| FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 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). | |||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
UNIVERSAL BIOSENSORS INC [ UBI ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 12/24/2013 | ||||||||||||||||||||||||||
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4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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| 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 Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
| Code | V | Amount | (A) or (D) | Price | ||||||
| Common Stock | 12/12/2013 | A | 2,040 | A | $0.00 | 2,446,266 | D | |||
| Common Stock | 12/24/2013 | M | 384,224 | A | $0.22 | 2,830,490 | D | |||
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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| 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) | ||||
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
| Stock Option (Right to Buy) | $0.00 | 12/12/2013 | A | 40,000 | (2) | 12/11/2020 | Common Stock | 40,000 | $0 | 40,000 | D | ||||
| Stock Option (Right to Buy) | $0.00 | (3) | 11/12/2019 | Common Stock | 25,000 | 25,000 | D | ||||||||
| Stock Option (Right to Buy) | $0.00 | (4) | 11/17/2018 | Common Stock | 25,000 | 25,000 | D | ||||||||
| Stock Option (Right to Buy) | $0.00 | (5) | 11/10/2017 | Common Stock | 25,000 | 25,000 | D | ||||||||
| Stock Option (Right to Buy) | $1.72(1) | (6) | 11/09/2019 | Common Stock | 100,000 | 100,000 | D | ||||||||
| Stock Option (Right to Buy) | $0.00 | (7) | 06/28/2019 | Common Stock | 105,000 | 105,000 | D | ||||||||
| Stock Option (Right to Buy) | $0.00 | (8) | 05/14/2019 | Common Stock | 16,667 | 16,667 | D | ||||||||
| Stock Option (Right to Buy) | $0.89(1) | (9) | 03/16/2018 | Common Stock | 100,000 | 100,000 | D | ||||||||
| Stock Option (Right to Buy) | $0.22 | 12/24/2013 | M | 384,224 | (10) | 12/30/2013 | Common Stock | 384,224 | $0.00 | 0 | D | ||||
| Stock Option (Right to Buy) | $0.26 | (11) | 12/31/2015 | Common Stock | 36,248 | 36,248 | D | ||||||||
| Stock Option (Right to Buy) | $1.18(1) | (12) | 03/22/2017 | Common Stock | 36,000 | 36,000 | D | ||||||||
| Explanation of Responses: |
| 1. The exercise price reported isstated in Australian dollars. |
| 2. 13,333 stock options vest and become exercisable on 12/31/2014, 13,333 stock options vest and become exercisable on 12/31/2015, and 13,334 stock options vest and become exercisable on 12/31/2016. |
| 3. 8,333 stock options vest and become exercisable on 12/31/2013, 8,333 stock options vest and become exercisable on 12/31/2014, and 8,334 stock options vest and become exercisable on 12/31/2015. |
| 4. 8,333 stock options vested and became exercisable on 12/31/2012, 8,333 stock options vest and become exercisable on 12/31/2013, and 8,334 stock options vest and become exercisable on 12/31/2014. |
| 5. 8,333 stock options vested and became exercisable on 12/31/2011, 8,333 stock options vested and became exercisable on 12/31/2012, and 8,334 stock options vest and become exercisable on 12/31/2013. |
| 6. 1/3 of the stock options vested and became exercisable on 12/31/10, 1/3 of the stock options vested and became exercisable on 12/31/11 and the remaining stock options vested and became exercisable on 12/31/12. |
| 7. 10,000 stock options vested and became exercisable on 12/31/10, 21,666 stock options vested and became exercisable on 12/31/11, 35,000 stock options vested and became exercisable on 12/31/12, 25,000 stock options vest and become exercisable on 12/31/13, and 13,334 stock options vest and become exercisable on 12/31/14. |
| 8. 8,333 stock options vested and became exercisable on 12/31/2009 and were exercised on February 10, 2010. 8,333 stock options vested and became exercisable on 12/31/2010 and the remaining stock options vested and became exercisable on 12/31/11. |
| 9. 1/3 of the stock options vested and became exercisable on 12/31/08. 1/3 of the stock options vested and became exercisable on 12/31/09. The remaining stock options vested and became exercisable on 12/31/10. |
| 10. The stock options vested and became exercisable in three equal tranches on 12/31/04, 12/31/05, and 12/31/06 of which 384,224 options were exercised on June 11, 2013 and the balance of 384,224 options exercised on December 24, 2013. |
| 11. 1/3 of the stock options vested and became exercisable on 01/01/07; 1/3 of the stock options vested and became exercisable on 01/01/08, and the remaining stock options vested and became exercisable on 01/01/09. |
| 12. The stock options vested and became exercisable in three equal tranches on 12/31/07, 12/31/08, and 12/31/09. |
| /s/ Cameron Billingsley, Attorney-in-Fact | 12/24/2013 | |
| ** 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. | ||