SEC FORM
3
SEC Form 3
| FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF 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 |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
| C/O HARVARD BIOSCIENCE, INC. |
| 84 OCTOBER HILL ROAD |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
11/01/2019
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3. Issuer Name and Ticker or Trading Symbol
HARVARD BIOSCIENCE INC
[ HBIO ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
Director |
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10% Owner |
| X |
Officer (give title below) |
|
Other (specify below) |
| Vice President |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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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 Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
|
2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
|
|---|
| 1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of Responses: |
| Remarks: |
|
| No securities are beneficially owned. |
|
/s/ Chad Porter, attorney in fact |
11/06/2019 |
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** 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
5
(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. |
EXHIBIT 24.1
LIMITED POWER OF ATTORNEY
I, Kenneth Olson, hereby appoints Chad Porter, Robert Petitt and Michael
Andreasen of Burns & Levinson LLP of Boston, Massachusetts, and other designated
attorneys and paralegals of such firm, as well as Michael Rossi and David Sirois
of Harvard Bioscience, Inc., a Delaware corporation (the "Company"), and other
designated agents of the Company, including its Chief Financial Officer and
Director of Corporate Accounting & SEC Reporting, to be his true and lawful
attorney-in-fact (his "Attorney") in his name and on his behalf to:
(1) prepare, execute, acknowledge, deliver and file SEC Form ID's and any
other documents necessary with the United States Securities and Exchange
Commission on behalf of the undersigned to obtain filing codes for the
undersigned;
(2) prepare, execute, acknowledge, deliver and file Forms 3, 4, and 5
(including any amendments thereto) with respect to the securities of the
Company, with the United States Securities and Exchange Commission, any national
securities exchanges and the Company, all 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, if necessary or advisable in connection with performing
the acts described in (1) above or under Section 16(a) of the Exchange Act,
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 any such information to
the undersigned and approves and ratifies any such release of information; and
(4) perform any and all other acts which in the discretion of such
attorney-in-fact are necessary or desirable for and on behalf of the undersigned
in connection with the foregoing.
The undersigned acknowledges and agrees that:
(1) this Limited Power of Attorney authorizes, but does not require, such
attorney-in-fact to act in their discretion on information provided to such
attorney-in-fact without independent verification of such information and such
attorney-in-fact may presume that any such information he receives is accurate
and complete and he has no obligation to independently verify such information
and is not responsible for any liability based on the inaccuracy or
incompleteness of such information as it is provided by the undersigned;
(2) any documents prepared and/or executed by such 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 such
attorney-in-fact, in his or her discretion, deems necessary or desirable;
(3) neither the Company nor such attorney-in-fact assumes (i) any
liability for the undersigned's responsibility to comply with the requirement of
the Exchange Act, (ii) any liability of the undersigned for any failure to
comply with such requirements, or (iii) any obligation or liability of the
undersigned for profit disgorgement under Section 16(b) of the Exchange Act;
(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; and
(5) The undersigned also hereby agrees that the Attorney shall not be
liable for any error of judgment or for any act reasonably done or step
reasonably taken or omitted in good faith, and that the undersigned agrees to
indemnify, defend on a current basis, and hold harmless the Attorney from and
against any and all claims, obligations, liabilities or causes of action
asserted by any person relating to or arising out of, or as a consequence of,
any such action or omission hereunder.
The undersigned hereby gives and grants the foregoing 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 such attorney-in-fact of, for an 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
full force and effect until revoked by the undersigned in a signed writing
delivered to such attorney-in-fact.
This Limited Power of Attorney may be filed with the United States Securities
and Exchange Commission, any other federal, state or foreign securities
regulators, and other entities as a confirming statement of the authority
granted herein.
IN WITNESS whereof this Limited Power of Attorney has been duly executed this
24th day of October, 2019.
/s/ Kenneth Olson
Kenneth Olson
