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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 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 |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
DeCubellis Kenneth 17877 VON KARMAN AVE SUITE 300 IRVINE, CA 92614 |
X | X | Chief Financial Officer | |
Black Ridge Oil & Gas, Inc. 110 NORTH 5TH STREET, SUITE 410 MINNEAPOLIS, MN 55403 |
X |
/s/ Kenneth DeCubellis | 08/19/2019 | |
**Signature of Reporting Person | Date | |
/s/ James Moe, as CFO of Black Ridge Oil & Gas, Inc. | 08/19/2019 | |
**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) | On October 4, 2017, the Issuer effected a stock dividend of 0.2 shares for each share outstanding, resulting in the reporting person receiving an additional 575,000 shares, for an aggregate total ownership of 3,450,000 shares. |
(2) | Mr. DeCubellis, as Chairman and Chief Executive Officer of Black Ridge Oil & Gas, Inc. exercises voting and dispositive power over such shares. Mr. DeCubellis disclaims beneficial ownership of such shares except to the extent of his ultimate pecuniary interest. |
(3) | 400,000 shares of common stock were issued by the issuer as a result of the initial public offering on October 10,2017. |
(4) | 44,500 shares of common stock were issued as a result of the conversion of 44,500 rights to receive common stock as a result of the merger of AEM with the issuer on August 9, 2019. The closing price of the shares on August 9, 2019 was $4.42. |
(5) | 60,000 units were issued as conversion of a convertible promissory note issued by Black Ridge Oil & Gas, Inc. ("BRAC") to issuer, which had an outstanding principal amount of $600,000 and accrued no interest, at a rate of $10 per unit. Each unit was entitled to one shares of common stock, one warrant to purchases common stock, and a right to one-tenth of a share of common stock upon the consummation of a business combination by the issuer. The units were automatically converted as a result of the merger of AEM with the issuer on August 9, 2019 into 66,000 shares of common stock and 60,000 warrants. |
(6) | 600,000 shares were transferred to Primo Vital Limited in connection with the merger of AEM with the issuer on August 9, 2019. |
(7) | 720,000 shares were transferred to subscribers in the issuer's private placement that closed on August 9, 2019. |
(8) | 45,000 shares of common stock were issued by the issuer, subject to the underwriter's over-allotment option, on October 18, 2017. |