0000897069-24-001970.txt : 20241016 0000897069-24-001970.hdr.sgml : 20241016 20241016170235 ACCESSION NUMBER: 0000897069-24-001970 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20241014 FILED AS OF DATE: 20241016 DATE AS OF CHANGE: 20241016 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Kaufman Daniel Louis CENTRAL INDEX KEY: 0002001906 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41723 FILM NUMBER: 241375253 MAIL ADDRESS: STREET 1: PO BOX 495 CITY: PALMER STATE: PR ZIP: 00721 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Kaufman Kapital LLC CENTRAL INDEX KEY: 0002033227 ORGANIZATION NAME: STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41723 FILM NUMBER: 241375252 BUSINESS ADDRESS: STREET 1: 2158 PARK BOULEVARD CITY: SAN JUAN STATE: PR ZIP: 00913 BUSINESS PHONE: 786-835-5992 MAIL ADDRESS: STREET 1: 2158 PARK BOULEVARD CITY: SAN JUAN STATE: PR ZIP: 00913 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: BranchOut Food Inc. CENTRAL INDEX KEY: 0001962481 STANDARD INDUSTRIAL CLASSIFICATION: FOOD & KINDRED PRODUCTS [2000] ORGANIZATION NAME: 04 Manufacturing IRS NUMBER: 873980472 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 205 SE DAVIS AVENUE, STREET 2: SUITE C CITY: BEND STATE: OR ZIP: 97702 BUSINESS PHONE: 844-263-6637 MAIL ADDRESS: STREET 1: 205 SE DAVIS AVENUE, STREET 2: SUITE C CITY: BEND STATE: OR ZIP: 97702 4 1 form4.xml X0508 4 2024-10-14 0001962481 BranchOut Food Inc. BOF 0002001906 Kaufman Daniel Louis 2158 PARK BOULEVARD SAN JUAN PR 00913 PUERTO RICO true 0002033227 Kaufman Kapital LLC 2158 PARK BOULEVARD SAN JUAN PR 00913 PUERTO RICO true false Warrant to Purchase Common Stock 1.5 2024-10-14 4 J 0 0 0 A 2025-12-31 Common Stock 500000 500000 D Warrant to Purchase Common Stock 1 2024-10-14 4 J 0 0 0 A 2025-12-31 Common Stock 1000000 1000000 D 12% Convertible Note 0.7582 2024-10-14 4 J 0 0 0 A 2025-12-31 Common Stock 2637826 2637826 D As of October 14, 2024, the shareholders of the Issuer approved the exercise in full of the warrants reported in the Reporting Persons' Form 3. The Reporting Persons are no longer subject to a cap limiting the number of shares common stock that they may hold. As of October 14, 2024, the shareholders of the Issuer approved the conversion in full of the convertible note reported in the Reporting Persons' Form 3. The Reporting Persons are no longer subject to a cap limiting the number of shares common stock that they may hold. /s/ Daniel L. Kaufman as Power of Attorney for Daniel L. Kaufman, Managing Member 2024-10-16 /s/ Jessica S. Lochmann as Power of Attorney for Daniel L. Kaufman 2024-10-16