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 BioSolar Inc [ BSRC ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Date of Earliest Transaction (Month/Day/Year) 03/05/2014 | ||||||||||||||||||||||||||
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 | ||||||
Common Stock | 03/05/2014 | J(1) | 315,541 | A | (1) | 482,209 | D | |||
Common Stock | 04/20/2015 | J(2) | 1,093,846 | A | (2) | 1,576,055 | 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 | ||||||||
Options to purchase Common Stock | $0.09 | 03/24/2015 | A | 150,000 | (3) | 03/24/2022 | Common Stock | 150,000 | (3) | 150,000 | D | ||||
Convertible Note | (4) | 12/18/2014 | A | 603,960(4) | 12/18/2014 | 12/18/2016 | Common Stock | 603,960(4) | (4) | 603,960(4) | D | ||||
Convertible Note | (5) | 06/05/2013 | A | 100,000(5) | 06/05/2013 | 12/18/2016 | Common Stock | 100,000(5) | (5) | 100,000(5) | D |
Explanation of Responses: |
1. Issued to Reporting person upon the conversion of $25,000 of a convertible promissory note granted to the Reporting Person by the Issuer for unpaid salary. |
2. Issued to Reporting person upon the conversion of $65,000 of a convertible promissory note granted to the Reporting Person by the Issuer for unpaid salary. |
3. Issued directly to the Reporting Person by the Issuer as compensation for services provided. Such options shall vest in 25 equal monthly installments beginning on April 24, 2015. |
4. Issued directly to Reporting Person by the Issuer in satisfaction of unpaid salary. The balance of the Promissory Note is convertible into shares of the Issuer's common stock at a conversion price equal to the lesser of (i) $0.101 per share, or (ii) the closing prices of the Issuer's common stock on the last complete trading day immediately preceding the date of conversion. The original balance of the Promissory Note was $61,000. The number of shares represent the number of shares that may be issuable assuming a conversion price of $0.101. The actual number of shares may vary depending on the actual conversion price at the date of conversion. |
5. Issued directly to Reporting Person by the Issuer in satisfaction of unpaid salary. The balance of the Promissory Note is convertible into shares of the Issuer's common stock at a conversion price equal to the lesser of (i) $0.24 per share, or (ii) the closing prices of the Issuer's common stock on the last complete trading day immediately preceding the date of conversion. The original balance of the Promissory Note was $114,000, however, only $24,000 of such balance remains. The number of shares represents the number of shares that may be issuable assuming a conversion price of $0.24. The actual number of shares may vary depending on the actual conversion price at the date of conversion. |
/s/ Stanley Levy | 04/24/2015 | |
** 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. |