Statement of Changes in Beneficial Ownership (4)
May 20 2020 - 04:41PM
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).
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
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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 * RAVICH
MARK H |
2. Issuer Name and Ticker or Trading
Symbol ROCKWELL MEDICAL, INC. [ RMTI ] |
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)
C/O ROCKWELL MEDICAL, INC., 411 HACKENSACK AVENUE, SUITE
501 |
3. Date of Earliest Transaction (MM/DD/YYYY)
5/18/2020
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(Street)
HACKENSACK, NJ 07601
(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 |
Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned
|
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) |
Code |
V |
Amount |
(A) or (D) |
Price |
Common Stock |
5/18/2020 |
|
A(1) |
|
30800 |
A |
$0 |
387509 (2) |
D |
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Common Stock |
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|
|
|
|
|
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10000 |
I |
By: Norman and Sally Ravich Family
Trust (3) |
Common Stock |
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|
|
|
|
|
|
25000 |
I |
By: Alexander Coleman Ravich 1991 Irrevocable
Trust (4) |
Common Stock |
|
|
|
|
|
|
|
25000 |
I |
By: Alyssa Danielle Ravich 1991 Irrevocable
Trust (5) |
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
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 |
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 Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct
(D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr.
4) |
Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Stock Option (Right to Buy) |
$2.04 |
5/18/2020 |
|
A |
|
34024 |
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(6) |
5/18/2030 |
Common Stock |
34024.0 |
$0 |
34024 |
D |
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Explanation of
Responses: |
(1) |
Restricted stock units vest
on May 18, 2021, subject to the Reporting Person's continued
service to the Issuer. |
(2) |
Includes 19,759 shares of
common stock underlying unvested restricted stock units that vest
based on the achievement of certain time-based
milestones. |
(3) |
Represents securities owned
directly by Norman and Sally Ravich Family Trust ("NSR Trust"). Mr.
Ravich, as the trustee of NSR Trust, may be deemed to beneficially
own the securities owned directly by NSR Trust. |
(4) |
Represents securities owned
directly by Alexander Coleman Ravich 1991 Irrevocable Trust ("ACR
Trust"). Mr. Ravich, as the trustee of ACR Trust, may be deemed to
beneficially own the securities owned directly by ACR
Trust. |
(5) |
Represents securities owned
directly by Alyssa Danielle Ravich 1991 Irrevocable Trust ("ADR
Trust"). Mr. Ravich, as the trustee of ADR Trust, may be deemed to
beneficially own the securities owned directly by ADR
Trust. |
(6) |
Stock options vest on May
18, 2021, subject to the Reporting Person's continued service to
the Issuer. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
RAVICH MARK H
C/O ROCKWELL MEDICAL, INC.
411 HACKENSACK AVENUE, SUITE 501
HACKENSACK, NJ 07601 |
X |
|
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Signatures
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/s/ Michael G. Costello, Attorney-in-Fact for
Mark H. Ravich |
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5/20/2020 |
**Signature of
Reporting Person |
Date |