FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
CombiMatrix Corp [ CBMX ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 08/11/2010 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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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) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction 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 | 04/07/2011 | A | 136,791 | A | (3) | 136,791 | I | by R. Judd & Charlene L. Jessup Trust |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) | 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: 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 | ||||||||
Common Stock Warrants (right to buy) | $2.14 | 04/07/2011 | A | 58,136 | 10/08/2011 | 04/07/2016 | Common Stock | 58,136 | (3) | 58,136 | I | by R. Judd & Charlene L. Jessup Trust | |||
Employee Stock Option (right to buy) | $2.74 | 08/11/2010(2) | A | 400,000 | (1) | 08/11/2021 | Common Stock | 400,000 | $0 | 400,000 | D |
Explanation of Responses: |
1. 25% of the shares subject to the stock option vest on August 11, 2011, and the remaining 75% of the shares subject to the stock option will vest in equal monthly installments thereafter through August 11, 2014. |
2. The reporting person's original Form 3 filed on August 17, 2010 reported ownership of an employee stock option which should have been omitted from the Form 3 and reported instead on Form 4. The employee stock option entry in the reporting person's original Form 3 should be disregarded because he owned no equity securities of the issuer before becoming subject to Section 16, and is reporting on this Form 4 his acquisition of the employee stock option awarded to him upon becoming subject to Section 16. |
3. The reported securities are included within 136,791 Units purchased from CombiMatrix by the reporting person for $2.193125 per Unit. Each Unit consists of one share of common stock and one warrant to purchase 0.425 shares of common stock. |
Remarks: |
Exhibit List: Exhibit 24 - Power of Attorney |
/s/ Scott Burell, as attorney-in-fact for R. Judd Jessup | 04/11/2011 | |
** 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 Number. |