Initial Statement of Beneficial Ownership (3)
January 07 2019 - 5:37PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
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Lantz Keri
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2. Date of Event Requiring Statement (MM/DD/YYYY)
1/1/2019
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3. Issuer Name
and
Ticker or Trading Symbol
ACHILLION PHARMACEUTICALS INC [ACHN]
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(Last)
(First)
(Middle)
C/O ACHILLION PHARMACEUTICALS, INC., 300 GEORGE STREET
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
___
X
___ Officer (give title below)
_____ Other (specify below)
See Remarks /
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(Street)
NEW HAVEN, CT 06511
(City)
(State)
(Zip)
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5. 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 Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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11848
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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. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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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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Employee Stock Option
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(1)
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12/18/2019
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Common Stock
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13000
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$3.28
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D
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Employee Stock Option
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(1)
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12/16/2020
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Common Stock
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25000
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$3.10
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D
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Employee Stock Option
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(1)
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12/12/2021
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Common Stock
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9500
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$7.59
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D
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Employee Stock Option
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(1)
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12/18/2022
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Common Stock
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12900
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$8.64
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D
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Employee Stock Option
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(1)
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12/17/2023
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Common Stock
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20000
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$3.02
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D
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Employee Stock Option
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(1)
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12/4/2024
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Common Stock
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14100
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$13.80
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D
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Employee Stock Option
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(2)
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1/25/2026
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Common Stock
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18000
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$7.54
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D
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Employee Stock Option
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(3)
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7/25/2026
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Common Stock
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6000
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$8.42
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D
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Employee Stock Option
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(4)
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1/25/2027
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Common Stock
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30000
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$4.17
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D
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Employee Stock Option
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(5)
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2/16/2028
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Common Stock
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75000
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$3.20
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D
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Employee Stock Option
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(6)
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8/6/2028
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Common Stock
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10000
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$2.52
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D
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Explanation of Responses:
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(1)
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This option is fully vested and exercisable.
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(2)
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This option was granted on January 25, 2016 and vests as to 25% of the original number of shares on the first anniversary of the grant date and as to an additional 6.25% of the original number of shares at the end of each successive three-month period thereafter.
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(3)
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This option was granted on July 25, 2016 and vests as to 25% of the original number of shares on the first anniversary of the grant date and as to an additional 6.25% of the original number of shares at the end of each successive three-month period thereafter.
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(4)
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This option was granted on January 25, 2017 and vests as to 25% of the original number of shares on the first anniversary of the grant date and as to an additional 6.25% of the original number of shares at the end of each successive three-month period thereafter.
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(5)
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This option was granted on February 16, 2018 and vests as to 25% of the original number of shares on the first anniversary of the grant date and as to an additional 6.25% of the original number of shares at the end of each successive three-month period thereafter.
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(6)
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This option was granted on August 6, 2018 and vests as to 25% of the original number of shares on the first anniversary of the grant date and as to an additional 6.25% of the original number of shares at the end of each successive three-month period thereafter.
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Remarks:
Vice President of Finance, Corporate Controller, Interim Principal Financial Officer and Interim Principal Accounting Officer.
See Exhibit 24.1, Power of Attorney
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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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Lantz Keri
C/O ACHILLION PHARMACEUTICALS, INC.
300 GEORGE STREET
NEW HAVEN, CT 06511
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See Remarks
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Signatures
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/s/ Keri Lantz
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1/7/2019
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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 5(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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