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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 | ||||||||
Forward Industries Common Stock Option | $ 2.02 | 08/12/2010 | M | 10,000 | 08/10/2010(1) | 12/11/2019 | Forward Industries Common Stock | 10,000 | $ 0 | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
SABRA DOUGLAS 7441 BRUNSWICK CIRCLE BOYNTON BEACH, FL 33472 |
former CEO and Director |
James McKenna, by Power of Attorney | 08/16/2010 | |
**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 vesting of these options was accelerated to 8/10/2010 in conjunction with Mr. Sabra's Severance and Release Agreement. Orginal vesting of these shares were as follows: 3,334 vesting on 12/10/2010 3,333 vesting on 12/10/2011 3,333 vesting on 12/10/2012 |
(2) | $3.53 represents the closing stock price of FORD on 8/12/2010, the date the net share exercise was submitted. |
(3) | 5,722 shares were withheld as payment of exercise price ($20,200) for 10,000 options (strike price of $2.02). The number of shares withheld was calculated using the closing stock price on the date of exercise, which was $3.53 on 8/12/2010. |
(4) | Consists of 4,278 shares (representing the net amount of shares issued from 8/12/2010 exercise of options) and 26,666 shares of restricted stock which became fully vested on 8/10/2010 in connection with Mr. Sabra's Seveance and Release Agreement. |