Statement of Changes in Beneficial Ownership (4)
November 02 2021 - 03:19PM
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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APPROVAL
OMB Number: 3235-0287
Estimated average burden
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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 * SIEGEL NED L |
2. Issuer Name and Ticker or Trading
Symbol Worksport Ltd [ WKSP ] |
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)
9/6/2021
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(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 |
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 |
Common Stock |
8/6/2021 |
(2) |
A |
|
15000 |
A |
$5.50 |
15000 |
I |
See Footnote (1) |
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 |
Non-Qualified Stock Options |
$5.50 (3) |
8/6/2021 |
|
A |
|
15000 |
|
1/1/2022 |
8/6/2026 |
Common Stock |
15000 |
$0.0001 |
15000 |
D |
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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 restricted stock units ("RSUs") which represent a
contingent right to receive one share of Common Stock for each RSU
priced at the stock's price on the date the agreement was signed.
The RSUs vest entirely on January 1st of 2022. Unless otherwise
provided, on the vesting date, shares of Common Stock will
automatically be sold to satisfy the Reporting Person's tax
withholding obligations in a non-discretionary
transaction. |
(3) |
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 $5.50. The NQSOs vest entirely on January 1st of
2022. These NQSOs expire on August 6th, 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
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
SIEGEL NED L
7299 E DANBRO CRESCENT
MISSISSAUGA,, A6 L5N 6P8 |
X |
|
|
|
Signatures
|
/s/ Ned L. Siegel |
|
11/1/2021 |
**Signature of
Reporting Person |
Date |
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