SEC Form 5 · accession 0001594062-18-000027
Rafina Innovations Inc. · VICA
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Christos Kapatos
Director
Period of report
Dec 31, 2017
Accepted (ET)
Feb 1, 2018 · 4:35 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001402737
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common stockF1 | Dec 12, 2017 | A | 18,500,000 | $0.05 | A | 32,500,000 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock OptionF2 | $0.05 | Dec 11, 2017 | A | 25,000,000 | A | Dec 11, 2017 | Dec 11, 2023 | Common Stock | 25,000,000 | 25,000,000 | D |
Explanation of responses
- F1On December 12, 2017 the Reporting Person was granted a stock award in the amount of 18,500,000 common shares at the market value on the date of issue of $0.05 per share.
- F2On December 11, 2017 the Reporting Person and the Issuer entered into an amended consulting agreement where under the Reporting Person is entitled to acquire at his discretion 25,000,000 shares of the Issuer's common stock at a price of $US0.05 for a term of six years from the date of the amended agreement.
Remarks
All share numbers and per share prices disclosed on this Form 4 give effect to the Issuer's seven-for-one (7 for 1) forward stock split completed on August 7, 2015.