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Schwartz Carl I. – ‘5’ for 12/31/20 re: Sigma Labs, Inc.

On:  Thursday, 2/11/21, at 4:45pm ET   ·   For:  12/31/20   ·   Accession #:  1179110-21-1589   ·   File #:  1-38015

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

 2/11/21  Schwartz Carl I.                  5                      1:8K   Sigma Labs, Inc.                  Section16 Direct/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 --                         
                edgar.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:  12/31/20
Not Subject to Section 16:  1
Form 3 Holdings Reported:  0
Form 4 Transactions Reported:  1
Issuer:
Issuer CIK:  788611
Issuer Name:  SIGMA LABS, INC.
Issuer Trading Symbol:  SGLB
Reporting Owner:
Reporting Owner ID:
Owner CIK:  1573354
Owner Name:  Schwartz Carl I.
Reporting Owner Address:
Owner Street 1:  3750 LAS VEGAS BLVD. SOUTH
Owner Street 2:  APT. 4303
Owner City:  LAS VEGAS
Owner State:  NV
Owner ZIP Code:  89158
Owner State Description:
Reporting Owner Relationship:
Is Director?  No
Is Officer?  No
Is Ten Percent Owner?  No
Is Other?  Yes
Officer Title:
Other Text:  Former 10% holder
Non-Derivative Table:
Non-Derivative Holding:
Security Title:
Value:  Common Stock
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  200,000
Footnote ID:  F1
Ownership Nature:
Direct or Indirect Ownership:
Value:  D
Non-Derivative Holding:
Security Title:
Value:  Common Stock
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  40,000
Footnote ID:  F1
Ownership Nature:
Direct or Indirect Ownership:
Value:  I
Nature of Ownership:
Value:  By Carl I. Schwartz Revocable Family Trust dtd 3/14/19
Derivative Table:
Derivative Transaction:
Security Title:
Value:  Series E Convertible Preferred Stock
Conversion or Exercise Price:
Value:  10.30
Footnote ID:  F4
Transaction Date:
Value:  1/28/20
Transaction Coding:
Transaction Form Type:  4
Transaction Code:  P
Equity Swap Involved?  No
Transaction Timeliness:
Value:  L
Transaction Amounts:
Transaction Shares:
Value:  266.67
Transaction Price Per Share:
Value:  1,500
Transaction Acquired-Disposed Code:
Value:  A
Exercise Date:
Value:  1/28/20
Expiration Date:
Footnote ID:  F2
Underlying Security:
Underlying Security Title:
Value:  Common Stock
Underlying Security Shares:
Value:  38,835
Footnote ID:  F1
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  266.67
Ownership Nature:
Direct or Indirect Ownership:
Value:  I
Nature of Ownership:
Value:  By Carl & Shirley Schwartz Trust
Derivative Transaction:
Security Title:
Value:  Warrants to Purchase Common Stock
Conversion or Exercise Price:
Value:  11.13
Footnote ID:  F4
Transaction Date:
Value:  1/28/20
Transaction Coding:
Transaction Form Type:  4
Transaction Code:  P
Equity Swap Involved?  No
Transaction Timeliness:
Value:  L
Transaction Amounts:
Transaction Shares:
Value:  38,835
Transaction Price Per Share:
Footnote ID:  F3
Transaction Acquired-Disposed Code:
Value:  A
Exercise Date:
Value:  7/26/20
Expiration Date:
Value:  7/26/25
Underlying Security:
Underlying Security Title:
Value:  Common Stock
Underlying Security Shares:
Value:  38,835
Footnote ID:  F1
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  38,835
Footnote ID:  F1
Ownership Nature:
Direct or Indirect Ownership:
Value:  I
Nature of Ownership:
Value:  By Carl & Shirley Schwartz Trust
Footnotes:
Footnote - F1:  Share ownership totals have been adjusted to reflect a 1 for 10 reverse stock split effected by the issuer on February 27, 2020.
Footnote - F2:  No expiration date.
Footnote - F3:  Purchase was made in conjunction with purchase of Series E Convertible Preferred Stock.
Footnote - F4:  Conversion and exercise prices have been adjusted to reflect a 1 for 10 reverse stock split effected by the issuer on February 27, 2020.
Owner Signature:
Signature Name:  /s/ Carl I. Schwartz, DDS
Signature Date:  2/9/21


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