SEC Form 4 · accession 0001437749-17-011613
SPAN AMERICA MEDICAL SYSTEMS INC · SPAN
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
William Derrill Darby
Officer — Director - Quality
Period of report
Jun 16, 2017
Accepted (ET)
Jun 21, 2017 · 12:02 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000718924
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Common stockF2 | $14.90 | Jun 16, 2017 | D | 3,000 | D | Jul 1, 2011 | Nov 9, 2020 | Common stock | 3,000 | 0 | D |
Explanation of responses
- F1Pursuant to a Stock Option Cancellation Agreement dated May 1, 2017 by and between Span-America and the Reporting Person, the stock option was cancelled as of the Effective Date of the Merger contemplated in the Merger Agreement, and the Reporting Person received a lump sum cash payment from Span-America in an amount equal to the number of shares subject to that stock option multiplied by an amount equal to $29.00 minus the exercise price of that stock option.
- F2Exercisable at the rate of 1,000 shares on noted date and an additional 1,000 shares on each anniversary of noted date.