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) 04/15/2015 |
3. Issuer Name and Ticker or Trading Symbol
KEMPHARM, INC [ KMPH ] |
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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 | 20,000 | 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) | (1) | 07/01/2019 | Common Stock | 20,000 | $4.65 | D | |
Stock Option (right to buy) | (2) | 07/09/2024 | Common Stock | 20,000 | $5.85 | D | |
Series A Convertible Preferred Stock | (3)(4) | (5) | Common Stock | 26,355 | (3)(4) | D | |
Series B Convertible Preferred Stock | (3)(6) | (5) | Common Stock | 16,129 | (3)(6) | D | |
Series C Convertible Preferred Stock | (3)(7) | (5) | Common Stock | 136,410 | (3)(7) | D |
Explanation of Responses: |
1. Grant to the Reporting Person of a stock option under the Issuer's Incentive Stock Plan (the "Plan"). The shares subject to the option are fully vested. |
2. Grant to the Reporting Person of a stock option under the Plan. The shares subject to the option vest in four equal annual installments on each of July 9, 2015, July 9, 2016, July 9, 2017 and July 9, 2018, provided that at the relevant vesting dates such optionee's employment relationship has not been terminated as defined in and as determined under the Plan. The option expires ten years after the date of grant. |
3. Immediately convertible into shares of the Issuer's Common Stock at the Reporting Person's election. |
4. The shares will automatically convert into 3,514 shares of the Issuer's Common Stock immediately upon the closing of a Qualified Public Offering (as defined in the Issuer's Restated Certificate of Incorporation). |
5. The shares do not have an expiration date. |
6. The shares will automatically convert into 2,150 shares of the Issuer's Common Stock immediately upon the closing of a Qualified Public Offering. |
7. The shares will automatically convert into 18,188 shares of the Issuer's Common Stock immediately upon the closing of a Qualified Public Offering. |
Remarks: |
/s/ Sven Guenther | 04/15/2015 | |
** 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. |