SEC Form 4 · accession 0001415889-15-002786
VIVOS INC · RDGL
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Carlton M Cadwell
Director · 10% Owner
Period of report
Aug 14, 2015
Accepted (ET)
Aug 17, 2015 · 5:23 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 | Aug 14, 2015 | A | 400,000 | — | A | 8,210,609 | 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,F2 | $0.001 | Aug 14, 2015 | A | — | A | Aug 14, 2015 | Aug 14, 2016 | Common Stock | 10,000,000 | — | D |
Explanation of responses
- F1On August 14, 2015, in exchange for $10,000, the Reporting Person purchased from the Issuer a Convertible Note in the principal amount of $10,000 and acquired from the Issuer 400,000 shares of the Issuer's common stock as a loan origination fee.
- F2Shares issuable upon conversion of the Convertible Note as of August 14, 2015.