UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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 control number. |
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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Warrant to Purchase Common Stock | 11/26/2014 | 11/26/2019 | Common Stock | 4,385 | $ 1.48 | D | |
Stock Options (2) | 03/03/2015 | 03/05/2024 | Common Stock | 25,000 | $ 0.95 | D | |
Stock Options (3) (4) | 01/07/2016 | 01/07/2025 | Common Stock | 74,000 | $ 0.97 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
LOMBARDI TY C/O AMEDICA CORPORATION 1885 W 2100 SOUTH SALT LAKE CITY, UT 84119 |
VP Finance |
/s/ Ty Lombardi | 01/20/2015 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | 8,000 shares of common stock are held in an IRA account. |
(2) | Option to purchase 25,000 shares of Common Stock at an exercise price of $.95 per share, expiring March 5, 2024; vesting over a four year period with 28% vesting after one year and 2% vesting per month thereafter until fully vested. |
(3) | Annual Stock Option award to purchase 49,000 shares of Common Stock at an exercise price of $.97 per share, expiring January 7, 2025; vesting over a three year period with 28% vesting after one year and 3% vesting per month thereafter until fully vested. |
(4) | Option to purchase 25,000 shares of Common Stock at an exercise price of $.97 per share, expiring January 7, 2025; vesting over a three year period with 28% vesting after one year and 3% vesting per month thereafter until fully vested, awarded in connection to promotion to VP of Finance. |