Universal Biosensors (UVBIF) Form 4 UNIVERSAL BIOSENSORS / Salesh Balak ownership change

SEC Form 4

FORM 4

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
or Section 30(h) of the Investment Company Act of 1940

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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

1. Name and Address of Reporting Person^*

Balak Salesh

(Last) (First) (Middle)

1 CORPORATE AVENUE

ROWVILLE

(Street)

VICTORIA C3 3178

(City) (State) (Zip)

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

3. Date of Earliest Transaction (Month/Day/Year)
08/19/2021

4. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	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	08/19/2021		M		40,000	A	$0	306,558(1)	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 (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 Securities Underlying Derivative Security (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: 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
Performance Rights	(7)	08/19/2021		A		500,000		(7)	03/24/2025	Common Stock	500,000	$0	500,000	D
Performance Rights	(8)	08/19/2021		A		250,000		(8)	03/24/2025	Common Stock	250,000	$0	250,000	D
Stock Option (Right to Buy)	$0.3(2)							(3)	03/24/2025	Common Stock	500,000		500,000	D
Stock Option (Right to Buy)	$0.5(2)							(4)	04/20/2023	Common Stock	721,000		721,000	D
Stock Option (Right to Buy)	$0.5(2)							(5)	02/27/2024	Common Stock	216,300		216,300	D
Stock Option (Right to Buy)	$0	08/19/2021		M			40,000	(6)	01/29/2022	Common Stock	40,000	$0	0	D

Explanation of Responses:

1. Includes (i) 302,392 shares in the form of CDIs Mr. Balak holds directly and (ii) 4,166 restricted fully paid shares.

2. The price reported is stated in Australian dollars.

3. The options are fully vested but can only be exercised after 03/01/2021.

4. 206,000 of the stock options vested and became exercisable on 10/05/2016, 412,000 of the stock options vested and became exercisable on 12/31/2016 and 103,000 of the stock options vested and became exercisable on 02/23/2017.

5. 216,300 stock options vested and became exercisable on 12/31/2017.

6. 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 vested and became exercisable on 12/31/2017. These options were exercised on 08/19/2021.

7. Each performance right represents a contingent right to receive one share of common stock of Universal Biosensors, Inc. ("UBI"). The performance rights vest upon, among other triggers, UBI's market capitalization having achieved a specified threshold.

8. Each performance right represents a contingent right to receive one share of common stock of UBI. The performance rights vest upon a change of control transaction with a value greater a specified threshold.

	/s/ Salesh Balak	09/14/2021
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* 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).
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