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 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*
| CONNAUGHT HOUSE, 1 BURLINGTON RD, FL. 4 |
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(Street)
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2. Issuer Name and Ticker or Trading Symbol
Jazz Pharmaceuticals plc
[ JAZZ ]
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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)
08/11/2016
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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 |
| Ordinary Shares |
08/11/2016 |
|
A
|
|
1,365
|
A |
$0.0
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5,586 |
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 |
| Non-Qualified Stock Option (right to buy) |
$138.08
|
08/11/2016 |
|
A
|
|
3,415 |
|
|
08/10/2026 |
Ordinary Shares |
3,415 |
$0.0
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3,415 |
D |
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| Explanation of Responses: |
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By: /s/ Peter A Christou as attorney in fact For: Norbert G. Riedel |
08/15/2016 |
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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 presents, that the undersigned hereby
constitutes and appoints each of SUZANNE SAWOCHKA HOOPER,
VALERIE PIERCE AND KAREN EBERLE, signing individually, the
undersigned"s true and lawful attorneys-in fact and agents to:
1)execute for and on behalf of the undersigned (a) Forms 3, 4
and 5 in accordance with Section 16(a) of the Securities
Exchange Act of 1934, as amended (the "Exchange Act") and the
rules thereunder and (b) Forms 144 in accordance with Rule 144
promulgated under the Securities Act of 1933, as amended, as
such Rule may be amended from time to time (or any successor
rule) ("Rule 144");
2)do and perform any and all acts for and on behalf of the
undersigned that may be necessary or desirable to complete and
execute such Forms 3, 4, 5 or 144 (collectively, the "Forms"),
complete and execute any amendment or amendments thereto, and
timely file such Forms or amendments with the U.S. Securities
and Exchange Commission and any stock exchange or similar
authority; and
3)take any other action of any nature whatsoever in
connection with the foregoing which, in the opinion of such
attorney-in-fact, may be of benefit, in the best interest of, or
legally required by, the undersigned, including but not limited
to executing and delivering for and on behalf of the undersigned
any seller"s representation letter that may be required to be
submitted to any broker effecting any sale of securities issued
by Jazz Pharmaceuticals plc (the "Company") for the account of
the undersigned, it being understood that the documents executed
by such attorney-in-fact on behalf of the undersigned pursuant
to this Power of Attorney shall 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 such attorney-in-fact
full 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 of substitution
or revocation, hereby ratifying and confirming all that such
attorney-in-fact, or such attorney-in-fact"s substitute or
substitutes, 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 the foregoing attorneys-in-
fact, in serving in such capacity at the request of the
undersigned, are not assuming, nor is the Company or any of its
affiliates, assuming, any of the undersigned"s responsibilities
to comply with (a) Section 16 of the Exchange Act and (b) all of
the applicable conditions of the Rule 144 safe harbor with
respect to a sale of securities issued by the Company.
This Power of Attorney shall remain in full force and
effect until the earliest to occur of (a) the undersigned is no
longer required to file any Forms with respect to the
undersigned"s holdings of and transactions in securities issued
by the Company, (b) revocation by the undersigned in a signed
writing delivered to the foregoing attorneys-in-fact or (c) as
to any attorney-in-fact individually, until such attorney-in-
fact shall no longer be employed by the Company or an affiliate
of the Company.
IN WITNESS WHEREOF, the undersigned has caused this Power of
Attorney to be executed as of this 5th day of November 2015.
/s/ Norbert G. Riedel
Norbert G. Riedel
