Statement of Changes in Beneficial Ownership (4)
06 9월 2019 - 7:30AM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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0.5
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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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1. Name and Address of Reporting Person
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Rajpal Rajesh K. |
2. Issuer Name and Ticker or Trading Symbol
AVEDRO INC
[
AVDR
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) Chief Medical Officer
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(Last)
(First)
(Middle)
C/O AVEDRO, INC., 201 JONES ROAD |
3. Date of Earliest Transaction
(MM/DD/YYYY)
3/1/2019
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(Street)
WALTHAM, MA 02451
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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3/1/2019
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M
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106
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A
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$0.00
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115500
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D
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Common Stock
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6/3/2019
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M
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106
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A
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$0.00
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115606
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D
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Common Stock
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9/3/2019
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M
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1049
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A
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$0.00
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116655
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D
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code (Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4)
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8. Price of Derivative Security (Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Restricted Stock Units
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(1)
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3/1/2019
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M
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106
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(2)
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(2)
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Common Stock
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106
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$0.00
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425
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D
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Restricted Stock Units
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(1)
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6/3/2019
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M
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106
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(2)
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(2)
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Common Stock
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106
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$0.00
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319
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D
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Restricted Stock Units
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(1)
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9/3/2019
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M
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107
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(2)
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(2)
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Common Stock
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107
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$0.00
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212
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D
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Restricted Stock Units
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(1)
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9/3/2019
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M
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942
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(3)
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(3)
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Common Stock
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942
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$0.00
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14130
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D
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Explanation of Responses:
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(1)
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Each restricted stock unit ("RSU") represents a contingent right to receive one share of the Issuer's common stock.
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(2)
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1,169 shares underlying the RSUs vested on February 13, 2019, with the remainder vesting in five (5) quarterly equal installments beginning on March 1, 2019, subject to the Reporting Person continuing to provide service through each such date.
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(3)
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The RSUs vest quarterly in 16 equal installments, with the first quarterly installment occurring on September 3, 2019, subject to Reporting Person's continuous service as of each such vesting date.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Rajpal Rajesh K. C/O AVEDRO, INC. 201 JONES ROAD WALTHAM, MA 02451
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Chief Medical Officer
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Signatures
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/s/ Paul S. Bavier, Attorney-in-Fact
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9/5/2019
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**Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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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.
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