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Hemosense Inc – ‘10-K’ for 9/30/06 – EX-10.12

On: Tuesday, 12/26/06, at 8:23pm ET · As of: 12/27/06 · For: 9/30/06 · Accession #: 1193125-6-259977 · File #: 1-32541

  As Of                Filer                Filing    For·On·As Docs:Size              Issuer               Agent

12/27/06  Hemosense Inc                     10-K        9/30/06    6:1.0M                                   RR Donnelley/FA

Annual Report — Form 10-K
Filing Table of Contents

Document/Exhibit                   Description                      Pages   Size 

 1: 10-K        Annual Report                                       HTML    813K 
 2: EX-10.12    Loan and Security Agreement No. 3821                HTML    102K 
 3: EX-23.1     Consent of Pricewaterhousecoopers LLP               HTML      6K 
 4: EX-31.1     Certification of CEO Pursuant to Section 302        HTML     12K 
 5: EX-31.2     Certification of CFO Pursuant to Section 302        HTML     12K 
 6: EX-32.1     Certification of CEO and CFO Pursuant to Section    HTML      8K 
                          906

EX-10.12 — Loan and Security Agreement No. 3821

This exhibit is an HTML Document rendered as filed. [ Alternative Formats ]

Loan and Security Agreement No. 3821

Exhibit 10.12

AMENDMENT NO. 01

Dated April 30, 2004

that certain Loan and Security Agreement No. 3821

dated as of March 5, 2004, (“Agreement”), by and between

LIGHTHOUSE CAPITAL PARTNERS V, L.P. (“Lender”) and

HEMOSENSE, INC. (“Borrower”).

(All capitalized terms not otherwise defined herein shall have the meanings given to such terms in the Agreement)

Without limiting or amending any other provisions of the Agreement, Lender and Borrower agree to the following:

In Section 1, “Definitions” of the Agreement, the following definitions shall be deleted in their entirety and replaced with the following:

“Commitment” means Seven Million Five Hundred Thousand Dollars ($7,500,000), provided, however, the amount available to Borrower shall be increased by an additional One Million Five Hundred Thousand Dollars ($1,500,000) (i) upon Borrower’s achieving the Additional Debt Milestones as defined herein (the “Additional Commitment”) or (ii) at Lender’s sole discretion (in the absence of the Additional Debt Milestones).

“GAAP” means generally accepted accounting principles and practices consistent with those principles and practices promulgated or adopted by the Financial Accounting Standards Board and the Board of the American Institute of Certified Public Accountants, their respective predecessors and successors. Each accounting term used but not otherwise expressly defined herein shall have the meaning given it by GAAP.

“Minimum Funding Amount” means One Million Dollars ($ 1,000,000), provided, however, in the case of the Additional Commitment, “Minimum Funding Amount” means One Million Five Hundred Thousand Dollars ($1,500,000).

“Subordinated Debt” means debt incurred by Borrower which is subordinated to Borrower’s Indebtedness owed to Lender both with respect to right of payment and any security interest, if applicable, granted to secure such Indebtedness, and which terms of subordination are reflected in a written agreement in form and substance acceptable to and approved by Lender.

In Section 1, “Definitions” of the Agreement, the following definitions shall be added:

“Additional Debt Milestones” means Borrower shall have achieved all of the following: (i) Borrower shall have consummated an preferred stock equity financing with minimum gross proceeds to Borrower of at least Three Million Five Hundred Thousand Dollars ($3,500,000) from one, or all of its existing investors and/or new investors; (ii) Borrower shall have net sales determined in accordance with GAAP in the 2004 calendar year of at least Seven Million Three Hundred Thirty-Eight Thousand Eight Hundred Fifty-Five Dollars ($7,338,855); and (iii) Borrower shall not report a net loss determined in accordance with GAAP for calendar year 2004 of greater than Eight Million Eight Hundred Ninety Thousand Seven Hundred Thirty-Three Dollars ($8,890,733).

