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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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*
Poliakoff Abba David

(Last) (First) (Middle)
C/O CHAMPIONS ONCOLOGY, INC.
ONE UNIVERSITY PLAZA, SUITE 307

(Street)
HACKENSACK NJ 07601

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
CHAMPIONS ONCOLOGY, INC. [ CSBR ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
01/19/2021
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 01/19/2021 M 10,000 A $1.59 70,147 D
Common Stock 01/19/2021 M 10,000 A $3.21 80,147 D
Common Stock 01/19/2021 M 10,000 A $5.43 90,147 D
Common Stock 01/19/2021 F(1) 8,873 A $11.53 81,274 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
Option to purchase Common Stock $1.59 01/19/2021 M 10,000 (2) 11/01/2021 Common Stock 10,000 $0 0 D
Option to purchase Common Stock $3.21 01/19/2021 M 10,000 (3) 10/31/2022 Common Stock 10,000 $0 0 D
Option to purchase Common Stock $5.43 01/19/2021 M 10,000 (4) 11/04/2024 Common Stock 10,000 $0 0 D
Explanation of Responses:
1. Represents a "net exercise" of outstanding stock options. The shares were withheld by Champions Oncology, Inc. for payment of the exercise price based on the market price of Champions Oncology, Inc. common stock on January 19,2021.
2. The options vest and are exercisable over a twelve month period, with vesting to occur on November 1, 2016, February 1, 2017, May 1, 2017 and August 1, 2017 respectively.
3. The options vest and are exercisable over a twelve month period, with vesting to occur on November 1, 2017, February 1, 2018, May 1, 2018 and August 1, 2018, respectively.
4. The options vest and are exercisable over a twelve month period, with vesting to occur on November 4, 2019, February 4, 2020, May 4, 2020 and August 4, 2020, respectively.
Remarks:
/s/ Abba D. Poliakoff 02/08/2021
** 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.
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