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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) |
7. Title and Amount of Underlying Securities (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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
''Right to buy'' common stock options | $ 0.215 | 03/10/2015 | D | 40,000 | 08/27/2013 | 08/27/2020 | Common Stock | 40,000 | (2) | 0 | D | ||||
''Right to buy'' common stock options | $ 0.1 | 03/10/2015 | D | 40,000 | 08/27/2012 | 08/27/2019 | Common Stock | 40,000 | (3) | 0 | D | ||||
''Right to buy'' common stock options | $ 0.085 | 03/10/2015 | D | 40,000 | 08/29/2011 | 08/29/2018 | Common Stock | 40,000 | (4) | 0 | D | ||||
''Right to buy'' common stock options | $ 0.107 | 03/10/2015 | D | 40,000 | 09/28/2010 | 09/28/2017 | Common Stock | 40,000 | (5) | 0 | D | ||||
''Right to buy'' common stock options | $ 0.099 | 03/10/2015 | D | 40,000 | 10/06/2009 | 10/06/2016 | Common Stock | 40,000 | (6) | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Gouze Stephen P 11575 MAIN STREET, SUITE 400 BROOMFIELD, CO 80020 |
X |
/s/ Stephen P. Gouze | 03/11/2015 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Disposed of in exchange for a cash payment of $0.27 per share pursuant to that certain Agreement and Plan of Merger, dated as of August 27, 2014, by and among Corgenix Medical Corp ("Corgenix"), Centennial Medical Holdings, Inc. ("Centennial") and Centennial Integrated, Inc., a wholly owned subsidiary of Centennial, pursuant to which Corgenix has been acquired by Centennial (the "Merger"). |
(2) | This option, which has vested in full, was cancelled in the Merger in exchange for a cash payment of $2,200, representing (a) the number of shares underlying the option, multiplied by (b) the excess of $0.27 over the exercise price per share of the option (the "Option Merger Consideration"). |
(3) | This option, which has vested in full, was cancelled in the Merger in exchange for a cash payment of $6,800, representing the Option Merger Consideration. |
(4) | This option, which has vested in full, was cancelled in the Merger in exchange for a cash payment of $7,400, representing the Option Merger Consideration. |
(5) | This option, which has vested in full, was cancelled in the Merger in exchange for a cash payment of $6,520, representing the Option Merger Consideration. |
(6) | This option, which has vested in full, was cancelled in the Merger in exchange for a cash payment of $6,840, representing the Option Merger Consideration. |