SEC Form 4/A · accession 0001140361-15-014965
VIVOS INC · RDGL
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
This is an amendment (Form 4/A). It replaces an earlier filing for the same period.
Reporting owner
Carlton M Cadwell
Director · 10% Owner
Period of report
Dec 17, 2014
Accepted (ET)
Apr 9, 2015 · 6:36 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001449349
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Dec 17, 2014 | A | 2,813,360 | — | A | 3,878,055 | D | |
| Common Stock | holding | — | — | — | 21,529,907 | I | By Cadwell Family Irrevocable Trust | |
| Common Stock | holding | — | — | — | 3,261,335 | I | By Cadwell Industries, Inc. | |
| Common Stock | holding | — | — | — | 28,335 | I | By Cadwell Vista Field Limited | |
| Common Stock | holding | — | — | — | 37,500 | I | As Trustee for child | |
| Common Stock | holding | — | — | — | 87,500 | I | As Trustee for child |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Convertible NoteF1,F3,F2 | $0.001 | Dec 17, 2014 | A | — | A | Dec 17, 2014 | Dec 17, 2015 | Common Stock | 35,800,000 | — | D |
Explanation of responses
- F1On 12/17/14, in exchange for $35,800, the reporting person purchased from the issuer a Convertible Note in the principal amount of $35,800 and acquired from the issuer 2,813,360 shares of Common Stock as a loan origination fee.
- F2Conversion shares as of 12/17/14.
- F3This amendment correctly reflects the conversion price to $0.001 par value.