1. Title of Derivate Security
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date (Month/Day/Year)
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3A. Deemed Execution Date, if any (Month/Day/Year)
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4. Transaction Code
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
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8. Price of Derivative Security
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
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11. Nature of Indirect Beneficial Ownership
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expriation Date
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Title
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Amount or Number of Shares
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(*)
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If the form is filed by more than one reporting person, see Instruction 5(b)(v).
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(**)
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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(1)
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On June 30, 2024, Danielle Lominy voluntarily surrendered 500,000 options registered to the Dominic Bassani 2019 Irrevocable Trust ("2019 Trust") for cancellation. Danielle Lominy is the 50% beneficial owner of 1,000,000 options registered to the 2019 Trust.
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(2)
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As of June 30, 2024 1,511,477 shares underlying warrants are held by The Danielle Christine Bassani Trust with the exercise price of $.75 until January 15, 2025. These warrants carry a potential price adjustment of 75%.
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(3)
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As of June 30, 2024, Ms. Lominy is the owner of 311,458 warrants with the exercise price of $.75 until January 15, 2025. These warrants carry a potential price adjustment ranging from 75% to 90%.
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(4)
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As of June 30, 2024, 105,000 warrants are jointly owned with Danielle's spouse with the exercise price of $.75 until January 15, 2025. These warrants carry a potential price adjustment of 75%.
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(5)
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As of June 30, 2024, 230,000 warrants are registered to Ms. Lominy's minor daughter who resides with her. These warrants have an exercise price of $.75 with the potential price adjustment ranging from 75% to 90%.
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(6)
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As of June 30, 2024, Ms. Lominy 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%.
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(7)
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As of June 30, 2024, Ms. Lominy is the 50% beneficial owner of the Adjusted 2020 Trust Convertible Obligation in the amount of $459,277.02. As of result, Ms. Lominy 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.
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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.