FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 12/05/2018 |
3. Issuer Name and Ticker or Trading Symbol
REPRO MED SYSTEMS INC [ REPR ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 0 | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Options to Purchase Common Stock | 11/18/2017(1) | 11/18/2020 | Common Stock | 95,000 | $0.36 | D | |
Options to Purchase Common Stock | 07/28/2019(2) | 07/28/2022 | Common Stock | 50,000 | $0.46 | D | |
Options to Purchase Common Stock | (3) | 10/11/2022 | Common Stock | 250,000 | $0.5 | D |
Explanation of Responses: |
1. REPRO MED SYSTEMS, INC. d/b/a RMS Medical Products (the "Company") awarded Mr. Marques these incentive stock options on November 18, 2015 under the Company's 2015 Stock Option Plan, as amended. These options are subject to acceleration in certain instances of mergers, consolidations, or sales or transfers by the Company of substantially all of its assets. As of 11/18/2017 these options are fully vested. |
2. The Company awarded Mr. Marques these incentive stock options on July 28, 2017 under the Company's 2015 Stock Option Plan, as amended. These options will vest on July 28, 2019. These options are subject to acceleration in certain instances of mergers, consolidations, or sales or transfers by the Company of substantially all of its assets. |
3. The Company awarded Mr. Marques these incentive stock options on October 11, 2017 under the Company's 2015 Stock Option Plan, as amended. The options vest at a rate of 15,625 every three months following October 11, 2017 until fully vested. These options are subject to acceleration in certain instances of termination without cause. |
/s/ Manuel A. Marques | 12/13/2018 | |
** 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 5 (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. |