Annual Statement of Changes in Beneficial Ownership (5)
April 13 2022 - 06:56PM
Edgar (US Regulatory)
FORM 5
[ ] Check this box if no longer subject to Section
16. Form 4 or Form 5 obligations may continue. See
Instruction 1(b).
[ ] Form 3 Holdings Reported
[X] Form 4 Transactions Reported |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL
OWNERSHIP OF SECURITIES
|
OMB APPROVAL
OMB Number: 3235-0362
Estimated average burden
hours per response... 1.0 |
|
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 * Remillard Jason L
M |
2. Issuer Name and Ticker or Trading
SymbolData443 Risk Mitigation, Inc. [ATDS] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)__X__
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
President; CEO; Secretary |
(Last)
(First)
(Middle)
101 J. MORRIS COMMONS LANE |
3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/31/2021
|
(Street)
MORRISVILLE, NC 27560
(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) |
Amount |
(A) or (D) |
Price |
Series A Preferred Stock |
11/15/2017 |
|
J4 (1) |
1334 (3) |
A |
$0 |
1334 (3) |
D |
|
Series A Preferred Stock |
3/30/2020 |
|
A4 |
4666 |
A |
$0 |
6000 |
D |
|
Series A Preferred Stock |
8/14/2020 |
|
J4 (2) |
144000 |
A |
$0 |
150000 |
D |
|
Common Stock |
4/19/2020 |
|
A4 |
379 (4) |
A |
$0 |
379 (4) |
D |
|
Table II - Derivative Securities Acquired, Disposed of, or
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
(MM/DD/YYYY) |
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 at End of Issuer's Fiscal Year
(Instr. 4) |
10. Ownership Form of Derivative Security: Direct
(D) or Indirect (I)
(Instr. 4) |
11. Nature of Indirect Beneficial Ownership
(Instr. 4) |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Explanation of
Responses: |
(1) |
In November 2017, Mr.
Remillard acquired controlling interest and 100% of the outstanding
preferred shares of the Company, which was then named LandStar,
Inc. In connection therewith, Mr. Remillard acquired 1,334 issued
and outstanding shares of the Company's Series A Preferred
Stock. |
(2) |
In January 2018, the Company
acquired substantially all of the assets of Myriad Software
Productions, LLC, a company owned 100% by Mr. Remillard. The
consideration for the acquisition included 144,000 shares of the
Company's Series A Preferred Stock (after adjustment for subsequent
reverse stock splits), which were issued to Mr. Remillard as part
of a Share Settlement Agreement on August 14, 2020. |
(3) |
Amount gives effect to the
750-for-1 reverse stock split effected by the Issuer on October 14,
2019. |
(4) |
Amount gives effect to the
2,000-for-1 and the 8-for-1 reverse stock splits effected by the
Issuer on June 10, 2021 and March 7, 2022,
respectively. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
Remillard Jason L M
101 J. MORRIS COMMONS LANE
MORRISVILLE, NC 27560 |
X |
|
President; CEO; Secretary |
|
Signatures
|
/s/ Jason Remillard |
|
4/13/2022 |
**Signature of
Reporting Person |
Date |
Reminder: Report on a separate line for each class
of securities beneficially owned directly or
indirectly. |
* |
If the form is filed by more than one
reporting person, see Instruction 4(b)(v). |
** |
Intentional misstatements or omissions
of facts constitute Federal Criminal Violations. See 18
U.S.C. 1001 and 15 U.S.C. 78ff(a). |
Note: |
File three copies of this Form, one of
which must be manually signed. If space is insufficient, see
Instruction 6 for procedure. |
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. |
DATA443 Risk Mitigation (PK) (USOTC:ATDS)
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