Statement of Changes in Beneficial Ownership (4)
December 09 2020 - 4:59PM
Edgar (US Regulatory)
FORM 4
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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).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
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
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RAVICH MARK H |
2. Issuer Name and Ticker or Trading Symbol
ROCKWELL MEDICAL, INC.
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RMTI
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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)
12/7/2020 |
(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
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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 | 12/7/2020 | | J(1) | | 219905 | D | $1.224 | 0 | I | By: Cindy Libman Irrevocable Trust (2) |
Common Stock | 12/7/2020 | | J(1) | | 219905 | A | $1.224 | 219905 | I | BY: Revocable Trust of Mark H Ravich (3) |
Common Stock | | | | | | | | 203604 (4) | D | |
Common Stock | | | | | | | | 9000 | I | By: Alexander Coleman Ravich 1991 Irrevocable Trust (5) |
Common Stock | | | | | | | | 16000 | I | By: Alyssa Danielle Ravich 1991 Irrevocable Trust (6) |
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) | 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 |
Explanation of Responses: |
(1) | Represents the transfer of shares of common stock from Cindy Libman Irrevocable Trust ("CL Trust") to Revocable Trust of Mark H Ravich ("MHR Trust"). The Reporting Person is the trustee of each of the CL Trust and the MHR Trust. The Reporting Person's total beneficial ownership in the Issuer has not changed, as he was the beneficial owner of these shares both before and after the transfer reported herein. |
(2) | Represents securities owned directly by CL Trust. Mr. Ravich, as the trustee of CL Trust, may be deemed to beneficially own the securities owned directly by CL Trust. |
(3) | Represents securities owned directly by Revocable Trust of Mark H Ravich ("MHR Trust"). Mr. Ravich, as the trustee of MHR Trust, may be deemed to beneficially own the securities owned directly by MHR Trust. |
(4) | Includes 30,800 shares of common stock underlying unvested restricted stock units that vest based on the achievement of certain time-based milestones. |
(5) | 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. |
(6) | 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. |
Reporting Owners
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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 | | 12/9/2020 |
**Signature of Reporting Person | Date |
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