1. Title of Derivate Security
|
2. Conversion or Exercise Price of Derivative Security
|
3. Transaction Date (Month/Day/Year)
|
3A. Deemed Execution Date, if any (Month/Day/Year)
|
4. Transaction Code
|
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
|
6. Date Exercisable and Expiration Date
|
7. Title and Amount of Securities Underlying Derivative Security
|
8. Price of Derivative Security
|
9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s)
|
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
|
11. Nature of Indirect Beneficial Ownership
|
Code
|
V
|
(A)
|
(D)
|
Date Exercisable
|
Expriation Date
|
Title
|
Amount or Number of Shares
|
(*)
|
If the form is filed by more than one reporting person, see Instruction 5(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).
|
(1)
|
On June 30, 2024, Christopher Parlow voluntarily surrendered 500,000 options registered to the Dominic Bassani 2019 Irrevocable Trust ("2019 Trust") for cancellation. Christopher Parlow is the 50% beneficial owner of 1,000,000 options registered to the 2019 Trust.
|
(2)
|
As of June 30, 2024, 1,614,000 shares underlying warrants are held by the Christopher Parlow Trust with the exercise price of $.75 until
|
(3)
|
As of June 30, 2024, Mr. Parlow is the owner of 150,000 warrants with the exercise price of $.75 until January 15, 2025. These warrants carry a potential price adjustment of 90%.
|
(4)
|
As of June 30, 2024, 147,154 warrants are jointly owned with Christopher's spouse with the exercise price of $.75 until January 15, 2025. These warrants carry a potential price adjustment of 75%.
|
(5)
|
As of June 30, 2024, 459,780 warrants are registered to Mr. Parlow's minor children who reside with him. These warrants have an exercise price of $.75 with the potential price adjustment ranging from 75% to 90%. These warrants will expire on January 15, 2025.
|
(6)
|
As of June 30, 2024, Mr. Parlow is the owner of 1,500,000 warrants as 50% beneficial owner of the 2019 Trust. These warrants are exercisable at $.75 until January 15, 2025 and carry a potential price adjustment of 75%.
|
(7)
|
As of June 30, 2024 Mr. Parlow is the 50% beneficial owner of the Adjusted 2020 Trust Convertible Obligation in the amount of $459,277.02. As a result, Mr. Parlow is the owner of $229,638.51 of the note balance which is convertible @ $.0953 into 2,409,639 shares and 1,607,229 warrants.
|
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
Instruction 6 for procedure.Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.