SEC Form 5 · accession 0001213900-17-000930
Jerrick Media Holdings, Inc. · JMDA
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Andrew Fleming Taffin
Director
Period of report
Dec 31, 2016
Accepted (ET)
Feb 3, 2017 · 12:08 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001357671
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Options to Purchase Common StockF1 | $0.25 | Jul 1, 2016 | A | 300,000 | A | Jul 1, 2016 | Jun 30, 2021 | Common Stock | 300,000 | 300,000 | D |
| Warrants to Purchase Common StockF2,F3 | $0.23 | Feb 5, 2016 | P | 100,000 | A | Feb 5, 2016 | Dec 9, 2019 | Common Stock | 100,000 | 100,000 | D |
| Warrants to Purchase Common StockF2,F4 | $0.23 | Feb 5, 2016 | J | 200,000 | A | Feb 5, 2016 | Nov 17, 2020 | Common Stock | 200,000 | 200,000 | D |
| Warrants to Purchase Common StockF2,F5 | $0.23 | Feb 5, 2016 | A | 40,000 | A | Feb 5, 2016 | Nov 17, 2020 | Common Stock | 40,000 | 40,000 | D |
| Series A Preferred StockF2,F4 | $0.164 | Feb 5, 2016 | J | 1,113 | A | Feb 5, 2016 | Nov 17, 2020 | Common Stock | 678,658 | 1,113 | D |
Explanation of responses
- F1Derivative Securities issued to Andrew Taffin for serving on the Issuer's Board of Directors.
- F2On February 5, 2016, Andrew Taffin was appointed as a Director of the Issuer (then, prior to a name change, "Great Plains Holdings, Inc.").
- F3Issued in consideration for Andrew Taffin's purchase of a Convertible Debenture, dated December 10, 2014 in the principal amount of $100,000 pursuant to the terms of a Bridge Financing.
- F4Received from the Issuer as consideration for exchange of a Convertible Debenture, dated December 10, 2015 in the principal amount of $100,000.
- F5Received from the Company as consideration for Andrew Taffin's agreement to amend the terms of a Convertible Debenture, dated December 10, 2014 in the principal amount of $100,000.