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)
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2. Date of Event Requiring Statement
(Month/Day/Year) 11/10/2021 |
3. Issuer Name and Ticker or Trading Symbol
KIDPIK CORP. [ PIK ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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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 | 252,967 | D(1)(2) | |
Common Stock | 354,288(3)(4) | I | u/a/d 02/02/1997, Trust FBO Yaacov Dabah |
Common Stock | 334,829(3)(4) | I | u/a/d 02/02/1997, Trust FBO Moshe Dabah |
Common Stock | 327,448(3)(4) | I | u/a/d 02/02/1997, Trust FBO Joia Dabah |
Common Stock | 167,750(3)(4) | I | u/a/d 02/02/1997, Trust FBO Eva Dabah |
Common Stock | 324,093(3)(4) | I | u/a/d 02/02/1997, Trust FBO Chana Dabah |
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 |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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Explanation of Responses: |
1. The reported securities are held directly by Renee Dabah. |
2. This Form 3 does not include shares of common stock of the Company held by Ezra Dabah, the Chief Executive Officer, President and Chairman of the Issuer, and shares which he has the right to vote pursuant to the Voting Agreement, discussed below, which Renee Dabah may be deemed to beneficially own as the spouse of Mr. Dabah, and which securities are disclosed separately in the Form 3 (and will be disclosed in separate Form 4s) filed by Mr. Dabah. Mrs. Dabah disclaims ownership of the securities held by, and beneficially owned by, Mr. Dabah, except to the extent of her pecuniary interest therein. |
3. Excludes securities owned by members of a Voting Group relating to a voting agreement dated September 1, 2021, between the reporting persons and members of the Voting Group, for which the reporting persons disclaim beneficial ownership (except as expressly set forth above). The Voting Group refers to members of a voting agreement with (and with respect to the reported securities owned by) Moshe Dabah, Eva Dabah, Joia Kazam, Chana Rapaport, Yaacov Dabah; Trust FBO Josh A. Kazam, whose trustee is Greg Kiernan; Gila Goodman; Isaac Dabah and his spouse; GMM Capital LLC; Sterling Macro Fund, and each of the trusts described footnote 4, below, for purposes of Section 13(d) of the Securities Exchange Act of 1934, each of which provided complete authority to Mr. Ezra Dabah, the Chief Executive Officer of the Issuer (and the spouse of Renee Dabah), to vote the shares held by such persons and entities at any and all meetings of stockholders of the Company and via any written consents. |
4. The securities are held in the name of each applicable trust referenced, of which the Reporting Persons (Renee Dabah and Raine Silverstein) are co-trustees, and as such, each Reporting Person may be deemed to beneficially own the securities held by each applicable trust. Raine Silverstein is the mother-in-law of Ezra Dabah. The Reporting Persons disclaim ownership of the reported securities except to the extent of their own pecuniary interest therein. |
/s/ Renee Dabah | 12/03/2021 | |
/s/ Raine Silverstein | 12/03/2021 | |
** 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. |