SEC Form 4 · accession 0001415889-15-003032
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
Sep 10, 2015
Accepted (ET)
Sep 11, 2015 · 6:00 am EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001449349
Table I — non-derivative securities
No Table I lines on this filing.
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 StockF1,F2,F3 | $0.005 | Sep 10, 2015 | J | 207,620 | A | Sep 10, 2015 | — | Common Stock | 207,620,000 | 207,620 | D |
| Series A Convertible Preferred StockF4,F5,F2,F3 | $0.005 | Sep 10, 2015 | J | 148,309 | A | Sep 10, 2015 | — | Common Stock | 148,309,000 | 148,309 | I |
Explanation of responses
- F1In consideration for 207,620 shares of Series A Convertible Preferred Stock ("Series A Preferred"), the Reporting Person exchanged certain promissory notes with an outstanding balance of $3,114,303.7, which amount includes all principal and accrued but unpaid interest thereon.
- F2The Series A Preferred has no expiration date.
- F3Each share of Series A Preferred is convertible into that number of shares of the Issuer's common stock equal to the stated value thereof, divided by $0.005. The current stated value of the Series A Preferred is $5.00 per share.
- F4In consideration for 148,309 shares of Series A Convertible Preferred Stock ("Series A Preferred"), the Cadwell Dynasty Trust exchanged certain promissory notes with an outstanding balance of $2,224,637.37, which amount includes all principal and accrued but unpaid interest thereon.
- F5In total, the Reporting Person exchanged promissory notes in the aggregate amount of $5,338,941.08, including all principal and accrued but unpaid interest, for 355,929 shares of Series A Preferred on the transaction date.