SEC Form 4/A · accession 0001140361-15-014969
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
James C Katzaroff
Officer — CEO · Director · 10% Owner
Period of report
Dec 17, 2014
Accepted (ET)
Apr 9, 2015 · 6:37 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 | 1,673,870 | — | A | 4,339,704 | D | |
| Common StockF3,F1 | Dec 17, 2014 | D | 1,673,870 | — | D | 2,665,834 | D |
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 | 21,300,000 | 21,300 | D |
| Convertible NoteF1 | $0.001 | Dec 17, 2014 | D | — | D | Dec 17, 2015 | Dec 17, 2015 | Common Stock | 21,300,000 | 0 | D |
Explanation of responses
- F1On 12/17/14, in exchange for $21,300, the reporting person purchased from the issuer a Convertible Note in the principal amount of $21,300 and acquired from the issuer 1,673,870 shares of Common Stock as a loan origination fee.
- F2Conversion shares as of 12/17/14.
- F3This amendment reflects the agreement between the parties effective December 17, 2014 to adjust the conversion price to $0.001 par value and to fully rescind this agreement effective December 31, 2014.