SEC Form 4 · accession 0001018584-16-000005
Omagine, Inc. · OMAG
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Jack A Smith
Director
Period of report
Aug 24, 2016
Accepted (ET)
Aug 26, 2016 · 5:05 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000820600
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Convertible Promissory NoteF1,F2,F3 | $0.75 | Aug 24, 2016 | J | 135,562 | A | Aug 24, 2016 | Dec 24, 2016 | Common Stock | 135,562 | 135,562 | D |
Explanation of responses
- F1The Reporting Person is a fifty percent owner of an entity that holds a four month $100,000 Convertible Note from the Issuer due December 24, 2016, interest at 5% per annum, with principal and accrued interest convertible into the Issuer's Common Stock at a conversion price of $0.75 per Common Share.
- F2A maximum of 135,562 of the Issuer's Common Shares could be issued based on the principal and accrued interest assuming conversion of the Convertible Note is made on the expiration date of December 24, 2016.
- F3The Reporting Person is a fifty percent owner of the entity that holds the Convertible Note which optionally may be converted into a maximum of 135,562 of the Issuer's Common Shares.