Initial Statement of Beneficial Ownership (3)
November 14 2018 - 4:37PM
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
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Evelyn Potter Rose Survivor's Trust
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2. Date of Event Requiring Statement (MM/DD/YYYY)
11/13/2018
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3. Issuer Name
and
Ticker or Trading Symbol
REATA PHARMACEUTICALS INC [RETA]
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(Last)
(First)
(Middle)
3963 MAPLE AVENUE, SUITE 200
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
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X
___ 10% Owner
_____ Officer (give title below)
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X
___ Other (specify below)
/ Member of a 10% owner group
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(Street)
DALLAS, TX 75219
(City)
(State)
(Zip)
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5. 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 Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Class A common stock
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879281
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D
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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)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Class B common stock
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(1)
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(1)
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Class A common stock
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1877998
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(1)
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D
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Explanation of Responses:
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(1)
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The Class B common stock is convertible into Class A common stock on a one-for-one basis. The conversion right of the Class B common stock has no expiration date.
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Remarks:
Charles E. Gale and Evelyn P. Rose serve as co-trustees of the Evelyn Potter Rose Survivor's Trust.
The reporting person may be deemed to be a member of a group with other affiliated entities that collectively are 10% owners, which group includes William E. Rose, Evelyn P. Rose, Evelyn P. Rose Fidelity Rollover IRA, Evelyn Potter Rose Survivor's Trust, Charles Henry Rose 2001 Trust, John William Rose 2002 Trust, Charles E. Gale, Charles E. Gale Fidelity Rollover IRA, Montrose Investments I, L.P. and Montrose Investments GP, LLC (collectively, the "Affiliated Rose Reporting Persons"). The reporting persons disclaim the existence of a group and disclaim beneficial ownership of any securities held by the other Affiliated Rose Reporting Persons, except to the extent of their respective pecuniary interests therein
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Evelyn Potter Rose Survivor's Trust
3963 MAPLE AVENUE, SUITE 200
DALLAS, TX 75219
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X
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Member of a 10% owner group
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Signatures
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/s/ Charles E. Gale, Trustee
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11/14/2018
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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 control number.
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