Thumzup Media Corporation
11/04/2024 | Press release | Distributed by Public on 11/04/2024 18:20
Initial Statement of Beneficial Ownership - Form 3
Ownership Submission
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, See 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.
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FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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. Title of Derivate Security | 2. Date Exercisable and Expiration Date | 3. Title and Amount of Securities Underlying Derivative Security | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) | 6. Nature of Indirect Beneficial Ownership |
| Date Exercisable | Expriation Date | Title | Amount or Number of Shares |
Reporting Owners
| Reporting Owner Name / Address | Relationships | |||
| Director | 10% Owner | Officer | Other | |
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HAAG ROBERT L 11854 W. OLYMPIC BLVD, STE 1100W #13 LOS ANGELES, CA90064 |
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Signatures
| /s/ Robert Haag | 2024-11-04 |
| **Signature of Reporting Person | Date |
Explanation of Responses:
| (*) | 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) | Mr. Haag is the Managing Member and sole owner of Westside Strategic Partners, LLC ("Westside"). Robert Haag has voting control and investment discretion over securities held by Westside. As such, Robert Haag may be deemed to be the beneficial owner (as determined under Section 13(d) of the Exchange Act) of the securities held by Westside. |
| (2) | As stated in the Amended and Restated Certificate of Designation of Series A Preferred Convertible Voting Stock dated September 26, 2022 (the "Series A Preferred Certificate of Designation"), Series A Preferred Convertible Voting Stock is exercisable upon issuance, and has no expiration date. |
| (3) | Series A Preferred Convertible Voting Stock converts into 15 shares of Common Stock at a Reference Rate of $3.00, subject to adjustments as specified in the Series A Preferred Certificate of Designation. |
| (4) | The Amended and Restated Certificate of Designation of Series B Preferred Convertible Voting Stock dated April 17, 2024 (the "Series B Preferred Certificate of Designation") allows for conversion by Mr. Haag at any time, as well as providing for automatic conversion by the Company following the 6-month anniversary of the listing on a National Stock Exchange, the Series B Preferred shall automatically convert into common stock should the Company's common stock be listed on a National Stock Exchange and close at $8.00 or more for ten (10) consecutive trading days. |
| (5) | Each share of Series B Preferred Convertible Voting Stock was initially convertible into 10 shares of Common Stock (the "Conversion Rate") at a reference rate of $5.00 per share of Common Stock (the "Reference Rate"), which adjusted to a 20% discount to the offering price of the Company's Offering on Form S-1 in conjunction with an up-listing to a National Stock Exchange, or $4.00 per share of Common Stock, subject to adjustments as specified in the Series B Preferred Certificate of Designation. |
| (6) | Should Mr. Haag resign or be removed prior to completing full 12 month term, the remaining portion of the options that the Director was entitled to shall be clawed back pursuant to the Company's Compensation Recovery Policy and the discretion of the Board of Directors. |