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*
Crombez Eric

(Last) (First) (Middle)
C/O ULTRAGENYX PHARMACEUTICAL INC.
60 LEVERONI COURT

(Street)
NOVATO CA 94949

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
05/01/2023
3. Issuer Name and Ticker or Trading Symbol
Ultragenyx Pharmaceutical Inc. [ RARE ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
EVP and Chief Medical Officer
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 Stock 25,854(1) 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
Stock Option (Right to Buy) (2) 11/17/2027 Common Stock 7,500 $48.11 D
Stock Option (Right to Buy) (3) 03/01/2029 Common Stock 8,000 $67.55 D
Stock Option (Right to Buy) (4) 03/01/2030 Common Stock 13,000 $56.08 D
Stock Option (Right to Buy) (5) 03/01/2031 Common Stock 4,310 $142.47 D
Stock Option (Right to Buy) (6) 03/01/2032 Common Stock 6,335 $67.37 D
Stock Option (Right to Buy) (7) 03/01/2033 Common Stock 9,845 $45.65 D
Explanation of Responses:
1. Includes 12,601 Restricted Stock Units ("RSUs") awarded under the Company's 2014 Incentive Plan. The RSUs vest with respect to 1/4th of the underlying shares on each anniversary of the grant date, such that the RSUs are fully vested on the fourth anniversary of the grant date. Of the 12,601 RSUs, 1,115 RSUs were granted on March 1, 2020, 720 RSUs were granted on March 1, 2021, 1,000 RSUs were granted on April 16, 2021, 2,381 RSUs were granted on March 1, 2022 and 7,385 RSUs were granted on March 1, 2023.
2. 1/4th of the shares initially subject to the option vested on November 17, 2018; thereafter, 1/48th of the shares initially subject to the option vested monthly.
3. 1/4th of the shares initially subject to the option vested on March 1, 2020; thereafter, 1/48th of the shares initially subject to the option vested monthly.
4. 1/4th of the shares initially subject to the option vested on March 1, 2021 thereafter, 1/48th of the shares initially subject to the option shall vest monthly.
5. 1/4th of the shares initially subject to the option vested on March 1, 2022 thereafter, 1/48th of the shares initially subject to the option shall vest monthly.
6. 1/4th of the shares initially subject to the option vested on March 1, 2023 thereafter, 1/48th of the shares initially subject to the option shall vest monthly.
7. 1/4th of the shares initially subject to the option will vest on March 1, 2024 thereafter, 1/48th of the shares initially subject to the option shall vest monthly.
Remarks:
/s/ Karah Parschauer, attorney-in-fact 05/02/2023
** 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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