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 |
|
1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 11/01/2016 | 3. Issuer Name and Ticker or Trading Symbol Meridian Waste Solutions, Inc. [ MRDN ] | |||||||||||||
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)
|
Table I - Non-Derivative Securities Beneficially Owned | |||
---|---|---|---|
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, $0.025 par value per share | 1,000(1) | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
---|---|---|---|---|---|---|---|
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 | ||||
NonEmployee Stock Option (Right to Purchase)(2) | (2) | 11/01/2021 | Common Stock, par value $0.025 per share | 3,750(2) | 20(2) | D |
Explanation of Responses: |
1. Reflects 1 - for - 20 reverse stock split effected by the Company on November 3, 2016. |
2. In connection with his appointment to the Board, Mr. Davis received, pursuant to a stock option agreement entered into as of November 1, 2016, by and between the Company and Mr. Davis, stock options to purchase up to three thousand seven hundred fifty (3,750) shares of the Company?s common stock, par value $0.025 per share, at an exercise price per share equal to $20.00, giving effect to the Company's 1for20 reverse split. The options are exercisable for a period of five (5) years and vest in equal amounts over a period of three (3) years at the rate of three hundred thirteen (313) options per fiscal quarter at the end of such quarter, commencing in the quarter ended December 31, 2016, and prorated for the number of days Mr. Davis served on Board during the first fiscal quarter. |
/s/ Jackson W. Davis, Jr. | 11/14/2016 | |
** 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. |