SEC Form 4 · accession 0001094891-16-000585
Long Blockchain Corp. · LBCC
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Julian Davidson
Officer — Executive Chairman · Director
Period of report
Aug 18, 2016
Accepted (ET)
Aug 22, 2016 · 4:10 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001629261
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1,F2 | Aug 18, 2016 | A | 2,635 | — | A | 4,302 | I | by the Julian and Diane Davidson Family Trust |
| Common StockF3,F2 | Aug 18, 2016 | A | 50,000 | — | A | 54,302 | I | by the Julian and Diane Davidson Family Trust |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (Right to Buy)F4 | $5.50 | Aug 18, 2016 | A | 286,744 | A | — | Jul 28, 2021 | Common Stock | 286,744 | 286,744 | D |
Explanation of responses
- F1The reporting person was granted $10,000 per month (pro rated for partial days in any month) in shares at a value of $6.00 per shares as compensation for services.
- F2These shares are held in a trust for the benefit of the reporting person and members of the reporting person's immediate family. The reporting person's spouse controls the trustee of the trust. The reporting person disclaims beneficial ownership of these securities, and the filing of this report is not an admission that the reporting person is the beneficial owner of these securities for purposes of Section 16 or for any other purpose, except to the extent of the reporting person's pecuniary interest therein.
- F3The reporting person was granted 50,000 shares pursuant to his consulting agreement with the issuer.
- F4The option vests in three equal annual installments on the date of grant, July 28, 2017 and July 28, 2018, subject to certain other conditions being met, including shareholder approval by the stockholders of the issuer.