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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 | ||||||||
Series A Convertible Preferred Stock | $ 0.48 | 12/19/2007 | C | 38.7444 | 05/04/2005 | (7) | Common Stock | 2,421,526 | (1) | 0 | D | ||||
Series B Convertible Preferred Stock | $ 0.48 | 12/19/2007 | C | 1.0854 | 01/29/2005 | (7) | Common Stock | 113,067 | (3) | 0 | D | ||||
Warrant (right to buy) | $ 0.4 | 12/19/2007 | C | 337,500 | (8) | (9) | Common Stock | 337,500 | (6) | 2,205,731 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Siebert Lawrence A. 3661 HORSEBLOCK ROAD MEDFORD, NY 11763 |
X | X | Chairman & President |
Lawrence A. Siebert | 12/21/2007 | |
**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) | The reporting person converted 38.74442 shares of Series A Convertible Preferred Stock at a conversion price of $.48 per share in conjunction with the closing of the Company's plan to simplify its capital structure announced in its Form 8K on December 19, 2007 the Plan, resulting in his acquisition of 2,421,526 shares of Common Stock. |
(2) | The amount shown in column 5 assume completion of all the transactions reported on this form. |
(3) | The reporting person converted 1.08545 share of Series B Convertible Preferred Stock at a conversion price of $0.48 per share in conjunction with the closing of the Plan, resulting in his acquisition of 113,067 shares of Common Stock. |
(4) | Acquired as payment of dividend on Series A Preferred Stock of Chembio Diagnostics, Inc. |
(5) | Acquired as payment of dividend on Series B Preferred Stock of Chembio Diagnostics, Inc. |
(6) | The reporting person converted 259,632 and 77,868 Warrant Shares, originally priced at $0.90 and $0.61 respectively, at a conversion price of $0.40 per share in accordance with the Plan, resulting in his acquisition of 337,500. |
(7) | Does not expire. |
(8) | 259,632 exercisable as of 05/04/2004 and 77,868 exercisable as of 1/29/2005 |
(9) | 259,632 expire on 05/04/2009 and 77,868 expire on 1/29/2010 |