SEC Form 5 · accession 0001415889-18-000258
VIVOS INC · RDGL
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
James C Katzaroff
Director
Period of report
Dec 31, 2017
Accepted (ET)
Feb 16, 2018 · 3:36 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 Stock | Feb 2, 2017 | C | 1,545,400 | $0.50 | A | 1,064,246 | D | |
| Common StockF1 | May 31, 2017 | A | 600,000 | — | A | 600,540 | I | By Spouse |
| Common StockF2 | Jul 21, 2017 | A | 1,500,000 | — | A | 1,064,246 | D | |
| Common Stock | Mar 30, 2017 | S | 35,000 | $0.13 | D | 1,064,246 | D | |
| Common Stock | Mar 31, 2017 | S | 10,000 | $0.14 | D | 1,064,246 | D | |
| Common Stock | Apr 7, 2017 | S | 10,000 | $0.12 | D | 1,064,246 | D | |
| Common Stock | Apr 11, 2017 | S | 30,000 | $0.13 | D | 1,064,246 | D | |
| Common Stock | Apr 17, 2017 | S | 10,000 | $0.12 | D | 1,064,246 | D | |
| Common Stock | Apr 20, 2017 | S | 10,000 | $0.12 | D | 1,064,246 | D | |
| Common Stock | Apr 28, 2017 | S | 10,000 | $0.11 | D | 1,064,246 | D | |
| Common Stock | Apr 28, 2017 | S | 5,000 | $0.11 | D | 1,064,246 | D | |
| Common Stock | May 1, 2017 | S | 33,859 | $0.12 | D | 1,064,246 | D | |
| Common Stock | May 2, 2017 | S | 20,000 | $0.11 | D | 1,064,246 | D | |
| Common Stock | May 4, 2017 | S | 15,000 | $0.11 | D | 1,064,246 | D | |
| Common Stock | May 17, 2017 | S | 10,000 | $0.10 | D | 1,064,246 | D | |
| Common Stock | May 23, 2017 | S | 25,000 | $0.10 | D | 1,064,246 | D | |
| Common Stock | May 24, 2017 | S | 10,000 | $0.12 | D | 1,064,246 | D | |
| Common Stock | Jun 6, 2017 | S | 20,000 | $0.09 | D | 1,064,246 | D | |
| Common Stock | Jul 21, 2017 | S | 25,000 | $0.08 | D | 1,064,246 | D | |
| Common Stock | Jul 24, 2017 | S | 25,000 | $0.08 | D | 1,064,246 | D | |
| Common Stock | Jul 25, 2017 | S | 20,000 | $0.08 | D | 1,064,246 | D | |
| Common Stock | Aug 7, 2017 | S | 23,016 | $0.07 | D | 1,064,246 | D | |
| Common Stock | Aug 30, 2017 | S | 11,882 | $0.07 | D | 1,064,246 | D | |
| Common Stock | Sep 5, 2017 | S | 22,141 | $0.07 | D | 1,064,246 | D | |
| Common Stock | Sep 11, 2017 | S | 22,000 | $0.07 | D | 1,064,246 | D | |
| Common Stock | Sep 15, 2017 | S | 15,000 | $0.06 | D | 1,064,246 | D | |
| Common Stock | Sep 19, 2017 | S | 10,000 | $0.06 | D | 1,064,246 | D | |
| Common Stock | Sep 20, 2017 | S | 15,000 | $0.07 | D | 1,064,246 | D | |
| Common Stock | Sep 29, 2017 | S | 25,000 | $0.08 | D | 1,064,246 | D | |
| Common StockF3 | Oct 9, 2017 | S | 15,000 | $0.08 | D | 1,064,246 | D |
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 StockF4 | $0.50 | Feb 2, 2017 | C | 154,540 | D | Apr 15, 2016 | — | Common Stock | 1,545,400 | 150,000 | D |
| Series A Convertible Preferred StockF1,F4 | $0.50 | May 31, 2017 | A | 10,000 | A | Apr 15, 2016 | — | Common Stock | 100,000 | 10,000 | I |
| Series A Convertible Preferred StockF2,F4 | $0.50 | Jul 21, 2017 | A | 150,000 | A | Apr 15, 2016 | — | Common Stock | 1,500,000 | 150,000 | D |
Explanation of responses
- F1Shares issued to Reporting Person's spouse as payment of $66,092.56 owed for services rendered to the Issuer prior to Ms. Katzaroff's resignation.
- F2Shares issued to Reporting Person as payment of $206,071.51 owed for services rendered to the Issuer prior to the Reporting Person's resignation.
- F3See Exhibit 99.1 for additional transactions.
- F4The Series A Convertible Preferred Stock has no expiration date.