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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 | ||||||||
Employee Stock Option (right to buy) | $ 4.37 | 12/31/2017 | D | 5,400 (3) | (3) | (3) | Common Stock | 5,400 | $ 0 | 1,800 (4) | D | ||||
Employee Stock Option (right to buy) | $ 6.35 | 12/31/2017 | D | 34,000 (5) | (5) | (5) | Common Stock | 34,000 | $ 0 | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
MATTHIESSEN ROBERT E C/O INTEST CORP 804 EAST GATE DRIVE, SUITE 200 MT. LAUREL, NJ 08054 |
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/s/ Hugh T. Regan, Jr., Attorney-in-Fact for Robert E. Matthiessen | 01/30/2018 | |
**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) | The shares disposed are unvested restricted shares forfeited as a result of the reporting person's retirement as President and CEO on 12/31/17. Of the total shares forfeited, 7,200 shares (75%) are from the 1/22/16 restricted stock award grant and 11,500 (100%) are from the 3/15/17 restricted stock award granted to the reporting person. |
(2) | The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed to be an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose. |
(3) | The options disposed are unvested employee stock options forfeited as a result of the report person's retirement on 12/31/17. |
(4) | The option is 25% vested and exercisable, but will expire on 12/31/18, the one year anniversary of the reporting person's retirement. |
(5) | The options disposed are unvested employee stock options forfeited as a result of the reporting person's retirement on 12/31/17. The option was completely unvested and therefore was 100% forfeited as of 12/31/17. |