Statement of Changes in Beneficial Ownership (4)
September 29 2016 - 5:39PM
Edgar (US Regulatory)
FORM 4
[ ]
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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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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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
*
MAHONEY SCOTT
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2. Issuer Name
and
Ticker or Trading Symbol
Jayhawk Energy, Inc.
[
JYHW
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
Interim President, CEO, CFO
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(Last)
(First)
(Middle)
10119 W. LARIAT LANE
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3. Date of Earliest Transaction
(MM/DD/YYYY)
9/20/2016
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(Street)
PEORIA, AZ 85383
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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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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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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9/22/2016
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9/22/2016
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S
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118874159
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D
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$0.0005
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203228202
(1)
(2)
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I
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By Vast Exploration LLC
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Table II - Derivative Securities 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
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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 Following Reported Transaction(s) (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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Code
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V
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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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Warrants
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$0.005
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9/20/2016
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S
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94333678
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10/8/2015
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10/8/2020
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Common stock
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94333678
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$23583.4
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203228202
(1)
(2)
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I
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By Vast Exploration LLC
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Explanation of Responses:
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(
1)
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Note 1: Vast Exploration, LLC beneficially owns 203,228,202 shares of common stock and pursuant to the terms of certain Convertible Debentures, a Revolving Credit Note, and Warrants held by Vast Exploration, LLC. 115,510,105 of the shares beneficially owned are in the form of convertible debentures that is unavailable for conversion until such time as the Issuer increases its authorized capital, because the Issuer has insufficient authorized capital to honor a conversion of said convertible debentures.
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(
2)
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Note 1, continued: 52,072,225 of the shares beneficially owned are in the form of a convertible line of credit note that is unavailable for conversion until such time as the Issuer increases its authorized capital, because the Issuer has insufficient authorized capital to honor a conversion of said convertible line of credit note. 39,645,872 of the shares beneficially owned are in the form of a common stock purchase warrant that is unavailable for exercise until such time as the Issuer increases its authorized capital, because the Issuer has insufficient authorized capital to honor an exercise of said common stock purchase warrant.
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Remarks:
Scott Mahoney, as the CEO and Manager of Vast Exploration, LLC, is the natural person with voting and dispositive control over Vast Exploration, LLC and is deemed to be a beneficial owner. Mr. Mahoney disclaims beneficial ownership of the Vast Exploration, LLC shares.
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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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MAHONEY SCOTT
10119 W. LARIAT LANE
PEORIA, AZ 85383
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X
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Interim President, CEO, CFO
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Signatures
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/s/ Scott Mahoney
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9/23/2016
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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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