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
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
Domingo Angelita Rebamontan

(Last) (First) (Middle)
2361 MCGAW AVENUE

(Street)
IRVINE CA 92614

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
12/20/2021
3. Issuer Name and Ticker or Trading Symbol
PRO DEX INC [ PDEX ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
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)
Common Stock 7,011 D
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
Stock Option (Right to buy)(1) 07/01/2021 07/01/2031 Common Stock 4,250 $27.5 D
Stock Option (Right to buy)(1) 07/01/2022 07/01/2032 Common Stock 4,250 $39 D
Stock Option (Right to buy)(1) 07/01/2024 07/01/2034 Common Stock 4,250 $42 D
Stock Option (Right to buy)(1) 07/01/2028 07/01/2038 Common Stock 4,250 $47.5 D
Stock Option (Right to buy)(1) 07/01/2030 07/01/2040 Common Stock 4,250 $50 D
Performance Award(2) 07/01/2022 (2) Common Stock 5,800 $0 D
Performance Award(2) 07/01/2024 (2) Common Stock 5,800 $0 D
Performance Award(2) 07/01/2026 (2) Common Stock 5,800 $0 D
Explanation of Responses:
1. These options were awarded under Pro-Dex's 2016 Equity Incentive Plan. The percentage of options that may vest and become exercisable, if any, are 100%, 50%, and 25%, respectively, based upon the volume-weighted average price of Pro-Dex's common stock equaling or exceeding the applicable exercise price for the 60 trading days immediately preceding the date the option becomes exercisable, six months from the date the option becomes exercisable, or twelve months from the date the option becomes exercisable, respectively.
2. These performance awards were awarded under Pro-Dex's 2016 Equity Incentive Plan. Shares of Pro-Dex common stock will be granted to the reporting person in the amounts shown above on the date exercisable shown above, as the vesting criteria for these performance awards have already been satisfied as of the date of this report.
Remarks:
EXHIBIT LIST: Exhibit 24 - Power of Attorney
/s/ Alisha Charlton, attorny-in-fact pursuant to power of attorney filed herewith 01/06/2022
** 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.