SEC Form 5 · accession 0001477932-18-001545
DAIS ANALYTIC CORP · DLYT
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Patricia Kelly Tangredi
10% Owner
Period of report
Dec 31, 2017
Accepted (ET)
Mar 30, 2018 · 5:46 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001125699
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Oct 19, 2016 | J | 200,000 | $0.00 | A | 546,601 | D | |
| Common StockF1 | Jan 30, 2017 | J | 20,000 | $0.00 | A | 566,601 | D | |
| Common StockF1 | Feb 21, 2017 | J | 440,000 | $0.00 | A | 1,006,601 | D | |
| Common StockF1 | Mar 14, 2017 | J | 200,000 | $0.00 | A | 1,206,601 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| WarrantF2 | $0.01 | Feb 14, 2017 | J | 1,000,000 | A | Feb 14, 2017 | Feb 14, 2027 | Common Stock | 1,000,000 | 3,047,500 | D |
| WarrantF2 | $0.01 | Feb 21, 2017 | J | 3,000,000 | A | Feb 21, 2017 | Feb 21, 2027 | Common Stock | 3,000,000 | 6,047,500 | D |
| WarrantF2 | $0.01 | May 1, 2017 | J | 250,000 | A | May 1, 2017 | May 1, 2027 | Common Stock | 250,000 | 6,297,500 | D |
| WarrantF2 | $0.01 | Jul 27, 2017 | J | 2,000,000 | A | Jul 27, 2017 | Jul 27, 2027 | Common Stock | 2,000,000 | 8,297,500 | D |
| WarrantF2 | $0.01 | Aug 28, 2017 | J | 5,000,000 | A | Aug 28, 2017 | Aug 28, 2027 | Common Stock | 5,000,000 | 13,297,500 | D |
| WarrantF2 | $0.01 | Oct 18, 2017 | J | 5,000,000 | A | Oct 18, 2017 | Oct 18, 2027 | Common Stock | 5,000,000 | 18,297,500 | D |
| WarrantF2 | $0.01 | Dec 31, 2017 | J | 10,000,000 | A | Dec 31, 2017 | Dec 31, 2027 | Common Stock | 10,000,000 | 28,297,500 | D |
| Common Stock Purchase Option | $0.036 | Nov 23, 2017 | A | 600,000 | A | Nov 23, 2017 | Nov 23, 2027 | Common Stock | 600,000 | 9,135,058 | I |
Explanation of responses
- F1Common Stock issued pursuant to terms of June 24, 2016 Secured Promissory Note and Security Agreement, as amended.
- F2Common Stock Warrant issued pursuant to terms of June 24, 2016 Secured Promissory Note and Security Agreement of same date, as amended.