Initial Statement of Beneficial Ownership (3)
08 March 2017 - 9:01AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
*
Dyer Jeffrey Hansen
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2. Date of Event Requiring Statement (MM/DD/YYYY)
3/2/2017
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3. Issuer Name
and
Ticker or Trading Symbol
POLARITYTE, INC. [COOL]
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(Last)
(First)
(Middle)
C/O POLARITYTE, INC., 4041-T HADLEY ROAD
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__
X
__ Director
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Street)
S. PLAINFIELD, NJ 07080
(City)
(State)
(Zip)
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5. 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 Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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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. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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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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Option to Purchase Common Stock
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12/7/2016
(1)
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12/7/2026
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Common Stock
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141000
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$3.12
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D
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Explanation of Responses:
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(
1)
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The Reporting Person was appointed as a member of the Issuer's Board of Directors on March 2, 2017. The 10 year option to purchase 141,000 shares of the Issuer's common stock pursuant to the Issuer's 2017 Equity Incentive Plan (the "2017 Plan") will vest in 24 equal monthly installments commencing on the one month anniversary of the grant date. The 2017 Plan, the vesting and the exercise of the option are subject to stockholder approval.
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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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Dyer Jeffrey Hansen
C/O POLARITYTE, INC.
4041-T HADLEY ROAD
S. PLAINFIELD, NJ 07080
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X
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Signatures
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/s/ Jeff Dyer
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3/7/2017
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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 5(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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