SEC Form 3
FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 05/19/2015 | 3. Issuer Name and Ticker or Trading Symbol PERCEPTRON INC/MI [ PRCP ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. 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 Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 3,000 | D | |
Common Stock | 2,000(1) | D | |
Common Stock | 5,400(2) | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Employee Stock Option (right to buy) | (3) | 05/01/2021 | Common Stock | 3,000 | 6.05 | D | |
Employee Stock Option (right to buy) | (4) | 08/31/2021 | Common Stock | 4,500 | 6.14 | D | |
Employee Stock Option (right to buy) | (5) | 09/03/2022 | Common Stock | 8,000 | 5.7 | D | |
Employee Stock Option (right to buy) | (6) | 09/02/2023 | Common Stock | 5,000 | 10.55 | D |
Explanation of Responses: |
1. On October 13, 2014, the reporting person was granted 2,000 shares of Common Stock under the 2004 Stock Incentive Plan, an exempt plan. The shares vest on the first anniversary of the grant date provided the reporting person remains employed with the Issuer as of that date. |
2. On October 13, 2014, the reporting person was granted 5,400 shares of Common Stock under the 2004 Stock Incentive Plan, an exempt plan. Provided the reporting person remains employed with the Issuer on each of the relevant dates, the shares will vest as follows: 1,800 shares on the first anniversary of the grant date; 1,800 shares on the second anniversary of the grant date; and 1,800 shares on the third anniversary of the grant date. |
3. On May 2, 2011, the reporting person was granted an option to purchase 6,000 shares of Common Stock under the 2004 Stock Incentive Plan, an exempt plan, of which 3,000 shares remain outstanding. The option expires ten years from the grant date. |
4. On September 1, 2011, the reporting person was granted an option to purchase 6,000 shares of Common Stock under the 2004 Stock Incentive Plan, an exempt plan, of which 4,500 shares remain outstanding. The option vests 25% annually on the anniversary of the grant date and expires ten years from the grant date. |
5. On September 4, 2012, the reporting person was granted an option to purchase 8,000 shares of Common Stock under the 2004 Stock Incentive Plan, an exempt plan. The option vests 25% annually on the anniversary of the grant date and expires ten years from the grant date. |
6. On September 3, 2013, the reporting person was granted an option to purchase 5,000 shares of Common Stock under the 2004 Stock Incentive Plan, an exempt plan. The option vests 25% annually on the anniversary of the grant date and expires ten years from the grant date. |
Song Yop Chung | 05/27/2015 | |
** 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 5 (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. |