Filing Details

Accession Number:
0001584388-14-000002
Form Type:
4
Zero Holdings:
No
Publication Time:
2014-08-04 16:44:09
Reporting Period:
2014-07-28
Filing Date:
2014-08-04
Accepted Time:
2014-08-04 16:44:09
SEC Url:
Form 4 Filing
Issuer
Cik Name Symbol Sector (SIC) IRS No
1143238 Poly Shield Technologies Inc. SHPR Telephone Communications (No Radiotelephone) (4813) 330953557
Insiders
Cik Name Reported Address Insider Title Director Officer Large Shareholder Other
1584388 C. Robert Kopple 10866 Wilshire Blvd., Suite 1500
Los Angeles CA 90024
No No Yes No
Reported Non-Derivative Transactions
Sec. Name Acquisiton - Disposition Date Amount Price Remaning Holdings Equity Swap Involved Form Type Code Nature of Ownership Explanation
Common Stock Acquisiton 2014-07-28 4,000,000 $0.50 6,716,667 No 4 P Indirect See footnote
Common Stock Acquisiton 2014-07-28 4,000,000 $0.50 10,716,667 No 5 P Indirect See footnote
Equity Swap Involved Form Type Code Nature of Ownership Explanation
No 4 P Indirect See footnote
No 5 P Indirect See footnote
Reported Derivative Transactions
Sec. Name Sec. Type Acquisiton - Disposition Date Amount Price Amount - 2 Price - 2
Common Stock Warrants Acquisiton 2014-07-28 9,600,000 $0.00 9,600,000 $0.50
Remaning Holdings Exercise Date Expiration Date Equity Swap Involved Transaction Form Type Transaction Code Nature of Ownership
16,504,546 2014-07-28 2019-09-01 No 4 P Indirect
Footnotes
  1. Securities held by KF Business Ventures LP. The Reporting Person has the sole power to vote or to direct the vote and the sole power to dispose or to direct the disposition of the shares for this entity.
  2. Closing for purchase of these common shares is scheduled for November 3, 2014, pursuant to a binding agreement.
  3. Warrants issued as additional consideration for a loan to the Issuer in the amount of $2,400,000.