SEC Form 5 · accession 0001474646-16-000002
COPsync, Inc. · COYN
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Joel Hochberg
Director
Period of report
Dec 31, 2015
Accepted (ET)
Jan 28, 2016 · 6:11 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 Stock | Nov 13, 2015 | A | 19,000 | $0.00 | A | 0 | D | |
| Common StockF1 | Nov 13, 2015 | M | 19,000 | $6.25 | A | 0 | D | |
| Common Stock | Nov 18, 2015 | P | 16,000 | $3.49 | A | 149,000 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series B Preferred StockF3,F2 | $0.00 | Nov 13, 2015 | M | 95,000 | D | Nov 24, 2009 | Nov 13, 2015 | Common Stock | 95,000 | 0 | D |
| Series B Warrant | $6.25 | Nov 13, 2015 | M | 19,000 | D | Oct 14, 2009 | Oct 14, 2017 | Common Stock | 19,000 | 0 | D |
| WarrantF4 | $3.125 | Nov 18, 2015 | P | 16,000 | A | Nov 18, 2015 | Nov 20, 2020 | Common Stock | 16,000 | 18,733 | D |
Explanation of responses
- F1Shares acquired pursuant to Warrant exercise.
- F2The Company's Series B Preferred Stock converted into 40 shares of common stock per Preferred share.
- F3Original per share price for the Series B Preferred Stock.
- F4Includes 2,733 shares purchasable by Mr. Hochberg within 60 days under an option agreement
- F5As consideration for Mr. Hochberg agreeing to convert his shares of Series B Preferred Stock into shares of Common Stock, terminate the Investor's Rights Agreement and waive any rights he may have under such agreement, the Company agreed to issue an additional 23,750 shares of common stock.