SEC Form 5 · accession 0001140361-16-052638

VIVOS INC · RDGL

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director · 10% Owner

Period of report

Dec 31, 2015

Accepted (ET)

Feb 16, 2016 · 10:10 am EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001449349

Table I — non-derivative securities

Security	Date	Code	Shares	A/D	Owned after	D/I	Nature of ownership
Common Stock	holding	—	—	—	1,048,295	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

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Series A Convertible Preferred Stock^F1	$0.005	holding	—	—	—	Sep 10, 2015	—	Common Stock	207,620,000	207,620	D
Series A Convertible Preferred Stock^F1	$0.005	holding	—	—	—	Sep 10, 2015	—	Common Stock	148,309,000	148,309	I
Rights to Common Stock^F4,F2,F3	—	holding	—	—	—	—	—	Common Stock	13,760,314	13,760,314	D

F1The Series A Convertible Preferred Stock ("Series A Preferred") has no expiration date.
F2Not issuable until such time as the Company has a sufficient number of authorized but unissued and unreserved shares of Common Stock. The Rights to Common Stock represent shares of Common Stock issuable to the Reporting Person for which the consideration previously was paid but could not be issued until there are authorized but unissued shares of Common Stock available.
F3There is no expiration date.
F4The rights were issued as loan origination fees for providing certain loans to the Company.