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*
Pecoraro Laura

(Last) (First) (Middle)
47827 HALYARD DRIVE

(Street)
PLYMOUTH MI 48170

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/16/2019
3. Issuer Name and Ticker or Trading Symbol
PERCEPTRON INC/MI [ PRCP ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Vice President of Finance
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 6,786(1) 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 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
Employee Stock Options (right to buy) (2) 01/03/2027 Common Stock 5,000 $6.72 D
Explanation of Responses:
1. Includes 4,767 shares of unvested restricted stock units granted to the reporting person under the 2004 Stock Incentive Plan, an exempt plan. Each restricted stock unit represents a contingent right to receive one share of Common Stock of the Issuer. Provided the reporting person remains employed with the Issuer on each of the relevant dates, the units will vest on various dates between October 1, 2019 & October 2, 2021.
2. On January 3, 2017, the reporting person was granted an option to purchase 5,000 shares of Common Stock under the 2004 Stock Incentive Plan, an exempt plan. The shares are exercisable in three equal annual installments. The first installment became exercisable on January 3, 2018, the second installment became exercisable on January 3, 2019 and the third installment will become exercisable on January 3, 2020 at an exercise price equal to the fair market value of the Company's Common Stock as of January 3, 2017.
Remarks:
/s/ Laura Pecoraro 09/26/2019
** 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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