Statement of Changes in Beneficial Ownership (4)
January 21 2021 - 4:15PM
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).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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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
*
JACOBSEN MICHAEL A |
2. Issuer Name and Ticker or Trading Symbol
OMEROS CORP
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OMER
]
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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) VP FINANCE AND CAO |
(Last)
(First)
(Middle)
C/O OMEROS CORPORATION, 201 ELLIOTT AVENUE WEST |
3. Date of Earliest Transaction
(MM/DD/YYYY)
1/19/2021 |
(Street)
SEATTLE, WA 98119
(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 | 1/19/2021 | | S(1) | | 9500 | D | $19.95 | 4000 | D | |
Common Stock | 1/20/2021 | | M | | 10000 | A | $9.37 | 14000 | D | |
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) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Stock Option (right to buy) | $9.37 | 1/20/2021 | | M | | | 10000 | (2)(3) | 9/24/2023 | Common Stock | 30000 | $9.37 | 19188 | D | |
Explanation of Responses: |
(1) | Open market sale pursuant to a Rule 10b5-1 trading plan adopted by the reporting person on September 3, 2020, at which time the trading schedule, including sale periods, price and the number of shares to be sold, was established in accordance with Rule 10b5-1 under the Securities Exchange Act of 1934, as amended. |
(2) | 25% of the total number of shares subject to this option vested on September 3, 2014, and the remaining shares subject to the option vested and became exercisable in equal monthly installments over the 36 months following the initial vesting date. |
(3) | On January 20, 2021, the reporting person paid the exercise price and exercised options to purchase 10,000 shares of the company's common stock. These shares have not been sold and are held for the account of the reporting person. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
JACOBSEN MICHAEL A C/O OMEROS CORPORATION 201 ELLIOTT AVENUE WEST SEATTLE, WA 98119 |
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| VP FINANCE AND CAO |
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Signatures
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/s/ Peter B. Cancelmo, Attorney-in-Fact | | 1/21/2021 |
**Signature of Reporting Person | Date |
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