0001161697-21-000082.txt : 20210204
0001161697-21-000082.hdr.sgml : 20210204
20210204162232
ACCESSION NUMBER: 0001161697-21-000082
CONFORMED SUBMISSION TYPE: 5
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20201231
FILED AS OF DATE: 20210204
DATE AS OF CHANGE: 20210204
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Goldberger Daniel S
CENTRAL INDEX KEY: 0001382042
FILING VALUES:
FORM TYPE: 5
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39086
FILM NUMBER: 21591464
MAIL ADDRESS:
STREET 1: 24 CARPENTER ROAD
CITY: CHESTER
STATE: NY
ZIP: 10918
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: REPRO MED SYSTEMS INC
CENTRAL INDEX KEY: 0000704440
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
IRS NUMBER: 133044880
STATE OF INCORPORATION: NY
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 24 CARPENTER RD
CITY: CHESTER
STATE: NY
ZIP: 10918
BUSINESS PHONE: 845-469-2042
MAIL ADDRESS:
STREET 1: 24 CARPENTER RD
CITY: CHESTER
STATE: NY
ZIP: 10918
5
1
form_5.xml
FORM 5 FOR 12-31-2020
X0306
5
2020-12-31
0
0
0
0000704440
REPRO MED SYSTEMS INC
KRMD
0001382042
Goldberger Daniel S
C/O REPRO MED SYSTEMS, INC
24 CARPENTER ROAD
CHESTER
NY
10918
1
0
0
0
Common Stock, $0.01 par value
2020-11-13
5
G
0
94422
0.00
D
6390
D
On November 13, 2020, the reporting person gifted 94,422 shares of common stock, $0.01 par value, to the D.S.G. Charitable Remainder Trust (the "Trust"). The Trust is an irrevocable trust, of which Massachusetts Institute of Technology is the sole trustee. The reporting person disclaims beneficial ownership of the shares gifted to the Trust.
/s/ Daniel S. Goldberger
2021-02-04