Sec Form 4 Filing - Balak Salesh @ UNIVERSAL BIOSENSORS INC - 2017-10-24

Insider filing report for Changes in Beneficial Ownership
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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
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Balak Salesh
2. Issuer Name and Ticker or Trading Symbol
UNIVERSAL BIOSENSORS INC [ UBI]
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
(Last) (First) (Middle)
1 CORPORATE AVENUE, ROWVILLE
3. Date of Earliest Transaction (MM/DD/YY)
10/24/2017
(Street)
VICTORIA, C33178
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction 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 10/24/2017 M 16,667 A $ 0 99,058 ( 11 ) D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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) $ 0.5 ( 1 ) ( 10 ) 04/20/2023 Common Stock 721,000 721,000 D
Stock Option (Right to Buy) $ 0 ( 2 ) 01/29/2022 Common Stock 40,000 40,000 D
Stock Option (Right to Buy) $ 0 ( 3 ) 12/11/2020 Common Stock 40,000 40,000 D
Stock Option (Right to Buy) $ 0 ( 4 ) 11/12/2019 Common Stock 25,000 25,000 D
Stock Option (Right to Buy) $ 0 ( 5 ) 11/17/2018 Common Stock 25,000 25,000 D
Stock Option (Right to Buy) $ 0 10/24/2017 M 16,667 ( 6 ) 11/10/2017 Common Stock 16,667 $ 0 0 D
Stock Option (Right to Buy) $ 1.72 ( 1 ) ( 7 ) 11/09/2019 Common Stock 100,000 100,000 D
Stock Option (Right to Buy) $ 0 ( 8 ) 06/28/2019 Common Stock 73,334 73,334 D
Stock Option (Right to Buy) $ 0.89 ( 1 ) ( 9 ) 03/16/2018 Common Stock 100,000 100,000 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Balak Salesh
1 CORPORATE AVENUE
ROWVILLE
VICTORIA, C33178
Chief Financial Officer
Signatures
s/ Cameron Billingsley, Attorney-in-Fact 10/26/2017
Signature of Reporting Person Date
Explanation of Responses:
( 1 )The price reported is stated in Australian dollars.
( 2 )13,333 stock options vested and became exercisable on 12/31/2015, 13,333 stock options vested and became exercisable on 12/31/2016, and 13,334 stock options vest and become exercisable on 12/31/2017.
( 3 )13,333 stock options vested and became exercisable on 12/31/2014, 13,333 stock options vested and became exercisable on 12/31/2015, and 13,334 stock options vested and became exercisable on 12/31/2016.
( 4 )8,333 stock options vested and became exercisable on 12/31/2013, 8,333 stock options vested and became exercisable on 12/31/2014, and 8,334 stock options vested and became exercisable on 12/31/2015.
( 5 )8,333 stock options vested and became exercisable on 12/31/2012, 8,333 stock options vested and became exercisable on 12/31/2013, and 8,333 stock options vested and became exercisable on 12/31/2014.
( 6 )8,333 stock options vested and became exercisable on 12/31/2011 and were exercised on August 27 2012, 8,333 stock options vested and became exercisable on 12/31/2012, and 8,334 stock options vested and became exercisable on 12/31/2013.
( 7 )1/3 of the stock options vested and became exercisable on 12/31/2010, 1/3 of the stock options vested and became exercisable on 12/31/2011 and the remaining stock options vested and became exercisable on 12/31/2012.
( 8 )10,000 stock options vested and became exercisable on 12/31/2010 and were exercised on 11/10/2011. 21,666 stock options vested and became exercisable on 12/31/11 and were exercised on 08/27/2012, 35,000 stock options vested and became exercisable on 12/31/2012, 25,000 stock options vested and became exercisable on 12/31/2013, and 13,334 stock options vested and became exercisable on 12/31/2014.
( 9 )1/3 of the stock options vested and became exercisable on 12/31/2008, 1/3 of the stock options vested and became exercisable on 12/31/2009; and the remaining stock options vested and became exercisable on 12/31/2010.
( 10 )206,000 of the stock options vested and became exercisable on October 5, 2016, 412,000 of the stock options vested and became exerciseable on December 31, 2016 and 103,000 of the stock options vested and became exercisable on February 23, 2017.
( 11 )Includes (i) 89,181 shares in the form of CDIs Mr. Balak holds directly and (ii) 9,877 restricted fully paid shares.

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