SEC Form 4 · accession 0001185185-16-004149
Petrolia Energy Corp · BBLS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Leo B Womack
Director · 10% Owner
Period of report
Sep 23, 2015
Accepted (ET)
Apr 4, 2016 · 6:44 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001368637
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| OptionF1,F3 | $0.06 | Sep 23, 2015 | P | 1,000,000 | A | Jan 1, 2016 | Dec 31, 2018 | Common Stock | 1,000,000 | 1,466,667 | D |
| OptionF2 | $0.06 | Mar 17, 2016 | P | 1,000,000 | A | Mar 17, 2016 | Mar 17, 2019 | Common Stock | 1,000,000 | 2,466,667 | D |
Explanation of responses
- F1On September 23, 2015, the reporting person was granted qualified stock options to purchase 1,000,000 shares of common stock of the issuer as part of the 2015 Director's Compensation Plan.
- F2On March 17, 2016, the reporting person was granted an option to acquire 1,000,000 shares of the Corporation's common stock at a strike price of .06 cents per share, exercisable for a period of 36 months from March 17, 2016. This grant is part of the 2016 Director's Compensation Plan and in the event a Director resigns or is removed for due cause during 2016 the option shares shall be reduced by a pro-rata amount based on the period of non-service.
- F3On June 26, 2015, the reporting person reported the acquisition of a Warrant for 300,000 shares of the issuer's common stock, which such transaction was previously reported on Form 4. As a result of that transaction, the number of derivative securities beneficially owned following that reported transaction should have indicated a total of 466,667 shares of common stock of the issuer, including the Warrants reported on May 13, 2015.