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 |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
EVERGREEN ATLANTIC LLC 2344 SPRUCE STREET SUITE A BOULDER, CO 80302 |
 |  X |  |  |
HOREJSI STEWART R 200 SOUTH SANTA FE SALINA, KS 67401 |
 |  X |  |  |
SUSAN L CICIORA TRUST 1029 WEST 3RD AVENUE, SUITE 400 ANCHORAGE, AK 99503 |
 |  X |  |  |
STEWART WEST INDIES TRUST 2344 SPRUCE STREET SUITE A BOULDER, CO 80302 |
 |  X |  |  |
Stewart R. Horejsi, Manager | 03/24/2015 | |
**Signature of Reporting Person | Date | |
Susan L. Ciciora Trust, Member | 03/24/2015 | |
**Signature of Reporting Person | Date | |
Stewart West Indies Trust, Member | 03/24/2015 | |
**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) | Received in exchange for 343,749 shares of Boulder Total Return Fund, Inc. (BTF) common stock pursuant to an Agreement and Plan of Reorganization between the Issuer and BTF and two affiliated funds (the Merger). On March 20, 2015, the effective date of the Merger, shares of Issuer were exchanged for Shares of BTF at a conversion rate of 3.121182 Shares of Issuers common stock (net asset value $10.73 per share) for each share of BTFs common stock (net asset value $33.50 per share). |
(2) | The manager of Evergreen Atlantic LLC ("Evergreen Atlantic") is Stewart R. Horejsi. The members of Evergreen Atlantic are the Susan L. Ciciora Trust and the Stewart West Indies Trust. Mr. Horejsi may be deemed to control Evergreen Atlantic and may be deemed to possess indirect beneficial ownership of the Shares held by Evergreen Atlantic. |
(3) | Trusts, persons and entities affiliated with the reporting person(s), including Evergreen Atlantic, Lola Brown Trust No. 1B, Ernest Horejsi Trust No. 1B, Mildred B. Horejsi Trust, Stewart West Indies Trust, Stewart R. Horejsi Trust No. 2 and the Susan L. Ciciora Trust, will own an aggregate of 45,444,848 Shares of the Issuer after the reorganization of the Issuer on March 20, 2015. |