SEC Form 4 · accession 0001140361-16-071941
USA TECHNOLOGIES INC · USAT
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Albin F Moschner
Director
Period of report
Jul 1, 2016
Accepted (ET)
Jul 7, 2016 · 4:32 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000896429
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Jul 1, 2016 | A | 9,479 | $0.00 | A | 417,762 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Non-Qualified Stock Option (Right to Buy)F3,F4 | $2.05 | Mar 7, 2016 | G | 20,000 | D | — | Jun 18, 2021 | Common Stock | 20,000 | 0 | D |
| Non-Qualified Stock Option (Right to Buy)F3,F4 | $2.05 | Mar 7, 2016 | G | 20,000 | A | — | Jun 18, 2021 | Common Stock | 20,000 | 20,000 | I |
| Series A Convertible Preferred StockF2 | — | holding | — | — | — | — | — | Common Stock | 1,358 | 7,000 | D |
Explanation of responses
- F1The shares vest as follows: 3,160 on 7/1/17; 3,160 on 7/1/18; and 3,159 on 7/1/19.
- F2As of April 25, 2016, each share of series A convertible preferred stock was convertible into 0.1940 of a share of common stock at the option of the holder and is subject to further adjustment as provided in the Articles of Incorporation. The shares do not have an expiration date.
- F3Represents non-qualified stock options assigned by Mr. Moschner to the Moschner Family LLC, an Illinois limited liability company, of which Mr. Moschner is the manager.
- F4The options vested or vest as follows: 6,667 on 6/18/15; 6,667 on 6/18/16; and 6,666 on 6/18/17.