Statement of Changes in Beneficial Ownership (4)
July 08 2022 - 6:22PM
Edgar (US Regulatory)
FORM 4
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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
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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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KAUFMAN SCOTT D |
2. Issuer Name and Ticker or Trading Symbol
Creek Road Miners, Inc.
[
CRKR
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director __X__ 10% Owner __X__ Officer (give title below) _____ Other (specify below) CO-CEO and President |
(Last)
(First)
(Middle)
C/O CREEK ROAD MINERS, INC., 2700 HOMESTEAD ROAD, SUITE 50 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
6/30/2022 |
(Street)
PARK CITY, UT 84098
(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 | | | | | | | | 1202523 | 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. 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 |
Series A Preferred Stock | (1) | 6/30/2022 | | A | | 5361 | | 6/30/2022 | (1) | Common Stock | 306342 | (1) | 15020 | D | |
Series A Preferred Stock | (1) | | | | | | | (2) | (1) | Common Stock | 858285 | | 15020 | D | |
Options | $2.65 | | | | | | | 12/1/2021 | (3) | Common Stock | 2625000 | | 2625000 | D | |
Options | $0.25 | | | | | | | 8/3/2020 | 8/3/2025 | Common Stock | 37500 | | 37500 | D | |
Convertible Debenture | $0.175 | | | | | | | 12/19/2019 | 12/31/2022 | Common Stock | 14267714 | | $2496850 | I | See Footnote 4. (4) |
Warrant | $0.175 | | | | | | | 12/19/2019 | 12/1/2024 | Common Stock | 4285174 | | 4285174 | I | See Footnote 4. (4) |
Explanation of Responses: |
(1) | Each share of Series A Preferred Stock (the "Preferred Stock") is convertible into a number of shares of common stock determined by dividing the stated value of each share of Preferred Stock (currently $10) by the conversion price then in effect (currently $0.175). The Preferred Stock does not expire. |
(2) | 6,250 of the Preferred Shares became exercisable on 12/31/2021, 3,409 of the Preferred Shares became exercisable on 03/31/2022, and the balance became exercisable on 06/30/2022. |
(3) | Options granted pursuant to incentive and award plans. 25% of the options vest when the common share VWAP computed over 30 trading days reaches $2.50, $3.00, $3.50 and $4.00. |
(4) | Securities held by Barlock 2019 Fund, LP, an entity over which Scott Kaufman has managerial control. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
KAUFMAN SCOTT D C/O CREEK ROAD MINERS, INC. 2700 HOMESTEAD ROAD, SUITE 50 PARK CITY, UT 84098 | X | X | CO-CEO and President |
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Signatures
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/s/ Scott D. Kaufman | | 7/8/2022 |
**Signature of Reporting Person | Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
Note: | File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. |
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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