Amended Annual Statement of Changes in Beneficial Ownership (5/a)
April 27 2016 - 5:29PM
Edgar (US Regulatory)
FORM 5
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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).
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Form 3 Holdings Reported
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Form 4 Transactions Reported
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0362
Estimated average burden
hours per response...
1.0
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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
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THAL Russell
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2. Issuer Name
and
Ticker or Trading Symbol
BALTIA AIR LINES INC [BLTA]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
Executive VP
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(Last)
(First)
(Middle)
TERMINAL 4 - JFK INTERNATIONAL AIRPORT, ROOM 262.089 - BALTIA AIR LINES
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3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/31/2010
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(Street)
JAMAICA, NY 11430
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
10/17/2012
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form Filed by One Reporting Person
___ Form Filed by More than One Reporting Person
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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)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
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7. Nature of Indirect Beneficial Ownership
(Instr. 4)
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Amount
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(A) or (D)
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Price
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Common Stock
(3)
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6/1/2010
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A5
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1000000
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A
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$0.0001
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15254600
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D
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Common Stock
(3)
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6/14/2010
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A5
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2000000
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A
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$0.0001
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15254600
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D
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Common Stock
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7/20/2010
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G5
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900000
(1)
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D
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$0
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15254600
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D
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Common Stock
(3)
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9/14/2010
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A5
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2000000
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A
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$0.0001
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15254600
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D
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Common Stock
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11/3/2010
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A5
(2)
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500000
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A
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$0.0001
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15254600
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D
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Common Stock
(3)
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11/3/2010
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G5
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500000
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D
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$0
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15254600
(4)
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D
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Common Stock
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12/1/2010
(5)
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P
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4600
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A
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$0.05
(6)
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15254600
(4)
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D
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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 Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year
(Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
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11. Nature of Indirect Beneficial Ownership
(Instr. 4)
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(
1)
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An audit of the issued shares shows that this disposition was 900,000 shares not 800,000 shares as originally reported in the original Form 5 filed 10/17/2012
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(
2)
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This transaction was not reported in the original Form 5 filing as no shares were issued directly to the reporting person. However since these shares were issued as compensation to the reporting person, but to a third party at his direction, they should have been reported as acquired prior to the disposition which was reported in the original filing. This error was discovered in an audit of the shares.
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(
3)
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This transaction was reported in the original filing.
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(
4)
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This total includes all the corrections made herein.
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(
5)
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The actual date of this transaction is unknown, but represents shares purchased by the reporting person on the open market.
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(
6)
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Actual price is unknown, but the market varied in 2010 between .02 and .11 a share.
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Remarks:
This is a correction made upon discovery of certain errors in prior submissions, in particular in connection with the distribution of shares at the direction of the reporting person, received as compensation, but not as actual shares issued to him. Only the distribution was reported in the earlier filing. In addition, there was a calculation error wherein 900,000 shares were disposed as gifts rather then 800,000 as previously reported.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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THAL Russell
TERMINAL 4 - JFK INTERNATIONAL AIRPORT
ROOM 262.089 - BALTIA AIR LINES
JAMAICA, NY 11430
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Executive VP
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Signatures
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Russell Thal by Albert Lewis POA
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4/27/2016
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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