FORM 4
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, Section
17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the
Investment Company Act of 1940
1. Name and Address of Reporting Person*
Patrick Grant
1020 10th Street
Charleston, IL 61920
2. Date of Event Requiring Statement (Month/Day/Year)
11/4/2002
3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary)
4. Issuer Name and Ticker or Trading Symbol
Flexible Solutions International, Inc. (FXSO)
5. Relationship of Reporting Person(s) to Issuer (Check All Applicable)
/ / Director
/X/ Officer (give title below)
President
Water$avr Global Solutions, Inc.,
wholly-owned subsidiary
/ / 10% Owner
/ / Other (specify below)
6. If Amendment, Date of Original (Month/Day/Year)
N/A
7. Individual or Joint/Group Filing (Check Applicable Line)
/X/ Form filed by One Reporting Person
/ / Form filed by More than One Reporting Person
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 4(b)(v).
Table 1 -- Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned
1. Title of Security (Instr. 3)
Common Stock
2. Transaction Date(s) (Month/Day/Year)
11-4-02
3. Transaction Code (Instr. 8)
S
4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
Date Amount(Shares) (A) or (D) Price per share
--------- -------------- ---------- ---------------
11/ 4/02 15,000 D 3.31
5. Amount of Securities Beneficially Owned at End of Month (Instr. 3 and 4)
45,000
6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
D
7. Nature of Indirect Beneficial Ownership (Instr. 4)
N/A
2
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).
Table II -- Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
------------------------------------------------------------------------------------------------------------------------------
1. Title of Derivative 2. Date Exercisable 3. Title and Amount of 4. Converstion 5. Ownership 6. Nature of
Security (Instr. 4) and Expiration Date Securities or Form of Indirect
(Month/Day/Year) Underlying Exercise Derivative Beneficial
Derivative Security Price of Security: Ownership
(Instr. 4) Derivative Direct (D) (Instr. 5)
Security or Indirect
(I) (Instr.
5)
------------------------ ------------------------
Date Expiration Title Amount
Exercisable Date or
Number
of Shares
----------------------------- ------------ ----------- ------------- ---------- --------------- --------------- --------------
Employee Stock Option 12/31/01 12/31/06 Common Stock 100,000 1.50 D
Employee Stock Option 6/30/02 6/30/07 Common Stock 100,000 1.50 D
Employee Stock Option 12/31/02 12/31/07 Common Stock 100,000 2.00 D
Employee Stock Option 6/30/03 6/30/08 Common Stock 100,000 2.00 D
Employee Stock Option 12/31/03 12/31/08 Common Stock 100,000 2.50 D
Employee Stock Option 6/30/04 6/30/09 Common Stock 100,000 2.50 D
Employee Stock Option 12/31/04 12/31/09 Common Stock 100,000 3.00 D
Employee Stock Option 6/30/05 6/30/10 Common Stock 100,000 3.00 D
Employee Stock Option 12/31/05 12/31/10 Common Stock 100,000 3.50 D
Employee Stock Option 6/30/06 6/30/11 Common Stock 100,000 3.50 D
----------------------------- ------------ ----------- ------------- ---------- --------------- --------------- --------------
Explanation of Responses:
All options were granted 7-1-2001
/s/ PATRICK GRANT 11/4/02
--------------------------------------- ---------
Patrick Grant
** Signature of Reporting Person Date
**Intentional misstatements or omissions of facts constitute Federal Criminal
Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).