Statement of Changes in Beneficial Ownership (4)
December 17 2020 - 4:12PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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
*
Marques Manuel A |
2. Issuer Name and Ticker or Trading Symbol
REPRO MED SYSTEMS INC
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KRMD
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) Chief Operating Officer |
(Last)
(First)
(Middle)
REPRO MED SYSTEMS, INC., 24 CARPENTER ROAD |
3. Date of Earliest Transaction
(MM/DD/YYYY)
12/15/2020 |
(Street)
CHESTER, NY 10918
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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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 Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock | 12/15/2020 | | F(1) | | 26920 | D | $5.535 (2) | 243080 | D | |
Common Stock | 12/15/2020 | | M | | 62500 | A | $0.50 | 305580 | D | |
Common Stock | 12/15/2020 | | M | | 75000 | A | $1.57 | 380580 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Options to Purchase Common Stock | $0.50 | 12/15/2020 | | M | | | 62500 | (3) | 10/10/2022 | Common Stock | 62500 | $0 | 62500 | D | |
Options to Purchase Common Stock | $1.57 | 12/15/2020 | | M | | | 75000 | 1/28/2020 | 1/28/2029 | Common Stock | 75000 | $0 | 225000 | D | |
Explanation of Responses: |
(1) | Represents the payment of the exercise price of stock options through the delivery of previously owned shares to the issuer. |
(2) | The price is equal to the Fair Market Value of the Common Stock, as defined in the stock option award agreements, and is used to determine the value of the shares delivered to the issuer in payment of the exercise price. |
(3) | Options vest in 15,625 increments quarterly. Date Excercisable 01/11/2018-10/11/2020. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Marques Manuel A REPRO MED SYSTEMS, INC. 24 CARPENTER ROAD CHESTER, NY 10918 |
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| Chief Operating Officer |
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Signatures
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/s/ Manuel A. Marques | | 12/17/2020 |
**Signature of Reporting Person | Date |
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