SEC Form 4 · accession 0001140361-17-037938
Lifeloc Technologies, Inc · LCTC
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Wayne Willkomm
Officer — CEO and President · Director
Period of report
Oct 1, 2017
Accepted (ET)
Oct 10, 2017 · 11:25 am EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001493137
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Options (Right to Buy)F1 | $8.83 | Oct 1, 2017 | D | 50,000 | D | — | Jan 18, 2026 | Common Stock | 50,000 | 50,000 | D |
| Stock Options (Right to Buy)F2 | $6.00 | Oct 1, 2017 | A | 50,000 | A | — | Oct 1, 2027 | Common Stock | 50,000 | 50,000 | D |
Explanation of responses
- F1The stock options were granted under the issuer's 2013 Stock Option Plan, and were subject to performance-based vesting based on the achievement of certain performance conditions set forth in the employment agreement between the issuer and the reporting person. The stock options were forfeited in connection with execution of an amended and restated employment agreement, which provided for revised performance metrics and a revised exercise price.
- F2The stock options were granted under the issuer's 2013 Stock Option Plan, and are subject to performance-based vesting based on the achievement of certain performance conditions set forth in the amended and restated employment agreement between the issuer and the reporting person.