SEC Form 3
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*
Blumhoff Jill

(Last) (First) (Middle)
2701 KENT AVENUE

(Street)
WEST LAFAYETTE IN 47906

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
05/09/2016
3. Issuer Name and Ticker or Trading Symbol
BIOANALYTICAL SYSTEMS INC [ BASI ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
VP, Finance & CFO
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
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)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
Employee Stock Option (right to buy) (1) 09/04/2018 Common Shares 2,000 $5.09 D
Employee Stock Option (right to buy) (2) 08/15/2020 Common Shares 2,000 $1.01 D
Employee Stock Option (right to buy) (3) 01/16/2023 Common Shares 500 $1.4 D
Employee Stock Option (right to buy) (4) 09/14/2025 Common Shares 10,000 $1.7 D
Explanation of Responses:
1. The option became exercisable in four equal annual installments. The first installment became exercisable on September 4, 2010, and the next three installments became exercisable on September 4, 2011, September 4, 2012 and September 4, 2013.
2. The option became exercisable in four equal annual installments. The first installment became exercisable on August 16, 2012, and the next three installments became exercisable on August 16, 2013, August 16, 2014 and August 16, 2015.
3. The option became exercisable in two equal annual installments. The first installment became exercisable on January 16, 2014 and the second installment became exercisable on January 16, 2015.
4. The option will become exercisable in four equal annual installments. The first installment will become exercisable on September 15, 2016, and the next three installments will become exercisable on September 15, 2017, September 15, 2018 and September 15, 2019.
Remarks:
Exhibit List:Exhibit 24.1--Power of Attorney
/s/ Jill C. Blumhoff 05/16/2016
** 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.