SEC Form 4
FORM 4 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol Jerrick Media Holdings, Inc. [ JMDA ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Date of Earliest Transaction (Month/Day/Year) 07/01/2016 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Options to Purchase Common Stock | $0.25 | 07/01/2016 | A | 100,000 | 07/01/2016 | 07/01/2021 | Common Stock | 100,000 | (1) | 692,500 | I | By Leonard M. Schiller Revocable Trust | |||
Options to Purchase Common Stock | $0.22 | 06/28/2017 | A | 50,000 | 06/28/2017 | 06/28/2022 | Common Stock | 50,000 | (2) | 742,500 | I | By Leonard M. Schiller Revocable Trust | |||
Options to Purchase Common Stock | $0.3 | 06/28/2017 | A | 50,000 | 06/28/2017 | 06/28/2022 | Common Stock | 50,000 | (3) | 792,500 | I | By Leonard M. Schiller Revocable Trust |
Explanation of Responses: |
1. Mr. Schiller reported an acquisition of 50,000 options to purchase common stock on a Form 3 filed with the Securities and Exchange Commission on February 16, 2016 (the "Form 3"), however, the Form 3 omitted in error the acquisition of an additional 100,000 options to purchase the Issuer's common stock pursuant to the same terms and conditions. All such options have an exercise price of $0.25. All such options were granted to Mr. Schiller in consideration for his service as a member of the Company's Board of Directors (the "Board"). |
2. On June 28, 2017 Mr. Schiller received 50,000 options to purchase the Issuer's common stock at an exercise price of $0.22 per share related to his service as a member of the Board. Specifically, Mr. Schiller was due these options for his service during the third fiscal quarter of 2016 but such options were not issued by the Company until June 28, 2017. |
3. On June 28, 2017 Mr. Schiller received 50,000 options to purchase the Issuer's common stock at an exercise price of $0.30 per share related to his service as a member of the Board. Specifically, Mr. Schiller was due these options for his service during the fourth fiscal quarter of 2016 but such options were not issued by the Company until June 28, 2017. |
/s/ Leonard Schiller | 06/29/2017 | |
** 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 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). | ||
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. |