SEC FORM
4
SEC Form 4
FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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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OMB APPROVAL |
OMB Number: |
3235-0287 |
Estimated average burden |
hours per response: |
0.5 |
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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). |
1. Name and Address of Reporting Person*
C/O AKEBIA THERAPEUTICS, INC |
245 FIRST STREET |
(Street)
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2. Issuer Name and Ticker or Trading Symbol
Akebia Therapeutics, Inc.
[ AKBA ]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X |
Director |
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10% Owner |
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Officer (give title below) |
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Other (specify below) |
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3. Date of Earliest Transaction
(Month/Day/Year) 06/06/2019
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4. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Security (Instr.
3)
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2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction 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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Code |
V |
Amount |
(A) or (D) |
Price |
Common Stock |
06/06/2019 |
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A |
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13,700
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A |
$0.00
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13,700 |
D |
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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 Derivative Security (Instr.
3)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction 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
(Month/Day/Year) |
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 Following Reported Transaction(s) (Instr.
4)
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10. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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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 |
Stock Option (Right to buy) |
$4.23
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06/06/2019 |
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A |
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20,100
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06/06/2020 |
06/06/2029 |
Common Stock |
20,100 |
$0.00
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20,100 |
D |
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Explanation of Responses: |
Remarks: |
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/s/ Nicole R. Hadas, attorney-in-fact for Cynthia Smith |
06/10/2019 |
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** Signature of Reporting Person |
Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
* 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). |
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure. |
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 Number. |
POWER OF ATTORNEY
Know all by these present, that the
undersigned hereby constitutes and appoints
each of John P. Butler,Jason Amello, Nicole R.
Hadas, and Andrea Paul signing singly, as the undersigned's
true and lawful attorney-in-fact to:
(1) prepare, execute in the undersigned's
name and on the undersigned's behalf, and submit
to the U.S. Securities and Exchange Commission
(the "SEC") a Form ID, including amendments
thereto,and any other documents necessary or
appropriate to obtain codes and passwords enabling
the undersigned to make electronic filings with
the SEC of reports required by Section 16(a)
of the Securities Exchange Act of 1934 or any
rule orregulation of the SEC;
(2) execute for and on behalf
of the undersigned, in the undersigned's
capacity as an officer and/or director or
shareholder of Akebia Therapeutics, Inc.
the "Company"),Forms3, 4 and 5 in accordance
with Section 16(a) of the Securities
Exchange Act of 1934, as
amended (the "Act"), and the rules thereunder;
(3) do and perform any and all
acts for and on behalf of the undersigned which
may be necessary or desirable to complete and
execute any such Form 3, 4 or 5 and timely file
such form with the United States Securities and
Exchange Commission and any stock exchange or
similar authority; and
(4) take any other action
of any type whatsoever in connection with
the foregoing which, in the opinion of
such attorney-in-fact, may be of benefit to,
in the best interest of, or legally
required by, the undersigned, it being understood
hat the documents executed by such attorney-in-fact
on behalf of the undersigned pursuant to this Power
of Attorneyshall be in such form and shall contain
such terms and conditions as such attorney-in-fact
may approve in such attorney-in-fact's
discretion.
The undersigned hereby grants to each
attorney-in-factfull power and authority to do
and perform any and every act and thing whatsoever
requisite, necessary or proper to be done in the
exercise of any of the rights and powers herein
granted, as fully to all intents and purposes as
the undersigned might or could do if personally
present, with full power ofsubstitution or
revocation, hereby ratifying and confirming all
the acts such attorney-in-fact shall lawfully do
or cause to be done by virtue of this power of
attorney and the rights and powers herein granted.
The undersigned acknowledges that each of the
foregoing attorneys-in-fact, in serving in such
capacity at the request of the undersigned,
is not assuming any of the undersigned's
responsibilities to comply with Section 16 of
the Act.
This Power of Attorney shall remain
in full force and effect until the undersigned
is no longer required to file
Forms 3, 4 and 5 with respect to the undersigned's
holdings of and transactions in securities issued
by the Company, unless earlier revoked by the
undersigned in a signed writing delivered
to each of the foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has
caused this Power of Attorney to be
executed as of August 27, 2018.
By: /s/Cynthia Smith
Name: Cynthia Smith