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*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
UNIVERSAL BIOSENSORS INC [ UBI ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 03/25/2024 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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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(1) | 03/25/2024 | P | 1,000,000 | A | $0.2(2) | 56,798,601 | I | By Partnership(3)(4)(6) | ||
Stock Option (Right to Buy - Exercise Price $0.92)(2) | 1,920,000 | I | By Partnership(3)(7) | |||||||
Stock Option (Right to Buy - Exercise Price $1.00)(2) | 1,920,000 | I | By Partnership(3)(8) | |||||||
Common Stock(1) | 753,620 | I | By the Coleman Super Fund(5) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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 |
Explanation of Responses: |
1. Traded as Chess Depository Interests ("CDIs") on the Australian Stock Exchange. CDIs represent beneficial interests in the common stock held by CHESS Depository Nominees Pty Ltd. |
2. The price reported is stated in Australian dollars. |
3. The Reporting Person is a director of Viburnum, which is the manager of each of VF Strategic Equities Fund ("Strategic Fund") and separately managed accounts on behalf of a Viburnum client ("Strategic Mandates") the direct beneficial owners of the common stock and stock options. The Reporting Person disclaims beneficial ownership within the meaning of Section 16 of the Securities Exchange Act of 1934, as amended, or otherwise of the common stock and stock options held by Strategic Fund, and Strategic Mandates, except to the extent of his pecuniary interest therein. |
4. Viburnum, as the manager of Strategic Fund and Strategic Mandates, may be deemed to beneficially own 56,798,601 shares of common stock, which consists of 23,169,559 and 33,629,042 shares of common stock held by Strategic Fund and Strategic Mandates, respectively. Viburnum, as the manager of each of Strategic Fund and Strategic Mandates, shares voting and dispositive power over, and may be deemed to beneficially own, the common stock held by the foregoing entities. The Reporting Person shares voting and dispositive power over, and may be deemed to beneficially own, the common stock held by the foregoing entities due to the Reporting Person serving as a director of Viburnum. |
5. Craig E. and Phylis Coleman are the trustees of the Coleman Super Fund, of which Mr. Coleman is a potential beneficiary. |
6. Viburnum, as the manager of Strategic Fund converted 1,000,000 stock options which an exercise price of A$0.20 on 03/25/2024. |
7. Viburnum, as the manager of Strategic Fund and Strategic Mandates, may be deemed to beneficially own 1,920,000 stock options which an exercise price of A$0.92 and expiry date of 05/26/2025. |
8. Viburnum, as the manager of Strategic Fund and Strategic Mandates, may be deemed to beneficially own 1,920,000 stock options which an exercise price of A$1.00 and expiry date of 05/26/2025. |
/s/ David St. Quintin, as attorney-in-fact | 03/26/2024 | |
** 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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
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 Number. |