Initial Statement of Beneficial Ownership (3)

Date : 08/29/2019 @ 2:10PM
Source : Edgar (US Regulatory)
Stock : Item 9 Labs Corporation (PK) (INLB)
Quote : 0.95  -0.05 (-5.00%) @ 9:00PM

Initial Statement of Beneficial Ownership (3)

FORM 3
        
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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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
                      

1. Name and Address of Reporting Person *

Skalla Bryce

2. Date of Event Requiring Statement (MM/DD/YYYY)
8/26/2019 

3. Issuer Name and Ticker or Trading Symbol

Item 9 Labs Corp. [INLB]

(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


Table I - Non-Derivative Securities Beneficially Owned
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)
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 Security5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
6. Nature of Indirect Beneficial Ownership
(Instr. 5)
Date ExercisableExpiration DateTitleAmount 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
Reporting Owner Name / Address
Relationships
Director10% OwnerOfficerOther
Skalla Bryce
1709 EAST BETHANY HOME ROAD
PHOENIX, AZ 85016
X
President

Signatures
Bryce Skalla8/29/2019
**Signature of Reporting PersonDate

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