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FORM 5
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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OMB APPROVAL
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1. Name and Address of Reporting Person *
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| DiPerna Paul |
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2. Issuer Name and Ticker or Trading Symbol
Modular Medical, Inc. [MODD]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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__X__ Director
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__X__ 10% Owner
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__X__ Officer (give title below)
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_____ Other (specify below)
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See Remarks
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C/O MODULAR MEDICAL, INC., 800 WEST VALLEY PARKWAY, SUITE 203 |
3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
03/31/2019 |
ESCONDIDO, CA 92025 |
4. If Amendment, Date Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Reporting
(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. Transaction Date (Month/Day/Year)
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2A. Deemed Execution Date, if any (Month/Day/Year)
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3. Transaction 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 at end of Issuer's Fiscal Year
(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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Amount
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(A) or (D)
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Price
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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 2270 (9-02) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date (Month/Day/Year)
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3A. Deemed Execution Date, if any (Month/Day/Year)
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4. Transaction 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
(Month/Day/Year)
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7. Title and Amount of Underlying Securities
(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 at End of Issuer's Fiscal Year
(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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(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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| Option to purchase common stock (1) |
$0.66 | 08/15/2018 |
| A | 18,013 |
| 08/15/2018 | 08/15/2028 | Common Stock |
18,013
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$0.66 | 18,013 (2) |
D
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| Option to purchase common stock (1) |
$0.66 | 09/15/2018 |
| A | 18,013 |
| 09/15/2018 | 09/15/2028 | Common Stock |
18,013
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$0.66 | 36,026 (2) |
D
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| Option to purchase common stock (1) |
$0.66 | 10/15/2018 |
| A | 18,013 |
| 10/15/2018 | 10/15/2028 | Common Stock |
18,013
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$0.66 | 54,039 (2) |
D
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| Option to purchase common stock (1) |
$2.25 | 11/15/2018 |
| A | 5,324 |
| 11/15/2018 | 11/15/2028 | Common Stock |
5,324
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$2.25 | 5,324 (2) |
D
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| Option to purchase common stock (1) |
$2.25 | 12/15/2018 |
| A | 5,324 |
| 12/15/2018 | 12/15/2028 | Common Stock |
5,324
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$2.25 | 10,648 (2) |
D
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| Option to purchase common stock (1) |
$2.25 | 01/15/2019 |
| A | 4,808 |
| 01/15/2019 | 01/15/2029 | Common Stock |
4,808
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$2.25 | 15,456 (2) |
D
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| Option to purchase common stock (1) |
$2.25 | 02/15/2019 |
| A | 4,921 |
| 02/15/2019 | 02/15/2029 | Common Stock |
4,921
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$2.25 | 20,378 (2) |
D
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| Option to purchase common stock (1) |
$2.25 | 03/15/2019 |
| A | 5,082 |
| 03/15/2019 | 03/15/2029 | Common Stock |
5,082
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$2.25 | 25,459 (2) |
D
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Reporting Owners
| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
DiPerna Paul
C/O MODULAR MEDICAL, INC.
800 WEST VALLEY PARKWAY, SUITE 203
ESCONDIDO, CA 92025 |
X
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X
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See Remarks |
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Signatures
| /s/ Paul DiPerna | | 02/14/2020 |
| **Signature of Reporting Person | Date |
Explanation of Responses:
| * | 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 option was fully vested and exercisable on the grant date, in accordance with the terms of an employment agreement between the Issuer and Mr. DiPerna. |
| (2) | In accordance with Instruction 4 to this Form, column 9 reports only total beneficial ownership of the "class" of derivative security reported in column 1. Options that have different exercise prices or vesting terms are not considered to be of the same "class." As a result of the grant reported herein, the Reporting Person currently has aggregate options to purchase a total of 79,498 shares of the Issuer. |
Remarks:
Title: Chairman, Chief Executive Officer, Chief Financial Officer, Secretary and Treasurer |
Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure.
Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.
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