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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) |
7. Title and Amount of Underlying Securities (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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Exchangeable Shares (Right to Convert to Common) (2) | (3) | 12/30/2016 | A | 77,121 | 12/30/2016 | 12/30/2021 | Common Stock | 77,121 (1) | $ 0 | 77,121 (1) | I | By Lewis Asset Mgmt. Corp. | |||
Exchangeable Shares (Right to Convert to Preferred) (2) | (3) | 12/30/2016 | A | 536,346 | 12/30/2016 | 12/30/2021 | Common Stock | 536,346 (1) | $ 0 | 536,346 (1) | I | By Lewis Asset Mgmt. Corp. | |||
Exchangeable Shares (Right to Convert to Common) (2) | (3) | 01/02/2017 | D | 77,121 | 12/30/2016 | 12/30/2021 | Common Stock | 77,121 (1) | $ 0 | 77,121 (1) | I | By Lewis Asset Mgmt. Corp. | |||
Exchangeable Shares (Right to Convert to Preferred) (2) | (3) | 01/02/2017 | D | 536,346 | 12/30/2016 | 12/30/2021 | Common Stock | 536,346 (1) | $ 0 | 536,346 (1) | I | By Lewis Asset Mgmt. Corp. | |||
Warrant (Right to Buy Exchgble Shares Convtble into Common) (2) | $ 1.46 | 12/30/2016 | A | 34,425 | 12/30/2016 | 12/30/2021 | Common Stock | 34,425 (1) | $ 0 | 34,425 (1) | I | By Lewis Asset Mgmt. Corp. | |||
Warrant (Right to Buy Exchgble Shares Convtble into Common) (2) | $ 1.46 | 12/30/2016 | A | 239,412 | 12/30/2016 | 12/30/2021 | Common Stock | 239,412 (1) | $ 0 | 239,412 (1) | I | By Lewis Asset Mgmt. Corp. |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Lewis William Austin IV C/O PAID, INC. 200 FRIBERG PKWY, STE 4004 WESTBOROUGH, MA 01581 |
PRESIDENT AND CFO |
/s/ W. Austin Lewis | 01/04/2017 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | All numbers reflect a reverse split of 1:3000 followed by an immediate forward split of 300:1 effective on December 30, 2016. |
(2) | Exchangeable shares are rights to PAID, Inc.'s common stock and preferred stock. These rights can be exercised by the conversion of the exchangeable shares into shares of common and preferred stock of PAID Inc. in accordance with an Exchange and Call Rights Agreement filed as Appendix I to its Consent Solicitation Statement on Form 14A of PAID Inc. filed on October, 7 2016. Mr. Lewis may exercise his exchangeable rights as specified in the Exchange and Call Rights Agreement. The Preferred stock of PAID, Inc. is non-voting. |
(3) | Merger consideration equal to a valuation at $1.46 per share. |