SEC FORM 4/A 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
 
OMB APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response: 0.5
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*
BLECH ISAAC

(Last) (First) (Middle)
C/O X4 PHARMACEUTICALS, INC.
955 MASSACHUSETTS AVENUE, 4TH FLOOR

(Street)
CAMBRIDGE MA 02139

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
X4 Pharmaceuticals, Inc [ XFOR ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
03/13/2019
4. If Amendment, Date of Original Filed (Month/Day/Year)
03/14/2019
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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 Securities Underlying Derivative Security (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: 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
Stock Option (right to buy) $6.84 03/13/2019 A 70,796 (1) 12/14/2025 Common Stock 70,796 (2) 70,796 D
Stock Option (right to buy) $18.66 03/13/2019 A 6,854 (3) 03/13/2029 Common Stock 6,854 $0.00 6,854 D
Explanation of Responses:
1. Fully vested.
2. Reflects the Reporting Person's stock option to acquire 744,967 shares of X4 common stock for $0.65 per share that was assumed by the Issuer in the merger of Artemis AC Corp., a wholly-owned subsidiary of the Issuer, with and into X4 Therapeutics, Inc. (formerly X4 Pharmaceuticals, Inc.) ("X4") on March 13, 2019 (the "Merger").
3. 33.3333% of the shares subject to the option shall vest on March 13, 2020, with the remainder vesting in equal monthly installments of 2.7777% of the shares subject to the option until the 36-month anniversary of the date of the award, subject to the Reporting Person continuing to provide service through each such date. This amendment is being filed solely to report this additional stock option grant, which was granted automatically on March 13, 2019 pursuant to the Issuer's Director Compensation Policy upon such Reporting Person's election to the Board of Directors of the Issuer in connection with the closing of the Merger.
Remarks:
All share and per share amounts of the Issuer's common stock and stock options reported in this Form 4/A reflect the 1-for-6 reverse stock split of the Issuer's common stock effected on March 13, 2019 after the completion of the Merger.
/s/ Adam S. Mostafa, attorney-in-fact 04/02/2019
** 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.