SEC Form 4 · accession 0001325077-16-000002
PURADYN FILTER TECHNOLOGIES INC · PFTI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Forrest Duane Hayes
Other
Period of report
Jun 30, 2016
Accepted (ET)
Jul 5, 2016 · 5:29 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001019787
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Options to purchase common stock | $0.18 | Jun 30, 2016 | A | 10,000 | A | Nov 16, 2013 | Nov 16, 2016 | Common stock | 10,000 | 10,000 | D |
| Options to purchase common stock | $0.12 | Jun 30, 2016 | A | 10,000 | A | Nov 9, 2014 | Jun 30, 2017 | Common Stock | 10,000 | 10,000 | D |
| Options to purchase common stock | $0.18 | Jun 30, 2016 | A | 10,000 | A | Nov 11, 2015 | Jun 30, 2017 | Common Stock | 10,000 | 10,000 | D |
Remarks
This Form 4 is being filed solely to report all beneficial holdings of Mr. Hayes as of June 30, 2016, which is the date of his resignation from the board of Puradyn Filter Technologies, Inc. All prior acquisitions and dispositions were previously reported by Mr. Hayes. See Current Report on Form 8-K as filed with the SEC on July 5, 2016.