Kamin Tony 4

4 · EMPIRE PETROLEUM CORP · Filed Mar 29, 2019

Form 4

Period: 2019-03-27

Director10% Owner

Transactions

Exercise of In-Money
Common Stock
2019-03-27$0.15/sh+66,667$10,000→ 456,667 total
Exercise of In-Money
Common Stock
2019-03-27$0.15/sh+266,667$40,000→ 484,304 total(indirect: By Partnership)
Exercise of In-Money
Common Stock Warrant (Right to Buy)
2019-03-27−66,667→ 73,333 total
Exercise: $0.15From: 2017-12-01Exp: 2019-12-31→ Common Stock (66,667 underlying)
Exercise of In-Money
Common Stock Warrant (Right to Buy)
2019-03-27−266,667→ 0 total(indirect: By Partnership)
Exercise: $0.15From: 2016-12-23Exp: 2019-12-31→ Common Stock (266,667 underlying)
Other
Convertible Note
2019-03-27+0(indirect: By Partnership)
Exercise: $0.10From: 2016-12-23Exp: 2019-12-31→ Common Stock (400,000 underlying)

Footnotes (2)

[F1]Common Stock Warrant was amended on 12/31/2018 to extend expiration date from 12/31/2018 to12/31/2019. Amended further on 3/27/2019 to adjust number of shares underlying warrant from 160,000 shares to 266,667 shares and to reduce exercise price from $0.25 per share to $0.15 per share.
[F2]On 12/31/2018 maturity date of Convertible Note in aggregate principal amount of $40,000 was extended from 12/31/2018 to 12/31/2019. Amended on 3/27/2019 to adjust number of shares underlying note from 266,667 shares to 400,000 shares and to reduce conversion price from $0.15 per share to $0.10 per share.

Documents

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