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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 |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
KAY E GERALD C/O INTEGRATED BIOPHARMA, INC. 201 ROUTE 22 HILLSIDE, NJ 07205 |
X | X | Chairman and CEO |
/s/E. Gerald Kay | 03/24/2005 | |
**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) | On the date hereof, the Reporting Person has a direct beneficial ownership interest in 5,117,039 shares of common stock, par value $.002 per share ("Common Stock") of Integrated BioPharma, Inc., consisting of (i) 3,493,013 shares of Common Stock and (ii) 1,624,026 shares of Common Stock issuable upon exercise of presently exercisable stock options. |
(2) | On the date hereof, the Reporting Person has an indirect beneficial ownership interest in 819,629 shares of Common Stock, which are directly beneficially owned by EGK LLC, of which the Reporting Person may be deemed to beneficially own by virtue of the fact that the Reporting Person is the manager and 50% owner of EGK LLC. |
(3) | On the date hereof, the Reporting Person has an indirect beneficial ownership interest in 169,358 shares of Common Stock, which are directly beneficially owned by the Christina Kay Trust, which the Reporting Person may be deemed to beneficially own by virtue of the fact that the Reporting Person is Trustee of the Christina Kay Trust. |
(4) | On the date hereof, the Reporting Person has an indirect beneficial ownership interest in 169,358 shares of Common Stock, which are directly beneficially owned by the Riva Sheppard Kay Trust, which the Reporting Person may be deemed to beneficially own by virtue of the fact that the Reporting Person is Trustee of the Riva Sheppard Kay Trust. |