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*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol Clovis Oncology, Inc. [ CLVS ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Date of Earliest Transaction (Month/Day/Year) 07/16/2015 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed (Month/Day/Year) 07/17/2015 | 6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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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 | 07/16/2015 | J(1) | 41,813 | D | (1) | 0 | I | By One Palmer Square Associates VII, LLC(2) | ||
Common Stock | 07/16/2015 | J(1) | 2,185 | A | (1) | 2,185 | D(3)(4)(5)(6) | |||
Common Stock | 07/16/2015 | J(1) | 2,927 | A | (1) | 2,927 | I | By Susan W. and James C. Blair Family L.P.(7) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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 |
Explanation of Responses: |
1. Distribution of shares in kind by One Palmer Square Associates VII, LLC to its members. |
2. As a managing member of One Palmer Square Associates VII, LLC, the Reporting Person may be deemed to indirectly beneficially own the securities of the Issuer held by One Palmer Square Associates VII, LLC. |
3. As a managing member of the sole general partner of Domain Partners VII, L.P., the Reporting Person may be deemed to indirectly beneficially own 2,081,745 shares of Common Stock held by Domain Partners VII, L.P. |
4. As a managing member of the sole general partner of DP VII Associates, L.P., the Reporting Person may also be deemed to indirectly beneficially own 35,506 shares of Common Stock held by DP VII Associates, L.P. |
5. As a managing member of Domain Associates, LLC, the Reporting Person may also be deemed to indirectly beneficially own 32,760 shares of Common Stock held by Domain Associates, LLC. |
6. Pursuant to Instruction 4(b)(iv) of Form 4, the Reporting Person has elected to report as indirectly beneficially owned the entire number of securities owned by Domain Partners VII, L.P., DP VII Associates, L.P., One Palmer Square Associates VII, LLC and Domain Associates, LLC , however he disclaims beneficial ownership of any securities, and any proceeds thereof, that exceed his pecuniary interest therein and/or that are not actually distributed to him. |
7. The Reporting Person disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein. This amendment is being filed solely to report the acquisition of shares of Common Stock by this entity on 07/16/2015, which was inadvertently omitted from the Form 4 filed on 07/17/2015. |
Remarks: |
Lisa A. Kraeutler, Attorney-in-Fact | 05/22/2017 | |
** 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. |