Amended Statement of Changes in Beneficial Ownership (4/a)
January 04 2017 - 3:12PM
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).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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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
*
Bruk Steven
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2. Issuer Name
and
Ticker or Trading Symbol
COUNTERPATH CORP
[
CPAH
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
__
X
__ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
3230 MATHERS AVENUE
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3. Date of Earliest Transaction
(MM/DD/YYYY)
12/15/2016
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(Street)
WEST VANCOUVER, A1 V7V 2K5
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
12/22/2016
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6. Individual or Joint/Group Filing
(Check Applicable Line)
___ Form filed by One Reporting Person
_
X
_ 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 Shares
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29347
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D
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Common Stock
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14600
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I
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Karen Bruk
(1)
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Common Shares
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12/21/2016
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P
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81200
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A
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$2.03
(3)
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95800
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I
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Karen Bruk
(1)
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Common Shares
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12/15/2016
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P
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243902
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A
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$2.05
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696307
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I
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KMB Trac Two Holdings Ltd.
(2)
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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)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Warrants
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$7.50
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9/4/2015
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9/4/2017
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Common Stock
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65000
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65000
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I
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KMB Trac Two Holdings Ltd.
(2)
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Explanation of Responses:
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(
1)
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Karen Bruk is the spouse of Steven Bruk.
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(
2)
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Karen Bruk is also the sole shareholder of KMB Trac Two Holdings Ltd. ("KMB"). Steven Bruk and Karen Bruk exercise shared investment power over the shares of common stock held by Karen Bruk and KMB.
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(
3)
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CDN$2.72 based on the Bank of Canada exchange rate of 0.7462 on December 21, 2016.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Bruk Steven
3230 MATHERS AVENUE
WEST VANCOUVER, A1 V7V 2K5
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X
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Bruk Karen
3230 MATHERS AVENUE
WEST VANCOUVER, A1 V7V 2K5
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X
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Signatures
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/s/ Steven Bruk
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1/4/2017
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**
Signature of Reporting Person
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Date
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/s/ Karen Bruk
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1/4/2017
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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 control number.
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