SEC Form 5 · accession 0001607062-15-000064
Kiwibox.Com, Inc. · KIWB
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Joseph J Tomasek
Director
Period of report
Dec 31, 2014
Accepted (ET)
Feb 18, 2015 · 3:46 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000838796
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock | Dec 31, 2013 | A | 250,000 | $0.00 | A | 500,000 | D | |
| Common StockF1 | Jan 1, 2015 | A | 200,000 | $0.00 | A | 700,000 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock OptionsF2 | $0.05 | Jan 1, 2015 | A | 1,200,000 | A | Jan 1, 2015 | Dec 31, 2020 | Common Shares | 6,000,000 | 6,000,000 | D |
| Stock WarrantF3 | $0.025 | Dec 3, 2010 | A | 500,000 | A | Dec 3, 2010 | Dec 4, 2015 | Common Shares | 500,000 | 500,000 | D |
Explanation of responses
- F11. Reporting Person received a stock grant of 200,000 restricted common shares as a Christmas bonus.
- F22. Reporting Person earns 100,000 common stock options for each month of legal services rendered to the Issuer. All stock options earned are exercisable at $.05 per share or on a cashless basis, during a 5-year exercise, commencing the date of grant. During calendar year 2010, 1,200,000; during calendar year 2011, 1,200,000; during calendar year 2012, 1,200,000 of these stock options; during calendar year 2013, 1,200,000 of these stock options, and; during calendar year 2014, 1,200,000 of these stock options. The value of the these stock options has not been determined for the 1,200,000, earned each of the calendar years, 2010, 2011, 2013 and 2014.
- F33. Reporting Person was awarded a common stock purchase warrant to purchase up to 500,000 common shares, exercisable at $.025 per share or on a cashless exercise basis, any time during the 5-year exercise period, commencing upon the grant date of December 3, 2010. The value of the Warrant has not been determined.