“Additional Commitment Warrants” means the additional Warrants in favor of Lender and its affiliated fund, Lighthouse Capital Partners IV, L.P. (“LCP-IV”) to purchase securities of Borrower substantially in the form of Exhibits B-3 and B-4.

In Section 1, “Definitions” of the Agreement, new clauses (h)-(j) shall be added to the defined term of “Permitted Indebtedness” such that clauses (g)-(j) shall read in their entirety as follows:

“(g) Guaranty obligations in favor of Silicon Valley Bank, not to exceed Twenty-Five Thousand Dollars ($25,000) in connection with a deposit account referred to in Section 7.10 for the purpose of securing a merchant banking account;

(h) Subordinated Debt;

(i) Indebtedness incurred by Borrower from a third party commercial lender in an amount equal to but not to exceed the Additional Commitment pursuant to Section 2.2(c) of this Agreement; and

(j) Extensions, refinancings, modifications, amendments and restatements of any items of Permitted Indebtedness (a) through (e) above, provided that the principal amount thereof is not increased or the terms thereof are not modified to impose more burdensome terms upon the Borrower.”

In Section 2.2, “Use of Proceeds; The Advances” of the Agreement, the following new sub-section shall be added:

“(c) If (i) the Additional Debt Milestones are not satisfied and (ii) Lender does not agree to provide the Additional Commitment, then Borrower may seek subordinated accounts receivable financing with another third party commercial lender, provided, however, Lender shall have no obligation to release any of its Collateral in support of Borrower’s subordinated accounts receivable financing with such other lender; and provided further, however, that such third party lender shall enter into an intercreditor or subordination agreement with Lender in form and substance satisfactory to Lender.”

Section 2.5(b), “Non-Usage Fee” of the Agreement is hereby amended and restated in its entirety to read:

“(b) Non-Usage Fee. A Non-Usage Fee, payable quarterly, equal to one percent (1%) of the average unfunded portion of the Commitment, measured on a per annum basis, which fee shall be due and payable on the first Business Day of the month following the end of such quarter, commencing on March 5, 2004. Such Non-Usage Fee shall be fully earned and non-refundable.”

In Section 3, “Conditions of Advances” of the Agreement, the following new sub-section shall be added:

Section 3.4 Conditions Precedent to Additional Advance. The obligation of Lender to make the Advance under the Additional Commitment, is further subject to the following conditions:

(a) Evidence that no Default or Event of Default shall have occurred and be continuing.

(b) Borrower and Lender shall have executed a Notice of Borrowing with respect to the proposed Advance.

(c) Borrower shall have executed and delivered to Lender the Additional Commitment Warrants.

In Section 6, “Affirmative Covanents” of the Agreement, the following new sub-section shall be added:

Section 6.14 Issuance of Additional Commitment Warrants. Should the Additional Commitment become available to Borrower (i) upon Borrower’s achieving the Additional Commitment Milestones, or (ii) Lender making the Additional Commitment available to Borrower in Lender’s sole discretion, and upon Borrower drawing upon the Additional Commitment, then Borrower shall be obligated to promptly execute and deliver the Additional Commitment Warrants in favor of Lender.

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Section 7.10 shall hereby be amended in its entirety to read as follows:

“7.10 Deposit Accounts. Maintain any deposit accounts or accounts holding securities owned by Borrower except accounts with respect to which Lender has obtained a perfected first priority security interest therein, provided, however, that Borrower shall be permitted to maintain an account at Silicon Valley Bank for the purposes of securing certain credit of the Borrower (the “SVB CD”) and that Lender shall not receive any interest in the SVB CD pursuant to the terms of this Agreement”

Except as amended hereby, the Agreement remains unmodified and unchanged.


BORROWER:		LENDER:

HEMOSENSE, INC.		LIGHTHOUSE CAPITAL PARTNERS V, L.P.

