0001280776-17-000047.txt : 20170525
0001280776-17-000047.hdr.sgml : 20170525
20170525173222
ACCESSION NUMBER: 0001280776-17-000047
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170523
FILED AS OF DATE: 20170525
DATE AS OF CHANGE: 20170525
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: VITAL THERAPIES INC
CENTRAL INDEX KEY: 0001280776
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 15010 AVENUE OF SCIENCE
STREET 2: STE. 200
CITY: SAN DIEGO
STATE: CA
ZIP: 92128
BUSINESS PHONE: 858-673-6840
MAIL ADDRESS:
STREET 1: 15010 AVENUE OF SCIENCE
STREET 2: STE. 200
CITY: SAN DIEGO
STATE: CA
ZIP: 92128
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Godshall Douglas Evan
CENTRAL INDEX KEY: 0001404227
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36201
FILM NUMBER: 17871083
MAIL ADDRESS:
STREET 1: SUITE 4 LEVEL 46 2 PARK STREET
CITY: SIDNEY
STATE: C3
ZIP: 2000
4
1
wf-form4_149574792815403.xml
FORM 4
X0306
4
2017-05-23
0
0001280776
VITAL THERAPIES INC
VTL
0001404227
Godshall Douglas Evan
C/O VITAL THERAPIES, INC.
15010 AVENUE OF SCIENCE, SUITE 200
SAN DIEGO
CA
92128
1
0
0
0
Stock Option (right to buy)
3.2
2017-05-23
4
A
0
45022
0
A
2027-05-22
Common Stock
45022.0
45022
D
Subject to the reporting person's continuing to be a Service Provider (as defined in the 2014 Equity Incentive Plan) through the vesting date, 100% of the shares will vest upon the earlier of the one (1) year anniversary from May 23, 2017 or the day prior to the Company's 2018 annual meeting of stockholders.
/s/ Michael V. Swanson, by power of attorney
2017-05-25