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Holmes John Stephen – ‘3’ for 12/5/16 re: ShiftPixy, Inc.

On:  Thursday, 12/8/16, at 5:20pm ET   ·   For:  12/5/16   ·   As:  10% Owner   ·   Accession #:  1477932-16-13986   ·   File #:  1-37954

Previous ‘3’:  None   ·   Next & Latest:  ‘3/A’ on / for 6/28/17

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  As Of                Filer                Filing    For·On·As Docs:Size              Issuer               Agent

12/08/16  Holmes John Stephen               3          10% Owner   1:5K   ShiftPixy, Inc.                   Discount Edgar/FA

Initial Statement of Beneficial Ownership of Securities   —   Form 3
Filing Table of Contents

Document/Exhibit                   Description                      Pages   Size 

 1: 3           Initial Statement of Beneficial Ownership of        HTML      6K 
                          Securities -- form3.xml/2.6                            





This ‘3’ Document is an XML Data File that may be rendered in various formats:

Form 3  –  Plain Text  –  EDGAR System  –  SEC Website  –  XML Data  –  <?xml?> File
 

 
SEC Info rendering:  Initial Statement of Beneficial Ownership of Securities
 
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
Holmes John Stephen

(Last) (First) (Middle)
1 VENTURE
SUITE 150

(Street)
IRVINE CA 92618

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
12/5/16
3. Issuer Name and Ticker or Trading Symbol
ShiftPixy, Inc. [ PIXY ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock, par value $0.0001 12,500,000 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Option to Acquire Preferred Stock (1) 12/31/23 Preferred Stock 12,500,000 0.0001 D
Explanation of Responses:
(1)  The Option may be exercised only upon the following events: 1. The acquisition of a Controlling interest by a shareholder or shareholders other than Scott Absher or Steve Holmes. "Controlling interest" means the ownership of outstanding voting shares of the Company sufficient to enable the acquiring person, directly or indirectly and individually or in association with others, to exercise one-fifth or more of all the voting power of the Company in the election of directors or any other business matter on which shareholders have the right to vote under Wyoming Law. 2. Prior to any proposed merger, consolidation (in which the Company's common stock is changed or exchanged) or sale of at least 50% of the Company's assets or earning power (other than a reincorporation).
/s/ Stephen Holmes 12/7/16
** 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 5 (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 Number.

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Filing Submission 0001477932-16-013986   –   Alternative Formats (Word / Rich Text, HTML, Plain Text, et al.)

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