SEC Form 5 · accession 0001511164-16-000740
Champion Pain Care Corp · CPAI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
CGPM, LLC
10% Owner
Period of report
Dec 31, 2015
Accepted (ET)
Apr 6, 2016 · 3:22 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001469284
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | May 6, 2015 | J | 4,500,000 | $0.005 | A | 4,500,000 | D | |
| Common StockF1 | Jun 19, 2015 | J | 8,000,000 | $0.005 | A | 12,500,000 | D |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1On May 6, 2015 and June 19, 2015, 2015, the Issuer provided 4,500,000 and 8,000,000 shares, respectively, of the Common Stock of the Issuer to CGPM, LLC as compensation according to the terms of a Consulting Agreement entered into by CGPM, LLC and the Issuer on May 1, 2015.