SEC Form 4 · accession 0001036262-18-000001
INTEST CORP · INTT
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Robert E Matthiessen
Director
Period of report
Dec 31, 2017
Accepted (ET)
Jan 30, 2018 · 3:15 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001036262
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Dec 31, 2017 | D | 18,700 | $0.00 | D | 86,481 | D | |
| Common StockF2 | holding | — | — | — | 61,618 | I | By Spouse |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Employee Stock Option (right to buy)F3,F4 | $4.37 | Dec 31, 2017 | D | 5,400 | D | — | — | Common Stock | 5,400 | 1,800 | D |
| Employee Stock Option (right to buy)F5 | $6.35 | Dec 31, 2017 | D | 34,000 | D | — | — | Common Stock | 34,000 | 0 | D |
Explanation of responses
- F1The shares disposed are unvested restricted shares forfeited as a result of the reporting person's retirement as President and CEO on 12/31/17. Of the total shares forfeited, 7,200 shares (75%) are from the 1/22/16 restricted stock award grant and 11,500 (100%) are from the 3/15/17 restricted stock award granted to the reporting person.
- F2The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed to be an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
- F3The options disposed are unvested employee stock options forfeited as a result of the report person's retirement on 12/31/17.
- F4The option is 25% vested and exercisable, but will expire on 12/31/18, the one year anniversary of the reporting person's retirement.
- F5The options disposed are unvested employee stock options forfeited as a result of the reporting person's retirement on 12/31/17. The option was completely unvested and therefore was 100% forfeited as of 12/31/17.