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*
Hodge Paul Jr.

(Last) (First) (Middle)
C/O LAIRD SUPERFOOD
275 W. LUNDGREN MILL DR

(Street)
SISTERS OR 97759

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/22/2020
3. Issuer Name and Ticker or Trading Symbol
Laird Superfood, Inc. [ LSF ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Executive Officer
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 263,278 I By Paul W. Hodge, Jr. Revocable Trust
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
Stock Option (right to buy) (1) 02/23/2026 Common Stock 50,000 $2 I By Paul W. Hodge, Jr. Revocable Trust
Stock Option (right to buy) (2) 02/20/2023 Common Stock 60,000 $9 I By Paul W. Hodge, Jr. Revocable Trust
Stock Option (right to buy) (3) 04/14/2023 Common Stock 16,566 $13.05 I By Paul W. Hodge, Jr. Revocable Trust
Explanation of Responses:
1. Stock option granted under the 2016 Stock Incentive Plan ("Stock Plan") on February 24, 2016 and became exercisable with respect to 25% of the shares of common stock on the date of grant and on each of the first three anniversaries of the date of grant.
2. Stock option granted under the Stock Plan on February 21, 2018 and became exercisable with respect to 50% of the shares of common stock on each of the first two anniversaries of the date of grant.
3. Stock option granted under the 2018 Equity Incentive Plan on April 15, 2020 and becomes exercisable with respect to approximately 25% of the shares of common stock on each of the first four anniversaries of the date of grant.
Remarks:
/s/ Andrew McCormick, as attorney-in-fact for Paul Hodge 09/22/2020
** 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.