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*
Godlewski Laura Lee

(Last) (First) (Middle)
C/O HTG MOLECULAR DIAGNOSTICS, INC.
3430 E. GLOBAL LOOP

(Street)
TUCSON AZ 85706

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
05/23/2019
3. Issuer Name and Ticker or Trading Symbol
HTG MOLECULAR DIAGNOSTICS, INC [ HTGM ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
VP of Accounting and Reporting
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 15,044 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
Stock Option (right to buy) (1) 06/03/2025 Common Stock 698 13.83 D
Stock Option (right to buy) (2) 11/24/2025 Common Stock 4,000 5.08 D
Stock Option (right to buy) (1) 01/31/2027 Common Stock 5,000 1.75 D
Stock Option (right to buy) (3) 05/31/2027 Common Stock 2,500 3.46 D
Stock Option (right to buy) (1) 07/25/2027 Common Stock 5,000 2.39 D
Stock Option (right to buy) (4) 06/28/2028 Common Stock 30,000 3.25 D
Stock Option (right to buy) (5) 08/16/2028 Common Stock 10,000 3.4 D
Explanation of Responses:
1. The shares subject to the stock option are fully vested.
2. The shares vest in a series of sixteen (16) successive equal quarterly installments on the last day of each calendar quarter, commencing with the last day of the calendar quarter first occurring after November 25, 2015.
3. The shares vest in a series of sixteen (16) equal installments every three months first occurring after May 31, 2017.
4. The shares vest in a series of sixteen (16) successive equal quarterly installments on the last day of each calendar quarter, commencing with the last day of the calendar quarter first occuring after June 28, 2018.
5. The shares vest in a series of sixteen (16) successive equal quarterly installments on the last day of each calendar quarter, commencing with the last day of the calendar quarter first occuring after August 16, 2018.
Remarks:
/s/ Laura Lee Godlewski 05/29/2019
** 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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