SEC Form 5 · accession 0001213900-17-000982
Jerrick Media Holdings, Inc. · JMDA
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Leonard M Schiller
Director
Period of report
Dec 31, 2016
Accepted (ET)
Feb 6, 2017 · 5:03 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Warrants to Purchase Common StockF1,F2 | $0.23 | Feb 5, 2016 | A | 50,000 | A | Feb 5, 2016 | Nov 18, 2020 | Common Stock | 50,000 | 480,000 | I |
| Warrants to Purchase Common StockF3 | $0.30 | Oct 24, 2016 | A | 30,000 | A | Oct 24, 2016 | Oct 24, 2021 | Common Stock | 30,000 | 480,000 | I |
Explanation of responses
- F1On February 5, 2016, Leonard Schiller was appointed as a Director of the Issuer (then, prior to a name change, "Great Plains Holdings, Inc.").
- F2The derivative securities were initially acquired in Jerrick Ventures, Inc. in consideration for Leonard Schiller's agreement to amend the terms of both a Convertible Debenture dated December 4, 2014 in the principal amount of $100,000 and 200 shares of Series "A" Preferred Stock. Jerrick Ventures, Inc. later merged into the Issuer.
- F3The derivative securities were issued pursuant to a Promissory Note issued by the Issuer in favor of Leonard Schiller in the principal amount of $15,000.