Statement of Changes in Beneficial Ownership (4)
April 02 2021 - 4:59PM
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
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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
*
Carney Domonic J. |
2. Issuer Name and Ticker or Trading Symbol
ShiftPixy, Inc.
[
PIXY
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) Chief Financial Officer |
(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)
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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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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-Statutory Stock Option (right to buy) | $5.40 | 3/31/2021 (1) | | A | | 11459 | | (2) | 7/1/2030 | Common Stock | 11459 | $0 | 11459 | D | |
Incentive Stock Option (right to buy) | $5.40 | 3/31/2021 (1) | | A | | 50000 | | (2) | 7/1/2030 | Common Stock | 50000 | $0 | 61459 | 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
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Carney Domonic J. C/O SHIFTPIXY, INC. 501 BRICKELL KEY DRIVE, SUITE 300 MIAMI, FL 33131 |
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| Chief Financial Officer |
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Signatures
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/s/ Domonic J. Carney | | 4/2/2021 |
**Signature of Reporting Person | Date |
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