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) 06/12/2014 | ||||||||||||||||||||||||||
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 | 06/12/2014 | A | 2,040 | A | $0.00(1) | 2,957 | D | |||
Common stock | 186,771 | I | By Macquarie Super Manager(2) |
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 | 60,000 | (3) | 12/11/2020 | Common Stock | 60,000 | $0.00 | 60,000 | D | ||||
Stock Option (Right to Buy) | $0.00 | (4) | 11/12/2019 | Common Stock | 37,500 | 37,500 | D | ||||||||
Stock Option (Right to Buy) | $1.38(1) | (5) | 02/23/2018 | Common Stock | 2,300,000 | 2,300,000 | D |
Explanation of Responses: |
1. The prices reported are stated in Australian dollars. |
2. The reported securities are held by the Macquarie Super Manager for the account of the Reporting Person. |
3. On December 12, 2013, the board of directors approved the grant of these options subject to shareholder approval. Such shareholder approval was received on June 12, 2014. The stock options vest and become exercisable in three equal tranches on 12/31/14, 12/31/15 and 12/31/16. |
4. On November 13, 2012, the board of directors approved the grant of these options subject to shareholder approval. Such shareholder approval was received on May 16, 2013. The stock options vest and become exercisable in three equal tranches on 12/31/13, 12/31/14 and 12/31/15. |
5. 1,400,000 options vest in equal tranches over three years subject to continued employment at the time of vesting. 500,000 of the options vested upon the company entering into a material partnership/licensing agreement with Siemens Healthcare Diagnostics, Inc. on September 9, 2011. 400,000 options vest upon CE marketing or first regulatory approval in the United States of the final test to which the partnership/licensing arranagement relates, subject to continued employment at the time of vesting. |
Remarks: |
/s/ Cameron Billingsley, attorney-in-fact | 06/12/2014 | |
** 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. |