FORM 3
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF
SECURITIES
OMB APPROVAL
OMB Number: 3235-0104 Estimated average burden hours per response... 0.5
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 * | 2. Date of Event Requiring | 3. Issuer Name and Ticker or Trading Symbol | |||||||||||||||||||||
Statement (MM/DD/YYYY) | |||||||||||||||||||||||
Ju William | 8/31/2019 | Brickell Biotech, Inc. [BBI] | |||||||||||||||||||||
(Last) | (First) | (Middle) | 4. Relationship of Reporting Person(s) to Issuer (Check all applicable) | ||||||||||||||||||||
C/O BRICKELL BIOTECH, | __X__ Director | _____ 10% Owner | |||||||||||||||||||||
INC., 5777 CENTRAL AVENUE, | _____ Officer (give title below) | _____ Other (specify below) | |||||||||||||||||||||
SUITE 102 | |||||||||||||||||||||||
(Street) | 5. If Amendment, Date | 6. Individual or Joint/Group Filing(Check Applicable Line) | |||||||||||||||||||||
BOULDER, CO 80301 | Original Filed(MM/DD/YYYY) | _X_ Form filed by One Reporting Person | |||||||||||||||||||||
___ Form filed by More than One Reporting Person | |||||||||||||||||||||||
(City) | (State) | (Zip) | |||||||||||||||||||||
Table I - Non-Derivative Securities Beneficially Owned | |||||||||||||||||||||||
1.Title of Security | 2. Amount of Securities | 3. Ownership | 4. Nature of Indirect Beneficial Ownership | ||||||||||||||||||||
(Instr. 4) | Beneficially Owned | Form: Direct | (Instr. 5) | ||||||||||||||||||||
(Instr. 4) | (D) or Indirect | ||||||||||||||||||||||
(I) | |||||||||||||||||||||||
(Instr. 5) | |||||||||||||||||||||||
Common Stock | 13363 | I | By Self as General Partner | ||||||||||||||||||||
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||||||||||
1. Title of Derivate Security | 2. Date Exercisable and | 3. Title and Amount of | 4. Conversion | 5. Ownership | 6. Nature of Indirect | ||||||||||||||||||
(Instr. 4) | Expiration Date | Securities Underlying | or Exercise | Form of | Beneficial Ownership | ||||||||||||||||||
(MM/DD/YYYY) | Derivative Security | Price of | Derivative | (Instr. 5) | |||||||||||||||||||
(Instr. 4) | Derivative | Security: | |||||||||||||||||||||
Security | Direct (D) or | ||||||||||||||||||||||
Date | Expiration | Title | Amount or | ||||||||||||||||||||
Indirect (I) | |||||||||||||||||||||||
Exercisable | Date | Number of | |||||||||||||||||||||
(Instr. 5) | |||||||||||||||||||||||
Shares | |||||||||||||||||||||||
Stock Options | 9/20/2014 | 9/20/2024 | Common | 8630 | $6.66 | D | |||||||||||||||||
Stock | |||||||||||||||||||||||
Stock Options | 4/22/2015 | 4/22/2025 | Common | 8630 | $12.17 | D | |||||||||||||||||
Stock | |||||||||||||||||||||||
Stock Options | 12/15/2016 | 12/15/2026 | Common | 3452 | $12.17 | D | |||||||||||||||||
Stock | |||||||||||||||||||||||
Stock Options | 12/15/2019 | 12/15/2028 | Common | 5178 | $16.45 | D | |||||||||||||||||
Stock | |||||||||||||||||||||||
Stock Options | 8/30/2020 | 8/30/2029 | Common | 34521 | $4.76 | D | |||||||||||||||||
Stock | |||||||||||||||||||||||
Explanation of Responses: | |||||||||||||||||||||||
Reporting Owners | |||||||||||||||||||||||
Reporting Owner Name / Address | Relationships | ||||||||||||||||||||||
Director | 10% OwnerOfficerOther | ||||||||||||||||||||||
Ju William | |||||||||||||||||||||||
C/O BRICKELL BIOTECH, INC. | X | ||||||||||||||||||||||
5777 CENTRAL AVENUE, SUITE 102 | |||||||||||||||||||||||
BOULDER, CO 80301 |
Signatures | ||
/s/ William Ju | 9/9/2019 | |
**Signature of Reporting Person | Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
- If the form is filed by more than one reporting person, see Instruction 5(b)(v).
- Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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.
Attachments
- Original document
- Permalink
Disclaimer
Vical Incorporated published this content on 09 September 2019 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 10 September 2019 00:51:01 UTC