SEC Form 3 · accession 0001391609-18-000259
Andover National Corp · AANC
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Peter A Cohen
10% Owner
Period of report
Sep 25, 2018
Accepted (ET)
Oct 5, 2018 · 4:25 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001712543
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF2 | holding | — | — | — | 2,924,100 | I | By The Peter A. Cohen Revocable Trust | |
| Series A Preferred StockF2 | holding | — | — | — | 2,500,000 | I | By The Peter A. Cohen Revocable Trust |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Class A Warrant (to purchase shares)F2,F1 | $3.00 | holding | — | — | — | — | Sep 25, 2028 | Common Stock | 1,250,000 | — | I |
| Class B Warrant (to purchase shares)F2,F1 | $5.00 | holding | — | — | — | — | Sep 25, 2018 | Common Stock | 1,250,000 | — | I |
Explanation of responses
- F1The securities are exercisable beginning on September 25, 2023.
- F2The securities listed on this Form 3 are purchased through The Peter A. Cohen Revocable Trust, of which Peter Cohen is the sole trustee.