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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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Warrants to purchase common stock | $ 5.16 | 01/30/2017 | A(5) | 302,663 | 01/30/2017 | 01/30/2022 | Common Stock | 302,663 | (5) | 302,663 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Cosman Jeffrey Scott 12540 BROADWELL ROAD SUITE 2104 MILTON, GA 30004 |
X | X | CEO, Chairman |
/s/ Jeffrey Cosman | 02/01/2017 | |
**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) | Effective November 3, 2016, the Issuer completed a 1-for-20 reverse stock split. All share amounts contained herein reflect such reverse stock split. |
(2) | Shares issued pursuant to 2016 Equity Incentive and Stock Plan, in accordance with the Employment Agreement between Mr. Cosman and Issuer. |
(3) | This amount includes 1,560 shares owned by Rush the Puck, LLC, a limited liability company in which Mr. Cosman is the majority member. |
(4) | Shares purchased from underwriters in the public offering of the Issuer?s common stock and warrants to purchase Issuer?s common stock pursuant to the Registration Statement on Form S-1 filed with the Securities and Exchange Commission on September 9, 2016, as amended, and as declared effective on January 24, 2017 (the ?Offering?). |
(5) | Pursuant to the Offering, investors purchased units (?Units?) comprised of one (1) share of the Issuer?s common stock and (1) warrant to purchase the Issuer?s common stock, for a price of $4.13 per Unit. Mr. Cosman paid $1,250,000 for 302,663 Units which include the securities. |