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