SEC Form 4
FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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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1. Name and Address of Reporting Person *
Fernandez Charles M.
(Last) (First) (Middle)
C/O NEXTPLAT CORP, 3250 MARY ST., SUITE 410
3. Date of Earliest Transaction (Month/Day/Year)
12/14/2022
4. If Amendment, Date of Original Filed (Month/Day/Year)
5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
X Director
X
Officer (give title below)
10% Owner
Other (specify below)
X Chairman & CEO
6. Individual or Joint/Group Filing (Check Applicable Line) X Form filed by One Reporting Person
Form filed by More than One Reporting Person
(Street)
COCONUT GROVE
FL 33133
(City) (State)
(Zip)
2. Issuer Name and Ticker or Trading Symbol NextPlat Corp [ NXPL ]
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3)
2. Transaction Date (Month/Day/Year)
2A. Deemed Execution Date, if any (Month/Day/Year)
3. 4. Securities Acquired (A) or Disposed Of Transaction (D) (Instr. 3, 4 and 5)
Code (Instr.
8)
Code V Amount (A) or Price (D)
PA
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)
Common Stock
12/14/2022
1,085,714(2)
$1,899,999.5
3,658,667
I
Held by eApeiron Partners, LLC(1)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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
12/14/2022 P
V
(A)
1,085,714(2)
(D)
Date Exercisable
12/14/2022
Expiration Date
12/14/2025
Title
Common Stock
Amount or Number of Shares
1,085,714 (2)
Common Stock Warrants
$1.75
1,685,714
Held by I eApeiron Partners,
LLC(1)
Explanation of Responses:
1. Mr. Fernandez is the sole member and managing partner of eAperion Partners LLC.
2. On December 14, 2022 eAperion Partners LLC purchased 1,085,714 units from the Issuer in a private placement for $1.75 per unit. Each unit consists of one share of common stock and one warrant to purchase one share of common stock of the Issuer. The warrants underlying units are immediately exercisable.
/s/ Charles M. Fernandez 12/20/2022
** 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 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.
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