Statement of Changes in Beneficial Ownership (4)
October 30 2018 - 10:01AM
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
*
Coelho Mary Theresa
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2. Issuer Name
and
Ticker or Trading Symbol
BALCHEM CORP
[
BCPC
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
Chief Financial Officer
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(Last)
(First)
(Middle)
C/O BALCHEM CORPORATION, 52 SUNRISE PARK ROAD
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3. Date of Earliest Transaction
(MM/DD/YYYY)
10/26/2018
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(Street)
NEW HAMPTON, NY 10958
(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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10/29/2018
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F
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1187
(1)
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D
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$96.42
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2105
(2)
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D
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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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Employee Stock Option (Right to Buy)
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$74.57
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10/26/2018
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A
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1132
(3)
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10/26/2018
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2/15/2028
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Common Stock
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1132
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$0
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3337
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D
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Explanation of Responses:
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(1)
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The Company granted 5,605 restricted shares under the Company's Long-Term Incentive Program. The shares were subject to certain restrictions under the applicable Restricted Stock Grant Agreements. 1,187 of the 3,210 shares that vested October 26, 2018 were withheld to cover withholding taxes due upon vesting.
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(2)
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In connection with a Separation Agreement and General Release (SA&GR) between the Company and the reporting person, 1,050 shares previously reported as beneficially owned in connection with Restricted Stock Grant Agreements were forfeited.
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(3)
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On February 15, 2018, the reporting person was granted an option to purchase 5,030 shares of common stock scheduled to vest in installments of 20%, 40%, and 40% per year over the three-year period. The option reported herein as acquired resulted from the acceleration of vesting of 22.5% of such option in connection with a SA&GR.
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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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Coelho Mary Theresa
C/O BALCHEM CORPORATION
52 SUNRISE PARK ROAD
NEW HAMPTON, NY 10958
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Chief Financial Officer
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Signatures
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/s/ Mary Theresa Coelho, by Attorney in Fact, Mark Stach
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10/29/2018
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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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