f4050715lubman

f4050715lubman_surge.xml
Ownership Document
4
FORM 4
1 of 1
05/07/2015 11:37 AM
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
OMB APPROVAL
Washington, D.C. 20549
2. Issuer Name and Ticker or Trading Symbol
(First)
(Check all applicable)
X
X
(Middle)
Director
10% Owner
Officer (give title below)
Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
Vice President
05/05/2015
C/O SURGE COMPONENTS, INC.
95 EAST JEFRYN BOULEVARD
(Street)
4. If Amendment, Date of Original Filed (Month/Day/Year)
DEER PARK
NY
11729
(City)
(State)
(Zip)
0.5
5. Relationship of Reporting Person(s) to Issuer
SURGE COMPONENTS INC [ SPRS ]
LUBMAN STEVEN J
December 31, 2014
Estimated average
burden hours
per response
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
1. Name and Address of Reporting Person *
3235-0287
Expires:
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Check this box if no longer subject to
Section 16. Form 4 or Form 5 obligations
may continue. See Instruction 1(b).
(Last)
OMB Number:
6. Individual or Joint/Group Filing (Check Applicable Line)
X
Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I – Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3)
2. Transaction Date
(Month/Day/Year)
Common Stock
2A. Deemed
Execution Date, if
any
(Month/Day/Year)
05/05/2015
3. Transaction
Code (Instr. 8)
Code
V
M
4. Securities Acquired (A) or Disposed Of (D)
(Instr. 3, 4 and 5)
Amount
(A) or (D)
Price
250,000
A
$0.25
5. Amount of Securities
Beneficially Owned
Following Reported
Transaction(s) (Instr. 3
and 4)
6. Ownership Form:
Direct (D) or Indirect
(I) (Instr. 4)
829,780
7. Nature of
Indirect
Beneficial
Ownership
(Instr. 4)
D
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)
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)
Code
Stock Option
$0.25
05/05/2015
M
V
5. Number of
Derivative
Securities Acquired
(A) or Disposed of
(D) (Instr. 3, 4
and 5)
(A)
(D)
6. Date Exercisable and
Expiration Date
(Month/Day/Year)
Date
Exercisable
7. Title and Amount of Securities
Underlying Derivative Security (Instr.
3 and 4)
Expiration
Date
Title
250,000 05/06/2011 05/06/2015 Common Stock
8. Price of
Derivative
Security
(Instr. 5)
9. Number of
Derivative
Securities
Beneficially
Owned
Following
Reported
Transaction(s)
(Instr. 4)
10.
Ownership
Form:
Direct (D)
or Indirect
(I) (Instr.
4)
$0
0
D
Amount or
Number of
Shares
250,000
Explanation of Responses:
Remarks:
/s/ Steven J. Lubman
05/07/2015
** Signature of Reporting Person
Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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 Number.
11. Nature of
Indirect
Beneficial
Ownership
(Instr. 4)