Initial Statement of Beneficial Ownership (3)
2015年5月28日 - 6:57AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
Estimated average burden
hours per response...
0.5
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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
*
Song Yop Chung
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2. Date of Event Requiring Statement (MM/DD/YYYY)
5/19/2015
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3. Issuer Name
and
Ticker or Trading Symbol
PERCEPTRON INC/MI [PRCP]
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(Last)
(First)
(Middle)
47827 HALYARD DRIVE
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
___
X
___ Officer (give title below)
_____ Other (specify below)
Sr. Vice President, CTO /
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(Street)
PLYMOUTH, MI 48170
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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3000
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D
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Common Stock
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2000
(1)
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D
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Common Stock
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5400
(2)
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Employee Stock Option (right to buy)
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(3)
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5/1/2021
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Common Stock
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3000
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$6.05
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D
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Employee Stock Option (right to buy)
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(4)
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8/31/2021
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Common Stock
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4500
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$6.14
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D
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Employee Stock Option (right to buy)
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(5)
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9/3/2022
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Common Stock
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8000
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$5.7
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D
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Employee Stock Option (right to buy)
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(6)
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9/2/2023
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Common Stock
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5000
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$10.55
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D
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Explanation of Responses:
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(
1)
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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.
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(
2)
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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.
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(
3)
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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.
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(
4)
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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.
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(
5)
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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.
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(
6)
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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.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Song Yop Chung
47827 HALYARD DRIVE
PLYMOUTH, MI 48170
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Sr. Vice President, CTO
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Signatures
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Song Yop Chung
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5/27/2015
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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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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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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