Statement of Changes in Beneficial Ownership (4)
November 10 2021 - 5:31PM
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
*
Tadayon Amer |
2. Issuer Name and Ticker or Trading Symbol
CLEANSPARK, INC.
[
CLSK
]
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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 Revenue Officer |
(Last)
(First)
(Middle)
1185 S. 1800 W., SUITE 3 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
11/8/2021 |
(Street)
WOODS CROSS, UT 84087
(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 | 11/8/2021 | | A | | 10000 (1) | A | $0 | 120132 | D | |
Common Stock | 11/8/2021 | | A | | 10000 (2) | A | $0 | 130.132 | D | |
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 |
Explanation of Responses: |
(1) | Represents 10,000 restricted stock units awarded to the Reporting Person under the Issuer's 2017 Equity Incentive Plan, as amended (the "Plan"), in connection with the Reporting Person's service as an executive officer of the Issuer, which restricted stock units shall vest as follows: (i) 833 are vested upon issuance, and (ii) the remaining 9,167 shall vest in equal monthly installments over the next 11 months. |
(2) | Represents 10,000 shares of restricted common stock, which restricted shares shall vest as follows: (i) 83 are vested upon issuance, (ii) 917 shall vest in equal monthly installments over the next 11 months, and (ii) the vesting of the remaining 9,000 is subject to the achievement of certain corporate milestones of the Issuer. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Tadayon Amer 1185 S. 1800 W. SUITE 3 WOODS CROSS, UT 84087 |
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| Chief Revenue Officer |
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Signatures
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/s/ Amer Tadayon | | 11/10/2021 |
**Signature of Reporting Person | Date |
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