Statement of Changes in Beneficial Ownership (4)
31 December 2021 - 9:14AM
Edgar (US Regulatory)
FORM 4
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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
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SIEGEL NED L |
2. Issuer Name and Ticker or Trading Symbol
Worksport Ltd
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WKSP
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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)
7299 E DANBRO CRESCENT |
3. Date of Earliest Transaction
(MM/DD/YYYY)
12/29/2021 |
(Street)
MISSISSAUGA,, A6 L5N 6P8
(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 | | | | | | | | 15000 | I | See Footnote (1) |
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 |
Non-Qualified Stock Options | $2.51 | 12/29/2021 | | A | | 30000 | | 12/29/2022 (2) | 12/29/2026 | Common Stock | 30000 | $0.0001 | 45000 | I (1) | See Footnote (1) |
Explanation of Responses: |
(1) | Shares to be held by The Siegel Group, Inc., which is controlled by Ned L. Siegel. |
(2) | The Reporting Person was granted Non-Qualified Stock Options ("NQSOs") which represent a contingent right to receive one share of Common Stock for each NQSO at a price of $2.51. The NQSOs vest 1/3 on December 29, 2022, 1/3 December 29, 2023 and 1/3 December 29, 2024. These NQSOs expire on December 29, 2026. The right of exercise shall be cumulative so that to the extent this Option is not exercised in any period to the maximum extent permissible it shall continue to be exercisable, in whole or in part, with respect to all Shares Subject to Option for which it is vested until the earlier of the date on which this Option is fully exercised and the Expiration Date. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
SIEGEL NED L 7299 E DANBRO CRESCENT MISSISSAUGA,, A6 L5N 6P8 | X |
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Signatures
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/s/ Ned L. Siegel | | 12/30/2021 |
**Signature of Reporting Person | Date |