|
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Warrant | $ 0.1 | 08/17/2018 | A | 20,000 (6) (8) | 08/17/2018 | 08/17/2019 | Common Stock | 20,000 | $ 0.1 | 686,667 | I | American Resources Offshore Inc. | |||
Warrant | $ 0.1 | 09/30/2018 | A | 250,000 (5) (8) | 09/30/2018 | 09/30/2020 | Common Stock | 250,000 | $ 0.1 | 936,667 | D | ||||
Warrant | $ 0.1 | 12/14/2018 | A | 312,500 (3) (8) | 12/14/2018 | 11/01/2020 | Common Stock | 312,500 | $ 0.1 | 1,249,167 | I | American Resources Offshore Inc. | |||
Warrant | $ 0.1 | 12/31/2018 | A | 250,000 (5) (8) | 12/31/2018 | 12/31/2020 | Common Stock | 250,000 | $ 0.1 | 1,499,167 | D | ||||
Warrant | $ 0.1 | 03/31/2019 | A | 250,000 (7) (8) | 03/31/2019 | 03/31/2021 | Common Stock | 250,000 | $ 0.1 | 1,749,167 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
SIEM IVAR 710 N. POST OAK RD., STE. 512 HOUSTON, TX 77024 |
X |
/s/ Ivar Siem | 05/10/2019 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Mr. Siem acquired these shares in a private third-party transaction at a market value of $0.065/share. |
(2) | Mr. Siem acquired these shares in a private third-party transaction at a market value of $0.064/share. |
(3) | Mr. Siem indirectly participated in Private Placement #4 at $0.08/share, participants also received 2x warrants for every share, exercisable for 2 years. |
(4) | Mr. Siem acquired these shares in a private third-party transaction at a market value of $0.05/share. |
(5) | Mr. Siem receives a 250,000-warrant issuance quarterly as part of his compensation 2018 compensation package for his service on the Board; exercisable for a 24 months period. |
(6) | Mr. Siem indirectly participated in a Bridge Loan for $20,000 in August 2018, as part of the compensation for the loan participants received an interest rate of 12% simple interest and one (1) warrant for every dollar loaned; exercisable for one year. |
(7) | Mr. Siem receives a 250,000-warrant issuance quarterly as part of his compensation 2019 compensation package for his service on the Board; exercisable for a 24 months period. |
(8) | Each Warrant unit represents a contingent right to receive one share of Petrolia's common stock. |