Statement of Changes in Beneficial Ownership (4)
February 07 2022 - 5:21PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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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
*
Shameze Rampertab |
2. Issuer Name and Ticker or Trading Symbol
ASENSUS SURGICAL, INC.
[
ASXC
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
__X__ Officer (give title below) _____ Other (specify below)
EVP, Chief Financial Officer |
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(Last)
(First)
(Middle)
C/O ASENSUS SURGICAL, INC., 1 TW ALEXANDER DRIVE, SUITE 160 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
2/4/2022 |
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(Street)
DURHAM, NC 27703
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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| Common Stock | 2/4/2022 | | M | | 98608 | A | $0.00 | 110717 | D | |
| Common Stock | 2/4/2022 | | F(1) | | 26711 | D | $0.80 | 84006 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 7. Title and Amount of Securities Underlying Derivative Security
(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) |
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
| Stock Options | $0.80 | 2/4/2022 | | A | | 222500 | | (2) | 2/4/2029 | Common Stock | 222500 | $0.00 | 222500 | D | |
| Restricted Stock Units (3) | $0.00 | 2/4/2022 | | A | | 187250 | | (4) | (4) | Common Stock | 187250 | $0.00 | 187250 | D | |
| Restricted Stock Units (5) | $0.00 | 2/4/2022 | | A | | 187250 | | (6) | (6) | Common Stock | 187250 | $0.00 | 187250 | D | |
| Restricted Stock Units (3) | $0.00 | 2/4/2022 | | A | | 84270 | | (7) | (7) | Common Stock | 84270 | $0.00 | 84270 | D | |
| Restricted Stock Units (3) | $0.00 | 2/4/2022 | | M | | | 19704 | (8) | (8) | Common Stock | 19704 | $0.00 | 39408 | D | |
| Restricted Stock Units (5) | $0.00 | 2/4/2022 | | M | | | 19704 | (9) | (9) | Common Stock | 19704 | $0.00 | 39408 | D | |
| Restricted Stock Units (3) | $0.00 | 2/4/2022 | | M | | | 59200 | (10) | (10) | Common Stock | 59200 | $0.00 | 0 | D | |
| Explanation of Responses: |
| (1) | This transaction represents the payment of a tax liability on the lapse of forfeiture restrictions on a derivative security and acquisition of the underlying shares. |
| (2) | Vests one-third annually on each of February 4, 2023, 2024 and 2025, subject to acceleration as set forth in the Registrant's Amended and Restated Incentive Compensation Plan ("Plan") and the Reporting Person's Employment Agreement with the Registrant ("Employment Agreement"). |
| (3) | Each restricted stock unit ("RSU") represents the right to receive one share of the Registrant's common stock. |
| (4) | Forfeiture restrictions will lapse on the RSUs in three equal installments on each of February 4, 2023, 2024 and 2025, as long as the Reporting Person remains in continuous service during the vesting period, subject to acceleration as set forth in the Plan and the Employment Agreement. |
| (5) | Each performance-based restricted stock unit ("PRSU") represents the right to receive one share of the Registrant's common stock. |
| (6) | PRSU award with time-based vesting in three equal installments on each of February 4, 2023, 2024 and 2025, and performance-based vesting only if designated corporate goals are met. |
| (7) | Represents a discretionary retention bonus. Forfeiture restrictions will lapse on the RSUs on February 4, 2023, as long as the Reporting Person remains in continuous service during the vesting period. |
| (8) | Lapse of forfeiture on one-third of an award of RSUs from this grant made on February 8, 2021. Forfeiture restrictions will lapse on the remaining RSUs in two equal installments on February 4, 2023 and 2024, as long as the Reporting Person remains in continuous service during the vesting period, subject to acceleration as set forth in the Registrant's Plan and the Reporting Person's Employment Agreement. |
| (9) | Lapse of forfeiture restrictions on one-third of a PRSU award granted on February 8, 2021, upon the achievement of time and performance goals. Forfeiture restrictions will lapse on the remaining PRSUs in two equal installments on each of February 4, 2023 and 2024, as long as the Reporting Person provides continuous service during the vesting period, subject to acceleration as set forth in the Registrant's Plan and the Reporting Person's Employment Agreement. |
| (10) | Lapse of forfeiture restrictions on a discretionary retention award made on February 8, 2021. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Shameze Rampertab
C/O ASENSUS SURGICAL, INC.
1 TW ALEXANDER DRIVE, SUITE 160
DURHAM, NC 27703 |
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| EVP, Chief Financial Officer |
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Signatures
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| /s/ Joshua Weingard, as attorney-in-fact for Shameze Rampertab | | 2/7/2022 |
| **Signature of Reporting Person | Date |
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