Initial Statement of Beneficial Ownership (3)
August 29 2019 - 9:10AM
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
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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
*
Skalla Bryce |
2. Date of Event Requiring Statement (MM/DD/YYYY)
8/26/2019
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3. Issuer Name and Ticker or Trading Symbol
Item 9 Labs Corp. [INLB]
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(Last)
(First)
(Middle)
1709 EAST BETHANY HOME ROAD |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__X__ Director _____ 10% Owner ___X___ Officer (give title below) _____ Other (specify below) President / |
(Street)
PHOENIX, AZ 85016
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 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) | 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 | 5503878 (1) | D | |
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) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: 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 |
Option | 5/8/2019 | 5/8/2028 | Common Stock | 2500 | $2.40 | D | |
Option | 5/8/2020 | 5/8/2028 | Common Stock | 2500 | $2.40 | D | |
Option | 5/8/2021 | 5/8/2028 | Common Stock | 2500 | $2.40 | D | |
Explanation of Responses: |
(1) | Mr. Skalla's beneficial ownership consists of 5,003,878 shares of restricted common stock held in his name and 500,000 shares held by a minor. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Skalla Bryce 1709 EAST BETHANY HOME ROAD PHOENIX, AZ 85016 | X |
| President |
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Signatures
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Bryce Skalla | | 8/29/2019 |
**Signature of Reporting Person | Date |
Item 9 Labs (CE) (USOTC:INLB)
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