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
OMB APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response: 0.5
  
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*
Goldman Steven M.

(Last) (First) (Middle)
C/O DOVA PHARMACEUTICALS, INC.
240 LEIGH FARM ROAD, SUITE 245

(Street)
DURHAM NC 27707

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Dova Pharmaceuticals Inc. [ DOVA ]
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)
06/20/2019
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 06/20/2019 M 917 A $7.32 141,697 D
Common Stock 06/20/2019 M 833 A $9.36 142,530 D
Common Stock 5,000 I By LLC(1)
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) $7.32 06/20/2019 M 917 (2) 05/24/2027 Common Stock 917 $0.00 11,000 D
Stock Option (right to buy) $9.36 06/20/2019 M 833 (3) 04/25/2029 Common Stock 833 $0.00 9,167 D
Explanation of Responses:
1. These shares are held by the Steven M. Goldman Family LLC (the "LLC"), of which the Reporting Person is the Managing Member. The voting and investment decisions of the LLC are made by an independent external asset manager. The Reporting Person disclaims beneficial ownership of the shares held by the LLC except to the extent of his pecuniary interest in the LLC, if any, and the inclusion of these shares on this report shall not be deemed an admission that the Reporting Person beneficially owns the shares for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or any other purpose.
2. The option vests over a period of three years as follows: (i) one-third of the total shares subject to the option shall vested on May 25, 2018, and (ii) 1/36th of total shares subject to the option shall vest monthly thereafter over the remaining two years of the vesting period, subject to the Reporting Person's continuous service with the Issuer on each such date. The option allows for early exercise, subject to the Issuer's repurchase option, with respect to any unvested shares of Common Stock.
3. Vesting monthly over one year from the grant date and in any event will be fully vested on the date of the next annual meeting of our stockholders, subject to continued service as a director though the applicable vesting date.
Remarks:
/s/ Mark Ballantyne, Attorney-in-Fact 06/24/2019
** 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.