SEC Form 4/A · accession 0001052918-15-000209
Jayhawk Energy, Inc. · JYHW
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
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 | 118,749,788 | $0.01 | A | 118,749,788 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 10% Sr. Secured Convertible Debenture 12/09/2009F1 | $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 12/09/2009F1 | $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 4/21/2010F1 | $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 4/21/2010F2,F1 | $0.01 | Apr 30, 2015 | C | 15,270,744 | D | Apr 17, 2015 | — | Common stock | 15,270,744 | 107,996,438 | D |
Explanation of responses
- F1None
- F2The number of Derivative Securities Beneficially owned represents additional unpaid 10% Convertible Debentures with an unpaid balance of $1,079,964.38 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.
Remarks
(1) Scott Mahoney, as the CEO and Managing Member of Vast Exploration, LLC is the natural person with voting and dispositive control over Vast Exploration, LLC and is deemed to be a beneficial owner. Mr. Mahoney disclaims beneficial ownership of the Vast Exploration, LLC shares. (2) This Form 4/A (this "Amendment") is being filed by the Reporting Person to amend and restate the Form 4 originally filed by the Reporting Person with the Securities and Exchange Commission on May 4, 2015 (the "Original Form 4"). This Amendment revises the Original Form 4 by (i) updating Table I, Column 4 to correct the number of securities acquired, (ii) updating Table I, Column 5 to correct the number of securities beneficially owned following the reported transaction, (iii) updating Table II, Column 9 to correct the number of derivative securities beneficially owned following the reported transaction and (iv) amend Note 1 to correct the unpaid balance due under the Convertible Debentures as of April 30, 2015.