SEC Form 5
FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
  
Form 3 Holdings Reported.
X
Form 4 Transactions Reported.
1. Name and Address of Reporting Person*
REBACK ROBERT H

(Last) (First) (Middle)
6979 S HIGH TECH DR

(Street)
SALT LAKE CITY UT 84047

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
CIMETRIX INC [ CMXX.OB ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
CHIEF EXECUTIVE OFFICER
3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
12/31/2011
4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned at end of Issuer's Fiscal Year (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Amount (A) or (D) Price
COMMON STOCK 02/28/2011 M4 12,500 A $0.05 12,500 I By IRA
COMMON STOCK 02/28/2011 M4 25,000 A $0.05 37,500 I By IRA
COMMON STOCK 08/01/2011 M4 25,000 A $0.05 25,000(4) I By 401(k) Plan
COMMON STOCK 1,064,125 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction 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 (Month/Day/Year) 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: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
(A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Warrant (right to buy) $0.35 11/11/2002 4A(1) 12,500 11/11/2002 09/30/2005 Common Stock 12,500 $0 12,500 I By IRA
Warrant (right to buy) $0.35 11/15/2002 4A(2) 25,000 11/05/2002 09/30/2005 Common Stock 25,000 $0 25,000 I By IRA
Warrant (right to buy) $0.05 01/26/2009 4A(3) 25,000 01/26/2009 09/30/2010 Common Stock 25,000 $0 25,000 I By 401(k) Plan(4)
Explanation of Responses:
1. This warrant was granted on 11/11/2002. The expiration date of the warrant was extended with Board approval on each of 9/8/2004, 6/5/2006, 3/22/2007, 9/3/2008 and 12/15/2009. The final expiration date of the warrant was 9/30/2012. The exercise price of the warrant was changed to $0.05 in connection with the extension of the expiration date on 9/3/2008. The warrant was exercised on 2/28/2011.
2. This warrant was granted on 11/15/2002. The expiration date of the warrant was extended with Board approval on each of 9/8/2004, 6/5/2006, 3/22/2007, 9/3/2008 and 12/15/2009. The final expiration date of the warrant was 9/30/2012. The exercise price of the warrant was changed to $0.05 in connection with the extension of the expiration date on 9/3/2008. The warrant was exercised on 2/28/2011
3. This warrant was granted on 1/26/09. The expiration date of the warrant was extended with Board approval to 9/30/2012 on 12/15/2009. The warrant was exercised on 8/1/2011.
4. This information is based on a 401(k) plan statement dated as of 12/31/2011.
Remarks:
Robert H. Reback 04/04/2012
** 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 4 (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.