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
|
| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
| PACIFIC BIOSCIENCES OF CALIFORNIA, INC. |
| 1380 WILLOW ROAD |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
03/27/2012
|
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, Market Development |
|
5. 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 |
|
Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
|
2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
|
4. Nature of Indirect Beneficial Ownership (Instr.
5)
|
| Common Stock |
8,049 |
D |
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
|
|---|
| 1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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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) |
|
11/26/2017 |
Common Stock |
112,500 |
1.96 |
D |
|
| Stock Option (right to buy) |
|
09/17/2018 |
Common Stock |
37,500 |
6.96 |
D |
|
| Stock Option (right to buy) |
|
02/17/2020 |
Common Stock |
50,000 |
8.5 |
D |
|
| Stock Option (right to buy) |
|
07/29/2020 |
Common Stock |
12,500 |
12.74 |
D |
|
| Stock Option (right to buy) |
|
03/15/2021 |
Common Stock |
150,000 |
14.24 |
D |
|
| Stock Option (right to buy) |
|
02/15/2022 |
Common Stock |
250,000 |
4.79 |
D |
|
| Explanation of Responses: |
|
|
|
|
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|
Brian Dow, Attorney-in-fact for Kevin P. Corcoran |
04/03/2012 |
|
** 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. |
| 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. |
rrd305514_344642.html
POWER OF ATTORNEY
The undersigned, as a Section 16 reporting person of Pacific Biosciences of California, Inc.
(the "Company"), hereby constitutes and appoints Susan K. Barnes, Brian Dow and Stephen Moore,
and each of them, the undersigned's true and lawful attorney-in-fact to:
1. complete and execute Forms 3, 4 and 5 and other forms and all amendments thereto as such
attorney-in-fact shall in his or her discretion determine to be required or advisable pursuant
to Section 16 of the Securities Exchange Act of 1934 (as amended) and the rules and regulations
promulgated thereunder, or any successor laws and regulations, as a consequence of the
undersigned's ownership, acquisition or disposition of securities of the Company; and
2. do all acts necessary in order to file such forms with the U.S. Securities and Exchange
Commission ("SEC"), any securities exchange or national association, the Company and such other
person or agency as the attorney-in-fact shall deem appropriate.
The undersigned also hereby constitutes and appoints the responsible attorneys and paralegals
of Wilson Sonsini Goodrich & Rosati P.C., and each of them, the undersigned's true and lawful
attorney-in-fact and agent to complete, execute and file an Update Passphrase Request and the
Update Passphrase Acknowledgement on the Electronic Data Gathering, Analysis, and Retrieval
system ("EDGAR") of the SEC, or such other forms and/or procedures as prescribed by the SEC in
order for the foregoing attorney-in-fact to re-generate the undersigned's SEC EDGAR Filing Codes.
The undersigned hereby ratifies and confirms all that said attorneys-in-fact and agents shall
do or cause to be done by virtue hereof. 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 assuming, any of the undersigned's responsibilities to comply with Section 16
of the Securities Exchange Act of 1934 (as amended).
This Power of Attorney shall remain in full force and effect until the undersigned is no
longer required to file Forms ID, 3, 4 and 5 with respect to the undersigned's holdings of and
transactions in securities issued by the Company, unless earlier revoked by the undersigned in
a signed writing delivered to the Company and the foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of
this 27th day of March, 2012.
Signature: /s/ Kevin P. Corcoran
Name: Kevin P. Corcoran
