SEC Form 3
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) 07/14/2016 | 3. Issuer Name and Ticker or Trading Symbol INTEGRATED ENVIRONMENTAL TECHNOLOGIES, LTD. [ IEVM ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. 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 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, par value $.001 per share | 3,970,439 | D |
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 | ||||
Warrant (Right to Buy) | 02/05/2015 | 02/05/2018 | Common Stock, par value $.001 | 530,303 | 0.066 | D | |
12% Convertible Debenture | 12/03/2015 | 12/03/2017 | Common Stock, par value $.001 | 1,587,300 | 0.07(1) | D | |
Warrant (Right to Buy) | 12/03/2015 | 12/03/2018 | Common Stock, par value $.001 | 793,650 | 0.1 | D | |
Warrant (Right to Buy) | 12/31/2015 | 12/31/2018 | Common Stock, par value $.001 | 515,875 | 0.04 | D | |
10% Secured Convertible Debenture | 07/14/2016 | 07/14/2017 | Common Stock, par value $.001 | 16,666,700 | 0.01(2) | D | |
Warrant (Right to Buy) | 07/14/2016 | 07/14/2021 | Common Stock, par value $.001 | 16,666,700 | 0.01 | D |
Explanation of Responses: |
1. The principal amount ($111,111) of the 12% Convertible Debenture (the "12% Debenture") is convertible into shares of the IEVM common stock, par value $.001 per share ("Common Stock"), at a conversion price of $0.07 per share, subject to adjustment as provided in the 12% Debenture. Interest is payable in annual installments beginning December 3, 2016 and may be paid in cash or in shares of Common Stock at the option of the Company. In the event that interest is paid in shares of Common Stock, the conversion price shall be the Market Price of Common Stock as defined in the 12% Debenture. |
2. The principal amount ($166,667) of the Zero Coupon Secured Convertible Debenture (the "Debenture") is convertible into shares of Common Stock at a conversion price of $0.01 per share, subject to adjustment as provided in the Debenture. |
/s/ Christopher Davis | 07/25/2016 | |
** 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. |