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
Adamas Pharmaceuticals Inc [ ADMS ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 04/15/2014 | ||||||||||||||||||||||||||
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 | 04/15/2014 | C | 1,104,596 | A | (1)(2)(3) | 2,172,128 | D |
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 | ||||||||
Series AA Convertible Preferred Stock | (2) | 04/15/2014 | C | 979,742 | (2) | (4) | Common Stock | 979,742 | $0.00 | 0 | D | ||||
Series AA-1 Convertible Preferred Stock | (1) | 04/15/2014 | C | 300 | (1) | (4) | Common Stock | 300 | $0.00 | 0 | D | ||||
Series AA Convertible Preferred Warrant | (5) | 04/15/2014 | X | 10,017 | 04/06/2011 | 04/06/2018 | Common Stock | 10,017 | $0.00 | 0 | D | ||||
Series AA Convertible Preferred Warrant | (6) | 04/15/2014 | X | 80,418 | 06/30/2011 | 06/30/2018 | Common Stock | 80,418 | $0.00 | 0 | D | ||||
Series AA Convertible Preferred Warrant | (7) | 04/15/2014 | X | 8,814 | 03/23/2012 | 03/22/2019 | Common Stock | 8,814 | $0.00 | 0 | D | ||||
Series AA Convertible Preferred Warrant | (8) | 04/15/2014 | X | 3,980 | 05/23/2012 | 05/22/2019 | Common Stock | 3,980 | $0.00 | 0 | D | ||||
Series AA Convertible Preferred Warrant | (9) | 04/15/2014 | X | 4,265 | 06/23/2012 | 06/22/2019 | Common Stock | 4,265 | $0.00 | 0 | D | ||||
Series AA Convertible Preferred Warrant | (9) | 04/15/2014 | X | 4,265 | 08/01/2012 | 07/31/2019 | Common Stock | 4,265 | $0.00 | 0 | D | ||||
Series AA Convertible Preferred Warrant | (9) | 04/15/2014 | X | 4,265 | 09/04/2012 | 09/03/2019 | Common Stock | 4,265 | $0.00 | 0 | D | ||||
Series AA Convertible Preferred Warrant | (9) | 04/15/2014 | X | 4,265 | 10/04/2012 | 10/03/2019 | Common Stock | 4,265 | $0.00 | 0 | D | ||||
Series AA Convertible Preferred Warrant | (9) | 04/15/2014 | X | 4,265 | 11/14/2012 | 11/13/2019 | Common Stock | 4,265 | $0.00 | 0 | D |
Explanation of Responses: |
1. Upon the closing of the Issuer's initial public offering, each 1000 shares of Series AA-1 Preferred Stock automatically converted into 1 share of Common Stock for no additional consideration and had no expiration date. |
2. Upon prior to the closing of the Issuer's initial public offering, each share of Series AA Preferred Stock automatically converted into 1 share of Common Stock for no additional consideration and had no expiration date. |
3. Upon the closing of the Issuer's initial public offering, the Series AA Convertible Preferred Warrants automatically net exercised into 124,554 shares of Series AA Convertible Preferred Stock. Each share of Series AA Preferred Stock then immediately automatically converted into 1 share of Common Stock for no additional consideration and had no expiration date. |
4. The shares do not have an expiration date. |
5. Upon the closing of the Issuer's initial public offering, the Series AA Convertible Preferred Warrant automatically net exercised into 10,017 shares of Series AA Convertible Preferred Stock. Each share of Series AA Preferred Stock then immediately automatically converted into 1 share of Common Stock for no additional consideration and had no expiration date. |
6. Upon the closing of the Issuer's initial public offering, the Series AA Convertible Preferred Warrant automatically net exercised into 80,418 shares of Series AA Convertible Preferred Stock. Each share of Series AA Preferred Stock then immediately automatically converted into 1 share of Common Stock for no additional consideration and had no expiration date. |
7. Upon the closing of the Issuer's initial public offering, the Series AA Convertible Preferred Warrant automatically net exercised into 8,814 shares of Series AA Convertible Preferred Stock. Each share of Series AA Preferred Stock then immediately automatically converted into 1 share of Common Stock for no additional consideration and had no expiration date. |
8. Upon the closing of the Issuer's initial public offering, the Series AA Convertible Preferred Warrant automatically net exercised into 3,980 shares of Series AA Convertible Preferred Stock. Each share of Series AA Preferred Stock then immediately automatically converted into 1 share of Common Stock for no additional consideration and had no expiration date. |
9. Upon the closing of the Issuer's initial public offering, the Series AA Convertible Preferred Warrant automatically net exercised into 4,265 shares of Series AA Convertible Preferred Stock. Each share of Series AA Preferred Stock then immediately automatically converted into 1 share of Common Stock for no additional consideration and had no expiration date. |
Remarks: |
/s/Ralph Woodford | 04/15/2014 | |
** 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. |