0000899243-17-000118.txt : 20170103 0000899243-17-000118.hdr.sgml : 20170103 20170103185259 ACCESSION NUMBER: 0000899243-17-000118 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20161229 FILED AS OF DATE: 20170103 DATE AS OF CHANGE: 20170103 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 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: 17503218 MAIL ADDRESS: STREET 1: 103 RICKETTS ROAD STREET 2: MT. WAVERLEY CITY: VICTORIA STATE: C3 ZIP: 3149 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2016-12-29 0 0001279695 UNIVERSAL BIOSENSORS INC UBI 0001397500 Balak Salesh 1 CORPORATE AVENUE ROWVILLE VICTORIA C3 3178 AUSTRALIA 0 1 0 0 Chief Financial Officer Restricted Shares of Common Stock 2016-12-29 4 A 0 3030 0.00 A 82391 D Stock Option (Right to Buy) 0.00 2020-12-11 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 Common Stock 25000 25000 D Stock Option (Right to Buy) 0.00 2018-11-17 Common Stock 25000 25000 D Stock Option (Right to Buy) 0.00 2017-11-10 Common Stock 16667 16667 D Stock Option (Right to Buy) 1.72 2019-11-09 Common Stock 100000 100000 D Stock Option (Right to Buy) 0.00 2019-06-28 Common Stock 73334 73334 D Stock Option (Right to Buy) 0.89 2018-03-16 Common Stock 100000 100000 D Stock Option (Right to Buy) 1.18 2017-03-22 Common Stock 208000 208000 D The issue price reported is stated in Australian dollars. 13,333 stock options vested and became exercisable on 12/31/2015, 13,333 stock options vest and become exercisable on 12/31/2016, and 13,334 stock options vest and become 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 vest and become 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. 8,333 stock options vested and became exercisable on 12/31/2012, 8,333 stock options vested and became exercisable on 12/31/2013, and 8,333 stock options vested and became exercisable on 12/31/2014. 8,333 stock options vested and became exercisable on 12/31/2011 and were exercised on August 27 2012, 8,333 stock options vested and became exercisable on 12/31/2012, and 8,334 stock options vested and became exercisable on 12/31/2013. 1/3 of the stock options vested and became exercisable on 12/31/2010, 1/3 of the stock options vested and became exercisable on 12/31/2011 and the remaining stock options vested and became exercisable on 12/31/2012. 10,000 stock options vested and became exercisable on 12/31/2010 and were exercised on 11/10/2011. 21,666 stock options vested and became exercisable on 12/31/11 and were exercised on 08/27/2012, 35,000 stock options vested and became exercisable on 12/31/2012, 25,000 stock options vested and became exercisable on 12/31/2013, and 13,334 stock options vested and became exercisable on 12/31/2014. 1/3 of the stock options vested and became exercisable on 12/31/2008, 1/3 of the stock options vested and became exercisable on 12/31/2009; and the remaining stock options vested and became exercisable on 12/31/2010. The stock options vested and became exercisable in three equal tranches on 12/31/2007, 12/31/2008, and 12/31/2009. Includes (i) 70,474 shares in the form of CDIs Mr. Balak holds directly and (ii) 8,887 restricted fully paid shares. /s/ Cameron Billingsley, Attorney-in-Fact 2017-01-03