Statement of Changes in Beneficial Ownership (4)
August 06 2020 - 12:50PM
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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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
*
Barbera Michael Vito |
2. Issuer Name and Ticker or Trading Symbol
BASANITE, INC.
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BASA
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
1423 SW 13TH DRIVE |
3. Date of Earliest Transaction
(MM/DD/YYYY)
7/21/2020 |
(Street)
BOCA RATON, FL 33486
(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 | 7/21/2020 | | C(1) | | 400195 | A | $0.132 | 4909195 | D | |
Common Stock | 7/21/2020 | | C(2) | | 195522 | A | $0.132 | 5104717 | 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 |
Convertible Promissory Note | $0.132 | 7/21/2020 | | C (1) | | | 400195 | 6/6/2020 | 7/16/2020 | Common Stock | 400195 | $0.132 | 0 | D | |
Convertible Promissory Note | $0.132 | 7/21/2020 | | C (2) | | | 195522 | 6/6/2020 | 10/13/2020 | Common Stock | 195522 | $0.132 | 0 | D | |
Warrant | $0.396 | 7/21/2020 | | J (3) | | 400195 | | 7/21/2020 | 7/21/2025 | Common Stock | 400195 | $0 (3) | 400195 | D | |
Warrant | $0.396 | 7/21/2020 | | J (4) | | 195522 | | 7/21/2020 | 7/21/2025 | Common Stock | 195522 | $0 (4) | 195522 | D | |
Explanation of Responses: |
(1) | On July 21, 2020, the Reporting Person converted a previously disclosed $50,000 12% Convertible Promissory Note (including $2,439.53 of accrued, unpaid interest) initially issued on January 16, 2020 (the "January Note") at a conversion price of $0.132. Pursuant to the terms of the January Note, the conversion price was calculated at 80% of the Issuer's closing trading price on June 5, 2020, which was $0.165. All such shares are "restricted securities" as defined by the Securities Act of 1933, as amended (the "Securities Act"). |
(2) | On July 21, 2020, the Reporting Person converted a previously disclosed $25,000 12% Convertible Promissory Note (including $590.41 of accrued, unpaid interest) initially issued on April 13, 2020 (the "April Note") at a conversion price of $0.132. Pursuant to the terms of the April Note, the conversion price was calculated at 80% of the Issuer's closing trading price on June 5, 2020, which was $0.165. All such shares are "restricted securities" as defined by the Securities Act. |
(3) | Pursuant to the terms of the January Note, as of the conversion date the Reporting Person was issued a five-year Warrant to Purchase Common Stock for up to 400,195 shares of the Issuer's common stock with an exercise price of $0.396, or three times the conversion price of the January Note. |
(4) | Pursuant to the terms of the April Note, as of the conversion date the Reporting Person was issued a five-year Warrant to Purchase Common Stock for up to 195,522 shares of the Issuer's common stock with an exercise price of $0.396, or three times the conversion price of the April Note. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Barbera Michael Vito 1423 SW 13TH DRIVE BOCA RATON, FL 33486 | X |
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Signatures
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/s/ Michael Vito Barbera | | 8/6/2020 |
**Signature of Reporting Person | Date |
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