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) 06/08/2020 | 3. Issuer Name and Ticker or Trading Symbol Amergent Hospitality Group, Inc [ BURG ] | |||||||||||||
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 | 637,400 | D(1)(2) |
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 | ||||
Common Stock Purchase Warrants (right to buy)(3) | 04/01/2020 | 04/01/2030 | Common Stock | 1,100,000(3) | 0.125 | D(1)(2) | |
Common Stock Purchase Warrants (right to buy)(3) | 04/01/2020 | 04/01/2030 | Common Stock | 462,600(3) | 0.5 | D(1)(2) | |
Convertible Debenture(4) | 04/01/2020 | 04/01/2022 | Common Stock | 40,378,890(4) | 0.1 | D(1)(2) |
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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Explanation of Responses: |
1. This statement on Form 3 is being jointly filed by Oz Rey, LLC, MV Amanth, LLC and Robert S. Hersch (collectively, the "Reporting Persons"). The securities are owned directly by Oz Rey, LLC. MV Amanth, as the owner of 100% of the common units of Oz Rey, LLC, has the ability to appoint all of the managers of Oz Rey, LLC. Robert S. Hersch, is the sole member of MV Amanth, LLC. Consequently, each of MV Amanth, LLC and Mr. Hersch may be deemed to have beneficial ownership of the securities owned by Oz Rey, LLC under Section 13 of the Securities Exchange Act of 1934, as amended. |
2. The Reporting Persons disclaim beneficial ownership of the securities indicated except to the extent of their pecuniary interest therein, and the reporting herein of such securities shall not be construed as an admission that the Reporting Persons are the beneficial owners thereof. |
3. The Common Stock Purchase Warrants were issued on April 1, 2020, are immediately exercisable, and will remain exercisable until April 1, 2030. 1,100,000 of the Common Stock Purchase Warrants are exercisable into a share of common stock at $0.125 per share and 462,600 are exercisable at $0.50 per share. |
4. The 10% Secured Convertible Debenture ("Debenture") was originally issued on April 1, 2020, and is convertible at any time into shares of common stock at the lower of $0.10 per share or the daily volume weighted average price of the common stock on the 10 trading days immediately prior to delivery of the conversion notice. The number of shares reported was determined by dividing the $4,037,889 in principal originally outstanding on the Debenture by $0.10 per share. The maturity date for the Debenture is April 1, 2022 ("Maturity Date"). The Maturity Date may be extended, at the sole option of the holder for a two-year period. At the election of the holder, the Maturity Date may be extended for additional two-year periods, provided that in no event shall the Maturity Date be extended beyond 10 years from the original issue date. |
/s/ Robert S. Hersch, Oz Rey, LLC | 06/08/2020 | |
/s/ Robert S. Hersch, MV Amanth, LLC | 06/08/2020 | |
/s/ Robert S. Hersch | 06/08/2020 | |
** 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. |