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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Lazovsky David E INTERMOLECULAR, INC. 3011 NORTH FIRST STREET SAN JOSE, CA 95134-2004 |
X | President & CEO |
/s/Sandeep Jaggi as Attorney-in-Fact for Mr. Lazovsky | 03/07/2013 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | This sale was conducted as described in Footnote 2. The shares were sold by the executing broker over a period of three business days - March 4-6, 2013. The Reporting Person was informed by the broker of the total number of shares sold on March 6, 2013. Accordingly, pursuant to Rule 16a-3(g)(2),the deemed execution date was March 6, 2013. |
(2) | This sale was made as part of a "sell to cover taxes" arrangement in connection with the March 1, 2013 vesting of certain shares of restricted stock that the Reporting Person acquired pursuant to a restricted stock grant dated March 29, 2012. The sale was made pursuant to a 10b5-1 plan entered into by the Reporting Person. No shares were withheld by or surrendered to the issuer. |
(3) | The transaction was executed in multiple trades in prices ranging from $9.6201 to $10.00, inclusive. The price reported in Column 4 above reflects the weighted average sale price. The Reporting Person hereby undertakes to provide upon request to the SEC staff, the Issuer, or a stockholder of the Issuer, information regarding the number of shares and prices at which the transaction was effected. |
(4) | The sale reported was effected pursuant to a Rule 10b5-1 Sales Plan adopted by Mr. Lazovsky on May 14, 2012. |
(5) | The transaction was executed in multiple trades in prices ranging from $9.55 to $9.76, inclusive. The price reported in Column 4 above reflects the weighted average sale price. The Reporting Person hereby undertakes to provide upon request to the SEC staff, the Issuer, or a stockholder of the Issuer, information regarding the number of shares and prices at which the transaction was effected. |
(6) | These shares are held by The Lazovsky 2010 Irrevocable Children's Trust. |
(7) | These shares are held by The David E. Lazovsky 2010 Annuity Trust. |
(8) | These shares are held by The Juel D. Lazovsky 2010 Annuity Trust. |