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*
van Gunsteren Job Leonard

(Last) (First) (Middle)
C/O BALCHEM CORPORATION
5 PARAGON DRIVE

(Street)
MONTVALE NJ 07645

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
02/10/2022
3. Issuer Name and Ticker or Trading Symbol
BALCHEM CORP [ BCPC ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
SVP and GM, Specialty Products
5. If Amendment, Date of Original Filed (Month/Day/Year)
02/17/2022
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(1) 6,661 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
Explanation of Responses:
1. Shares held directly
Remarks:
This Form 3/A amends the original Form 3 filed on February 17, 2022, which inadvertently omitted (due to administrative error) 5,260 shares held directly by the Reporting Person. This Form 3/A is also deemed to adjust, accordingly, the reported balance on the Form 4s filed by the Reporting Person on August 5, 2022, August 9, 2022, and August 16, 2022, respectively. In this regard, as of the date of this filing, the Reporting Person directly holds 5,260 shares. Note: The title of the Reporting Person on this Form 3/A reflects his title as of the date of filing of this Form 3/A. Exhibit 24 - Power of Attorney is attached.
/s/ Hatsuki Miyata, Attorney-in-Fact for Job van Gunsteren 10/07/2022
** 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.