Sec Form 4 Filing - Pickle William Henry @ INFORMATION ANALYSIS INC - 2021-12-10

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Pickle William Henry
2. Issuer Name and Ticker or Trading Symbol
INFORMATION ANALYSIS INC [ IAIC]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
C/O INFORMATION ANALYSIS INCORPORATED, 12015 LEE JACKSON MEMORIAL HWY STE 210
3. Date of Earliest Transaction (MM/DD/YY)
12/10/2021
(Street)
FAIRFAX, VA22033
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 12/10/2021 A 16,448 A $ 3.04( 1 ) 131,448 I Shares owned by William and Jean Pickle Trust under shared voting and dispositive power.
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Warrants (right-to-buy) $ 4.5 12/10/2021 A 3,290 01/01/2023 12/31/2026 Common Stock 3,290 $ 3.72 108,290( 2 ) I Warrants for a total of 68,290 shares are owned by William and Jean Pickle Trust under shared voting
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Pickle William Henry
C/O INFORMATION ANALYSIS INCORPORATED
12015 LEE JACKSON MEMORIAL HWY STE 210
FAIRFAX, VA22033
X
Signatures
/s/ Matthew T. Sands 12/14/2021
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Mr. Pickle purchased $50,000 of Units in a private placement transaction at $3.04/ Unit, which consisted of 16,448 shares of common stock and Warrants to purchase additional 3,290 shares of common stock. Unit price was based on the Volume Weighted Average Price per share for the five trading days ended December 2, 2021.
( 2 )Warrants to acquire 3,290 shares of common stock reported herein are not exercisable until January 1, 2023.

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* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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