0001299967-13-000021.txt : 20130318
0001299967-13-000021.hdr.sgml : 20130318
20130318190842
ACCESSION NUMBER: 0001299967-13-000021
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20130312
FILED AS OF DATE: 20130318
DATE AS OF CHANGE: 20130318
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Cerkovnik Edward
CENTRAL INDEX KEY: 0001556567
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-32438
FILM NUMBER: 13699467
MAIL ADDRESS:
STREET 1: 600 N. BRAND BLVD.
STREET 2: SUITE 230
CITY: GLENDALE
STATE: CA
ZIP: 91203
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: MediaShift, Inc.
CENTRAL INDEX KEY: 0001299967
STANDARD INDUSTRIAL CLASSIFICATION: CRUDE PETROLEUM & NATURAL GAS [1311]
IRS NUMBER: 201373949
STATE OF INCORPORATION: NV
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 600 NORTH BRAND BLVD., SUITE 230
CITY: GLENDALE
STATE: CA
ZIP: 91203
BUSINESS PHONE: (818) 649-5710
MAIL ADDRESS:
STREET 1: 600 NORTH BRAND BLVD., SUITE 230
CITY: GLENDALE
STATE: CA
ZIP: 91203
FORMER COMPANY:
FORMER CONFORMED NAME: JMG Exploration, Inc.
DATE OF NAME CHANGE: 20040806
4
1
primary_doc.xml
PRIMARY DOCUMENT
X0306
4
2013-03-12
0
0001299967
MediaShift, Inc.
JMGED
0001556567
Cerkovnik Edward
600 N. BRAND BLVD.
SUITE 230
GLENDALE
CA
91203
1
0
0
0
Common Stock
2013-03-12
4
M
0
10000
A
10000
D
Stock Option
1.14
2013-03-12
4
C
0
50000
A
2012-08-31
2018-08-31
Common Stock
50000
50000
D
Note
3
2013-03-06
Common Stock
10000
10000
D
Warrants
4
2013-03-06
2013-07-31
Common Stock
5000
5000
D
Warrants
6
2013-03-06
2014-07-31
Common Stock
5000
10000
D
Automatic cashless conversion of Class M Preferred Stock.
Stock option exercisable into Class M Preferred Stock automatically converted into stock option exercisable into Common Stock.
Maturity date of this note is 2/15/2015.
/s/ Edward Cerkovnik
2013-03-18