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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 |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
BAXTER INTERNATIONAL INC ONE BAXTER PARKWAY DEERFIELD, IL 60015 |
X |
/s/ David P. Scharf, Corporate Vice President, Corporate Secretary and General Counsel of Baxter International Inc. | 07/02/2015 | |
**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) | Prior to June 30, 2015, Baxter International Inc. ("Baxter") owned 100 shares of the outstanding common stock of Baxalta International ("Baxalta") (mistakenly reported as 5,000 shares on Baxter's Form 3 filed June 9, 2015), which represented 100% of Baxalta's issued and outstanding common stock. Solely as a result of the 6,764,242.02 -for-1 stock split that was effected pursuant to a Certificate of Amendment to the Certificate of Incorporation of Baxalta filed with the Secretary of State of the State of Delaware on June 30, 2015, the 100 shares owned by the Reporting Person were split into and became an aggregate of 676,424,202 shares. The receipt of common stock in the split was exempt pursuant to Rule 16a-9 under the Securities Exchange Act of 1934. |
(2) | On July 1, 2015, Baxter made a pro rata distribution of approximately 80.5% percent of Baxalta's common shares held by it to Baxter's shareholders of record as of June 17, 2015. Additional information about the distribution can be found in Baxalta's filings with the Securities and Exchange Commission, including a registration statement on Form 10. |