Document:

Northstar Healthcare Inc. - Exhibit 10.43 - Filed by newsfilecorp.com

EMPLOYMENT AGREEMENT 

EMPLOYMENT AGREEMENT (this “Agreement”), dated
effective the 1st Day of August, 2014 (the “Effective Date”) by
and among Andy Chen (the “Executive”), Northstar Healthcare Acquisitions,
L.L.C., a Delaware limited liability company (the “Company”), and
Northstar Healthcare Inc., a corporation incorporated under the laws of British
Columbia (the “Issuer”). 

           
WHEREAS, the Company wishes to employ the Executive upon the terms and
conditions hereinafter set forth, and the Executive is willing and able to
accept such employment on such terms and conditions. 

           
AND WHEREAS, the Company is an indirect subsidiary of the Issuer. 

            AND
WHEREAS, the Issuer wishes for the Executive to serve as a “C-level”
Executive of the Issuer for no additional compensation upon the terms and
conditions hereinafter set forth, and the Executive is willing and able to serve
in such capacity on such terms and conditions. 

           
NOW, THEREFORE, in consideration of the mutual premises set forth
below, the Company, the Issuer and the Executive agree as follows: 

	1. 	
      Employment Duties. The Company hereby employs the
      Executive, and the Executive accepts employment, as Chief Financial
      Officer, or such other “C-level” officer of the Issuer mutually agreed to
      by the parties, subject to the direction and control of the Board of
      Managers of the Company (the “Board”) and the Board of Directors of
      the Issuer (the “Issuer Board”), to whom the Executive shall
      report. During the employment period, the Executive shall have such
      duties, responsibilities and authority with the Company and its
      subsidiaries and affiliates that are consistent with such position(s) and
      are assigned by the Board, the Issuer Board or the Chief Executive Officer
      of the Company, as applicable. Executive may (a) manage his own passive
      investments, and (b) serve on civic, charitable or non-profit boards or
      committees, including any board of directors of such organization on which
      the Executive currently serves (a list of which is attached hereto as
      Schedule “A”), so long as any of such activities do not interfere with the
      performance of the Executive’s responsibilities pursuant to this
      Agreement.

	 	 
	2. 	
      Term. The Executive’s employment shall commence on
      the date of this Agreement and, unless earlier terminated as provided
      herein, shall continue until the date that is two (2) years from the
      Effective Date. This Agreement shall automatically renew for additional
      one (1) year terms unless written notice is provided by either the
      Executive or the Company at least 30 days prior to the expiration of any
      term hereunder.

	 	 
	3. 	
      Place of Employment.

	 	 
		
      The Executive’s place of employment will be the Company’s
      head office located in Houston, Texas.

	 	 
	4. 	
      Compensation and
Benefits.

	 	(a) 	
      Base Salary. The Company will pay the Executive a
      salary of One Hundred and Seventy Thousand United States dollars (U.S.
      $170,000) per annum (“Full Base Salary”) payable in accordance with the Company’s
      normal payroll practices. Said Full Base Salary shall increase to Two
      Hundred Thousand United States dollars (U.S. $200,000) per annum on
  January 1, 2015.

- 2 - 

	 	(b) 	
      STIP. The Executive will be eligible to
      participate in the Company’s short-term incentive plan for senior
      management (the “STIP”). The Executive’s target annual bonus under
      the STIP shall be forty percent (40%) of his Base Salary, as determined by
      the Compensation, Nominating and Corporate Governance Committee of the
      Issuer Board (the “Compensation Committee”) in its sole
      discretion.

	 	 	 
	 	(c) 	
      Stock Options. The Executive shall receive as
      additional compensation two hundred thousand Stock Options to be issued in
      accordance with the Company’s plan.

	 	 	 
	 	(d) 	
      Benefits. During the Term, the Executive shall be
      entitled to participate in all benefit plans and programs generally made
      available by the Company to its senior executives. The Executive shall
      also be entitled to all fringe benefits and vacations for which his
      position makes him eligible in accordance with the Company’s usual
      policies and the terms and provisions of such plans, policies or
      arrangements. During the Term, the Company shall pay the Executive’s
      reasonable health insurance premium expenses for any time period during
      which the Executive is not covered by the Company’s benefit plan (e.g.,
      during a “waiting period”), including, without limitation, the Executive’s
      COBRA payments for health insurance continuation.

	 	 	 
	 	(e) 	
      Execution of this Agreement. As consideration for
      executing this Agreement Executive agrees to the following conditions with
      respect to any and all common stock of Issuer that Executive owns or
      controls: 30 day hold.

	 	 	 
	 	(f) 	
      Expenses. The Company shall pay or reimburse the
      Executive for ordinary and necessary business expenses incurred by him in
      the performance of his duties as an employee of the Company in accordance
      with the Company’s usual policies for expenses.

	 	 	 
	 	(g) 	
      Vacation. The Executive shall be entitled to three
      (3) weeks’ vacation per calendar year during the Term. Any unused vacation
      will be forfeited at the end of each calendar year during the
  Term.

	5. 	
      Termination of Employment. The Executive’s
      employment may be terminated as follows:

	 	 	 
		(a) 	
      By the Executive Without Good Reason. The
      Executive shall have the right to terminate the Executive’s employment at
      any time during the Term upon Sixty (60) days prior written notice, and
      upon such termination, the Executive shall have the right to receive any
      earned but unpaid Base Salary through the date of termination,
      accrued but unused vacation time and any expenses incurred but
      unreimbursed at the date of termination (the “Termination
      Benefits”), all of which shall be paid in cash either, at the discretion of
      the Issuer Board, within thirty (30) days following such termination date
      or over the course of the 60-day notice period in accordance with the
  Company’s standard payroll practices.

- 3 - 

	 	(b) 	
      By the Executive for Good Reason. The Executive
      may terminate his employment hereunder during the Term for Good Reason by
      providing written notice to the Board and the Issuer Board within thirty
      (30) days following the occurrence of any of the events specified below.
      Such notice shall specify the circumstances relating thereto and, unless
      the Company or the Issuer, as applicable, cures the defect within thirty
      (30) days after receipt of such notice, the Executive’s employment shall
      terminate ten (10) days after such cure period. For purposes of this
      Section 5, “Good Reason” shall mean any of the
  following:

	 	(i) 	 	
      the Executive’s assignment of title, duties or
      responsibilities that are inconsistent in any material respect with the
      scope of the title, duties or responsibilities as set forth in this
      Agreement;

	 	 	 	 
	 	(ii) 	 	
      the Executive’s duties or responsibilities are
      significantly reduced, except with respect to any corporate action
      initiated or recommended by the Executive and approved by the Board and
      the Issuer Board;

	 	 	 	 
	 	(iii) 	 	
      the failure of the Company or the Issuer to perform
      substantially any material term or provision of this Agreement required to
      be performed by it;

	 	 	 	 
	 	(iv) 	 	
      the Executive’s principal office is relocated more than
      fifty (50) miles from the location at which the Executive was based
      immediately prior to the relocation;

	 	 	 	 
	 	(v) 	 	
      the Executive’s Base Salary is reduced, other than in
      connection with a reduction of compensation for executives in response to
      adverse financial circumstances; or

	 	 	 	 
	 	(vi) 	 	
      in the event that there is a change in control of the
      Issuer.

