SEC Form 4 · accession 0001615774-16-007322
Beeline Holdings, Inc. · BLNE
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Steve Shum
Officer — Chief Financial Officer
Period of report
Jul 7, 2016
Accepted (ET)
Sep 22, 2016 · 4:28 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 StockF1 | Jul 7, 2016 | A | 26,666 | $0.0693 | A | 26,666 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series A Preferred StockF2 | $0.075 | holding | — | — | — | Apr 4, 2016 | — | Common Stock | 1,293,334 | 97 | D |
| Warrant | $0.10 | holding | — | — | — | Apr 4, 2016 | Apr 4, 2019 | Common Stock | 1,293,204 | 1,293,204 | D |
| Stock Option | $0.45 | holding | — | — | — | Oct 1, 2015 | Oct 1, 2020 | Common Stock | 850,000 | 850,000 | D |
Explanation of responses
- F1Shares received in respect of paid-in-kind dividend on Series A Preferred stock
- F2Not applicable.