SEC Form 4 · accession 0001213900-17-000277
MyDx, Inc. · MYDX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Rida Yazbeck Daniel
Officer — Chairman of the Board and CEO · Director
Period of report
Dec 23, 2016
Accepted (ET)
Jan 12, 2017 · 1:52 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001582341
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1,F2 | Dec 23, 2016 | A | 30,000,000 | — | A | 39,701,606 | I | See footnote |
| Common StockF3 | Dec 30, 2016 | D | 210,894 | $0.50 | D | 209,106 | I | YCIG, Inc. |
| Preferred Stock (Series A Super Voting)F1 | Dec 24, 2016 | A | 51 | — | A | 51 | D | |
| Preferred Stock (Series B Convertible)F1,F4 | Dec 23, 2016 | A | 300,000 | $1.00 | A | 300,000 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Warrant - Common StockF1,F5,F6 | $0.01 | Jan 3, 2017 | A | 89,229,104 | A | Jan 3, 2017 | Jan 3, 2019 | Common Stock | 89,229,104 | 89,729,104 | I |
Explanation of responses
- F1Consideration is comprised of covenants and conditions under the Settlement & Release Agreement - Daniel R. Yazbeck and MyDx, Inc., dated December 23, 2016, as previously disclosed as Ex. 10.5 to Form 8-K filed with the SEC on January 11, 2017.
- F2Beneficial ownership of Daniel R. Yazbeck, directly and indirectly, as of the date of the filing of this Form 4 is disclosed as a footnote to the "Security Ownership of Certain Beneficial Owners and Management" table included on the DEF 14C filed with the SEC on January 11, 2017.
- F3Consideration for the return of shares comprised of covenants and conditions under the Settlement & Release Agreement - YCIG, Inc. and MyDx, Inc., dated January 4, 2017, as previously disclosed as Ex. 10.6 to Form 8-K filed with the SEC on January 11, 2017.
- F4Shares acquired, in part, pursuant to the Securities Purchase Agreement, dated December 23, 2016, as previously disclosed as Ex. 10.2 to Form 8-K filed with the SEC on January 11, 2017.
- F5Warrant entitles holder to purchase up to 15% of the Issuer's common shares issued and outstanding as of January 3, 2017, per the Form of Warrant as previously disclosed as Ex. 10.4 of Form 8-K filed with the SEC on January 11, 2017.
- F6Includes the Warrant disclosed on this Form 4 as well as 500,00 options to purchase shares of the Issuer's common stock at an exercise price of $0.08 per share, as previously disclosed on Form 3 filed with the SEC on May 8, 2015.