Initial Statement of Beneficial Ownership (3)
11 Agosto 2022 - 6:38PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
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3235-0104
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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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Ballengee James H. |
2. Date of Event Requiring Statement (MM/DD/YYYY)
8/1/2022
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3. Issuer Name and Ticker or Trading Symbol
Vivakor, Inc. [VIVK]
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(Last)
(First)
(Middle)
5151 BELTLINE ROAD, SUITE 715 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director ___X___ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
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(Street)
DALLAS, TX 75234
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 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 Beneficially Owned
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1.Title of Security
(Instr. 4) | 2. Amount of Securities Beneficially Owned
(Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5) | 4. Nature of Indirect Beneficial Ownership
(Instr. 5) |
| Common stock, par value $0.001 | 3009552 | I | See Footnote (1) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4) | 2. Date Exercisable and Expiration Date
(MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5) | 6. Nature of Indirect Beneficial Ownership
(Instr. 5) |
| Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
| Promissory Note | (2) | 8/1/2025 | Common stock (2) | (2) | (2) | I | See Footnote (2) |
| Explanation of Responses: |
| (1) | Mr. Ballengee has beneficial ownership of shares owned by Jorgan Development, LLC (2,979,456 shares) and JBAH Holdings, LLC (30,096 shares). |
| (2) | August 1,2022, Vivakor, Inc. ("Vivakor") issued 3-year secured, convertible promissory notes ("Notes") in the aggregate principal amount of $28,664,284 to Jorgan Development, LLC ($28,337,641) and JBAH Holdings, LLC ($286,643). Payment of principal and interest is payable monthly on the twentieth day of the month with the first payment payable on September 20, 2022. Subject to compliance with Nasdaq Rule 5635(d), on each payment date, Vivakor can make payment of principal and interest in the form of unrestricted shares of Vivakor common stock valued at the five-day volume weighted average price for Vivakor's common stock during the 5 trading days immediately preceding the issuance date ("Stock"). No more than 50% of any monthly payment of principal and interest and no more than 50% of the original principal amount of the Notes can be paid in Stock without the consent of the applicable noteholder. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Ballengee James H.
5151 BELTLINE ROAD, SUITE 715
DALLAS, TX 75234 |
| X |
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Signatures
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| /s/ James Ballengee | | 8/11/2022 |
| **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 5(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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