SEC Form 4 · accession 0001493152-19-001085
Muscle Maker, Inc. · MMB
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
III Alfred B. Southall
Director
Period of report
Jan 9, 2019
Accepted (ET)
Jan 29, 2019 · 3:16 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001701756
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock | holding | — | — | — | 100,071 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 15% Senior Secured Convertible Promissory NotesF1 | $1.00 | Jan 9, 2019 | A | — | A | Jan 9, 2019 | — | Common Stock | 50,000 | 50,000 | D |
| Common Stock Purchase Warrants | $1.20 | Jan 9, 2019 | A | 25,000 | A | Jan 9, 2019 | Jan 9, 2024 | Common Stock | 25,000 | 25,000 | D |
| Warrant (right to buy)F1 | $9.33 | holding | — | — | — | Aug 14, 2017 | Aug 14, 2020 | Common Stock | 5,356 | 5,356 | D |
| Convertible debt (right to buy)F2 | $1.625 | holding | — | — | — | Aug 7, 2017 | Feb 7, 2018 | Common Stock | 61,538 | 61,538 | D |
Explanation of responses
- F1The issuer granted the reporting person a 3-year warrant to purchase 5,356 shares of common stock of the issuer at an exercise price of $9.33 per share in connection with a loan made by the reporting person to the issuer in 2017.
- F2On August 7, 2017, the issuer issued a convertible note to the reporting person for a loan of $100,000, maturing six months after issuance of the convertible note, convertible into common stock at a price per share of $1.625, and, if not converted, a stated interest rate of 10% per six months, will become due and payable along with the principal amount.