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 |
| |||||||||||||||
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*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol Ambient Water Corp [ AWGI ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| ||||||||||||||||||||||||
3. Date of Earliest Transaction (Month/Day/Year) 06/04/2015 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable Line)
|
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 | 14,941,438 | D | ||||||||
Common stock | 12,788,712 | I(1) | Shares held by holding company. | |||||||
Common stock | 06/04/2015 | S | 50,000 | D | $0.0435 | 12,738,712 | I(1) | Shares held by holding company. | ||
Common stock | 06/04/2015 | S | 50,000 | D | $0.041 | 12,688,712 | I(1) | Shares held by holding company. | ||
Common stock | 06/04/2015 | S | 45,000 | D | $0.0434 | 12,643,712 | I(1) | Shares held by holding company. | ||
Common stock | 06/04/2015 | S | 50,000 | D | $0.0531 | 12,593,712 | I(1) | Shares held by holding company. | ||
Common stock | 06/04/2015 | S | 50,000 | D | $0.0437 | 12,543,712 | I(1) | Shares held by holding company. | ||
Common stock | 06/04/2015 | S | 25,000 | D | $0.048 | 12,518,712 | I(1) | Shares held by holding company. | ||
Common stock | 06/04/2015 | S | 50,000 | D | $0.051 | 12,468,712 | I(1) | Shares held by holding company. |
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 options | $0.11 | (2) | 07/22/2023 | Common stock | 750,000 | 750,000 | D |
Explanation of Responses: |
1. Common stock registered to 0967761 BC, Ltd. Keith White has voting and dispositive control over the 0967761 BC, Ltd. shares. |
2. On July 22, 2013, the board of directors authorized the issuance of 750,000 common stock options to Keith White, the Company's Chief Executive Officer and Chief Technology Officer. These common stock options have an exercise price of $0.11 per share. On July 22, 2014, twenty-five percent (25%) of the options vested. Thereafter, the options vest at six and a quarter percent (6.25%) each quarter or 46,875 option shares quarterly. Vesting quarters are October 22, January 22, April 22 and July 22. The common stock options have a ten (10) year exercise term. At April 10, 2014, a total of 234,375 options shares had vested. |
/s/ Keith R. White | 10/23/2015 | |
** 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. |