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*
C/O UPJOHN INC. |
235 EAST 42ND STREET |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 08/06/2020
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3. Issuer Name and Ticker or Trading Symbol
Upjohn Inc
[ VTRS ]
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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 Financial 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, par value $0.01 per share |
0 |
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 |
Explanation of Responses: |
Remarks: |
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/s/ Susan E. Grant, by power of atty., for Sanjeev Narula |
08/06/2020 |
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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. |
POWER OF ATTORNEY
The undersigned hereby constitutes and appoints each of Tara J. Gabbai, Susan E.
Grant, Lori P. Hernando, Margaret M. Madden, 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, Margaret M. Madden, 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/ Sanjeev Narula
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Sanjeev Narula