Statement of Changes in Beneficial Ownership (4)
January 13 2020 - 11:31AM
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).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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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
*
Matlack William Fuller |
2. Issuer Name and Ticker or Trading Symbol
Timberline Resources Corp
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TLRS
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director __X__ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
C/O TIMBERLINE RESOURCES CORP., 101 EAST LAKESIDE AVENUE |
3. Date of Earliest Transaction
(MM/DD/YYYY)
10/29/2019 |
(Street)
COEUR D'ALENE, ID 83814
(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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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) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Stock Options | $0.08 | 10/29/2019 | | A | | 404348 | | 10/29/2019 | 10/29/2024 | Common shares | 404348 | $0 | 1807582 (1) | D | |
Explanation of Responses: |
(1) | Warrants may not be exercised, except within 61 days of expiration, if such exercise would cause holder to beneficially own or exercise control or direction over 9.99% or greater of the issued and outstanding voting shares of the issuer. Warrants may not be exercised if such exercise would cause holder to beneficially own or exercise control or direction over 19.99% or greater of the issued and outstanding voting shares of the issuer. Stock options were acquired upon joining the issuer's board of directors on 10/29/2019. Number of derivative securities was calculated as 19.98% of shares issued and outstanding minus 13,021,679 common shares beneficially owned given restrictions on the exercise of warrants described herein. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Matlack William Fuller C/O TIMBERLINE RESOURCES CORP. 101 EAST LAKESIDE AVENUE COEUR D'ALENE, ID 83814 | X | X |
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Signatures
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William Matlack | | 1/13/2020 |
**Signature of Reporting Person | Date |
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