0000899243-19-028060.txt : 20191125 0000899243-19-028060.hdr.sgml : 20191125 20191125153241 ACCESSION NUMBER: 0000899243-19-028060 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191112 FILED AS OF DATE: 20191125 DATE AS OF CHANGE: 20191125 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Balak Salesh CENTRAL INDEX KEY: 0001397500 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-52607 FILM NUMBER: 191245904 MAIL ADDRESS: STREET 1: 103 RICKETTS ROAD STREET 2: MT. WAVERLEY CITY: VICTORIA STATE: C3 ZIP: 3149 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: UNIVERSAL BIOSENSORS INC CENTRAL INDEX KEY: 0001279695 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 980424072 STATE OF INCORPORATION: DE BUSINESS ADDRESS: STREET 1: 1 CORPORATE AVENUE STREET 2: ROWVILLE CITY: VICTORIA STATE: C3 ZIP: 3178 BUSINESS PHONE: 613-9213-9000 MAIL ADDRESS: STREET 1: 1 CORPORATE AVENUE STREET 2: ROWVILLE CITY: VICTORIA STATE: C3 ZIP: 3178 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2019-11-12 0 0001279695 UNIVERSAL BIOSENSORS INC UBI 0001397500 Balak Salesh 1 CORPORATE AVENUE ROWVILLE VICTORIA C3 3178 AUSTRALIA 0 1 0 0 See Remarks Common Stock 2019-11-12 4 M 0 25000 0.00 A 226558 D Stock Option (Right to Buy) 0.50 2023-04-20 Common Stock 721000 721000 D Stock Option (Right to Buy) 0.50 2024-02-27 Common Stock 216300 216300 D Stock Option (Right to Buy) 0.00 2022-01-29 Common Stock 40000 40000 D Stock Option (Right to Buy) 0.00 2020-12-11 Common Stock 40000 40000 D Stock Option (Right to Buy) 0.00 2019-11-12 4 M 0 25000 0.00 D 2019-11-12 Common Stock 25000 0 D The price reported is stated in Australian dollars. 13,333 stock options vested and became exercisable on 12/31/2015, 13,333 stock options vested and became exercisable on 12/31/2016, and 13,334 stock options vested and became exercisable on 12/31/2017. 13,333 stock options vested and became exercisable on 12/31/2014, 13,333 stock options vested and became exercisable on 12/31/2015, and 13,334 stock options vested and became exercisable on 12/31/2016. 8,333 stock options vested and became exercisable on 12/31/2013, 8,333 stock options vested and became exercisable on 12/31/2014, and 8,334 stock options vested and became exercisable on 12/31/2015. These options were exercised on 11/12/2019. 206,000 of the stock options vested and became exercisable on 10/05/2016, 412,000 of the stock options vested and became exercisable on 12/31/2016 and 103,000 of the stock options vested and became exercisable on 02/23/2017. 216,300 stock options vested and became exercisable on 12/31/2017. Includes (i) 219,362 shares in the form of CDIs Mr. Balak holds directly and (ii) 7,196 restricted fully paid shares. Acting Chief Executive Officer/Chief Financial Officer /s/ Salesh Balak 2019-11-22