UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF 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. | SEC 1473 (7-02) | ||
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. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
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) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Warrant to Purchase Common Stock | Â (1) | 03/04/2020 | Common Stock, $0.001 par value | 138,095,238 | $ 0.042 | I | See footnote 2 (2) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Delek Group, Ltd. 19 ABBA EBAN BLVD P.O.B. 2054 HERZLIYA, L3 4612001 |
 |  X |  |  |
Sharon Itshak 19 ABBA EBAN BLVD. P.O.B. 2054 HERZLIYA, L3 4612001 |
 |  X |  |  |
DKL Investments Ltd 47 ESPLANADE ST HELIER, CHANNEL ISLANDS, Y9 JE1 0BD |
 |  X |  |  |
Delek GOM Holdings, LLC C/O THE CORPORATION TRUST COMPANY CORPORATION TRUST CENTER, 1209 ORANGE ST WILMINGTON, DE 19801 |
 |  X |  |  |
Delek GOM Investments, LLC C/O THE CORPORATION TRUST COMPANY CORPORATION TRUST CENTER, 1209 ORANGE ST WILMINGTON, DE 19801 |
 |  X |  |  |
/s/ Itshak Sharon (Tshuva) | 03/07/2019 | |
**Signature of Reporting Person | Date | |
/s/ Leora Pratt Levin, as Authorized Signatory of DELEK GROUP LTD. | 03/07/2019 | |
**Signature of Reporting Person | Date | |
/s/ Stephanie Marriott, as Authorized Signatory of DKL INVESTMENTS LIMITED | 03/07/2019 | |
**Signature of Reporting Person | Date | |
/s/ Leora Pratt Levin, as Authorized Signatory of DELEK GOM HOLDINGS, LLC | 03/07/2019 | |
**Signature of Reporting Person | Date | |
/s/ Leora Pratt Levin, as Authorized Signatory of DELEK GOM INVESTMENTS, LLC | 03/07/2019 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | The warrant can be exercised at any time, either by paying the aggregate exercise price in cash or through the full extinguishment of obligations of GulfSlope Energy, Inc. ("Issuer") under a separate credit agreement between the Issuer and Delek GOM Investments, LLC ("Delek GOM Investments"). |
(2) | These securities are held of record by Delek GOM Investments. Delek GOM Holdings, LLC ("Holdings") is the sole member of Delek GOM Investments. DKL Investments Limited ("DKL") is the sole member of Holdings. The sole stockholder of DKL is Delek Group Ltd. ("Delek Group"). As of the date of this report, the majority of Delek Group's outstanding share capital and voting rights are owned, directly and indirectly, by Itshak Sharon Tshuva through private companies wholly-owned by him. As such, Itshak Sharon Tshuva, Delek Group, DKL and Holdings may each be deemed to have voting and investment power with respect to the securities held by Delek GOM Investments noted above and as a result may be deemed to have beneficial ownership over such securities. Each reporting person disclaims beneficial ownership of all interests reported on this Form 3 except to the extent of such reporting person's pecuniary interest. |