0001437749-21-013629.txt : 20210528 0001437749-21-013629.hdr.sgml : 20210528 20210528083205 ACCESSION NUMBER: 0001437749-21-013629 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20181231 FILED AS OF DATE: 20210528 DATE AS OF CHANGE: 20210528 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Aubrey de Lavenu Harold Andre CENTRAL INDEX KEY: 0001737899 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-55557 FILM NUMBER: 21976293 MAIL ADDRESS: STREET 1: APT 627 VALE DO LOBO CITY: ALMANCIL STATE: S1 ZIP: 8135-034 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: CEN BIOTECH INC CENTRAL INDEX KEY: 0001653821 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 000000000 STATE OF INCORPORATION: Z4 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 300-3295 QUALITY WAY CITY: WINDSOR STATE: A6 ZIP: N8T 3R9 BUSINESS PHONE: 226-344-0660 MAIL ADDRESS: STREET 1: 300-3295 QUALITY WAY CITY: WINDSOR STATE: A6 ZIP: N8T 3R9 5 1 rdgdoc.xml FORM 5 X0306 5 2018-12-31 0 1 0001653821 CEN BIOTECH INC CENBF 0001737899 Aubrey de Lavenu Harold Andre 300-3295 QUALITY WAY WINDSOR, ONTARIO, CANADA A6 N8T 3R9 ONTARIO, CANADA 1 Convertible note 1.60 2018-11-15 4 J 0 171632 1.60 D 2016-11-25 Common Stock 107270 548980 D On November 15, 2018, $171,632 of a $200,000 convertible promissory note issued by the issuer on November 25, 2016 to the reporting person was repaid by the issuer to the reporting person thereby reducing the amount due under the note to $28,368 and accordingly reducing the number of common stock shares of the issuer issuable upon conversion of the promissory note from 125,000 shares of common stock by 107,270 shares of common stock to 17,730 shares of common stock. The convertible note matured on November 25, 2018, however, the ability to convert the note into shares did not expire on such maturity date. At December 31, 2018, the reporting person also held 33,321 shares of the issuer's common stock directly, and held convertible promissory notes convertible into 548,980 shares of the issuer's common stock. The reporting person has served as a member of the board of directors of the issuer since July 2017 and was appointed to serve as a vice president of the issuer on April 2, 2021. /s/ Harold Aubrey de Lavenu 2021-05-28