Initial Statement of Beneficial Ownership (3)
November 13 2019 - 5:35PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
*
Aurora Daljit Singh |
2. Date of Event Requiring Statement (MM/DD/YYYY)
11/11/2019
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3. Issuer Name and Ticker or Trading Symbol
Dermira, Inc. [DERM]
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(Last)
(First)
(Middle)
C/O DERMIRA, INC., 275 MIDDLEFIELD ROAD, SUITE 150 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner
___X___ Officer (give title below) _____ Other (specify below)
Chief Scientific Affairs Off / |
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(Street)
MENLO PARK, CA 94025
(City)
(State)
(Zip)
| 5. 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
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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) |
| Common Stock | 30089.00 (1) | 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. 4) | 2. Date Exercisable and Expiration Date
(MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: 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 |
| Restricted Stock Unit | (3) | (2) | Common Stock | 574.00 | (2) | D | |
| Restricted Stock Unit | (4) | (2) | Common Stock | 6250.00 | (2) | D | |
| Restricted Stock Unit | (5) | (2) | Common Stock | 708.00 | (2) | D | |
| Restricted Stock Unit | (5) | (2) | Common Stock | 2814.00 | (2) | D | |
| Restricted Stock Unit | (6) | (2) | Common Stock | 22500.00 | (2) | D | |
| Restricted Stock Unit | (7) | (2) | Common Stock | 10000.00 | (2) | D | |
| Stock Options (Right to buy) | (8) | 2/16/2027 | Common Stock | 11500.00 | $33.84 | D | |
| Stock Options (Right to buy) | (9) | 8/7/2026 | Common Stock | 67500.00 | $31.36 | D | |
| Stock Options (Right to buy) | (10) | 2/14/2028 | Common Stock | 7040.00 | $28.25 | D | |
| Stock Options (Right to buy) | (10) | 2/14/2028 | Common Stock | 28130.00 | $28.25 | D | |
| Stock Options (Right to buy) | (11) | 2/10/2029 | Common Stock | 50000.00 | $6.97 | D | |
| Explanation of Responses: |
| (1) | These shares include prior ESPP purchases. |
| (2) | Each RSU represents a contingent right to receive one share of DERM common stock. |
| (3) | Vested as to 10% of the shares on August 15, 2017 and 30% of the shares on August 15, 2018. 30% of the shares will vest on each of August 15, 2019 and August 15, 2020, subject to the Reporting Person's continuous status as a service provider on the applicable vesting date. |
| (4) | Vested as to 25% of the shares on August 15, 2017 and 25% of the shares on August 15, 2018. 25% of the shares will vest on each of August 15, 2019 and August 15, 2020, subject to the Reporting Person's continuous status as a service provider on the applicable vesting date. |
| (5) | Vested as to 10% of the shares on August 15, 2018. 30% of the shares will vest on each of August 15, 2019, August 15, 2020 and August 15, 2021, subject to the Reporting Person's continuous status as a service provider on the applicable vesting date. |
| (6) | Vests as to 50% of the shares on each of May 17, 2019 and May 17, 2020, subject to the Reporting Person's continuous status as a service provider on the applicable vesting date. |
| (7) | Vests as to 50% of the shares on each of March 5, 2020 and March 5, 2021, subject to the Reporting Person's continuous status as a service provider on the applicable vesting date. |
| (8) | The stock option vests and becomes exercisable as to 1/48th of the shares in equal monthly installments with the first 1/48th of the shares vesting on February 1, 2017, subject to the continuing employment of the Reporting person on the applicable vesting date. |
| (9) | 25% of the total shares underlying the option vested and became exercisable on July 18, 2017 and 1/48 of the total shares underlying the option vest and become exercisable each month thereafter, subject to the continuing employment of the Reporting person on the applicable vesting date. |
| (10) | The stock option vests and becomes exercisable as to 1/48th of the shares in equal monthly installments with the first 1/48th of the shares vesting on February 1, 2018, subject to the continuing employment of the Reporting person on the applicable vesting date. |
| (11) | The stock option vests and becomes exercisable as to 1/48th of the shares in equal monthly installments with the first 1/48th of the shares vesting on February 1, 2019, subject to the continuing employment of the Reporting person on the applicable vesting date. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Aurora Daljit Singh
C/O DERMIRA, INC.
275 MIDDLEFIELD ROAD, SUITE 150
MENLO PARK, CA 94025 |
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| Chief Scientific Affairs Off |
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Signatures
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| /s/ Valerie Barnett as attorney-in-fact | | 11/13/2019 |
| **Signature of Reporting Person | Date |
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