Statement of Changes in Beneficial Ownership (4)
2022年7月7日 - 8:01AM
Edgar (US Regulatory)
FORM 4
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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).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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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
*
Orzechowski Frank |
2. Issuer Name and Ticker or Trading Symbol
SIGMA LABS, INC.
[
SASI
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) CFO, PFO and PAO |
(Last)
(First)
(Middle)
3900 PASEO DEL SOL |
3. Date of Earliest Transaction
(MM/DD/YYYY)
7/1/2022 |
(Street)
SANTA FE, NM 87507
(City)
(State)
(Zip)
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4. 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 Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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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. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: 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 |
Stock Option (right to buy) | $2.50 | 7/1/2022 | | A | | 52170 | | (1) | 7/1/2027 | Common Stock | 52170 | $0 | 52170 | D | |
Stock Appreciation Right | $1.30 | 7/1/2022 | | A | | 97038 | | (2) | 7/1/2027 | Common Stock | 97038 | $0 | 97038 | D | |
Stock Appreciation Right | $2.50 | 7/1/2022 | | A | | 69470 | | (3) | 7/1/2027 | Common Stock | 69470 | $0 | 69470 | D | |
Explanation of Responses: |
(1) | The stock option vests, as follows: (i) 13,043 shares subject to the option vested on the date of grant, and (ii) the remaining 39,127 shares will vest in equal (as nearly as possible) monthly installments over the succeeding 36 months, subject, in each case, to the Reporting Person remaining an employee of the Issuer on the applicable vesting date. |
(2) | The stock appreciation right ("SAR") is payable in cash only, and vests on March 15, 2025, subject to the Reporting Person being in the continuous employ of the Issuer on the vesting date. |
(3) | The SAR is payable in cash only and vests as follows: (i) 25% of the SAR vested on the date of grant, and (ii) the balance of the SAR will vest in equal (as nearly as possible) monthly installments over the succeeding 36 months, subject, in each case, to the Reporting Person remaining an employee of the Issuer on the applicable vesting date. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Orzechowski Frank 3900 PASEO DEL SOL SANTA FE, NM 87507 |
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| CFO, PFO and PAO |
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Signatures
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/s/ Frank Orzechowski | | 7/6/2022 |
**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 control number. |
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