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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 | ||||||||
Director Stock Option (right to buy) | $ 9.95 | 06/12/2018 | A | 6,000 | (2) | 06/12/2028 | Common Stock | 6,000 | $ 0 | 6,000 | D | ||||
Restricted Stock Unit | (3) | 06/12/2018 | A | 3,000 | (4) | (3) | Common Stock | 3,000 | $ 0 | 3,000 | D | ||||
Restricted Stock Unit | (3) | 06/13/2018 | M | 3,000 | (5) | (3) | Common Stock | 3,000 | $ 0 | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Fust Matthew K C/O DERMIRA, INC. 275 MIDDLEFIELD ROAD, SUITE 150 MENLO PARK, CA 94025 |
/s/ Christine Ring, by power of attorney | 06/14/2018 | |
**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) | Represents shares acquired upon vesting of RSU granted on June 13, 2017. |
(2) | The stock option will vest and become exercisable as to 100% of the shares on June 12, 2019, subject to the continuing service of the Reporting Person on such vesting date. |
(3) | Each RSU represents a contingent right to receive one share of DERM common stock. |
(4) | The RSU will vest 100% of the shares on June 12, 2019, subject to the continuing service of the Reporting Person on such vesting date. |
(5) | The RSU, which was granted on June 13, 2017, fully vested on June 13, 2018. |