Annual Statement of Changes in Beneficial Ownership (5)
28 Mai 2021 - 2:32PM
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
[X]
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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3235-0362
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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
*
Aubrey de Lavenu Harold Andre | 2. Issuer Name and Ticker or Trading SymbolCEN BIOTECH INC [CENBF] |
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)
300-3295 QUALITY WAY | 3. Statement for Issuer's Fiscal Year Ended (MM/DD/YYYY) 12/31/2018 |
(Street)
WINDSOR, ONTARIO, CANADA, A6 N8T 3R9
(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 |
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 |
Convertible note | $1.60 | 11/15/2018 | | J4
(1) | | 171632 | 11/25/2016 | (2) | Common Stock | 107270 | $1.60 | 548980 (3) | D | |
Explanation of Responses: |
(1) | On November 15, 2018, $171,632 of a $200,000 convertible promissory note issued by the issuer on November 25, 2016 to the reporting person was repaid by the issuer to the reporting person thereby reducing the amount due under the note to $28,368 and accordingly reducing the number of common stock shares of the issuer issuable upon conversion of the promissory note from 125,000 shares of common stock by 107,270 shares of common stock to 17,730 shares of common stock. |
(2) | The convertible note matured on November 25, 2018, however, the ability to convert the note into shares did not expire on such maturity date. |
(3) | At December 31, 2018, the reporting person also held 33,321 shares of the issuer's common stock directly, and held convertible promissory notes convertible into 548,980 shares of the issuer's common stock. |
Remarks: The reporting person has served as a member of the board of directors of the issuer since July 2017 and was appointed to serve as a vice president of the issuer on April 2, 2021. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Aubrey de Lavenu Harold Andre 300-3295 QUALITY WAY WINDSOR, ONTARIO, CANADA, A6 N8T 3R9 | X |
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Signatures
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/s/ Harold Aubrey de Lavenu | | 5/28/2021 |
**Signature of Reporting Person | Date |
CEN Biotech (CE) (USOTC:CENBF)
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CEN Biotech (CE) (USOTC:CENBF)
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