	 	(c) 	
      By the Company Without Cause. The Company (subject
      to the prior agreement of the Issuer Board, upon the recommendation of the
      Compensation Committee) shall have the right to terminate the Executive’s
      employment at any time during the Term without Cause (as defined below),
      by providing written notice to the Executive specifying the effective date
      of termination (which may be forthwith).

	 	 	 
	 	(d) 	
      Severance Pay on a Termination Without Cause or for
      Good Reason. Subject to Section 2, if the Company terminates the
      Executive during the Term without Cause or the Executive terminates his
      employment during the Term for Good Reason, the Executive shall be
      entitled to the Termination Benefits and to receive severance pay equal
      to:

	 	(i) 	
      All Base Salary that would be due to Executive, in
      accordance with the Company’s standard payroll
practices.

- 4 - 

	 	(e) 	
      For Cause. Either the Issuer or the Company, with
      the prior approval of the Issuer Board upon the recommendation of the
      Compensation, Nominating and Corporate Governance Committee of the Issuer
      Board, may terminate this Agreement during the Term at any time for Cause,
      effective immediately upon written notice to the Executive, in which event
      the Executive shall be entitled to payment of the Termination Benefits and
      neither the Issuer nor the Company shall have any further obligation to
      him. For purposes of this Agreement, “Cause” shall mean any of the
      following:

	 	(i) 	 	
      the Executive’s continued failure, whether wilful or not,
      to perform substantially all of his duties hereunder (other than as a
      result of being Disabled);

	 	 	 	 
	 	(ii) 	 	
      the Executive’s dishonesty or gross negligence in the
      discharge of his duties hereunder;

	 	 	 	 
	 	(iii) 	 	
      the Executive’s conviction of, or entering a plea of nolo
      contendere to, a crime that constitutes a felony under the federal,
      provincial or state laws of Canada or the United States (other than a
      traffic violation);

	 	 	 	 
	 	(iv) 	 	
      any wilful act or omission on the Executive’s part which
      is materially injurious to the financial condition or business reputation
      of the Company, the Issuer or any of their subsidiaries or
    affiliates;

	 	 	 	 
	 	(v) 	 	
      the Executive’s failure or refusal to comply with a
      lawful oral or written directive from the Company’s Chief Executive
      Office, the Board or the Issuer Board; or

	 	 	 	 
	 	(vi) 	 	
      the Executive’s breach of Section 6 or 7 of this
      Agreement.

	6. 	
      Protection of Confidential Information;
      Non-Competition.

	 	(a) 	
      Acknowledgment. The Executive agrees and
      acknowledges that, in the course of rendering services to the Company and
      its clients and customers, he has acquired and will acquire access to and
      become acquainted with confidential information about the professional,
      business and financial affairs of the Company, its subsidiaries and
      affiliates (including the Issuer) that is non-public, confidential or
      proprietary in nature. The Executive acknowledges that the Company is
      engaged in a highly competitive business and that the success of the
      Company and the Issuer in the marketplace depends upon their good will and
      reputation for quality and dependability. The Executive agrees and
      acknowledges that reasonable limits on his ability to engage in activities
      competitive with the Company are warranted to protect their substantial
      investment in developing and maintaining its status in the marketplace,
      reputation and good will. The Executive recognizes that in order to guard
      the legitimate interests of the Company and the Issuer, it is necessary
      for them to protect all confidential information. The Executive further
      agrees that his obligations under Sections 6(b) and 6(c) shall be absolute
      and unconditional.

- 5 - 

	 	(b) 	
      Confidential Information. During the Term and at
      all times following the Executive’s termination of employment, the
      Executive shall keep secret all non- public information, matters and
      materials of the Company (including subsidiaries or affiliates (including
      the Issuer)), including, without limitation, know-how, trade secrets,
      customer lists, pricing policies, operational methods, any information
      relating to the Company’s (including any subsidiaries or affiliates
      (including the Issuer)) products, processes, customers and services and
      other business and financial affairs of the Company and the Issuer
      (collectively, the “Confidential Information”), to which the
      Executive has had or may have access and shall not use or disclose such
      Confidential Information to any person other than: (i) the Company, its
      authorized employees and such other persons to whom the Executive has been
      instructed to make disclosure by the Issuer Board, in each case only to
      the extent required in the course of the Executive’s employment with the
      Company or as otherwise expressly required in connection with court
      process; (ii) as may be required by law (in which case the Executive will
      provide the Company with prompt notice so that it may seek a protective
      order or other appropriate remedy); or (iii) to the Executive’s personal
      advisers for purposes of enforcing or interpreting this Agreement, or to a
      court for the purpose of enforcing or interpreting this Agreement, and who
      in each case have been informed as to the confidential nature of such
      Information and, as to advisers, their obligation to keep such Information
      confidential. “Confidential Information” shall not include any information
      which is in the public domain during the Executive’s employment, provided
      such information is not in the public domain as a consequence of his
      disclosure in violation of this Agreement. Upon termination of the
      Executive’s employment for any reason, he shall deliver to the Company all
      documents, papers and records (including, but not limited to, electronic
      media) in his possession or subject to his control that (x) belong to the
      Issuer or the Company or (y) contain or reflect any information concerning
      the Company, its subsidiaries or affiliates (including the
  Issuer).

