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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 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. | |||
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. | SEC 1474 (9-02) |
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 Underlying Securities (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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
stock option (right to buy) | $ 4.95 | 01/25/2011 | A | 12,000 | 01/25/2011(1) | 01/20/2021 | common stock | 12,000 | $ 0 (2) | 12,000 | D | ||||
stock option (right to buy) | $ 4.95 | 01/25/2011 | A | 15,000 | (3) | 01/20/2021 | common stock | 15,000 | $ 0 (2) | 15,000 | D | ||||
restricted stock unit | $ 0 (4) | 01/25/2011 | A | 5,000 | (5) | 04/01/2012 | common stock | 5,000 | $ 0 (6) | 5,000 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
QUILTY EDWARD J DERMA SCIENCES, INC. 214 CARNEGIE CENTER, SUITE 300 PRINCETON, NJ 08540 |
X | President & CEO |
Edward J. Quilty, by Raymond C. Hedger, Jr., Attorney In Fact | 01/25/2011 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | The options vested as to 25% on January 25, 2011, the date of the execution of the stock option agreement reflecting the subject grant, and will vest as to an additional 25% on January 20 of 2012, 2013 and 2014. |
(2) | The options were issued in consideration of the reporting person's services to the issuer and without payment of cash consideration, under the issuer's stock option plan. |
(3) | The options will vest, if at all, to the extent of the issuer's performance in 2011 and the grantee's contribution thereto as determined by the issuer's board of directors not later than April 1, 2012. |
(4) | Upon vesting, the reporting person will receive the number of shares of the issuer's common stock equal to the number of restricted stock units, without payment of further consideration. |
(5) | The restricted stock units will vest, if at all, to the extent of the issuer's performance in 2011 and the grantee's contribution thereto as determined by the issuer's board of directors not later than April 1, 2012. |
(6) | The restricted stock units were issued in consideration of the reporting person's services to the issuer and without payment of cash consideration, under the issuer's restricted stock plan. |