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 INSITE VISION INC [ INSV ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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| 3. Date of Earliest Transaction (Month/Day/Year) 11/02/2015 | ||||||||||||||||||||||||||
| 4. If Amendment, Date of Original Filed (Month/Day/Year) | 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 | ||||||
| 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 | ||||||||
| Stock Option (right to buy) | $0.6 | 11/02/2015 | D | 40,000 | 03/24/2009(1) | 03/24/2018 | Common Stock | 40,000 | (2) | 0 | D | ||||
| Stock Option (right to buy) | $0.2 | 11/02/2015 | D | 300,000 | 02/17/2010(1) | 02/17/2019 | Common Stock | 300,000 | $0.35(3) | 0 | D | ||||
| Stock Option (right to buy) | $0.42 | 11/02/2015 | D | 300,000 | 04/01/2011(1) | 04/01/2020 | Common Stock | 300,000 | (2) | 0 | D | ||||
| Stock Option (right to buy) | $0.36 | 11/02/2015 | D | 250,000 | 01/21/2012(1) | 01/21/2021 | Common Stock | 250,000 | (2) | 0 | D | ||||
| Stock Option (right to buy) | $0.5 | 11/02/2015 | D | 250,000 | 01/27/2013(1) | 01/27/2022 | Common Stock | 250,000 | (2) | 0 | D | ||||
| Stock Option (right to buy) | $0.32 | 11/02/2015 | D | 325,000 | 01/24/2014(1) | 01/24/2023 | Common Stock | 325,000 | $0.35(3) | 0 | D | ||||
| Stock Option (right to buy) | $0.29 | 11/02/2015 | D | 325,000 | 01/07/2015(1) | 01/07/2024 | Common Stock | 325,000 | $0.35(3) | 0 | D | ||||
| Stock Option (right to buy) | $0.21 | 11/02/2015 | D | 325,000 | 01/28/2016(1) | 01/28/2025 | Common Stock | 325,000 | $0.35(3) | 0 | D | ||||
| Explanation of Responses: |
| 1. The option is scheduled to vest as to 25% of the shares covered by the option on the first anniversary of the grant date and as to the remaining 75% of the shares on a daily basis over the three-year period thereafter. |
| 2. In accordance with the terms of the Agreement and Plan of Merger, dated September 15, 2015, as amended and restated, by and among Thea Acquisition Corp ("Purchaser"), Ranbaxy, Inc. and InSite Vision Incorporated ("Issuer") pursuant to which Purchaser was merged with and into Issuer (the "Merger"), this stock option was cancelled at the effective time of the Merger without consideration because the exercise price of the stock option equaled or exceeded $0.35 per share. |
| 3. This option was cancelled in connection with the Merger in exchange for a cash payment per share equal to the difference between $0.35 and the exercise price of the option. |
| Remarks: |
| /s/ Kamran Hosseini | 11/04/2015 | |
| ** 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. | ||