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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 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 | ||||||||
Warrant to Purchase Common Stock | $ 7.43 | 12/21/2016 | J | 44,446 | 03/02/2017 | 09/02/2021 | Common Stock, par value $0.001 | 44,446 | (2) | 44,446 | D | ||||
Warrant to Purchase Common Stock | $ 1.5 | 08/29/2017 | P | $ 183,486 | 03/01/2018 | 08/28/2020 | Common Stock, par value $0.001 | $ 183,486 | (3) | $ 227,932 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
SHEFTS MARK C/O ALLIANCE MMA, INC. 590 MADISON AVENUE, 21ST FLOOR NEW YORK, NY 10022 |
X |
/s/ Mark Shefts | 04/11/2018 | |
**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) | In addition to the 222,374 shares of common stock held directly, this also includes 151,389 shares held by the Rushcap Group, Inc., of which Mr. Shefts and his spouse, Wanda Shefts, are the sole stockholders. Mr. Shefts has voting and dispositive power over the shares held by the Rushcap Group, Inc. |
(2) | Warrants allocated to Network 1 Financial Securities, Inc., during the initial public offering that were allocated to Mr. Shefts in conjucntion with initial public offering, prior to Mr. Shefts becoming areporting person. |
(3) | Fully vested warrants were issued in a prior reported purchase on the Form 4 filed on January 26, 2018. The warrants were issued at a rate of one warrant per one share of common stock at a unit price of $1.09 per unit. |
Remarks: The original Form 4, filed on January 26, 2018, is being amended by this Form 4 amendment to correct an administrative error, which misreported a purchase that occured on October 20, 2017 as a total of 183,486 shares of common stock, when in fact an equal number of warrants to purchase common stock were also included in that purchase and the correct purchase date was August 29, 2017. As a result of this administrative error, the number of derivative securites beneficially owned by the reporting person is updated in Table II. |