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*
MOONEY EDWARD P

(Last) (First) (Middle)
245 SIR FRANCIS DRAKE BOULEVARD

(Street)
SAN ANSELMO CA 94960

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
COLOMBIA CLEAN POWER & FUELS, INC [ CCPF.OB ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
12/21/2010
4. If Amendment, Date of Original Filed (Month/Day/Year)
09/14/2011
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 05/24/2011 S 100,000 D (1) 12,140,004 I See Footnote(2)
Common Stock 05/24/2011 J 3,093(3) D (3) 12,136,911 I See Footnote(2)
Common Stock 05/25/2011 S 100,000 D (4) 12,036,911 I See Footnote(2)
Common Stock 05/25/2011 J 687(3) D (3) 12,036,224 I See Footnote(2)
Common Stock 09/09/2011 S 118,645 D (5) 11,918,279(6) I See Footnote(2)
Common Stock 432,482 I See Footnote(7)
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
Warrants $0.01 12/21/2010 A 32,000 12/21/2010 06/30/2015 Common Stock 32,000 $0 32,000 I See Footnote(2)
Stock Option $2.5 12/28/2010 A 50,000 (8) 12/28/2015 Common Stock 50,000 $0 50,000 D
Stock Option $5 12/28/2010 A 50,000 (8) 12/28/2015 Common Stock 50,000 $0 50,000 D
Series A Preferred Stock (9) 06/02/2011 A 8,000 (9) (9) Common Stock 40,000 (10) 8,000 I See Footnote(2)
Warrants $0.01 06/02/2011 A 2,800 06/02/2011 05/31/2016 Common Stock 2,800 (10) 2,800 I See Footnote(2)
10% Convertible Note Due 6/30/12 $2.5 06/02/2011 D 80,000 12/21/2010 06/30/2012 Common Stock 32,000 (10) 0 I See Footnote(2)
Explanation of Responses:
1. Represents common stock transferred by LIFE (as defined below) to a service provider in consideration for services rendered at a deemed price of $2.00 per share.
2. Represents securities owned by LIFE Power & Fuels, LLC, a Delaware limited liability ("LIFE"). The Reporting Person is the Managing Member of LIFE, but disclaims beneficial ownership of such securities except to the extent of his pecuniary interest therein.
3. On February 11, 2011, LIFE made a distribution to its members of 15% of the Reporting Person's ownership of the Issuer's shares. The number of shares reported in Table I represents shares of the Issuer that were erroneously not distributed to certain members of the Reporting Person, which were subsequently distributed.
4. Represents common stock transferred by LIFE to a service provider in consideration for services rendered at a deemed price of $2.00 per share.
5. Represents common stock transferred by LIFE to a service provider in consideration for services rendered at a deemed price of $2.00 per share.
6. LIFE also received 100 shares of common stock and 600 shares of common stock pursuant to stock dividends on its shares of Series A Preferred Stock on June 15, 2011 and September 15, 2011, respectively.
7. Represents common stock held by Edward P. and Teresa M. Mooney Revocable Living Trust.
8. Vests in four equal installments on December 28, 2010, 2011, 2012 and 2013.
9. Each share of Series A Preferred Stock is convertible into five shares of common stock, and is convertible at any time without expiration.
10. LIFE received (i) 8,000 shares of Series A convertible preferred stock at a deemed purchase price of $10.00 per share, and (ii) warrants to purchase 2,800 shares of Common Stock at an exercise price of $0.01 per share, in consideration for the cancellation by the Issuer of a convertible promissory note issued to LIFE in the principal amount of $80,000 due June 30, 2012.
/s/ Edward P. Mooney 10/14/2011
** 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).
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