1. Name and Address of Reporting Person * |
Â
Lazovsky David E |
|
2. Date of Event Requiring Statement (Month/Day/Year) 11/17/2011 |
3. Issuer Name and Ticker or Trading Symbol INTERMOLECULAR INC [IMI]
|
INTERMOLECULAR, INC., 3011 NORTH FIRST STREET |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__X__ Director |
_____ 10% Owner |
__X__ Officer (give title below) |
_____ Other (specify below) |
President & CEO |
|
5. If Amendment, Date Original Filed(Month/Day/Year)
|
SAN JOSE, CA 95134-2004 |
6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
|
|
Table I - Non-Derivative Securities Beneficially Owned |
|
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) |
Common Stock, $0.001 par value
|
3,297,752
|
D
|
Â
|
Common Stock, $0.001 par value
|
225,000
|
I
|
By GRAT
(1)
|
Common Stock, $0.001 par value
|
225,000
|
I
|
By Wife's GRAT
(2)
|
Common Stock, $0.001 par value
|
45,882
|
I
|
By Children's Trust
(3)
|
|
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
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 |
Stock Option (right to buy)
|
Â
(4)
|
09/04/2017 |
Common Stock
|
300,000
|
$
1.66
|
D
|
Â
|
Stock Option (right to buy)
|
Â
(5)
|
01/19/2019 |
Common Stock
|
200,000
|
$
2
|
D
|
Â
|
Stock Option (right to buy)
|
Â
(6)
|
02/03/2020 |
Common Stock
|
187,500
|
$
2.66
|
D
|
Â
|
Stock Option (right to buy)
|
Â
(7)
|
03/30/2021 |
Common Stock
|
52,500
|
$
6.2
|
D
|
Â
|
* |
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). |
(1) |
These shares are held by The David E. Lazovsky 2010 Annuity Trust. |
(2) |
These shares are held by The Juel D. Lazovsky 2010 Annuity Trust. |
(3) |
These shares are held by The Lazovsky 2010 Irrevocable Children's Trust. |
(4) |
The option was immediately exercisable in full on September 5, 2007; however, the shares vest pursuant to the following schedule: Twenty-Five Percent (25%) of the shares subject to the option vest on the first anniversary measured from July 9, 2007 (the "Vesting Commencement Date") and the remaining shares subject to the option vest in 36 successive, equal monthly installments thereafter on each monthly anniversary of the Vesting Commencement Date, subject to the Reporting Person's continued employment or service relationship with the Issuer on each such vesting date. |
(5) |
The shares vest pursuant to the following schedule: Twenty-Five Percent (25%) of the shares subject to the option vest on the first anniversary measured from January 20, 2009 (the "Vesting Commencement Date") and the remaining shares subject to the option vest in 36 successive, equal monthly installments thereafter on each monthly anniversary of the Vesting Commencement Date, subject to the Reporting Person's continued employment or service relationship with the Issuer on each such vesting date. |
(6) |
The shares vest pursuant to the following schedule: Twenty-Five Percent (25%) of the shares subject to the option vest on the first anniversary measured from February 1, 2010 (the "Vesting Commencement Date") and the remaining shares subject to the option vest in 36 successive, equal monthly installments thereafter on each monthly anniversary of the Vesting Commencement Date, subject to the Reporting Person's continued employment or service relationship with the Issuer on each such vesting date. |
(7) |
The shares vest pursuant to the following schedule: Twenty-Five Percent (25%) of the shares subject to the option vest on the first anniversary measured from February 2, 2011 (the "Vesting Commencement Date") and the remaining shares subject to the option vest in 36 successive, equal monthly installments thereafter on each monthly anniversary of the Vesting Commencement Date, subject to the Reporting Person's continued employment or service relationship with the Issuer on each such vesting date. |