SEC Form 5 · accession 0001511164-15-000076
Champion Pain Care Corp · CPAI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock | Oct 18, 2013 | J | 31,500,000 | $0.0001 | A | 31,500,000 | D | |
| Common Stock | Jun 13, 2014 | J | 30,000,000 | $0.0001 | D | 1,500,000 | D | |
| Common Stock | Nov 24, 2014 | J | 1,500,000 | $0.10 | A | 3,000,000 | D | |
| Common Stock | Nov 28, 2014 | J | 985,000 | $0.214 | D | 2,015,000 | D | |
| Common Stock | Nov 28, 2014 | J | 1,500,000 | $0.0001 | D | 515,000 | D |
Table II — derivative securities
Remarks
1. On October 18, 2013, the Issuer acquired a 100% interest in Champion Pain Care Corp., a Nevada Corporation that was a wholly owned subsidiary of Champion Care Corp. ("Champion Toronto") a company incorporated in Ontario, Canada, in exchange for 31,500,000 shares of the Common Stock of the Issuer ("Shares"). Details of this transaction are provided in the Form 8-K filed on the SEC website on October 23, 2013. 2. On June 13, 2014, Champion Care Corp. transferred 7,500,000 shares to each of Terrance Owen, Jack Fishman, Emil Schiller and Jason Gold who are all shareholders of the Champion Toronto and accepted the shares for services rendered to Champion Toronto. 3. On November 24, 2014, the Issuer issued 1,500,000 new shares to Champion Toronto for services rendered by Champion Toronto to the issuer. 4. On November 28, 2014, Champion Toronto transferred 985,000 shares to certain creditors of Champion Toronto. 5. On November 28, 2014, Champion Toronto transferred 1,500,000 shares to Jason Gold for services rendered.