SEC Form 4 · accession 0001615774-16-008107
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
Sep 20, 2016
Accepted (ET)
Nov 8, 2016 · 5:00 pm EST
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 Stock | Nov 4, 2016 | C | 64,666 | $1.50 | A | 66,000 | 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 StockF1 | $1.50 | Nov 4, 2016 | C | 97 | D | Apr 4, 2016 | — | Common Stock | 64,666 | 0 | D |
| WarrantsF2 | $2.00 | Nov 4, 2016 | D | 64,660 | D | Apr 4, 2016 | Apr 4, 2019 | Common Stock | 64,660 | 0 | D |
| Incentive Stock OptionF4,F3 | $1.60 | Sep 20, 2016 | A | 60,000 | A | Sep 20, 2016 | Sep 20, 2026 | Common Stock | 60,000 | 60,000 | D |
| Stock Option | $9.00 | holding | — | — | — | Oct 1, 2015 | Oct 1, 2020 | Common Stock | 42,500 | 42,500 | D |
Explanation of responses
- F1Not applicable.
- F2The warrants were cancelled and returned to the Issuer.
- F3The Incentive Stock Options vest quarterly for three years, commencing on January 1, 2017 and the first day of each quarter thereafter.
- F4The options were issued pursuant to the Issuer's 2016 Equity Incentive Plan.