0001104659-21-112144.txt : 20210901 0001104659-21-112144.hdr.sgml : 20210901 20210901190102 ACCESSION NUMBER: 0001104659-21-112144 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210831 FILED AS OF DATE: 20210901 DATE AS OF CHANGE: 20210901 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Pruzanski Mark CENTRAL INDEX KEY: 0001559569 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35668 FILM NUMBER: 211231334 MAIL ADDRESS: STREET 1: C/O INTERCEPT PHARMACEUTICALS, INC. STREET 2: 18 DESBROSSES ST. CITY: NEW YORK STATE: NY ZIP: 10013 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: INTERCEPT PHARMACEUTICALS, INC. CENTRAL INDEX KEY: 0001270073 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 223868459 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 10 HUDSON YARDS, 37TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10001 BUSINESS PHONE: 646-747-1000 MAIL ADDRESS: STREET 1: 10 HUDSON YARDS, 37TH FLOOR CITY: New York STATE: NY ZIP: 10001 FORMER COMPANY: FORMER CONFORMED NAME: INTERCEPT PHARMACEUTICALS INC DATE OF NAME CHANGE: 20031113 4 1 tm2126794-1_4seq1.xml OWNERSHIP DOCUMENT X0306 4 2021-08-31 0 0001270073 INTERCEPT PHARMACEUTICALS, INC. ICPT 0001559569 Pruzanski Mark C/O INTERCEPT PHARMACEUTICALS, INC. 10 HUDSON YARDS, FLOOR 37 NEW YORK NY 10001 1 0 0 0 Common Stock 2021-08-31 4 A 0 6138 14.91 A 615749 D Common Stock 2021-08-31 4 F 0 3817 14.91 D 611932 D Represents shares of common stock delivered in respect of performance stock unit awards previously granted to the reporting person; such delivery being made pursuant to the Retirement and Consulting Agreement by and between the Issuer and the reporting person, dated December 9, 2020. Represents shares of common stock withheld by the Issuer to satisfy taxes associated with the partial vesting of restricted stock unit and performance stock unit awards previously granted to the reporting person. /s/ Mary J. Grendell, as attorney-in-fact 2021-09-01