	 	 	 
	 	(c) 	
      Non-Competition and Non-Solicitation. In
      consideration of the obligations of the Company and the Issuer hereunder,
      the Executive shall not, in any capacity, whether for his own account or
      for any other person or organization, directly or indirectly, with or
      without compensation:

	 	(i) 	
      during the Term and for a period following his
      termination of employment corresponding with the amount of severance paid
      under this Agreement (and not, for clarity, the time period over which
      such severance is paid) (A) own, operate, manage, or control, (B) serve as
      an officer, director, partner, employee, agent, consultant, advisor or
      developer or in any similar capacity to (C) have any financial interest
      in, or aid or assist anyone else in the conduct of an enterprise of, or
      (D) engage in any undertaking, provide services to, lend money or
      guarantee the obligations of, any person who carries on business that
      competes in any material respect with the business or any material part
      thereof, of the identification, development, acquisition, ownership,
      operation or management of ambulatory surgery centres (including the
      Issuer) within ten (10) miles of any ambulatory surgery centre owned, directly or
      indirectly, by the Issuer, during the Term of this agreement, or call
      upon, solicit, divert, take away or attempt to solicit any of the
      customers or suppliers or any other business contacts of the Company any
  of its subsidiaries or affiliates;

- 6 - 

	 	(ii) 	
      during the Term and for a period ending twelve (12)
      months following his termination of employment, solicit, retain, hire,
      offer to hire, entice away or in any manner persuade or attempt to
      persuade any officer, employee or agent of the Company, the Issuer
      (including any subsidiaries or affiliates thereof, including, without
      limitation, any physician limited partner or contract physician employed
      by or working at any of the ambulatory surgery centres owned (directly or
      indirectly) or managed by the Company) to discontinue his or her
      relationship with the Company, the Issuer or such subsidiaries or
      affiliates; or

	 	 	 
	 	(iii) 	
      during the Term and for a period ending twelve (12)
      months following his termination of employment, solicit, divert or
      appropriate any customers, clients, vendors or distributors of the Company
      (including any subsidiaries or affiliates
thereof).

	 		
      Notwithstanding anything to the contrary contained
      herein, nothing in this Section 6(c) shall prohibit the Executive from
      acquiring or holding not more than five percent (5%) of any class of
      publicly traded securities or, following his termination of employment,
      serving as an officer, director, partner, employee, agent, consultant or
      advisor of a hospital that derives no more than 5% of its revenues from
      the operation and/or management of an ambulatory surgery centre or
      outpatient clinic; provided that the Executive shall not serve in any such
      capacity if such service relates in any material respect to the
      identification, development, acquisition, ownership, operation or
      management of ambulatory surgery centres by such hospital.

	 	 	 
	 		
      For clarity and by way of example, if the Executive is
      entitled to a severance payment equal to sixty (60) days’ Base Salary, the
      Executive’s obligations not to compete pursuant to Section 6(c)(i) above
      shall extend for sixty (60) days following the date of
  termination.

	 	 	 
	 	(d) 	
      Modification. The parties agree and acknowledge
      that the duration, scope and geographic area of the covenants described in
      this Section 6 are fair, reasonable and necessary in order to protect the
      good will and other legitimate interests of the Company, that adequate
      consideration has been received by the Executive for such obligations, and
      that these obligations do not prevent the Executive from earning a
      livelihood. If, however, for any reason any court of competent
      jurisdiction determines that the restrictions in this Section 6 are not
      reasonable, that consideration is inadequate or that the Executive has
      been prevented unlawfully from earning a livelihood, such restrictions
      shall be interpreted, modified or rewritten to include as much of the
      duration, scope and geographic area identified in this Section 6 as will
      render such restrictions valid and
enforceable.

- 7 - 

	 	(e) 	
      Remedies for Breach. The Company, the Issuer, and
      the Executive agree that the restrictive covenants contained in this
      Agreement are severable and separate, and the unenforceability of any
      specific covenant herein shall not affect the validity of any other
      covenant set forth herein. The Executive acknowledges that the Company and
      the Issuer will suffer irreparable harm as a result of a breach of such
      restrictive covenants by the Executive for which an adequate monetary
      remedy does not exist and a remedy at law may prove to be inadequate.
      Accordingly, in the event of any actual or threatened breach by the
      Executive of any provision of this Agreement, the Company and the Issuer
      shall, in addition to any other remedies permitted by law, be entitled to
      obtain remedies in equity, including, without limitation, specific
      performance, injunctive relief, a temporary restraining order, and/or a
      permanent injunction in any court of competent jurisdiction, to prevent or
      otherwise restrain a breach of Sections 6(b) and 6(c), without the
      necessity of proving damages, posting a bond or other security, and to
      recover any and all costs and expenses, including reasonable counsel fees,
      incurred in enforcing this Agreement against the Executive, and the
      Executive hereby consents to the entry of such relief against him and
      agrees not to contest such entry. Such relief shall be in addition to and
      not in substitution of any other remedies available to the Company. The
      existence of any claim or cause of action of the Executive against the
      Company or the Issuer, whether predicated on this Agreement or otherwise,
      shall not constitute a defense to the enforcement by the Company or the
      Issuer of said covenants. The Executive shall not defend on the basis that
      there is an adequate remedy at law.

	7. 	
      Intellectual Property. All copyrights, trademarks,
      trade names, servicemarks, and other intangible or intellectual property
      rights that may be invented, conceived, developed or enhanced by the
      Executive during the Term that relate to the business or operations of the
      Company or any subsidiary or affiliate thereof (including the Issuer) or
      that result from any work performed by the Executive for the Company or
      any such subsidiary or affiliate shall be the sole property of the Company
      or such subsidiary or affiliate, as the case may be, and the Executive
      hereby waives any right or interest that he may otherwise have in respect
      thereof. Upon the reasonable request of the Company or the Issuer, the
      Executive shall execute, acknowledge and deliver any instrument or
      document reasonably necessary or appropriate to give effect to this
      Section 7 and, at the Company’s cost, do all other acts and things
      reasonably necessary to enable the Company or such subsidiary or
      affiliate, as the case may be, to exploit the same or to obtain patents or
      similar protection with respect thereto.

	 	 
	8. 	
      Notices. All notices or other communications
      hereunder shall be in writing and shall be deemed to have been duly given
      (a) when delivered personally, (b) upon confirmation of receipt when such
      notice or other communication is sent by facsimile, (c) one day after
      delivery to an overnight delivery courier, or (d) on the fifth day
      following the date of deposit in the United States mail if sent first
      class, postage prepaid, by registered or certified mail. The addresses for
      such notices shall be as follows:

- 8 - 

	 	(a) 	
      For notices and communications to the Company and the
      Issuer:

	 	 	 
	 		
      Northstar Healthcare Acquisitions, L.L.C. 
4120
      Southwest Freeway, Suite 150 
Houston, Texas 77027

	 		
      Attn: Donald L. Kramer, M.D., Chief Executive Officer
      
Fax: 713-355-8615 
E-mail: dkramer@northstar-healthcare.com

	 	 	 
	 	(b) 	
      For notices and communications to the Executive, to the
      address or facsimile set forth below his signature hereto. Any party
      hereto may, by notice to the other, change its address for receipt of
      notices hereunder.

