SEC Form 5 · accession 0001433042-16-000001
COPsync, Inc. · COYN
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Jason Shane Rapp
Officer — President · Director
Period of report
Dec 31, 2015
Accepted (ET)
Jan 28, 2016 · 5:27 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001383154
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Nov 18, 2015 | P | 8,500 | $3.49 | A | 316,365 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| WarrantF2 | $3.125 | Nov 18, 2015 | P | 8,500 | A | Nov 18, 2015 | Nov 18, 2020 | Common Stock | 8,500 | 10,500 | D |
Explanation of responses
- F1Includes 296,945 shares held by Mr. Rapp directly, 19,420 shares held by RSIV, LLC, which is controlled and owned equally by Mr. Chaney and Mr. Rapp.
- F2Includes 2,000 shares issuable upon conversion of 100,000 shares of our Series A preferred stock held by RSIV, LLC