Statement of Changes in Beneficial Ownership (4)
August 23 2016 - 11:32AM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
HOLT ALYN R
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2. Issuer Name
and
Ticker or Trading Symbol
INTEST CORP
[
INTT
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
__
X
__ 10% Owner
__
X
__ Officer (give title below)
__
X
__ Other (specify below)
Exec Chairman
/
Member of 10% 13d Group
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(Last)
(First)
(Middle)
C/O INTEST CORP, 804 EAST GATE DR., SUITE 200
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3. Date of Earliest Transaction
(MM/DD/YYYY)
8/19/2016
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(Street)
MT. LAUREL, NJ 08054
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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8/19/2016
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S
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3034
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D
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$4
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1124972
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D
(1)
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Common Stock
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150427
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I
(2)
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By Trust under the Will of deceased Spouse
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Common Stock
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178598
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I
(3)
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By Daughter
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Common Stock
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260000
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I
(4)
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By 2003 Trust
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Common Stock
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115000
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I
(5)
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By 2000 Trust
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(
1)
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These shares are owned solely by Alyn R. Holt. Mr. Holt is a member of a "13d Group" with Kristen Holt Thompson, the Alyn R. Holt Trust FBO Kristen Holt Thompson u/a dated 4/14/03 ("2003 Trust"), the Holt Charitable Remainder Unitrust u/a dated 5/22/00 ("2000 Trust"), and a Testamentary Trust established under the will of the reporting person's deceased spouse for purposes of Section 13(d) of the Exchange Act.
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(
2)
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These shares are owned solely by a Testamentary Trust established under the will of the reporting person's deceased spouse for the benefit of the reporting person's daughter, and this report shall not be deemed to be an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
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(
3)
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These shares are owned solely by the reporting person's daughter. The reporting person gained attributable beneficial ownership in these shares when his daughter moved into his household. The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed to be an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
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(
4)
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These shares are owned solely by the 2003 Trust established for the benefit of the reporting person's daughter. The reporting person gained attributable beneficial ownership in these shares when his daughter moved into his household. The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed to be an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
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(
5)
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These shares are owned solely by the 2000 Trust of which the reporting person is trustee and of which the reporting person is the sole non-charitable beneficiary, and this report shall not be deemed to be an admission that the report person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except to the extent of his pecuniary interest therein.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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HOLT ALYN R
C/O INTEST CORP
804 EAST GATE DR., SUITE 200
MT. LAUREL, NJ 08054
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X
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X
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Exec Chairman
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Member of 10% 13d Group
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Signatures
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/s/ Alyn R. Holt
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8/23/2016
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
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