	9. 	
      General

	 	 	 
		(a) 	
      Governing Law. This Agreement shall be governed by
      the laws of the State of Texas, without regard to any conflicts of laws
      principles thereof that would call for the application of the laws of any
      other jurisdiction. Any action or proceeding seeking to enforce any
      provision of, or based on any right arising out of, this Agreement may be
      brought against either of the parties in the courts of the State of Texas,
      or if it has or can acquire jurisdiction, in the United States District
      Court for the Southern District of Texas and each of the parties hereby
      consents to the jurisdiction of such courts (and of the appropriate
      appellate courts) in any such action or proceeding and waives any
      objection to venue laid therein. Process in any action or proceeding
      referred to in the preceding sentence may be served on any party anywhere
      in the world, whether within or without the State of Texas.

	 	 	 
		(b) 	
      Amendment: Waiver. This Agreement may be amended,
      modified, superseded, cancelled, renewed or extended, and the terms hereof
      may be waived, only by a written instrument executed by both of the
      parties hereto or, in the case of a waiver, by the party waiving
      compliance. The failure of either party at any time or times to require
      performance of any provision hereof shall in no manner affect the right at
      a later time to enforce the same. No waiver by either party of the breach
      of any term or covenant contained in this Agreement, whether by conduct or
      otherwise, in any one or more instances, shall be deemed to be, or
      construed as, a further or continuing waiver of any such breach, or a
      waiver of the breach of any other term or covenant contained in this
      Agreement.

	 	 	 
		(c) 	
      Successors and Assigns. This Agreement shall be
      binding upon the Executive, without regard to the duration of his
      employment by the Company and the Issuer or reasons for the cessation of
      such employment, and inure to the benefit of his administrators,
      executors, heirs and assigns, although the obligations of the Executive
      are personal and may be performed only by him. This Agreement shall also
      be binding upon and inure to the benefit of the Company, the Issuer and
      their respective subsidiaries, successors and assigns, including any
      corporation with which or into which the Company or its successors may be
      merged or which may succeed to its assets or
business.

- 9 - 

	 	(d) 	
      Counterparts. This Agreement may be executed in
      multiple counterparts, each of which shall be considered to have the force
      and effect of an original.

	 	 	 
	 	(e) 	
      Entire Agreement. This Agreement supersedes all
      prior agreements between the parties with respect to its subject matter
      and is intended (with the documents referred to herein) as a complete and
      exclusive statement of the terms of the agreement between the parties with
      respect thereto.

	 	 	 
	 	(f) 	
      Deductions and Withholding. The Executive
      acknowledges and agrees that the Company shall be entitled to withhold
      from the compensation payable hereunder, including the Base Salary and any
      bonus, all federal, state, local or other taxes which the Company
      determines are required to be withheld on amounts payable to the Executive
      pursuant to this Agreement or otherwise.

	 	 	 
	 	(g) 	
      Representation. The Executive hereby acknowledges
      that he has been represented by an attorney of his choice in negotiating
      this Agreement (or has chosen not to be so represented) and that counsel
      for the Company and the Issuer has not advised or represented him in any
      way in this matter.

	 	 	 
	 	(h) 	
      Severability. The invalidity of one or more of the
      words, phrases, sentences, clauses or sections contained herein shall not
      affect the enforceability of the remaining portions of this Agreement, or
      any part thereof, all of which are inserted conditionally on their being
      valid in law, and, in the event any one of the words, phrases, sentences,
      clauses or sections in this Agreement shall be declared invalid, this
      Agreement shall be construed as if such invalid word(s), phrase(s),
      sentence(s), clause(s) or section(s) had not been inserted.

	 	 	 
	 	(i) 	
      Section Headings. The section headings in this
      Agreement are for reference purposes only and shall not affect in any way
      the meaning or interpretation of this Agreement.

[Intentionally Blank] 

- 10 - 

      
     IN WITNESS WHEREOF, the parties have executed this
Agreement as of the date first above written. 

NORTHSTAR HEALTHCARE ACQUISITIONS,
L.L.C. 

 

	 	By: 	/s/
      Harry Fleming 
	 	 	Name: 
	 	 	Title: 

 

NORTHSTAR HEALTHCARE INC. 

 

	 	By: 	/s/
      Harry Fleming 
	 	 	Name: 
	 	 	Title: 

 

EXECUTIVE 

 

	 	 
                       /s/ Andy
      Chen 
	 	Name: Andy Chen 
	 	Address: 

SCHEDULE “A” 

Existing Board/Committee CommitmentsForm of Medium-Term Notes, Series K, Principal at Risk Securities

 Exhibit 4.1 

[Face of Note] 

Unless this certificate is presented by an authorized representative of The Depository Trust Company, a New York corporation
(“DTC”), to the Company or its agent for registration of transfer, exchange or payment, and any certificate issued is registered in the name of Cede & Co. or in such other name as requested by an authorized representative
of DTC (and any payment is made to Cede & Co. or such other entity as is requested by an authorized representative of DTC), ANY TRANSFER, PLEDGE OR OTHER USE HEREOF FOR VALUE OR OTHERWISE BY OR TO ANY PERSON IS WRONGFUL inasmuch as the
registered owner hereof, Cede & Co., has an interest herein. 
  

	 CUSIP NO. 94986RTW1 
	
FACE AMOUNT: $                   
          

 REGISTERED NO.      

WELLS FARGO & COMPANY 

MEDIUM-TERM NOTE, SERIES K 

Due Nine Months or More From Date of Issue 

Principal at Risk Securities Linked to the Russell 2000® Index 

due December 30, 2016 

WELLS FARGO & COMPANY, a corporation duly organized and existing under the laws of the State of Delaware (hereinafter
called the “Company,” which term includes any successor corporation under the Indenture hereinafter referred to), for value received, hereby promises to pay to CEDE & Co., or registered assigns, an amount equal to the
Redemption Amount (as defined below) on the Stated Maturity Date (as defined below), unless this Security is automatically called prior to the Stated Maturity Date as provided below under “Automatic Call,” and to pay Contingent Coupon
Payments (as defined below) on the Face Amount of this Security to the extent provided herein on Contingent Coupon Payment Dates specified herein at the Contingent Coupon Rate (as defined below) until the earlier of the Stated Maturity Date and the
Call Settlement Date (as defined below), if any. The “Initial Stated Maturity Date” shall be December 30, 2016. If the Final Calculation Day (as defined below) is not postponed, the Initial Stated Maturity Date will be the
“Stated Maturity Date.” If the Final Calculation Day is postponed, the “Stated Maturity Date” shall be the later of (i) the Initial Stated Maturity Date and (ii) the third Business Day after the Final
Calculation Day as postponed. “Business Day” shall mean a day, other than a Saturday or Sunday, that is neither a legal holiday nor a day on which banking institutions are authorized or required by law or regulation to close in New
York, New York. 
 “Face Amount” shall mean, when used with respect to this Security, the amount set forth
on the face of this Security as its “Face Amount.” 

