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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN 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(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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 control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 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 (Month/Day/Year) |
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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Common Stock Warrant (Right to Buy) | $ 0.15 | 03/27/2019 | X | 66,667 | 12/01/2017 | 12/31/2019 | Common Stock | 66,667 | $ 0 | 73,333 | D | ||||
Common Stock Warrant (Right to Buy) | $ 0.15 (1) | 03/27/2019(1) | X | 266,667 | 12/23/2016 | 12/31/2019(1) | Common Stock | 266,667 (1) | $ 0 | 0 | I | By RLR Services Partnership | |||
Convertible Note | $ 0.1 (2) | 03/27/2019(2) | J | 0 (2) | 12/23/2016 | 12/31/2019(2) | Common Stock | 400,000 (2) | $ 0 | $ 40,000 | I | By RLR Services Partnership |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Kamin Tony 619 BLUFF STREET GLENCOE, IL 60022 |
X | X |
/s/ Tony Kamin | 03/29/2019 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(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). |
(1) | Common Stock Warrant was amended on 12/31/2018 to extend expiration date from 12/31/2018 to12/31/2019. Amended further on 3/27/2019 to adjust number of shares underlying warrant from 160,000 shares to 266,667 shares and to reduce exercise price from $0.25 per share to $0.15 per share. |
(2) | On 12/31/2018 maturity date of Convertible Note in aggregate principal amount of $40,000 was extended from 12/31/2018 to 12/31/2019. Amended on 3/27/2019 to adjust number of shares underlying note from 266,667 shares to 400,000 shares and to reduce conversion price from $0.15 per share to $0.10 per share. |