SEC Form 4 · accession 0001096906-18-000656
BlackRidge Technology International, Inc. · BRTI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
John William Hayes
Officer — Chief Technology Officer · Director · 10% Owner
Period of report
Sep 28, 2018
Accepted (ET)
Nov 19, 2018 · 7:23 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001456212
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Sep 30, 2018 | A | 908,152 | $0.35 | A | 18,659,763 | D | |
| Common StockF2 | Sep 28, 2018 | J | 4,645,082 | $0.25 | A | 23,304,845 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Warrant to Purchase Common StockF3 | $0.25 | Sep 28, 2018 | A | 3,845,082 | A | Sep 28, 2018 | Sep 28, 2023 | Common Stock | 3,845,082 | 11,212,367 | D |
Explanation of responses
- F1On September 30, 2018, the issuer issued restricted common stock, par value $0.0001 per share, to Mr. Hayes in lieu of cash payment of deferred wages and compensation at $0.35 per share for his service as a director on the issuer's board of directors.
- F2Shares of common stock, par value $0.0001 per share, acquired in exchange for the extinguishment of debt represented by three notes (the "Notes"), in the principal amount of $$ ], plus $[ ] of interest. The shares were issued on September 28, 2018 to Mr. Hayes.
- F3Issued as further consideration for the extinguishment of the debt represented by the Notes described in footnote 2 above.