Initial Statement of Beneficial Ownership (3)
January 15 2020 - 4:21PM
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
*
Cieplinska Agnieszka |
2. Date of Event Requiring Statement (MM/DD/YYYY)
1/8/2020
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3. Issuer Name and Ticker or Trading Symbol
MOMENTA PHARMACEUTICALS INC [MNTA]
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(Last)
(First)
(Middle)
C/O MOMENTA PHARMACEUTICALS, INC., 301 BINNEY ST. |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner ___X___ Officer (give title below) _____ Other (specify below) VP FINANCE, CONTROLLER (PAO) / |
(Street)
CAMBRIDGE, MA 02142
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 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) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
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) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) |
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Stock Option (Right to Buy) | (1) | 4/12/2029 | Common Stock | 25000 | $13.85 | D | |
Explanation of Responses: |
(1) | The stock option will vest and become exercisable with respect to 6,250 shares on the first anniversary of the grant date, and the remainder will vest in equal quarterly installments thereafter. All vesting is subject to Agnieszka Cieplinska's continued service to the Company through the applicable vesting date. |
Remarks: Exhibit List: Exhibit 24 - Power of Attorney |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Cieplinska Agnieszka C/O MOMENTA PHARMACEUTICALS, INC. 301 BINNEY ST. CAMBRIDGE, MA 02142 |
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| VP FINANCE, CONTROLLER (PAO) |
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Signatures
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/s/ R. Mark Chamberlin as attorney in fact | | 1/15/2020 |
**Signature of Reporting Person | Date |
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