SEC Form 4/A · accession 0001580695-18-000112
Petrolia Energy Corp · BBLS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
This is an amendment (Form 4/A). It replaces an earlier filing for the same period.
Reporting owner
James Edward Burns
Officer — President · Director
Period of report
Apr 18, 2017
Accepted (ET)
Feb 15, 2018 · 5:03 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001368637
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock | holding | — | — | — | 1,550,000 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series A Convertible Preferred StockF1 | $0.14 | May 26, 2017 | A | 10,500 | A | May 26, 2017 | — | Common Stock | 750,000 | 10,500 | D |
| Series A Convertible Preferred StockF1 | $0.14 | May 23, 2017 | A | 3,000 | A | May 23, 2017 | — | Common Stock | 214,286 | 13,500 | D |
| Series A Convertible Preferred StockF1 | $0.14 | Apr 18, 2017 | A | 2,900 | A | Apr 18, 2017 | — | Common Stock | 207,143 | 16,400 | D |
Explanation of responses
- F1The Issuer's Series A Convertible Preferred Stock have a face value of $10 per share and convert into common stock of the Issuer (along with any accrued dividends thereon), at any time at the option of the holder thereof, and automatically when the Issuer's common stock market price equals or exceeds $0.30 per share for 30 consecutive days, at a conversion price of $0.14 per share (each share of preferred stock converts into 71.42 shares of common stock). The Series A Convertible Preferred Stock also accrues a cumulative dividend at a rate of 9% per annum and includes a blocker, preventing the conversion of such preferred stock into common stock if upon such conversion the holder would hold more than 4.99% of the Issuer's outstanding common stock.
Remarks
This Form 4/A is being filed to correct certain errors in the disclosure of the preferred stock acquired by the Reporting Person as reported herein and move the preferred stock from the Non-Derivative Security table to the Derivative Security table due to the conversion terms thereof. This Form 4/A also corrects the earliest transaction date reported.