0001104659-21-075217.txt : 20210601 0001104659-21-075217.hdr.sgml : 20210601 20210601190139 ACCESSION NUMBER: 0001104659-21-075217 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210527 FILED AS OF DATE: 20210601 DATE AS OF CHANGE: 20210601 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ROSA-BJORKESON DAGMAR CENTRAL INDEX KEY: 0001643934 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35668 FILM NUMBER: 21987062 MAIL ADDRESS: STREET 1: C/O BAXALTA INCORPORATED STREET 2: 1200 LAKESIDE DRIVE CITY: BANNOCKBURN STATE: IL ZIP: 60015 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: INTERCEPT PHARMACEUTICALS, INC. CENTRAL INDEX KEY: 0001270073 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 223868459 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 10 HUDSON YARDS, 37TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10001 BUSINESS PHONE: 646-747-1000 MAIL ADDRESS: STREET 1: 10 HUDSON YARDS, 37TH FLOOR CITY: New York STATE: NY ZIP: 10001 FORMER COMPANY: FORMER CONFORMED NAME: INTERCEPT PHARMACEUTICALS INC DATE OF NAME CHANGE: 20031113 4 1 tm2118118-4_4seq1.xml OWNERSHIP DOCUMENT X0306 4 2021-05-27 0 0001270073 INTERCEPT PHARMACEUTICALS, INC. ICPT 0001643934 ROSA-BJORKESON DAGMAR C/O INTERCEPT PHARMACEUTICALS, INC. 10 HUDSON YARDS, FLOOR 37 NEW YORK NY 10001 1 0 0 0 Common Stock 2021-05-27 4 A 0 10543 0 A 10543 D Option to Purchase Common Stock 17.08 2021-05-27 4 A 0 17719 0 A 2031-05-27 Common Stock 17719 17719 D Represents restricted stock units granted to the Reporting Person. Each restricted stock unit represents a contingent right to receive one share of the Issuer's Common Stock. 1/3rd of the shares subject to the award shall vest on each anniversary of the Vesting Commencement Date (or, if earlier in any given year, the day immediately preceding the date of the Issuer's Annual Meeting of Stockholders in such year). The Vesting Commencement Date is April 1, 2021. 1/3rd of the options subject to the award shall vest and become exercisable on each anniversary of the Vesting Commencement Date (or, if earlier in any given year, the day immediately preceding the date of the Issuer's Annual Meeting of Stockholders in such year). The Vesting Commencement Date is April 1, 2021. /s/ Mary J. Grendell, as attorney-in-fact 2021-06-01