FORM 3 |
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. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 07/26/2017 |
3. Issuer Name and Ticker or Trading Symbol
Surge Holdings, Inc. [ SURG ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common stock, $0.001 par value per share | 19,414,286 | D | |
Common stock, $0.001 par value per share | 4,813,885 | I | EWP Communications, LLC |
Common stock, $0.001 par value per share | 1,800,000 | I | BCAN Holdings, LLC |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Series A Preferred | (1) | (1) | Common Stock | 10,425,000 | (1) | D | |
Series A Preferred | (1) | (1) | Common Stock | 75,000 | (1) | I | EWP Communications, LLC |
Series C Preferred | (2) | (2) | Common Stock | 603,364 | (2) | D |
Explanation of Responses: |
1. Each ten shares of Series A Preferred are convertible into one share of Common Stock of the Issuer. Each share of Series A Preferred stock has ten votes per share on all matters submitted to votes of the Issuer's security holders. The Series A Preferred shares are convertible for no additional consideration at the election of the holder. |
2. Each share of Series C Preferred is convertible into two hundred fifty (250) shares of Common Stock of the Issuer. Each share of Series C Preferred stock has voting rights equal to two hundred fifty (250) shares of Common Stock on all matters submitted to votes of the Issuer's security holders. The Series C Preferred shares are convertible for no additional consideration at the election of the holder. |
/s/ Kevin Brian Cox | 10/09/2020 | |
** 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 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). | ||
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 Number. |