FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
MTS MEDICATION TECHNOLOGIES, INC /DE/ [ MTSI ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 12/22/2009 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 12/22/2009 | S | 1,000,000 | D | (1)(2) | 606,125 | I | By: Jade Partners | ||
Common Stock | 12/22/2009 | D(1) | 606,125 | D | (3) | 0 | I | By: Jade Partners | ||
Common Stock | 12/22/2009 | D(1) | 61,908 | D | (3) | 0 | D | |||
Common Stock | 12/22/2009 | D(1) | 1,100 | D | (3) | 0 | I | By: Son |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Options (right to buy) | $5.85 | 12/22/2009 | D(1) | 56,777 | (4) | 07/02/2018 | Common Stock | 56,777 | (5) | 0 | D |
Explanation of Responses: |
1. Disposed of pursuant to an Agreement and Plan of Merger, dated as of August 7, 2009 ("Merger Agreement"), by and among the Issuer, MedPak Holdings, Inc., a Delaware corporation ("Parent"), and MedPak Merger Sub, Inc., a Delaware corporation and a wholly owned subsidiary of Parent ("Merger Sub"), whereby Merger Sub merged with and into the Issuer (the "Merger"). |
2. 1,000,000 shares of the Issuer's common stock held by the reporting person were exchanged for 206,834 shares of Preferred Stock and 206,834 shares of Voting Common Stock of the Parent. |
3. The reporting person's remaining shares were exchanged for cash consideration of $5.75 per share (the "Merger Consideration"). The Merger was approved by the stockholders of the Issuer on December 18, 2009 and became effective on December 22, 2009. |
4. Options vested as follows: 18,925 on 07/02/2009; 18,926 on 07/02/2010; and 18,926 on 07/02/2011. |
5. The options were cancelled and terminated by the Issuer's Board of Directors in accordance with the terms of the Merger Agreement. The reporting person received, with respect to any shares of the Issuer's common stock issuable under a stock option, an amount equal to the excess, if any, of (i) the Merger Consideration per share over (ii) the exercise price per share payable with respect of such shares of the Issuer's common stock issuable under such stock option. |
Todd Siegel | 12/22/2009 | |
** 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 4 (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. |