Initial Statement of Beneficial Ownership (3)
20 Janvier 2018 - 12:32AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
Estimated average burden
hours per response...
0.5
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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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Young Lachlan Grant
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2. Date of Event Requiring Statement (MM/DD/YYYY)
12/31/2017
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3. Issuer Name
and
Ticker or Trading Symbol
ProtoKinetix, Inc. [PKTX]
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(Last)
(First)
(Middle)
66438 ROSEBERY AVENUE
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
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X
___ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Street)
WEST VANCOUVER, A1 V7W 2C6
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
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X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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6850000
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Stock Option
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(1)
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2/28/2020
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Common Stock
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5000000
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$0.04
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D
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Warrant
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(2)
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4/22/2020
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Common Stock
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6000000
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$0.10
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D
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Stock Option
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(3)
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12/31/2019
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Common Stock
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5000000
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$0.08
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D
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Stock Option
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(4)
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12/31/2020
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Common Stock
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5000000
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$0.05
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D
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Stock Option
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(5)
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8/31/2021
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Common Stock
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5000000
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$0.06
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D
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Explanation of Responses:
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(1)
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Options issued pursuant to the 2015 Stock Option and Stock Bonus Plan on March 1, 2015. 1,250,000 shares of common stock vested March 1, 2015; thereafter 1,250,000 vested every three months and became fully vested on December 1, 2015.
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(2)
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Warrant issued on April 22, 2015 for the right to purchase 6,000,000 shares of common stock, exercisable in whole or in part, at any time and from time to time prior to the expiration date.
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(3)
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Options issued pursuant to the 2017 Stock Option and Stock Bonus Plan on January 1, 2016. 1,250,000 shares of common stock vested on March 31, 2016; thereafter 1,250,000 shares vested every three months and became fully vested on December 31, 2016.
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(4)
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Options issued pursuant to the 2017 Stock Option and Stock Bonus Plan on January 1, 2017. 1,250,000 shares of common stock vested March 31, 2017; thereafter 1,250,000 vested every three months and became fully vested on December 31, 2017.
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(5)
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Options issued pursuant to the 2017 Stock Option and Stock Bonus Plan on September 1, 2017. 1,250,000 shares of common stock vested on December 31, 2017; thereafter 1,250,000 shall vest every three months until fully vested.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Young Lachlan Grant
66438 ROSEBERY AVENUE
WEST VANCOUVER, A1 V7W 2C6
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X
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Signatures
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/s/ Lachlan Grant Young
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1/19/2018
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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