Statement of Changes in Beneficial Ownership (4)
April 07 2021 - 11:42AM
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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3235-0287
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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
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BROMLEY HENRY WALFORD |
2. Issuer Name and Ticker or Trading Symbol
KIDOZ INC.
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KDOZF
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
__X__ Officer (give title below) _____ Other (specify below)
Chief Financial Officer |
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(Last)
(First)
(Middle)
C/O KIDOZ INC., SUITE 220, 1685 WEST 4TH AVENUE |
3. Date of Earliest Transaction
(MM/DD/YYYY)
4/6/2021 |
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(Street)
VANCOUVER, A1 V6J 1L8
(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
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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| Common Stock | | | | | | | | 375000 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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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 |
| Employee Stock (Right to Buy) | $0.81 | 4/6/2021 | 4/6/2021 | A | | 50000 | | 4/6/2021 | 4/6/2026 | Common Stock | 50000 (1) | $0.81 | 450000 | D | |
| Employee Stock (Right to Buy) | $0.43 | | | | | | | 12/22/2016 | 12/22/2021 | Common Stock | 100000 (2) | | 450000 | D | |
| Employee Stock (Right to Buy) | $0.43 | | | | | | | 11/8/2017 | 11/8/2022 | Common Stock | 25000 (3) | | 450000 | D | |
| Employee Stock (Right to Buy) | $0.42 | | | | | | | 6/4/2018 | 6/4/2023 | Common Stock | 175000 (4) | | 450000 | D | |
| Employee Stock (Right to Buy) | $0.33 | | | | | | | 6/30/2020 | 6/30/2025 | Common Stock | 50000 (5) | | 450000 | D | |
| Employee Stock (Right to Buy) | $0.39 | | | | | | | 2/1/2021 | 2/1/2026 | Common Stock | 50000 (6) | | 450000 | D | |
| Explanation of Responses: |
| (1) | Mr. H. Bromley was granted 50,000 stock options at CAD$1.02 (approximately US$0.813) on April 6, 2021. These options vest at 2% per month. |
| (2) | Mr. H. Bromley was granted 100,000 stock options at CAD$0.54 (approximately US$0.43) on December 22, 2016. These options vest immediately. |
| (3) | Mr. H. Bromley was granted 25,000 stock options at CAD$0.54 (approximately US$0.43) on November 8, 2017. These options vest immediately. |
| (4) | Mr. H. Bromley was granted 175,000 stock options at CAD$0.54 (approximately US$0.42) on June 4, 2018. These options vest immediately. |
| (5) | Mr. H. Bromley was granted 50,000 stock options at CAD$0.45 (approximately US$0.33) on June 30, 2020. These options vest 2.08% per month commencing June 30, 2021. |
| (6) | Mr. H. Bromley was granted 50,000 stock options at CAD$0.50 (approximately US$0.39) on February 1, 2021. These options vest 10% on grant date, 15% after one year and 2% per month thereafter. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
BROMLEY HENRY WALFORD
C/O KIDOZ INC.
SUITE 220, 1685 WEST 4TH AVENUE
VANCOUVER, A1 V6J 1L8 |
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| Chief Financial Officer |
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Signatures
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| /s/ H. W. Bromley | | 4/7/2021 |
| **Signature of Reporting Person | Date |
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