3: Initial statement of beneficial ownership of securities
Published on September 12, 2018
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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 control number. |
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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Options to Purchase Common Stock | (1) | 09/04/2023 | Common Stock | 1,000,000 | $ 1.23 | D |
Reporting Owners
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Pettigrew Donald B REPRO MED SYSTEMS, INC. 24 CARPENTER ROAD CHESTER, NY 10918 |
Pres./Chief Commercial Officer |
Signatures
/s/ Donald B. Pettigrew | 09/12/2018 | |
**Signature of Reporting Person | Date |
Explanation of Responses:
* | 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). |
(1) | REPRO MED SYSTEMS, INC. d/b/a RMS Medical Products (the "Company") hired Mr. Pettigrew on September 4, 2018 and as part of his employment agreement he was awarded these non-qualified stock options on the same date under the Company's 2015 Stock Option Plan, as amended. Twenty-five percent (25%) of the options shall vest as of the one (1) year anniversary of September 4, 2018, and (ii) twelve and one-half percent (12.5%) of the options shall vest every six (6) months thereafter until fully vested, subject to acceleration in accordance with the terms of the award agreement. |