Initial Statement of Beneficial Ownership (3)
April 10 2014 - 3:33PM
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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COFFEE MICHAEL DENIS
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2. Date of Event Requiring Statement (MM/DD/YYYY)
4/9/2014
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3. Issuer Name
and
Ticker or Trading Symbol
Adamas Pharmaceuticals Inc [ADMS]
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(Last)
(First)
(Middle)
C/O ADAMAS PHARMACEUTICALS, INC., 2200 POWELL ST, STE 220
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
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X
___ Officer (give title below)
_____ Other (specify below)
Senior VP, Strategy & Planning /
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(Street)
EMERYVILLE, CA 94608
(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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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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Stock Option (Right to Buy)
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(1)
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9/30/2019
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Common Stock
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36666
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$1.755
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D
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Stock Option (Right to Buy)
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(2)
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11/16/2021
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Common Stock
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20000
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$0.665
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D
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Stock Option (Right to Buy)
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(3)
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2/22/2022
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Common Stock
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8750
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$0.665
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D
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Stock Option (Right to Buy)
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(4)
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12/13/2023
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Common Stock
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110000
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$3.305
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D
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Explanation of Responses:
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(
1)
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The Option shares shall vest as follows: one-fourth (1/4th) of the shares vest one year after May 11, 2009; the balance of the shares vest in a series of forty-eight (48) successive equal monthly installments measured from the first anniversary of May 11, 2009, subject to Reporting Person's Continuous Service (as defined in the Issuer's 2007 Stock Plan) as of each such date. The Option shares are subject to an early exercise right and may be exercised in full prior to vesting.
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(
2)
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The Option shares shall vest as follows: 1/8th of the shares subject to such option shall vest each month after May 30, 2011, subject to Reporting Person's Continuous Service (as defined in the Issuer's 2007 Stock Plan) as of each such date. The Option shares are subject to an early exercise right and may be exercised in full prior to vesting.
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(
3)
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The Option shares shall vest as follows: 1/8th of the shares subject to such option shall vest on the last day of each fiscal quarter after March 1, 2012, subject to Reporting Person's Continuous Service (as defined in the Issuer's 2007 Stock Plan) as of each such date. The Option shares are subject to an early exercise right and may be exercised in full prior to vesting.
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(
4)
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The Option shares shall vest as follows: one-fifth (1/5th) of the shares vest one year after November 27, 2013; the balance of the shares vest in a series of forty-eight (48) successive equal monthly installments measured from the first anniversary of November 27, 2013, subject to Reporting Person's Continuous Service (as defined in the Issuer's 2007 Stock Plan) as of each such date. The Option shares are subject to an early exercise right and may be exercised in full prior to vesting.
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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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COFFEE MICHAEL DENIS
C/O ADAMAS PHARMACEUTICALS, INC.
2200 POWELL ST, STE 220
EMERYVILLE, CA 94608
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Senior VP, Strategy & Planning
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Signatures
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/s/Danielle Naftulin, Attorney-in-Fact
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4/10/2014
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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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