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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 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 (Month/Day/Year) |
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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
non-qualified stock options | $ 5.19 | 02/02/2006 | 01/01/2015 | common stock | 100,000 | 100,000 | D | ||||||||
non-qualified stock options | $ 2.65 | 01/29/2014 | M | 12,500 | 02/02/2008(4) | 02/01/2014 | common stock | 12,500 | $ 0 | 0 | D | ||||
non-qualified stock options | $ 0.85 | 01/29/2014 | M | 40,000 | 06/05/2009(4) | 06/04/2014 | common stock | 40,000 | $ 0 | 0 | D | ||||
non-qualified stock options | $ 4.94 | 06/08/2011(5) | 06/07/2017 | common stock | 6,525 | 6,525 | D | ||||||||
non-qualified stock option | $ 7.98 | 06/07/2012(5) | 06/06/2018 | common stock | 4,100 | 4,100 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
HOLMAN SUSAN HARTJES UROPLASTY, INC 5420 FELTL ROAD MINNETONKA, MN 55343 |
Sr VP Operations & Regulatory |
Larry E. Bakeman | 01/30/2014 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Includes 1,275 shares of restricted stock subject to risk of forfeiture that will lapse June 8, 2014. |
(2) | Includes 1,575 shares of restricted stock subject to risk of forfeiture that will lapse with respect to one half of such shares on June 7, 2014 and June 7, 2015 respectively. |
(3) | Includes 9,825 shares of restricted stock subject to risk of forfeiture that lapses with respect to one third of such shares on each of the second, third and fourth anniversaries of the grant date (June 7, 2012). |
(4) | Becomes exercisable with respect to one-third of the shares on such date, and an additional, cumulative one-third on the first and second anniversary of such date. |
(5) | Becomes exercisable with respect to one-third of the shares on the first, second and third anniversaries of the grant date (the grant date being one year prior to such date). |
(6) | The price reported in Column 4 is a weighted average price. These shares were purchased in multiple transactions at prices ranging from $4.18 to $4.821 per share, inclusive. The reporting person undertakes to provide to Uroplasty, Inc., any security holder of Uroplasty, Inc, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares purchased at each separate price within the ranges set forth in this footnote (6). |
Remarks: Signature is on behalf of Susan Hartjes Holman |