SEC Form 3
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 |
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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 12/31/2021 | 3. Issuer Name and Ticker or Trading Symbol FISION Corp [ FSSN ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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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 | 1,939,742(1) | D | |
Common Stock | 28,291,122(2) | I | By Capital Market Solutions LLC(2) |
Common Stock | 3,281,667 | I | By MGA Holdings LLC |
Common Stock | 5,509,733 | I | By Ignition Capital LLC |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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 | ||||
Common Stock Warrant | 04/01/2019 | 04/01/2024 | Common Stock | 30,000,000(3) | 0.2(3) | I | By Capital Market Solutions LLC |
Common Stock Warrant | 05/15/2020 | 05/15/2025 | Common Stock | 5,072,023(4) | 0.0422(4) | I | By Capital Market Solutions LLC |
Common Stock Warrant | 04/17/2019 | 04/17/2024 | Common Stock | 2,498,922(4) | 0.0435(4) | I | By Ignition Capital LLC |
Explanation of Responses: |
1. Director Compensation |
2. Consulting Agreement shares earned through ownership of Capital Market Solutions LLC |
3. Pursuant to a Consulting Agreement, warrants have a strike price of $0.20 per share, five year warrants. |
4. Pursuant to a debt conversion agreement with attached warrants, with a strike price of Volume Weighted Average Price (VWAP) with a ten-day look back period, with a term of five years. |
William Gerhauser | 01/05/2022 | |
** 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. |