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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 | ||||||||
Options to Purchase Common Stock | $ 0.12 | 10/19/2012 | A | 525,000 | (1) | 10/19/2017 | Common Stock | 525,000 | $ 0 (2) | 1,025,000 (3) | D | ||||
Options to Purchase Common Stock | $ 0.21 | 10/19/2012 | A | 225,000 | (4) | 10/19/2017 | Common Stock | 225,000 | $ 0 (2) | 1,250,000 (3) | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Chin Neil C/O 6135 NW 167 STREET SUITE E-21 MIAMI LAKES, FL 33015 |
X |
/s/Neil Chin | 10/22/2012 | |
**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) | Options vest in quarterly installments over a two (2) year period from the grant date (subject to acceleration in the event of a merger, asset sale or other "change in control" as defined in Fuse Science Inc.'s Incentive Stock Plan), contingent on continued services as a director. |
(2) | Options were issued pursuant to Fuse Science Inc.'s 2011 Incentive Stock Plan. |
(3) | Includes 500,000 stock options previously issued pursuant to the 2011 Incentive Stock Plan to purchase common stock, 400,000 of which are exercisable at $0.0339 per share and 100,000 of which are exercisable at $0.28 per share. |
(4) | Options vest in quarterly installments over a two (2) year period from the grant date (subject to acceleration in the event of a merger, asset sale or other "change in control" as defined in Fuse Science Inc.'s 2011 Incentive Stock Plan), contingent on continued service as a director and the approval by Fuse's board of directors and shareholders of an amendment to the 2011 Incentive Stock Plan increasing the number of shares of common stock reserved thereunder for issuance by at least 3,000,000 shares. |