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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1. Name and Address of Reporting Person*
BERGHEIM OLAV

(Last) (First) (Middle)
C/O GLAUKOS CORPORATION
26051 MERIT CIRCLE, SUITE 103

(Street)
LAGUNA HILLS CA 92653

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
06/24/2015
3. Issuer Name and Ticker or Trading Symbol
GLAUKOS Corp [ GKOS ]
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
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 352,800 I Through Fjordinvest, LLC(1)
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 Exercise 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) (2) 07/10/2024 Common Stock 10,000 $7.275 D
Explanation of Responses:
1. Fjordinvest, LLC is a Delaware limited liability company.Micro LLC, a Delaware limited liability company, is the managing member of Fjordinvest, LLC, and Mr. Bergheim is the president of Micro LLC. Mr. Bergheim shares voting and dispositive power over the shares held by Fjordinvest, LLC; however, he disclaims beneficial ownership of the shares held by such entity except to the extent of his pecuniary interest therein.
2. Granted July 10, 2014 pursuant to the Issuer's 2011 Stock Plan. Vests annually over a three-year period such that it is vested in full on the three-year anniversary of the grant date.
/s/ Richard L. Harrison, Attorney-in Fact 06/24/2015
** 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.
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