SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF 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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1. Name and Address of Reporting Person*
Jacobs Jeffrey W

(Last) (First) (Middle)
C/O ARDELYX, INC.
34175 ARDENWOOD BLVD, SUITE 200

(Street)
FREMONT CA 94555

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
06/09/2020
3. Issuer Name and Ticker or Trading Symbol
ARDELYX, INC. [ ARDX ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Scientific Officer
5. If Amendment, Date of Original Filed (Month/Day/Year)
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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 145,566(1) D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (Right to Buy) (2) 08/11/2021 Common Stock 17,500 0.54 D
Stock Option (Right to Buy) (2) 01/06/2025 Common Stock 11,850 23.02 D
Stock Option (Right to Buy) (2) 06/11/2025 Common Stock 5,000 14.6 D
Stock Option (Right to Buy) (2) 01/15/2026 Common Stock 68,467 10.55 D
Stock Option (Right to Buy) (3) 01/19/2027 Common Stock 79,535 13.9 D
Stock Option (Right to Buy) (2) 08/09/2027 Common Stock 19,884 4.7 D
Stock Option (Right to Buy) (4) 01/16/2028 Common Stock 87,828 7.1 D
Stock Option (Right to Buy) (5) 07/26/2028 Common Stock 54,730 4.3 D
Stock Option (Right to Buy) (6) 01/17/2029 Common Stock 80,000 2.32 D
Stock Option (Right to Buy) (7) 01/09/2030 Common Stock 139,365 7.6 D
Explanation of Responses:
1. Includes 100,000 restricted stock units ("RSUs"). The Reporting Person is entitled to receive one (1) shares of Common Stock for each one (1) RSU upon the vesting thereof.
2. The option is fully vested and exercisable.
3. The option becomes exercisable as it vests and the shares subject to the option vest in 48 successive, equal monthly installments on each monthly anniversary of January 19, 2017, subject to the Reporting Person's continued employment or service relationship with the Issuer on each such vesting date.
4. The option becomes exercisable as it vests and the shares subject to the option vest in 48 successive, equal monthly installments on each monthly anniversary of January 16, 2018, subject to the Reporting Person's continued employment or service relationship with the Issuer on each such vesting date.
5. The option becomes exercisable as it vests and the shares subject to the option vest in 48 successive, equal monthly installments on each monthly anniversary of July 26, 2018, subject to the Reporting Person's continued employment or service relationship with the Issuer on each such vesting date.
6. The option becomes exercisable as it vests and the shares subject to the option vest in 48 successive, equal monthly installments on each monthly anniversary of January 17, 2019, subject to the Reporting Person's continued employment or service relationship with the Issuer on each such vesting date.
7. The option becomes exercisable as it vests and the shares subject to the option vest in 48 successive, equal monthly installments on each monthly anniversary of January 9, 2020, subject to the Reporting Person's continued employment or service relationship with the Issuer on each such vesting date.
/s/ Elizabeth Grammer, Attorney-in-Fact for Jeffrey W. Jacobs 06/22/2020
** 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 5 (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.
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