SEC Form 4 · accession 0001179110-16-017666
ACTIVECARE, INC. · ACAR
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Period of report
Sep 23, 2015
Accepted (ET)
Jan 12, 2016 · 2:00 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001429896
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Sep 23, 2015 | J | 6,000,000 | — | A | 12,632,288 | I | By Tyumen Holdings, LLC |
| Common StockF2 | Sep 23, 2015 | A | 48,100 | — | A | 12,680,388 | I | By Tyumen Holdings, LLC |
| Common StockF3,F5 | Sep 23, 2015 | A | 2,000,000 | — | A | 4,759,277 | I | By Bluestone Advisors, LLC |
| Common StockF4 | Sep 23, 2015 | A | 201,056 | $0.27 | A | 4,960,333 | I | By Bluestone Advisors, LLC |
| Common StockF6 | Sep 23, 2015 | A | 359,375 | — | A | 5,319,708 | I | By Bluestone Advisors, LLC |
| Common Stock | holding | — | — | — | 378,148 | I | By Keystone Partners, LLC | |
| Common Stock | holding | — | — | — | 295,139 | I | By RimRock Capital | |
| Common Stock | holding | — | — | — | 2,862,966 | I | By Wynnman's Hill, LLC | |
| Common Stock | holding | — | — | — | 20,270 | I | By Banyan Investment Company, LLC |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1The shares of common stock were granted in consideration of an agreement by certain of the Reporting Person's affiliated entities to extend the terms of certain loan obligations of the issuer to such entities; however, at the request of the Reporting Person, the shares were issued to Tyumen Holdings, LLC.
- F2The shares of common stock were issued to pay dividends on shares of Series D Preferred Stock which were originally issued as compensation for services provided by Jeff Peterson; however, at Mr. Peterson's request, the shares of Series D Preferred Stock were issued in the name of Tyumen Holdings, LLC.
- F3The shares of common stock were granted as a stock bonus to Jeff Peterson; however, at Mr. Peterson's request, the shares were issued in the name of Bluestone Advisors, LLC.
- F4The shares of common stock were granted to pay accrued compensation for services rendered by Jeff Peterson; however, at Mr. Peterson's request, such shares were issued in the name of Bluestone Advisors, LLC.
- F5The shares vest in 24 equal monthly installments.
- F6The shares of common stock were granted in consideration of Jeff Peterson's agreement to guarantee certain loan obligations of the issuer; however, at the request of Mr. Peterson, the shares were issued to Bluestone Advisors, LLC.