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