UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL 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(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. | SEC 1473 (7-02) | ||
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. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Common Stock Warrant | 01/18/2018 | 05/30/2022 | Common Stock | 50,000 | $ 0.4 | D | Â |
Common Stock Warrant | 01/18/2018 | 05/30/2022 | Common Stock | 50,000 | $ 0.6 | D | Â |
Common Stock Warrant | 08/18/2018 | 08/15/2023 | Common Stock | 200,000 | $ 0.15 | D | Â |
Common Stock Warrant | 11/09/2018 | 10/31/2023 | Common Stock | 1,333,333 | $ 0.075 | D | Â |
Convertible Note (1) | 01/18/2019 | 07/18/2019 | Common Stock | 1,000,000 | $ 0.05 | D | Â |
Common Stock Warrant | 02/19/2019 | 02/19/2024 | Common Stock | 30,000 | $ 0.25 | D | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Barbera Michael Vito 1423 SW 13TH DRIVE BOCA RATON, FL 33486 |
 X |  |  |  |
/s/ Michael Vito Barbera | 02/21/2019 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 5(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) | Convertible Note (the "Note") with a principal balance of $50,000 which may be converted at any time prior to the maturity date of July 18, 2019. The Note carries a 15% per annum interest rate. Accrued interest may also be converted into shares of common stock at a conversion price of $0.05 per share. The Issuer may require conversion of the Note plus accrued interest any time prior to the maturity date. In the event the Note is converted rather than repaid by the Company, the Reporting Person shall receive a 5-year Common Stock Warrant effective as of such conversion date which may be exercised for up 666,667 shares of common stock at a per share exercise price of $0.075. |