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