- Amended Statement of Beneficial Ownership (3/A)
08 Août 2012 - 8:49PM
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, 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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1. Name and Address of Reporting Person
*
Belk Jeffrey
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2. Date of Event Requiring Statement (MM/DD/YYYY)
8/7/2012
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3. Issuer Name
and
Ticker or Trading Symbol
PEREGRINE SEMICONDUCTOR CORP [PSMI]
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(Last)
(First)
(Middle)
C/O PEREGRINE SEMICONDUCTOR CORPORATION, 9380 CARROLL PARK DRIVE
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__
X
__ Director
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Street)
SAN DIEGO, CA 92121
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
8/7/2012
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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
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20435
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D
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Common Stock
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10217
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I
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Jeffrey K. Belk and Kim Z. Belk Trust Dated July 22, 1998
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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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(1)
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4/14/2019
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Common Stock
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2724
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$1.76
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D
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Stock Option (Right to Buy)
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(2)
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5/28/2019
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Common Stock
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5108
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$1.76
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D
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Stock Option (Right to Buy)
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(3)
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5/28/2019
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Common Stock
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5108
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$1.76
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D
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Stock Option (Right to Buy)
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(4)
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1/28/2020
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Common Stock
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3269
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$5.73
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D
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Stock Option (Right to Buy)
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(5)
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7/22/2020
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Common Stock
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13623
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$7.12
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D
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Stock Option (Right to Buy)
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(6)
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7/22/2020
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Common Stock
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25544
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$7.12
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D
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Stock Option (Right to Buy)
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(7)
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10/25/2021
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Common Stock
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10899
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$9.76
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D
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Explanation of Responses:
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(
1)
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Subject to continuous service, the option is immediately exercisable for all shares. Any shares acquired upon exercise of the option are subject to a right of repurchase at the original exercise price per share. The right of repurchase lapses in successive equal daily installments from January 15, 2009 to December 31, 2009.
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(
2)
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Subject to continuous service, the option is immediately exercisable for all shares. Any shares acquired upon exercise of the option are subject to a right of repurchase at the original exercise price per share. The right of repurchase lapses in successive equal daily installments over a 12-month period from March 31, 2011.
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(
3)
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Subject to continuous service, the option is immediately exercisable for all shares. Any shares acquired upon exercise of the option are subject to a right of repurchase at the original exercise price per share. The right of repurchase lapses in successive equal daily installments over a 12-month period from March 31, 2012.
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(
4)
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Subject to continuous service, the option is immediately exercisable for all shares. Any shares acquired upon exercise of the option are subject to a right of repurchase at the original exercise price per share. The right of repurchase lapses in successive equal daily installments from January 28, 2010 to December 31, 2010.
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(
5)
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Subject to continuous service, the option is exercisable in successive equal daily installments over a 12-month period from April 1, 2013.
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(
6)
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Subject to continuous service, the option is exercisable in successive equal daily installments over a 36-month period from July 22, 2010.
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(
7)
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Subject to continuous service, the option is exercisable in 12 successive equal monthly installments from April 1, 2014.
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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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Belk Jeffrey
C/O PEREGRINE SEMICONDUCTOR CORPORATION
9380 CARROLL PARK DRIVE
SAN DIEGO, CA 92121
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X
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Signatures
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By: /s/ Jay Biskupski as Attorney-in-fact for Jeffrey K. Belk
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8/8/2012
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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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