Statement of Changes in Beneficial Ownership (4)
September 03 2021 - 7:18PM
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).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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
*
Aravanis Alexander |
2. Issuer Name and Ticker or Trading Symbol
ILLUMINA, INC.
[
ILMN
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) SVP, Chief Technology Officer |
(Last)
(First)
(Middle)
5200 ILLUMINA WAY |
3. Date of Earliest Transaction
(MM/DD/YYYY)
8/18/2021 |
(Street)
SAN DIEGO, CA 92122
(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 | 8/18/2021 | | A | | 21653 (1) | A | $510.61 | 26332 | D | |
Common Stock | 8/18/2021 | | F | | 9949 (2) | D | $510.61 | 16383 | D | |
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) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
(1) | Represents shares acquired by the reporting person pursuant to the terms of the Agreement and Plan of Merger, dated as of September 20, 2020, as amended, by and among Illumina, Inc. and GRAIL, Inc. ("GRAIL"), among others (the "Merger Agreement"). At the closing of the transactions contemplated by the Merger Agreement (the "Closing"), the reporting person became entitled to receive in respect of the shares of Class A Common Stock of GRAIL and GRAIL stock options held by him as of immediately prior to the Closing the shares of Illumina common stock reported above, based on, in each case, an exchange ratio determined pursuant to the terms of the Merger Agreement. |
(2) | Represents tax withholding, required pursuant to the terms of the Merger Agreement, in connection with the shares received in respect of the GRAIL stock options held by the reporting person as of immediately prior to the Closing. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Aravanis Alexander 5200 ILLUMINA WAY SAN DIEGO, CA 92122 |
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| SVP, Chief Technology Officer |
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Signatures
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By: Robert Maynes for Alexander Aravanis | | 9/3/2021 |
**Signature of Reporting Person | Date |
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