly with a market maker (as that term is defined under the Exchange Act) and the amount of securities being sold during any three-month period not exceeding the specified limitations.

 If all of the requirements of Rule 144 are not satisfied, Optionee may be able to sell the securities without registration pursuant to the
exemption contained in Rule 144(k), provided that the resale occurs not less than two years after the party has purchased, and made full payment (within the meaning of Rule 144) for, the securities. 
 5. Optionee further understands that at the time Optionee wishes to sell the securities there may be no public market upon which to make such a sale, and
that, even if such a public market then exists, the Company may not be satisfying the current public information requirements of Rules 144 or 701, and that, in such event, Optionee would be precluded from selling the securities under Rules 144 or
701 even if the one-year minimum holding period had been satisfied; however, Optionee may be able to sell the securities pursuant to the exemptions contained in Rule 144(k) if the two-year holding period has been satisfied. 
 6. Optionee further understands that in the event all of the applicable requirements of Rules 144, 144(k) or 701 are not satisfied, registration under
the Securities Act or some registration exemption will be required; and that, notwithstanding the fact that Rules 144, 144(k) and 701 are not exclusive, the Staff of the SEC has expressed its opinion that persons proposing to sell private placement
securities other than in a registered offering and otherwise than pursuant to Rules 144, 144(k) or 701 will have a substantial burden of proof in establishing that an exemption from registration is available for such offers or sales, and that such
persons and their brokers who participate in such transactions do so at their own risk. 
  

									
	Date	 		 		 	Signature of Optionee:	 	
					
	  
	 		 		 	  
	 	

  

 2

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