SEC Form 4 · accession 0001072613-17-000617
EMPIRE PETROLEUM CORP · EP
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Tony Kamin
Director · 10% Owner
Period of report
Dec 1, 2017
Accepted (ET)
Dec 5, 2017 · 3:01 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000887396
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock | Dec 1, 2017 | P | 140,000 | $0.10 | A | 140,000 | D | |
| Common Stock | holding | — | — | — | 217,637 | I | By RLR Services Partnership |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Common Stock Warrant (Right to Buy)F1 | $0.15 | Dec 1, 2017 | P | 140,000 | A | Dec 1, 2017 | Dec 31, 2019 | Common Stock | 140,000 | 140,000 | D |
| Common Stock Warrant (Right to Buy) | $0.25 | Dec 1, 2017 | A | 1,000,000 | A | Dec 1, 2017 | Dec 31, 2021 | Common Stock | 1,000,000 | 1,000,000 | D |
Explanation of responses
- F1The Common Stock Warrant was issued as partial consideration in connection with the purchase of Common Stock on 12/1/17.