 Automatic Call 

If the Closing Level (as defined below) of the Index (as defined below) on any of the first seven quarterly Calculation Days
(as defined below) is greater than or equal to the Starting Level (as defined below), this Security will be automatically called by the Company, and on the related Call Settlement Date the Holder hereof will receive the Call Price (as defined below)
plus a final Contingent Coupon Payment. Unless the Company defaults in the payment of the Call Price plus the final Contingent Coupon Payment, this Security will cease to be outstanding on such Call Settlement Date, no additional Contingent Coupon
Payments will be payable on this Security and the Holder hereof will have no further rights under this Security after such Call Settlement Date. The Holder hereof will not receive any notice from the Company in the event this Security is
automatically called pursuant to the terms hereof. The “Call Price” is equal to the Face Amount of this Security. 
 Payment of
Contingent Coupon Payments, the Redemption Amount and the Call Price 
 On each Contingent Coupon Payment Date, the
Company shall pay a Contingent Coupon Payment if, and only if, the Closing Level of the Index on the related Calculation Day is greater than or equal to the Threshold Level. A “Contingent Coupon Payment,” if payable as provided
herein, other than the Contingent Coupon Payment due on the Stated Maturity Date, shall be equal to the product of (i) the Face Amount of this Security, (ii) the Contingent Coupon Rate, and (iii) 90/360. If payable as provided herein,
the Contingent Coupon Payment due on the Stated Maturity Date shall be equal to the product of (i) Face Amount of this Security, (ii) Contingent Coupon Rate, and (iii) 60/360. The “Contingent Coupon Payment Dates”
shall be the fourth Business Day following each Calculation Day, as each such Calculation Day may be postponed as herein provided. The “Contingent Coupon Rate” is 7.20% per annum. Any Contingent Coupon Payments will be rounded to the
nearest cent, with one-half cent rounded upward. 
 Any Contingent Coupon Payment so payable, and punctually paid or duly
provided for, on any Contingent Coupon Payment Date will, as provided in the Indenture, be paid to the Person in whose name this Security (or one or more Predecessor Securities) is registered at the close of business on the Regular Record Date for
such Contingent Coupon Payment next preceding such Contingent Coupon Payment Date. The Regular Record Date for a Contingent Coupon Payment Date shall be the date one Business Day prior to such Contingent Coupon Payment Date. 

Any Contingent Coupon Payment not punctually paid or duly provided for will forthwith cease to be payable to the Holder on
such Regular Record Date and may either be paid to the Person in whose name this Security (or one or more Predecessor Securities) is registered at the close of business on a Special Record Date for the payment of such Defaulted Interest to be fixed
by the Trustee, notice whereof shall be given to Holders of Securities of this series not less than 10 days prior to such Special Record Date, or be paid at any time in any other lawful manner not inconsistent with the requirements of any
securities exchange on which the Securities of this series may be listed, and upon such notice as may be required by such exchange, all as more fully provided in the Indenture. 

Payment of any Contingent Coupon Payment on this Security will be made in immediately available funds at the office or agency
of the Company maintained for that purpose in the City of 

  
 2 

 
Minneapolis, Minnesota; provided, however, that, at the option of the Company, payment of any Contingent Coupon Payment may be paid by check mailed to the Person entitled thereto at such
Person’s last address as it appears in the Security Register or by wire transfer to such account as may have been designated by such Person. Payments of any Contingent Coupon Payment and the Redemption Amount or the Call Price, as applicable,
on this Security at Maturity, will be made against presentation of this Security at the office or agency of the Company maintained for that purpose in the City of Minneapolis, Minnesota and at any other office or agency maintained by the Company for
such purpose. Notwithstanding the foregoing, for so long as this Security is a Global Security registered in the name of the Depositary, any payments on this Security will be made to the Depositary by wire transfer of immediately available funds.

 Payment of the Redemption Amount or the Call Price, as applicable, and any Contingent Coupon Payments on this Security
will be made in such coin or currency of the United States of America as at the time of payment is legal tender for payment of public and private debts. 

Definitions Relating to Redemption Amount, the Call Price and Contingent Coupon Payments 

If this Security is not automatically called prior to the Stated Maturity Date as provided above under “Automatic
Call,” the “Redemption Amount” of this Security will equal: 
  

	 	•	 	 if the Ending Level is greater than or equal to the Threshold Level: the Face Amount; or 

 

	 	•	 	 if the Ending Level is less than the Threshold Level: the Face Amount minus: 

 

											
			 		Face Amount ×  		Starting Level – Ending Level		 		
			 			Starting Level		 	

 All calculations with respect to the Redemption Amount will be rounded to the nearest one hundred-thousandth,
with five one-millionths rounded upwards (e.g., 0.000005 would be rounded to 0.00001); and the Redemption Amount will be rounded to the nearest cent, with one-half cent rounded upward. 

“Index” shall mean the Russell 2000® Index. 

The “Pricing Date” is January 23, 2015. 

The “Starting Level” is 1188.928, the Closing Level of the Index on the Pricing Date. 

The “Closing Level” of the Index on any Trading Day means the official closing level of the Index as reported
by the Index Sponsor on such Trading Day, as obtained by the Calculation Agent on such Trading Day from the licensed third-party market data vendor contracted by the Calculation Agent at such time, taking into account the decimal precision and/or
rounding on such date, subject to the provisions set forth under “Discontinuance of the Index; Alteration of Method of Calculation” and “Market Disruption Events.” 

  
 3 

 The “Ending Level” will be the Closing Level of the Index on the
Final Calculation Day. 
 The “Threshold Level” is 832.2496, which is equal to 70% of the Starting Level.

 The “Call Settlement Date” for a Calculation Day shall be four Business Days after such Calculation Day,
as such Calculation Day may be postponed as provided herein. 
 “Index Sponsor” shall mean Frank Russell
Company, doing business as Russell Investment Group. 
 A “Trading Day” with respect to the Index means a
day, as determined by the Calculation Agent, on which (i) the Relevant Exchanges with respect to each security underlying the Index are scheduled to be open for trading for their respective regular trading sessions and (ii) each Related
Exchange is scheduled to be open for trading for its regular trading session. 
 The “Related Exchange” for
the Index means each exchange or quotation system where trading has a material effect (as determined by the Calculation Agent) on the overall market for futures or options contracts relating to the Index. 

