Statement of Changes in Beneficial Ownership (4)
November 13 2020 - 11:57AM
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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OMB
APPROVAL
OMB Number: 3235-0287
Estimated average burden
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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 * Welgus Howard G. |
2. Issuer Name and Ticker or Trading
Symbol Arcutis Biotherapeutics, Inc. [ ARQT ] |
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 ARCUTIS BIOTHERAPEUTICS, INC., 2945 TOWNSGATE ROAD,
SUITE 110 |
3. Date of Earliest Transaction (MM/DD/YYYY)
11/12/2020
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(Street)
WESTLAKE VILLAGE, CA 91361
(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 |
Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned
|
1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. 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 |
11/12/2020 |
|
M(1) |
|
1222 |
A |
$0.5802 |
179844 |
D |
|
Common Stock |
|
|
|
|
|
|
|
24991 |
I |
By Trust (2) |
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
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 |
Stock Option (Right to Buy) |
$0.5802 |
11/12/2020 |
|
M (1) |
|
|
1222 |
(3) |
6/13/2028 |
Common Stock |
1222 |
$0.00 |
26884 |
D |
|
Explanation of
Responses: |
(1) |
Reflects cash exercise of
stock option without the disposition of the underlying
shares. |
(2) |
The securities are held of
record by The Welgus Living Trust, of which the Reporting Person is
trustee. The Reporting Person disclaims beneficial ownership of
such securities except to the extent of his pecuniary interest
therein, and the inclusion of these securities in this report shall
not be deemed an admission of beneficial ownership of such
securities for purposes of Section 16 or for any other
purposes. |
(3) |
The option began vesting
monthly over 35 months beginning July 11, 2019, subject to the
Reporting Person's continuous provision of services to the Issuer
on each vesting date. The option contains an early-exercise
provision and is exercisable as to unvested shares, subject to the
Issuer's right of repurchase. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
Welgus Howard G.
C/O ARCUTIS BIOTHERAPEUTICS, INC.
2945 TOWNSGATE ROAD, SUITE 110
WESTLAKE VILLAGE, CA 91361 |
X |
|
|
|
Signatures
|
/s/ John W. Smither, as Attorney-in-Fact for
Howard G. Welgus |
|
11/13/2020 |
**Signature of Reporting
Person |
Date |
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