UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF 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. | SEC 1473 (7-02) | ||
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. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Warrant to Purchase Common Stock | 05/24/2016 | 05/24/2018 | Common Stock | 702,247 | $ 7.12 | I | By Subsidiary (1) |
Warrant to Purchase Common Stock | 11/24/2016 | 05/24/2019 | Common Stock | 1,605,131 | $ 9 | I | By Subsidiary (1) |
Convertible Term Note | 05/24/2016 | 05/24/2019 | Common Stock | 702,247 (2) | $ 7.12 | I | By Subsidiary (1) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Interstate Batteries, Inc. 12770 MERIT DRIVE SUITE 1000 DALLAS, TX 75251 |
X |
/s/ Thaddeus E. Chase, Jr., Attorney-in-Fact | 05/31/2016 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 5(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) | These securities are directly owned by Interstate Emerging Investments, LLC. The reporting entity is the sole member of Interstate Emerging Investments, LLC. |
(2) | The Convertible Term Note (the "Note") issued to the Reporting Person can either be paid in cash for the outstanding principal amount of the Note, plus any accrued, unpaid interest, or it can be converted by the Reporting Person at any time upon notice to the Issuer for 702,247 shares of Common Stock. |