Statement of Changes in Beneficial Ownership (4)
November 06 2018 - 5:41PM
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
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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
*
RAGUSA ROBERT P
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2. Issuer Name
and
Ticker or Trading Symbol
Twist Bioscience Corp
[
TWST
]
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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 TWIST BIOSCIENCE CORPORATION, 455 MISSION BAY BOULEVARD SOUTH
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3. Date of Earliest Transaction
(MM/DD/YYYY)
11/2/2018
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(Street)
SAN FRANCISCO, CA 94158
(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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11/2/2018
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C
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542203
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A
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(1)
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542203
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I
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By Illumina, Inc.
(2)
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Common Stock
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11/2/2018
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C
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329305
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A
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(1)
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871508
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I
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By Illumina, Inc.
(2)
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Common Stock
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11/2/2018
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C
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673378
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A
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(1)
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1544886
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I
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By Illumina, Inc.
(2)
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Common Stock
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11/2/2018
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C
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157215
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A
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(1)
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1702101
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I
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By Illumina, Inc.
(2)
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Common Stock
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0
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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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Series A Preferred Stock
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(1)
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11/2/2018
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C
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542203
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(1)
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(1)
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Common Stock
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542203
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$0.00
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0
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I
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By Illumina, Inc.
(2)
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Series B Preferred Stock
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(1)
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11/2/2018
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C
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329305
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(1)
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(1)
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Common Stock
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329305
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$0.00
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0
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I
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By Illumina, Inc.
(2)
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Series C Preferred Stock
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(1)
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11/2/2018
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C
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673378
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(1)
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(1)
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Common Stock
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673378
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$0.00
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0
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I
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By Illumina, Inc.
(2)
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Series D Preferred Stock
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(1)
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11/2/2018
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C
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157215
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(1)
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(1)
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Common Stock
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157215
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$0.00
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0
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I
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By Illumina, Inc.
(2)
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Explanation of Responses:
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(1)
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The Series A Preferred Stock, Series B Preferred Stock, Series C Preferred Stock and Series D Preferred Stock have no expiration date and converted into Common Stock on a 1:1 basis immediately prior to the closing of the Issuer's initial public offering.
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(2)
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The Reporting Person is the Senior Vice President, Global Quality and Operations of Illumina, Inc. and has sole voting and dispositive power over the shares held of record by Illumina, Inc. The Reporting Person disclaims beneficial ownership in these shares except as to the Reporting Person's pecuniary interest therein.
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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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RAGUSA ROBERT P
C/O TWIST BIOSCIENCE CORPORATION
455 MISSION BAY BOULEVARD SOUTH
SAN FRANCISCO, CA 94158
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X
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Signatures
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/s/ William Solis, as Attorney-in-Fact
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11/6/2018
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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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