SEC Form 5 · accession 0001477932-17-003635
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
Jun 30, 2017
Accepted (ET)
Aug 3, 2017 · 7:13 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001520118
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series B Preferred StockF1,F2 | — | Aug 29, 2016 | A | 30,000 | A | Aug 29, 2016 | — | Common Stock | 3,000,000 | 30,000 | D |
| Series B Preferred StockF1,F2 | — | Sep 1, 2016 | A | 30,000 | A | Sep 1, 2016 | — | Common Stock | 3,000,000 | 60,000 | D |
| Series B Preferred StockF1,F2 | — | Nov 1, 2016 | A | 30,000 | A | Nov 1, 2016 | — | Common Stock | 3,000,000 | 90,000 | D |
| Series B Preferred StockF1,F2 | — | Feb 22, 2017 | A | 30,000 | A | Feb 22, 2017 | — | Common Stock | 3,000,000 | 120,000 | D |
| Series B Preferred StockF1,F2 | — | May 2, 2017 | A | 30,000 | A | May 2, 2017 | — | Common Stock | 3,000,000 | 150,000 | D |
Explanation of responses
- F1Each share converts into 100 shares of common stock.
- F2N/A