SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Barbera Michael Vito

(Last) (First) (Middle)
1423 SW 13TH DRIVE

(Street)
BOCA RATON FL 33486

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
BASANITE, INC. [ BASA ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
07/21/2020
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 07/21/2020 C(1) 400,195 A $0.132 4,909,195 D
Common Stock 07/21/2020 C(2) 195,522 A $0.132 5,104,717 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction 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 (Month/Day/Year) 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: 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
Convertible Promissory Note $0.132 07/21/2020 C(1) 400,195 06/06/2020 07/16/2020 Common Stock 400,195 $0.132 0 D
Convertible Promissory Note $0.132 07/21/2020 C(2) 195,522 06/06/2020 10/13/2020 Common Stock 195,522 $0.132 0 D
Warrant $0.396 07/21/2020 J(3) 400,195 07/21/2020 07/21/2025 Common Stock 400,195 $0(3) 400,195 D
Warrant $0.396 07/21/2020 J(4) 195,522 07/21/2020 07/21/2025 Common Stock 195,522 $0(4) 195,522 D
Explanation of Responses:
1. On July 21, 2020, the Reporting Person converted a previously disclosed $50,000 12% Convertible Promissory Note (including $2,439.53 of accrued, unpaid interest) initially issued on January 16, 2020 (the "January Note") at a conversion price of $0.132. Pursuant to the terms of the January Note, the conversion price was calculated at 80% of the Issuer's closing trading price on June 5, 2020, which was $0.165. All such shares are "restricted securities" as defined by the Securities Act of 1933, as amended (the "Securities Act").
2. On July 21, 2020, the Reporting Person converted a previously disclosed $25,000 12% Convertible Promissory Note (including $590.41 of accrued, unpaid interest) initially issued on April 13, 2020 (the "April Note") at a conversion price of $0.132. Pursuant to the terms of the April Note, the conversion price was calculated at 80% of the Issuer's closing trading price on June 5, 2020, which was $0.165. All such shares are "restricted securities" as defined by the Securities Act.
3. Pursuant to the terms of the January Note, as of the conversion date the Reporting Person was issued a five-year Warrant to Purchase Common Stock for up to 400,195 shares of the Issuer's common stock with an exercise price of $0.396, or three times the conversion price of the January Note.
4. Pursuant to the terms of the April Note, as of the conversion date the Reporting Person was issued a five-year Warrant to Purchase Common Stock for up to 195,522 shares of the Issuer's common stock with an exercise price of $0.396, or three times the conversion price of the April Note.
/s/ Michael Vito Barbera 08/06/2020
** 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).
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