SEC Form 5 · accession 0001469709-16-000788
MedWellAI, Inc. · MWAI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Steve Rubakh
Officer — CEO · Director · 10% Owner
Period of report
Dec 31, 2015
Accepted (ET)
May 3, 2016 · 4:48 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001520118
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| COMMON STOCK | Mar 31, 2015 | J | 10,000,000 | $0.0066 | A | 10,000,000 | D | |
| COMMON STOCK | Aug 13, 2015 | A | 30,000 | $0.00 | A | 10,030,000 | D | |
| COMMON STOCK | Sep 18, 2015 | A | 30,000 | $0.00 | A | 10,060,000 | D | |
| COMMON STOCK | Oct 1, 2015 | A | 30,000 | $0.00 | A | 10,090,000 | D | |
| COMMON STOCK | Nov 1, 2015 | A | 30,000 | $0.00 | A | 10,120,000 | D | |
| COMMON STOCK | Dec 1, 2015 | A | 30,000 | $0.00 | A | 10,150,000 | D | |
| SERIES A PREFERRED STOCK | Mar 31, 2015 | J | 500,000 | $0.00 | A | 500,000 | 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 PURCHASE WARRANT | $0.74 | Oct 28, 2015 | A | 3,000,000 | A | Oct 28, 2015 | Oct 28, 2020 | COMMON STOCK | 3,000,000 | 3,000,000 | D |
Explanation of responses
- F1Shares of Common Stock received in sale of EMS Factory to the Company. Series A Preferred stock issued in recapitalization of the Company in connection with the acquisition of EMS Factory Inc.