0001179110-21-003022.txt : 20210308 0001179110-21-003022.hdr.sgml : 20210308 20210308110930 ACCESSION NUMBER: 0001179110-21-003022 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210130 FILED AS OF DATE: 20210308 DATE AS OF CHANGE: 20210308 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Simpson Tom CENTRAL INDEX KEY: 0001808347 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-14818 FILM NUMBER: 21721009 MAIL ADDRESS: STREET 1: 38 CORPORATE CIRCLE CITY: ALBANY STATE: NY ZIP: 12203 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Kaspien Holdings Inc. CENTRAL INDEX KEY: 0000795212 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL- COMPUTER & PRERECORDED TAPE STORES [5735] IRS NUMBER: 141541629 STATE OF INCORPORATION: NY FISCAL YEAR END: 0201 BUSINESS ADDRESS: STREET 1: 2818 N. SULLIVAN RD. CITY: SPOKANE STATE: WA ZIP: 99216 BUSINESS PHONE: 5184521242 MAIL ADDRESS: STREET 1: 2818 N. SULLIVAN RD. CITY: SPOKANE STATE: WA ZIP: 99216 FORMER COMPANY: FORMER CONFORMED NAME: TRANS WORLD ENTERTAINMENT CORP DATE OF NAME CHANGE: 19941212 FORMER COMPANY: FORMER CONFORMED NAME: TRANS WORLD MUSIC CORP DATE OF NAME CHANGE: 19920703 5 1 edgar.xml FORM 5 - X0306 5 2021-01-30 0 0 1 0000795212 Kaspien Holdings Inc. KSPN 0001808347 Simpson Tom 2818 N. SULLIVAN ROAD SPOKANE WA 99216 1 0 0 0 Common stock, par value $0.1 per share 2020-11-25 4 X 0 12593 0.01 A 12593 I By Kick Start III, LLC Common stock, par value $0.1 per share 2020-11-25 4 X 0 8395 0.01 A 8395 I By Kick Start IV, LLC Common Stock, par value $.01 per share 57000 D Common stock, par value $.01 per share 23879 I By WIN Partners Common Stock, par value $.01 per share 9737 I By Kick Start, LLC Common stock, par value $.01 per share 25 I By Wife Warrant to purchase Common Stock, par value $0.01 per share .01 2020-11-25 4 X 0 12593 0 D 2020-03-30 2025-03-30 Common Stock, par value $0.01 per share 12593 1448 I By Kick Start III, LLC Warrant to purchase Common Stock, par value $0.01 per share .01 2020-11-25 4 X 0 8395 0 D 2020-03-30 2025-03-30 Common Stock, par value $0.01 per share 8395 965 I By Kick Start IV,LLC Securities held by Kick Start, LLC. Mr. Simpson holds an interest, manages and has voting control of Kick Start, LLC. Securities held by Kick Start III, LLC. Mr. Simpson holds an interest, manages and has voting control of Kick Start III. Securities held by Kick Start IV, LLC. Mr. Simpson holds an interest, manages and has voting control of Kick Start IV, LLC. Securities held by WIN Partners. Mr. Simpson holds an interest, manages and has voting control of WIN Partners. Tom Simpson 2021-03-08