By:	/s/ *James Merselis*	By:	LIGHTHOUSE MANAGEMENT
Name:	James Merselis		PARTNERS V, L.L.C., its general partner
Title:	President & CEO

		By:	/s/ *Thomas Conneely*
		Name:	Thomas Conneely
		Title:	Vice President

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EXHIBIT B-3

THIS WARRANT HAS NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “1933 ACT’), OR ANY APPLICABLE STATE SECURITIES LAWS, AND MAY NOT BE SOLD OR TRANSFERRED UNLESS SUCH SALE OR TRANSFER IS IN ACCORDANCE WITH THE REGISTRATION REQUIREMENTS OF SUCH ACT AND APPLICABLE LAWS OR SOME OTHER EXEMPTION FROM THE REGISTRATION REQUIREMENTS OF SUCH ACT AND APPLICABLE LAWS IS AVAILABLE WITH RESPECT THERETO.

PREFERRED STOCK PURCHASE WARRANT


Warrant No. ___________		Number of Shares: 47,468
		Series C-l Preferred Stock

HEMOSENSE, INC.

Effective as of _________, 2005

Void after __________, 2012

1. Issuance. This Preferred Stock Purchase Warrant (the “Warrant”) is issued to LIGHTHOUSE CAPITAL PARTNERS V, L.P. by HEMOSENSE, INC., a Delaware corporation (hereinafter with its successors called the “Company”).

2. Purchase Price; Number of Shares. The registered holder of this Warrant (the “Holder”), commencing on the date hereof, is entitled upon surrender of this Warrant with the subscription form annexed hereto duly executed, at the principal office of the Company, to purchase from the Company, at a price per share of $1.58 (the “Purchase Price”), 47,468 fully paid and nonassessable shares of the Company’s Series C-l Preferred Stock, $0.001 par value (the “Preferred Stock”).

Until such time as this Warrant is exercised in full or expires, the Purchase Price and the securities issuable upon exercise of this Warrant are subject to adjustment as hereinafter provided. The person or persons in whose name or names any certificate representing shares of Preferred Stock is issued hereunder shall be deemed to have become the holder of record of the shares represented thereby as at the close of business on the date this Warrant is exercised with respect to such shares, whether or not the transfer books of the Company shall be closed.

3. Payment of Purchase Price. The Purchase Price may be paid (i) in cash or by check, (ii) by the surrender by the Holder to the Company of any promissory notes or other obligations issued by the Company, with all such notes and obligations so surrendered being credited against the Purchase Price in an amount equal to the principal amount thereof plus accrued interest to the date of surrender, or (iii) by any combination of the foregoing.

4. Net Issue Election. The Holder may elect to receive, without the payment by the Holder of any additional consideration, shares of Preferred Stock equal to the value of this Warrant or any portion hereof by the surrender of this Warrant or such portion to the Company, with the net issue election notice annexed hereto duly executed, at the principal office of the Company. Thereupon, the Company shall issue to the Holder such number of fully paid and nonassessable shares of Preferred Stock as is computed using the following formula:

X = Y(A-B)


where: X =		the number of shares of Preferred Stock to be issued to the Holder pursuant to this Section 4.

Y =		the number of shares of Preferred Stock covered by this Warrant in respect of which the net issue election is made pursuant to this Section 4.

A =		the Fair Market Value (defined below) of one share of Preferred Stock, as determined at the time the net issue election is made pursuant to this Section 4.

B =		the Purchase Price in effect under this Warrant at the time the net issue election is made pursuant to this Section 4.

“Fair Market Value” of a share of Preferred Stock (or fully paid and nonassessable shares of the Company’s common stock, $0.001 par value (the “Common Stock”) if the Preferred Stock has been automatically converted into Common Stock) as of the date that the net issue election is made (the “Determination Date”) shall mean:

(i) If the net issue election is made in connection with and contingent upon the closing of the sale of the Company’s Common Stock to the public in a public offering pursuant to a Registration Statement under the 1933 Act (a “Public Offering”), and if the Company’s Registration Statement relating to such Public Offering (“Registration Statement”) has been declared effective by the Securities and Exchange Commission, then the initial “Price to Public” specified in the final prospectus with respect to such offering multiplied by the number of shares of Common Stock into which each share of Preferred Stock is then convertible.

