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0967761 BC, Ltd. – ‘5’ for 4/22/15 re: Ambient Water Corp.

On:  Tuesday, 2/9/16, at 7:31pm ET   ·   For:  4/22/15   ·   Accession #:  1052918-16-803   ·   File #:  0-55408

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  As Of               Filer                 Filing    For·On·As Docs:Size             Issuer                      Filing Agent

 2/09/16  0967761 BC, Ltd.                  5                      1:17K  Ambient Water Corp.               Computerized Bo… Svcs/FA

Annual Statement of Changes in Beneficial Ownership of Securities by an Insider   —   Form 5   —   SEA’34
Filing Table of Contents

Document/Exhibit                   Description                      Pages   Size 

 1: 5           Annual Statement of Changes in Beneficial           HTML      3K 
                Ownership of Securities by an Insider --                         
                primary_doc.xml/3.6


        

This ‘5’ Document is an XML Data File that may be rendered in various formats:

  Form 5    –   Plain Text   –  SEC Website  –  EDGAR System  –    XML Data    –  <?xml?> File
 
 
Plain Text rendering:  Annual Statement of Changes in Beneficial Ownership of Securities by an Insider
 
                                                                                                                                                                                
Ownership Document
 
Schema Version:  X0306
Document Type:  5
Period of Report:  4/22/15
Not Subject to Section 16:  0
Form 3 Holdings Reported:  0
Form 4 Transactions Reported:  0
Issuer:
Issuer CIK:  1394872
Issuer Name:  Ambient Water Corp
Issuer Trading Symbol:  AWGI
Reporting Owner:
Reporting Owner ID:
Owner CIK:  1640984
Owner Name:  0967761 BC, Ltd.
Reporting Owner Address:
Owner Street 1:  7721 E TRENT
Owner Street 2:
Owner City:  SPOKANE
Owner State:  WA
Owner ZIP Code:  99212
Owner State Description:
Reporting Owner Relationship:
Is Director?  Yes
Is Officer?  Yes
Is Ten Percent Owner?  Yes
Is Other?  Yes
Officer Title:  CEO/CTO
Other Text:  Holding company of CEO/CTO
Non-Derivative Table:
Non-Derivative Holding:
Security Title:
Value:  Common Stock
Transaction Coding:
Transaction Form Type:
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  14,941,438
Ownership Nature:
Direct or Indirect Ownership:
Value:  D
Non-Derivative Holding:
Security Title:
Value:  Common Stock
Transaction Coding:
Transaction Form Type:
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  12,788,712
Ownership Nature:
Direct or Indirect Ownership:
Value:  I
Footnote ID:  F1
Nature of Ownership:
Value:  Shares held by holding company
Non-Derivative Transaction:
Security Title:
Value:  Common Stock
Transaction Date:
Value:  4/22/15
Transaction Coding:
Transaction Form Type:  5
Transaction Code:  S
Equity Swap Involved?  No
Transaction Timeliness:
Value:
Transaction Amounts:
Transaction Shares:
Value:  10,000
Transaction Price Per Share:
Value:  0.02
Transaction Acquired-Disposed Code:
Value:  D
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  12,778,712
Ownership Nature:
Direct or Indirect Ownership:
Value:  I
Footnote ID:  F1
Nature of Ownership:
Value:  Shares held by holding company
Non-Derivative Transaction:
Security Title:
Value:  Common Stock
Transaction Date:
Value:  4/28/15
Transaction Coding:
Transaction Form Type:  5
Transaction Code:  S
Equity Swap Involved?  No
Transaction Timeliness:
Value:
Transaction Amounts:
Transaction Shares:
Value:  16,380
Transaction Price Per Share:
Value:  0.02
Transaction Acquired-Disposed Code:
Value:  D
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  12,762,332
Ownership Nature:
Direct or Indirect Ownership:
Value:  I
Footnote ID:  F1
Nature of Ownership:
Value:  Shares held by holding company
Non-Derivative Transaction:
Security Title:
Value:  Common Stock
Transaction Date:
Value:  4/29/15
Transaction Coding:
Transaction Form Type:  5
Transaction Code:  S
Equity Swap Involved?  No
Transaction Timeliness:
Value:
Transaction Amounts:
Transaction Shares:
Value:  73,620
Transaction Price Per Share:
Value:  0.02
Transaction Acquired-Disposed Code:
Value:  D
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  12,688,712
Ownership Nature:
Direct or Indirect Ownership:
Value:  I
Footnote ID:  F1
Nature of Ownership:
Value:  Shares held by holding company
Non-Derivative Transaction:
Security Title:
Value:  Common Stock
Transaction Date:
Value:  6/9/15
Transaction Coding:
Transaction Form Type:  5
Transaction Code:  S
Equity Swap Involved?  No
Transaction Timeliness:
Value:
Transaction Amounts:
Transaction Shares:
Value:  50,000
Transaction Price Per Share:
Value:  0.051
Transaction Acquired-Disposed Code:
Value:  D
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  12,638,712
Ownership Nature:
Direct or Indirect Ownership:
Value:  I
