Statement of Changes in Beneficial Ownership (4)
March 07 2016 - 4:03PM
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
Estimated average burden
hours per response...
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
*
Silver David Samuel
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2. Issuer Name
and
Ticker or Trading Symbol
Targeted Medical Pharma, Inc.
[
TRGM
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
Chief Medical Officer
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(Last)
(First)
(Middle)
C/O TARGETED MEDICAL PHARMA, INC., 2980 BEVERLY GLEN CIRCLE, SUITE 100
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3. Date of Earliest Transaction
(MM/DD/YYYY)
3/4/2016
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(Street)
LOS ANGELES, CA 90077
(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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3/4/2016
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A
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575000
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A
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$0.05
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575000
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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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Options to Purchase Common Stock
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$3.38
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3/20/2010
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J
(2)
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177469
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(3)
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(3)
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Common Stock
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177469
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$0
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1225077
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D
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Options to Purchase Common Stock
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$3.38
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12/21/2011
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J
(2)
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400000
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(4)
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(4)
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Common Stock
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400000
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$0
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825077
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D
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Options to Purchase Common Stock
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$0.05
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3/4/2016
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A
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400000
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(1)
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3/3/2023
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Common Stock
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400000
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$0
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1225077
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D
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Explanation of Responses:
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(
1)
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The options were issued pursuant to the Company's 2011 Stock Incentive Plan. Options to purchase 400,000 shares vested on March 4, 2016 with a seven year term.
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(
2)
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Voluntary forfeiture by grantee.
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(
3)
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The option became exercisable as to 59,157 of the shares on March 20, 2010, and 59,156 shares on March 1, 2011 and 2012. The expiration date for these options is March 20, 2020.
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(
4)
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The option became exercisable as to 200,000 of the shares on December 21, 2011 and 200,000 shares on December 21, 2012. The expiration date for these options is December 21, 2021.
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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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Silver David Samuel
C/O TARGETED MEDICAL PHARMA, INC.
2980 BEVERLY GLEN CIRCLE, SUITE 100
LOS ANGELES, CA 90077
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X
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Chief Medical Officer
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Signatures
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/s/ David S. Silver
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3/7/2016
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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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