0001096906-18-000656.txt : 20181119
0001096906-18-000656.hdr.sgml : 20181119
20181119192351
ACCESSION NUMBER: 0001096906-18-000656
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20180928
FILED AS OF DATE: 20181119
DATE AS OF CHANGE: 20181119
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Hayes John William
CENTRAL INDEX KEY: 0001700177
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-53979
FILM NUMBER: 181193903
MAIL ADDRESS:
STREET 1: 21325 DELTA DRIVE
CITY: RENO
STATE: NV
ZIP: 89521
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: BlackRidge Technology International, Inc.
CENTRAL INDEX KEY: 0001456212
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372]
IRS NUMBER: 000000000
STATE OF INCORPORATION: NV
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 5390 KIETZKE LANE
STREET 2: SUITE 104
CITY: RENO
STATE: NV
ZIP: 89511
BUSINESS PHONE: 855-807-8776
MAIL ADDRESS:
STREET 1: 5390 KIETZKE LANE
STREET 2: SUITE 104
CITY: RENO
STATE: NV
ZIP: 89511
FORMER COMPANY:
FORMER CONFORMED NAME: GROTE MOLEN, INC.
DATE OF NAME CHANGE: 20170605
FORMER COMPANY:
FORMER CONFORMED NAME: GROTE MOLEN INC
DATE OF NAME CHANGE: 20090212
4
1
primary_doc.xml
PRIMARY DOCUMENT
X0306
4
2018-09-28
0
0001456212
BlackRidge Technology International, Inc.
BRTI
0001700177
Hayes John William
10615 PROFESSIONAL CIRCLE, SUITE 201
RENO
NV
89521
1
1
1
0
Chief Technology Officer
Common Stock
2018-09-30
4
A
0
908152
0.35
A
18659763
D
Common Stock
2018-09-28
4
J
0
4645082
0.25
A
23304845
D
Warrant to Purchase Common Stock
0.25
2018-09-28
4
A
0
3845082
A
2018-09-28
2023-09-28
Common Stock
3845082
11212367
D
On September 30, 2018, the issuer issued restricted common stock, par value $0.0001 per share, to Mr. Hayes in lieu of cash payment of deferred wages and compensation at $0.35 per share for his service as a director on the issuer's board of directors.
Shares of common stock, par value $0.0001 per share, acquired in exchange for the extinguishment of debt represented by three notes (the "Notes"), in the principal amount of $$ ], plus $[ ] of interest. The shares were issued on September 28, 2018 to Mr. Hayes.
Issued as further consideration for the extinguishment of the debt represented by the Notes described in footnote 2 above.
/s/John Hayes
2018-11-19