Statement of Changes in Beneficial Ownership (4)
25 January 2023 - 09:18AM
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 * Francois Cedric |
2. Issuer Name and Ticker or Trading
Symbol Apellis Pharmaceuticals, Inc. [ APLS ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)__X__
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
Chief Executive Officer |
(Last)
(First)
(Middle)
C/O APELLIS PHARMACEUTICALS, INC., 100 FIFTH AVENUE, 3RD
FLOOR |
3. Date of Earliest Transaction (MM/DD/YYYY)
1/20/2023
|
(Street)
WALTHAM, MA 02451
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
6. Individual or Joint/Group Filing
(Check Applicable Line) _X _ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person |
Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned
|
1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. Code
(Instr. 8) |
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned Following
Reported Transaction(s)
(Instr. 3 and 4) |
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr.
4) |
Code |
V |
Amount |
(A) or (D) |
Price |
Common Stock |
1/20/2023 |
|
F(1) |
|
9453 |
D |
$52.05 |
1039122 |
D |
|
Common Stock |
|
|
|
|
|
|
|
300000 |
I (2) |
Indirect Owner (The Francois Grossi
Trust) |
Common Stock |
|
|
|
|
|
|
|
234411 |
I (3) |
Indirect Owner (The Francois-DuBois Educational
Trust) |
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
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 |
Explanation of
Responses: |
(1) |
This represents shares
withheld for tax on a restricted stock unit release. |
(2) |
The securities are held by
The Francois Grossi Trust, for which Juliana Grossi, the spouse of
the reporting person, serves as trustee. The reporting person
disclaims beneficial ownership over the shares held by the Francois
Grossi Trust except to the extent of his pecuniary interest
therein. |
(3) |
The securities are held by
The Francois-DuBois Educational Trust, for which the Fiduciary
Trust Company of New England serves as trustee. The reporting
person disclaims beneficial ownership over the shares held by The
Francois-DuBois Educational Trust except to the extent of his
pecuniary interest therein. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
Francois Cedric
C/O APELLIS PHARMACEUTICALS, INC.
100 FIFTH AVENUE, 3RD FLOOR
WALTHAM, MA 02451 |
X |
|
Chief Executive Officer |
|
Signatures
|
/s/ David Watson, attorney-in-fact for Cedric
Francois |
|
1/24/2023 |
**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 control number. |
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