Statement of Changes in Beneficial Ownership (4)
June 09 2017 - 4:35PM
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
*
APPLE ROBERT F
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2. Issuer Name
and
Ticker or Trading Symbol
ANTARES PHARMA, INC.
[
ATRS
]
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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)
President & CEO
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(Last)
(First)
(Middle)
C/O ANTARES PHARMA, INC., 100 PRINCETON SOUTH, SUITE 300
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3. Date of Earliest Transaction
(MM/DD/YYYY)
2/22/2017
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(Street)
EWING, NJ 08628
(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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2/22/2017
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A
(1)
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5612
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A
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$0.00
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895612
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D
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Common Stock
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2/22/2017
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F
(1)
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1763
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D
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$2.37
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893849
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D
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Common Stock
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5/28/2017
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F
(2)
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14903
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D
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$2.51
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878946
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D
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Common Stock
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5/29/2017
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F
(3)
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3390
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D
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$2.51
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875556
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D
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Common Stock
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6/2/2017
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F
(4)
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38034
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D
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$2.57
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837522
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D
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Common Stock
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6/7/2017
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A
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338115
(5)
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D
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$2.66
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1175637
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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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Stock Option (right to buy)
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$2.66
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6/7/2017
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A
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725751
(6)
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(7)
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6/7/2027
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Common Stock
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725751
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$0.00
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725751
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D
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Explanation of Responses:
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(1)
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On May 22, 2013, Mr. Apple was granted a performance stock unit award that was contingent upon the Company achieving certain performance goals over a three year performance period ended December 31, 2016. The shares reported here represent the total number of shares that were earned upon the achievement and certification of one of the performance goals, which was net settled. The shares disposed represents the shares withheld to settle tax liability in connection with the vesting of the performance stock unit award.
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(2)
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Represents shares withheld to settle tax liability in connection with the vesting of a restricted stock unit award that was previously granted on May 28, 2015.
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(3)
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Represents shares withheld to settle tax liability in connection with the vesting of a restricted stock unit award that was previously granted on May 29, 2014.
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(4)
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Represents shares withheld to settle tax liability in connection with the vesting of a restricted stock unit award that was previously granted on June 2, 2016.
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(5)
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Represents grant of restricted stock units made under the Antares Pharma, Inc. 2008 Equity Compensation Plan. The shares vest in three equal annual installments from the date of grant.
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(6)
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Represents grant of options to purchase shares of common stock, par value $0.01 per share, issued under the Antares Pharma, Inc. 2008 Equity Compensation Plan.
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(7)
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The options vest in equal quarterly installments over three years from the date of grant.
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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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APPLE ROBERT F
C/O ANTARES PHARMA, INC.
100 PRINCETON SOUTH, SUITE 300
EWING, NJ 08628
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X
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President & CEO
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Signatures
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/s/Keith Muckenhirn as attorney-in-fact for Robert F. Apple
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6/9/2017
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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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