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 CORCEPT THERAPEUTICS INCORPORATED |
| 275 MIDDLEFIELD ROAD |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
04/14/2004
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3. Issuer Name and Ticker or Trading Symbol
CORCEPT THERAPEUTICS INC
[ CORT ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
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10% Owner |
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Officer (give title below) |
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Other (specify below) |
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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 |
|
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 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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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 |
| Stock Option (right to buy) |
|
04/17/2012 |
Common Stock |
50,000 |
7 |
D |
|
| Stock Option (right to buy) |
|
11/23/2013 |
Common Stock |
25,000 |
7 |
D |
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| Explanation of Responses: |
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|
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/s/Fred Kurland, CFO of Corcept Therapeutics Incorporated attorney-in-fact |
04/14/2004 |
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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. |
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POWER OF ATTORNEY FOR SECTION 16 REPORTING
The undersigned hereby appoints Joseph K. Belanoff, in his capacity as
Chief Executive Officer of Corcept Therapeutics Incorporated (the "Company"),
Fred Kurland, in his capacity as Chief Financial Officer of the Company, and
either of them with full power of substitution or their respective successors in any
such offices, as the attorney-in-fact of the undersigned to execute and file with the
Securities and Exchange Commission ("SEC") and any other authority required by
the rules and regulations of the SEC or any market or exchange on which shares of
the Company are traded and to submit to the Company, in the place and stead of
the undersigned, SEC Forms 3, 4 and 5 and any successor reporting forms
required by the SEC in connection with purchases and sales of securities of the
Company and any other transactions in securities of the Company reportable on
any such form. This Power of Attorney shall be effective until revoked by a
written instrument executed by the undersigned and delivered to the Company at
its headquarters to the attention of the Chief Financial Officer.
Dated: January 29, 2004
/s/ Joseph C. Cook, Jr.
Name: Joseph C. Cook, Jr.
