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*
| 3450 MONTE VILLA PARKWAY, SUITE 101 |
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(Street)
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2. Issuer Name and Ticker or Trading Symbol
AVI BIOPHARMA INC
[ AVII ]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
| X |
Officer (give title below) |
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Other (specify below) |
| SVP & Chief Medical Officer |
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3. Date of Earliest Transaction
(Month/Day/Year)
04/24/2012
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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 |
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 |
| Stock Option (right to buy) |
$0.9
|
04/24/2012 |
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A |
|
68,110 |
|
|
04/24/2022 |
Common Stock |
68,110 |
$0
|
68,110 |
D |
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| Explanation of Responses: |
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|
By: Michael Jacobsen For: Edward M. Kaye |
04/25/2012 |
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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
The undersigned, as a Section 16 reporting person of
AVI BioPharma, Inc. (the Company), hereby constitutes
and appoints each of Michael Jacobsen and Wilson
Sonsini Goodrich & Rosati, P.C. the undersigneds true
and lawful attorney in fact to:
1. complete and execute Forms ID, 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 undersigneds ownership, acquisition
or disposition of securities of the Company; and
2. do all acts necessary in order to file such forms
with the Securities and Exchange Commission, any securities
exchange or national association, the Company and such
other person or agency as the attorney in fact shall
deem appropriate. The undersigned hereby ratifies and
confirms all that said attorney in fact and agents shall
do or cause to be done by virtue hereof. The undersigned
acknowledges that each foregoing attorney in fact, in
serving in such capacity at the request of the undersigned,
is not assuming, nor is the Company assuming, any of the
undersigneds responsibilities to comply with Section 16
of the Securities Exchange Act of 1934 (as amended).
This Power of Attorney revokes any previously executed
powers of attorney and 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 undersigneds
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 each foregoing
attorney in fact.
IN WITNESS WHEREOF, the undersigned has caused this Power
of Attorney to be executed as of this 25th day of April, 2012.
Signature /s/ Edward M. Kaye
Edward M. Kaye
