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) 01/01/2016 | 3. Issuer Name and Ticker or Trading Symbol Adaptimmune Therapeutics PLC [ ADAP ] | |||||||||||||
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 with a nominal value of GBP0.001 per share(1) | 254,100 | I | Shares held by Sigal Family Investments, LLC |
Ordinary Shares with a nominal value of GBP0.001 per share(2) | 52,938 | 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 | ||||
Option to purchase Ordinary Shares | (3) | 03/16/2025 | Ordinary Shares | 519,481 | 0.74(4) | D | |
Option to purchase Ordinary Shares | 05/11/2015 | 05/11/2025 | Ordinary Shares | 24,596 | 2.8379(5) | D |
Explanation of Responses: |
1. Dr. Sigal is a manager of Sigal Family Investments, LLC. Dr. Sigal may be deemed to have voting and investment power over the shares held by Sigal Family Investments, LLC. Dr. Sigal disclaims beneficial ownership of such shares except to the extent of any pecuniary interest therein. |
2. Represented by 8,823 American Depositary Shares ("ADSs") held by Dr. Sigal. Dr. Sigal holds these Ordinary Shares in the form of ADSs. Each ADS represents six Ordinary Shares of Adaptimmune Therapeutics plc. |
3. Exercisable as to 129,870 Ordinary Shares on March 16, 2016 and will be exercisable as to the remainder in monthly installments of 10,822 Ordinary Shares on the sixteenth of each month from April 16, 2016 through February 16, 2019, and in one installment of 10,841 Ordinary Shares on March 16, 2019. |
4. The exercise price was converted from GBP0.50 based on the noon buying rate of the Federal Reserve Bank of New York for the U.S. dollar on the date of grant. The actual exercise price will be the pounds sterling amount regardless of the exchange rate on the date of grant or of exercise. |
5. The exercise price was converted from GBP1.82 based on the noon buying rate of the Federal Reserve Bank of New York for the U.S. dollar on the date of grant. The actual exercise price will be the pounds sterling amount regardless of the exchange rate on the date of grant or of exercise. |
/s/ Charles Elliott Sigal Name: Charles Elliott Sigal | 01/04/2016 | |
** 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. |