Statement of Changes in Beneficial Ownership (4)
February 08 2021 - 04:47PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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
*
Poliakoff Abba David |
2. Issuer Name and Ticker or Trading Symbol
CHAMPIONS ONCOLOGY, INC.
[
CSBR
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
C/O CHAMPIONS ONCOLOGY, INC., ONE UNIVERSITY PLAZA, SUITE 307 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
1/19/2021 |
(Street)
HACKENSACK, NJ 07601
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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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)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock | 1/19/2021 | | M | | 10000 | A | $1.59 | 70147 | D | |
Common Stock | 1/19/2021 | | M | | 10000 | A | $3.21 | 80147 | D | |
Common Stock | 1/19/2021 | | M | | 10000 | A | $5.43 | 90147 | D | |
Common Stock | 1/19/2021 | | F(1) | | 8873 | A | $11.53 | 81274 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: 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 |
Option to purchase Common Stock | $1.59 | 1/19/2021 | | M | | | 10000 | (2) | 11/1/2021 | Common Stock | 10000.0 | $0 | 0 | D | |
Option to purchase Common Stock | $3.21 | 1/19/2021 | | M | | | 10000 | (3) | 10/31/2022 | Common Stock | 10000.0 | $0 | 0 | D | |
Option to purchase Common Stock | $5.43 | 1/19/2021 | | M | | | 10000 | (4) | 11/4/2024 | Common Stock | 10000.0 | $0 | 0 | D | |
Explanation of Responses: |
(1) | Represents a "net exercise" of outstanding stock options. The shares were withheld by Champions Oncology, Inc. for payment of the exercise price based on the market price of Champions Oncology, Inc. common stock on January 19,2021. |
(2) | The options vest and are exercisable over a twelve month period, with vesting to occur on November 1, 2016, February 1, 2017, May 1, 2017 and August 1, 2017 respectively. |
(3) | The options vest and are exercisable over a twelve month period, with vesting to occur on November 1, 2017, February 1, 2018, May 1, 2018 and August 1, 2018, respectively. |
(4) | The options vest and are exercisable over a twelve month period, with vesting to occur on November 4, 2019, February 4, 2020, May 4, 2020 and August 4, 2020, respectively. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Poliakoff Abba David C/O CHAMPIONS ONCOLOGY, INC. ONE UNIVERSITY PLAZA, SUITE 307 HACKENSACK, NJ 07601 | X |
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Signatures
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/s/ Abba D. Poliakoff | | 2/8/2021 |
**Signature of Reporting Person | Date |
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