SEC Form 4 · accession 0001437749-15-005830
COGENTIX MEDICAL INC /DE/ · CGNT
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Lewis C Pell
Director · 10% Owner
Period of report
Mar 19, 2015
Accepted (ET)
Mar 23, 2015 · 5:00 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000894237
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Convertible Promissory Note | $1.11 | Mar 19, 2015 | J | — | A | Mar 19, 2015 | Jun 16, 2019 | common stock | 891,891 | 26,975,365 | D |
Explanation of responses
- F1The Issuer issued a $5.0 million revolving convertible promissory note to the Reporting Person on June 16, 2014 (the "2014 Note"). The Issuer borrowed $1.0 million under the 2014 Note on June 16, 2014, August 12, 2014, October 24, 2014 and December 30, 2014, and $990,000 under the 2014 Note on March 19, 2015, bringing the aggregate principal amount outstanding under the 2014 Note to $4,990,000. The outstanding balance under the 2014 Note is convertible, at the Reporting Person's opinion, into shares of the Issuer's common stock at a fixed conversion price of $1.11 per share.