Picis, Inc. Common Stock Certificate Issued to Mr. and Mrs. Sample

Summary

This document certifies that Mr. and Mrs. Sample are the registered owners of 600,620 fully paid and non-assessable shares of common stock in Picis, Inc., a Delaware corporation. The certificate outlines the rights and obligations of the shareholders, including transferability, subject to the company's Certificate of Incorporation and By-Laws. It also provides instructions for transferring shares and replacing lost certificates. The certificate must be properly endorsed and registered by the transfer agent to be valid.

EX-4.1 3 a2173554zex-4_1.txt EXHIBIT 4.1 Exhibit 4.1 016570| 003590|127C|RESTRICTED||4|057-423 COMMON STOCK [GRAPHIC] COMMON STOCK PAR VALUE $.01 ----------- -------------- CERTIFICATE PICIS, INC. SHARES NUMBER INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE **600620****** ZQ 000000 125,000,000 AUTHORIZED SHARES $.01 PAR VALUE ***600620***** ----------- ****600620**** *****600620*** ******600620** -------------- ----------------- THIS CERTIFIES THAT MR. SAMPLE & MRS. SAMPLE & CUSIP 71956K 10 0 ----------------- MR. SAMPLE & MRS. SAMPLE SEE REVERSE FOR CERTAIN DEFINITIONS is the owner of *** SIX HUNDRED THOUSAND SIX HUNDRED AND TWENTY*** FULLY-PAID AND NON-ASSESSABLE SHARES OF THE COMMON STOCK OF PICIS, INC. (HEREINAFTER CALLED THE "COMPANY"), transferable on the books of the Company in person or by duly authorized attorney, upon surrender of this Certificate properly endorsed. This Certificate and the shares represented hereby, are issued and shall be held subject to all of the provisions of the Certificate of Incorporation, as amended, and the By-Laws, as amended, of the Company (copies of which are on file with the Company and with the Transfer Agent), to all of which each holder, by acceptance hereof, assents. This Certificate is not valid unless countersigned and registered by the Transfer Agent and Registrar. WITNESS the facsimile seal of the Company and the facsimile signatures of its duly authorized officers. [SEAL] DATED ****Month Day, Year**** COUNTERSIGNED AND REGISTERED: /s/ Todd C. Cozzens COMPUTERSHARE TRUST COMPANY, INC. ------------------- (DENVER) President TRANSFER AGENT AND REGISTRAR, /s/ R. Scott Lentz ------------------- Treasurer By -------------------------------- AUTHORIZED SIGNATURE SECURITY INSTRUCTIONS ON REVERSE

PICIS, INC. TRANSFER FEE $25.00 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 _________ (Cust) (Minor) TEN ENT - as tenants by the under Uniform Gifts to Minors Act _____________ entireties (State) JT TEN - as joint tenants with right UNIF TRF MIN ACT __________ Custodian (until age__). ________ of survivorship and not as (Cust) (Minor) tenants in common under Uniform Transfers to Minors Act _____________ (State) Additional abbreviations may also be used though not in the above list.

THE COMPANY WILL FURNISH WITHOUT CHARGE TO EACH SHAREHOLDER WHO SO REQUESTS, A SUMMARY OF THE POWERS, DESIGNATIONS, PREFERENCES AND RELATIVE, PARTICIPATING, OPTIONAL OR OTHER SPECIAL RIGHTS OF EACH CLASS OF STOCK OF THE COMPANY AND THE QUALIFICATIONS, LIMITATIONS OR RESTRICTIONS OF SUCH PREFERENCES AND RIGHTS, AND THE VARIATIONS IN RIGHTS, PREFERENCES AND LIMITATIONS DETERMINED FOR EACH SERIES, WHICH ARE FIXED BY THE ARTICLES OF INCORPORATION OF THE COMPANY, AS AMENDED, AND THE RESOLUTIONS OF THE BOARD OF DIRECTORS OF THE COMPANY, AND THE AUTHORITY OF THE BOARD OF DIRECTORS TO DETERMINE VARIATIONS FOR FUTURE SERIES. SUCH REQUEST MAY BE MADE TO THE OFFICE OF THE SECRETARY OF THE COMPANY OR TO THE TRANSFER AGENT. THE BOARD OF DIRECTORS MAY REQUIRE THE OWNER OF A LOST OR DESTROYED STOCK CERTIFICATE, OR HIS LEGAL REPRESENTATIVES, TO GIVE THE COMPANY A BOND TO INDEMNIFY IT AND ITS TRANSFER AGENTS AND REGISTRARS AGAINST ANY CLAIM THAT MAY BE MADE AGAINST THEM ON ACCOUNT OF THE ALLEGED LOSS OR DESTRUCTION OF ANY SUCH CERTIFICATE. PLEASE INSERT SOCIAL SECURITY OR OTHER For value received, __________________ hereby sell, assign and transfer unto IDENTIFYING NUMBER OF ASSIGNEE -------------------------------------------- -------------------------------------------- ___________________________________________________________________________________________________________________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING POSTAL ZIP CODE, OF ASSIGNEE) ___________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ Shares of the capital stock represented by the within Certificate, and do hereby irrevocably constitute and appoint __________________________________________________________________________________________________________________ Attorney to transfer the said stock on the books of the within-named Corporation with full power of substitution in the premises. --------------------------------------------- Dated: ___________________________________________________ 20 _____________ Signature(s) Guaranteed: Medallion Guarantee Stamp Signature: ________________________________________________________________ THE SIGNATURE(S) SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (Banks, Signature: ________________________________________________________________ Stockbrokers, Savings and Loan Associations and Credit Unions) WITH MEMBERSHIP IN AN Notice: The signature to this assignment must correspond with APPROVED SIGNATURE GUARANTEE MEDALLION the name as written upon the face of the certificate, in PROGRAM, PURSUANT TO S.E.C. RULE 17Ad-15. every particular, without alteration or enlargement, or --------------------------------------------- any change whatever.

~~SECURITY INSTRUCTIONS THIS IS WATERMARKED PAPER. DO NOT ACCEPT WITHOUT NOTING [GRAPHIC] WATERMARK. HOLD TO LIGHT TO VERIFY WATERMARK.~~