SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Keller Michael R

(Last) (First) (Middle)
C/O SUPER LEAGUE GAMING, INC.
2906 COLORADO AVE.

(Street)
SANTA MONICA CA 90404

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Super League Gaming, Inc. [ SLGG ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
06/21/2019
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 06/21/2009 P 3,300 A $8.0709 100,301(1) I By the Michael R. Keller Trust
Common Stock 2,854(2) I By the Keller 2004 IRR Trust FBO William
Common Stock 2,854(3) I By the Keller 2004 IRR Trust FBO Charles
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Common Stock Purchase Warrant $9.35 05/28/2018 05/28/2023 Common Stock 54,465 54,465 I By the Michael R. Keller Trust
Common Stock Purchase Warrant $9.35 05/30/2018 05/30/2023 Common Stock 10,696 10,696 I By the Michael R. Keller Trust
Common Stock Purchase Warrant $9.35 08/17/2018 08/17/2023 Common Stock 21,070 21,070 I By the Michael R. Keller Trust
Common Stock Purchase Warrant $10.8 03/14/2018 03/14/2023 Common Stock 9,260 9,260 I By the Michael R. Keller Trust
Common Stock Purchase Warrant $9.35 08/17/2018 08/17/2023 Common Stock 2,674 2,674 I By the Keller 2004 IRR Trust FBO William
Common Stock Purchase Warrant $9.35 08/17/2018 08/17/2023 Common Stock 2,674 2,674 I By the Keller 2004 IRR Trust FBO Charles
Explanation of Responses:
1. Includes 91,546 shares issued to the Michael R. Keller Trust (the "Keller Trust") upon conversion of 9.00% Secured Convertible Promissory Notes (the "Notes") previously issued to the Keller Trust. The outstanding principal and all accrued but unpaid interest on the Notes were automatically converted into shares of the Issuer's common stock in connection with the Issuer's initial public offering on February 27, 2019.
2. Includes 2,854 shares issued to the Keller 2004 IRR Trust FBO William (the "FBO William Trust") upon conversion of 9.00% Secured Convertible Promissory Notes (the "Notes") previously issued to the FBO William Trust. The outstanding principal and all accrued but unpaid interest on the Notes were automatically converted into shares of the Issuer's common stock in connection with the Issuer's initial public offering on February 27, 2019.
3. Includes 2,854 shares issued to the Keller 2004 IRR Trust FBO Charles (the "FBO Charles Trust") upon conversion of 9.00% Secured Convertible Promissory Notes (the "Notes") previously issued to the FBO Charles Trust. The outstanding principal and all accrued but unpaid interest on the Notes were automatically converted into shares of the Issuer's common stock in connection with the Issuer's initial public offering on February 27, 2019.
/s/ Clayton Haynes, Attorney-in-Fact 06/25/2019
** 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 4 (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.