SEC Form 4 · accession 0001140361-15-037197
InsPro Technologies Corp · ITCC
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owners
AmeriHealth, Inc.
Director · 10% Owner
Independence Health Group, Inc.
Director · 10% Owner
Independence Blue Cross, LLC
Director · 10% Owner
Period of report
Oct 6, 2015
Accepted (ET)
Oct 8, 2015 · 4:32 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001309442
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series B Convertible Preferred StockF1,F2,F3 | — | Oct 6, 2015 | P | 333,333 | A | Oct 6, 2015 | — | Common | 6,666,660 | 2,500,000 | I |
| Warrants to Purchase Common StockF1,F3 | $0.15 | Oct 6, 2015 | P | 3,333,330 | A | Oct 6, 2015 | Nov 20, 2017 | Common | 3,333,330 | 3,333,330 | I |
Explanation of responses
- F1In a private placement conducted by the Issuer on October 6, 2015, Independence Blue Cross, LLC purchased 333,333 Units, at $3.00 per Unit, with each Unit consisting of one share of Series B Convertible Preferred Stock (convertible into 20 shares of the Issuer's Common Stock, subject to certain adjustments), and a Warrant to purchase 10 shares of the Issuer's Common Stock. There is no expiration date for the conversion of the Series B Convertible Preferred Stock, and no exercise price to be paid in connection therewith. The expiration date to exercise such Warrants is November 20, 2017, and the exercise price to be paid in connection with each share of such Issuer's Common Stock is $0.15.
- F2Reflects the total number of shares of Series B Convertible Preferred Stock owned by the Reporting Persons, which are collectively convertible into 50,000,000 shares of common stock. Previous reports filed reported the number of shares of common stock into which the derivative securities were convertible.
- F3The reported securities are owned directly by Independence Blue Cross, LLC, which is a wholly owned subsidiary of AmeriHealth, Inc., which in turn is a wholly owned subsidiary of Independence Health Group, Inc. AmeriHealth, Inc. and Independence Health Group, Inc. are indirect beneficial owners of the reported securities. A senior officer of the reporting persons is a member of the board of directors of the Issuer.