0000899243-15-000629.txt : 20150706 0000899243-15-000629.hdr.sgml : 20150703 20150706203839 ACCESSION NUMBER: 0000899243-15-000629 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150701 FILED AS OF DATE: 20150706 DATE AS OF CHANGE: 20150706 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Baxalta Inc CENTRAL INDEX KEY: 0001620546 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 471869689 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: ONE BAXTER PARKWAY CITY: DEERFIELD STATE: IL ZIP: 60015 BUSINESS PHONE: 224-948-2000 MAIL ADDRESS: STREET 1: ONE BAXTER PARKWAY CITY: DEERFIELD STATE: IL ZIP: 60015 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HOMBACH ROBERT J. CENTRAL INDEX KEY: 0001496182 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36782 FILM NUMBER: 15975051 MAIL ADDRESS: STREET 1: ONE BAXTER PARKWAY, BUILDING 1 CITY: DEERFIELD STATE: IL ZIP: 60015 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2015-07-01 0 0001620546 Baxalta Inc BXLT 0001496182 HOMBACH ROBERT J. C/O BAXALTA INCORPORATED ONE BAXTER PARKWAY DEERFIELD IL 60015 0 1 0 0 EVP, CFO and COO Common Stock, par value $0.01 per share 2015-07-01 4 J 0 22568 0.00 A 22568 D Common Stock, par value $0.01 per share 2015-07-01 4 J 0 88989 0.00 A 111557 D Stock Option (Right to Buy) 24.83 2015-07-01 4 J 0 49628 0.00 A 2021-03-04 Common Stock, par value $0.01 per share 49628 49628 D Stock Option (Right to Buy) 26.53 2015-07-01 4 J 0 88597 0.00 A 2022-03-06 Common Stock, par value $0.01 per share 88597 88597 D Stock Option (Right to Buy) 32.42 2015-07-01 4 J 0 95163 0.00 A 2023-03-05 Common Stock, par value $0.01 per share 95163 95163 D Stock Option (Right to Buy) 31.86 2015-07-01 4 J 0 103181 0.00 A 2024-03-04 Common Stock, par value $0.01 per share 103181 103181 D Stock Option (Right to Buy) 32.04 2015-07-01 4 J 0 287936 0.00 A 2025-03-03 Common Stock, par value $0.01 per share 287936 287936 D Stock Option (Right to Buy) 31.50 2015-07-01 4 A 0 380535 0.00 A 2025-07-01 Common Stock, par value $0.01 per share 380535 380535 D Stock Option (Right to Buy) 31.50 2015-07-01 4 A 0 35170 0.00 A 2025-07-01 Common Stock, par value $0.01 per share 35170 35170 D Represents shares of Baxalta Incorporated ("Baxalta") common stock received in connection with the spin-off (the "Spin-off") of Baxalta from Baxter International Inc. ("Baxter"), in an exempt transaction pursuant to Rule 16a-9. Shares beneficially owned includes shares of common stock for which delivery has been deferred. Represents restricted stock units granted by Baxalta to the reporting person as a result of the adjustment of existing Baxter restricted stock units held by the reporting person prior to the Spin-off. These restricted stock units vest on the schedule set forth in the original grant agreement. Represents options to purchase shares of Baxalta common stock granted to the reporting person as a result of adjustments to existing Baxter stock options made in connection with the Spin-Off. This option is presently exercisable in full. Two-thirds of this option is presently exercisable. The remaining one third becomes exercisable on March 5, 2016. One-third of this option is presently exercisable. The remaining two thirds become exercisable on March 4, 2016 and March 4, 2017. This option will vest in three equal annual installments beginning on March 3, 2016, the first anniversary of the grant date of the existing option award. This option becomes exercisable in full on the fifth anniversary of the date of the grant. This option will vest in three equal annual installments beginning on July 1, 2016. /s/ Stephanie D. Miller, as attorney-in-fact for Robert J. Hombach 2015-07-06