Statement of Changes in Beneficial Ownership (4)
06 May 2021 - 6:45AM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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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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1. Name and Address of Reporting Person
*
Simpson Tom |
2. Issuer Name and Ticker or Trading Symbol
Kaspien Holdings Inc.
[
KSPN
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
PO BOX 462 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
5/3/2021 |
(Street)
EAST SCHODACK, NY 12063
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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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 Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. 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 Following Reported Transaction(s) (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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Code
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V
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Amount
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(A) or (D)
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Price
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Common stock, par value $0.1 per share | 5/3/2021 | | A | | 3000 | A | $20.41 (3) | 60000 | D | |
Common stock, par value $0.01 per share | | | | | | | | 12593 | I | By Kick Start III, LLC (5) |
Common stock. par value $0.01 per share | | | | | | | | 8395 | I | By Kick Start IV, LLC (6) |
Common stock, par value $0.01 per share | | | | | | | | 23879 | I | By WIN Partners (7) |
Common stock, par value $0.01 per share | | | | | | | | 9737 | I | BY Kick Start, LLC (4) |
Common stock, par value $0.01 per share | | | | | | | | 25 | I | By Wife |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: 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 |
Director Stock Option (Right to Buy) (1) | $20.41 | 5/3/2021 | | A | | 1250 | | (2) | 5/3/2031 | Common stock, par value $0.1 per share | 1250 | $0 | 2000 | D | |
Warrant to purchase common stock, par value $0.01 per share | $.01 | | | | | | | 3/30/2020 | 3/30/2025 | Common stock, par value $0.01 per share | 1448 | | 1448 | I | By Kick Start III, LLC (5) |
Warrant to purchase common stock, par value $0.01 per share | $.01 | | | | | | | 3/30/2020 | 3/30/2025 | Common stock, par value $0.1 per share | 965 | | 965 | I | By Kick Start IV, LLC (6) |
Explanation of Responses: |
(1) | The equity transactions listed above is pursuant to equity plans qualified under 16b-3 and exempt from Section 16(b) of the Securities Exchange Act |
(2) | Option grants become exercisable in 4 equal annual installments beginning on the first anniversary of the date of grant and expire 10 years after grant. |
(3) | Annual compensation paid in shares of common stock pursuant to the 2005 Long Term Incentive and Share Award Plan, as Amended, which such plan qualifies under Section 16(b)-3 |
(4) | Securities held by Kick Start, LLC. Mr. Simpson holds an interest, manages and has voting control of Kick Start, LLC. |
(5) | Securities held by Kick Start III, LLC. Mr. Simpson holds an interest, manages and has voting control of Kick Start III, LLC. |
(6) | Securities held by Kick Start IV, LLC. Mr. Simpson holds an interest, manages and has voting control of Kick Start IV, LLC. |
(7) | Securities held by WIN Partners. Mr. Simpson holds an interest, manages and has voting control of WIN Partners. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Simpson Tom PO BOX 462 EAST SCHODACK, NY 12063 | X |
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Signatures
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Tom Simpson | | 5/5/2021 |
**Signature of Reporting Person | Date |
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