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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | 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 control number. | SEC 2270 (9-02) |
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 Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
Common Stock Warrant | $ 0.25 | 02/29/2016 | Â | A(3) | $ 450,000 | Â | 02/29/2016 | 04/01/2019 | Common Stock | $ 0.25 | $ 450,000 | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
WIT CORNELIS F 2101 W. COMMERCIAL BLVD. SUITE 3500 FORT LAUDERDALE, FL 33309 |
 X |  X |  Chief Executive Officer |  |
/s/ Cornelis F. Wit | 02/13/2017 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | This transaction was originally reported on Form 4 filed by the Reporting Person on 8-18-16. The Transaction Code was incorrectly reported on the Form 4 and is hereby amended to reflect the correct Transaction Code. This Form 5 also corrects the end of period ownership of the Reporting Person as reported on such Form 4 by also reflecting the Reporting Person's contribution to the Cornelis F. Wit Revocable Living Trust Dated October 15, 2009 as Amended and Restated on June 11, 2015 (the "Trust"), on 1-21-2016, of 49,644,716 shares that had previously been acquired directly by the Reporting Person. The Trust is a revocable trust established by the Reporting Person as grantor with respect to which the Reporting Person is the sole trustee, and the Reporting Person, his spouse and children are beneficiaries, and, as a result, the Reporting Person may be deemed to have retained beneficial ownership of such shares. |
(2) | The contribution of such shares to the Trust was a change in form of beneficial ownership that was exempt from Section 16 by reason of Rule 16a-13; but should have been reflected in the amount of securities beneficially owned following reported transaction totals reported on the Form 4 filed 8-18-16. The end of the year totals in this Form 5 also reflect the Reporting Person's contribution to the Trust, on September 6, 2016, of the 80,000 shares acquired on 8-18-16. This contribution of shares to the Trust was also a change in form of beneficial ownership that was exempt from Section 16 by reason of Rule 16a-13. |
(3) | This transaction was originally reported on Form 4 filed by the Reporting Person on 3-2-2016. The Transaction Code was incorrectly reported on the Form 4 and is hereby amended to reflect the correct Transaction Code. |