| 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) 02/20/2017 | 3. Issuer Name and Ticker or Trading Symbol ROCKWELL MEDICAL, INC. [ RMTI ] | |||||||||||||
| 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(1) | 284,750 | D | |
| Common Stock(1) | 44,400 | I | By: Norman J. Ravich Irrevocable Trust(2) |
| Common Stock(1) | 25,000 | I | By: Alexander Coleman Ravich 1991 Irrevocable Trust(3) |
| Common Stock(1) | 25,000 | I | By: Alyssa Danielle Ravich 1991 Irrevocable Trust(4) |
| 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 | ||||
| Call Option (right to buy) | (6) | 05/19/2017 | Common Stock(1) | 30,000 | 6 | D | |
| Call Option (right to buy) | (6) | 05/19/2017 | Common Stock(1) | 20,000 | 7 | D | |
| Call Option (right to buy) | (6) | 05/19/2017 | Common Stock(1) | 20,000 | 8 | D | |
| Call Option (right to buy) | (6) | 05/19/2017 | Common Stock(1) | 10,000 | 6 | I | By: Norman and Sally Ravich Family Trust(5) |
| Call Option (right to buy) | (6) | 05/19/2017 | Common Stock(1) | 8,500 | 7 | I | By: Norman and Sally Ravich Family Trust(5) |
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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| Explanation of Responses: |
| 1. This Form 3 is filed jointly by Norman J. Ravich Irrevocable Trust ("NJR Trust"), Norman and Sally Ravich Family Trust ("NSR Trust"), Alexander Coleman Ravich 1991 Irrevocable Trust ("ACR Trust"), Alyssa Danielle Ravich 1991 Irrevocable Trust ("ADR Trust") and Mark H. Ravich (collectively, the "Reporting Persons"). Each of the Reporting Persons may be deemed to be a member of a Section 13(d) group that may be deemed to collectively beneficially own more than 10% of the Issuer's outstanding shares of Common Stock. Each of the Reporting Persons disclaims beneficial ownership of the securities reported herein except to the extent of his or its pecuniary interest therein. The filing of this Form 3 shall not be deemed an admission that the Reporting Persons are, for purposes of Section 13(d) of the Securities Exchange Act of 1934, as amended, the beneficial owners of any securities of the Issuer he or it does not directly own. |
| 2. Represents securities owned directly by NJR Trust. Mr. Ravich, as the trustee of NJR Trust, may be deemed to beneficially own the securities owned directly by NJR Trust. |
| 3. Represents securities owned directly by ACR Trust. Mr. Ravich, as the trustee of ACR Trust, may be deemed to beneficially own the securities owned directly by ACR Trust. |
| 4. Represents securities owned directly by ADR Trust. Mr. Ravich, as the trustee of ADR Trust, may be deemed to beneficially own the securities owned directly by ADR Trust. |
| 5. Represents securities owned directly by NSR Trust. Mr. Ravich, as the trustee of NSR Trust, may be deemed to beneficially own the securities owned directly by NSR Trust. |
| 6. The Call Options reported herein are currently exercisable. |
| By: /s/ Mark H. Ravich | 03/02/2017 | |
| By: Norman J. Ravich Irrevocable Trust, By: /s/ Mark H. Ravich, Trustee | 03/02/2017 | |
| By: Norman and Sally Ravich Family Trust, By: /s/ Mark H. Ravich, Trustee | 03/02/2017 | |
| By: Alexander Coleman Ravich 1991 Irrevocable Trust, By: /s/ Mark H. Ravich, Trustee | 03/02/2017 | |
| By: Alyssa Danielle Ravich 1991 Irrevocable Trust, By: /s/ Mark H. Ravich, Trustee | 03/02/2017 | |
| ** 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. | ||
