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 Eagle Mountain Corp [ EMTC ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Date of Earliest Transaction (Month/Day/Year) 06/05/2015 | ||||||||||||||||||||||||||
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 | 06/05/2015 | J | 90,000,000 | A | $0(1) | 90,000,000 | I | Through Amir Holdings Group Limited(1) | ||
Common stock | 07/17/2015 | C | 40,000,000 | A | $0 | 130,000,000 | I | Through Amir Holdings Group Limited | ||
Common stock | 10/23/2015 | D | 40,000,000 | D | $0 | 90,000,000 | I | Through Amir Holdings Group Limited |
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 | ||||||||
Series B Convertible Preferred Stock | $0 | 06/05/2015 | J | 8,000,000 | 07/17/2015 | (2) | Common Stock | 40,000,000 | $0 | 8,000,000 | I | Through Amir Holdings Group Limited(1) | |||
Series E Convertible Preferred Stock | $0 | 10/23/2015 | J | 8,000,000 | 10/23/2015 | (2) | Common Stock | 40,000,000 | $0 | 8,000,000 | I | Through Amir Holdings Group Limited(3) |
Explanation of Responses: |
1. The shares are directly owned by Amir Holdings Group Limited ("Amir Holdings"), which received 90,000,000 shares of common stock and 8,000,000 shares of Series B Convertible Preferred Stock of Eagle Mountain Corporation (the "Company") pursuant to an assignment and assumption agreement dated June 5, 2015, between the Company and Eagle Mountain Ltd. The reporting person is the director of Amir Holdings and in such capacity is deemed to have holding voting and investment power over the shares held by Amir Holdings. |
2. There is no expiration date. |
3. Pursuant to an Exchange Agreement between the Company and the reporting person, the reporting person exchanged 40,000,000 shares of the Company's common stock and received 8,000,000 shares of the Company's Series E Convertible Preferred Stock. There is no expiration date for the conversion rights. |
/s/Ehud Amir | 11/04/2015 | |
** 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. |