SEC Form 4
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*
TELLEZ CORA M

(Last) (First) (Middle)
C/O CORMEDIX INC.
1430 HIGHWAY 206, SUITE 200

(Street)
BEDMINSTER NJ 07921

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
CorMedix Inc. [ CRMD ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
02/28/2017
4. 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 Acquired, Disposed of, or Beneficially Owned
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 02/28/2017 P 1,540(1) A $2.0979 118,071 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
Stock Option (Right to Buy Common Stock) $2.24 (2) 02/21/2027 Common Stock 40,000 40,000 D
Restricted Stock Units (3) (3) (3) Common Stock 20,714 20,714 D
Phantom Stock $0(4) (4) (4) Common Stock 3,472 3,472 D
Phantom Stock $0(4) (4) (4) Common Stock 4,143 4,143 D
Stock Option (Right to Buy Common Stock) $2.05 (5) 04/03/2024 Common Stock 30,000 30,000 D
Stock Option (Right to Buy Common Stock) $5.62 (2) 03/01/2025 Common Stock 50,000 50,000 D
Phantom Stock $0(4) (4) (4) Common Stock 4,205 4,205 D
Phantom Stock $0(4) (4) (4) Common Stock 2,873 2,873 D
Phantom Stock $0(4) (4) (4) Common Stock 1,371 1,371 D
Phantom Stock $0(4) (4) (4) Common Stock 2,868 2,868 D
Phantom Stock $0(4) (4) (4) Common Stock 3,645 3,645 D
Stock Option (Right to Buy Common Stock) $1.91 (2) 02/21/2026 Common Stock 100,000 100,000 D
Phantom Stock $0(4) (4) (4) Common Stock 4,104 4,104 D
Phantom Stock $0(4) (4) (4) Common Stock 2,767 2,767 D
Phantom Stock $0(4) (4) (4) Common Stock 4,335 4,335 D
Explanation of Responses:
1. The purchase was effected pursuant to a Rule 10b5-1 trading plan executed by the reporting person on August 19, 2016.
2. These options vest in full on the first anniversary of the date of grant, subject to continued service on the board.
3. Each restricted stock unit represents the right to receive one share of CorMedix Inc. common stock. The restricted stock units vest in full on the first anniversary of the date of grant, subject to continued service on the board.
4. Each share of phantom stock is the economic equivalent of one share of common stock. The shares of phantom stock become payable in common stock on the tenth business day of January of the year following the reporting person's termination of service as a director.
5. The options vest 1/3 on the date of grant, 1/3 on the first anniversary of the date of grant, and 1/3 on the second anniversary of the date of grant.
/s/ Alexander M. Donaldson, by Power of Attorney 03/01/2017
** 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.