SEC Form 4 · accession 0000899243-17-008687

UNIVERSAL BIOSENSORS INC · UBI

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Salesh Balak

Officer — Chief Financial Officer

Period of report

Oct 5, 2016

Accepted (ET)

Mar 27, 2017 · 6:14 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001279695

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Restricted Shares of Common Stock^F11	Dec 28, 2016	A	3,030	$0.00	A	82,391	D

Table II — derivative securities

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Stock Option (Right to Buy)^F1,F10	$0.50	holding	—	—	—	—	Apr 20, 2023	Common Stock	721,000	742,000	D
Stock Option (Right to Buy)^F2	$0.00	holding	—	—	—	—	Jan 29, 2022	Common Stock	40,000	40,000	D
Stock Option (Right to Buy)^F3	$0.00	holding	—	—	—	—	Dec 11, 2020	Common Stock	40,000	40,000	D
Stock Option (Right to Buy)^F4	$0.00	holding	—	—	—	—	Nov 12, 2019	Common Stock	25,000	25,000	D
Stock Option (Right to Buy)^F5	$0.00	holding	—	—	—	—	Nov 17, 2018	Common Stock	25,000	25,000	D
Stock Option (Right to Buy)^F6	$0.00	holding	—	—	—	—	Nov 10, 2017	Common Stock	16,667	16,667	D
Stock Option (Right to Buy)^F1,F7	$1.72	holding	—	—	—	—	Nov 9, 2019	Common Stock	100,000	100,000	D
Stock Option (Right to Buy)^F8	$0.00	holding	—	—	—	—	Jun 28, 2019	Common Stock	73,334	73,334	D
Stock Option (Right to Buy)^F1,F9	$0.89	holding	—	—	—	—	Mar 16, 2018	Common Stock	100,000	100,000	D

Explanation of responses

F1The price reported is stated in Australian dollars.
F10206,000 of the stock options vested and became exercisable on October 5, 2016, 412,000 of the stock options vested and became exerciseable on December 31, 2016 and 103,000 of the stock options vested and became exercisable on February 23, 2017.
F11Includes (i) 72,514 shares in the form of CDIs Mr. Balak holds directly and (ii) 9,877 restricted fully paid shares.
F213,333 stock options vested and became exercisable on 12/31/2015, 13,333 stock options vested and became exercisable on 12/31/2016, and 13,334 stock options vest and become exercisable on 12/31/2017.
F313,333 stock options vested and became exercisable on 12/31/2014, 13,333 stock options vested and became exercisable on 12/31/2015, and 13,334 stock options vested and became exercisable on 12/31/2016.
F48,333 stock options vested and became exercisable on 12/31/2013, 8,333 stock options vested and became exercisable on 12/31/2014, and 8,334 stock options vested and became exercisable on 12/31/2015.
F58,333 stock options vested and became exercisable on 12/31/2012, 8,333 stock options vested and became exercisable on 12/31/2013, and 8,333 stock options vested and became exercisable on 12/31/2014.
F68,333 stock options vested and became exercisable on 12/31/2011 and were exercised on August 27 2012, 8,333 stock options vested and became exercisable on 12/31/2012, and 8,334 stock options vested and became exercisable on 12/31/2013.
F71/3 of the stock options vested and became exercisable on 12/31/2010, 1/3 of the stock options vested and became exercisable on 12/31/2011 and the remaining stock options vested and became exercisable on 12/31/2012.
F810,000 stock options vested and became exercisable on 12/31/2010 and were exercised on 11/10/2011. 21,666 stock options vested and became exercisable on 12/31/11 and were exercised on 08/27/2012, 35,000 stock options vested and became exercisable on 12/31/2012, 25,000 stock options vested and became exercisable on 12/31/2013, and 13,334 stock options vested and became exercisable on 12/31/2014.
F91/3 of the stock options vested and became exercisable on 12/31/2008, 1/3 of the stock options vested and became exercisable on 12/31/2009; and the remaining stock options vested and became exercisable on 12/31/2010.