FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 10/08/2013 |
3. Issuer Name and Ticker or Trading Symbol
LDR HOLDING CORP [ P139 ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 116,981 | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Incentive Stock Option (right to buy) | 04/01/2009(1) | 04/01/2014 | Common Stock | 11,111 | $1.9305 | D | |
Incentive Stock Option (right to buy) | 01/01/2012(2) | 11/19/2015 | Common Stock | 20,056 | $3.4155 | D | |
Incentive Stock Option (right to buy) | 07/10/2013(3) | 07/10/2022 | Common Stock | 10,737 | $6.534 | D | |
Medical Class A Stock | (4) | (4) | Common Stock(4) | 1,161,335 | (4) | D | |
Non-Qualified Stock Option (right to buy) | 07/10/2013(3) | 07/10/2022 | Common Stock | 24,315 | $6.534 | D |
Explanation of Responses: |
1. The option becomes exercisable for 100% of the shares granted immediately on April 1, 2009. |
2. The option becomes exercisable for 25% of the shares granted one year from the vesting commencement date of January 1, 2011, then in thirty-six equal monthly installments thereafter. |
3. ISO becomes exercisable in combination with NQSO granted on the same date wherein 25% of the shares granted become exercisable upon one year from the vesting commencement date of July 10, 2012, then in thirty-six equal monthly installments thereafter. |
4. The Medical Class A Stock, which is capital stock of the Issuer's majority-owned subsidiary LDR Medical S.A.S., is convertible into the Issuer's Common Stock on a 1 for 5.80087 basis and has no expiration date. |
Remarks: |
Exhibit 24.1 - Confirming Statement |
By: Denise Cruz For: Christophe Lavigne | 10/08/2013 | |
** 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 5 (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 Number. |