SEC Form 3
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
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
Oliveto Joseph

(Last) (First) (Middle)
C/O MILESTONE PHARMACEUTICALS INC.
1111 DR. FREDERIK-PHILIPS BLVD, STE 420

(Street)
MONTR?AL A8 H4M 2X6

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
05/08/2019
3. Issuer Name and Ticker or Trading Symbol
Milestone Pharmaceuticals Inc. [ MIST ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
President and CEO
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
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 Shares 273,155 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
Employee Stock Option (right to buy) (1) 09/19/2026 Common Shares 121,574 $1.12 D
Employee Stock Option (right to buy) (2) 01/03/2027 Common Shares 8,960 $1.12 D
Employee Stock Option (right to buy) (3) 12/12/2027 Common Shares 121,256 $1.54 D
Employee Stock Option (right to buy) (4) 10/25/2028 Common Shares 191,479 $2.66 D
Employee Stock Option (right to buy) (5) 11/20/2028 Common Shares 263,192 $2.66 D
Explanation of Responses:
1. The original grant was for 253,720 option shares. Twenty-five percent (25%) of the shares subject to the option vested on September 19, 2017, and one thirty-sixth (1/36th) of the remaining shares subject to the option vested or shall vest each month thereafter, subject to the Reporting Person continuing to provide service through each such date.
2. The original grant was for 18,375 option shares. Twenty-five percent (25%) of the shares subject to the option vested on September 19, 2017, and one thirty-sixth (1/36th) of the remaining shares subject to the option vested or shall vest each month thereafter, subject to the Reporting Person continuing to provide service through each such date.
3. The original grant was for 252,853 option shares. Twenty-five percent (25%) of the shares subject to the option vested on September 19, 2017, and one thirty-sixth (1/36th) of the remaining shares subject to the option vested or shall vest each month thereafter, subject to the Reporting Person continuing to provide service through each such date.
4. Twenty-five percent (25%) of the shares subject to the option vested on September 19, 2017, and one thirty-sixth (1/36th) of the remaining shares subject to the option vested or shall vest each month thereafter, subject to the Reporting Person continuing to provide service through each such date.
5. Twenty-five percent (25%) of the shares subject to the option shall vest on November 21, 2019, and one thirty-sixth (1/36th) of the remaining shares subject to the option shall vest each month thereafter, subject to the Reporting Person continuing to provide service through each such date.
Remarks:
Exhibit List - Exhibit 24 - Power of Attorney
/s/ Eric Popp, Attorney-in-Fact 05/08/2019
** 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.