SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response: 0.5
X
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
JEFFS ROGER

(Last) (First) (Middle)
C/O DOVA PHARMACEUTICALS, INC.
240 LEIGH FARM ROAD, SUITE 245

(Street)
DURHAM NC 27707

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Dova Pharmaceuticals Inc. [ DOVA ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
11/12/2019
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 11/12/2019 D 66,993(1) D (1) 0 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (Right to Buy) $7.32 11/12/2019 D 33,000 (2) 05/24/2027 Common Stock 33,000 (2) 0 D
Stock Option (Right to Buy) $9.36 11/12/2019 D 10,000 (3) 04/25/2029 Common Stock 10,000 (3) 0 D
Explanation of Responses:
1. Disposed pursuant to an agreement and plan of merger by and between the Issuer, Swedish Orphan Biovitrum AB and Dragonfly Acquisition Corp. (the "Merger") in exchange for $27.50 per share of Issuer's common stock including any shares subject to each restricted stock unit on the effective date of the Merger, plus (ii) one non-transferable contingent value right per share, which represents the right to receive $1.50, without interest and subject to any withholding taxes, upon the achievement of a specified milestone.
2. This option, which provided for vesting over a period of three years as follows: (i) one-third of the total shares subject to the option shall vest on May 25, 2018, and (ii) 1/36th of total shares subject to the option shall vest monthly thereafter over the remaining two years of the vesting period, was accelerated and canceled in the Merger in exchange for a cash payment of $665,940.00, representing the difference between the exercise price of outstanding shares subject to the option and the market value of the underlying common stock on the effective date of the Merger ($27.50 per share). In addition, one non-transferable contingent value right per share, which represents the right to receive $1.50, without interest and subject to any withholding taxes, upon the achievement of a specified milestone was awarded to the Reporting Person for each outstanding share subject to the option.
3. This option, which provided for vesting monthly over one year from the grant date and in any event will be fully vested on the date of the next annual meeting of our stockholders, was canceled in the Merger in exchange for a cash payment of $181,400.00, representing the difference between the exercise price of outstanding shares subject to the option and the market value of the underlying common stock on the effective date of the Merger ($27.50 per share). In addition, one non-transferable contingent value right per share, which represents the right to receive $1.50, without interest and subject to any withholding taxes, upon the achievement of a specified milestone was awarded to the Reporting Person for each outstanding share subject to the option.
Remarks:
/s/ Mark Ballantyne, Attorney-in-Fact 11/12/2019
** 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 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).
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.