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 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 06/01/2011 |
3. Issuer Name and Ticker or Trading Symbol
ANTARES PHARMA, INC. [ AIS ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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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 | 141,552(1) | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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) | (2) | 05/13/2018 | Common Stock | 125,000 | $0.85 | D | |
Stock Option (right to buy) | (2) | 11/11/2018 | Common Stock | 175,000 | $0.47 | D | |
Stock Option (right to buy) | (2) | 12/04/2018 | Common Stock | 25,000 | $0.37 | D | |
Stock Option (right to buy) | (2) | 08/11/2019 | Common Stock | 25,000 | $0.95 | D | |
Stock Option (right to buy) | (2) | 11/11/2019 | Common Stock | 75,000 | $1.1 | D | |
Stock Option (right to buy) | (2) | 11/10/2020 | Common Stock | 75,000 | $1.52 | D | |
Stock Option (right to buy) | (2) | 05/16/2021 | Common Stock | 51,000 | $1.66 | D |
Explanation of Responses: |
1. Includes: (i) 89,937 shares issued to and owned by Dr. Dave; (ii) 19,615 shares of restricted common stock, par value $0.01 per share, issued under the Antares Pharma, Inc. 2008 Equity Compensation Plan that will vest 100% on February 22,2013; and (iii) 32,000 shares representing the target number of shares Dr. Dave may receive pursuant to the terms of the performance stock unit award made to Dr. Dave under the 2008 Equity Compensation Plan if certain performance goals are attained over the three-year period beginning January 1, 2011 and ending December 31, 2013 and Dr. Dave continues in employment with the Company through that period. |
2. The options vest in equal quarterly installments over three years beginning ten years prior to the expiration date. |
Remarks: |
Exhibit Index: Exhibit 24, Power of Attorney |
Robert F. Apple as attorney-in-fact for Kaushik J. Dave | 06/08/2011 | |
** 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. |