Statement of Changes in Beneficial Ownership (4)
July 01 2015 - 4:04PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Meckler Jeffrey A
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2. Issuer Name
and
Ticker or Trading Symbol
QLT INC/BC
[
QLTI
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
C/O QLT INC., 887 GREAT NORTHERN WAY, SUITE 250
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3. Date of Earliest Transaction
(MM/DD/YYYY)
6/29/2015
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(Street)
VANCOUVER, A1 V5T 4T5
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Shares
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6/29/2015
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M
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12500
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A
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$3.67
(1)
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94500
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D
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Common Shares
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6/29/2015
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M
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12500
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A
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$3.30
(2)
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107000
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Stock Option (right to buy)
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$3.67
(1)
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6/29/2015
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M
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12500
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(3)
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7/15/2023
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Common Shares
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12500
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$0
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0
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D
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Stock Option (right to buy)
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$3.30
(2)
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6/29/2015
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M
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12500
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(4)
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12/17/2024
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Common Shares
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12500
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$0
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0
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D
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Explanation of Responses:
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(
1)
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Price reflects the conversion of Canadian dollars to US dollars based on the exchange rate in effect as of the date of the reportable event. The option exercise price is CAD $4.54 per share, which was the closing price of the Issuer's common stock on the Toronto Stock Exchange as of the date of grant.
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(
2)
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Price reflects the conversion of Canadian dollars to US dollars based on the exchange rate in effect as of the date of the reportable event. The option exercise price is CAD $4.08 per share, which was the closing price of the Issuer's common stock on the Toronto Stock Exchange as of the date of grant.
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(
3)
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The options were scheduled to vest and become exercisable in thirty-six (36) successive and equal monthly installments beginning on the one-month anniversary of the date of grant (or August 15, 2013), such that 100% of the options would be fully vested on July 15, 2016. On June 7, 2015, the Board of Directors of QLT approved the immediate vesting of all stock options held by the Reporting Person.
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(
4)
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The options were scheduled to vest and become exercisable in thirty-six (36) successive and equal monthly installments beginning on the one-month anniversary of the date of grant (or January 17, 2015), such that 100% of the options would be fully vested on December 17, 2017. On June 7, 2015, the Board of Directors of QLT approved the immediate vesting of all stock options held by the Reporting Person.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Meckler Jeffrey A
C/O QLT INC.
887 GREAT NORTHERN WAY, SUITE 250
VANCOUVER, A1 V5T 4T5
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X
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Signatures
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Dori Assaly, as Attorney-in-Fact
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7/1/2015
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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