Footnote ID:  F1
Nature of Ownership:
Value:  Shares held by holding company
Non-Derivative Transaction:
Security Title:
Value:  Common Stock
Transaction Date:
Value:  6/9/15
Transaction Coding:
Transaction Form Type:  5
Transaction Code:  S
Equity Swap Involved?  No
Transaction Timeliness:
Value:
Transaction Amounts:
Transaction Shares:
Value:  25,000
Transaction Price Per Share:
Value:  0.048
Transaction Acquired-Disposed Code:
Value:  D
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  12,613,712
Ownership Nature:
Direct or Indirect Ownership:
Value:  I
Footnote ID:  F1
Nature of Ownership:
Value:  Shares held by holding company
Non-Derivative Transaction:
Security Title:
Value:  Common Stock
Transaction Date:
Value:  6/9/15
Transaction Coding:
Transaction Form Type:  5
Transaction Code:  S
Equity Swap Involved?  No
Transaction Timeliness:
Value:
Transaction Amounts:
Transaction Shares:
Value:  50,000
Transaction Price Per Share:
Value:  0.0437
Transaction Acquired-Disposed Code:
Value:  D
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  12,563,712
Ownership Nature:
Direct or Indirect Ownership:
Value:  I
Footnote ID:  F1
Nature of Ownership:
Value:  Shares held by holding company
Non-Derivative Transaction:
Security Title:
Value:  Common Stock
Transaction Date:
Value:  6/9/15
Transaction Coding:
Transaction Form Type:  5
Transaction Code:  S
Equity Swap Involved?  No
Transaction Timeliness:
Value:
Transaction Amounts:
Transaction Shares:
Value:  50,000
Transaction Price Per Share:
Value:  0.0531
Transaction Acquired-Disposed Code:
Value:  D
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  12,513,712
Ownership Nature:
Direct or Indirect Ownership:
Value:  I
Footnote ID:  F1
Nature of Ownership:
Value:  Shares held by holding company
Non-Derivative Transaction:
Security Title:
Value:  Common Stock
Transaction Date:
Value:  6/9/15
Transaction Coding:
Transaction Form Type:  5
Transaction Code:  S
Equity Swap Involved?  No
Transaction Timeliness:
Value:
Transaction Amounts:
Transaction Shares:
Value:  45,000
Transaction Price Per Share:
Value:  0.0434
Transaction Acquired-Disposed Code:
Value:  D
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  12,468,712
Ownership Nature:
Direct or Indirect Ownership:
Value:  I
Footnote ID:  F1
Nature of Ownership:
Value:  Shares held by holding company
Non-Derivative Transaction:
Security Title:
Value:  Common Stock
Transaction Date:
Value:  6/9/15
Transaction Coding:
Transaction Form Type:  5
Transaction Code:  S
Equity Swap Involved?  No
Transaction Timeliness:
Value:
Transaction Amounts:
Transaction Shares:
Value:  50,000
Transaction Price Per Share:
Value:  0.041
Transaction Acquired-Disposed Code:
Value:  D
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  12,418,712
Ownership Nature:
Direct or Indirect Ownership:
Value:  I
Footnote ID:  F1
Nature of Ownership:
Value:  Shares held by holding company
Non-Derivative Transaction:
Security Title:
Value:  Common Stock
Transaction Date:
Value:  6/9/15
Transaction Coding:
Transaction Form Type:  5
Transaction Code:  S
Equity Swap Involved?  No
Transaction Timeliness:
Value:
Transaction Amounts:
Transaction Shares:
Value:  50,000
Transaction Price Per Share:
Value:  0.0435
Transaction Acquired-Disposed Code:
Value:  D
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  12,368,712
Ownership Nature:
Direct or Indirect Ownership:
Value:  I
Footnote ID:  F1
Nature of Ownership:
Value:  Shares held by holding company
Derivative Table:
Derivative Holding:
Security Title:
Value:  Common stock otpions
Conversion or Exercise Price:
Value:  0.11
Transaction Coding:
Transaction Form Type:
Exercise Date:
Footnote ID:  F2
Expiration Date:
Value:  7/22/23
Underlying Security:
Underlying Security Title:
Value:  Common stock
Underlying Security Shares:
Value:  750,000
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  750,000
Ownership Nature:
Direct or Indirect Ownership:
Value:  D
Footnotes:
Footnote - F1:  Common stock registered to 0967761 BC, Ltd. Keith White, who is CEO, CTO and a director of Ambient Water Corp., has sole voting and dispositive control over the 0967761 BC, Ltd. shares.
Footnote - F2:  On July 22, 2013, the board of directors authorized the issuance of 750,000 common stock options to Keith White, the Company's Chief Executive Officer and Chief Technology Officer. These common stock options have an exercise price of $0.11 per share. On July 22, 2014, twenty-five percent (25%) of the options vested. Thereafter, the options vest at six and a quarter percent (6.25%) each quarter or 46,875 option shares quarterly. Vesting quarters are October 22, January 22, April 22 and July 22. The common stock options have a ten (10) year exercise term.
Owner Signature:
Signature Name:  /s/ Keith White
Signature Date:  2/9/16


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