Statement of Changes in Beneficial Ownership (4)
April 03 2019 - 5:50PM
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
*
Burns Thomas William
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2. Issuer Name
and
Ticker or Trading Symbol
GLAUKOS Corp
[
GKOS
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
Chief Executive Officer
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(Last)
(First)
(Middle)
C/O GLAUKOS CORPORATION,, 229 AVENIDA FABRICANTE
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3. Date of Earliest Transaction
(MM/DD/YYYY)
3/14/2019
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(Street)
SAN CLEMENTE, CA 92672
(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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3/14/2019
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A
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41963
(1)
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A
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$0
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61379
(2)
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D
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Common Stock
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4/1/2019
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F
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18855
(3)
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D
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$0
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42524
(2)
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D
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Common Stock
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277847
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I
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Through the Burns Family Trust
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Common Stock
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238107
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I
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Through the Burns Annuity Trust
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Common Stock
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120000
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I
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Through the Burns Charitable Remainder Trust
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Common Stock
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100000
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I
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Through the Thomas W. Burns Irrevocable Trust
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Common Stock
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100000
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I
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Through the Janet M. Burns Irrevocable Trust
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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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Explanation of Responses:
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(1)
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Represents shares of common stock subject to a restricted stock unit award previously granted by the Issuer on April 1, 2018 pursuant to the Reporting Person's election to receive his annual bonus for 2018 in the form of restricted stock units rather than cash (the "Bonus Election"). The Compensation Committee determined on March 14, 2019 the annual bonus payable to the Reporting Person pursuant to the Issuer's 2018 executive bonus plan and the number of stock units earned by the Reporting Person in accordance with the Bonus Election, subject to continued employment through the vesting date. The restricted stock units vested on April 1, 2019 and are payable on a one-for-one basis in shares of the Issuer's common stock.
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(2)
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Includes 19,416 restricted stock units that have not yet vested or been delivered to the Reporting Person.
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(3)
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Consists of shares withheld by the Issuer with respect to income taxes payable by the Reporting Person upon vesting and delivery of shares of common stock underlying restricted stock units previously granted by the Issuer on April 1, 2018.
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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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Burns Thomas William
C/O GLAUKOS CORPORATION,
229 AVENIDA FABRICANTE
SAN CLEMENTE, CA 92672
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X
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Chief Executive Officer
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Signatures
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Robert L. Davis, Attorney-in-Fact
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4/3/2019
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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 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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