Initial Statement of Beneficial Ownership (3)
19 Enero 2017 - 9:20AM
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
Estimated average burden
hours per response...
0.5
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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
*
Hauser Brent
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2. Date of Event Requiring Statement (MM/DD/YYYY)
1/17/2017
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3. Issuer Name
and
Ticker or Trading Symbol
Zeltiq Aesthetics Inc [ZLTQ]
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(Last)
(First)
(Middle)
C/O ZELTIQ AESTHETICS, INC., 4410 ROSEWOOD DRIVE
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
___
X
___ Officer (give title below)
_____ Other (specify below)
President, North America /
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(Street)
PLEASANTON, CA 94588
(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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Common Stock
(1)
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2125
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D
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Common Stock
(2)
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3500
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D
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Common Stock
(3)
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2854
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D
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Common Stock
(4)
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4436
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D
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Common Stock
(5)
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4718
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D
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Common Stock
(6)
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8986
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D
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Common Stock
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1434
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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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Stock Option (right to buy)
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(7)
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6/23/2023
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Common Stock
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937
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$5.97
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D
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Stock Option (right to buy)
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(8)
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3/13/2023
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Common Stock
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1250
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$4.00
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D
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Stock Option (right to buy)
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(9)
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1/8/2027
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Common Stock
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17149
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$42.71
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D
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Explanation of Responses:
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(
1)
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Represents grant of restricted stock units payable solely in common stock that vest in four equal annual installments, with the vesting commencement date of February 1, 2013.
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(
2)
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Represents grant of restricted stock units payable solely in common stock that vest in four equal annual installments, with the vesting commencement date of March 14, 2014.
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(
3)
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Represents grant of restricted stock units payable solely in common stock that vest in four equal annual installments, with the vesting commencement date of March 14, 2015.
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(
4)
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Represents grant of restricted stock units payable solely in common stock that vest in four equal annual installments, with the vesting commencement date of September 11, 2015.
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(
5)
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Represents grant of restricted stock units payable solely in common stock that vest in four equal annual installments, with the vesting commencement date of March 14, 2016.
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(
6)
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Represents grant of restricted stock units payable solely in common stock that vest in four equal annual installments, with the vesting commencement date of January 17, 2017.
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(
7)
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25% of the total number of shares subject to the option vested on November 20, 2013, and the remainder vest in equal monthly installments over a 36-month period thereafter, subject to the Reporting Person's continued service to the Issuer.
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(
8)
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25% of the total number of shares subject to the option vested on February 1, 2014, and the remainder vest in equal monthly installments over a 36-month period thereafter, subject to the Reporting Person's continued service to the Issuer.
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(
9)
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25% of the total number of shares subject to the option shall vest on January 17, 2018, and the remainder shall vest in equal monthly installments over a 36-month period thereafter, subject to the Reporting Person's continued service to the Issuer.
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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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Hauser Brent
C/O ZELTIQ AESTHETICS, INC.
4410 ROSEWOOD DRIVE
PLEASANTON, CA 94588
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President, North America
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Signatures
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/s/ Brent Hauser
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1/19/2017
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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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