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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 02/09/2023
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3. Issuer Name and Ticker or Trading Symbol
NEUROCRINE BIOSCIENCES INC
[ NBIX ]
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4. 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) |
Chief Regulatory Officer |
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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)
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 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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Common Stock |
3,382 |
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 |
Incentive Stock Option |
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02/01/2031 |
Common Stock |
3,359 |
106.02 |
D |
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Non-Qualified Stock Option |
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02/01/2031 |
Common Stock |
9,367 |
106.02 |
D |
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Incentive Stock Option |
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01/31/2032 |
Common Stock |
827 |
79.02 |
D |
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Non-Qualified Stock Option |
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01/31/2032 |
Common Stock |
12,261 |
79.02 |
D |
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Restricted Stock Unit |
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Common Stock |
4,717 |
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D |
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Restricted Stock Unit |
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Common Stock |
5,435 |
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D |
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Restriced Stock Unit |
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Common Stock |
3,202 |
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D |
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Explanation of Responses: |
Remarks: |
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/s/ Darin Lippoldt, Attorney-in-Fact |
02/15/2023 |
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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. |
LIMITED POWER OF ATTORNEY - SECURITIES LAW COMPLIANCE
The undersigned, as an officer of Neurocrine Biosciences, Inc. (the
"Corporation"), hereby constitutes and appoints, jointly and severally Kevin C.
Gorman, Matt Abernethy, and Darin Lippoldt, each of them, the undersigned's
true and lawful attorney-in-fact and agent, each with the power of substitution
for her in any and all capacities to complete and execute such Forms 144,
advisable pursuant to Rule 144 promulgated under the Securities Act of 1933
(as amended) and Forms 3, 4, and 5 advisable pursuant to section 16 of the
Securities Exchange Act of 1934, and other forms as such attorney shall in his
or her discretion determine to be required by 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 Corporation, and to do all acts necessary
in order to file such forms with the Securities and Exchange Commission, any
securities exchange or national association, the Corporation and such other
person or agency as the attorney shall deem appropriate.
The undersigned hereby ratifies and confirms all that said attorneys-in-fact and
agents shall do or cause to be done by virtue hereof.
This Power of Attorney shall remain in full force and effect until the earliest
to occur of (a) the undersigned is no longer required to file Forms 144, 3, 4,
and 5 with repect to the undersigned's holdings of and transactions
in securities issued by the company, (b) revocation by the undersigned in a
signed writing delivered to the foregoing attorneys-in-fact or (c) as to any
attorney-in-fact individually, until such attorney-in-fact shall no
longer be employed by the company.
IN WITNESS WHEREOF, the undersigned has caused this Power Of Attorney to be
executed this 10th day of February 2023.
/s/ Ingrid Dalaet