0001096906-18-000523.txt : 20180912
0001096906-18-000523.hdr.sgml : 20180912
20180912180828
ACCESSION NUMBER: 0001096906-18-000523
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20171109
FILED AS OF DATE: 20180912
DATE AS OF CHANGE: 20180912
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Hayes John William
CENTRAL INDEX KEY: 0001700177
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-53979
FILM NUMBER: 181067563
MAIL ADDRESS:
STREET 1: 21325 DELTA DRIVE
CITY: RENO
STATE: NV
ZIP: 89521
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: BlackRidge Technology International, Inc.
CENTRAL INDEX KEY: 0001456212
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372]
IRS NUMBER: 000000000
STATE OF INCORPORATION: NV
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 5390 KIETZKE LANE
STREET 2: SUITE 104
CITY: RENO
STATE: NV
ZIP: 89511
BUSINESS PHONE: 855-807-8776
MAIL ADDRESS:
STREET 1: 5390 KIETZKE LANE
STREET 2: SUITE 104
CITY: RENO
STATE: NV
ZIP: 89511
FORMER COMPANY:
FORMER CONFORMED NAME: GROTE MOLEN, INC.
DATE OF NAME CHANGE: 20170605
FORMER COMPANY:
FORMER CONFORMED NAME: GROTE MOLEN INC
DATE OF NAME CHANGE: 20090212
4
1
primary_doc.xml
PRIMARY DOCUMENT
X0306
4
2017-11-09
0
0001456212
BlackRidge Technology International, Inc.
BRTI
0001700177
Hayes John William
10615 PROFESSIONAL CIRCLE, SUITE 201
RENO
NV
89521
1
0
0
0
Common Stock
2017-11-09
4
C
0
10757254
0
A
17751611
D
Common Stock Covertible
0.5
2017-11-09
4
C
0
10757254
D
2017-11-09
Common Stock
10757254
0
D
Warrant to Purchase Common Stock
0.5
2017-11-09
4
P
0
1344656
A
2017-11-09
2019-11-09
Common Stock
1344656
1344656
D
Warrant to Purchase Common Stock
0.5
2017-11-09
4
P
0
1344657
A
2017-11-09
2020-11-09
Common Stock
1344657
1344656
D
Warrant to Purchase Common Stock
0.5
2017-11-09
4
P
0
1344657
A
2017-11-09
2021-11-09
Common Stock
1344657
1344656
D
Warrant to Purchase Common Stock
0.5
2017-11-09
4
P
0
1344657
A
2017-11-09
2022-11-09
Common Stock
1344657
1344656
D
Warrant to Purchase Common Stock
0.25
2018-07-06
4
P
0
800000
A
2018-07-06
2023-07-06
Common Stock
800000
7367285
D
From 2011 to 2014, Mr. Hayes loaned a total of $2,673,200 to the issuer. On October 1, 2014, all prior notes including accrued interest were combined into a single $3,712,637 convertible note bearing interest at 12% annually and convertible into 4,125,154 shares of preferred stock at the rate of $0.90 per share. On November 9, 2017, the issuer converted the note and accrued interest of $1,665,991 into 10,757,254 shares of the issuer's common stock at a conversion rate of $0.50 per share. The issuer also issued a 5 year warrant to purchase an additional 5,378,627 shares of the issuer's common stock at a purchase price of $0.50 per share as further consideration for this conversion.
On July 10, 2018, Mr. Hayes purchased a convertible note in the principal amount of $200,000 and warrants to purchase 800,000 shares of the issuer's common stock for an aggregate amount of $200,000. The note is convertible into the issuer's Series B Preferred Stock.
/s/John Hayes
2018-09-12