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 Petrolia Energy Corp [ BBLS ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Date of Earliest Transaction (Month/Day/Year) 05/23/2017 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed (Month/Day/Year) 11/16/2017 | 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 | ||||||
Common Stock | 08/01/2017 | 08/01/2017 | M(2) | 2,000,000(2) | A | $0.14 | 3,270,000(2) | D | ||
Common Stock | 09/15/2017 | 09/15/2017 | M(3) | 1,035,000(3) | A | $0.06 | 4,305,000(3) | D | ||
Preferred Stock | 05/26/2017 | 05/26/2017 | A | 17,590(4) | A | $10 | 17,590(4) | D | ||
Preferred Stock | 06/02/2017 | 06/02/2017 | A | 2,900(5) | A | $10 | 20,590(5) | D |
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 | ||||||||
Warrant | $0.14 | 08/01/2017 | 08/01/2017 | P | 2,000,000(2) | 08/01/2017 | 08/01/2020 | Common | 2,000,000(2) | $0.14 | 4,537,500(2) | D | |||
Warrant | $0.06 | 09/15/2017 | 09/15/2017 | C(3) | 1,035,000(3) | 09/23/2015 | 09/23/2018 | Common | 1,035,000(3) | $0.06 | 3,502,500(3) | D | |||
Warrant | $0.12 | 05/23/2017(1) | 05/23/2017 | P | 500,000(6) | 05/23/2017 | 05/23/2020 | Common | 500,000(6) | $0.12 | 2,267,500(6) | D | |||
Warrant | $0.22 | 05/23/2017(1) | 05/23/2017 | P | 270,000(7) | 05/23/2017 | 05/23/2020 | Common | 270,000(7) | $0.2 | 2,537,500(7) | D |
Explanation of Responses: |
1. The original Form 4 indicated an earliest transaction date of 05/23/2017, it should have been 08/01/17. |
2. The original Form 4 filed on 11/16/2017 erroneously reported the number 280,000. The correct number is 2,000,000 Common Shares and was previously reported on 09/15/2017. Additionally, 2,000,000 Warrants @ $0.14/share, exercisable for 3 years from transaction date, were issued in connection with the board-approved transaction that helped to guarantee a $200,000 Line of credit. The details will be disclosed in the forthcoming 2017 10-k filing. |
3. The original Form 4 filed on 11/16/2017 erroneously reported the number 62,065. The correct number is 1,035,000 Common Shares. The disposition of warrants associated with this transaction was a collection of smaller warrant issuances that were all set at a $0.06/share conversion rate. |
4. The original Form 4 filed on 11/16/2017 erroneously reported the number 175,900. The correct number is 17,590 Preferred Shares and was previously reported form 4, dated 06/16/2017. |
5. The original Form 4 filed on 11/16/2017 erroneously reported the number 29,000. The correct number is 2,900 Preferred shares. |
6. The original Form 4 filed on 11/16/2017 erroneously reported the issuance of 500,000 warrants twice; once in the original Form 4 dated 06/16/2017 and the original Form 4, dated 11/16/2017. |
7. The original Form 4 filed on 11/16/2017 erroneously reported the issuance of 270,000 warrants twice; once in the original Form 4 dated 06/16/2017 and the original Form 4, dated 11/16/2017. |
Remarks: |
All other line items previously reported on the original Form 4 have been omitted from this Form 4/A as they have not changed. |
/s/ Joel M Oppenheim | 02/13/2018 | |
** 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. |