The “Relevant Exchange” for any security then underlying the Index means the primary exchange or quotation
system on which such security is traded, as determined by the Calculation Agent. 
 The “Calculation Days”
shall mean the 23rd day of each January, April, July and October, commencing April 2015 and ending October 2016, and the Final Calculation Day. If any Calculation Day is not a Trading Day, such
Calculation Day will be postponed to the next succeeding Trading Day. A Calculation Day is also subject to postponement due to the occurrence of a Market Disruption Event. If a Market Disruption Event occurs or is continuing with respect to the
Index on a Calculation Day, such Calculation Day will be postponed to the first succeeding Trading Day on which a Market Disruption Event has not occurred and is not continuing. If such first succeeding Trading Day has not occurred as of the eighth
Trading Day after the originally scheduled Calculation Day, that eighth Trading Day shall be deemed the Calculation Day. If a Calculation Day has been postponed eight Trading Days after the originally scheduled Calculation Day and a Market
Disruption Event occurs or is continuing with respect to the Index on such eighth Trading Day, the Calculation Agent will determine the Closing Level of the Index on such eighth Trading Day in accordance with the formula for and method of
calculating the Closing Level of the Index last in effect prior to commencement of the Market Disruption Event, using the closing price (or, with respect to any of the relevant securities, if a Market Disruption Event has occurred, its good faith
estimate of the value of such securities at the Scheduled Closing Time (as defined below) on the Relevant Exchanges) on such date of each security included in the Index. See “—Market Disruption Events.” As used herein,
“closing price” means, with respect to any security on any date, the relevant exchange traded or quoted price of such security as of the Close of Trading (as defined below) on such date. 

  
 4 

 The “Final Calculation Day” is December 23, 2016, subject
to postponement as provided herein. 
 “Calculation Agent Agreement” shall mean the Calculation Agent
Agreement dated as of May 29, 2012 between the Company and the Calculation Agent, as amended from time to time. 

“Calculation Agent” shall mean the Person that has entered into the Calculation Agent Agreement with the
Company providing for, among other things, the determination of whether this Security will be automatically called on any of the first seven quarterly Calculation Days and whether a Contingent Coupon Payment will be made, the Call Price, if any, the
Redemption Amount, if any, and the Ending Level, which term shall, unless the context otherwise requires, include its successors under such Calculation Agent Agreement. The initial Calculation Agent shall be Wells Fargo Securities, LLC. Pursuant to
the Calculation Agent Agreement, the Company may appoint a different Calculation Agent from time to time after the initial issuance of this Security without the consent of the Holder of this Security and without notifying the Holder of this
Security. 
 Discontinuance Of The Index; Alteration Of Method Of Calculation 

If the Index Sponsor discontinues publication of the Index, and the Index Sponsor or another entity publishes a successor or
substitute equity index that the Calculation Agent determines, in its sole discretion, to be comparable to the Index (a “Successor Equity Index”), then, upon the Calculation Agent’s notification of that determination to the
Trustee and the Company, the Calculation Agent will substitute the Successor Equity Index as calculated by the relevant Index Sponsor or any other entity and calculate the Ending Level or Closing Level on any Calculation Day as described above. Upon
any selection by the Calculation Agent of a Successor Equity Index, the Company will cause notice to be given to the Holder of this Security. 

In the event that the Index Sponsor discontinues publication of the Index prior to, and the discontinuance is continuing on, a
Calculation Day and the Calculation Agent determines that no Successor Equity Index is available at such time, the Calculation Agent will calculate a substitute Closing Level for the Index in accordance with the formula for and method of calculating
the Index last in effect prior to the discontinuance, but using only those securities that comprised the Index immediately prior to that discontinuance. If a Successor Equity Index is selected or the Calculation Agent calculates a level as a
substitute for the Index, the Successor Equity Index or level will be used as a substitute for the Index for all purposes, including the purpose of determining whether a Market Disruption Event exists. 

If on a Calculation Day the Index Sponsor of the Index fails to calculate and announce the level of the Index, the Calculation
Agent will calculate a substitute Closing Level of the Index in accordance with the formula for and method of calculating the Index last in effect prior to the failure, but using only those securities that comprised the Index immediately prior to
that failure; provided that, if a Market Disruption Event occurs or is continuing on such day, then the provisions set forth above under the definition of “Calculation Day” shall apply in lieu of the foregoing. 

  
 5 

 If at any time the Index Sponsor makes a material change in the formula for or
the method of calculating the Index, or in any other way materially modifies the Index (other than a modification prescribed in that formula or method to maintain the Index in the event of changes in constituent stock and capitalization and other
routine events), then, from and after that time, the Calculation Agent will, at the close of business in New York, New York, on each date that the Closing Level of the Index is to be calculated, calculate a substitute Closing Level of the Index in
accordance with the formula for and method of calculating the Index last in effect prior to the change, but using only those securities that comprised the Index immediately prior to that change. Accordingly, if the method of calculating the Index is
modified so that the level of the Index is a fraction or a multiple of what it would have been if it had not been modified, then the Calculation Agent will adjust the Index in order to arrive at a level of the Index as if it had not been modified.

 Market Disruption Events 

A “Market Disruption Event” means, with respect to the Index, any of the following events as determined by
the Calculation Agent in its sole discretion: 
  

	 	(A)	 The occurrence or existence of a material suspension of or limitation imposed on trading by the Relevant Exchanges or otherwise relating to
securities which then comprise 20% or more of the level of the Index or any Successor Equity Index at any time during the one-hour period that ends at the Close of Trading on that day, whether by reason of movements in price exceeding limits
permitted by those Relevant Exchanges or otherwise. 

  

	 	(B)	 The occurrence or existence of a material suspension of or limitation imposed on trading by any Related Exchange or otherwise in futures or options
contracts relating to the Index or any Successor Equity Index on any Related Exchange at any time during the one-hour period that ends at the Close of Trading on that day, whether by reason of movements in price exceeding limits permitted by the
Related Exchange or otherwise. 

  

	 	(C)	 The occurrence or existence of any event, other than an early closure, that materially disrupts or impairs the ability of market participants in
general to effect transactions in, or obtain market values for, securities that then comprise 20% or more of the level of the Index or any Successor Equity Index on their Relevant Exchanges at any time during the one-hour period that ends at the
Close of Trading on that day. 

  

	 	(D)	 The occurrence or existence of any event, other than an early closure, that materially disrupts or impairs the ability of market participants in
general to effect transactions in, or obtain market values for, futures or options contracts relating to the Index or any Successor Equity Index on any Related Exchange at any time during the one-hour period that ends at the Close of Trading on that
day. 

  

	 	(E)	 The closure on any Exchange Business Day of the Relevant Exchanges on which securities that then comprise 20% or more of the level of the Index or
any 

  
 6 

	 	 
Successor Equity Index are traded or any Related Exchange prior to its Scheduled Closing Time unless the earlier closing time is announced by the Relevant Exchange or Related Exchange, as
applicable, at least one hour prior to the earlier of (1) the actual closing time for the regular trading session on such Relevant Exchange or Related Exchange, as applicable, and (2) the submission deadline for orders to be entered into
the Relevant Exchange or Related Exchange, as applicable, system for execution at the Close of Trading on that day. 

