Initial Statement of Beneficial Ownership (3)
October 03 2016 - 1:30PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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
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MAHONEY SCOTT
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2. Date of Event Requiring Statement (MM/DD/YYYY)
9/20/2016
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3. Issuer Name
and
Ticker or Trading Symbol
Jayhawk Energy, Inc. [JYHW]
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(Last)
(First)
(Middle)
10119 W. LARIAT LANE
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__
X
__ Director
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X
___ 10% Owner
___
X
___ Officer (give title below)
_____ Other (specify below)
Interim President and CEO /
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(Street)
PEORIA, AZ 85383
(City)
(State)
(Zip)
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5. 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 Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common stock
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39624719
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I
(1)
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By Catalyst Capital, 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. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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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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Convertible Promissory Note
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9/20/2016
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9/19/2018
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Common stock
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1000000
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$0.0065
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I
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By Catalyst Capital, LLC
(1)
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Stock Purchase Warrant
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10/8/2015
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10/7/2020
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Common stock
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23583418
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$0.005
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I
(1)
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By Catalyst Capital, LLC
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Explanation of Responses:
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(
1)
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Mr. Scott Mahoney is the Managing Member of Catalyst Capital, LLC, and therefore is deemed to be a Beneficial Owner of Catalyst Capital, bLLC's ownership interests in JayHawk Energy, Inc. by virtue of the voting and dispositive control Mr. Mahoney has over Catalyst Capital, LLC. Mr. Mahoney disclaims any Beneficial Ownership in the JayHawk Energy, Inc. interests.
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Remarks:
No securities are beneficially owned by the Person signing on behalf of the Reporting Person.
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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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X
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Interim President and CEO
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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 5(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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