| 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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 | | OMB APPROVAL | | OMB Number: | 3235-0104 | | Expires: | February 28, 2011 | | Estimated average burden | | hours per response | 0.5 |
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|
1. Name and Address of Reporting Person*
| 875 THIRD AVENUE, 18TH FLOOR | |
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year)
09/23/2009 | 3. Issuer Name and Ticker or Trading Symbol
Alexza Pharmaceuticals Inc.
[ALXA]
|
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)| X | Director | | 10% Owner | | Officer (give title below) | | Other (specify below) | |
| 5. 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 |
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| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
| 2.
Amount of Securities Owned (Instr.
4)
| 3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
| 4. Nature of Indirect Beneficial Ownership (Instr.
5)
|
|---|
|
Common Stock
|
0
|
D
| |
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities) |
|---|
| 1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year)
| 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Excercise Price of Derivative Security
| 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)
| 6. Nature of Indirect Beneficial Ownership (Instr. 5)
|
|---|
| Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
|---|
|
Stock Option (right to buy)
| 10/23/2009 | 09/23/2019 |
Common Stock
|
25,000
|
$
2.34
|
D
| |
| Explanation of Responses: |
|
| /s/ Andrew L. Busser | 09/25/2009 |
| ** 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. |
EX-24
Power of Attorney
style="margin-left: 0.25in; width: 7.2in; font-family: 'Times New Roman',Times,serif">
Exhibit 24
POWER OF ATTORNEY
Know all by these
presents, that the undersigned hereby constitutes and appoints each of Thomas
B. King, August J. Moretti, James C.T. Linfield and Brent D. Fassett, signing
individually, the undersigned’s true and lawful attorneys-in fact and
agents to:
(1) execute for and on behalf of the undersigned, an
officer, director or holder of 10% of more of a registered class of securities
of Alexza Pharmaceuticals, Inc. (the “Company”), Forms 3, 4 and 5
in accordance with Section 16(a) of the Securities Exchange Act of 1934, as
amended (the “Exchange Act”) and the rules thereunder;
(2) do and perform any and all acts for and on behalf of
the undersigned that may be necessary or desirable to complete and execute such
Form 3, 4 or 5, complete and execute any amendment or amendments thereto,
and timely file such forms or amendments with the United States Securities and
Exchange Commission and any stock exchange or similar authority; and
(3) take any other action of any nature whatsoever in
connection with the foregoing which, in the opinion of such attorney-in-fact,
may be of benefit, in the best interest of, or legally required by, the
undersigned, it being understood that the documents executed by such
attorney-in-fact on behalf of the undersigned pursuant to this Power of
Attorney shall be in such form and shall contain such terms and conditions as
such attorney-in-fact may approve in such attorney-in-fact’s discretion.
The undersigned
hereby grants to each such attorney-in-fact full power and authority to do and
perform any and every act and thing whatsoever requisite, necessary, or proper
to be done in the exercise of any of the rights and powers herein granted, as
fully to all intents and purposes as the undersigned might or could do if
personally present, with full power of substitution or revocation, hereby
ratifying and confirming all that such attorney-in-fact, or such
attorney-in-fact’s substitute or substitutes, shall lawfully do or cause
to be done by virtue of this power of attorney and the rights and powers herein
granted. The undersigned acknowledges that the foregoing attorneys-in-fact, in
serving in such capacity at the request of the undersigned, are not assuming,
nor is the Company assuming, any of the undersigned’s responsibilities to
comply with Section 16 of the Exchange Act.
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 3, 4 and 5 with
respect 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 or Cooley Godward Kronish LLP, as applicable.
In Witness Whereof, the
undersigned has cause this Power of Attorney to be executed as of this
25th day of September, 2009.
/s/
Andrew L.
Busser
Andrew L. Busser