SEC Form 4 · accession 0001249155-18-000041
Beeline Holdings, Inc. · BLNE
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Period of report
Jul 6, 2018
Accepted (ET)
Jul 10, 2018 · 4:34 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001534708
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF2 | Jul 6, 2018 | C | 70,000 | $6.00 | A | 662,885 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 5% Convertible Note Due 2020F2,F3 | $6.00 | Jul 6, 2018 | C | — | D | Jun 30, 2017 | Jun 30, 2020 | Common Stock | 70,000 | — | D |
Explanation of responses
- F1Shares were issued upon conversion of a 5% convertible promissory note due 2020 in the principal amount of $400,000, plus $20,000 in accrued interest.
- F2Glenbrook Capital, LP ("GBLP") is the direct beneficial owner of the securities reported herein. However, these securities may also be deemed to be indirectly beneficially owned by Glenbrook Capital Management ("GCM"), the general partner of GBLP. GCM disclaims beneficial ownership of such securities, except to the extent of its pecuniary interest therein, if any. This report shall not be deemed an admission that GCM is the beneficial owner of the shares described herein for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or for any other purpose.
- F3Includes conversion of $400,000 in principal and $20,000 of accrued interest, at $6.00 per share.