(ii) If the net issue election is not made in connection with and contingent upon a Public Offering, then as follows:

(a) If traded on a securities exchange or the Nasdaq National Market, the fair market value of the Common Stock shall be deemed to be the average of the closing or last reported sale prices of the Common Stock on such exchange or market over the five day period ending five trading days prior to the Determination Date, and the fair market value of the Preferred Stock shall be deemed to be such fair market value of the Common Stock multiplied by the number of shares of Common Stock into which each share of Preferred Stock is then convertible;

(b) If otherwise traded in an over-the-counter market, the fair market value of the Common Stock shall be deemed to be the average of the closing ask prices of the Common Stock over the five day period ending five trading days prior to the Determination Date, and the fair market value of the Preferred Stock shall be deemed to be such fair market value of the Common Stock multiplied by the number of shares of Common Stock into which each share of Preferred Stock is then convertible; and

(c) If there is no public market for the Common Stock, then fair market value shall be determined in good faith by the Company’s Board of Directors.

5. Partial Exercise. This Warrant may be exercised in part, and the Holder shall be entitled to receive a new warrant, which shall be dated as of the date of this Warrant, covering the number of shares in respect of which this Warrant shall not have been exercised.

6. Fractional Shares. In no event shall any fractional share of Preferred Stock be issued upon any exercise of this Warrant. If, upon exercise of this Warrant in its entirety, the Holder would, except as provided in this Section 6, be entitled to receive a fractional share of Preferred Stock, then the Company shall issue the next higher number of full shares of Preferred Stock, issuing a full share with respect to such fractional share.

7. Expiration Date; Automatic Exercise. This Warrant shall expire at the close of business on __________, 2012, and shall be void thereafter (the “Expiration Date”). Notwithstanding the foregoing, this Warrant shall automatically be deemed to be exercised in full pursuant to the provisions of Section 4 hereof, without any further action on behalf of the Holder, immediately prior to the time this Warrant would otherwise expire pursuant to the preceding sentence.

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8. Reserved Shares; Valid Issuance. The Company covenants that it will at all times from and after the date hereof reserve and keep available such number of its authorized shares of Preferred Stock and Common Stock free from all preemptive or similar rights therein, as will be sufficient to permit, respectively, the exercise of this Warrant in full and the conversion into shares of Common Stock of all shares of Preferred Stock receivable upon such exercise. The Company further covenants that such shares as may be issued pursuant to such exercise and/or conversion will, upon issuance, be duly and validly issued, fully paid and nonassessable and free from all taxes, liens and charges with respect to the issuance thereof.

9. Stock Splits and Dividends. If after the date hereof the Company shall subdivide the Preferred Stock, by split-up or otherwise, or combine the Preferred Stock, or issue additional shares of Preferred Stock in payment of a stock dividend on the Preferred Stock, the number of shares of Preferred Stock issuable on the exercise of this Warrant shall forthwith be proportionately increased in the case of a subdivision or stock dividend, or proportionately decreased in the case of a combination, and the Purchase Price shall forthwith be proportionately decreased in the case of a subdivision or stock dividend, or proportionately increased in the case of a combination.

10. Adjustments for Diluting Issuances. The other antidilution rights applicable to the Preferred Stock and the Common Stock of the Company are set forth in the Amended and Restated Certificate of Incorporation, as amended from time to time (the “Articles”), a true and complete copy in its current form which is attached hereto as Exhibit A. Such rights shall not be restated, amended or modified in any manner which affects the Holder differently than the holders of Series C-l Preferred without such Holder’s prior written consent. The Company shall promptly provide the Holder hereof with any restatement, amendment or modification to the Articles promptly after the same has been made.

