SEC Form 3 · accession 0001065949-18-000201
MEDICAL INNOVATION HOLDINGS, INC. · MIHI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Daniel Medina
10% Owner
Period of report
Nov 27, 2018
Accepted (ET)
Dec 26, 2018 · 11:03 am EST
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 | holding | — | — | — | 37,611 | 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 SharesF2,F1,F3 | — | holding | — | — | — | — | — | Common Stock | 15 | — | D |
| Series "A" Convertible Preferred SharesF4,F2,F1 | — | holding | — | — | — | — | — | Common Stock | 20 | — | I |
Explanation of responses
- F1Not Applicable.
- F2Each share of Series "A" Convertible Preferred Stock votes equivalent of the common stock - 1%. Due to administrative delays, the stock was not issued until December 21, 2018.
- F315 shares via repossession under purchase default. Due to administrative delays, the stock was not issued until December 21, 2018.
- F4Combined vote 50% effectively through the 20 Series "A" Convertible Preferred Shares.