Initial Statement of Beneficial Ownership (3)
December 14 2018 - 6:25AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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
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Marques Manuel A
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2. Date of Event Requiring Statement (MM/DD/YYYY)
12/5/2018
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3. Issuer Name
and
Ticker or Trading Symbol
REPRO MED SYSTEMS INC [REPR]
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(Last)
(First)
(Middle)
REPRO MED SYSTEMS, INC., 24 CARPENTER ROAD
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
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X
___ Officer (give title below)
_____ Other (specify below)
Chief Operating Officer /
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(Street)
CHESTER, NY 10918
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
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X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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0
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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. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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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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Options to Purchase Common Stock
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11/18/2017
(1)
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11/18/2020
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Common Stock
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95000
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$0.36
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D
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Options to Purchase Common Stock
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7/28/2019
(2)
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7/28/2022
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Common Stock
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50000
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$0.46
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D
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Options to Purchase Common Stock
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(3)
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10/11/2022
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Common Stock
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250000
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$0.50
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D
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Explanation of Responses:
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(1)
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REPRO MED SYSTEMS, INC. d/b/a RMS Medical Products (the "Company") awarded Mr. Marques these incentive stock options on November 18, 2015 under the Company's 2015 Stock Option Plan, as amended. These options are subject to acceleration in certain instances of mergers, consolidations, or sales or transfers by the Company of substantially all of its assets. As of 11/18/2017 these options are fully vested.
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(2)
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The Company awarded Mr. Marques these incentive stock options on July 28, 2017 under the Company's 2015 Stock Option Plan, as amended. These options will vest on July 28, 2019. These options are subject to acceleration in certain instances of mergers, consolidations, or sales or transfers by the Company of substantially all of its assets.
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(3)
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The Company awarded Mr. Marques these incentive stock options on October 11, 2017 under the Company's 2015 Stock Option Plan, as amended. The options vest at a rate of 15,625 every three months following October 11, 2017 until fully vested. These options are subject to acceleration in certain instances of termination without cause.
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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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Marques Manuel A
REPRO MED SYSTEMS, INC.
24 CARPENTER ROAD
CHESTER, NY 10918
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Chief Operating Officer
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Signatures
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/s/ Manuel A. Marques
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12/13/2018
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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 5(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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