SEC Form 4 · accession 0001140361-16-051183

Great Basin Scientific, Inc. · GBSN

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director

Period of report

Jan 31, 2016

Accepted (ET)

Feb 9, 2016 · 6:36 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001512138

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1	Jan 31, 2016	M	1,908,172	—	A	2,271,837	I	By Spring Forth Investments, LLC

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Series C Common Stock Warrants^F1	$2.55	Jan 31, 2016	M	170,680	D	Aug 25, 2015	Feb 25, 2020	Common Stock	1,908,172	0	I

F1The warrant price was included in purchase price of units purchased by the reporting person on 8/21/15 for $16.99 per unit. Each unit consisted of one share of Series E Convertible Preferred Stock and eight Series C Warrants. The warrants had a conversion price of $2.55 per warrant or could be exercised on a cashless basis pursuant to the terms of the purchase agreement. The reporting person's warrants were automatically converted into common shares on a cashless basis on January 21, 2016, resulting in the issuance of 1,908,172 common shares to the reporting person.