Statement of Changes in Beneficial Ownership (4)
30 August 2022 - 6:32AM
Edgar (US Regulatory)
FORM 4
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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
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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
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DIBELLA JOHN |
2. Issuer Name and Ticker or Trading Symbol
ENVIRO TECHNOLOGIES U.S., INC.
[
EVTN
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) CEO & CFO |
(Last)
(First)
(Middle)
821 NW 57 PLACE |
3. Date of Earliest Transaction
(MM/DD/YYYY)
8/23/2022 |
(Street)
FT. LAUDERDALE, FL 33309
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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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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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) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
6% Unsecured Convertible Promissory Note | $0.06 | 8/23/2022 | | A | | $815565 | | (1) | (1) | Common Stock | 13592750 | $815565 | 0 (1) | D | |
Explanation of Responses: |
(1) | On August 23, 2022 Enviro Technologies U.S., Inc. (the "Company") entered into a Share Exchange Agreement (the "Agreement") with Banner Midstream Corp., a Delaware corporation ("Banner Midstream") and Ecoark Holdings, Inc., a Nevada corporation and the sole shareholder of Banner Midstream. The Agreement contains customary representations and warranties, customary covenants and conditions to closing and additional conditions to closing. Pursuant to the Agreement, on August 23, 2022 the Company issued the Reporting Person a 6% convertible promissory note in the principal amount of $815,565, convertible at the option of the Reporting Person at $0.06 per share, with a maturity date of 12 months from the closing of the Agreement in satisfaction all of the Reporting Person's accrued payroll to the Company. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
DIBELLA JOHN 821 NW 57 PLACE FT. LAUDERDALE, FL 33309 | X |
| CEO & CFO |
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Signatures
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/s/ John A. DiBella | | 8/26/2022 |
**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 control number. |
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