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) 04/11/2022 | 3. Issuer Name and Ticker or Trading Symbol CHEMBIO DIAGNOSTICS, INC. [ CEMI ] | |||||||||||||
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 | 7,885 | 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 | ||||
Incentive stock options | (1) | 10/27/2026 | Common Stock | 29,883 | 5.61 | D | |
Incentive stock options | (2) | 03/14/2031 | Common Stock | 65,476 | 4.65 | D | |
Restricted stock units | (3) | (3) | Common Stock | 10,594 | (4) | D | |
Restricted stock units | (5) | (5) | Common Stock | 15,771 | (4) | D |
Explanation of Responses: |
1. The incentive stock options are scheduled to vest in three equal installments on October 28 of each of 2020, 2021 and 2022, subject to continued service through each vesting date. |
2. The incentive stock options are scheduled to vest in four equal installments on March 15 of each of 2022, 2023, 2024 and 2025, subject to continued service through each vesting date. |
3. The restricted stock units are scheduled to vest on October 28, 2022, subject to continued service through each vesting date. |
4. Each restricted stock unit represents a contingent right to receive one share of common stock. |
5. The restricted stock units are scheduled to vest in two equal installments on March 15 of each of 2023 and 2024, subject to continued service through each vesting date. |
Remarks: |
Executive Vice President and Chief Operations Officer Exhibit List: Exhibit 24 - Power of Attorney |
/s/ Mark L. Johnson, Attorney-in-Fact for Paul Angelico | 04/27/2022 | |
** 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 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. |