0000914190-19-000416.txt : 20191118 0000914190-19-000416.hdr.sgml : 20191118 20191118121232 ACCESSION NUMBER: 0000914190-19-000416 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191118 FILED AS OF DATE: 20191118 DATE AS OF CHANGE: 20191118 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Evans Daron CENTRAL INDEX KEY: 0001411726 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32288 FILM NUMBER: 191226667 MAIL ADDRESS: STREET 1: C/O NEPHROS, INC. STREET 2: 380 LACKAWANNA PLACE CITY: SOUTH ORANGE STATE: NJ ZIP: 07079 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: NEPHROS INC CENTRAL INDEX KEY: 0001196298 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 133971809 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 380 LACKAWANNA PLACE CITY: SOUTH ORANGE STATE: NJ ZIP: 07079 BUSINESS PHONE: 201.343.5202 MAIL ADDRESS: STREET 1: 380 LACKAWANNA PLACE CITY: SOUTH ORANGE STATE: NJ ZIP: 07079 4 1 edgar.xml PRIMARY DOCUMENT X0306 4 2019-11-18 0001196298 NEPHROS INC NEPH 0001411726 Evans Daron C/O NEPHROS, INC. 380 LACKAWANNA PLACE SOUTH ORANGE NJ 07079 1 1 0 0 President and CEO Common Stock 2019-11-18 4 P 0 1000 8.35 A 119933 D Common Stock 8185 I By UTMA #1 Common Stock 7907 I By UTMA #2 Common Stock 888 I By UTMA #3 Common Stock 888 I By UTMA #4 Common Stock 6111 I By PoC Capital, LLC Stock Option (Right to Buy) 4.14 2024-03-26 Common Stock 8374 8374 D Stock Option (Right to Buy) 5.40 2025-04-15 Common Stock 145614 145614 D Stock Option (Right to Buy) 4.50 2027-12-20 Common Stock 93014 93014 D Common Stock Warrants (Right to Buy) 2.70 2016-06-03 2021-06-03 Common Stock 1112 1112 I By UTMA #1 Common Stock Warrants (Right to Buy) 2.70 2016-06-03 2021-06-03 Common Stock 1112 1112 I By UTMA #2 Common Stock Warrants (Right to Buy) 2.70 2017-03-17 2022-03-17 Common Stock 4630 4630 I By UTMA #1 Common Stock Warrants (Right to Buy) 2.70 2017-03-17 2022-03-17 Common Stock 4630 4630 I By UTMA #2 The Reporting Person is a managing director of the LLC that owns the reported securities. The Reporting Person disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein. Fully exercisable. On 4/15/15, the Reporting Person was granted an option to purchase up to 242,690 shares of common stock of the Company. Options to purchase 84,941 shares vest quarterly in 16 equal amounts commencing on 6/30/15; options to purchase 36,404 shares vested upon the approval of the listing of the Company's common stock on the Nasdaq Stock Market; and options to purchase 121,345 shares will vest, if ever, upon the Company's achievement of certain annual revenue milestones as specified in that certain Employment Agreement dated 4/15/15 between the Reporting Person and the Company. The Company achieved the $3,000,000 annual revenue milestone in fiscal year 2017 and options to purchase 24,269 shares vested on 2/1/18. On 12/20/17, the Reporting Person was granted an option to purchase 93,014 shares of common stock of the Company. Options to purchase 23,253 shares vested on 12/20/18 and options to purchase 69,761 shares vest quarterly in 12 equal amounts commencing on 3/20/19. /s/ Daron Evans 2019-11-18