SEC Form 4 · accession 0001415889-15-003330
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
Oct 5, 2015
Accepted (ET)
Oct 8, 2015 · 5:39 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 | Oct 5, 2015 | J | 6,600,000 | $0.00 | A | 14,810,609 | 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
No Table II lines on this filing.
Explanation of responses
- F1Shares issued as payment of a loan origination fee on a non-convertible promissory note in the principal amount of $82,500 (the "Note"). The Note accrues interest at a rate of 10% per annum and is due and payable by the Issuer on or before October 5, 2016.