SEC FORM 4

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

OMB APPROVAL

OMB Number:			3235-0287
Estimated average burden
hours per response:			0.5

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^*

Hayes John William

(Last)

(First)

(Middle)

10615 PROFESSIONAL CIRCLE, SUITE 201

(Street)

RENO

89521

(City)

(State)

(Zip)

2. Issuer Name and Ticker or Trading Symbol
BlackRidge Technology International, Inc. [ BRTI ]

5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	10% Owner
	Officer (give title below)	Other (specify below)

3. Date of Earliest Transaction (Month/Day/Year)
11/09/2017

4. 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 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)
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	Code	V	Amount	(A) or (D)	Price		6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
Common Stock	11/09/2017		C		10,757,254	A	$0⁽¹⁾	17,751,611	D

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)
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)	Code	V	(A)	(D)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	8. Price of Derivative Security (Instr. 5)		10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
Common Stock Covertible⁽¹⁾	$0.5	11/09/2017		C			10,757,254	⁽¹⁾	11/09/2017	Common Stock	10,757,254	⁽¹⁾	0	D
Warrant to Purchase Common Stock⁽¹⁾	$0.5	11/09/2017		P		1,344,656		11/09/2017	11/09/2019	Common Stock	1,344,656	⁽¹⁾	1,344,656	D
Warrant to Purchase Common Stock⁽¹⁾	$0.5	11/09/2017		P		1,344,657		11/09/2017	11/09/2020	Common Stock	1,344,657	⁽¹⁾	1,344,656	D
Warrant to Purchase Common Stock⁽¹⁾	$0.5	11/09/2017		P		1,344,657		11/09/2017	11/09/2021	Common Stock	1,344,657	⁽¹⁾	1,344,656	D
Warrant to Purchase Common Stock⁽¹⁾	$0.5	11/09/2017		P		1,344,657		11/09/2017	11/09/2022	Common Stock	1,344,657	⁽¹⁾	1,344,656	D
Warrant to Purchase Common Stock	$0.25	07/06/2018		P		800,000		07/06/2018	07/06/2023	Common Stock	800,000	⁽²⁾	7,367,285	D

Explanation of Responses:

1. From 2011 to 2014, Mr. Hayes loaned a total of $2,673,200 to the issuer. On October 1, 2014, all prior notes including accrued interest were combined into a single $3,712,637 convertible note bearing interest at 12% annually and convertible into 4,125,154 shares of preferred stock at the rate of $0.90 per share. On November 9, 2017, the issuer converted the note and accrued interest of $1,665,991 into 10,757,254 shares of the issuer's common stock at a conversion rate of $0.50 per share. The issuer also issued a 5 year warrant to purchase an additional 5,378,627 shares of the issuer's common stock at a purchase price of $0.50 per share as further consideration for this conversion.

2. On July 10, 2018, Mr. Hayes purchased a convertible note in the principal amount of $200,000 and warrants to purchase 800,000 shares of the issuer's common stock for an aggregate amount of $200,000. The note is convertible into the issuer's Series B Preferred Stock.

	/s/John Hayes	09/12/2018
	** 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 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.