SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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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1. Name and Address of Reporting Person*
Rosen Arthur

(Last) (First) (Middle)
C/O JERRICK MEDIA HOLDINGS, INC.
202 S. DEAN ST.

(Street)
ENGLEWOOD NJ 07631

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/08/2017
3. Issuer Name and Ticker or Trading Symbol
Jerrick Media Holdings, Inc. [ JMDA ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock, $0.001 par value per share 566,660(1) D
Common Stock, $0.001 par value per share 5,100,000 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Warrants to Purchase Common Stock 05/26/2016 05/26/2021 Common Stock 1,000,000 $0.2 D
Warrants to Purchase Common Stock 09/12/2016 09/12/2021 Common Stock 150,000 $0.2 D
Warrants to Purchase Common Stock 10/31/2016 10/31/2021 Common Stock 10,000 $0.3 D
Warrants to Purchase Common Stock 01/25/2017 01/25/2022 Common Stock 50,000 $0.3 D
Warrants to Purchase Common Stock 04/13/2017 04/13/2022 Common Stock 10,000 $0.3 D
Warrants to Purchase Common Stock 04/25/2017 04/25/2022 Common Stock 17,500 $0.2 D
Warrants to Purchase Common Stock 05/04/2017 05/04/2022 Common Stock 10,500 $0.2 D
Warrants to Purchase Common Stock 07/06/2017 07/06/2022 Common Stock 18,750 $0.2 D
Warrants to Purchase Common Stock 09/07/2017 09/07/2022 Common Stock 750,640 $0.2 D
Warrants to Purchase Common Stock 09/07/2017 09/07/2022 Common Stock 1,313,827 $0.2 D
Warrants to Purchase Common Stock 09/08/2017 09/08/2022 Common Stock 25,000 $0.2 D
Warrants to Purchase Common Stock 09/08/2017 09/08/2022 Common Stock 1,650,000 $0.2 D
Warrants to Purchase Common Stock 11/13/2017 11/13/2022 Common Stock 100,000 $0.2 D
Warrants to Purchase Common Stock 12/21/2017 12/21/2022 Common Stock 500,000 $0.2 I See footnote(8)
Warrants to Purchase Common Stock 02/08/2018 02/08/2023 Common Stock 81,500 $0.2 D
Warrants to Purchase Common Stock 02/20/2018 02/20/2023 Common Stock 448,000 $0.2 D
Warrants to Purchase Common Stock 02/26/2018 02/26/2022 Common Stock 500,000 $0.2 I See footnote(8)
Warrants to Purchase Common Stock 03/04/2018 03/04/2023 Common Stock 10,000 $0.2 D
Warrants to Purchase Common Stock 03/09/2018 03/09/2023 Common Stock 15,000 $0.2 D
Warrants to Purchase Common Stock 03/13/2018 03/13/2023 Common Stock 10,000 $0.2 D
Warrants to Purchase Common Stock 03/28/2018 03/28/2022 Common Stock 525,000 $0.2 I See footnote(8)
Secured Convertible Promissory Note 09/07/2017 09/07/2019 Common Stock (2) $0.2 D
Secured Convertible Promissory Note 09/08/2017 09/08/2019 Common Stock (3) $0.2 D
Secured Convertible Promissory Note 12/21/2017 12/21/2019 Common Stock (4) $0.2 I See footnote(9)
Convertible Promissory Note 02/08/2018 09/30/2018 Common Stock (5) $0.2 D
Secured Convertible Promissory Note 02/26/2018 02/26/2020 Common Stock (6) $0.2 I See footnote(9)
Secured Convertible Promissory Note 03/28/2018 03/28/2020 Common Stock (7) $0.2 I See footnote(9)
Explanation of Responses:
1. On June 14, 2016, the Reporting Person was issued 566,660 shares of the Company's common stock in exchange for the termination of that certain Revenue Share Agreement dated July 22, 2013 with Jerrick Ventures, LLC and that certain Line of Credit Agreement with the Company's Chief Executive Officer dated July 2, 2014.
2. On September 7, 2017, the Reporting Person was issued two Secured Convertible Promissory Notes in the aggregate amount of $412,893.26 which, as of February 6, 2018 has accrued interest in the amount of $25,791.69 and are convertible into 2,193,245 shares of the Company's Common Stock at a conversion rate of the unpaid principal and interest divided by $0.20.
3. On September 8, 2017, the Reporting Person was issued a Secured Convertible Promissory Note in the amount of $330,000 which, as of February 6, 2018 has accrued interest in the amount of $120,478.08 and is convertible into 1,752,390 shares of the Company's Common Stock at a conversion rate of the unpaid principal and interest divided by $0.20.
4. On December 21, 2017, Pearl Digital Opportunities Fund LLC ("Pearl"), of which Reporting Person is a managing member, was issued a Convertible Promissory Note in the amount of $100,000 which is convertible into 500,000 shares of the Company's Common Stock for a period of two (2) years at a conversion rate of the unpaid principal and interest divided by $0.20.
5. On February 8, 2018 the Reporting Person was issued a Secured Convertible Promissory Note in the amount of $46,047 which is currently convertible into 230,235 shares of the Company's Common Stock.
6. On February 26, 2018, Pearl Digital Opportunities Fund LLC ("Pearl"), of which Reporting Person is a managing member, was issued a Convertible Promissory Note in the amount of $100,000 which is convertible into 500,000 shares of the Company's Common Stock for a period of two (2) years at a conversion rate of the unpaid principal and interest divided by $0.20.
7. On March 28, 2018, Pearl Digital Opportunities Fund LLC ("Pearl"), of which Reporting Person is a managing member, was issued a Convertible Promissory Note in the amount of $105,000 which is convertible into 520,000 shares of the Company's Common Stock for a period of two (2) years at a conversion rate of the unpaid principal and interest divided by $0.20.
8. Pearl Digital Opportunities Fund LLC ("Pearl") holds such common stock purchase warrant. Mr. Rosen is the Managing Member of Pearl.
9. Pearl Digital Opportunities Fund LLC ("Pearl") holds such secured convertible promissory note. Mr. Rosen is the Managing Member of Pearl.
/s/ Arthur Rosen 04/23/2018
** 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 5 (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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