- Statement of Changes in Beneficial Ownership (4)
2012年8月15日 - 5:41AM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Kelly Dylan
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2. Issuer Name
and
Ticker or Trading Symbol
PEREGRINE SEMICONDUCTOR CORP
[
PSMI
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
Vice President MWS
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(Last)
(First)
(Middle)
C/O PEREGRINE SEMICONDUCTOR CORPORATION, 9380 CARROLL PARK DRIVE
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3. Date of Earliest Transaction
(MM/DD/YYYY)
8/13/2012
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(Street)
SAN DIEGO, CA 92121
(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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Code
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V
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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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8/13/2012
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8/13/2012
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M
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419
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A
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$.73
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419
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D
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Common Stock
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8/13/2012
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8/13/2012
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M
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207
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A
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$.73
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626
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D
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Common Stock
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8/13/2012
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8/13/2012
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S
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626
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D
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$14.00
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0
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D
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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. 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
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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 Following Reported Transaction(s) (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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Code
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V
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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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Employee Stock Option (Right to Buy)
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$.73
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8/13/2012
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8/13/2012
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M
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419
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(1)
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11/21/2012
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Common Stock
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419
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$0
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204775
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D
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Employee Stock Option (Right to Buy)
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$.73
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8/13/2012
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8/13/2012
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M
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207
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(2)
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1/30/2013
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Common Stock
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207
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$0
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204568
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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, this option, which was fully exercisable at grant, is subject to a vesting schedule that lapses with respect to 25% of the shares to this option on September 4, 2003 and in equal monthly installments over a 36-month period of the remaining shares subject to this option thereafter.
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(
2)
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Subject to continuous service, this option, which was fully exercisable at grant, is subject to a vesting schedule that lapses with respect to 25% of the shares to this option on January 30, 2004 and in equal monthly installments over a 36-month period of the remaining shares subject to this option thereafter.
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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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Kelly Dylan
C/O PEREGRINE SEMICONDUCTOR CORPORATION
9380 CARROLL PARK DRIVE
SAN DIEGO, CA 92121
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Vice President MWS
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Signatures
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/s/ Jay Biskupski as Attorney-in-fact for Dylan J. Kelly
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8/14/2012
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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 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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