Amended Statement of Changes in Beneficial Ownership (4/a)
17 April 2018 - 4:26AM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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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
*
Tracy Joel Daniel
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2. Issuer Name
and
Ticker or Trading Symbol
Alliance MMA, Inc.
[
AMMA
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
C/O ALLIANCE MMA, INC., 590 MADISON AVENUE, 21ST FLOOR
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3. Date of Earliest Transaction
(MM/DD/YYYY)
8/29/2017
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(Street)
NEW YORK, NY 10022
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
1/26/2018
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock par value $0.001
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8/29/2017
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P
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45872
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A
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$50000
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334860
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D
(1)
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Warrant to Purchase Common Stock
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$1.50
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8/29/2017
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P
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45872
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3/1/2018
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8/28/2020
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Common Stock, par value $0.001
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45872
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(2)
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45872
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D
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Warrant to Purchase Common Stock
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$1.50
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3/1/2018
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8/28/2020
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Common Stock, par value $0.001
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25000
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70872
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I
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See Footnote
(3)
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Warrant to Purchase Common Stock
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$1.75
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3/1/2018
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8/28/2020
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Common Stock, par value $0.001
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100000
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170872
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I
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See Footnote
(3)
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Explanation of Responses:
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(1)
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In addition to the 184,860 shares of common stock held directly, also includes 150,000 shares held by relations of Mr. Tracy. Mr. Tracy has voting and disposition power over the shares.
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(2)
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Fully vested warrants were issued in a prior reported purchase on the Form 4 filed on January 26, 2018. The warrants were issued at a rate of one warrant per one share of common stock at a unitprice of $1.09 per unit.
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(3)
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In addition to the 45,872 warrants held directly, also includes 125,000 warrants held be relations to Mr. Tracy. Mr. Tracy has voting and disposition power over the warrants.
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Remarks:
The original Form 4, filed on January 26, 2018, is being amended by this Form 4 amendment to correct an administrative error, which misrepresented a purchase that occured on October 20, 2017,as a total of 45,872 shares of common stock, when in fact an equal number of warrants to purchase common stock were also included in that purchase, and the correct purchase date was August 29,2017. As a result of this administrative error, the number of derivative securites beneficially owned by the reporting person is 45,872.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Tracy Joel Daniel
C/O ALLIANCE MMA, INC.
590 MADISON AVENUE, 21ST FLOOR
NEW YORK, NY 10022
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X
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Signatures
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/s/ Joel Tracy
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4/11/2018
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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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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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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 control number.
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