SEC Form 3
FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
|
1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 03/22/2018 | 3. Issuer Name and Ticker or Trading Symbol CHIASMA, INC [ CHMA ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
|
Table I - Non-Derivative Securities Beneficially Owned | |||
---|---|---|---|
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 | 5,124 | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
---|---|---|---|---|---|---|---|
1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: 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 | ||||
Stock Option (Right to Buy) | (1) | 09/10/2025 | Common Stock | 14,084 | 28.4 | D | |
Stock Option (Right to Buy) | (1) | 09/10/2025 | Common Stock | 45,916 | 28.4 | D | |
Stock Option (Right to Buy) | (2) | 02/10/2026 | Common Stock | 969 | 9.93 | D | |
Stock Option (Right to Buy) | (2) | 02/10/2026 | Common Stock | 14,531 | 9.93 | D | |
Stock Option (Right to Buy) | (3) | 10/25/2026 | Common Stock | 25,003 | 2.6 | D | |
Stock Option (Right to Buy) | (3) | 10/25/2026 | Common Stock | 74,997 | 2.6 | D | |
Stock Option (Right to Buy) | (4) | 02/23/2028 | Common Stock | 52,011 | 1.52 | D | |
Stock Option (Right to Buy) | (5) | 02/23/2028 | Common Stock | 18,189 | 1.52 | D |
Explanation of Responses: |
1. This option vests over a four-year period at a rate of twenty-five percent (25%) on August 26, 2016 and 36 equal monthly installments thereafter. |
2. This option vests over a four-year period at a rate of twenty-five percent (25%) on February 10, 2017 and in 12 equal quarterly installments thereafter. |
3. This option vests over a four-year period at a rate of twenty-five percent (25%) on October 25, 2017 and in 12 equal quarterly installments thereafter. |
4. This option vests over a four-year period in 16 equal quarterly installments, the first such installment vesting on May 23, 2018. |
5. This option vests as follows: (i) 40% of such award will be earned upon FDA acceptance of a new drug application ("NDA") for Mycapssa, of which amount 50% will be immediately vested and 50% will vest upon the one year anniversary of such acceptance; and (ii) 60% of such award will be earned upon FDA approval of such NDA, of which amount 50% will be immediately vested and 50% will vest upon the one year anniversary of such approval. |
Remarks: |
Title: Senior Vice President, Clinical and Medical Affairs |
/s/ William Ludlam | 04/02/2018 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 5 (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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
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 Number. |