SEC Form 4 · accession 0001477932-16-014325
PREMIER BIOMEDICAL INC · BIEI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
William A. Hartman
Officer — CEO and President · Director · 10% Owner
Period of report
Jan 29, 2016
Accepted (ET)
Dec 27, 2016 · 6:02 am EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001515740
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Dec 20, 2016 | M | 6,000,000 | $0.00 | A | 9,000,000 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Warrant (right to buy)F1 | $0.00 | Dec 20, 2016 | M | 6,000,000 | D | Jun 21, 2010 | Jun 21, 2020 | Common Stock | 6,000,000 | 11,000,000 | D |
| Warrant (right to buy) | $0.001 | Jan 29, 2016 | M | 1,000,000 | D | Jun 21, 2010 | Jun 21, 2020 | Series A Convertible Preferred Stock | 1,000,000 | 0 | D |
| Series A Convertible Preferred StockF2 | $0.00 | Jan 29, 2016 | M | 1,000,000 | A | Jan 29, 2016 | — | Common Stock | 1,000,000 | 1,000,000 | D |
| Warrant (right to buy) | $1.45 | holding | — | — | — | Jun 15, 2013 | Sep 28, 2019 | Common Stock | 50,000 | 50,000 | D |
| Warrant (right to buy) | $1.45 | holding | — | — | — | Jun 15, 2013 | Sep 28, 2019 | Common Stock | 105,000 | 105,000 | D |
| Warrant (right to buy) | $0.25 | holding | — | — | — | Jun 15, 2015 | Nov 18, 2021 | Common Stock | 1,600,000 | 1,600,000 | D |
| Warrant (right to buy) | $0.05 | holding | — | — | — | Oct 7, 2015 | Oct 7, 2025 | Common Stock | 1,000,000 | 1,000,000 | D |
Explanation of responses
- F1Price is $0.00001.
- F2No expiration date.