- Statement of Changes in Beneficial Ownership (4)
21 4월 2010 - 10:59PM
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).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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February 28, 2011
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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(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
SRYBNIK SIMON
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2. Issuer Name
and
Ticker or Trading Symbol
VASOMEDICAL INC
[
VASO.OB
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
__
X
__ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
140 53RD STREET
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3. Date of Earliest Transaction
(MM/DD/YYYY)
3/16/2010
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(Street)
BROOKLYN, NY 11232
(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
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21428572
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I
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By Kerns Manufacturing Corp.
(1)
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Common Stock
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3/16/2010
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A
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7824167
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A
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(5)
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17815007
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I
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By Living Data Technology Corporation
(2)
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Common Stock
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3/16/2010
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A
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60625
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A
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(6)
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310625
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D
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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)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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2004 Stock Option/Stock Issuance Plan
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$.12
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7/26/2007
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A
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150000
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(4)
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7/25/2017
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Common Stock
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150000
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$.12
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150000
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D
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Warrant (right to buy)
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$.08
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6/21/2007
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6/20/2012
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Common Stock
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4285.714
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4285.714
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I
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By Kerns Manufacturing Corp.
(3)
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Explanation of Responses:
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(
1)
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The reporting person and his brother Louis Srybnik are the sole directors and the Chairman of the Board and the President, respectively, of the record holder of these shares. They also are the sole shareholders of the record holder, each holding 50% of the shares. The reporting person, accordingly, shares with his brother voting and dispositive powers over these shares and, as a result, may be deemed to be the co-beneficial owner thereof.
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(
2)
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The reporting person and his brother Louis Srybnik are the sole directors and officers of the record holder of these shares. They also each own 35% of the outstanding shares of the record holder. The reporting person, accordingly, shares with his brother voting and dispositive powers over these shares and, as a result, may be deemed to be the co-beneficial owner thereof.
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(
3)
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See Note (1) as to why the reporting person may be deemed to be the co-beneficial owner of this warrant.
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(
4)
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Options vest immediately.
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(
5)
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Shares issued pursuant to the terms of an Amendment to Supplier Agreement between Living Data Technology Corporation and Vasomedical, Inc.
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(
6)
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Director fees.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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SRYBNIK SIMON
140 53RD STREET
BROOKLYN, NY 11232
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X
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X
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Signatures
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/s/ Simon Srybnik
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4/16/2010
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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