Statement of Changes in Beneficial Ownership (4)
November 18 2016 - 4:12PM
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
*
Huizenga Theodore Alan
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2. Issuer Name
and
Ticker or Trading Symbol
Ultragenyx Pharmaceutical Inc.
[
RARE
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
Controller and PAO
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(Last)
(First)
(Middle)
C/O ULTRAGENYX PHARMACEUTICAL INC., 60 LEVERONI COURT
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3. Date of Earliest Transaction
(MM/DD/YYYY)
11/16/2016
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(Street)
NOVATO, CA 94949
(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 Stock
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11/16/2016
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M
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2000.00
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A
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$21.00
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13134.00
(1)
(2)
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D
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Common Stock
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11/16/2016
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S
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2000.00
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D
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$79.73
(3)
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11134.00
(1)
(2)
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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 Options (Right to buy)
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$21.00
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11/16/2016
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M
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2000.00
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(4)
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1/29/2024
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Common Stock
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2000.00
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$0.00
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22403.00
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D
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Explanation of Responses:
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(
1)
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Includes previously reported shares of common stock underlying Restricted Stock Units granted to the Reporting Person, which are subject to certain vesting conditions.
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(
2)
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Due to a clerical error, the Forms 4 filed by the Reporting Person on each of June 19, 2015, December 18, 2015, January 19, 2016, February 17, 2016, May 24, 2016, and May 27, 2016 listed incorrect amounts in Column 5. The Form 4 filed on June 19, 2015 has been amended to reflect the correct share ownership following the reported transaction of 4,300 shares rather than 2,500 shares. The Form 4 filed on December 18, 2015 should have reflected 4,300 shares rather than 2,500 shares; the Form 4 filed on January 19, 2016 should have reflected 5,300 shares rather than 3,500 shares; the Form 4 filed on February 17, 2016 should have reflected 6,300 shares rather than 4,500 shares; the Form 4 filed May 24, 2016 should have reflected 6,134 shares rather than 4,334 shares; and the Form 4 filed on May 27, 2016 should have reflected 11,134 shares rather than 9,334 shares.
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(
3)
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The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $79.70 to $79.82 inclusive. The Reporting Person undertakes to provide to the Issuer, any security holder of the Issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range.
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(
4)
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1/4 of the shares underlying the option vested on January 27, 2015, with 1/48th of the underlying shares vesting monthly thereafter, provided the Reporting Person has not terminated services with the Issuer.
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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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Huizenga Theodore Alan
C/O ULTRAGENYX PHARMACEUTICAL INC.
60 LEVERONI COURT
NOVATO, CA 94949
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Controller and PAO
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Signatures
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/s/ Theodore A. Huizenga
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11/18/2016
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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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