Statement of Changes in Beneficial Ownership (4)
September 20 2021 - 06:27PM
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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APPROVAL
OMB Number: 3235-0287
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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
|
|
| 1. Name
and Address of Reporting Person *
Peisert Daniel A. |
2. Issuer Name and Ticker or Trading
Symbol Assertio Holdings, Inc. [ ASRT ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)__X__
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
President and CEO |
|
(Last)
(First)
(Middle)
ASSERTIO HOLDINGS, INC., 100 SOUTH SAUNDERS ROAD, SUITE
300 |
3. Date of Earliest Transaction (MM/DD/YYYY)
9/18/2021
|
|
(Street)
LAKE FOREST, IL 60045
(City)
(State)
(Zip)
|
4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
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 |
9/18/2021 |
|
M |
|
2905 |
A |
$0 |
92881 |
D |
|
|
Common Stock |
9/18/2021 |
|
F |
|
851 (1) |
D |
$0.93 |
92030 |
D |
|
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 |
|
Restricted Stock Units |
(2) |
9/18/2021 |
|
M |
|
|
2905 |
(3) |
9/18/2021 |
Common Stock |
2905.0 |
$0 (4) |
0 |
D |
|
| Explanation of
Responses: |
| (1) |
Represents shares of common
stock withheld for payment of taxes upon the vesting of restricted
stock units. |
| (2) |
Each restricted stock unit
represents a contingent right to receive one share of the
registrant's common stock. |
| (3) |
These restricted stock units
are scheduled to vest 25% on September 18, 2018, 25% on September
18, 2019, 25% on September 18, 2020 and 25% on September 18,
2021. |
| (4) |
The derivative securities
were granted to the reporting person, and were not sold to the
reporting person. As such, the reporting person did not pay any
consideration for the derivative securities. |
Reporting
Owners
|
|
Reporting Owner Name / Address |
Relationships
|
|
Director |
10% Owner |
Officer |
Other |
Peisert Daniel A.
ASSERTIO HOLDINGS, INC.
100 SOUTH SAUNDERS ROAD, SUITE 300
LAKE FOREST, IL 60045 |
X |
|
President and CEO |
|
Signatures
|
|
/s/ Sam Schlessinger, attorney-in-fact for Daniel
A. Peisert |
|
9/20/2021 |
| **Signature of
Reporting Person |
Date |
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