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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) |
7. Title and Amount of Underlying Securities (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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Option | $ 24.59 | 11/10/2017 | A | 60,000 (6) | (6) | 11/10/2027 | Common Stock | 60,000 | $ 0 (7) | 32,500 (8) | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Stetson John C/O POLARITYTE, INC. 615 ARAPEEN DRIVE SALT LAKE CITY, UT 84108 |
X | Chief Financial Officer |
/s/ John Stetson | 11/13/2017 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Represents a restricted stock award under the PolarityTE, Inc. 2017 Equity Incentive Plan (the "Restricted Stock Award"), of which one-half shall vest on the date of grant and one-half shall vest in twenty four (24) equal monthly installments on the one month anniversary of the grant date. |
(2) | Restricted Stock Award is issued as a performance award for the Reporting Person's role as Chief Financial Officer and a director of the Issuer. |
(3) | Includes shares vested or to be vested within 60 days. |
(4) | Represents a restricted stock award under the PolarityTE, Inc. 2017 Equity Incentive Plan (the "Second Restricted Stock Award"), which shall vest immediately on the date of grant |
(5) | Second Restricted Stock Award is in connection with the Reporting Person entering into a new employment agreement with the Issuer. |
(6) | Represents an option award under the PolarityTE, Inc. 2017 Equity Incentive Plan (the "Option Award"), of which one-half shall vest on the date of grant and one-half shall vest in twenty four (24) equal monthly installments on the one month anniversary of the grant date. |
(7) | Option Award is compensation for the Reporting Person's service as Chief Financial Officer and director of the Issuer. |
(8) | Includes options vested or to be vested within 60 days pursuant to the Option Award. |