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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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1. Title of Derivative Security | 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 | 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 Securities Underlying Derivative Security (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) | |||
(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Consists of (i) 9,338,910 shares held by the Khandros-Bloch Revocable Trust U/A/D 1/24/1997 ("Revocable Trust"), (ii) 100,757 shares held by the Khandros 2018 3-Year GRAT (the "Khandros GRAT"), (iii) 100,757 shares held by the Bloch 2018 3-Year GRAT (the "Bloch GRAT"), (iv) 85,602 shares held by the Khandros 2018 2-Year GRAT (the "Khandros 2-Year GRAT"), and (v) 85,602 shares held by the Bloch 2018 2-Year GRAT (the "Bloch 2-Year GRAT", and together with the Khandros GRAT, Bloch GRAT, and Khandros 2-Year GRAT, the "GRATs"). As co-trustee of the Revocable Trust and the GRATs, Dr. Khandros may be deemed to beneficially own the shares held by the Revocable Trust and the GRATs. Dr. Khandros disclaims beneficial ownership of the shares held by the Revocable Trust and the GRATs except to the extent of his pecuniary interest therein. |
Signatures | ||
/s/ Stuart L. Merkadeau, Attorney-in-fact for Igor Khandros | 02/16/2021 | |
** 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. |