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, 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. | 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 | ||||
Warrants (right to buy) (1) (2) | 10/01/2018 | 09/30/2023 | Common Stock | 280,000 | $ 1.4 | D | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
RBI Private Investment III, LLC 3568 WILDWOOD AVENUE JACKSON, MI 49202 |
 |  |  | See Footnote 1 |
By: RBI Private Investment III, LLC; By: RBI PI Manager, LLC, Manager; By: /s/ David S. Richmond, Manager | 10/09/2018 | |
**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) | RBI Private Investment III, LLC ("RBI PIII") may be deemed to be a member of a Section 13(d) group that may be deemed to collectively beneficially own more than 10% of the Issuer's outstanding shares of Common Stock. |
(2) | Represents securities directly owned by RBI PIII. RBI PI Manager, LLC ("RBI Manager"), as the manager of RBI PIII, may be deemed to beneficially own the securities owned directly by RBI PIII. David S. Richmond, as the manager of RBI Manager, may be deemed to beneficially own the securities owned directly by RBI PIII. Each of the foregoing disclaims beneficial ownership of the securities reported herein except to the extent of his or its pecuniary interest therein. |