SEC 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
|Estimated average burden|
|hours per response:
1. Name and Address of Reporting Person*
|C/O UPJOHN INC.|
|235 EAST 42ND STREET|
2. Date of Event Requiring Statement
3. Issuer Name and Ticker or Trading Symbol
[ VTRS ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
||Officer (give title below)
||Other (specify below)
5. If Amendment, Date of Original Filed
6. Individual or Joint/Group Filing (Check Applicable Line)
||Form filed by One Reporting Person
||Form filed by More than One Reporting Person
|Table I - Non-Derivative Securities Beneficially Owned|
|1. Title of Security (Instr.
Amount of Securities Beneficially Owned (Instr.
||3. Ownership Form: Direct (D) or Indirect (I) (Instr.
||4. Nature of Indirect Beneficial Ownership (Instr.
|Common Stock, par value $0.01 per share
Table II - Derivative Securities Beneficially Owned|
(e.g., puts, calls, warrants, options, convertible securities)
|1. Title of Derivative Security (Instr.
||2. Date Exercisable and Expiration Date
||3. Title and Amount of Securities Underlying Derivative Security (Instr.
||4. Conversion or Exercise Price of Derivative Security
||5. Ownership Form: Direct (D) or Indirect (I) (Instr.
||6. Nature of Indirect Beneficial Ownership (Instr.
||Amount or Number of Shares
|Explanation of Responses:|
||/s/ Susan E. Grant, by power of atty., for Margaret M. Madden
||** Signature of Reporting Person
|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,
|** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
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,
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 hereby constitutes and appoints each of Tara J. Gabbai, Susan E.
Grant, Lori P. Hernando, Madelyn D. Purcell and Shehzad Siddiqui as the
undersigned's true and lawful attorney-in-fact and agent, and grants each of
them full power to act on behalf of the undersigned and in the undersigned's
name, place and stead, in any and all capacities, for the purpose of completing
and signing, on behalf of the undersigned,
* any Form 3, Form 4 or Form 5 required or permitted to be filed by the
undersigned pursuant to Section 16 of the Securities Exchange Act of
1934, as amended (the "Exchange Act"), and
* any and all other documents, including, without limitation, Form ID,
necessary or desirable to facilitate the filing by the undersigned of
forms under Section 16 of the Exchange Act,
with regard to the undersigned's ownership of or transactions in securities of
Upjohn Inc., including, without limitation, the power to complete and sign any
and all amendments to such forms and documents, if any, and to file such forms
and documents and amendments thereto with the Securities and Exchange
Commission, and to do and perform each and every act and thing requisite or
necessary to be done in connection with such forms and documents and amendments
thereto, as fully and to all intents and purposes as the undersigned might or
could do in person.
The authority of Tara J. Gabbai, Susan E. Grant, Lori P. Hernando, Madelyn D.
Purcell and Shehzad Siddiqui under this Power of Attorney shall continue until
the undersigned is no longer required to file Form 3, Form 4 or Form 5 with
regard to the undersigned's ownership of or transactions in securities of Upjohn
Inc., unless earlier revoked in writing. The undersigned acknowledges that Tara
J. Gabbai, Susan E. Grant, Lori P. Hernando, Margaret M. Madden, Madelyn D.
Purcell and Shehzad Siddiqui are not assuming any of the undersigned's
responsibilities to comply with Section 16 of the Exchange Act.
/s/ Margaret M. Madden
Margaret M. Madden