- Annual Statement of Changes in Beneficial Ownership (5)
31 Agosto 2012 - 3:02PM
Edgar (US Regulatory)
FORM 5
[
X
]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
[ ]
Form 3 Holdings Reported
[ ]
Form 4 Transactions Reported
|
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
|
OMB APPROVAL
OMB Number:
3235-0362
Estimated average burden
hours per response...
1.0
|
|
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public
Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940
|
|
1. Name and Address of Reporting Person
*
DUQUE BEATRIZ MONTOYA
|
2. Issuer Name
and
Ticker or Trading Symbol
SOUTH AMERICAN GOLD CORP. [SAGD]
|
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
_____ Officer (give title below)
__
X
__ Other (specify below)
Former Director
|
(Last)
(First)
(Middle)
3645 EAST MAIN STREET, SUITE 119
|
3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
6/30/2012
|
(Street)
RICHMOND, IN 47374
(City)
(State)
(Zip)
|
4. 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
|
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
|
1.Title of Security
(Instr. 3)
|
2. Trans. Date
|
2A. Deemed Execution Date, if any
|
3. Trans. 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)
|
Amount
|
(A) or (D)
|
Price
|
Common Stock
(1)
|
4/12/2011
|
|
A
|
125000
|
A
|
(1)
|
125000
|
D
|
|
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
|
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
(MM/DD/YYYY)
|
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 at End of Issuer's Fiscal Year
(Instr. 4)
|
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
|
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
|
(A)
|
(D)
|
Date Exercisable
|
Expiration Date
|
Title
|
Amount or Number of Shares
|
Employee Stock Option (right to buy)
|
$0.59
|
3/22/2011
|
|
A
|
200000
|
|
3/22/2011
|
3/21/2021
|
Common Stock
|
200000
|
$0.0
(2)
|
200000
|
D
|
|
Explanation of Responses:
|
(
1)
|
These shares were acquired on April 12, 2011 for $10.00
|
(
2)
|
The Company granted options at a strike price of $.59 on March 22, 2011 in the amount of 200,000 shares, pursuant to the 2010 Stock Incentive Plan.
|
Reporting Owners
|
Reporting Owner Name / Address
|
Relationships
|
Director
|
10% Owner
|
Officer
|
Other
|
DUQUE BEATRIZ MONTOYA
3645 EAST MAIN STREET
SUITE 119
RICHMOND, IN 47374
|
|
|
|
Former Director
|
Signatures
|
/s/ Beatriz Duque Montoya
|
|
8/31/2012
|
**
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.
|
South American Gold (CE) (USOTC:SAGD)
Gráfico Histórico do Ativo
De Dez 2024 até Jan 2025
South American Gold (CE) (USOTC:SAGD)
Gráfico Histórico do Ativo
De Jan 2024 até Jan 2025
Notícias em tempo-real sobre South American Gold Corp (CE) da OTCMarkets bolsa de valores: 0 artigos recentes
Mais Notícias de South American Gold Corp." (QB)