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
COLOMBIA CLEAN POWER & FUELS, INC [ CCPF.OB ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
||||||||||||||||||||||||
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)
|
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). | ||
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. |