Initial Statement of Beneficial Ownership (3)
October 02 2019 - 4:24PM
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
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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
*
Staley Allan Richard |
2. Date of Event Requiring Statement (MM/DD/YYYY)
9/27/2019
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3. Issuer Name and Ticker or Trading Symbol
MISONIX INC [MSON]
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(Last)
(First)
(Middle)
C/O MISONIX, INC., 1938 NEW HIGHWAY |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner ___X___ Officer (give title below) _____ Other (specify below) PRESIDENT / |
(Street)
FARMINGDALE, NY 11735
(City)
(State)
(Zip)
| 5. 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 Beneficially Owned
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1.Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 214311 (1) | D | |
Common Stock | 22540 (1) | I | By Solsys NN, LLC |
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) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) |
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
(1) | 42,750 and 2,311 of the shares of Common Stock issued to Mr. Staley and Solsys NN, LLC, respectively, are being held in escrow and are subject to forfeiture during the 15-month period following the effective date of the merger, pursuant to the Agreement and Plan of Merger between Misonix, Inc., New Misonix, Inc., Motor Reincorp. Sub One, Inc., Surge Sub Two, LLC, Solsys Medical, LLC, and Greg Madden solely in his capacity as representative, to satisfy any post-closing purchase price adjustments and indemnification claims. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Staley Allan Richard C/O MISONIX, INC. 1938 NEW HIGHWAY FARMINGDALE, NY 11735 |
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| PRESIDENT |
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Signatures
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/s/ Allan Staley | | 10/1/2019 |
**Signature of Reporting Person | Date |
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