SEC Form 4 · accession 0001654954-18-011182
Pharma-Bio Serv, Inc. · PBSV
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Dov Perlysky
Director
Period of report
Oct 15, 2018
Accepted (ET)
Oct 15, 2018 · 8:29 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001304161
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock | Oct 15, 2018 | M | 10,000 | $0.52 | A | 35,310 | D | |
| Common StockF1 | Oct 15, 2018 | F | 5,200 | $1.00 | D | 30,110 | D | |
| Common StockF2 | holding | — | — | — | 1,164,554 | I | Managing Member | |
| Common StockF3 | holding | — | — | — | 772,791 | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock OptionF4 | $0.52 | Oct 15, 2018 | M | 10,000 | D | — | Jan 10, 2023 | Common Stock | 10,000 | 10,000 | D |
Explanation of responses
- F1Represents the aggregate amount of shares of common stock withheld for a cashless exercise.
- F2The Reporting Person is the Managing Member of Krovim LLC, which owns the 1,164,554 shares of common stock reported herein.
- F3The Reporting Person's wife is the Managing Member of LDP Family Partnership, which owns the 772,791 shares of common stock, of which the Reporting Person disclaims beneficial ownership.
- F4The option vests in two equal installments on July 10, 2018 and July 10, 2019.