| FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL 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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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 09/20/2016 | 3. Issuer Name and Ticker or Trading Symbol Jayhawk Energy, Inc. [ JYHW ] | |||||||||||||
| 4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) 09/29/2016 | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Beneficially Owned | |||
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| 1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
| Common stock | 39,583,263 | I(1) | By Smart Oil, LLC |
| Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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| 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: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
| Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
| Convertible Promissory Note | 09/20/2016 | 09/19/2018 | Common stock | 1,000,000 | 0.0065 | I(1) | By Smart Oil, LLC |
| Stock Purchase Warrant | 10/08/2015 | 10/07/2020 | Common stock | 23,583,418 | 0.005 | I(1) | By Smart Oil, LLC |
| Explanation of Responses: |
| 1. This Amendment clarifies the number of Common Shares beneficially owned by Mr. Shawn Smart. Mr. Shawn Smart is the Managing Member of Smart Oil, LLC, and therefore is deemed to be a Beneficial Owner of Smart Oil, LLC's ownership interests in JayHawk Energy, Inc. by virtue of the voting and dispositive control Mr. Smart has over Smart Oil, LLC. Mr. Smart disclaims any Beneficial Ownership in the JayHawk Energy, Inc. interests. |
| Remarks: |
| No securities are beneficially owned by the Person signing on behalf of the Reporting Person. |
| /s/ Shawn Smart | 01/26/2017 | |
| ** Signature of Reporting Person | Date | |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
| * 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). | ||
| Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
| 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 Number. | ||
