Annual Statement of Changes in Beneficial Ownership (5)
December 30 2019 - 12:23PM
Edgar (US Regulatory)
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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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Form 3 Holdings Reported
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Form 4 Transactions Reported
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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
*
Dwyer Robert V | 2. Issuer Name and Ticker or Trading SymbolMESA LABORATORIES INC /CO [MLAB] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
12100 W 6TH AVE | 3. Statement for Issuer's Fiscal Year Ended (MM/DD/YYYY) 3/31/2019 |
(Street)
LAKEWOOD, CO 80228
(City)
(State)
(Zip)
| 4. If Amendment, Date Original Filed(MM/DD/YYYY) | 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) | 2. Trans. Date | 2A. Deemed Execution Date, if any | 3. Trans. Code (Instr. 8) | 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) |
Amount | (A) or (D) | Price |
Common Stock | 11/21/2018 | | G | 5349 | D | $0 | 0 | I | By grantor retained annuity trust (1) |
Common Stock | 3/28/2019 | | G | 9173 | D | $0 | 0 | I | By grantor retained annuity (2) |
Common Stock | 3/31/2019 | | P | 0 | A | $0 | 43016 | D | |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (MM/DD/YYYY) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
(1) | In connection with the termination of Robert V. Dwyer, Jr. 2015 Grantor Retained Annuity Trust previously established by the reporting person, 5,349 shares of common stock were distributed to the adult children of the reporting person. The remaining 14,651 shares were previously distributed to the reporting person and continue to be reported in this form as directly owned. |
(2) | In connection with the termination of the Robert V. Dwyer, Jr. 2016 Grantor Retained Annuity Trust II previously established by the reporting person, 9,173 shares of common stock were distributed to the adult children of the reporting person. The remaining 10,827 shares were previously distributed to the reporting person and continue to be reported in this form as directly owned. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Dwyer Robert V 12100 W 6TH AVE LAKEWOOD, CO 80228 | X |
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Signatures
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Robert Dwyer | | 12/30/2019 |
**Signature of Reporting Person | Date |
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