Annual Statement of Changes in Beneficial Ownership (5)
14 Février 2020 - 10:27PM
Edgar (US Regulatory)
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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Form 3 Holdings Reported
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Form 4 Transactions Reported
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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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Lin Jan-Yuan | 2. Issuer Name and Ticker or Trading SymbolAerkomm Inc. [AKOM] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
C/O AERKOMM INC.,, 923 INCLINE WAY, #39 | 3. Statement for Issuer's Fiscal Year Ended (MM/DD/YYYY) 12/31/2019 |
(Street)
INCLINE VILLAGE, NV 89451
(City)
(State)
(Zip)
| 4. If Amendment, Date Original Filed(MM/DD/YYYY) | 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) | 2. Trans. Date | 2A. Deemed Execution Date, if any | 3. Trans. Code (Instr. 8) | 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) |
Amount | (A) or (D) | Price |
Common Stock | | | | | | | 372905 | D | |
Common Stock | | | | | | | 959230 | I | Held by Dmedia Holding LP (1) |
Common Stock | | | | | | | 89498 | I | Held by spouse |
Table II - Derivative Securities Acquired, Disposed of, or 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 (MM/DD/YYYY) | 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 at End of Issuer's Fiscal Year (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Stock option (right to buy) | $3.96 | 7/2/2019 | | A (2) | 6000 | | 7/2/2019 (2) | 7/2/2029 | Common Stock | 6000 | $0 | 9000 (3) | D | |
Explanation of Responses: |
(1) | The reporting person holds an 42.4% interest in Dmedia Holding LP and an 7% ownership interest in Dmedia LLC, the General Partner of Dmedia Holding LP. As such, the reporting person has a pecuniary interest in 959,230 shares held by Dmedia Holding LP. |
(2) | Represents ten-year qualified stock options to purchase 6,000 shares of the Issuer's common stock, granted to the Reporting Person under the Issuer's equity incentive plan, pursuant to a stock option agreement, dated July 2, 2019. The options will vest 25% upon the date of issuance of the grant, 25% upon the date the Company obtains from the AMF a visa on the Company's European listing prospectus, 25% upon the first anniversary of the date of issuance of the grant, and 25% upon the second anniversary of the date of issuance of the grant; except that, if the Company does not obtain from the AMF a visa on the Company's European listing prospectus, the stock options shall vest according to the following schedule: 25% upon the date of issuance of the grant, 50% upon the first anniversary of the date of issuance of the grant, and 25% upon the second anniversary of the date of issuance of the grant. |
(3) | Includes previously reported ten-year non-qualified stock options to purchase 3,000 shares (after reflecting 5 to 1 reverse split) at $30.25 per share, granted to the Reporting Person on June 23, 2017 under the Issuer's equity incentive plan, pursuant to a stock option agreement, dated June 23, 2017, which will vest in three equal installments commencing on the first anniversary of the grant date. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Lin Jan-Yuan C/O AERKOMM INC., 923 INCLINE WAY, #39 INCLINE VILLAGE, NV 89451 | X |
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Signatures
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/s/ Jan-Yung Lin | | 1/27/2020 |
**Signature of Reporting Person | Date |
Aerkomm (PK) (USOTC:AKOM)
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Aerkomm (PK) (USOTC:AKOM)
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