Form 4 ANTARES PHARMA, INC. For: Jun 10 Filed by: GARRITY THOMAS J
June 14, 2021 6:21 PM EDT
FORM
4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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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OMB APPROVAL |
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3235-0287 |
Expires: |
December 31, 2014 |
Estimated average burden |
hours per response: |
0.5 |
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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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1. Name and Address of Reporting Person
*
C/O ANTARES PHARMA, INC. |
100 PRINCETON SOUTH, SUITE 300 |
(Street)
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2. Issuer Name
and
Ticker or Trading Symbol
ANTARES PHARMA, INC.
[
ATRS
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X |
Director |
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10% Owner |
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Officer (give title below) |
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Other (specify below) |
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3. Date of Earliest Transaction
(Month/Day/Year) 06/10/2021
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4. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check
Applicable Line)
X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting
Person |
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Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned |
1.
Title of Security (Instr.
3)
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2.
Transaction Date
(Month/Day/Year) |
2A.
Deemed Execution Date, if any
(Month/Day/Year) |
3.
Transaction 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 |
V |
Amount |
(A) or (D) |
Price |
Common Stock
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06/10/2021 |
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A |
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25,452
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A
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$
4.42
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249,858
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D
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
3)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction 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
(Month/Day/Year) |
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: Direct (D) or Indirect (I) (Instr.
4)
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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)
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$
4.42
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06/10/2021 |
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A |
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48,542
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|
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06/10/2031 |
Common Stock
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48,542
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$
0
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48,542
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D
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Explanation of Responses: |
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/s/ Lisa M. Kallebo as attorney-in-fact for Thomas Garrity |
06/14/2021 |
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** Signature of Reporting Person |
Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
* 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). |
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure. |
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 Number. |
POWER OF ATTORNEY
KNOW ALL PERSONS BY THESE PRESENTS, that I, Thomas J. Garrity, hereby
constitute and appoint Fred M. Powell, Peter J. Graham, Lisa M. Kallebo and
Keith Muckenhirn, each of them, my true and lawful attorneys-in-fact and agents,
each acting alone, with full powers of substitution and resubstitution for me
and in my name, place and stead, to sign any reports on Form 3 (Initial
Statement of Beneficial Ownership), Form 4 (Statement of Changes in Beneficial
Ownership of Securities) and Form 5 (Annual Statement of Changes in Beneficial
Ownership) relating to transactions by me in Common Stock or other securities of
Antares Pharma, Inc., and all amendments thereto, and to file the same with the
Securities and Exchange Commission and appropriate securities listing agency, if
required, granting unto said attorneys-in-fact and agents, and each of them, or
their substitutes, full power and authority to do and perform each and every act
and thing requisite or necessary to be done, as fully to all intents and
purposes as I might or could do in person, hereby ratifying and confirming all
that said attorneys-in-fact and agents, and each of them, or their substitutes,
may lawfully do or cause to be done by virtue hereof. This Power of Attorney
shall be effective until such time as I deliver a written revocation thereof to
my above-named attorneys-in-fact and agents.
/s/ Thomas Garrity
Dated: June 8, 2021
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