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
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1. Name and Address of Reporting Person*
Belk Jeffrey

(Last) (First) (Middle)
C/O PEREGRINE SEMICONDUCTOR CORPORATION
9380 CARROLL PARK DRIVE

(Street)
SAN DIEGO CA 92121

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
08/07/2012
3. Issuer Name and Ticker or Trading Symbol
PEREGRINE SEMICONDUCTOR CORP [ PSMI ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
08/07/2012
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 Stock 20,435 D
Common Stock 10,217 I Jeffrey K. Belk and Kim Z. Belk Trust Dated July 22, 1998
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
Stock Option (Right to Buy) (1) 04/14/2019 Common Stock 2,724 1.76 D
Stock Option (Right to Buy) (2) 05/28/2019 Common Stock 5,108 1.76 D
Stock Option (Right to Buy) (3) 05/28/2019 Common Stock 5,108 1.76 D
Stock Option (Right to Buy) (4) 01/28/2020 Common Stock 3,269 5.73 D
Stock Option (Right to Buy) (5) 07/22/2020 Common Stock 13,623 7.12 D
Stock Option (Right to Buy) (6) 07/22/2020 Common Stock 25,544 7.12 D
Stock Option (Right to Buy) (7) 10/25/2021 Common Stock 10,899 9.76 D
Explanation of Responses:
1. Subject to continuous service, the option is immediately exercisable for all shares. Any shares acquired upon exercise of the option are subject to a right of repurchase at the original exercise price per share. The right of repurchase lapses in successive equal daily installments from January 15, 2009 to December 31, 2009.
2. Subject to continuous service, the option is immediately exercisable for all shares. Any shares acquired upon exercise of the option are subject to a right of repurchase at the original exercise price per share. The right of repurchase lapses in successive equal daily installments over a 12-month period from March 31, 2011.
3. Subject to continuous service, the option is immediately exercisable for all shares. Any shares acquired upon exercise of the option are subject to a right of repurchase at the original exercise price per share. The right of repurchase lapses in successive equal daily installments over a 12-month period from March 31, 2012.
4. Subject to continuous service, the option is immediately exercisable for all shares. Any shares acquired upon exercise of the option are subject to a right of repurchase at the original exercise price per share. The right of repurchase lapses in successive equal daily installments from January 28, 2010 to December 31, 2010.
5. Subject to continuous service, the option is exercisable in successive equal daily installments over a 12-month period from April 1, 2013.
6. Subject to continuous service, the option is exercisable in successive equal daily installments over a 36-month period from July 22, 2010.
7. Subject to continuous service, the option is exercisable in 12 successive equal monthly installments from April 1, 2014.
By: /s/ Jay Biskupski as Attorney-in-fact for Jeffrey K. Belk 08/08/2012
** 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.
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