SEC Form 4 · accession 0001052918-15-000196

Jayhawk Energy, Inc. · JYHW

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

A later amendment supersedes this filing — read the amendment. The figures below are kept as originally reported (version chain, not an overwrite).

Reporting owner

10% Owner

Period of report

Apr 30, 2015

Accepted (ET)

May 4, 2015 · 6:46 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001308710

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common stock	Apr 30, 2015	C	118,249,788	$0.01	A	118,249,788	D

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
10% Sr. Secured Convertible Debenture 12/09/2009^F1	$0.01	Apr 30, 2015	C	26,984,215	D	Apr 17, 2015	—	Common stock	26,984,215	0	D
10% Sr. Secured Convertible Debenture 12/09/2009^F1	$0.01	Apr 30, 2015	C	4,778,471	D	Apr 17, 2015	—	Common stock	4,778,471	0	D
10% Sr. Secured Convertible Debenture 4/21/2010^F1	$0.01	Apr 30, 2015	C	71,716,358	D	Apr 17, 2015	—	Common stock	71,716,358	0	D
10% Sr. Secured Convertible Debenture 4/21/2010^F2,F1	$0.01	Apr 30, 2015	C	15,270,744	D	Apr 17, 2015	—	Common stock	15,270,744	108,496,438	D

F1None
F2The number of Derivative Securities Beneficially owned represents additional unpaid 10% Convertible Debentures with an unpaid balance of $1,084,964.38 as of April 30, 2015. The Issuer, JayHawk Energy, Inc. has insufficient authorized common stock capital to permit the Debenture Holder to convert anymore debentures until such time as JayHawk amends its Articles of Incorporation thereby authorizing an increase in common stock capital.

No securities are beneficially owned by the Person signing on behalf of the Reporting Person.