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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
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 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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Saucier Robert B. 6767 SPENCER STREET LAS VEGAS, NV 89119 |
X |
/s/ Robert Saucier | 10/12/2017 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Effective September 22, 2017, Triangulum Partners, LLC ("Triangulum"), entered into 5 Voting and Dispositive Control Transfer Agreements (the "VDCTAs") with 5 individuals (the "Recipients"), pursuant to which Triangulum transferred voting and dispositive control of an aggregate of 6,345,805 shares of common stock of Galaxy Gaming, Inc., held by Triangulum (1,269,161 shares under each VDCTA). Pursuant to the terms of the VDCTAs, upon the expiration of the term of the VDCTAs, all control rights, including all voting and dispositive rights, relating to the shares will revert and return to Triangulum. The VDCTAs and the transaction are described more fully in a Current Report on Form 8-K filed by Galaxy Gaming, Inc., on September 27, 2017. |
(2) | Triangulum Partners, LLC is the holder of record of the shares of common stock of Galaxy Gaming, Inc. Mr. Saucier is the sole manager and an owner of Triangulum Partners, LLC. Mr. Saucier has voting and dispositive control over the remaining securities held by Triangulum Partners, LLC, following the entry by Triangulum into the VDCTAs. |