| 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 DERMA SCIENCES, INC. [ DSCI ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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| 3. Date of Earliest Transaction (Month/Day/Year) 02/24/2017 | ||||||||||||||||||||||||||
| 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 | ||||||
| Common Stock | 02/24/2017 | D | 81,771 | D | (1) | 0 | D | |||
| Common Stock | 02/24/2017 | D | 17,500(2) | A | (4) | 17,500 | D | |||
| 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) | $4.11(3) | 02/24/2017 | D | 17,375 | (4) | (4) | Common Stock | 17,375 | $0(6) | 0 | D | ||||
| Restricted Stock Units | (5) | 02/24/2017 | D | 17,500 | (5) | (5) | Common Stock | 17,500 | $0(7) | 0 | D | ||||
| Explanation of Responses: |
| 1. Pursuant to the terms of the Agreement and Plan of Merger, dated January 10, 2017, by and among the Issuer, Integra Derma, Inc. and Integra LifeSciences Holdings Corporation (the "Merger Agreement"), as of the Effective Time (as defined in the Merger Agreement), the shares of the Issuer's common stock were converted into the right to receive $7.00 per share to the reporting person in cash. |
| 2. Represents shares of the Issuer's common stock received upon the vesting of 17,500 restricted stock units, as described herein. |
| 3. Represents the weighted average exercise price for in-the-money stock options, as described in a Schedule TO and the Issuer's Schedule 14D-9, each as filed with the Securities and Exchange Commission on January 25, 2017, pursuant to which Integra Derma, Inc. offered to purchase all of the Issuer's common stock for $7.00 per share (the "Offer"). |
| 4. In connection with the expiration of the Offer and the subsequent closing of the merger pursuant to the terms of the Merger Agreement, all outstanding stock options became fully vested and exercisable on such date. Each stock option held by the reporting person was then cancelled in exchange for a cash payment representing the difference between the exercise price of such option and $7.00 per share, payable without any interest thereon and subject to any required tax withholdings. |
| 5. Upon the Effective Time, the restricted stock units were converted into the right to receive an amount in cash equal to $7.00 with respect to each share of common stock underlying such award, payable without any interest thereon and subject to any required tax withholdings. |
| 6. The options were originally granted in consideration of the reporting person's services to the Issuer and without payment of consideration. |
| 7. The restricted stock units were originally granted in consideration of the reporting person's services to the Issuer and without payment of consideration. |
| /s/ Robert G. Moussa | 02/24/2017 | |
| ** 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. | ||
