SEC Form 5 · accession 0001052918-16-000803
Ambient Water Corp · AWGI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
0967761 BC, Ltd.
Officer — CEO/CTO · Director · 10% Owner · Other
Period of report
Apr 22, 2015
Accepted (ET)
Feb 9, 2016 · 7:31 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001394872
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Apr 22, 2015 | S | 10,000 | $0.02 | D | 12,778,712 | I | Shares held by holding company |
| Common StockF1 | Apr 28, 2015 | S | 16,380 | $0.02 | D | 12,762,332 | I | Shares held by holding company |
| Common StockF1 | Apr 29, 2015 | S | 73,620 | $0.02 | D | 12,688,712 | I | Shares held by holding company |
| Common StockF1 | Jun 9, 2015 | S | 50,000 | $0.051 | D | 12,638,712 | I | Shares held by holding company |
| Common StockF1 | Jun 9, 2015 | S | 25,000 | $0.048 | D | 12,613,712 | I | Shares held by holding company |
| Common StockF1 | Jun 9, 2015 | S | 50,000 | $0.0437 | D | 12,563,712 | I | Shares held by holding company |
| Common StockF1 | Jun 9, 2015 | S | 50,000 | $0.0531 | D | 12,513,712 | I | Shares held by holding company |
| Common StockF1 | Jun 9, 2015 | S | 45,000 | $0.0434 | D | 12,468,712 | I | Shares held by holding company |
| Common StockF1 | Jun 9, 2015 | S | 50,000 | $0.041 | D | 12,418,712 | I | Shares held by holding company |
| Common StockF1 | Jun 9, 2015 | S | 50,000 | $0.0435 | D | 12,368,712 | I | Shares held by holding company |
| Common Stock | holding | — | — | — | 14,941,438 | D | ||
| Common StockF1 | holding | — | — | — | 12,788,712 | I | Shares held by holding company |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Common stock otpionsF2 | $0.11 | holding | — | — | — | — | Jul 22, 2023 | Common stock | 750,000 | 750,000 | D |
Explanation of responses
- F1Common stock registered to 0967761 BC, Ltd. Keith White, who is CEO, CTO and a director of Ambient Water Corp., has sole voting and dispositive control over the 0967761 BC, Ltd. shares.
- F2On July 22, 2013, the board of directors authorized the issuance of 750,000 common stock options to Keith White, the Company's Chief Executive Officer and Chief Technology Officer. These common stock options have an exercise price of $0.11 per share. On July 22, 2014, twenty-five percent (25%) of the options vested. Thereafter, the options vest at six and a quarter percent (6.25%) each quarter or 46,875 option shares quarterly. Vesting quarters are October 22, January 22, April 22 and July 22. The common stock options have a ten (10) year exercise term.