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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 | ||||||||
Warrant (right to buy) | $ 5 (2) | 10/30/2013 | C(2) | 3,000 | (2) | 08/27/2020 | Common Stock | 3,000 | $ 0 | 3,000 | D | ||||
Series A-4 Preferred Stock | (1) | 10/30/2013 | C(1) | 18,651 | (1) | (1) | Common Stock | 18,651 | $ 0 | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Kopczynski Casey C. C/O AERIE PHARMACEUTICALS, INC. 135 U.S. HIGHWAY 206, SUITE 15 BEDMINSTER, NJ 07921 |
Chief Scientific Officer |
/s/ Richard J. Rubino, Attorney-in-Fact for Casey C. Kopczynski | 11/01/2013 | |
**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) | Upon the closing of the issuer's initial public offering pursuant to a registration statement on Form S-1 under the Securities Act of 1933, as amended, 93,256 shares of Series A-4 Preferred Stock were automatically converted into 18,651 shares of Common Stock, which reflects a 1-for-5 reverse stock split of the issuer's Common Stock effected on October 8, 2013. Prior to the conversion, the shares of Series A-4 Preferred Stock had no expiration date. |
(2) | Upon the closing of the issuer's initial public offering pursuant to a registration statement on Form S-1 under the Securities Act of 1933, as amended, a warrant to purchase 15,000 shares of Series A-4 Preferred Stock with an exercise price of $1.00 per share was automatically converted into this warrant to purchase 3,000 shares of Common Stock with an exercise price of $5.00 per share, which reflects a 1-for-5 reverse stock split of the issuer's Common Stock effected on October 8, 2013. This warrant is immediately exercisable. |