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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) | ||
| 1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
| Common Stock | $ 0 (1) | 11/14/2016 | 11/14/2016 | P | 4,143 (2) | (1) | (1) | Common Stock | 4,143 | $ 0 | 4,143 | D | |||
| Stock Option (Right to Buy Common Stock) | $ 2.05 | (3) | 04/03/2024 | Common Stock | 30,000 | 30,000 | D | ||||||||
| Stock Option (Right to buy Common Stock) | $ 5.62 | (4) | 03/01/2025 | Common Stock | 50,000 | 50,000 | D | ||||||||
| Phantom Stock | $ 0 (1) | (1) | (1) | Common Stock | 4,205 | 4,205 | D | ||||||||
| Phantom Stock | $ 0 (1) | (1) | (1) | Common Stock | 2,873 | 2,873 | D | ||||||||
| Phantom Stock | $ 0 (1) | (1) | (1) | Common Stock | 1,371 | 1,371 | D | ||||||||
| Phantom Stock | $ 0 (1) | (1) | (1) | Common Stock | 2,868 | 2,868 | D | ||||||||
| Phantom Stock | $ 0 (1) | (1) | (1) | Common Stock | 3,645 | 3,645 | D | ||||||||
| stock Option (Right to buy Common Stock) | $ 1.91 | (4) | 02/21/2026 | Common Stock | 100,000 | 100,000 | D | ||||||||
| Phantom Stock | $ 0 (1) | (1) | (1) | Common Stock | 4,104 | 4,104 | D | ||||||||
| Phantom Stock | $ 0 (1) | (1) | (1) | Common Stock | 2,767 | 2,767 | D | ||||||||
| Phantom Stock | $ 0 (1) | (1) | (1) | Common Stock | 4,335 | 4,335 | D | ||||||||
| Reporting Owner Name / Address | Relationships | |||
| Director | 10% Owner | Officer | Other | |
| TELLEZ CORA M C/O CORMEDIX INC. 1430 HIGHWAY 206, SUITE 200 BEDMINSTER, NJ 07921 |
X | |||
| /s/ Alexander M. Donaldson, by Power of Attorney | 11/16/2016 | |
| **Signature of Reporting Person | Date |
| * | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
| ** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
| (1) | Each share of phantom stock is the economic equivalent of one share of common stock. The shares of phantom stock become payable in common stock on the tenth business day of January of the year following the reporting person's termination of service as a director. |
| (2) | These shares were credited automatically to the reporting person's account pursuant to the reporting person's election to defer the receipt of cash compensation for directors' fees. |
| (3) | The options vest 1/3 on the date of grant, 1/3 on the first anniversary of the date of grant, and 1/3 on the second anniversary of the date of grant. |
| (4) | The options vest in full on the first anniversary of the date of grant. |