Specimen Common Stock Certificate of Altus Medical, Inc.

Summary

This document is a specimen common stock certificate for Altus Medical, Inc., a Delaware corporation. It certifies ownership of fully paid and nonassessable shares of common stock, which are transferable on the corporation's books by the holder or an authorized attorney upon proper endorsement and surrender of the certificate. The certificate is only valid when countersigned by the transfer agent and registrar. It also outlines procedures for replacement if lost and provides information on how to request details about stock rights and preferences.

EX-4.1 5 dex41.txt SPECIMEN COMMON STOCK CERTIFICATE OF REGISTRANT [LOGO] NUMBER SHARES ZQ ALTUS INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE THIS CERTIFIES THAT SEE REVERSE FOR CERTAIN DEFINITIONS IS THE OWNER OF FULLY PAID AND NONASSESSABLE SHARES OF COMMON STOCK, $.001 PAR VALUE PER SHARE, OF ___________________________ __________________________ ___________________________ ALTUS MEDICAL, INC. __________________________ ___________________________ __________________________ transferable only on the books of the Corporation by the holder hereof in person or by duly authorized Attorney upon surrender of this certificate properly endorsed. This certificate is not valid until countersigned by the Transfer Agent and Registrar. WITNESS the facsimile signatures of its duly authorized officers. Dated: /s/ Ronald J. Santilli /s/ Kevin P. Connors CHIEF FINANCIAL OFFICER AND SEAL PRESIDENT AND CHIEF EXECUTIVE TREASURER OFFICER ALTUS MEDICAL, INC. THE CORPORATION WILL FURNISH WITHOUT CHARGE TO EACH STOCKHOLDER WHO SO REQUESTS THE POWERS, DESIGNATIONS, PREFERENCES AND RELATIVE PARTICIPATING, OPTIONAL OR OTHER SPECIAL RIGHTS OF EACH CLASS OF STOCK OR SERIES THEREOF AND THE QUALIFICATIONS, LIMITATIONS OR RESTRICTIONS OF SUCH PREFERENCES AND/OR RIGHTS. SUCH REQUEST MUST BE MADE TO THE CORPORATION'S SECRETARY AT THE PRINCIPAL EXECUTIVE OFFICE OF THE CORPORATION. Keep this Certificate in a safe place. If it is lost, stolen or destroyed, the Corporation will require a bond of indemnity as a condition to the issuance of a replacement certificate. The following abbreviations, when used in the inscription on the face of this certificate, shall be construed as though they were written out in full according to applicable laws or regulations: TEN COM - as tenants in common UNIF GIFT MIN ACT- __________ Custodian___________________ TEN ENT - as tenants by the entireties (Cust) (Minor) JT TEN - as joint tenants with right under Uniform Gifts to Minors of survivorship and not as tenants in common Act______________________________________ (State) UNIF TRF MIN ACT- __________ Custodian (until age _______) (Cust) ______________ under Uniform Transfers (Minor) to Minors Act ___________________________ (State)

Additional abbreviations may also be used though not in the above list. For Value Received,___________________________ hereby sell, assign and transfer unto PLEASE INSERT SOCIAL SECURITY NUMBER OR OTHER IDENTIFYING NUMBER OF ASSIGNEE - --------------------------------------------- - --------------------------------------------- ________________________________________________________________________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE OF ASSIGNEE(S) ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Shares represented by the within Certificate, and do hereby irrevocably constitute and appoint _______________________________________________ Attorney to transfer the said Shares on the books of the within named Corporation with full power of substitution in the premises. Dated ___________________ ________________________________________ NOTICE: THE SIGNATURE TO THIS ASSIGNMENT In presence of MUST CORRESPOND WITH THE NAME AS WRITTEN UPON THE FACE OF THE CERTIFICATE IN EVERY PARTICULAR, WITHOUT ALTERATION OR _________________________ ENLARGEMENT, OR ANY CHANGE WHATEVER. _________________________ Signature(s) Guaranteed By______________________________________________________________________________ THE SIGNATURES MUST BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM) PURSUANT TO S.E.C, RULE 17Ad-16