11. Mergers and Reclassifications. If after the date hereof the Company shall enter into any Reorganization (as hereinafter defined), this Warrant shall expire and terminate effective as of the closing of such Reorganization. Notwithstanding the foregoing, in the event that any outstanding warrants to purchase equity securities of the Company are assumed by the successor entity of a Merger (or parent thereof), this Warrant shall also be similarly assumed. Notwithstanding the foregoing, this Warrant shall automatically be deemed to be exercised in full pursuant to the provisions of Section 4 hereof, without any further action on behalf of the Holder, immediately prior to the time this Warrant would otherwise expire pursuant to the preceding sentence. For the purposes of this Section 11, the term “Reorganization” shall include without limitation any reclassification, capital reorganization or change of the Preferred Stock (other than as a result of a subdivision, combination or stock dividend provided for in Section 9 hereof), or any consolidation of the Company with, or merger of the Company into, another corporation or other business organization (other than a merger in which the Company is the surviving corporation and which does not result in any reclassification or change of the outstanding Preferred Stock), or any sale or conveyance to another corporation or other business organization of all or substantially all of the assets of the Company.

12. Certificate of Adjustment. Whenever the Purchase Price is adjusted, as herein provided, the Company shall promptly deliver to the Holder a certificate of the Company’s chief financial officer setting forth the Purchase Price after such adjustment and setting forth a brief statement of the facts requiring such adjustment.

13. Notices of Record Date, Etc. In the event of:

(a) any taking by the Company of a record of the holders of any class of securities for the purpose of determining the holders thereof who are entitled to receive any dividend or other distribution, or any right to subscribe for, purchase, sell or otherwise acquire or dispose of any shares of stock of any class or any other securities or property, or to receive any other right;

(b) any reclassification of the capital stock of the Company, capital reorganization of the Company, consolidation or merger involving the Company (other than a merger in which the Company is the surviving corporation and which does not result in any reclassification or change of the outstanding Preferred Stock), or sale or conveyance of all or substantially all of its assets; or

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(c) any voluntary or involuntary dissolution, liquidation or winding-up of the Company; then in each such event the Company will provide or cause to be provided to the Holder a written notice thereof. Such notice shall be provided at least twenty (20) business days prior to the date specified in such notice on which any such action is to be taken.

14. Representations, Warranties and Covenants. This Warrant is issued and delivered by the Company and accepted by each Holder on the basis of the following representations, warranties and covenants made by the Company:

(a) The Company has all necessary authority to issue, execute and deliver this Warrant and to perform its obligations hereunder. This Warrant has been duly authorized issued, executed and delivered by the Company and is the valid and binding obligation of the Company, enforceable in accordance with its terms.

(b) The shares of Preferred Stock issuable upon the exercise of this Warrant have been duly authorized and reserved for issuance by the Company and, when issued in accordance with the terms hereof, will be validly issued, fully paid and nonassessable.

(c) The issuance, execution and delivery of this Warrant do not, and the issuance of the shares of Preferred Stock upon the exercise of this Warrant in accordance with the terms hereof will not, (i) violate or contravene the Company’s Articles or by-laws, or any law, statute, regulation, rule, judgment or order applicable to the Company, (ii) violate, contravene or result in a breach or default under any contract, agreement or instrument to which the Company is a party or by which the Company or any of its assets are bound or (iii) require the consent or approval of or the filing of any notice or registration with any person or entity.

(d) As long as this Warrant is, or any shares of Preferred Stock issued upon exercise of this Warrant or any shares of Common Stock issued upon conversion of such shares of Preferred Stock are, issued and outstanding, the Company will provide to the Holder the financial and other information described in that certain Loan and Security Agreement No. 3821 between the Company and Lighthouse Capital Partners V, L.P. dated as of March 5, 2004.

