SEC Form 4 · accession 0001493152-16-015575
BLUSKY AI INC. · BSAI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Trent D'Ambrosio
Officer — CFO · Director
Period of report
Jul 29, 2016
Accepted (ET)
Dec 1, 2016 · 12:11 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001416090
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Convertible Promissory NoteF2,F3 | $0.23 | Jul 29, 2016 | C | 881,057 | A | Jan 1, 2016 | Oct 2, 2016 | Common Shares | 881,057 | 0 | D |
Explanation of responses
- F1Common shares acquired through the exercise of a convertible promissory note (the "Note") issued to the Reporting Owner. Pursuant to the Note, the Reporting Owner was permitted to convert outstanding debt owed by the Company to shares of the Company's common stock to satisfy those debt obligations. The Reporting Owner is deemed to beneficially own one derivative security until all debt eligible for conversion under the Note has been converted to shares of the Company's common stock or the Note is amended (see Note 2, below), at which point this derivative security will be disposed of completely.
- F2As of October 2, 2016, the Reporting Owner and the Company entered into a Note Amendment through which all the convertible provisions of the Note were removed and the due date was extended until December 31, 2017. Accordingly, as of the date of this filing, there are no derivative securities underlying the Note.
- F3Assigned through Conversion of MDL Ventures, LLC convertible promissory note