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*
Zaccarin Denis

(Last) (First) (Middle)
PACIFIC BIOSCIENCES OF CALIFORNIA, INC.
1305 O'BRIEN DRIVE

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
04/01/2020
3. Issuer Name and Ticker or Trading Symbol
PACIFIC BIOSCIENCES OF CALIFORNIA, INC. [ PACB ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
SVP, Research & Development
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 81,281(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) 07/29/2020 Common Stock 5,001 12.74 D
Stock Option (right to buy) (2) 06/15/2021 Common Stock 5,000 11.64 D
Stock Option (right to buy) (2) 02/15/2022 Common Stock 28,000 4.79 D
Stock Option (right to buy) (2) 02/15/2023 Common Stock 20,000 2.18 D
Stock Option (right to buy) (2) 02/18/2024 Common Stock 50,000 7.05 D
Stock Option (right to buy) (2) 02/17/2025 Common Stock 50,000 6.91 D
Stock Option (right to buy) (2) 02/16/2026 Common Stock 60,000 8.9 D
Stock Option (right to buy) 03/15/2017(3) 02/15/2027 Common Stock 65,000 5.27 D
Stock Option (right to buy) 03/15/2018(3) 02/15/2028 Common Stock 45,000 2.54 D
Explanation of Responses:
1. Includes 65,000 shares represented by restricted stock units ("RSUs"). Each RSU represents the Reporting Person's right to receive one share of Common Stock of the Issuer subject to the applicable vesting schedule, provided that the Reporting Person is a service provider through each vesting date.
2. The shares subject to the option are fully vested and exercisable.
3. One forty-eighth (1/48) of the shares subject to the option vests monthly over a four year period, provided that the Reporting Person is a service provider through each vesting date.
Remarks:
/s/ Denis Zaccarin 04/02/2020
** 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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