(e) As of the date hereof, the authorized capital stock of the Company consists of (i) 50,000,000 shares of Common Stock, of which 1,349,403 shares are issued and outstanding and 47,468 shares are reserved for issuance upon the exercise of this Warrant with respect to Common Stock and the conversion of the Preferred Stock into Common Stock if this Warrant is exercised with respect to Preferred Stock, and (ii) 1,429,566 shares of Series A-l Preferred Stock, of which 1,429,566 are issued and outstanding shares, (iii) 3,813,289 shares of Series B-l Preferred Stock, of which 3,813,289 are issued and outstanding shares, and (iv) 16,684,897 shares of Series C-l Preferred Stock, of which 16,106,669 are issued and outstanding shares. Attached hereto as Exhibit B is a capitalization table summarizing the capitalization of the Company. At Holder’s request, not more than once per calendar quarter, the Company will provide Holder with a current capitalization table indicating changes, if any, to the number of outstanding shares of common stock and preferred stock.

15. Registration Rights. The Company grants to the Holder, and the Holder accepts, all of the rights and obligations of a “Holder” and an “Investor” under the Company’s Investor Rights Agreement dated as of May 21, 2003 (the “Rights Agreement”), including, without limitation, the registration rights contained therein, and agrees to amend the Rights Agreement so that (i) the shares of Common Stock issuable upon conversion of the shares of Preferred Stock issuable upon exercise of this Warrant shall be “Registrable Securities,” and (ii) the Holder shall be a “Holder” and an “Investor” for all purposes of such Rights Agreement.

16. Amendment. The terms of this Warrant may be amended, modified or waived only with the written consent of the Holder.

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17. Representations and Covenants of the Holder. This Warrant has been entered into by the Company in reliance upon the following representations and covenants of the Holder, which by its execution hereof the Holder hereby confirms:

(a) Investment Purpose. The right to acquire Preferred Stock or the Preferred Stock issuable upon exercise of the Holder’s rights contained herein will be acquired for investment and not with a view to the sale or distribution of any part thereof, and the Holder has no present intention of selling or engaging in any public distribution of the same except pursuant to a registration or exemption.

(b) Accredited Investor. Holder is an “accredited investor” within the meaning of the Securities and Exchange Rule 501 of Regulation D, as presently in effect.

(c) Private Issue. The Holder understands (i) that the Preferred Stock issuable upon exercise of the Holder’s rights contained herein is not registered under the 1933 Act or qualified under applicable state securities laws on the ground that the issuance contemplated by this Warrant will be exempt from the registration and qualifications requirements thereof, and (ii) that the Company’s reliance on such exemption is predicated on the representations set forth in this Section 17.

(d) Financial Risk. The Holder has such knowledge and experience in financial and business matters as to be capable of evaluating the merits and risks of its investment and has the ability to bear the economic risks of its investment.

18. Notices, Transfers, Etc.

(a) Any notice or written communication required or permitted to be given to the Holder may be given by certified mail or delivered to the Holder at the address most recently provided by the Holder to the Company.

(b) Subject to compliance with applicable federal and state securities laws, this Warrant may be transferred by the Holder with respect to any or all of the shares purchasable hereunder. Upon surrender of this Warrant to the Company, together with the assignment notice annexed hereto duly executed, for transfer of this Warrant as an entirety by the Holder, the Company shall issue a new warrant of the same denomination to the assignee. Upon surrender of this Warrant to the Company, together with the assignment hereof properly endorsed, by the Holder for transfer with respect to a portion of the shares of Preferred Stock purchasable hereunder, the Company shall issue a new warrant to the assignee, in such denomination as shall be requested by the Holder hereof, and shall issue to such Holder a new warrant covering the number of shares in respect of which this Warrant shall not have been transferred.

