Sec Form 4 Filing - Hayes John William @ BlackRidge Technology International, Inc. - 2018-09-28

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Hayes John William
2. Issuer Name and Ticker or Trading Symbol
BlackRidge Technology International, Inc. [ BRTI]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director X __ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
Chief Technology Officer
(Last) (First) (Middle)
10615 PROFESSIONAL CIRCLE, SUITE 201
3. Date of Earliest Transaction (MM/DD/YY)
09/28/2018
(Street)
RENO, NV89521
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 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 09/30/2018 A 908,152 A $ 0.35 ( 1 ) 18,659,763 D
Common Stock 09/28/2018 J 4,645,082 A $ 0.25 ( 2 ) 23,304,845 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 (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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
Warrant to Purchase Common Stock $ 0.25 09/28/2018 A 3,845,082 09/28/2018 09/28/2023 Common Stock 3,845,082 ( 3 ) 11,212,367 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Hayes John William
10615 PROFESSIONAL CIRCLE, SUITE 201
RENO, NV89521
X X Chief Technology Officer
Signatures
/s/John Hayes 11/19/2018
Signature of Reporting Person Date
Explanation of Responses:
( 1 )On September 30, 2018, the issuer issued restricted common stock, par value $0.0001 per share, to Mr. Hayes in lieu of cash payment of deferred wages and compensation at $0.35 per share for his service as a director on the issuer's board of directors.
( 2 )Shares of common stock, par value $0.0001 per share, acquired in exchange for the extinguishment of debt represented by three notes (the "Notes"), in the principal amount of $$ ], plus $[ ] of interest. The shares were issued on September 28, 2018 to Mr. Hayes.
( 3 )Issued as further consideration for the extinguishment of the debt represented by the Notes described in footnote 2 above.

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