SEC Form 5 · accession 0001607062-16-000640
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, 2015
Accepted (ET)
Feb 9, 2016 · 3:23 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 StockF1 | Feb 3, 2016 | A | 400,000 | $0.00 | A | 1,100,000 | 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, 2016 | A | 1,200,000 | A | Jan 1, 2016 | Dec 31, 2021 | Common Shares | 7,200,000 | 6,000,000 | D |
Explanation of responses
- F11. Reporting Person received a stock grant of 400,000 restricted common shares as a Christmas bonus.
- F2Reporting 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 2015, Reporting Person earned 1,200,000 of these stock options whose value has not been determined.