0001437749-21-022139.txt : 20210914 0001437749-21-022139.hdr.sgml : 20210914 20210914202613 ACCESSION NUMBER: 0001437749-21-022139 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210819 FILED AS OF DATE: 20210914 DATE AS OF CHANGE: 20210914 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: 211253878 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 rdgdoc.xml FORM 4 X0306 4 2021-08-19 0001279695 UNIVERSAL BIOSENSORS INC UBI 0001397500 Balak Salesh 1 CORPORATE AVENUE ROWVILLE VICTORIA C3 3178 AUSTRALIA 1 Chief Financial Officer Common Stock 2021-08-19 4 M 0 40000 0 A 306558 D Performance Rights 2021-08-19 4 A 0 500000 0 A 2025-03-24 Common Stock 500000 500000 D Performance Rights 2021-08-19 4 A 0 250000 0 A 2025-03-24 Common Stock 250000 250000 D Stock Option (Right to Buy) 0.3000 2025-03-24 Common Stock 500000 500000 D Stock Option (Right to Buy) 0.5000 2023-04-20 Common Stock 721000 721000 D Stock Option (Right to Buy) 0.5000 2024-02-27 Common Stock 216300 216300 D Stock Option (Right to Buy) 0 2021-08-19 4 M 0 40000 0 D 2022-01-29 Common Stock 40000 0 D Includes (i) 302,392 shares in the form of CDIs Mr. Balak holds directly and (ii) 4,166 restricted fully paid shares. The price reported is stated in Australian dollars. The options are fully vested but can only be exercised after 03/01/2021. 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. 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. These options were exercised on 08/19/2021. Each performance right represents a contingent right to receive one share of common stock of Universal Biosensors, Inc. ("UBI"). The performance rights vest upon, among other triggers, UBI's market capitalization having achieved a specified threshold. Each performance right represents a contingent right to receive one share of common stock of UBI. The performance rights vest upon a change of control transaction with a value greater a specified threshold. /s/ Salesh Balak 2021-09-14