SEC Form 5 · accession 0001415889-18-000230
VIVOS INC · RDGL
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Michael K Korenko
Officer — CEO AND PRESIDENT
Period of report
Dec 31, 2017
Accepted (ET)
Feb 13, 2018 · 7:52 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 StockF1 | Sep 1, 2017 | A | 4,000,000 | $0.00 | A | 6,230,000 | D | |
| Common StockF2 | Sep 1, 2017 | A | 2,000,000 | $0.00 | A | 6,230,000 | D | |
| Common Stock | holding | — | — | — | 282,300 | I | By IRA Account | |
| Common Stock | holding | — | — | — | 1,500 | I | By IRA SEP Account | |
| Common StockF3 | holding | — | — | — | 717,500 | I | By Elaine M. Korenko Bypass Trust | |
| Common StockF4 | holding | — | — | — | 45,000 | I | By Michael Korenko ROTH IRA | |
| Common StockF4 | holding | — | — | — | 45,000 | I | By Robert Korenko ROTH IRA | |
| Common StockF4 | holding | — | — | — | 10,000 | I | By Robert Korenko |
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 StockF5 | $0.50 | Sep 1, 2017 | A | 100,000 | A | Sep 1, 2017 | — | Common Stock | 1,000,000 | 100,000 | D |
Explanation of responses
- F1Represents grant of restricted stock units. Shares vested on January 10, 2018.
- F2Represents grant of restricted stock units. Shares will vest in five equal installments on a quarterly basis beginning on December 31, 2017.
- F3The Reporting Person disclaims beneficial ownership with respect to these shares.
- F4The Reporting Person has trading authority only with respect to these shares.
- F5The Series A Convertible Preferred Stock has no expiration date.