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EXHIBIT 99.14
QUADRAMED CORPORATION
EMPLOYEE STOCK PURCHASE PLAN ("ESPP")
ENROLLMENT/CHANGE FORM
Action Complete Sections:
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SECTION 1:
/ / New Enrollment 2, 3, 7 and sign attached
ACTION Stock Purchase Agreement
/ / Change Payroll
Deductions 2, 4, 7
/ / Terminate Payroll
Deductions 2, 5, 7
/ / Leave of Absence 2, 6, 7
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SECTION 2:
Name ______________________________________________________________
PERSONNEL Last First MI Dept.
DATA
Home Address ______________________________________________________
Street
______________________________________________________________
City State Zip Code
Social Security #: / / / /-/ / /-/ / / /
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SECTION 3:
Effective with the Purchase
NEW Interval Beginning: Payroll Deduction Amount:
ENROLLMENT / / February 1, 199_ _____% of base salary*
/ / August 1, 199_ * Must be a multiple of 1% up to
a maximum of 10% of base salary
/ / Initial Offering Period -- _________, 1996
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SECTION 4:
Effective with the
CHANGE Pay Period Beginning: ______________________________
PAYROLL Month, Day and Year
DEDUCTIONS
I authorize the following new level of payroll deductions:
___% of base salary*
* Must be a multiple of 1% up to a maximum of 10% of base
salary
NOTE: You may reduce your rate of payroll deductions once per
purchase interval to become effective as soon as possible
following the filing of the change form. You may also
increase your rate of payroll deductions to become effective
as of the start date of the next purchase interval.
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SECTION 5:
Effective with the
TERMINATE Pay Period Beginning: _____________________________
PAYROLL Month, Day and Year
DEDUCTIONS
Your election to terminate your payroll deductions for the
balance of the offering period cannot be changed, and you
may not rejoin the offering period at a later date. You will
not be able to resume participation in the ESPP until a new
offering period begins.
In connection with my voluntary termination of payroll deductions,
I elect the following action with respect to my ESPP payroll
deductions to date in the current six (6)-month purchase interval:
/ / Purchase shares of QuadraMed at end of the interval
OR
/ / Refund ESPP payroll deductions collected
NOTE: If your employment terminates for any reason or your
eligibility status changes (less than 20 hrs/wk or less than
5 months/yr), you will immediately cease to participate in
the ESPP, and your ESPP payroll deductions collected in that
purchase interval will automatically be refunded to you.
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SECTION 6
LEAVE OF
ABSENCE In connection with my unpaid leave of absence, I elect the
following action with respect to my ESPP payroll deductions to date
in the current purchase interval:
/ / Purchase shares of QuadraMed at end of the interval
OR
/ / Refund ESPP payroll deductions collected
NOTE: If you take an unpaid leave of absence, your payroll
deductions will immediately cease. Upon your return to
active service, your payroll deductions will automatically
resume at the rate in effect for you at the time you went on
leave.
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SECTION 7
AUTHORIZATION
I hereby authorize the specific action or actions indicated above.
_______________________ __________________________________
Date Signature of Employee