(c) In case this Warrant shall be mutilated, lost, stolen or destroyed, the Company shall issue a new warrant of like tenor and denomination and deliver the same (i) in exchange and substitution for and upon surrender and cancellation of any mutilated Warrant, or (ii) in lieu of any Warrant lost, stolen or destroyed, upon receipt of an affidavit of the Holder or other evidence reasonably satisfactory to the Company of the loss, theft or destruction of such Warrant

19. No Impairment. The Company will not, by amendment of its Articles or through any reclassification, capital reorganization, consolidation, merger, sale or conveyance of assets, dissolution, liquidation, issue or sale of securities or any other voluntary action, avoid or seek to avoid the observance of performance of any of the terms of this Warrant, but will at all times in good faith assist in the carrying out of all such terms and in the taking of all such action as may be necessary or appropriate in order to protect the rights of the Holder.

20. Governing Law. The provisions and terms of this Warrant shall be governed by and construed in accordance with the internal laws of the State of California without giving effect to its principles regarding conflicts of laws.

21. Successors and Assigns. This Warrant shall be binding upon the Company’s successors and assigns and shall inure to the benefit of the Holder’s successors, legal representatives and permitted assigns.

22. Business Days. If the last or appointed day for the taking of any action required or the expiration of any rights granted herein shall be a Saturday or Sunday or a legal holiday in California, then such action may be taken or right may be exercised on the next succeeding day which is not a Saturday or Sunday or such a legal holiday.

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23. Qualifying Public Offering. If the Company shall effect a firm commitment underwritten public offering of shares of Common Stock which results in the conversion of the Preferred Stock into Common Stock pursuant to the Company’s Articles in effect immediately prior to such offering, then, effective upon such conversion, this Warrant shall change from the right to purchase shares of Preferred Stock to the right to purchase shares of Common Stock, and the Holder shall thereupon have the right to purchase, at a total price equal to that payable upon the exercise of this Warrant in full, the number of shares of Common Stock which would have been receivable by the Holder upon the exercise of this Warrant for shares of Preferred Stock immediately prior to such conversion of such shares of Preferred Stock into shares of Common Stock, and in such event appropriate provisions shall be made with respect to the rights and interest of the Holder to the end that the provisions hereof (including, without limitation, the provisions for the adjustment of the Purchase Price and of the number of shares purchasable upon exercise of this Warrant and the provisions relating to the net issue election) shall thereafter be applicable to any shares of Common Stock deliverable upon the exercise hereof.

24. Value. The Company and the Holder agree that the value of this Warrant on the date of grant is $50.


HEMOSENSE, INC.

By:

Name:

Title:

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Subscription



To:

Date:

The undersigned hereby subscribes for _________________ shares of Preferred Stock covered by this Warrant. The certificate(s) for such shares shall be issued in the name of the undersigned or as otherwise indicated below:

Signature

Name for Registration

Mailing Address

Net Issue Election Notice


To: _________________________________		Date: _________________

The undersigned hereby elects under Section 4 to surrender the right to purchase shares of Preferred Stock pursuant to this Warrant. The certificate(s) for such shares issuable upon such net issue election shall be issued in the name of the undersigned or as otherwise indicated below:

Signature

Name for Registration

Mailing Address

Assignment

For value received _________________________________________________________ hereby sells, assigns and transfers unto

____________________________________________________________________________________________________

[Please print or typewrite name and address of Assignee]

the within Warrant, and does hereby irrevocably constitute and appoint ____________________________________________ its attorney to transfer the within Warrant on the books of the within named Company with full power of substitution on the premises.



Dated:

Signature

Name for Registration

In the Presence of:

EXHIBIT A

Amended and Restated Articles of Incorporation

See attached pages.

EXHIBIT B

Capitalization Table

EXHIBIT B-4

THIS WARRANT HAS NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “1933 ACT”), OR ANY APPLICABLE STATE SECURITIES LAWS, AND MAY NOT BE SOLD OR TRANSFERRED UNLESS SUCH SALE OR TRANSFER IS IN ACCORDANCE WITH THE REGISTRATION REQUIREMENTS OF SUCH ACT AND APPLICABLE LAWS OR SOME OTHER EXEMPTION FROM THE REGISTRATION REQUIREMENTS OF SUCH ACT AND APPLICABLE LAWS IS AVAILABLE WITH RESPECT THERETO.