  

	 	(F)	 The Relevant Exchange for any security underlying the Index or Successor Equity Index or any Related Exchange fails to open for trading during its
regular trading session. 

 For purposes of determining whether a Market Disruption Event has occurred:

  

	 	(1)	 the relevant percentage contribution of a security to the level of the Index or any Successor Equity Index will be based on a comparison of
(x) the portion of the level of the Index attributable to that security and (y) the overall level of the Index or Successor Equity Index, in each case immediately before the occurrence of the Market Disruption Event; 

 

	 	(2)	 the “Close of Trading” means the Scheduled Closing Time of the Relevant Exchanges with respect to the securities underlying the
Index or any Successor Equity Index; 

  

	 	(3)	 the “Scheduled Closing Time” of any Relevant Exchange or Related Exchange on any Trading Day for the Index or any Successor Equity
Index means the scheduled weekday closing time of such Relevant Exchange or Related Exchange on such Trading Day, without regard to after hours or any other trading outside the regular trading session hours; and 

 

	 	(4)	 an “Exchange Business Day” means any Trading Day for the Index or any Successor Equity Index on which each Relevant Exchange for
the securities underlying the Index or any Successor Equity Index and each Related Exchange are open for trading during their respective regular trading sessions, notwithstanding any such Relevant Exchange or Related Exchange closing prior to its
Scheduled Closing Time. 

 Calculation Agent 

The Calculation Agent will determine whether this Security will be automatically called on any of the first seven quarterly
Calculation Days, the Call Price, if any, the Redemption Amount, if any, the Contingent Coupon Payments, if any, and the Ending Level. In addition, the Calculation Agent will (i) determine if adjustments are required to the Closing Level of the
Index under the circumstances described in this Security, (ii) if publication of the Index is discontinued, select a Successor Equity Index or, if no Successor Equity Index is available, determine the Closing Level of the Index under the
circumstances described in this Security, and (iii) determine whether a Market Disruption Event has occurred. 

  
 7 

 The Company covenants that, so long as this Security is Outstanding, there shall
at all times be a Calculation Agent (which shall be a broker-dealer, bank or other financial institution) with respect to this Security. 

All determinations made by the Calculation Agent with respect to this Security will be at the sole discretion of the
Calculation Agent and, in the absence of manifest error, will be conclusive for all purposes and binding on the Company and the Holder of this Security. 

Redemption and Repayment 

This Security is not subject to repayment at the option of the Holder hereof prior to December 30, 2016. Except as set
forth above under “Automatic Call,” this Security is not subject to redemption prior to December 30, 2016. This Security is not entitled to any sinking fund. 

Acceleration 
 If
an Event of Default, as defined in the Indenture, with respect to this Security shall occur and be continuing, the Redemption Amount (calculated as set forth in the next two sentences) of this Security may be declared due and payable in the manner
and with the effect provided in the Indenture. The amount payable to the Holder hereof upon any acceleration permitted under the Indenture will be equal to the Redemption Amount hereof, calculated as provided herein, plus a portion of a final
Contingent Coupon Payment, if any. The Redemption Amount and any final Contingent Coupon Payment will be calculated as though the date of acceleration was the Final Calculation Day. The final Contingent Coupon Payment, if any, will be
prorated from and including the immediately preceding Contingent Coupon Payment Date to but excluding the date of acceleration. 
  

 

Reference is hereby made to the further provisions of this Security set forth on the reverse hereof, which further provisions
shall for all purposes have the same effect as if set forth at this place. 
 Unless the certificate of authentication
hereon has been executed by the Trustee referred to on the reverse hereof by manual signature or its duly authorized agent under the Indenture referred to on the reverse hereof by manual signature, this Security shall not be entitled to any benefit
under the Indenture or be valid or obligatory for any purpose. 
 [The remainder of this page has been left intentionally blank] 

  
 8 

 IN WITNESS WHEREOF, the Company has caused this instrument to be duly executed
under its corporate seal. 
 DATED:
                                 

 

					
	WELLS FARGO & COMPANY
		
	By:		 
			 
			Its:		 

 [SEAL] 
  

					
	Attest:		 
			 
			Its:		 

  

			
	 TRUSTEE’S CERTIFICATE OF

AUTHENTICATION
 This is one of the Securities of the

series designated therein described
 in the within-mentioned Indenture.

	
	 CITIBANK, N.A.,

      as Trustee

		
	By:		 
			Authorized Signature
	
	OR
	
	 WELLS FARGO BANK, N.A.,

  as Authenticating Agent for the Trustee

		
	By:		 
			Authorized Signature

  
 9 

 [Reverse of Note] 

WELLS FARGO & COMPANY 

MEDIUM-TERM NOTE, SERIES K 

Due Nine Months or More From Date of Issue 

Principal at Risk Securities Linked to the Russell 2000® Index 

due December 30, 2016 

This Security is one of a duly authorized issue of securities of the Company (herein called the
“Securities”), issued and to be issued in one or more series under an indenture dated as of July 21, 1999, as amended or supplemented from time to time (herein called the “Indenture”), between the Company and
Citibank, N.A., as Trustee (herein called the “Trustee,” which term includes any successor trustee under the Indenture), to which Indenture and all indentures supplemental thereto reference is hereby made for a statement of the
respective rights, limitations of rights, duties and immunities thereunder of the Company, the Trustee and the Holders of the Securities, and of the terms upon which the Securities are, and are to be, authenticated and delivered. This Security is
one of the series of the Securities designated as Medium-Term Notes, Series K, of the Company, which series is limited to an aggregate principal amount or face amount, as applicable, of $25,000,000,000 or the equivalent thereof in one or more
foreign or composite currencies. The amount payable on the Securities of this series may be determined by reference to the performance of one or more equity-, commodity- or currency-based indices, exchange traded funds, securities, commodities,
currencies, statistical measures of economic or financial performance, or a basket comprised of two or more of the foregoing, or any other market measure or may bear interest at a fixed rate or a floating rate. The Securities of this series may
mature at different times, be redeemable at different times or not at all, be repayable at the option of the Holder at different times or not at all and be denominated in different currencies. 

Article Sixteen of the Indenture shall not apply to this Security. 

The Securities are issuable only in registered form without coupons and will be either
(a) book-entry securities represented by one or more Global Securities recorded in the book-entry system maintained by the Depositary or (b) certificated
securities issued to and registered in the names of, the beneficial owners or their nominees. 
 The Company agrees, to the
extent permitted by law, not to voluntarily claim the benefits of any laws concerning usurious rates of interest against a Holder of this Security. 

