Form 4 Hosseini Kamran

4 - Statement of changes in beneficial ownership of securities

Published: 2015-10-30 11:28:10
Submitted: 2015-10-30
Period Ending In: 2015-10-28
doc4.html FORM 4 SUBMISSION


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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
OMB APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response: 0.5
  
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*
Hosseini Kamran

(Last) (First) (Middle)
965 ATLANTIC AVENUE

(Street)
ALAMEDA CA 94501

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
INSITE VISION INC [ INSV ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
VP, Clinical Affairs & CMO
3. Date of Earliest Transaction (Month/Day/Year)
10/28/2015
4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock(1) 10/28/2015 U 4,353 D $0.35 0 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. On October 28, 2015, Thea Acquisition Corp, ("Purchaser"), a wholly owned subsidiary of Ranbaxy, Inc. ("Ranbaxy"), which is an indirect wholly owned subsidiary of Sun Pharmaceutical Industries Ltd., completed a tender offer for all the outstanding shares of InSite Vision Incorporated ("Issuer") for a purchase price of $0.35 per share, all pursuant to that certain Agreement and Plan of Merger, dated September 15, 2015, as amended and restated, by and among Purchaser, Ranbaxy and Issuer.
Remarks:
/s/ Kamran Hosseini 10/30/2015
** 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.
1
doc4.xml FORM 4 SUBMISSION
Schema Version:
X0306
Document Type:
4
Period Of Report:
2015-10-28
Not Subject To Section16:
0

Issuer

Issuer Cik
0000802724
Issuer Name
INSITE VISION INC
Issuer Trading Symbol
INSV

Reporting Owner

Reporting Owner Id

Rpt Owner Cik
0001430587
Rpt Owner Name
Hosseini Kamran

Reporting Owner Address

Rpt Owner Street1
965 ATLANTIC AVENUE
Rpt Owner City
ALAMEDA
Rpt Owner State
CA
Rpt Owner Zip Code
94501

Reporting Owner Relationship

Is Director
0
Is Officer
1
Is Ten Percent Owner
0
Is Other
0
Officer Title
VP, Clinical Affairs & CMO

Non Derivative Transaction

Security Title

Value
Common Stock
@attributes Id
F1
Transaction Date
2015-10-28

Transaction Coding

Transaction Form Type
4
Transaction Code
U
Equity Swap Involved
0

Transaction Amounts

Transaction Shares
4353
Transaction Price Per Share
0.35
Transaction Acquired Disposed Code
D
Shares Owned Following Transaction
0
Direct Or Indirect Ownership
D
Footnotes Footnote
On October 28, 2015, Thea Acquisition Corp, ("Purchaser"), a wholly owned subsidiary of Ranbaxy, Inc. ("Ranbaxy"), which is an indirect wholly owned subsidiary of Sun Pharmaceutical Industries Ltd., completed a tender offer for all the outstanding shares of InSite Vision Incorporated ("Issuer") for a purchase price of $0.35 per share, all pursuant to that certain Agreement and Plan of Merger, dated September 15, 2015, as amended and restated, by and among Purchaser, Ranbaxy and Issuer.

Owner Signature

Signature Name
/s/ Kamran Hosseini
Signature Date
2015-10-30
Additional Files
FileSequenceDescriptionTypeSize
0001209191-15-077359.txt   Complete submission text file   5034
$INSV

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