0001493152-16-015575.txt : 20161201
0001493152-16-015575.hdr.sgml : 20161201
20161201121124
ACCESSION NUMBER: 0001493152-16-015575
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160729
FILED AS OF DATE: 20161201
DATE AS OF CHANGE: 20161201
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: INCEPTION MINING INC.
CENTRAL INDEX KEY: 0001416090
STANDARD INDUSTRIAL CLASSIFICATION: GOLD & SILVER ORES [1040]
IRS NUMBER: 352302128
STATE OF INCORPORATION: NV
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 5330 SO 900 E
STREET 2: STE 280
CITY: MURRAY
STATE: UT
ZIP: 84117
BUSINESS PHONE: 801-312-8113
MAIL ADDRESS:
STREET 1: 5330 SO 900 E
STREET 2: STE 280
CITY: MURRAY
STATE: UT
ZIP: 84117
FORMER COMPANY:
FORMER CONFORMED NAME: GOLD AMERICAN MINING CORP.
DATE OF NAME CHANGE: 20100628
FORMER COMPANY:
FORMER CONFORMED NAME: SILVER AMERICA, INC.
DATE OF NAME CHANGE: 20100310
FORMER COMPANY:
FORMER CONFORMED NAME: GOLF ALLIANCE CORP
DATE OF NAME CHANGE: 20080225
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: D'Ambrosio Trent
CENTRAL INDEX KEY: 0001611150
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-55219
FILM NUMBER: 162027499
MAIL ADDRESS:
STREET 1: 5320 SOUTH 900 EAST
STREET 2: #260
CITY: MURRAY
STATE: UT
ZIP: 84107
4
1
form4.xml
X0306
4
2016-07-29
0
0001416090
INCEPTION MINING INC.
IMII
0001611150
D'Ambrosio Trent
5330 SOUTH 900 EAST, SUITE 280
MURRAY
UT
84117
1
1
0
0
CFO
Convertible Promissory Note
0.23
2016-07-29
2016-07-29
4
C
0
881057
200000
A
2016-01-01
2016-10-02
Common Shares
881057
0
D
Common shares acquired through the exercise of a convertible promissory note (the "Note") issued to the Reporting Owner. Pursuant to the Note, the Reporting Owner was permitted to convert outstanding debt owed by the Company to shares of the Company's common stock to satisfy those debt obligations. The Reporting Owner is deemed to beneficially own one derivative security until all debt eligible for conversion under the Note has been converted to shares of the Company's common stock or the Note is amended (see Note 2, below), at which point this derivative security will be disposed of completely.
As of October 2, 2016, the Reporting Owner and the Company entered into a Note Amendment through which all the convertible provisions of the Note were removed and the due date was extended until December 31, 2017. Accordingly, as of the date of this filing, there are no derivative securities underlying the Note.
Assigned through Conversion of MDL Ventures, LLC convertible promissory note
/s/ Trent D'Ambrosio
2016-12-01