Statement of Changes in Beneficial Ownership (4)
25 June 2021 - 6:16AM
Edgar (US Regulatory)
FORM 4
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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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OMB APPROVAL
OMB Number:
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
*
Racine Jean-Olivier |
2. Issuer Name and Ticker or Trading Symbol
Outset Medical, Inc.
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OM
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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) Chief Technology Officer |
(Last)
(First)
(Middle)
3052 ORCHARD DRIVE |
3. Date of Earliest Transaction
(MM/DD/YYYY)
6/22/2021 |
(Street)
SAN JOSE, CA 95134
(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 | 6/22/2021 | | A | | 18879 (1) | A | $0.0 | 18879 | 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 |
Non-Qualified Stock Option (right to buy) | $50.82 | 6/22/2021 | | A | | 34220 | | (2) | 6/22/2031 | Common Stock | 34220 | $0.0 | 34220 | D | |
Explanation of Responses: |
(1) | Represent Restricted Stock Units (RSUs) granted to the reporting person on June 22, 2021. Each RSU represents a contingent right to receive one share of common stock. These RSUs shall vest 25% on June 22, 2022, then quarterly over three years on each February 15th, May 15th, August 15h and November 15th, subject to the reporting person's continuous service through the applicable vesting date. |
(2) | This option vests 25% on June 22, 2022 and then in 36 equal monthly installments thereafter, subject to the reporting person's continuous service through the applicable vesting date. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Racine Jean-Olivier 3052 ORCHARD DRIVE SAN JOSE, CA 95134 |
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| Chief Technology Officer |
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Signatures
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By: John L Brottem For: Jean-Olivier Racine | | 6/23/2021 |
**Signature of Reporting Person | Date |
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