SEC Form 3
| FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 01/01/2021 | 3. Issuer Name and Ticker or Trading Symbol DBV Technologies S.A. [ DBVT ] | |||||||||||||
| 4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. 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 Beneficially Owned | |||
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| 1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
| Ordinary Shares(1) | 23,500(2) | D | |
| Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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| 1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
| Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
| Employee Stock Option (right to buy) | (3) | 12/24/2030 | Ordinary Shares | 51,000 | 5.09(4) | D | |
| Explanation of Responses: |
| 1. The Ordinary Shares may be represented by American Depositary Shares, each of which currently represents one-half of one Ordinary Share. |
| 2. Includes 8,400 shares of the Issuer's ordinary shares underlying restricted stock units ("RSUs"). Each RSU represents a contingent right to receive one share of the Issuer's ordinary share. Includes (a) 100 RSUs granted on December 19, 2019, which vests on December 19, 2021; and (b) 8,300 RSUs granted on November 24, 2020, with 25% vesting on November 24, 2021, and the remaining RSUs vesting in six equal semi-annual installments thereafter, subject in each case to the Reporting Person continuing to provide service through each such date. |
| 3. 25% of the shares subject to the Option vest on November 24, 2021, with the remaining shares vesting in six equal semi-annual installments thereafter, subject to the Reporting Person continuing to provide service through each such date. |
| 4. This exercise price is in US Dollars and reflects the conversion of EURO to USD at an exchange rate of $1.223 to EURO 1.00 as of December 31, 2020. |
| Remarks: |
| Exhibit List - Exhibit 24 - Power of Attorney |
| /s/ Jason Minio, Attorney-in-Fact | 01/11/2021 | |
| ** 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 5 (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. | ||