Initial Statement of Beneficial Ownership (3)
January 11 2021 - 5:22PM
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
*
Mohideen Pharis |
2. Date of Event Requiring Statement (MM/DD/YYYY)
1/1/2021
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3. Issuer Name and Ticker or Trading Symbol
DBV Technologies S.A. [DBVT]
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(Last)
(First)
(Middle)
C/O DBV TECHNOLOGIES S.A., 177-181 AVENUE PIERRE BROSSOLETTE |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner
___X___ Officer (give title below) _____ Other (specify below)
Chief Medical Officer / |
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(Street)
MONTROUGE, I0 92120
(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) |
| Ordinary Shares (1) | 15500 (2) | 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 |
| Employee Stock Option (right to buy) | (3) | 7/22/2029 | Ordinary Shares | 75000 | $21.89 (4) | D | |
| Employee Stock Option (right to buy) | (5) | 12/24/2030 | Ordinary Shares | 95400 | $5.09 (4) | D | |
| Explanation of Responses: |
| (1) | The Ordinary Shares may be represented by American Depositary Shares, each of which currently represents one-half of one Ordinary Share. |
| (2) | Represents shares of the Issuer's ordinary shares underlying restricted stock units ("RSUs"). Each RSU represents a contingent right to receive one share of the Issuer's ordinary share. 25% of the share underlying the RSU vests on November 24, 2021, and the remaining RSUs vesting in six equal semi-annual installments thereafter, subject in each case to the Reporting Person continuing to provide service through each such date. |
| (3) | 25% of the shares subject to the Option vested on July 22, 2020, with the remaining shares vesting in six equal semi-annual installments thereafter, subject to the Reporting Person continuing to provide service through each such date. |
| (4) | This exercise price is in US Dollars and reflects the conversion of EURO to USD at an exchange rate of $1.223 to EURO 1.00 as of December 31, 2020. |
| (5) | 25% of the shares subject to the Option vest on November 24, 2021, with the remaining shares vesting in six equal semi-annual installments thereafter, subject to the Reporting Person continuing to provide service through each such date. |
Remarks:
Exhibit List - Exhibit 24 - Power of Attorney |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Mohideen Pharis
C/O DBV TECHNOLOGIES S.A.
177-181 AVENUE PIERRE BROSSOLETTE
MONTROUGE, I0 92120 |
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| Chief Medical Officer |
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Signatures
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| /s/ Jason Minio, Attorney-in-Fact | | 1/11/2021 |
| **Signature of Reporting Person | Date |
DBV Technologies Boulogn... (GM) (USOTC:DBVTF)
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