SEC Form 5 · accession 0001140361-16-052425
VIVOS INC · RDGL
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Leonard Bruce Jolliff
Officer — Chief Financial Officer
Period of report
Dec 31, 2015
Accepted (ET)
Feb 12, 2016 · 5:49 pm EST
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 Stock | holding | — | — | — | 4,033,333 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series A Convertible Preferred StockF2,F1 | $0.005 | Jun 18, 2015 | A | 1,600 | A | Dec 4, 2015 | — | Common Stock | 1,600,000 | 104,700 | D |
| Series A Convertible Preferred StockF2,F1 | $0.005 | Sep 9, 2015 | A | 600 | A | Dec 4, 2015 | — | Common Stock | 600,000 | 104,700 | D |
Explanation of responses
- F1The Series A Convertible Preferred Stock has no expiration date.
- F2Issued as a loan origination fee in connection with a loan by the Reporting Person to the Company.