SEC Form 4 · accession 0001096906-17-000065
ACTIVECARE, INC. · ACAR
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Jeffrey S Peterson
Officer — CEO · Director · 10% Owner
Period of report
Jan 31, 2017
Accepted (ET)
Feb 2, 2017 · 5:27 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001429896
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 G Preferred StockF1 | — | Jan 31, 2017 | A | 32,415 | A | — | — | Common Stock | — | 32,415 | D |
Explanation of responses
- F1A class of Series G Convertible Preferred Stock ("Series G") was created on January 31, 2017. Mr. Peterson was issued 32,415 shares of Series G stock. The Series G automatically converts into common stock only upon the happening of certain specified events. Each share of Series G has a stated value of $500. The Series G converts into common stock at the stated value of such shares at the time of conversion.