PREFERRED STOCK PURCHASE WARRANT


Warrant No. ___________		Number of Shares: 47,468
		Series C-l Preferred Stock

HEMOSENSE, INC.

Effective as of _________, 2005

Void after __________, 2012

1. Issuance. This Preferred Stock Purchase Warrant (the “Warrant”) is issued to LIGHTHOUSE CAPITAL PARTNERS IV, L.P. by HEMOSENSE, INC., a Delaware corporation (hereinafter with its successors called the “Company”).

X = Y(A-B)


where: X =		the number of shares of Preferred Stock to be issued to the Holder pursuant to this Section 4.

Y =		the number of shares of Preferred Stock covered by this Warrant in respect of which the net issue election is made pursuant to this Section 4.

A =		the Fair Market Value (defined below) of one share of Preferred Stock, as determined at the time the net issue election is made pursuant to this Section 4.

B =		the Purchase Price in effect under this Warrant at the time the net issue election is made pursuant to this Section 4.

(ii) If the net issue election is not made in connection with and contingent upon a Public Offering, then as follows:

(c) If there is no public market for the Common Stock, then fair market value shall be determined in good faith by the Company’s Board of Directors.

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12. Certificate of Adjustment. Whenever the Purchase Price is adjusted, as herein provided, the Company shall promptly deliver to the Holder a certificate of the Company’s chief financial officer setting forth the Purchase Price after such adjustment and setting forth a brief statement of the facts requiring such adjustment.

13. Notices of Record Date, Etc. In the event of:

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16. Amendment. The terms of this Warrant may be amended, modified or waived only with the written consent of the Holder.

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(b) Accredited Investor. Holder is an “accredited investor” within the meaning of the Securities and Exchange Rule 501 of Regulation D, as presently in effect.

18. Notices, Transfers, Etc.

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24. Value. The Company and the Holder agree that the value of this Warrant on the date of grant is $50.


HEMOSENSE, INC.

By:

Name:

Title:

-6-

Subscription



To:

Date:

Signature

Name for Registration

Mailing Address

Net Issue Election Notice


To: _________________________________		Date: _________________

Signature

Name for Registration

Mailing Address

Assignment

For value received _________________________________________________ hereby sells, assigns and transfers unto

______________________________________________________________________________________________________

[Please print or typewrite name and address of Assignee]

the within Warrant, and does hereby irrevocably constitute and appoint ________________________________________

its attorney to transfer the within Warrant on the books of the within named Company with full power of substitution on the premises.



Dated:

Signature

Name for Registration

In the Presence of:

EXHIBIT A

Amended and Restated Articles of Incorporation

See attached pages.

EXHIBIT B

Capitalization Table

Dates Referenced Herein

This ‘10-K’ Filing	Date	Other Filings

Filed as of:	12/27/06	None on these Dates
Filed on:	12/26/06
For Period End:	9/30/06
	4/30/04
	3/5/04
	5/21/03
		List all Filings

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Filing Submission 0001193125-06-259977 – Alternative Formats (Word / Rich Text, HTML, Plain Text, et al.)

Hemosense Inc – ‘10-K’ for 9/30/06 – EX-10.12

On: Tuesday, 12/26/06, at 8:23pm ET · As of: 12/27/06 · For: 9/30/06 · Accession #: 1193125-6-259977 · File #: 1-32541

Previous ‘10-K’: ‘10-K’ on 12/2/05 for 9/30/05 · Latest ‘10-K’: This Filing

Annual Report — Form 10-KFiling Table of Contents

EX-10.12 — Loan and Security Agreement No. 3821

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Dates Referenced Herein

Annual Report — Form 10-K
Filing Table of Contents