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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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*
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2430 VANDERBILT BEACH ROAD, #108 - 190 |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 05/09/2017
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3. Issuer Name and Ticker or Trading Symbol
UroGen Pharma Ltd.
[ URGN ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
X |
10% Owner |
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Officer (give title below) |
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Other (specify below) |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Form filed by One Reporting Person |
X |
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)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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Ordinary Shares, par value NIS 0.01 per share |
1,451,329 |
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 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)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
1. Name and Address of Reporting Person*
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2430 VANDERBILT BEACH ROAD, #108 - 190 |
(Street)
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1. Name and Address of Reporting Person*
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2430 VANDERBILT BEACH ROAD, #108 - 190 |
(Street)
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1. Name and Address of Reporting Person*
C/O PROQUEST INVESTMENTS |
2430 VANDERBILT BEACH ROAD, #108 - 190 |
(Street)
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1. Name and Address of Reporting Person*
C/O PROQUEST INVESTMENTS |
2430 VANDERBILT BEACH ROAD, #108 - 190 |
(Street)
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Explanation of Responses: |
Remarks: |
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/s/ Pasquale DeAngelis |
07/20/2017 |
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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
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. |
Exhibit 24.1
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, that each of the undersigned hereby constitutes
and appoints, as of the date hereof, Pasquale DeAngelis, his or her true and lawful attorney-in-fact
with full power of substitution, resubstitution and revocation, for the undersigned and in the
undersigned's name, place and stead, in any and all capacities, including, but not limited to, the
undersigned's individual capacity, to execute all agreements, certificates, forms, instruments, or
other documents, and to take any action, necessary to file beneficial ownership reports on
Schedules 13D and 13G and Forms 3, 4 and 5 (including any amendments thereto, and including
any beneficial ownership reports which may in the future be required by the Securities and
Exchange Commission to be filed provided that the purpose and form of such reports is
substantially similar to Schedules 13D or 13G or Form 3, 4 or 5) under the Securities Exchange
Act of 1934 with the Securities and Exchange Commission or any stock exchange or similar
authority, in connection with any equity investments in Urogen Pharma Ltd. by each of the
undersigned in his or her individual capacity.
In connection with the appointment of such attorney-in-fact, each of the undersigned hereby
grants unto said attorney-in-fact full power and authority to do and perform each and every act
and thing which, in the opinion of such attorney-in-fact, may be requisite, necessary, proper or of
benefit to be done in and about the premises, as fully to all intents and purposes as the
undersigned might or could do in person, thereby ratifying and confirming all that said
attorney-in-fact (or attorney-in-fact's substitute or substitutes), may lawfully do or cause to be
done by virtue hereof, 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 his own discretion. Each of the
undersigned acknowledges that the foregoing attorney-in-fact, in serving in such capacity at the
request of the undersigned, is not assuming any of the undersigneds' responsibilities to comply with
Section 13 or Section 16 of the Securities Exchange Act of 1934.
This Power of Attorney shall remain in full force and effect until each of the undersigned is no
longer required to file Forms 3, 4 and 5 or Schedules 13D or 13G 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 foregoing attorney-in-fact.
Dated: July 20, 2017
/s/ Jay Moorin
______________________________
Jay Moorin
/s/ Alain Schreiber
______________________________
Alain Schreiber