SEC Form 4
FORM 4 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol Sysorex, Inc. [ SYSX ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Date of Earliest Transaction (Month/Day/Year) 08/31/2018 | ||||||||||||||||||||||||||
4. 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 Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction 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) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 422(1) | D | ||||||||
Common Stock | 40(1) | I | By Qureishi Ali Grandchildren Trust(2) | |||||||
Common Stock | 203(1) | I | By Lubna Qureishi (wife) | |||||||
Common Stock | 08/31/2018 | P | 1,000,000 | A | (3) | 1,000,000 | I | By Sysorex Consulting, Inc.(4) | ||
Common Stock | 27(1) | I | By Naheed Qureishi (mother-in-law) | |||||||
Common Stock | 412(1) | I | By the Qureishi 1998 Family Trust(5) |
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 Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) | 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 Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
1. Reflects shares of common stock received in a pro-rata distribution upon completion of the spin-off of Sysorex, Inc. from Inpixon. |
2. The shares are held directly by the Qureishi Ali Grandchildren Trust (the "Ali Grandchildren Trust"). The reporting person is a trustee of the Ali Grandchildren Trust and may be deemed to share voting and dispositive power with regard to the reported shares held by the Ali Grandchildren Trust. |
3. Pursuant to that certain Trademark License Agreement, effective as of August 31, 2018, by and between Sysorex, Inc. ("Sysorex") and Sysorex Consulting, Inc. ("Sysorex Consulting") Sysorex agreed to issue 1,000,000 shares of common stock to Sysorex Consulting as part of the consideration for the trademark license granted by Sysorex Consulting. |
4. The shares are held directly by Sysorex Consulting, a company controlled by the reporting person's farther-in-law, A. Salam Qureishi. |
5. The shares are held of record by the Qureishi 1998 Family Trust, of which the reporting person's father-in-law, A. Salam Qureishi, is the sole trustee. |
/s/ Nadir Ali | 09/05/2018 | |
** 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 4 (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. |