SEC Form 4 · accession 0001213900-16-014449
BioSolar Inc · NEWH
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Stanley Burton Levy
Officer — VP and CTO · 10% Owner
Period of report
Jun 21, 2016
Accepted (ET)
Jun 23, 2016 · 2:31 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001371128
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Jun 21, 2016 | J | 240,659 | — | A | 1,816,714 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Convertible NoteF1 | — | Jun 21, 2016 | J | 240,659 | D | Jun 5, 2013 | Dec 18, 2017 | Common Stock | 240,659 | 0 | D |
Explanation of responses
- F1Common Stock was issued to Reporting person upon the conversion of $24,000 principal and $3,675.78 interest of a convertible promissory note granted to the Reporting Person by the Issuer pursuant to a Convertible Note Agreement dated June 5, 2013 which was issued directly to Reporting Person by the Issuer in satisfaction of unpaid salary. The balance of the Promissory Note was convertible into shares of the Issuer's common stock at a conversion price equal to the lesser of (i) $0.24 per share, or (ii) the closing prices of the Issuer's common stock on the last complete trading day immediately preceding the date of conversion. The original balance of the Promissory Note was $114,000. There is no longer a balance on this Promissory Note.