Modification and Waivers 

The Indenture permits, with certain exceptions as therein provided, the amendment thereof and the modification of the rights
and obligations of the Company and the rights of the Holders of the Securities of each series to be affected under the Indenture at any time by the Company and the Trustee with the consent of the Holders of a majority in principal amount of the
Securities at the 

  
 10 

 
time Outstanding of all series to be affected, acting together as a class. The Indenture also contains provisions permitting the Holders of a majority in principal amount of the Securities of all
series at the time Outstanding affected by certain provisions of the Indenture, acting together as a class, on behalf of the Holders of all Securities of such series, to waive compliance by the Company with those provisions of the Indenture. Certain
past defaults under the Indenture and their consequences may be waived under the Indenture by the Holders of a majority in principal amount of the Securities of each series at the time Outstanding, on behalf of the Holders of all Securities of such
series. Solely for the purpose of determining whether any consent, waiver, notice or other action or Act to be taken or given by the Holders of Securities pursuant to the Indenture has been given or taken by the Holders of Outstanding Securities in
the requisite aggregate principal amount, the principal amount of this Security will be deemed to be equal to the amount set forth on the face hereof as the “Face Amount” hereof. Any such consent or waiver by the Holder of this Security
shall be conclusive and binding upon such Holder and upon all future Holders of this Security and of any Security issued upon the registration of transfer hereof or in exchange herefor or in lieu hereof, whether or not notation of such consent or
waiver is made upon this Security. 
 Defeasance 

Section 403 and Article Fifteen of the Indenture and the provisions of clause (ii) of Section 401(1)(B) of the
Indenture, relating to defeasance at any time of (a) the entire indebtedness on this Security and (b) certain restrictive covenants and certain Events of Default, upon compliance by the Company with certain conditions set forth therein,
shall not apply to this Security. The remaining provisions of Section 401 of the Indenture shall apply to this Security. 
 Authorized
Denominations 
 This Security is issuable only in registered form without coupons in denominations of $1,000 or any
amount in excess thereof which is an integral multiple of $1,000. 
 Registration of Transfer 

Upon due presentment for registration of transfer of this Security at the office or agency of the Company in the City of
Minneapolis, Minnesota, a new Security or Securities of this series, with the same terms as this Security, in authorized denominations for an equal aggregate Face Amount will be issued to the transferee in exchange herefor, as provided in the
Indenture and subject to the limitations provided therein and to the limitations described below, without charge except for any tax or other governmental charge imposed in connection therewith. 

This Security is exchangeable for definitive Securities in registered form only if (x) the Depositary notifies the
Company that it is unwilling or unable to continue as Depositary for this Security or if at any time the Depositary ceases to be a clearing agency registered under the Securities Exchange Act of 1934, as amended, and a successor depositary is not
appointed within 90 days after the Company receives such notice or becomes aware of such ineligibility, (y) the Company in its sole discretion determines that this Security shall be exchangeable for definitive Securities in registered form
and notifies the Trustee thereof or (z) an Event of Default with respect to the Securities represented hereby has occurred and is continuing. If this Security is exchangeable pursuant to the preceding sentence, it shall be exchangeable for
definitive Securities in registered 

  
 11 

 
form, bearing interest at the same rate, having the same date of issuance, Stated Maturity Date and other terms and of authorized denominations aggregating a like amount. 

This Security may not be transferred except as a whole by the Depositary to a nominee of the Depositary or by a nominee of the
Depositary to the Depositary or another nominee of the Depositary or by the Depositary or any such nominee to a successor of the Depositary or a nominee of such successor. Except as provided above, owners of beneficial interests in this Global
Security will not be entitled to receive physical delivery of Securities in definitive form and will not be considered the Holders hereof for any purpose under the Indenture. 

Prior to due presentment of this Security for registration of transfer, the Company, the Trustee and any agent of the Company
or the Trustee may treat the Person in whose name this Security is registered as the owner hereof for all purposes, whether or not this Security be overdue, and neither the Company, the Trustee nor any such agent shall be affected by notice to the
contrary. 
 Obligation of the Company Absolute 

No reference herein to the Indenture and no provision of this Security or the Indenture shall alter or impair the obligation
of the Company, which is absolute and unconditional, to pay the Contingent Coupon Payments, if any, and the Redemption Amount or the Call Price, as applicable, on this Security at the times, place and rate, and in the coin or currency, herein
prescribed, except as otherwise provided in this Security. 
 No Personal Recourse 

No recourse shall be had for the payment of any Contingent Coupon Payments or the Redemption Amount or the Call Price, as
applicable, on this Security, or for any claim based hereon, or otherwise in respect hereof, or based on or in respect of the Indenture or any indenture supplemental thereto, against any incorporator, stockholder, officer or director, as such, past,
present or future, of the Company or any successor corporation, whether by virtue of any constitution, statute or rule of law, or by the enforcement of any assessment or penalty or otherwise, all such liability being, by the acceptance hereof and as
part of the consideration for the issuance hereof, expressly waived and released. 
 Defined Terms 

All terms used in this Security which are defined in the Indenture shall have the meanings assigned to them in the Indenture
unless otherwise defined in this Security. 
 Governing Law 

This Security shall be governed by and construed in accordance with the law of the State of New York, without regard to
principles of conflicts of laws. 

  
 12 

 ABBREVIATIONS 

The following abbreviations, when used in the inscription on the face of this instrument, shall be construed as though they
were written out in full according to applicable laws or regulations: 
  

					
	 TEN COM
		  -- 
		 as tenants in common

			
	 TEN ENT
		  -- 
		 as tenants by the entireties

			
	 JT TEN
		  -- 
		 as joint tenants with right

of survivorship and not
 as
tenants in common

  

									
	 UNIF GIFT MIN ACT
		  -- 
		 		 Custodian
		 
					(Cust)				(Minor)

  

	
	Under Uniform Gifts to Minors Act
	
	   

	(State)

 Additional abbreviations may also be used though not in the above list. 

FOR VALUE RECEIVED, the undersigned hereby sell(s) and transfer(s) unto 

 

	
	 Please Insert Social Security or
 Other
Identifying Number of Assignee

	
	   

  
  

 
  
  

 
 (PLEASE
PRINT OR TYPE NAME AND ADDRESS INCLUDING POSTAL ZIP CODE OF ASSIGNEE)

  
 13 

 the within Security of WELLS FARGO & COMPANY and does hereby irrevocably constitute and
appoint                                      attorney to
transfer the said Security on the books of the Company, with full power of substitution in the premises. 
 Dated:
                                         
        
  

	
	   

  

	
	   

 NOTICE: The signature to this assignment must correspond with the name as written upon the face of the
within instrument in every particular, without alteration or enlargement or any change whatever. 

  
 14

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00239-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00239-of-00352.parquet"}]]