Initial Statement of Beneficial Ownership (3)
June 26 2020 - 05:11PM
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
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 * Ciulla Thomas |
2. Date of Event Requiring Statement
(MM/DD/YYYY)
6/18/2020
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3. Issuer Name and Ticker or Trading
Symbol Clearside Biomedical, Inc. [CLSD] |
(Last)
(First)
(Middle)
C/O CLEARSIDE BIOMEDICAL, INC., 900 NORTH POINT PARKWAY,
SUITE 200 |
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)_____
Director _____
10% Owner
___X___ Officer (give title
below) _____
Other (specify below)
Chief Medical Officer / |
(Street)
ALPHARETTA, GA 30005
(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 |
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) |
Common Stock |
145000 (1) |
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. 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 |
Employee Stock Option (right to buy) |
(2) |
10/24/2028 |
Common Stock |
80000 |
$5.04 |
D |
|
Employee Stock Option (right to buy) |
(3) |
2/5/2029 |
Common Stock |
100000 |
$1.24 |
D |
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Employee Stock Option (right to buy) |
(4) |
1/8/2030 |
Common Stock |
75000 |
$2.37 |
D |
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Explanation of
Responses: |
(1) |
Includes 70,000 restricted
stock units ("RSUs"). Fifty percent (50%) of the shares underlying
these RSUs vest on September 18, 2020 and twenty-five percent (25%)
of the remaining RSUs vest in four equal quarterly installments
thereafter. Also includes an additional 50,000 RSUs. Twenty-five
percent (25%) of the shares underlying these RSUs vest in four
equal annual installments on January 8, 2021, January 8, 2022,
January 8, 2023 and January 8, 2024. Each RSU represents a
contingent right to receive one share of common stock of the
Issuer. Vesting is subject to the Reporting Person's continuous
service as of each such vesting date, and subject to accelerated
vesting in specified circumstances. |
(2) |
One-fourth of the shares
underlying this option vested on October 24, 2019 and the balance
of the shares vested or vest in a series of 36 successive equal
monthly installments thereafter, subject to the reporting person's
continuous service as of each such vesting date. |
(3) |
One-fourth of the shares
underlying this option vested on February 5, 2020 and the balance
of the shares vested or vest in a series of 36 successive equal
monthly installments thereafter, subject to the reporting person's
continuous service as of each such vesting date. |
(4) |
One-fourth of the shares
underlying this option vest on January 8, 2021 and the balance of
the shares vest in a series of 36 successive equal monthly
installments thereafter, subject to the reporting person's
continuous service as of each such vesting date. |
Remarks:
Exhibit List - Exhibit 24 - Power of Attorney |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
Ciulla Thomas
C/O CLEARSIDE BIOMEDICAL, INC.
900 NORTH POINT PARKWAY, SUITE 200
ALPHARETTA, GA 30005 |
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Chief Medical Officer |
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Signatures
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/s/ Mark Ballantyne,
Attorney-in-Fact |
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6/26/2020 |
**Signature of Reporting
Person |
Date |
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