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
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 * | 2. Issuer Name and Ticker or Trading Symbol | 5. Relationship of Reporting Person(s) to Issuer |
(Check all applicable) |
SAMAD SAM | ILLUMINA, INC. [ ILMN ] | _____ Director | _____ 10% Owner | ||||||||||||||||||||||||||||||||
(Last) | (First) | (Middle) | 3. Date of Earliest Transaction (MM/DD/YYYY) | ||||||||||||||||||||||||||||||||
__X__ Officer (give title below) _____ Other (specify below) | |||||||||||||||||||||||||||||||||||
5200 ILLUMINA WAY | 1/6/2020 | SVP and CFO | |||||||||||||||||||||||||||||||||
(Street) | 4. If Amendment, Date Original Filed (MM/DD/YYYY) | 6. Individual or Joint/Group Filing (Check Applicable Line) | |||||||||||||||||||||||||||||||||
SAN DIEGO, CA 92122 | _X _ Form filed by One Reporting Person | ||||||||||||||||||||||||||||||||||
(City) | (State) | (Zip) | ___ Form filed by More than One Reporting Person | ||||||||||||||||||||||||||||||||
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | |||||||||||||||||||||||||||||||||||
1.Title of Security | 2. Trans. Date | 2A. Deemed | 3. Trans. Code | 4. Securities Acquired (A) | 5. Amount of Securities Beneficially Owned | 6. | 7. Nature | ||||||||||||||||||||||||||||
(Instr. 3) | Execution | (Instr. 8) | or Disposed of (D) | Following Reported Transaction(s) | Ownership | of Indirect | |||||||||||||||||||||||||||||
Date, if any | (Instr. 3, 4 and 5) | (Instr. 3 and 4) | Form: | Beneficial | |||||||||||||||||||||||||||||||
Direct (D) | Ownership | ||||||||||||||||||||||||||||||||||
or Indirect | (Instr. 4) | ||||||||||||||||||||||||||||||||||
(A) or | (I) (Instr. | ||||||||||||||||||||||||||||||||||
Code | V | Amount | (D) | Price | 4) | ||||||||||||||||||||||||||||||
Common Stock | 1/6/2020 | F | 212 | D | $325.53 | 3249 | D | ||||||||||||||||||||||||||||
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||||||||||||||||||||||
1. Title of Derivate | 2. | 3. Trans. | 3A. Deemed | 4. Trans. Code | 5. Number of | 6. Date Exercisable and | 7. Title and Amount of | 8. Price of | 9. Number of | 10. | 11. Nature | ||||||||||||||||||||||||
Security | Conversion | Date | Execution | (Instr. 8) | Derivative Securities | Expiration Date | Securities Underlying | Derivative | derivative | Ownership | of Indirect | ||||||||||||||||||||||||
(Instr. 3) | or Exercise | Date, if any | Acquired (A) or | Derivative Security | Security | Securities | Form of | Beneficial | |||||||||||||||||||||||||||
Price of | Disposed of (D) | (Instr. 3 and 4) | (Instr. 5) | Beneficially | Derivative | Ownership | |||||||||||||||||||||||||||||
Derivative | (Instr. 3, 4 and 5) | Owned | Security: | (Instr. 4) | |||||||||||||||||||||||||||||||
Security | Following | Direct (D) | |||||||||||||||||||||||||||||||||
Date | Expiration | Title | Amount or Number of | Reported | or Indirect | ||||||||||||||||||||||||||||||
Code | V | (A) | (D) | Exercisable | Date | Shares | Transaction(s) | (I) (Instr. | |||||||||||||||||||||||||||
(Instr. 4) | 4) | ||||||||||||||||||||||||||||||||||
Explanation of Responses: | |||||||||||||||||||||||||||||||||||
Reporting Owners | |||||||||||||||||||||||||||||||||||
Reporting Owner Name / Address | Relationships | ||||||||||||||||||||||||||||||||||
Director | 10% Owner | Officer | Other | ||||||||||||||||||||||||||||||||
SAMAD SAM | |||||||||||||||||||||||||||||||||||
5200 ILLUMINA WAY | SVP and CFO | ||||||||||||||||||||||||||||||||||
SAN DIEGO, CA 92122 | |||||||||||||||||||||||||||||||||||
Signatures | |||||||||||||||||||||||||||||||||||
By: Robert Maynes for Sam Samad | 1/8/2020 | ||||||||||||||||||||||||||||||||||
**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 4(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).
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Illumina Inc. published this content on 08 January 2020 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 08 January 2020 21:57:08 UTC