|
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 |
|
| |||||||||||||||||||||||||||||
|
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) |
||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Convertible Promissory Note | $ 0.3 (3) | 05/18/2018 | C | $ 650,000 | 10/08/2015 | 06/01/2018 | Common Stock | 2,166,667 (4) | $ 0.3 (2) | $ 100,000 | I | $100,000 convertible promissory note held through corporate entity of which Reporting Person is bene |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
STROMMEN JACK B. 7108 31ST AVENUE NORTH MINNEAPOLIS, MN 55427 |
X |
/s/ John R. Browning, Attorney in fact | 05/22/2018 | |
**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) | Shares were issued to Reporting Person in exchange for conversion of the promissory note reported as "disposed" in Table II, issued in exchange for a $650,000 investment in Issuer's 2015 Unit Offering, and include shares issued as payment of principal at $0.30 per share and accrued interest at $0.25 per share. |
(2) | Represents the conversion price set forth in the Convertible Promissory Note reported herein. |
(3) | Reporting Person elected to reduce conversion price of subject promissory note from $0.35 to $0.30 through the payment of $39,000. |
(4) | Upon reduction of conversion price to $0.30, number of shares of common stock underlying the note increased from 1,857,143 to 2,166,667. |