| FORM
4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities
Exchange Act of 1934
or Section 30(h) of the Investment Company Act of
1940
|
| OMB APPROVAL |
| OMB Number: |
3235-0287 |
| Expires: |
December 31, 2014 |
| Estimated average burden |
| hours per response: |
0.5 |
|
|
|
Check this box if no longer subject to Section 16. Form 4 or Form 5
obligations may continue.
See
Instruction 1(b).
|
1. Name and Address of Reporting Person
*
| C/O TRANSCAT, INC. |
| 35 VANTAGE POINT DRIVE |
(Street)
|
2. Issuer Name
and
Ticker or Trading Symbol
TRANSCAT INC
[
TRNS
]
|
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
|
10% Owner |
|
Officer (give title below) |
|
Other (specify below) |
|
|
3. Date of Earliest Transaction
(Month/Day/Year)
09/02/2015
|
4. If Amendment, Date of Original Filed
(Month/Day/Year)
|
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) |
2A.
Deemed Execution Date, if any
(Month/Day/Year) |
3.
Transaction Code (Instr.
8)
|
4.
Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
|
5.
Amount of Securities Beneficially Owned Following Reported
Transaction(s) (Instr.
3 and 4)
|
6.
Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
|
7.
Nature of Indirect Beneficial Ownership (Instr.
4)
|
| Code |
V |
Amount |
(A) or (D) |
Price |
|
Common Stock, $.50 par value
|
09/02/2015 |
|
P |
|
6,000
|
A
|
$
9.24
|
13,484
|
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)
|
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 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: 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 Option (Right to Buy)
|
$
9.66
|
|
|
|
|
|
|
01/26/2015 |
01/26/2020 |
Common Stock, par value $.50 per share
|
10,000
|
|
10,000
|
D
|
|
| Explanation of Responses: |
|
|
|
/s/ John J. Zimmer, Attorney-in-fact for Gary J. Haseley |
09/04/2015 |
|
** 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. |
Gary J. Haseley
Limited Power of Attorney
for Section 16 Reporting Obligations
Know all by these presents, that the undersigned hereby
makes, constitutes and appoints each of Lee D. Rudow and
John J. Zimmer, each acting individually, as the
undersigned's true and lawful attorney-in-fact, with full
power and authority as hereinafter described on behalf of
and in the name, place and stead of the undersigned to:
(1) prepare, execute and submit to the U.S. Securities and
Exchange Commission (the "SEC") a Form ID - Uniform
Application for Access Codes to File on EDGAR, and any other
documents necessary or appropriate to obtain codes and
passwords enabling the undersigned to make electronic
filings with the SEC of reports required by Section 16(a)
of the Securities Exchange Act of 1934 or any rule or
regulation of the SEC;
(2) prepare, execute, acknowledge, deliver and file any
and all forms including, without limitation, Forms 3, 4 and
5 (including any amendments thereto) with respect to the
securities of Transcat, Inc., an Ohio corporation
(the "Company"), with the SEC, any national securities
exchanges and the Company, as considered necessary or
advisable under Section 16(a) of the Securities Exchange Act
of 1934 and the rules and regulations promulgated thereunder,
as amended from time to time (the "Exchange Act");
(3) seek or obtain, as the undersigned's representative and
on the undersigned's behalf, information on transactions in
the Company's securities from any third party, including
brokers, employee benefit plan administrators and trustees,
and the undersigned hereby authorizes any such person to
release such information to the undersigned's representative
and approves and ratifies the release of such information; and
(4) perform any and all other acts which, in the discretion of
either attorney-in-fact, are necessary or desirable for and
on behalf of the undersigned in connection with the foregoing.
The undersigned acknowledges that:
(1) this Limited Power of Attorney authorizes, but does
not require, each attorney-in-fact to act in his discretion
on information provided to the attorney-in-fact
without independent verification of such information;
(2) any documents prepared and/or executed by either
attorney-in-fact on behalf of the undersigned pursuant
to this Limited Power of Attorney will be in such form and
will contain such information and disclosure as the
attorney-in-fact, in his discretion, deems necessary or
desirable;
(3) neither the Company nor either attorney-in-fact assumes
(i) any liability for the undersigned's responsibility
to comply with the requirements of the Exchange Act, (ii) any
liability of the undersigned for any failure to comply with
these requirements, or (iii) any obligation or liability of
the undersigned for profit disgorgement under Section 16(b)
of the Exchange Act; and
(4) this Limited Power of Attorney does not relieve the
undersigned from responsibility for compliance with the
undersigned's obligations under the Exchange Act, including,
without limitation, the reporting requirements under Section
16 of the Exchange Act.
The undersigned hereby gives and grants each attorney-in-fact
full power and authority to do and perform all and every act
and thing whatsoever requisite, necessary or appropriate to
be done in and about the foregoing matters as fully to all
intents and purposes as the undersigned might or could do if
present, hereby ratifying all that each attorney-in-fact of,
for and on behalf of the undersigned, shall lawfully do or
cause to be done by virtue of this Limited Power of Attorney.
This Limited Power of Attorney shall remain in effect until
the undersigned is no longer required to file forms under
Section 16(a) of the Exchange Act with respect to the
undersigned's holdings and transactions in securities issued
by the Company, unless earlier revoked by the undersigned
in a signed writing delivered to each attorney-in-fact.
IN WITNESS WHEREOF, the undersigned has signed this Limited
Power of Attorney this 26th day of January, 2015.
/s/ Gary J. Haseley
Signature
Gary J. Haseley
Print Name
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