tTAp Catalyst - Survey Interest Areas We are building a tool to better match catalysts to companies that fit there interest as we expand our reach, and more companies become interested. I look for your interest in primarily in two ways: past experience, potential roles. * 1. Please provide contact and identification information Name Company (if operate as one) Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Email Address Phone Number(s) * 2. What are the top five therapeutic areas of interest that you have worked on in the past? Interest one: Interest two: Interest three: Interest four: Interest five: * 3. What are the top "technology" areas that you have worked with (gene therapy, combination device, fibrin, mitochondria base therapies....) Tech one: Tech two: Tech three: Tech four: Tech five: * 4. For the right portfolio company you would be interested in the following roles: Workshop Review Only Advisor: 10 hours every month or quarter Lead Advisor: 20 hours every month or quarter Management Role: 40 hours/month * 5. I describe catalysts as experienced in the growth and commercialization of existing products in the market. Companies are keenly interested in business development executives, or serial CEOs, but we also need other areas to round out the teams. Which of the following description(s) fits you? (please list or fill in the blank) I've been a VP(or highest title) of......(type of department(s) in Company xyz) I have transactional experience in the .... ($1M- $1 B size - and role in the transaction, lead, support,etc.) I've successfully been CEO, CFO, COO, etc. (which) for .... (co. names) I've been responsible (role) for launched products in the ($1M- $1B) range (doing what role) Other * 6. We structure portfolio contract relationships such that every participant is compensated: either with cash up front, or based on a multiple for taking the risk with the company. Note, we use a structure that proposes cash out along the way if the company is successful, even if the structure is equity driven. For the right portfolio company you would be interested in the following compensation structure: (the typical first amount of time required for a portfolio company is 1-2 days/month or quarter for 6 periods of time, which ever is appropriate for the company. Cash only Cash and equity mix Equity only is OK with the right firm Volunteer basis * 7. I would like to learn more about the process Before the next workshop Before I attend next Within the next six months Other (please specify) Done