11/01/2024 | Press release | Distributed by Public on 11/01/2024 16:44
FORM 4
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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 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) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Francois Cedric C/O APELLIS PHARMACEUTICALS, INC. 100 FIFTH AVENUE, 3RD FLOOR WALTHAM, MA 02451 |
X | Chief Executive Officer |
/s/ David Watson, attorney-in-fact for Cedric Francois | 11/01/2024 |
**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) | The shares were transferred from The Cedric Francois Irrevocable Trust of 2023 to Juliana Grossi pursuant to a divorce settlement. |
(2) | The securities are held by The Cedric Francois Irrevocable Trust of 2023. William V. A. Zorn is the trustee of The Cedric Francois Irrevocable Trust of 2023. The reporting person disclaims beneficial ownership over the shares held by The Cedric Francois Irrevocable Trust of 2023 except to the extent of his pecuniary interest therein. |
(3) | The securities are held by The Cedric Francois Irrevocable Trust of 2023 - 2. William V. A. Zorn is the trustee of The Cedric Francois Irrevocable Trust of 2023 - 2. The reporting person disclaims beneficial ownership over the shares held by The Cedric Francois Irrevocable Trust of 2023 - 2 except to the extent of his pecuniary interest therein. |
(4) | The securities are held by The Francois Grossi Trust, for which Juliana Grossi serves as trustee. The reporting person disclaims beneficial ownership over the shares held by the Francois Grossi Trust except to the extent of his pecuniary interest therein. |
(5) | The securities are held by The Francois-DuBois Educational Trust, for which the Fiduciary Trust Company of New England serves as trustee. The reporting person disclaims beneficial ownership over the shares held by The Francois-DuBois Educational Trust except to the extent of his pecuniary interest therein. |