|
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT 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 2270 (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 at End of Issuer's Fiscal Year (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
|||
(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
Warrants to Purchase Common Stock | $ 11.5 | 10/18/2017 | J4 (2) | 45,000 | 11/18/2017 | 10/18/2022 | Common Stock | (2) | 45,000 | |||||
Right to purchase common stock | 10/18/2017 | J4 (2) | 4,500 | 08/09/2019 | 08/19/2019 | Common Stock | (2) | 4,500 | Held by Black Ridge Oil & Gas, Inc. (1) |
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 | 09/17/2019 | |
**Signature of Reporting Person | Date | |
/s/ Kenneth DeCubellis, Chairman and CEO | 09/17/2019 | |
**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. 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. |
(2) | The reporting person purchased 45,000 private placement units, including 45,000 shares and certain rights and warrants, at a price of $10.00 per unit. |