Statement of Changes in Beneficial Ownership (4)
April 02 2021 - 04:59PM
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
|
OMB
APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response... 0.5 |
|
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 * Gans Robert
S. |
2. Issuer Name and Ticker or Trading
Symbol ShiftPixy, Inc. [ PIXY ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)_____
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
Secretary & Corporate Counsel |
|
(Last)
(First)
(Middle)
C/O SHIFTPIXY, INC., 501 BRICKELL KEY DRIVE, SUITE
300 |
3. Date of Earliest Transaction (MM/DD/YYYY)
3/31/2021
|
|
(Street)
MIAMI, FL 33131
(City)
(State)
(Zip)
|
4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
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. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. 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 |
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
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 |
|
Incentive Stock Option (right to
buy) |
$5.40 |
3/31/2021 (1) |
|
A |
|
50000 |
|
(2) |
7/1/2030 |
Common Stock |
50000 |
$0 |
50000 |
D |
|
| Explanation of
Responses: |
| (1) |
The option grant was
approved by the board of directors of ShiftPixy, Inc. (the
"Company") on July 1, 2020, subject to shareholder approval of an
amendment to the ShiftPixy, Inc. 2017 Stock Option/Stock Issuance
Plan (the "Plan"). The Company's shareholders approved the
amendment to the Plan on March 31, 2021. |
| (2) |
The holder's options shall
become exercisable as follows: (i) 25% of the options shall become
exercisable upon the holder's completion of one year of service
following July 1, 2020, and (ii) the balance of the options shall
become exercisable in a series of twelve successive equal quarterly
installments upon the holder's completion of each additional
quarter of service following July 1, 2021. |
Reporting
Owners
|
|
Reporting Owner Name / Address |
Relationships
|
|
Director |
10% Owner |
Officer |
Other |
Gans Robert S.
C/O SHIFTPIXY, INC.
501 BRICKELL KEY DRIVE, SUITE 300
MIAMI, FL 33131 |
|
|
Secretary & Corporate Counsel |
|
Signatures
|
|
/s/ Robert Gans |
|
4/2/2021 |
| **Signature of
Reporting Person |
Date |
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