Annual Statement of Changes in Beneficial Ownership (5)
14 Février 2014 - 9:13PM
Edgar (US Regulatory)
FORM 5
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
[
X
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Form 3 Holdings Reported
[
X
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Form 4 Transactions Reported
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0362
Estimated average burden
hours per response...
1.0
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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
*
GLAXOSMITHKLINE PLC
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2. Issuer Name
and
Ticker or Trading Symbol
NUPATHE INC. [PATH]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
__
X
__ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
980 GREAT WEST ROAD
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3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/31/2013
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(Street)
BRENTFORD MIDDLESEX, X0 TW8 9GS
(City)
(State)
(Zip)
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4. 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 Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
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7. Nature of Indirect Beneficial Ownership
(Instr. 4)
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Amount
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(A) or (D)
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Price
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Common Stock
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3
(1)
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1151211
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I
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By S.R. One, Limited
(5)
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Common Stock
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1/26/2013
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C4
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1516806
(4)
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A
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(3)
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2668017
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I
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By S.R. One, Limited
(5)
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year
(Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
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11. Nature of Indirect Beneficial Ownership
(Instr. 4)
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(A)
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(D)
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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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Warrant (right to buy)
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$2.00
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3
(1)
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4/23/2013
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10/23/2017
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Common Stock
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1500000
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1500000
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I
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By S.R. One, Limited
(5)
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Warrant (right to buy)
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$7.45
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3
(1)
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(2)
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8/20/2016
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Common Stock
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15635
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15635
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I
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By S.R. One, Limited
(5)
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Series A Preferred Stock
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3
(1)
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(3)
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(3)
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Common Stock
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0
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I
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By S.R. One, Limited
(5)
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Series A Preferred Stock
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1/26/2013
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C4
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1500
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(3)
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(3)
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Common Stock
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1516806
(4)
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(3)
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0
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I
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By S.R. One, Limited
(5)
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Explanation of Responses:
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(
1)
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The reporting person became a 10% Owner as a result of its purchase on October 23, 2012 of 1,500 shares of Series A Preferred Stock convertible at the holder's option into 1,500,000 shares of Common Stock, par value $0.001 per share ("Common Stock") of NuPathe Inc. (the "Issuer").
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(
2)
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The Warrants are exercisable at the holder's option.
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(
3)
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Each 1/1,000 of a share of Series A Preferred Stock of the Issuer was convertible, at the holder's option, into such number of shares of Common Stock of the Issuer equal to (i) a $2.00 divided by the conversion price then in effect (which conversion price was initially equal to $2.00), plus (ii) an amount equal to all accrued but unpaid dividends on such fractional share divided by the closing price of Common Stock on the trading day immediately preceding the date of conversion, unless the Issuer elected to pay the dividend amount in cash upon conversion. The Series A Preferred Stock had no expiration date.
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(
4)
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Reflects the conversion of 1,500 shares of Series A Preferred Stock of the Issuer into 1,500,000 shares of Common Stock of the Issuer and the issuance by the Issuer of 16,806 shares of Common Stock as accrued but unpaid dividends on such shares of Series A Preferred Stock of the Issuer.
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(
5)
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Shares are held by S.R. One Limited, an indirect, wholly-owned subsidiary of GlaxoSmithKline plc (Reporting Person).
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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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GLAXOSMITHKLINE PLC
980 GREAT WEST ROAD
BRENTFORD MIDDLESEX, X0 TW8 9GS
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X
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Signatures
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/s/ Simon Dingemans, Chief Financial Officer
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2/14/2014
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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 4(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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