SEC Form 4 · accession 0001493152-18-018080

PetVivo Holdings, Inc. · PETV

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Robert James Rudelius

Director

Period of report

Dec 28, 2018

Accepted (ET)

Dec 28, 2018 · 5:16 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001512922

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I
Common Stock	Dec 10, 2018	X	45,000	$0.30	A	226,727	D
Common Stock	Dec 10, 2018	X	12,500	$0.30	A	239,727	D
Common Stock^F3	Dec 10, 2018	J	19,167	$0.30	A	258,394	D
Common Stock	Dec 11, 2018	O	25,000	$0.30	A	283,394	D
Common Stock^F7	Dec 11, 2018	J	8,333	$0.30	A	291,727	D
Common Stock^F4	Dec 11, 2018	J	172,406	$51,722.00	A	464,133	D
Common Stock	Dec 11, 2018	O	25,861	$0.30	A	489,994	D
Common Stock^F6	Dec 11, 2018	J	8,621	$0.30	A	498,615	D

Table II — derivative securities

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Common Stock Warrant^F2	$0.30	Dec 10, 2018	X	45,000	D	Dec 7, 2017	Dec 7, 2020	Common Stock	45,000	125,000	D
Common Stock Warrant^F1,F2	$0.30	Dec 10, 2018	X	12,500	D	Aug 20, 2018	Aug 20, 2023	Common Stock	12,500	112,500	D
Common Stock Warrant^F2	$0.30	Dec 11, 2018	O	25,000	D	Sep 24, 2018	Sep 24, 2021	Common Stock	25,000	87,500	D
Common Stock Warrant^F5	$0.30	Dec 11, 2018	A	25,861	A	Dec 11, 2018	Dec 31, 2018	Common Stock	25,861	113,361	D
Common Stock Warrant^F5	$0.30	Dec 11, 2018	O	25,861	D	Dec 11, 2018	Dec 31, 2018	Common Stock	25,861	87,500	D

Explanation of responses

F1100,000 warrants were granted to Robert Rudelius on August 20, 2018 pursuant to his Director Agreement; these warrants vest quarterly over a two-year period in equal tranches of 12,500, have a term of 5 years, and a strike price of $1.00 per warrant. Mr. Rudelius exercised 12,500 warrants that he was granted pursuant to his Director Agreement.
F2These warrants were exercised pursuant to a special, one-time Discounted Warrant Exercise Agreement whereby all warrant-holders were given the option to exercise their warrants at $.30 per warrant on or before December 15th, 2018.
F3A Stock Transfer Agreement was entered into between John Lai and Robert Rudelius pursuant to entering into the Discounted Warrant Exercise Agreement mentioned in note 2 above and called for the transfer of common stock shares from John Lai to Robert Rudelius in the amount of one-third the amount of warrants exercised pursuant to the Discounted Warrant Exercise Agreement; 19,167 shares were transferred to Robert Rudelius from John Lai pursuant to this agreement
F4Pursuant to a Bridge Promissory Note Conversion Agreement, Mr. Rudelius converted $51,721.86 in debt owed to him into 172,406 shares of common stock at a rate of $.30 per share.
F5Pursuant to a Bridge Promissory Note Conversion Agreement, Mr. Rudelius received, and subsequently exercised, 1 warrant for every $2 of the outstanding balance of his Note. The warrants had a strike price of $.30 per warrant, vested immediately, and an expiration date of December 31, 2018.
F6Pursuant to a Bridge Promissory Note Conversion Agreement, Mr. Rudelius entered into a Stock Transfer Agreement whereby he received 8,621 shares of common stock from John Lai; this number was calculated using a 3-to-1 warrant to share issuance rate (1 share was transferred for every 3 warrants exercised).
F7A Stock Transfer Agreement was entered into between John Lai and Robert Rudelius pursuant to entering into the Discounted Warrant Exercise Agreement mentioned in note 2 above and called for the transfer of common stock shares from John Lai to Robert Rudelius in the amount of one-third the amount of warrants exercised pursuant to the Discounted Warrant Exercise Agreement; 8,333 shares were transferred to Robert Rudelius from John Lai pursuant to this agreement.