SEC Form 4 · accession 0001065949-16-000411
MEDICAL INNOVATION HOLDINGS, INC. · MIHI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Daniel Medina
Other
Period of report
Apr 30, 2015
Accepted (ET)
Jun 1, 2016 · 3:30 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001093248
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| COMMON STOCK | Apr 30, 2015 | J | 319,565 | $0.00 | D | 11,901,102 | D | |
| COMMON STOCK | Apr 29, 2016 | J | 11,525,000 | $100.00 | D | 376,102 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| SERIES "A" CONVERTIBLE PREFERRED STOCKF3,F2 | — | Apr 29, 2016 | J | 15 | D | — | — | COMMON STOCK | 15 | 0 | D |
Explanation of responses
- F1Mr. Medina retired 319,565 shares to the Company's treasury.
- F2In connection with an Acquisition and Purchase Agreement between Medina International Holdings, Inc. and Medical Innovation Holdings, Joint Venture, Mr. Medina retired the shares to treasury for $100.
- F3Each 1 share of Series "A" Convertible Preferred Stock shall be converted into 1% of the Company's common stock outstanding at the time of conversion.