SEC Form 3
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*
BENOIT GERALD JAMES JR

(Last) (First) (Middle)
C/O INFORMATION ANALYSIS INCORPORATED
12015 LEE JACKSON MEMORIAL HWY STE 210

(Street)
FAIRFAX VA 22033

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
08/26/2021
3. Issuer Name and Ticker or Trading Symbol
INFORMATION ANALYSIS INC [ IAIC ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
CEO
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
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 750,000(1) D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
Warrants (right-to-buy) 08/26/2021 08/31/2026 Common Stock 750,000 $3 D
Options (right-to-buy) 08/26/2024 08/26/2026 Common Stock 30,000(2) $2.8 D
Explanation of Responses:
1. Commensurate with appointment as Chairman and CEO, Mr. Benoit purchased 750,000 units in a private placement at $2.00 per unit. One unit equals 1 share common stock and a warrant to purchase 1 additional share common stock at $3.00 per share, expiring August 31, 2026.
2. Three-year vesting schedule for options began 08/26/2021 and will end on 08/26/2024.
/s/ MATTHEW T SANDS 08/30/2021
** 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.
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